bluuebunny/crossref_metadata_2025 huggingface dataset:
0110 Nap-Related Change in Memory Precision may be Related to Slow-Wave Sleep in Early Childhood
Authors: Holmes Jennifer , Lokhandwala Sanna , Canada Kelsey , Riggins Tracy , Spencer Rebecca
Published: May 2022

Introduction

In early childhood (3-5 years), naps comprise part of children’s 24-hr sleep. Naps support some types of learning (declarative, emotional), enhancing children’s ability to correctly identify previously seen items. During this time, children’s ability to form precise memories also improves, likely due to ongoing hippocampal development and maturation of processes allowing for pattern separation. Whether naps support the ability to form precise memory representations, allowing children to discriminate between previously seen vs. similar but novel items, is unclear. Here, we used a mnemonic similarity task to examine whether daytime naps support children’s recall of specific images more so than a period of wake. Further, we tested whether this nap-related improvement persists across overnight sleep. We hypothesized that task improvement would be associated with slow-wave sleep (SWS), as this stage has been shown to support episodic memory in preschool-aged children.

Methods

Participants (N=7, 4 females, Mage=56.1 mos) encoded items in the morning, verbally categorizing each image as something they would find “inside” or “outside”. They recalled items at three time points: immediately following encoding, after their nap/wake period, and the following morning after overnight sleep. Recall involved being shown a single image and responding whether it had been previously seen or not. Recall items included targets, foils, and lures. PSG was recorded during the nap and overnight sleep bouts.

Results

When controlling for age, children forgot fewer target items following a nap than a comparable period of wake (p=.05). Following a nap and overnight sleep, children also exhibited marginally less forgetting of target items than following a period of wake and overnight sleep (p=.102). Lure discrimination index (LDI; false alarm lures minus false alarm foils) did not differ between nap and wake conditions. Change in target recall following the nap was associated with SWS% during the nap (r=.96, p=.01), but not nap duration (p=.27).

Conclusion

Napping supported children’s ability to recall target items, but not to correctly reject lures, suggesting naps’ benefit towards more generalized memory. Nap SWS% was associated with less forgetting of target items, supporting its role in hippocampal-dependent memory consolidation. Analyses of overnight sleep data and inclusion of more participants may help better elucidate the relationship between preschool children’s sleep and memory development.

Support (If Any)

NSF BCS 1749280 NIH R21 HD094758 NIH R01 HL111695
0122 Sleep Hygiene Education Intervention: Sleep Factors and Cognition in College Students
Authors: Anderson Noah , Horton Alexis , Gibson Matelyn , Mullins Kayla , Reynolds Alexandria
Published: May 2022

Introduction

College students often struggle to adjust to the demanding nature of college life, which can translate to decreased overall health and poor sleep. Healthy sleep practices are important for obtaining good sleep quality and quantity, leading to optimal cognitive performance. Interventions, including educational approaches to improve sleep in college students, may lead to better concentration, memory retention, and subsequent academic performance. The focus of the current study was to examine habitual sleep habits in college students, provide a brief educational intervention, and investigate potential changes in sleep and cognition.

Methods

Participants included 14 undergraduate students (6 men, average age M=20.64 years, SD=2.13) who wore wrist actigraphs to measure their typical sleep habits. After one week, participants completed questionnaires about sleep (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Epworth Sleepiness Scale, ESS), and fatigue (Multidimensional Assessment of Fatigue Scale, MAF). Participants also completed cognitive tests (Stroop, Digit Span, and Simple Reaction Time). Subjects participated in a short lecture about healthy sleep hygiene habits and the importance of sleep and then repeated the one-week observational study.

Results

Paired sample t-tests revealed a significant increase from baseline average sleep duration (M=5.83 hours) to post-intervention sleep duration (6.64 hours; t(13)=-2.532, p=.013). Sleep efficiency (actigraphy) and quality (PSQI) did not improve significantly. ESS scores decreased significantly (t(13)=3.76, p=.002 (pre M=9.29; post M=5.43) and MAF scores decreased significantly (t(13)=2.19, p=.047 (pre M=20.48; post M=15.60). A difference in reaction times for Stroop incongruent prompts approached significance (p=.083, pre M=979.46; post M=884.70), but no differences were found for errors, Digit Span, or Simple Reaction Times.

Conclusion

The results of this study suggest that one educational lecture about sleep hygiene may be a start to improving sleep in college students. Even a 48-minute increase resulted in decreased sleepiness and fatigue. However, no improvements were found in sleep quality or efficiency. Although a slight improvement was found in reaction time, no other cognitive benefits were noted. More research should be conducted on how to improve sleep habits in college students beyond an educational approach.

Support (If Any)

None.
0129 Region-Specific Changes in Brain Peptidoglycan Following Sleep Deprivation
Authors: English Erika , Dykstra-Aiello Cheryl , Savenkova Marina , Karatsoreos Ilia , Krueger James
Published: May 2022

Introduction

Bacterial cell wall peptidoglycan (PG) and muramyl peptides (MPs), isolated from mammalian brains and urine following sleep deprivation (SD), promote non-rapid eye movement sleep. These PG/MPs likely originate from the host microbiome and have been quantified in neonatal murine brain. PG/MP amounts and dynamics in healthy, adult murine brain remain unknown.

