bluuebunny/crossref_metadata_2025 huggingface dataset:
704 The Association of Sleep Disorders in Patients with Chronic Pain Disorders
Authors: Khachatryan Marine , Kay Jenna , Jain Sejal
Published: May 2021

Introduction

Sleep and pain are interrelated and have a bidirectional relationship. The study was performed to identify the impact of sleep disorders on pain perception.

Methods

The institutional review board approved the study. Patients evaluated in the Pain Clinic between 1/1/2014 and 12/31/2017 who had polysomnography done were identified by database search. Chart review identified demographics, initial pain score, pain treatments, sleep disorder diagnosis, treatments of sleep disorder and pain scores after sleep treatments. Numerical pain score (NPS) and insomnia severity index (ISI) were used as a measure of pain and sleep quality, respectively. The descriptive statistics were presented by percentages, mean and standard deviations. Regression analysis was performed between initial NPS and ISI. T-test compared change in NPS for compliant and non-compliant subjects, before and after sleep treatments. Linear regression model identified factors associated with changes in pain perception after sleep treatments.

Results

Of the 320 participants identified, complete data was available for 180 subjects. The average age was 55.9±13.9; 51.41% were female; 60.2% were Caucasian and 26.64% were Hispanic. Initial NPS was 8.8±1.7, average ISI was 15.00±6.41, average BMI was 35.4±10.2. Ninety-five percent had a diagnosis of obstructive sleep apnea (OSA), 27.81% had restless leg syndrome, and 7.19% had complex sleep apnea. Since most patients had OSA, details of positive airway pressure (PAP) treatments were also investigated. Of 84% of subjects treated with PAP, compliance data were available for 53%, which showed 69% (n=55) being complaint with PAP. Initial NPS correlated positively with ISI (R2: 0.064±0.024, p<0.01). No difference in NPS was found in groups based on compliance, before and after PAP treatments. Regression model identified that BMI was the most significant factor in the change in NPS following sleep treatment (R2: 0.083±0.034, p = 0.03).

Conclusion

The study identified that the severity of pain is associated with poor quality of sleep. While this study failed to identify improvement in pain perception after successful OSA treatment, limited number of subjects in our study were compliant with PAP treatment which may have impacted the results. Future prospective studies are needed to understand the complex association between improvement in sleep quality and pain perception.

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708 Rapid Adoption of Telemedicine during COVID-19 Pandemic: Impact on PAP Adherence and Health Care Utilization
Authors: Stothard Ellen , Hickey Mark , McCarty David , Wertz Adam
Published: May 2021

Introduction

The COVID-19 pandemic has required rapid reconfiguration of healthcare services from in-person to telemedicine. Positive Airway Pressure (PAP) is the gold-standard treatment for sleep apnea, but success requires substantial clinical support, which has traditionally been provided in-person. In this quality analysis, we examined the impact of PAP initiation (PAPI) via telemedicine on adherence and subsequent health care utilization, compared to the conventional, in-person model.

Methods

Patients who completed PAPI and initial adherence period between April-August 2020 were included. During this window, telemedicine visits were encouraged, but not required. Adequate adherence status was considered met if 21/30 consecutive days with use >4h was achieved by day 90 therapy. Health care utilization was represented by the number of follow-up visits, stratified by provider type (Physician, Physician Assistant (PA), or PAP Technologist).

Results

839 patients (54% telemedicine, 46% in-person), 38.0% female, aged 54.2±0.5 years, BMI 32.4±0.3 (±SEM) were included. Adherence was similarly achieved following both initiation methods: 78.8% (telemedicine) and 76.4% (in-person) (p>0.4). Clinical follow-up was lower after in-person PAPI compared to telemedicine, regardless of adherence status (p<0.05). Non-adherent patients also had less clinical follow-up than adherent patients after both initiation methods (p<0.0001), though this differed by provider type. Non-adherent patients in both initiation methods were less likely to follow-up with a PA or PAP Technologist (p<0.01), though follow-up rate with Physician providers was similar (p>0.1). Clinical follow-up with PAP Technologist was increased after telemedicine compared to in-person PAPI (p<0.01).

Conclusion

Implementation of a telemedicine PAP initiation protocol during the COVID-19 pandemic resulted in similar rates of adherence compared to the conventional in-person method, which suggests that telemedicine is an appropriate alternative to in-person PAPI. However, clinical follow-up was lower after in-person PAPI compared to telemedicine regardless of adherence status. Further, non-adherent patients had less follow-up with PAs and PAP Technologists, but similar follow-up with Physicians. This may indicate that provider type plays a role in supporting patients through the adherence process and should be considered. Further research is needed to understand the relationship between care teams, adherence, and healthcare utilization in the age of telemedicine.

