bluuebunny/crossref_metadata_2025 huggingface dataset:
632 Family History of Children Diagnosed with Obstructive Sleep Apnea
Authors: Porterfield-Pruss Kristi , Willis Denise , Spray Beverly , Jambhekar Supriya
Published: May 2021

Introduction

Limited evidence suggests a familial association of OSA. It is not known how often children who require positive airway pressure (PAP) devices have a family member with OSA or that requires PAP. It is felt that PAP adherence in children is affected by PAP adherence in parents. We wanted to explore the relationship of OSA in children requiring PAP to OSA in immediate family members as well as the association of obesity and adherence between children and family members.

Methods

Caregivers of children who utilize PAP devices at home were invited to complete an electronic questionnaire regarding family history of OSA. Descriptive statistics were utilized to summarize results.

Results

The study was completed by 75 participants. The majority of children were male (64%, 48/75), black (47%, 35/75) and non-Hispanic (88%, 66/75). The mean age was 11.8 years (median 13) and mean BMI was 32.8 (median 29.8). The mean AHI on the diagnostic polysomnogram was 28.4 events per hour (median 15.3). Mean adherence to PAP > 4 hours per night was 56.5 (Median 68.2). Most, 87% (65/75), have other underlying medical problems. Twenty-four percent (18/75) have a biological father with OSA of whom 61% (11/18) are considered moderately/extremely obese. Of mothers, 13% (10/75) have OSA and 70% (7/10) are obese. Overall, 29% (22/75) had either a paternal (11%, 8/75) or maternal (19%, 14/75) grandfather with OSA of which 36% (8/22) are obese. For grandmothers, 31% (23/75) have OSA and 22% (5/23) are obese with more being paternal (19%, 14/75) compared to maternal (12%, 9/75). Of the 73 total family members reported to have OSA, 86% (63/73) use PAP and most (65%, 41/63) use it for > 4 hours every night. Few participants had siblings with OSA.

Conclusion

There were more fathers with OSA than mothers, but mothers were reported to be obese more often. Grandparents were reported to have OSA but were reported to be obese less often than parents. Maternal grandparents with OSA were reported to be obese more than paternal grandparents. The majority of family members with OSA who use CPAP report nightly use.

Support (if any):
638 Sleep and circadian markers of BMI in a diverse sample of 9-year old children from the Fragile Families Child and Wellbeing Study
Authors: Chung Alicia , Moore Jesse , Jin Peng , Nunes Joao , Jean-Louis Giardin , Seixas Azizi
Published: May 2021

Introduction

Hispanic and Black school-age children from low-income communities experience disproportionate rates of obesity (26% Hispanic, 22% Black) compared to their White counterparts (14%). Sleep patterns and circadian regulation of biological markers are associated with BMI status. However, little is known about racial and ethnic disparities in circadian regulation among children of color. These suggest that it is important to investigate biological markers that could help delineate associations between sleep-circadian regulation and obesity among children of color. Serotonin transporter gene, a neurotransmitter associated with circadian rhythm regulation, has emerged as an important biological variable. In this study, we investigated whether this factor could serve as a proxy for studying associations of circadian rhythm regulation with weight status in this diverse sample.

Methods

Statistical analysis included descriptive and linear regression analysis of the wave 5, Year 9 cohort of the Fragile Families Child and Wellbeing Study dataset. Interviews were conducted with the participant child around their ninth birthday for data collection on home routines and other parent relationship and school connectedness variables. Biological variables were derived from saliva samples at Year 9 to assess telomere length and DNA methylation levels and changes. Variables of interest included sleep duration, sleep timing, and biological variables 5httlpr (insomnia and sleep quality), skin 2 (serotonin transporter), telomere length (stress) and rs9939609 (fat mass and obesity), with BMI as the outcome.

Results

The final sample of 466 children comprised 52% male were 9 years old. Participants’ race was: 35% White, 46% Black, 20% Hispanic, 4% Asian and 5% other. Median family income was $42,500. Sleep duration obtained from these children was negatively associated with BMI (β = -0.245 with p=0.022). We found that gk5stin212 (serotonin transporter gene) was positively associated with BMI (β = 0.991, p = 0.009), while no significant associations was found for genetic variable gk5stin210.

Conclusion

Circadian rhythm dysregulation may serve as a biological mechanism driving overweight or obesity among minority children. Lifestyle and behavioral interventions aimed at the family unit may be needed to modify household and environmental factors that affect circadian regulation among children.