Methods

Wildtype mice acclimated to standard lab conditions were sacrificed at Zeitgeber time (ZT) 3 or ZT15 with (treatment, N=8), or without (control, N=8) 3h of SD prior to time points. Hypothalamic (HT), somatosensory cortex (Sctx) and brain stem (BS) areas were dissected, homogenized in phosphate buffered saline and centrifuged. PG/MP contents in resultant supernatants were determined using an ELISA (MyBioSource), interpolating sample PG from the standard curve, and expressed as ng peptidoglycan per mg tissue wet weight (ng/mg).

Results

At ZT3 and ZT15, BS PG values were significantly higher than HT or Sctx values, while HT and Sctx values did not differ from each other. At ZT3, mean PG values from control mice were: 3.6 in HT, 3.7 in Sctx, and 8.6 ng/mg in BS. After SD, corresponding values were: 3.0, 4.8 (statistically significant increase, p<0.05), and 7.5 ng/mg. Further, within all 8 individual mice after SD prior to ZT3, PG levels in Sctx were higher than corresponding values in HT (p<0.001).At ZT15, PG control values were: 4.6 in HT, 4.6 in Sctx, and 8.9 ng/mg in BS. After SD, PG level at ZT15 was not significantly changed in any brain area assayed. However, PG values after SD at ZT15 compared to ZT3 SD values were significantly higher for HT and BS (p<0.0005 and p<0.005, respectively). In an independent experiment (see Dykstra-Aiello et. al. this volume) we confirmed PG values at ZT15 in BS were significantly higher than Sctx values.

Conclusion

Results indicate unique PG regulation by brain area, sleep loss, and time-of-day suggesting physiological roles for brain PG guiding host behaviors such as sleep. Thus, mammalian sleep-wake regulation and its various associated cognitive states, are the product of millions of years of co-evolutionary symbioses between microbes and their hosts.

Support (If Any)

Supported by the W.M. Keck Foundation and NIH (NS025378).
0138 Exploring the influencing factors of sleep disturbance and work well-being among shift-work nurses in Taiwan
Authors: Chang Shu-Chen , Chen Shu-Yu , Yao Ting-Yu , Wang Mei-Ling , Tu Ming-Hsiang , Lee Shih-Yu
Published: May 2022

Introduction

Job-related stress and sleep disturbances are common problems among registered nurses (RNs). At present, more than half of the nursing staff in Taiwan have the intention to leave, so this is a problem that cannot be ignored. This cross-sectional correlational research based on Job Demands-Resources Model aimed to explore the influencing factors of work well-being from sleep and job crafting perspective.

Methods

A total of 220 (13.3% was male) shift-work RNs (mean age= 30.6, SD= 6.5), were recruited from seven intensive care units of a teaching hospital in central Taiwan. All nurses completed a battery questionnaires measuring their job-related stress, sleep disturbances, fatigue severity, self-efficacy, job crafting, and work well-being. In addition, a 7-day sleep diary were collected to estimate their total sleep time (TST).

Results

Majority of the RNs reported poor sleep quality (61.5%), insufficient sleep quantity (62.8%), and poor daytime functioning (49.5%). According to the sleep diary, their average TST (464 minutes, SD= 91.7) was close to what they needed to feel refreshed (472 minutes, SD= 87.5); however, more than three-quarters of them experienced clinically significant fatigue before bedtime (92.3%) and after waking up (72.7%). Job-related stress was measured by the Copenhagen Psychosocial Questionnaire II, the top three stressors were from value at work level, interpersonal relations and leadership, and work organization. Sleep disturbances was correlated with poor work well-being. After controlling for personal factors (age, gender, and years in nursing) and sleep disturbances, self-efficacy, job-related stress, and job crafting explained 49.8% of work well-being; work organization, value at work level, and job crafting are the significant predictors.

Conclusion

Most RNs in this study reported sleep disturbances and severe fatigue, which had a negative impact on their work well-being. Job-related stress contributed to sleep disturbances, and calls for further study on job-crafting and shift work coping.

Support (If Any)

Changhua Christian Hospital,Taichung, Taiwan
0162 Sleep in Pacific Ocean Populations: A Scoping Review
Authors: Gilles Allyson , Frakes Elizabeth , Aitaoto Nia , Hazelbaker Avery , Nonu Sitiveni , Tran Julianna , Baron Kelly
Published: May 2022

Introduction

Sleep research focused on individuals categorized as Native Hawaiian/Pacific Islander suggests that sleep deficiencies(short sleep, insomnia symptoms) are highly prevalent among adults. Given the large degree of diversity related to family origin of Pacific ocean populations and assimilation, a more robust understanding of unique risk factors related to sleep challenges for these heterogenous communities is warranted. We are conducting a scoping review of studies that examine associations of health, practice, sociodemographic, and influential mechanisms with sleep in Pacific ocean populations.

Methods

A literature search conducted in Medline, Embase, Psychinfo, and Cochrane encompassed three domains: sleep-related and sleep-disorder terms, oceanic island and ancestry names, and sub-population names inclusive of the geographic regions of Polynesia, Micronesia, and Melanesia. The primary search retrieved 2364 articles. Studies were selected by abstract and full text analysis by one reviewer, followed by independent data extraction by four reviewers. Using a standardized form, synthesis of results and assessment of sample demographics, sampling strategy, sleep data source and findings, theoretical framework, and covariates was conducted per article. Inclusion criteria included articles with at least one quantitative sleep-related finding for a Pacific island population. We excluded non-primary research articles. Studies that categorically combined other racial/ethnic groups with Pacific ocean populations(Asian/Pacific Islander) or geographic regions(Asian-Pacific region) in reporting findings were excluded.