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711 Changes in Healthcare Visits and Sleep Medication Use in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Debian Ahmad , Arentson-Lantz Emily , Kokanda Manasa , Shaib Fidaa , Nowakowski Sara
Published: May 2021

Introduction

Patients may be experiencing increased stress and sleep disturbance due to healthcare changes during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and sleep medication use on sleep disturbance and insomnia severity.

Methods

Between June-November 2020, 81 sleep medicine clinic patients (54.8 ± 15.9 y, 44% male, 69% Caucasian) completed an online survey that included questions about COVID-19 (tested for coronavirus, test results, willingness to be vaccinated for COVID-19, changes in health care visits and sleep medications during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). Stepwise linear regression was performed using SAS to determine if changes in healthcare and sleep medications predicted poorer sleep.

Results

Among participants, 32% were tested for coronavirus, out of those 8% tested positive for COVID-19. 74% were willing to get vaccinated and 65% were willing to get their children vaccinated. 35% changed their healthcare office appointments to telephone visits, 54% changed to video visits; whereas 26% cancelled and 32% rescheduled their healthcare appointments. Changes in health care visits during the pandemic had a significant increase on ISI score (3.98 ± 1.66, p=0.019). Changes in sleep medication during the pandemic had significant effect on Sleep Disturbance (7.15 ± 2.51, p=0.005), Sleep-Related Impairments (8.69 ± 2.68, p=0.001) and ISI (6.04 ± 1.66, p=0.001) measures.

Conclusion

Sleep medicine patients who reported changes in sleep medication reported higher insomnia severity, sleep disturbance, and sleep-related impairments. Patients who reported changes in healthcare visits during the pandemic reported higher insomnia severity. Assessing sleep medication changes and preference for healthcare visit format is advised when treating sleep medicine patients during the pandemic.

Support (if any)

This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).
712 COVID-19 Risk Perception, Sleep Health and Peritraumatic Distress Among New Yorkers: The NYU COVID-19 Mental Health Study
Authors: Blanc Judite , Seixas Azizi , Bubu Omonigho , Briggs Anthony , Compas Alain Claude , Williams Yolette , Jean-Louis Giardin
Published: May 2021

Introduction

Long-term exposure to pandemics like COVID-19 may increase psychological distress (e.g., peri-traumatic and post-traumatic distress) and sleep problems. Little is known about the effects of COVID-19 on peritraumatic distress, a well-documented risk factor for post-traumatic stress disorders (PTSD). The aim of this study was to investigate the association between COVID-19 risk perception and peritraumatic distress, and whether this relationship is moderated by sleep quality among individuals located in NY.

Methods

We examined data from 541 individuals (69% were female, mean age (SD) = 40.9 (15.3)] recruited online during summer and fall 2020 in New York for the NYU-COVID-19 Mental Health Study. Data were gathered on sociodemographic, COVID-19 risk perception (yes or no items), peri-traumatic distress measured by Peritraumatic Distress Inventory (PDI), and sleep quality measured by the Pittsburg Sleep Quality Index (PSQI). Descriptive, regression analysis and interaction terms were conducted using SPSS v. 25 to examine associations between COVID-19 risk perception with symptoms of peritraumatic distress and sleep quality.

Results

Of the 541 participants, 311(57.5%) reported they felt at risk for contracting COVID-19. PSQI was positively correlated with PDI (r =.38, p =0.01). An independent sample t student test indicated, on average, that the symptoms of PDI [(mean (SD)=27.3 (7.63), t = 7.07, n =307)] and PSQI [mean(SD)=10.62(3.57), t=4.31 n=311)] of our participants who felt at risk for contracting the COVID-19 significantly exceeded those who did not [(PDI mean(SD)=22.7(7.13), n =228); PSQI (mean(SD) =9.25(3.72), n=229]. Results of multiple linear regression analysis shown that COVID-19 risk perception was the strongest predictor of PDI [B(t) = −.630(12.7); p < .001]. Furthermore, the interaction effect of PSQI scores and COVID-19 risk perception revealed that sleep quality significantly reduced the association between COVID-19 risk perception and PDI [B(t) = .319(5.71); p <.001], such that poorer sleep and feeling at risk of contracting COVID-19 resulted in more severe PDI scores.

Conclusion

COVID-19 risk perception was associated with peritraumatic distress and poorer sleep quality, and sleep quality attenuated this relationship.

Support (if any)

NIH (T32HL129953, K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453)
725 Serious Illness, Sleep Quality, and Spirituality: an exploratory study in a multicultural inpatient setting
Authors: Castro Laura , Peteet John , Balboni Tracy , Koenig Harold , Cintra Fatima
Published: May 2021

Introduction

Spiritual well-being can impact quality of life and survival among diseased populations, similarly to sleep. Despite beneficial effects of spiritual-based practices on sleep, few studies have investigated an association between these attributes. Our goal was to explore correlations between measures of sleep quality and spirituality among severe medical inpatients hospitalized for different reasons, testing whether sleep could be a mechanism by which spirituality influences clinical outcomes.