Support (if any)

NIH (T32HL129953), K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
641 The status of life satisfaction and physical stress experience among children with sleep related issues: PROMIS approach
Authors: Xu Sarah , Miller Michael , Maddalozzo John , Issa Yazan , Bhushan Bharat
Published: May 2021

Introduction

To identify the status of health-related quality of life (HR-QoL) domains in children with sleep disturbance.

Methods

Patients ages 5–17 years visiting sleep laboratory from 09/2019 to 01/2020 for overnight PSG participated in the study. Age and sex matched control participants were seen in general pediatrics during 02/2020 for issues other than sleep disturbance. HR-QoL was assessed by PROMIS V1.0 questionnaires. Statistical analysis was conducted using R 3.6.0.

Results

122 patients were included in the final analysis: 70 males (57.4%). Ninety nine (81.15%) patients were included from the sleep laboratory and 23 (18.85%) controls were recruited from the department of pediatrics. Among the patients visiting sleep laboratory, thirty one (25.4%) had mild OSA, 12 (9.8%) moderate OSA, 19 (15.6%) severe OSA, 37 (30.3%) were diagnosed with No-OSA. Twenty three (18.9%) controls were visiting to the hospital for their routine wellness examination requiring no PSG. Severity of OSA was not correlated with any HR-QoL domain. Patients visiting the sleep laboratory had lower life satisfaction (p=0.05) and higher physical stress experience (p=0.005). Age, BMI were negatively and N3 sleep was positively associated with family relations (p<0.001, 0.03, 0.006, respectively). N3 sleep was positively and age was negatively associated with life satisfaction (p<0.001, p=0.003, respectively). Increase in arousals was associated with increased physical stress experience (p=0.03). N3 sleep and anger were negatively associated with each other (p=0.05).

Conclusion

Children visiting sleep laboratory had higher physical stress experience and lower life satisfaction as compared to controls. Deep sleep was associated with problems with family relations, life satisfaction and anger. Regression analysis suggested that age was negatively associated with family relations and life satisfaction.

Support (if any)

None
646 The Impact of the COVID-19 Pandemic on Nighttime Room Entries and Sleep Disruptions for Pediatric Patients
Authors: Riehm Joseph , Arora Vineet , Tatineni Swetha , Erondu Amarachi , Mozer Christine , Cook David , Byron Maxx , Mordell Lisa , Ye Fanheng , Orlov Nicola
Published: May 2021

Introduction

Sleep is critical to children’s health and recovery, but pediatric inpatient sleep is often disrupted by nonessential overnight interruptions. The COVID-19 pandemic necessitated social distancing policies which minimized contact with low-risk patients. These policies have the potential to decrease overnight disruptions and improve sleep for hospitalized patients.

Methods

This cohort study compared sleep disruptions for pediatric inpatients admitted prior to (Sep 2018 – Feb 2020) and during (Apr 2020 – Aug 2020) the COVID-19 pandemic at a single site, urban academic medical center. Objective disruptions were measured as room entries detected by hand hygiene sensors for occupied rooms pre-pandemic (n_average=56) and during the pandemic (n_average=48) for 69 and 154 nights, respectively. Subjective reports of overnight disruptions, sleep quantity, and caregiver mood were measured by surveys adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale. Caregivers of a convenience sample of pediatric general medicine inpatients completed surveys. Caregivers pre-pandemic were surveyed in person, and during the pandemic, surveys were conducted over the phone.

Results

293 pre-pandemic (age_patients=4.1±4.4 years) and 154 pandemic (age_patients=8.7±5.6 years) surveys were collected from caregivers. The majority (71% pre-pandemic and 52% pandemic) of the study population identified as Black/African American. Nighttime room entries initially decreased 36% (95% CI: 30%, 42%, p<0.001), then returned towards pre-pandemic levels as the COVID-19 hospital caseload decreased. Despite this, caregivers reported more disrupted patient sleep (p<0.001) due to tests (21% vs. 38%) as well as stress (30% vs. 49%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 minutes less (95% CI: 12 min, 110 min, p<0.001) and had more awakenings. Caregivers self-reported feeling more sad and weary, less calm, and worse overall (p<0.001 for all).

Conclusion

Despite fewer objective room entries, caregivers reported increased sleep disruptions and an hour less nighttime sleep with more awakenings during the pandemic for pediatric patients. Caregivers also self-reported worse mood. This highlights the importance of addressing subjective perceptions and experiences of hospitalized children and their caregivers during hospitalization.