Results

Of the 99 articles included in the review, 18 included children/adolescents, 56 included adults, 13 included multiple age groups, and 12 reported no or only mean participant age. Seventy-two studies allowed participants to self-identify their major ethnic group as a single race(e.g., Tongan, Kirbati). Seventeen studies included objective methods(e.g., actigraphy). The most common sleep-related factors were issues of sleep patterns(n=51), physical health(n=43), mental health(n=28), socioeconomic deprivation(n=26), daytime sleepiness/fatigue(n=20), sleep disorders or symptoms (snoring)(n=17), sleep-supporting practices(n=9), and integration into main culture/born in US(n=3).

Conclusion

Preliminary results suggest that few studies have examined identifiable factors that may impact sleep within diverse Pacific ocean communities, with most studies focused on adults, self-reporting, and sleep pattern problems. Future studies should examine underlying mechanisms related to sleep deficiencies in both children and adults to better understand variability in risk across the lifespan.

Support (If Any)
0200 Does Sleep Predict Antibody Response and Maintenance to the COVID-19 Vaccine?
Authors: Prather Aric , Epel Elissa , Drury Stacy , Robinson James
Published: May 2022

Introduction

There is growing evidence that insufficient sleep can negatively impact the immune system, including vaccination response. Prior laboratory studies have shown that acute sleep restriction can result in impaired antibody resposne to the hepatitis A and influenza vaccine. Similarly, prospective studies have shown that short sleep duration, measured by self-report and wrist actigraphy, is associated with muted antibody responses. These prior findings have critical implications for the COVID-19 pandemic and the efficacy and durability of the COVID-19 vaccines currently available. Whether sleep accounts for variability in response to the COVID-19 vaccination series has not been investigated.

Methods

We recruited 530 healthy participants (mean age= 52.4, SD=12.1, range: 18-88 years; 64.1% female) who were naive to the COVID-19 vaccination series. Participants completed self-report questionaires (e.g., Pittsburgh Sleep Quality Index) and morning sleep diaries for 7-consecutive days surrounding COVID-19 vaccine administrations. Additionally, 198 participants wore a sleep tracking device (Oura ring) continuously for ~2 months beginning prior to vaccination, which provides behavioral sleep data on days prior to and following the COVID-19 vaccination series. Blood samples were collected prior to vaccination, +1 month after their final vaccine shot (peak response), and +6 months after their final vaccine shot (maintenance); neutralization assays using pseudotype virus will be carried out to quantify antibody titers.

Results

Data collection concludes December 2021, with antibody assays to be completed February 2022. Initial baseline data indicates that most participants reported poor overall global sleep quality (PSQI mean=6.3, SD=3.6; 52% PSQI>5). Linear mixed models will be conducted to test associations between habitual sleep duration (averaged over the measurement time points), sleep efficiency, and subjective sleep quality with antibody responses over time. Additionally, we will report on the relevance of sleep timing (midpoint) and vaccination timing (receiving the vaccine in the morning vs afternoon vs evening), and the role of self-reported sleep disorders (e.g., obstructive sleep apnea) and shift worker status. Covariates in these analyses will include age, gender, race, body mass index, prior COVID infection, and vaccine type (Moderna, Pfizer, Johnson and Johnson).

Conclusion

These analyses will provide new knowledge about the role of sleep in mounting and maintaining antibody response to the COVID-19 vaccination series. These findings may provide novel insights into when and for whom improvements in sleep may result in better vaccine efficacy.

Support (If Any)

R24AG048024
0207 Mothers’ Adverse Childhood Experiences and Protective Factors are Associated with Rest-activity Rhythms in their Children
Authors: Condon Eileen , Jeon Sangchoon , Sadler Lois , Redeker Nancy
Published: May 2022

Introduction

Mothers’ history of adverse childhood experiences (ACEs; e.g. maltreatment, household dysfunction) are associated with poor health outcomes in their children, but mechanisms underlying this intergenerational transmission are poorly understood. Given links between circadian rhythm and the stress-response system, we test the hypothesis that maternal ACEs influence child health through disrupted rest-activity rhythm (RAR) in the mother and child. We also explore whether mothers’ benevolent childhood experiences (BCEs) are protective against disrupted RAR.

Methods

We conducted a cross-sectional pilot study of maternal-child dyads with preschool-age children. Mothers reported history of childhood adversity (ACEs Scale, Childhood Trauma Questionnaire) and protective factors (BCE Scale). Dyads wore wrist actigraphs for 8-10 days and mothers completed daily electronic diaries. Nonparametric measures of RAR (e.g. interdaily stability [IS], intradaily variability [IV]) were calculated. We used linear regression to examine associations between mothers’ childhood history and maternal and child RAR measures, controlling for household size and maternal employment.

Results

Maternal-child dyads (N=20) identified as white (75%), Black (15%), and Hispanic/Latina (10%). Mean child age was 4.2 years (40% female). Average household size was 4.5 ±.1.1 and 65% of mothers were employed. Forty-two percent of mothers reported 1-2 ACEs and 25% reported 3 or more ACEs. Maternal childhood history was not associated with mothers’ RAR. However, maternal ACEs and CTQ total score were associated with decreased child IS (ACEs: β= -0.47, SE=0.01, p=.02; CTQ total: β= -0.53, SE=.01, p=.001) and increased child IV (ACEs: β=0.29, SE=.01, p=.051; CTQ total: β=0.38, SE+.00, p=.03). CTQ subscales revealed maternal childhood physical abuse (β= -0.54, SE=.01, p<.0001), emotional abuse (β= -0.42, SE=.00, p=.002), and sexual abuse (β= -.73, SE=.00, p<.0001) were associated with decreased child IS, while maternal childhood emotional neglect was associated with increased child IV (β= 0.39, SE=.01, p=.04). Maternal BCEs were associated with decreased child IV (β= -0.44, SE=.01, p=.03).