Methods

Patients (18+ years) admitted in two units of the University’s hospital between Oct/2018 and Aug/2019 were invited to participate. Semi-structured interviews included the Duke Religiousness Index, the Belief into Action Scale, the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being, the Pittsburgh Sleep Quality Index (PSQI), and the Short Form Six-Dimension (SF-6D) health index. Diagnoses were defined by the International Classification of Diseases. We used the Chi-square test, bivariate correlations, and Generalized Linear Models.

Results

A total of 146 consecutive patients were included (46.8±15.9 years, 51% men), 28% admitted for cardiovascular diseases, 26% for cancer, 20% rheumatologic disorders, and 26% for other conditions including hematological, nephro-urological, infectious, among other diseases. The mean PSQI was 10.1±4.7 and 55% of patients rated their sleep as poor. Average sleep duration was 6.5±1.9 hours. Insomnia (64%) was the most frequent sleep complaint, followed by nocturia (43%), pain (42%), and discomfort breathing (29%). There was a modest correlation between sleep quality and spiritual well-being (-0.23; p<0.01). Maintenance insomnia correlated with less spiritual peace/meaning (-0.27; p<0.01) and faith (-0.21; p=0.01), whereas pain, with more social (0.21; p=0.01) and private (0.24; p<0.01) religious activities. Initial insomnia also correlated with private activities (0.18; p=0.04). Seep quality (0.43; 0.25–0.62), spiritual peace/meaning (-0.21; -0.40-[-0.01]), and social religious activities (0.18; 0.04–0.32) were independent indicators of higher SF-6D scores, additional to an interacting effect between sleep quality and spiritual well-being predicting better quality of life.

Conclusion

Subjective sleep quality is associated with spiritual well-being and quality of life, independently of the nature and severity of the medical disease. Our findings also suggest that patients suffering from nocturnal pain and trouble falling asleep might be more engaged with religious activities.

Support (if any)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
726 Relationships Between Sleep and Psychological Adjustment During the COVID-19 Pandemic
Authors: Gilles Allyson , Qeadan Fares , Baron Kelly
Published: May 2021

Introduction

Disruption of daily routines (employment, social interaction, health behaviors) during the COVID-19 pandemic has contributed to psychological distress (worry, rumination), likely impacting sleep-related behaviors. This study evaluated change in psychological adjustment and insomnia symptoms during the COVID-19 pandemic.

Methods

The sample included 192 adults from Utah who completed three data collection cycles across 9 consecutive months to assess self-reported depressive, anxiety, and insomnia symptoms. Anxiety and depressive symptoms were assessed via the Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire depression scale (PHQ-8). Insomnia was measured by the Insomnia Severity Index (ISI). Data were analyzed using mixed-effect modeling and adjusted for anxiety and depression to determine their independent effects on insomnia symptoms. Spaghetti plots examined mean changes over time and significance was set at p<0.05. Average anxiety, depression, and insomnia severity scores were aggregated for each month.

Results

As participants’ symptoms of anxiety and depression increased in severity, insomnia symptoms increased similarly. Over half of participants reported clinically significant ISI scores (59.38%). In both the random intercept and random slope models, there were significant independent effects of anxiety on insomnia severity (F=20.69; p<0.0001) and significant effects of depression on insomnia severity (F=87.44, p<0.0001). While the change in insomnia severity over time was on the boundary of statistical significance (F=3.54; p=0.0618), dropping from 15.17 (April) to 12.58 (December), our longitudinal analyses revealed no significant difference for the effect of anxiety or depression in predicting insomnia severity over time. Participants’ monthly averages varied for sleep and psychological scores (ISI) from 12.58 to 16.07 (SD=3.76 to 6.34 for December and September, respectively), (GAD-7) from 3.47 to 6.39 (SD=3.36 to 5.26 for December and June, respectively), and (PHQ-8) 4.47 to 6.10 (SD=4.65 to 4.39 for December and June, respectively).

Conclusion

Results demonstrate high prevalence of insomnia symptoms during the COVID-19 pandemic and underscore the importance of examining mental health functioning and psychological resiliency on sleep in order to enhance prevention efforts in response to a significant stressor.

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732 A daily diary study of nightmare reports among combat-exposed Veterans
Authors: Miller Katherine , Goldstein Elly , Barilla Holly , Carroll Rain , Ross Richard , Kling Mitchel , Bhatnagar Seema , Gehrman Philip
Published: May 2021

Introduction

Nightmare occurrences may, in part, result from prior-day arousal (e.g., the continuity hypothesis), and that they then influence next-day symptoms. Recent ecological momentary assessment (EMA) studies in samples of civilian trauma survivors found that elevated PTSD symptoms, pre-sleep cognitive arousal, and greater sleep onset latency predicted nightmare reports. This study adds to these works by using EMA in a sample of combat-exposed Veterans.