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649 Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic
Authors: Tracy Eunjin , Chin Brian , Matthew Lehrer H , Carroll Lucas , Buysse Daniel , Hall Martica
Published: May 2021

Introduction

The COVID-19 pandemic is an enormous stressor that can impact various dimensions of health, including sleep health. Older adults may be particularly vulnerable. Coping strategies to manage stress can also impact health outcomes by modifying the relationships between perceived stress and health outcomes. This study examined concurrent and longitudinal associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether coping strategies moderate these associations.

Methods

Older adults (n = 115; Mage = 68.62, 58.3% female) reported perceived stress (PSS), coping strategies (Brief COPE), global sleep quality (PSQI global sleep quality score and dichotomous good/poor sleep quality), depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12) before and during the COVID-19 pandemic.

Results

The number of individuals with poor sleep quality was greater during the COVID-19 pandemic than before (50% vs. 36.5%). Participants also reported poorer physical health during the COVID-19 pandemic than before. Hierarchical linear regression and hierarchical logistic regression revealed that higher perceived stress was cross-sectionally associated with poorer sleep (e.g., higher total PSQI score and dichotomous sleep quality category). Higher perceived stress was associated with worse depressive symptoms and global mental health concurrently and longitudinally. Coping strategies moderated the relationships between perceived stress and physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health for those who have lower problem-focused coping—but not for those with higher problem-focused coping—both concurrently and longitudinally.

Conclusion

Perceived stress influences cross-sectional and longitudinal measures of sleep health and general health among older adults during the COVID-19 pandemic. Coping strategies can moderate the effects of perceived stress on health outcomes. Older adults may benefit from prevention and intervention strategies targeting stress management and problem-focused coping strategies.

Support (if any)

This research was supported by the National Institute of Aging (R01AG047139), the National Heart, Lung, and Blood Institute (T32HL007560; T32HL082610), and the National Institute of Mental Health (T32MH019986)
658 Adjusting Fire - Piloting an Online Sleep Class in a U.S. Air Force Population in Response to COVID-19 Patient Care Restrictions
Authors: Patience Marc , Estevez Burns Rosemary , Cassidy Daniel
Published: May 2021

Introduction

Sleep problems remain problematically prevalent among U.S. service members. In 2015 over 60% of sampled service members reported getting less than 7 hours of sleep per night, 31.4% getting 5 hours or less, and nearly 50% reported subthreshold insomnia symptoms on the Pittsburgh Sleep Quality Index. Ongoing COVID-19 service delivery restrictions necessitate a rapid shift to virtual health solutions and illuminate barriers to the delivery of sleep interventions. This process improvement pilot was a proof-of-concept during uncertain times.

Methods

From September to January 2020, 10 weekly 1-time, 60-min virtual sleep classes were held over Microsoft Teams. Interventions were consistent with Motivational Interviewing and Brief Behavioral Treatment for Insomnia. Participants completed the STOP BANG and Insomnia Severity Index (ISI) before each class, and accomplished the ISI again at a 2-week contact during which they rated progress toward problem resolution and were offered additional clinical services as-needed.

Results

Forty-six participants attended the class. 67% responded to the post-class survey. 74% responded to the two-week follow-up. A majority (84%) indicated either agreement or strong agreement with the statement ’I plan to CHANGE a behavior or TRY an intervention I learned to better my sleep’, and many proceeded to establish a more consistent sleep schedule (n=14; 45%), remove electronics from the bedroom (n=13; 42%), and/or go to bed only when sleepy (n=11; 35%). 84% would recommend this class to others with similar concerns. Scaled from 1 (‘no change’) to 10 (‘full resolution’), participants reported having derived modest benefit from the intervention (M = 4.1, SD=1.7). Eleven (35%) denied need for additional sleep-related services, and 84% expressed intent to recommend the class to others with similar concerns.

Conclusion

Results suggest a military population is receptive to a 1-time, virtual sleep class consistent with social distancing strictures. This service provided patients rapid access to care while contemporaneously reducing demand for time-intensive one-to-one appointments. As hypothesized, receipt of the intervention was associated with intention to modify sleep-relevant behavior, and with meaningful progress toward resolution of sleep difficulty as assessed at 2-week follow-up. Broadly disseminated, this intervention could introduce an internet-based, stepped-care approach to management of sleep insufficiency across the DoD.