Conclusion

Maternal ACE history may influence child health through effects on children’s circadian rhythm (i.e. decreased synchronization, increased fragmentation), while maternal BCEs may protect against rhythm fragmentation. Additional research is needed to support these novel preliminary findings.

Support (If Any)

National Institute of Nursing Research (K99NR018876) and American Nurses Foundation.
0220 Changes in Light Exposure During the Daylight Saving Time to Standard Time Transition
Authors: Linton Sabrina , Withrow Dana , Wright Kenneth , Rodheim Katrina
Published: May 2022

Introduction

Although sunrise and sunset do not change, the Daylight Saving Time (DST) to Standard Time (ST) transition results in an earlier clock hour of sunrise and sunset. It has been hypothesized that ST results in brighter mornings and dimmer afternoons/early evenings compared to DST. However, how the time change from DST to ST influences light exposure measured at the level of the individual has not been quantified. Thus, we aimed to determine if the time change from DST to ST increases morning and decreases evening light exposure under typical living conditions.

Methods

25 young healthy adults [7 males (25.6±7.8yr; mean±SD)] completed a ~2 week-long at home protocol. Light exposure was collected with wrist worn Actiwatch Spectrum Plus (Philips Respironics, Bend, OR) one week prior and one week after the transition from DST to ST in Fall 2020. Participants were instructed to continue with their typical work/school schedule, to maintain a nighttime sleep schedule, and to not stay up all night throughout the study. Data were analyzed comparing light exposure levels in the morning (0600-1200h) and afternoon/early evening hours (1200-1800h) across the work/school week with mixed model ANOVA and planned comparisons assessed.

Results

A significant week by time-of-day by week interaction (p<0.05) was observed showing brighter light exposure levels in the morning during the week after the change from DST to ST (p < 0.01), whereas similar light exposure levels were observed in the afternoon/evening hours across weeks (p = 0.64).

Conclusion

Consistent with expectations, individuals were exposed to brighter mornings but contrary to expectations individuals were not exposed to dimmer afternoons/early evenings during ST versus DST. Early morning light exposure is important for entrainment of the on average longer-than-24-hour human circadian period to the 24h day, and for maintenance of sleep schedules that are conducive to work/school start times. Future research is needed to highlight the health, performance, and safety benefits of brighter morning light exposure demonstrated here during ST, especially given current efforts to end the time change between DST and ST.

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0299 The Effects of Chronic Sleep Restriction on Calorie and Macronutrient Intake
Authors: Hilditch Cassie , Costedoat Gregory , Flynn-Evans Erin
Published: May 2022

Introduction

Chronic sleep restriction (CSR) has been associated with increased calorie intake and increased consumption of fats and carbohydrates, with inconsistent changes in protein. However, the majority of studies have either been observational field studies with no sleep intervention, or laboratory-based studies where food availability may not have reflected participants’ real-world choices. We hypothesized that calorie, fat, and carbohydrate intake would increase during a week of imposed CSR compared to a week of sleep satiation (SS) among individuals living in their home environment.

Methods

Twelve healthy participants (6 females) kept a fixed sleep-wake schedule, with a constant waketime, at home for four weeks (actigraphy confirmed compliance). During weeks one and three, participants maintained 9 hours in bed. During weeks two and four, participants were randomly assigned to experimental weeks of 5 and 9 hours of time-in-bed in a crossover design. Participants documented their food consumption during both experimental weeks using a picture-based meal logging application (MealLogger). Intake of calories and macronutrients were classified by two blinded evaluators. Descriptive statistics were calculated in SAS (Cary, NC).

Results

Participants averaged 4.43 ± 0.33 (SD) hours of sleep per night during CSR compared to 7.42 ± 0.42 hours during SS. Participants consumed a daily average of 1812 ± 672 kilocalories, 71 ± 31 grams of total fat, 217 ± 69 grams of carbohydrates, and 84 ± 40 grams of protein during CSR, compared to 1682 ± 514 kilocalories, 68 ± 23 grams of total fat, 198 ± 61 grams of carbohydrates, and 77 ± 32 grams of protein during SS.

Conclusion

Preliminary descriptive findings suggest that, on average, participants consumed more calories, from an increase in consumption of each macronutrient group, during a week of sleep restriction compared to a week of sleep satiation. Further analysis is needed to determine whether these differences are statistically different and to identify when calories were consumed in each of the experimental conditions.

Support (If Any)

Supported by the Force Health Protection Program of the Office of Naval Research (SAA2402925-1, Contract Award no. N0001418IP00050) and the NASA Airspace Operations and Safety Program, System-Wide Safety.
0332 Objective and subjective sleep quality in Mexican Americans and non-Hispanic Whites: the HABLE-Dormir Study
Authors: Leng Yue , Johnson Leigh , Stone Katie , Redline Susan , O'Bryant Sid , Yaffe Kristine
Published: May 2022

Introduction

The ongoing prospective Health & Aging Brain among Latino Elders (HABLE)-Dormir Study is designed to investigate the association between objective and subjective sleep quality and cognitive impairment among Mexican Americans and non-Hispanic Whites (NHWs).