Methods

Data were analyzed from a study examining neurobiological and neuropsychological factors associated with PTSD in a sample of 27 combat-exposed OEF/OIF Veterans, with and without PTSD. Participants engaged in EMA for 6 days, with assessments across the day inquiring about mood, activity, and stressful events. Morning reports also included the consensus sleep diary and prompts on nightmare experiences. Those reporting nightmares were asked about nightmare disturbance and the level of replicability to a traumatic event (replays or symbolic/unrelated). Multi-level modeling analyses were used.

Results

A total of 113 morning reports were acquired, in which 40 included a report of having a nightmare and 73 did not. Main effects were found for baseline PTSD symptom severity (OR=1.13, p=0.02), prior day time spent alone (OR=0.01, p=0.01) and prior day level of distraction (OR=0.25, p=0.02) on morning reports of nightmares. However, when accounting for the previous night’s nightmare report (OR=15.9, p<0.001), these effects were no longer significant. No other effects on nightmare reports were observed. Additionally, no factors predicted replicability of nightmare content or level of nightmare disturbance. Regarding daytime impact, nightmare reports were associated with greater levels of stress associated with events later that day (OR=2.48, p=0.04).

Conclusion

Greater baseline PTSD symptom severity, less daytime spent alone, and greater daytime attentiveness were significant predictors of nightmare reports. While daily social interactions and attentiveness may be beneficial, these factors also may be associated with hypervigilance, a known risk for sleep disruption. However, these data also suggest that day-to-day levels of stress may have less influence when a chronic nightmare pattern is present.

Support (if any)

Defense Advanced Research Projects Agency under a grant from the U.S. Army Research Office (W911NF1010093). U.S. Department of Veterans Affairs, Veterans Health Administration (CSR&D- IK2 CX001874).
733 PTSD and Sleep Disorders in Medical Learners and Healthcare Providers
Authors: Tinsley Meagan , Hunt Grace , Alvarez Mark , Gremillion Rachel , Jumonville Allison , Ghaffar Yahya , Champagne Kristin , Derouen Alyssa , Knox Brianne , Bokun Kevin , Allen Mariah , Ninh Michael , Harper Daniel , Chernyshev Oleg
Published: May 2021

Introduction

Medical student mental health and wellness has been an increasingly hot topic over the past decade. Much of the research, however, has remained focused more on anxiety and depression and less on other less common but just as detrimental mental health disorders such as PTSD, bipolar disorder, OCD and others. In addition to the more traditional psychological stresses medical students experience, they also experience physical consequences of their training, often with sleep patterns suffering most initially.

Methods

The questionnaire consists of thirty-five questions, compromising of demographic questions, questions relating to USMLE exams and education, the STOP-Bang Questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale and PTSD DSM-V Questionnaire. This survey was sent out between March and April of 2020 and was distributed to all medical students and residents with an LSU Health Shreveport email address via RedCAP, an encrypted electronic survey tool.

Results

A total of 78 participants responded to our survey, with 91.1% identifying as medical students and the rest as residents. 64.1%, identified as female, 34.6% identified as male and 1.3% declined to answer. While 43% of our participants found their educational experience emotionally traumatizing, 75% of them felt that preparing and/or taking USMLE exams was emotionally traumatizing. In regards the portions of our questionnaire that served as sleep disorder screening questions, the average score for the STOP-Bang was 1.48 (SD +/- 1.15) the average score for the ESS was 6.85 (SD +/- 4.72) and the average score for the FSS was 32.04 (SD +/- 11.99). It should be noted that, while the average score of the PTSD screening portion was 20.34 (SD +/- 17.47), 18 participants scored above 38, the minimum score needed to qualify for a PTSD diagnosis.

Conclusion

These results suggest some correlations that warrant further future study. It is worrisome that while less than half of our participants stated their educational experience as harrowing, 75% stated preparing for and/or taking these required exams was emotionally traumatizing. The possible connections suggested here between USMLE exams and an increase in fatigue, lack of motivation and PTSD symptoms urge us to look more closely at the impact of the USMLE.

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734 Prevalence and Correlates of Insomnia in Veterans with and without Military Sexual Trauma Receiving Care within a VA Med Center
Authors: Makar Karen , Rivera Louis , Mazur Rena , Aguiar Taylor , Krouse Ryan , Chakravorty Subhajit
Published: May 2021

Introduction

A prior study showed a higher prevalence of insomnia among younger Veterans with military sexual trauma (MST) before receiving care at a VA Medical Center (VAMC). We extend the literature to investigate the prevalence and correlates of insomnia in male Veterans with and without MST currently receiving care within a VAMC.

Methods

We evaluated cross-sectional data from a survey within the Philadelphia VAMC (N=138) using the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Sexual Harassment Scale (DRRI-2) to screen for MST; PTSD checklist for DSM-5 (PCL-5) PTSD symptoms; Quick Inventory of Depressive Symptomatology-Self report (QIDS-SR) to evaluate depressive symptoms; Alcohol Use Disorder Identification Test (AUDIT-C) to assess for harmful drinking; and, the nightmare question from the PCL-5 scale to screen for persistent nightmares. The association between ISI total score and variables were assessed separately in individuals with and without MST, using bivariate and multivariable analyses.

Results

The mean(SD) age was 55.2(12.8) years. They were likely to identify themselves as African-American (44.2%), and had a high school diploma (39.1%). MST was endorsed by 31.9% of the Veterans. Insomnia was more prevalent in those with MST [N=42(95.4%)] than those without [N=77(81.9%)]. Individuals with MST had higher ISI (19.9±5.0 Vs 16.7±7.2) and PCL-5 (48.4±14.4 Vs 38.1±19.7) total scores, than individuals without. Among those with MST, the bivariate analysis showed significant associations with PCL-5 (β=0.2, p<0.0001), QIDS (β=0.5, p=0.01), AUDIT-C (β=0.5, p=0.008), and nightmares (β=3.9, p=0.03). In the multivariable model, ISI total score was only associated with the PCL-5 total score (β=0.3, R2=0.18, p=0.0005). Among those without MST, the bivariate analysis showed significant associations between ISI total score and age (β=-0.1, p=0.02), total scores on the PCL-5 (β=0.2, p<0.0001), QIDS (β=0.9, p<0.00001), and nightmare (β=6.7, p<0.0001). In the multivariable model (R2=0.5, p<0.00001), the ISI total score was associated with PCL-5 (β=0.1, p=0.01), and QIDS (β=0.7, p=<0.0001) total scores.

Conclusion

There is a higher prevalence of insomnia among Veterans with MST currently receiving care within the VHA. Treatment of insomnia and PTSD is critical to improve their well-being and prevent complications.

Support (if any)

The study was supported by VA grant IK2CX000855 (S.C.).
735 Neighborhood Stress Predicts Fear of Sleep Independently of Posttraumatic Stress Disorder
Authors: Poindexter Milan , Stokes Alicia , Mellman Thomas
Published: May 2021

Introduction

Chronic insufficient sleep is linked to a variety of adverse health outcomes, with African Americans reporting and objectively receiving poorer sleep outcomes in comparison to their non-Hispanic white counterparts. African Americans live disproportionately in low-income and disordered neighborhoods that increase one’s risk of experiencing a traumatic event and interfere with sleep. It has been demonstrated that posttraumatic stress disorder disrupts sleep in part due to its association with sleep-related fears. However, less research has evaluated the additional contribution of perceived neighborhood stress on the sleep-related fears African Americans experience in their sleep environments.

Methods

The present study features a nonclinical sample of 163 African American participants (ages 18–35) who reside in DC to investigate whether PTSD severity (Clinician Administered PTSD Scale for DSM-5 Severity Score, CAPS-5) and perceived neighborhood stress (City Stress Index, CSI) are predictive of sleep-related fears (Fear of Sleep Inventory, FoSI).

Results

After controlling for gender, hierarchical linear regression analyses revealed that PTSD severity and perceptions of the neighborhood environment accounted for approximately 33% of the variance in sleep-related fears (∆R2 = .329, p = .000). Regression coefficients suggest that subjective perceptions of the neighborhood (β = .388) may be a stronger predictor of sleep-related fears than PTSD severity (β = .300)

Conclusion

Results from this study have implications for future interventions that involve improving coping skills among African Americans in the context of their sleep environments.

Support (if any)

5R01HL136626 from the National Heart Lung and Blood Institute
741 Sleep and postpartum depression in healthy fathers: Perceptions of sleep quality predict severity of symptoms
Authors: Kalogeropoulos Christopher , Burdayron Rebecca , Laganière Christine , Beliveau Marie-Julie , Dubois-Comtois Karine , Pennestri Marie-Helene
Published: May 2021

Introduction

Research on the link between sleep quality and depression in the postpartum period has focused primarily on mothers. Although fathers also experience poorer postpartum sleep and are at risk of developing depressive symptoms, they remain understudied. To date, the limited research focusing on paternal sleep and depression has relied on subjective measures of sleep, without objective verification. The current study implemented a multi-measure approach using subjective and objective indices to explore the relationship between sleep and depressive symptoms in fathers at 6 months postpartum.