Methods

We plan to recruit 1000 community-dwelling Mexican Americans and NHWs and elders (age 50 and above). Objective sleep duration and fragmentation were assessed by 7-day wrist actigraphy; presence of sleep disordered breathing (SDB) was determined using WatchPAT; and subjective sleep quality and excessive daytime sleepiness (EDS) were examined by Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.

Results

To date, 367 participants have been enrolled (62% women, 45% Mexican Americans, mean age 67.3±8.4 years); 296 (81%) of the participants had normal cognition, 56 (15%) had mild cognitive impairment (MCI), and 15 (4%) had dementia. On average, participants had a mean sleep duration of 7.3±1.1 hours, sleep efficiency of 88.3±5.3%, and wake after sleep onset (WASO) of 55.2±29.3 minutes. Almost half (51%) of the participants had moderate to severe SDB defined by WatchPAT-derived respiratory event index (REI) >=15, 54% had self-reported poor sleep quality (PSQI>5), and 10% reported EDS (ESS>=11). After adjustment for age, Mexican Americans had lower sleep efficiency (86.5% vs. 89.5%, p<0.001) and greater WASO (63.6 vs. 48.9 minutes, p<0.001), compared to NHWs. Sleep duration did not differ significantly among NHWs (7.2 hours) and Mexican Americans (7.4 hours); p=0.20. The prevalence of moderate to severe SDB was similar in NHWs (51.2%) and Mexican Americans (50.0%); p=0.84. Besides, NHWs and Mexican Americans had similar PSQI and prevalence of EDS.

Conclusion

In this initial analysis, Mexican Americans have worse objective sleep quality, but similar sleep duration, prevalence of SDB and subjective sleep quality as compared to NHWs. Continued investigations are needed to explore potential racial/ethnic disparities in sleep health and how differences in objective and subjective measurements vary by race and ethnicity.

Support (If Any)
0338 Association of Evening Circadian Preference and Languid/Flexible Circadian Type with Predisposing, Perpetuating Factors, and Treatment Acceptability in Patients with Chronic Insomnia Disorder
Authors: Singh Rupsha , Lenker Kristina , Calhoun Susan , Fernandez-Mendoza Julio
Published: May 2022

Introduction

Circadian factors may contribute to sleep difficulties among chronic insomnia disorder (CID) patients who do not otherwise meet full criteria for a circadian rhythm sleep-wake disorder, particularly delayed and advanced sleep-wake phase disorders. Current nosology suggests that using circadian preference measures can provide important diagnostic information and aid in differential diagnosis. However, there is a lack of research identifying clinical factors associated with circadian dimensions in patients with CID.

Methods

195 patients (45.50±15.99 years old, 66.2% female, 15.9% minority) with a diagnosis of CID and absent of any other sleep disorder were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center. All patients completed measures of circadian preference and type, insomnia severity, arousability, sleep reactivity, pre-sleep arousal, sleep-wake schedule and incompatible behaviors, dysfunctional beliefs and attitudes, mood and stress, and insomnia treatment acceptability. Multivariable linear regression examined which predisposing, perpetuating and treatment acceptability factors were associated with each circadian dimension, while adjusting for age, sex, race/ethnicity and insomnia severity.

Results

About 30% of the sample was classified as evening, 29% as morning, 74% as languid, and 43% as flexible types. Sleep-wake irregularity was associated with eveningness (β=-0.276, p<0.01), languidity (β=0.280, p<0.01) and flexibility (β=0.184, p<0.01). Pre-sleep cognitive arousal (β=-0.182, p<0.01) and sleep expectations (β=-0.127, p<0.05) were associated with eveningness. Negative cognitions about the consequences of insomnia (β=0.230, p<0.01) and sleep expectations (β=0.268, p<0.01) were associated with languidity. Sleep-incompatible behaviors (β=0.165, p<0.05) and perceived stress (β=0.267, p<0.01) were associated with flexibility, while trait anxiety (β=-0.137, p=0.058) and negative cognitions about the consequences of insomnia (β=-0.318, p<0.01) were associated with rigidity. Less agreeability to pharmacotherapy over behavioral therapy was associated with morningness (β=0.129, p<0.05), while greater agreeability to behavioral therapy over pharmacotherapy (β=-0.158, p<0.05) was associated with rigidity.

Conclusion

Sleep-wake irregularity in patients with CID is a perpetuating factor strongly associated with evening and languid/flexible circadian types, while other predisposing and perpetuating factors can be also determined by circadian preference and/or type. Circadian measures in the evaluation of CID patients may help clinicians individualize BSM treatments, including patients’ acceptability.