Methods

Fifty-four healthy fathers participated in this cross-sectional study. Paternal sleep was assessed for 2 weeks utilizing: 1) a self-report daily sleep diary, 2) a self-report perceived sleep quality rating, and 3) actigraphy. Subjective indices via the sleep diary measured participants’ perception of their total nocturnal sleep duration and total number of awakenings (self-reported sleep duration and fragmentation). Perceived sleep quality ratings measured participants’ perceptions of how well they thought they slept. Objective sleep variables measured through actigraphy included: total nocturnal sleep duration, number of awakenings, sleep efficiency, and wake after sleep onset (WASO). Paternal depressive symptoms were assessed with the Center for Epidemiologic Studies – Depression Scale (CES-D).

Results

Regression analyses showed that subjective sleep variables (measured by the sleep diary) and objective sleep variables (measured by actigraphy) did not significantly predict postpartum depressive symptoms in fathers (p > .05). However, self-reported perceived sleep quality significantly predicted postpartum depressive symptom severity in fathers (R2 = .172, p = .034).

Conclusion

These findings advance our understanding of the link between sleep and depression in fathers. The results highlight the important role of fathers’ perceptions of sleep quality, rather than the actual quality or quantity of their sleep (measured through the sleep diary or actigraphy), in the development of postpartum depressive symptoms. The multi-measure approach to sleep implemented in this study expanded our knowledge about how different facets of sleep relate to depression. These findings have important implications for the development of clinical interventions targeting paternal sleep and mood in the months following childbirth.

Support (if any)

Social-Science and Humanities Research Council (SSHRC) and Fonds de recherche du Québec – Santé (FRQS)
747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women
Authors: Arnett Lily , Kalmbach David , Ahmedani Brian , Gelaye Bizu , Drake Christopher , Cheng Philip
Published: May 2021

Introduction

This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression.

Methods

From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices.

Results

Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI.

Conclusion

Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.

Support (if any)

This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).
754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care
Authors: Vargas Ivan , Muench Alexandria , Seewald Mark , Livesey Cecilia , Press Matthew , Oslin David , Thase Michael , Perlis Michael
Published: May 2021

Introduction

Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late).

Methods

Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia.

Results

Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%).

Conclusion

According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general?

Support (if any)

Vargas: K23HL141581; Perlis: K24AG055602
758 Circadian rest-activity signatures in women with major depressive disorder
Authors: Yang Hui-Wen , Chellappa Sarah , Gaba Arlen , Cajochen Christian , Hu Kun
Published: May 2021

Introduction

Patients with major depressive disorder (MDD) show disrupted circadian rhythms and sleep, including reduced daytime physical activity and poor sleep quality. However, previous findings are masked by psychotropic medication intake, co-morbid diseases and years of chronic mental illness. Here, we aim at identifying circadian motor activity patterns in unmedicated women at the onset of MDD.

Methods

Twelve young unmedicated women with MDD (Mean+-SD: 24.9+-5.2y; range: 18-33y) and eight age-matched healthy women (Mean+-SD: 24.5+-3.2y; range: 20-31y) participated in our study. Activity recordings were collected using wrist-worn wearable devices (actigraphs) for ~7 days in real-life settings. Cosinor analyses were performed to assess the amplitude and phase of the 24-h rest-activity activity rhythms. Non-parametric analyses were used to quantify interdaily stability and intradaily variability of the rest-activity rhythm. Furthermore, we calculated the mean activity level and scaling exponent alpha, which quantifies the temporal correlation in activity fluctuations, per 3-h bins across the 24-h sleep-wake cycle.

Results

Women with MDD showed a significantly higher amplitude of the 24-h rest-activity activity rhythm (Mean+-SD: 332.7+-120.8 arbitrary units) than the controls (179.7+-122.9; p=0.002), elicited by higher activity levels during the daytime (0-12h after habitual wake-up time; p<0.01). In contrast, women with MDD showed a trend for lower interdaily stability levels than controls (respectively, 0.41+-0.07 and 0.46+-0.08; p=0.05). Interestingly, a significant interaction effect of “group” and “time since habitual wake” was elicited for scaling exponent alpha (p<0.001). Accordingly, women with MDD had higher alpha values during habitual sleep (0–6 hours before habitual wake-up time) than controls (respectively, 1.18+-0.22 and 1.12+-0.22).

Conclusion

Unmedicated women at the onset of MDD had altered circadian motor activity patterns, as indexed by higher amplitude particularly during daytime while awake, less stable 24-h activity rhythms, and highly correlated activity patterns during sleep that closely resemble those typically occurring during wakefulness. These findings suggest that MDD per se may be associated with impaired rest-activity profiles. Ultimately, the use of wearable devices might hold important prospects for the early detection of individuals at risk for mood disorders.