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0407 Early Efficacy With Once-Nightly Sodium Oxybate (ON-SXB; FT218): Post-hoc Analyses From REST-ON
Authors: Krahn Lois , Roy Asim , Winkelman John , Morse Ann Marie , Seiden David , Dubow Jordan , Gudeman Jennifer
Published: May 2022

Introduction

Extended-release once-nightly sodium oxybate (ON-SXB; FT218) is in development for adults with narcolepsy. In REST-ON, significant improvements on the Maintenance of Wakefulness test, Clinical Global Impression of Improvement rating, and number of weekly cataplexy episodes occurred with all analyzed ON-SXB doses vs placebo (week 3, 6-g dose; week 8, 7.5-g dose; week 13, 9-g dose; all P<0.001). ON-SXB was superior to placebo on Epworth Sleepiness Scale (ESS) score and sleep quality and refreshing nature of sleep using visual analog scales (VAS; all P<0.001). ON-SXB 4.5 g significantly reduced cataplexy episodes vs placebo at week 1 (P<0.05). Post hoc analyses investigated ON-SXB efficacy on ESS score, VAS sleep quality, and VAS refreshing nature of sleep at weeks 1 and 2.

Methods

Participants in the double-blind, phase 3 REST-ON (NCT02720744) trial were ≥16 years old, had narcolepsy type 1 or 2, and were randomized 1:1 to ON-SXB (4.5 g, 1 week; 6 g, 2 weeks; 7.5 g, 5 weeks; 9 g, 5 weeks) or placebo. Participants recorded ESS scores and VAS for sleep quality and refreshing nature of sleep (1-100; 1=poor quality/unrefreshing sleep; 100=good quality/refreshing sleep) using electronic diaries. P-values were calculated using a mixed-effects model for repeated measures in the modified intent-to-treat (mITT) population (ie, participants receiving ≥1 dose of study drug having ≥1 efficacy assessment at week 3).

Results

In the mITT population (n=190; ON-SXB, n=97; placebo, n=93), baseline ESS scores were 16.6 and 17.5 with ON-SXB and placebo, respectively. At week 2, ESS score was significantly improved with ON-SXB vs placebo (P<0.02) with numerical improvement seen at week 1. At baseline, sleep quality was 53.8 and 55.9 on VAS in the ON-SXB and placebo groups, respectively, and baseline refreshing nature of sleep was 46.5 and 49.9. At weeks 1 and 2, sleep quality (P<0.01; P<0.001) and refreshing nature of sleep (P<0.05; P=0.001) were significantly improved for ON-SXB vs placebo.

Conclusion

Improvement in daytime sleepiness, sleep quality, and refreshing nature of sleep occurred with ON-SXB beginning the first week of treatment. Some patients may experience early narcolepsy symptom relief with ON-SXB.

Support (If Any)

Avadel Pharmaceuticals
0416 The Impact of Idiopathic Hypersomnia on Social and Romantic Relationships of Young Adults
Authors: Davidson Ryan , Blattner Margot , Scammell Thomas , Zhou Eric
Published: May 2022

Introduction

Idiopathic hypersomnia (IH) is a rare and debilitating neurologic disorder characterized by hypersomnolence, often beginning in adolescence. As IH has significant impacts on quality of life and may have greater social impact than narcolepsy, we studied how IH impacts social, romantic, and sexual relationships in young adults.

Methods

Young adults (18-39 years; N=106) with a self-reported IH diagnosis were recruited through national patient organizations. Participants completed an online survey to evaluate social, romantic, and sexual relationships, and communication with medical providers.

Results

Participants (mean=29.6 years; SD=5.2) were primarily female (90%), White/Caucasian (90%) and employed (80%). Almost all participants indicated that IH made social life or entering relationships more difficult (98% and 92%, respectively). Eighty-nine percent of participants indicated that IH had affected their sex life (“Too tired to engage in sexual activities or to feel aroused. …I want to sleep if I am in bed …”). IH symptoms impacted relationships in majority of participants (84%) and contributed to the breakup of a romantic relationship for almost 1 in 3 (32%). Rates of cohabitation and marriage were comparable to nationally representative samples. On the Multidimensional Scale of Perceived Social Support, participants reported receiving significantly more support from their significant others (mean=4.3; SD=1.8) compared to their family (mean=3.9; SD=1.6; p<.05) or friends (mean=4.0; SD=1.6; p<.05). There was no difference between the level of support received from family or friends (V = 2154; p =.77). Medical providers rarely asked about the social (34%) or sex lives (9%) of participants. In contrast, many participants wanted clinicians to ask about the impact of IH symptoms on social life (70%) and sex life (35%).

Conclusion

IH substantially impacts social and romantic health in young adults. Similar to findings in narcolepsy, individuals with IH appear to prioritize romantic partnerships over other personal relationships. Many participants were interested in discussing their social and sexual relationships with their medical providers. However, only a small proportion of clinicians ask about these relationships. To provide effective treatment for the whole patient, clinicians should be prepared to evaluate and provide further support for the social health of young adults with IH.

Support (If Any)

Jazz Pharmaceuticals.
0447 Racial disparities in patient outcomes and treatment engagement in cognitive behavioral therapy for insomnia among pregnant women
Authors: Kalmbach David , Cheng Philip , Pitts D'Angela , O'Brien Louise , Seymour Grace , Cuamatzi-Castelan Andrea , Bazan Luisa , Drake Christopher
Published: May 2022

Introduction

Insomnia affects over half of pregnant women, and epidemiological data suggest that insomnia rates are twice as high among black women relative to white women in pregnancy. Recently, cognitive behavioral therapy for insomnia (CBTI) has been supported as an efficacious intervention for prenatal insomnia. However, it remains unclear whether CBTI is equally efficacious across racial groups, which is necessary to help reduce race-related disparities in prenatal insomnia.