Support (if any)

Swiss National Science Foundation Grants START #3100–055385.98, 3130-0544991.98 and 320000-108108; NIH RF1AG064312, RF1AG059867
759 Sleep and Mental Health in New Mothers with a History of Depression: Preliminary Data from Late Pregnancy to 1-month Postpartum
Authors: Okun Michele , Feliciano Leilani , Karp Harvey , Lindsay Keston
Published: May 2021

Introduction

Perinatal women report more sleep disruptions than non-pregnant women. This phenomenon is exaggerated among women with a history of depression, as sleep complaints are one of the most frequent symptoms of depression. Understanding the change in sleep and mental health from late pregnancy to postpartum may provide insights into prevention and intervention. Presented here are preliminary data from new mothers regarding sleep and mental health.

Methods

Preliminary examination of sleep and psychological data from 22 women enrolled in a study to assess the efficacy of the SNOO on infant and maternal sleep during the first 6 months of life. Participants were eligible if they had a history of, but no active depression as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Data are from late pregnancy and at 1-month postpartum. Questionnaires included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Symptom Questionnaire (ISQ), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), and the Generalized Anxiety Disorder scale (GAD). Paired t-tests or chi-square tests were used to assess change over the first month postpartum. Linear regressions were done to determine whether sleep in late pregnancy was associated with depression and anxiety scores.

Results

Participants were 30 ± 2.2 years of age and 72.7% were White. In the first month postpartum, sleep was negatively impacted. Clinical insomnia increased (4 (18.2%) vs 5 (22.7%); X2 = 7.61, p = .006), sleep quality (PSQI) worsened (6.13 ± 3.54 vs 8.89 ± 3.54; t = -3.03, p =n .006), daytime sleepiness was higher (4.77 ± 2.51 vs 6.64 ±3.44; t = -3.31, p = .003), and fatigue was greater (9.55 ± 4.73 vs 13.36 ± 5.86; t = -3.21, p = .004). Likewise, depression and generalized anxiety increased (p’s < .01). Insomnia in late pregnancy was associated with more depression (β = .542, p = .009) and more anxiety (β = .510, p = .015).

Conclusion

Pregnant women with a history of depression are at risk for more sleep disturbances, and therefore more likely to be at significant risk for a recurrent depressive episode. Improving sleep in the perinatal period could have a positive impact.

Support (if any)

Happiest Baby Inc.
764 Neural activation accompanying fear conditioning and extinction in Generalized Anxiety Disorder with and without Insomnia Disorder
Authors: Seo Jeehye , Oliver Katelyn , Daffre Carolina , Lasko Natasha , Pace-Schott Edward
Published: May 2021

Introduction

We examined associations of sleep quality with neural responses to fear conditioning and extinction in individuals with Generalized Anxiety Disorder (GAD) with (INS) and without (NOI) Insomnia Disorder (ID). We hypothesized fear-related regions would show greater, and emotion-regulatory regions lesser activity in INS versus NOI and across both groups with decreasing sleep quality.

Methods

Participants were assigned to either an INS group with Insomnia Severity Index (ISI) ≥ 13 (N=21) or NOI with ISI ≤ 12 (N=14). Two weeks of actigraphy and sleep diaries were followed by a 2-session protocol with fMRI. During Session 1, mild electric shock produced conditioned fear to 2 different colors (CS+s) but not a third (CS-) (Fear Conditioning). Immediately afterward, one CS+ (CS+E) but not the other (CS+U) was extinguished (Extinction Learning). All 3 stimuli were presented 24h later (Extinction Recall). An acclimation/diagnostic ambulatory polysomnography (PSG) night was followed by PSGs before Session 1 and between Sessions 1 and 2. Using SPM8, t-tests compared groups, and multiple regressions predicted anterior cerebral activations (as a whole and as ROIs) using ISI, actigraph and diary sleep efficiency (SE) and latency (SOL), and sleep architecture.

Results

Beginning Fear Conditioning, differential activation to the reinforced stimulus (CS+>CS-) in the right insula was greater in INS than NOI, and greater actigraph SE predicted greater prefrontal activation. Change in activation to the CS+ across Extinction Learning (late CS+>early CS+) did not differentiate groups or correlate with sleep measures. During Extinction Recall, NOI versus INS showed less activation in bilateral amygdala ROIs (CS+E>CS-) but more activation in prefrontal regulatory regions (CS+U>CS-) and bilateral insula ROIs (both contrasts). Greater activation of prefrontal emotion-regulatory areas was associated with greater REM% (CS+E>CS+U and CS+E>CS-), lesser ISI (CS+E>CS- and CS+U>CS-), and greater actigraph SE (CS+U>CS). However for CS+E>CS+U, lesser diary SE and greater ISI were associated with greater prefrontal activity.

Conclusion

Results, on balance, suggest that persons with GAD and ID activated more fear-related and less prefrontal emotion-regulatory regions during fear conditioning and extinction recall than those with GAD alone. Across groups, greater REM% and sleep quality were associated with greater activity of emotion-regulatory areas.

Support (if any)

Funding: R21MH115279, R01MH109638
768 The Relationship Between Circadian Rhythm and Autism Spectrum Disorder Traits and Executive Function Across the Life Span
Authors: Smidt Stacey Elkhatib , Ghorai Arpita , Gehringer Brielle , Dow Holly , Smernoff Zoe , Taylor Sara , Rawot Eric , Langer Allison , Zhang Jing , Rader Daniel , Almasy Laura , Brodkin Edward , Bucan Maja
Published: May 2021

Introduction

Children and adults with autism spectrum disorder (ASD) often have sleep, circadian, and executive function impairments, which can affect daytime quality. Yet, the relationship between sleep or circadian traits and ASD traits is still unknown. Thus, we aimed to determine if sleep and circadian traits were associated with ASD traits, including executive function.

Methods

We studied data from participants with and without ASD enrolled in the family-based study Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania. We used GGIR to analyze actigraphy-derived sleep and circadian traits from 250 participants (219 adults ages 18–87 years, mean 44.2 ± 17.3 years; 31 children ages 4–17 years, mean 11.3 ± 3.9 years). These traits were compared to ASD traits (social impairment and restricted/repetitive behavior via Social Responsiveness Scale, Second Edition) and executive function (Behavior Rating Inventory of Executive Function) using linear multivariate regression models adjusted for age, age2, and sex via Sequential Oligogenic Linkage Analysis Routines.

Results

In adults, earlier start time of the 10 hours of highest activity in a 24-hour day (M10 start time; p = 0.02), decreased robustness of the rest/activity rhythm (relative amplitude; p = 0.03), and increased intradaily variability of rest/activity rhythm (p = 0.04) were associated with more social impairment. In children, earlier M10 start time (p = 0.02) and decreased relative amplitude (p = 0.03) were associated with more social impairment. In adults, higher average 5-hour period of lowest activity in a 24-hour day (L5 average; p = 0.03), lower average 10-hour period of highest activity in a 24-hour day (M10 average; p = 0.005), earlier M10 start time (p = 0.02), decreased relative amplitude (p = <0.001), increased intradaily variability (p = <0.001) and decreased sleep efficiency (p = 0.04) were associated with increased executive function impairment. In children, earlier M10 start time (p = 0.006) and intradailty variability (p = 0.008) were associated with increased executive function impairment.

Conclusion

Circadian traits are significantly associated with ASD traits, including executive function, suggesting the importance of sleep-wake rhythm dysfunction in ASD.

Support (if any)

Anonymous donor; NIH T32HL07713; University of Pennsylvania’s Institute for Translational Medicine and Therapeutics
779 Effects of lifetime trauma exposure on the association between neighborhood safety and sleep
Authors: Alcántara Carmela , Diaz Sarah
Published: May 2021

Introduction

Greater perceived neighborhood safety (PNS) has been linked to better sleep quality and longer sleep duration. There is also evidence that past exposure to traumatic events may be associated with lower perceived personal safety and poor mental health. Yet, the moderating effects of lifetime trauma exposure on the association between PNS and sleep (duration & latency), has not been assessed.

Methods

We used cross-sectional data from 190 healthy NYC Latino adults. Lifetime trauma exposure was measured using the Life Events Checklist [LEC] (a count of traumatic events that happened to or were witnessed). In the first set of models, we regressed self-reported sleep duration in minutes (continuous), on PNS (safe vs. not safe), a single item scale, with three covariates (i.e. age, gender, education). In the second set, self-reported sleep latency in minutes, replaced sleep duration. To test for moderation, interaction terms—LEC x PNS—were added to covariate-adjusted models. In sensitivity analyses, regression models were re-run with adjustment for PTSD symptoms, and with short sleep duration (<7hours) as the outcome.

Results

On average, participants were 37.9 years old (SE= 1.02), 65.8% female, 59.5% foreign-born, and 33.2% completed < Bachelor’s degree. Overall, 43.68% slept <7 hours and 83.68% were exposed to >1 traumatic event in their lifetime. In adjusted models, each traumatic event (b= -2.95, SE = 1.34, p=0.03) was negatively associated with sleep duration. When PTSD symptoms was added, trauma was no longer statistically significant (b=-1.08, SE=1.02, p=0.18). However, each traumatic event exposure was associated with a 10% higher odds of short sleep duration (OR= 1.10, CI=1.02, 1.15), and this association remained significant with adjustment for PTSD symptoms. No interaction terms were significant. In models for sleep latency, there were no statistically significant main effects for LEC or interaction terms.

Conclusion

We found a dose response in the negative association between lifetime exposure to trauma and sleep duration, but not sleep latency. Trauma history did not moderate the association between PNS and sleep. These results suggest that short sleep duration may be particularly sensitive to lifetime exposure to trauma independent of neighborhood safety. Future studies should replicate these results in population-based samples.

Support (if any):