Methods

This study is a secondary analysis of a single-site trial. Thirty-nine women who self-identified as white (n=24) and black (n=15) completed CBTI during pregnancy. Insomnia was measured using the Insomnia Severity Index (ISI). Before CBTI, patients reported sociodemographics. Treatment outcomes were collected a week after completing treatment during pregnancy.

Results

Although racial groups did not differ in ISI before treatment, white patients reported significantly larger decreases in ISI relative to black patients after CBTI (-5.75 vs -2.13, p=.046). Notably, black women were less engaged in treatment than white women based on mean number of sessions attended (4.20 vs 5.54 sessions, p=.013). Even so, multivariate linear regression showed that posttreatment ISI was 4 points higher for black women than white women (b=4.10, p=.049) when controlling for baseline ISI (p=.001), obesity (p=.072), poverty (p=.091), sessions attended (p=.155), and short sleep (p=.406). Notably, 41.7% of white CBTI patients remitted relative to 26.7% of black CBTI patients, suggesting that white women are 56% more likely to remit from CBTI than black women.

Conclusion

Our data suggest that black pregnant women exhibit poorer response to digital CBTI than white pregnant women. Moreover, racial disparities in CBTI response during pregnancy were not attributable to differences in session attendance. We must identify barriers to treatment response in black women, thereby guiding refinement to CBTI to provide better care for black women during pregnancy.

Support (If Any)

Ameriican Academy of Sleep Medicine
0468 Predictors of Response to Digital CBTI in a Randomized Controlled Trial of Middle Aged and Older Adults with Insomnia
Authors: Gumport Nicole , Tutek Joshua , Tully Isabelle , Simpson Norah , Dietch Jessica , Zulman Donna , Rosas Lisa , Palaniappan Latha , Manber Rachel
Published: May 2022

Introduction

Digital CBTI (dCBTI) may serve as a good initial intervention in a stepped-care approach to treat insomnia. Understanding who is likely to respond to dCBTI can guide triaging of care, thus shortening wait times for those who most need to meet with an insomnia therapist. The purpose of this study was to examine baseline predictors of response to a dCBTI program after two months of access.

Methods

Participants were 173 middle aged and older adults with insomnia (M age=63.56 [SD=8.43], 76% female) who received the dCBTI SleepioTM for two months in the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Baseline predictors included the Epworth Sleepiness Scale (ESS), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), preference for treatment (digital vs. therapist-delivered), and comfort with technology. At baseline and two-month follow-up, participants completed outcome measures, including the Insomnia Severity Index (ISI) and the PROMIS-Sleep Related Impairment (PROMIS-SRI). Multilevel modeling was used.

Results

In the full sample, no predictors were associated with change on the ISI. Among our predictors, only higher DBAS scores were associated with a smaller reduction in PROMIS-SRI scores from baseline to two-month follow-up (Beta=-0.88, SE=0.35, p=0.01 , 95% CI=-1.57, -0.19). Among those who preferred digital CBTI (n=52), none of the predictors were associated with the ISI or PROMIS-SRI. Among those who preferred therapist-led CBTI (n=66), greater comfort with technology was associated with greater reduction on the ISI (Beta=-1.77, S =0.78, p=0.02 , 95% CI=-3.30, -0.24) and higher DBAS scores were associated with a smaller reduction on the PROMIS-SRI (Beta=-1.63, S =0.56, p<0.01 , 95% CI=-2.73, -0.53).

Conclusion

The results highlight the importance of targeting dysfunctional beliefs and attitudes, which is consistent with research examining the DBAS in CBTI. Results also indicate that patient preference is an important factor to consider when triaging patients to insomnia care. While additional predictors should be examined, these preliminary findings indicate that dCBTI may be a good initial treatment option for those with high level of comfort using technology and lacking a preference for therapist-led CBTI.

Support (If Any)

R01AG057500 and T32MH019938
0485 Verbal Hostility Moderates Parental and Child Sleep Onset Latency in Children with Autism Spectrum Disorder
Authors: Stearns Melanie , Sparrow Emilie , Nair Neetu , Mazurek Micah , Curtis Ashley , Beversdorf David , Sohl Kristin , Davis Beth Ellen , Takahashi Nicole , McCrae Christina
Published: May 2022

Introduction

Research indicates parent and child sleep onset latency (SOL) are positively correlated. In addition, parents who have difficulty sleeping may be more tired and report using negative parenting behaviors, such as verbal hostility. Experiencing verbal hostility may increase child anxiety and make it harder for them to fall asleep. Given that up to 80% of children with ASD experience sleep problems, it is important to understand potential relations among sleep and parenting behavior in this population. The current study examined whether verbal hostility moderated the relationship between parent and child SOL.

Methods

The sample (N=56) consisted of parents (90% female) reporting on their children aged 6-12 (M=8.63, SD = 2.00; 77% male) who expressed interest in a study exploring behavioral treatments for sleep. All children were diagnosed with ASD and had parent reported sleep complaints (e.g., difficulty falling asleep, waking up in the night). Baseline data were examined in the current analyses. Measures included an average of parent and child SOL on daily sleep diaries over 14 days of baseline. Verbal hostility was measured using the verbal hostility subscale on the Parenting Styles and Dimensions Questionnaire – Short Version. Covariates included child and parent age.

Results

Moderation analyses were conducted using SPSS PROCESS. Parent and child SOL were significantly correlated (r(55)=.28, p=.04). Parent nor child SOL were correlated with verbal hostility. The interaction between parent SOL and verbal hostility t (1, 55) = 5.34, p = .02 was significantly associated with child SOL, such that higher levels of verbal hostility exacerbated the association between greater parent and child SOL.

Conclusion

These results suggest that the association between parent and child SOL depends in part on the level of verbal hostility a parent uses to discipline their child with ASD. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships. In addition, teaching positive parenting techniques to parents of children with ASD may be an important component to behavioral sleep treatment so that both child sleep and disciplinary strategies are targeted.

Support (If Any)

United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA W81XWH2010399).
0494 The Associations Between Insomnia Symptoms and Emotional Regulation Among Typically Developing Adolescents during the COVID-19 Pandemic
Authors: Scholes Samantha , Somerville Gail , Saha Sujata , Tobia Jessica , Piccireli Mikaela , Barnard Sophia , Patel Krupali , Gruber Reut
Published: May 2022

Introduction

A high prevalence of sleep disturbances was observed in adolescents during the coronavirus disease (COVID-19) pandemic. This has been interpreted as being related to disruptions in daily routines and social life caused by pandemic-related societal restrictions. Although the COVID-19 pandemic interrupted the routines of all adolescents, not all adolescents developed insomnia in response to pandemic-related changes. A reduced ability to regulate negative emotions is associated with a higher risk of developing insomnia, yet it is not known if it is associated with higher levels of insomnia in adolescents. Cognitive reappraisal, which consists of changing the way one thinks about potentially emotion-inducing events, is effective in downregulating negative emotion. Expressive suppression, which is changing the way one behaviorally responds to emotion-eliciting events, can decrease a positive emotional experience but does not alter the experience of negative emotion. The objective of this study was to examine the associations between insomnia symptoms in typically developing adolescents during the COVID-19 pandemic and the tendency to use cognitive reappraisal or expressive suppression to regulate emotions. It was hypothesized that high levels of insomnia symptoms among adolescents during the COVID-19 pandemic would be associated with more frequent use of expressive suppression and less frequent use of cognitive reappraisal when regulating emotions.

Methods

49 adolescents aged 11-16 (M= 13.43, SD= 1.67) participated in the study during the first wave of the COVID-19 pandemic in Canada (May 15 to June 30, 2020). The Insomnia Severity Index (ISI) was used to assess the severity of nighttime and daytime components of insomnia. The Emotion Regulation Questionnaire was used to assess respondents' tendencies to regulate their emotions using cognitive reappraisal or expressive suppression.

Results

Higher ISI total scores were significantly associated with lower reappraisal scores on the Emotion Regulation Questionnaire.

Conclusion

A higher level of insomnia symptoms among typically developing adolescents during the COVID-19 pandemic was associated with less frequent use of emotional regulation strategy that is effective in downregulating negative emotion. Limitations: Given the cross-sectional design of the study, it is not possible to determine causality.

Support (If Any)

CIHR 418638 to Reut GruberRGPIN-2015-04467 to Reut Gruber
0506 Clinical efficacy of intravenous ferric carboxymaltose for restless legs symptoms and low serum ferritin in children with autism spectrum disorder
Authors: DelRosso Lourdes , Cho Yeilim , Ferri Raffaele , Krell Melissa , Reuter-Yuill Lilith , Mogavero Maria , Picchietti Daniel
Published: May 2022

Introduction

Restless legs syndrome (RLS) may be underdiagnosed in children with autism spectrum disorder (ASD) due to difficulty expressing the symptoms in their own words. In addition, administration of oral iron may be particularly difficult in ASD children.

Methods

Retrospective case series of children with ASD, restless legs (RL) symptoms, and serum ferritin <30 μg/L treated with intravenous (IV) ferric carboxymaltose (FCM). Patients received a single dose of IV FCM, 15 mg/kg if weighting <50 kg or 750 mg if weighting >50 kg. Data collected included presenting symptoms, serum ferritin, iron profile, and Clinical Global Impression Scale (CGI-Severity pre-infusion and CGI-Improvement post-infusion).

Results

Nineteen subjects, 4-11 years old (12 male, median age 6, interquartile range (IQR) were included. Thirteen children took melatonin, median dose 3 mg (IQR 1-6). Full RLS diagnostic criteria were identified in 6 verbal children (31.6%). RL symptoms in the 13 other children occurred at night and began or worsened during periods of rest or inactivity and included: need for a parent to rub or massage legs (5), fidgeting (2), wiggling (2), kicking (2), pacing (1), and discomfort (1), but improvement of symptoms with movement was difficult to determine. Baseline median values were ferritin 10 µg/L (IQR 10-16), iron 66.5 μg/dL (IQR 57-96), TIBC 382 μg/dL (IQR 360-411) and transferrin 19 mg/dL (IQR 14-28). Median CGI-S was 4 (moderate symptoms) (IQR 3-4). After IV FCM all measures improved and were statistically significant at the Wilcoxon test for paired datasets. Median ferritin was 68 µg/L (IQR 62.5-109, p<0.00045). The median CGI-I was 1 (very much improved) (IQR 1-2). All children meeting full RLS criteria improved. Three children in the RL symptom group did not improve. Children meeting the full RLS criteria had lower baseline ferritin levels than those with a suspected diagnosis (9 µg/L, IQR 9-10 vs. 13 µg/L, IQR 10-16, Mann-Whitney test p<0.045).

Conclusion

The majority of children (84.2%) with ASD and RL symptoms had clinical improvement after IV FCM. All serum iron parameters improved significantly after a single IV infusion.

Support (If Any)

None