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661 Chronotype, Mood, and Diabetes-Related Distress in Adults with Type 2 Diabetes
Authors: Jeon Bomin , Chasens Eileen
Published: May 2021

Introduction

Chronotype refers to an individual’s preferred timing of sleep and wakefulness, which can be classified as ‘normal’ or ‘late’ chronotypes. The purpose of this study was to examine whether late sleep timing was associated with impaired mood and diabetes-related distress in persons with type 2 diabetes (T2D).

Methods

The study is a secondary analysis of pooled cross-sectional baseline data from two studies of treatment of obstructive sleep apnea (R01-DK96028) and insomnia (K24-NR016685) in persons with T2D. Sleep timing was measured by the bedtime from a 7-day sleep diary. “Normal” sleep timing was defined as bedtime between 9PM to 12AM ≥ 85% per week. “Late” sleep timing as bedtime after 12AM with normal sleep timing < 85% per week. Other sleep variables evaluated were sleep duration, daytime sleepiness (Epworth Sleepiness Scale [ESS]), and OSA severity (apnea-hypopnea index [AHI]). The Profiles of Mood States measured Total Mood Disturbance (TMD) and the subscales of Tension-Anxiety (T-A), Depression-Dejection (D-D), Anger-Hostility (A-H), Vigor-Activity (V-A), Fatigue-Inertia (F-I), and Confusion-Bewilderment (C-B). Diabetes-related distress was measured by the Problem Areas in Diabetes (PAID). Hierarchical multiple regression was performed to determine whether sleep timing was associated with mood and diabetes-related distress.

Results

The sample (N=296) had 61% with late sleep timing (n=181). Persons with normal vs late sleep timing were similar in age, sex, race, and education (p >.05). Persons with late sleep timing were less likely to be partnered, had shorter sleep duration and greater mood impairment (TMD and T-A, D-D, A-H, C-B subscales) than those with normal timing (all p values <.05); there was no significant difference by sleep timing in PAID scores (p=.256). Hierarchical regression analyses adjusting for demographics (age, sex, race, marital status, education level), clinical (HbA1c, BMI), and sleep variables (sleep duration, ESS, AHI) revealed that late sleep timing was not significantly associated with impaired mood (TMD and subscales) or PAID. However, ESS was statistically significant in predicting greater TMD (β=.310, p <.001), mood subscales (all p-values <.05) and PAID (β =.222, p <.001).

Conclusion

Daytime sleepiness, not late sleep timing, is a significant sleep-related symptom for increased mood impairment and diabetes-related distress in persons with T2D.

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667 Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: A pilot study
Authors: Reutrakul Sirimon , Martyn-Nemeth Pamela , Quinn Laurie , Danielson Kirstie , Rydzon Brett , Baron Kelly , Duffecy Jennifer
Published: May 2021

Introduction

Experimental and epidemiological data have linked insufficient sleep to increased diabetes risk. Women with a history of gestational diabetes (GDM) have a 7-fold greater risk of developing type 2 diabetes. This pilot study explored the feasibility of a sleep extension intervention in women with a history of GDM and short sleep, and the effects on glucose metabolism.

Methods

Women age 18–45 years with a history of GDM (at least 1 year postpartum) and actigraphy confirmed short sleep duration (<7h/night) on weekdays were randomized at a ratio of 1 control (healthy living information) to 2 cases (6 weeks of “Sleep Extend” intervention: use of a Fitbit, weekly digital content, interactive tools, and coach delivered feedback in order to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording and questionnaires were obtained at baseline and 6 weeks (at the end of the intervention).

Results

Twelve women (mean (SD) age 40.3 (4.5) years) participated (n=8 Sleep Extend, n=4 control). Compared to baseline, nightly sleep duration increased in Sleep Extend group (+30.6 (48.8) minutes) but decreased in the control group (-6.8 (22.9) minutes). Both fasting and 2-h glucose levels from OGTT increased in both groups but were greater in the control group (Sleep extend vs. healthy living: fasting glucose +2.1 (9.8) vs. +12.8 (7.3) mg/dL; 2-h glucose +8.2 (21.9) vs. +20.0 (19.4) mg/dL). Self-reported sleep quality improved in both groups. When compared controls, Sleep Extend participants reported improved fatigue symptoms (Promis fatigue score change -5.1 (9.3) vs. 7.0 (1.0), p=0.008), and self-reported physical activity tended to increase (+1614 (3659) vs. -2900 (3922) MET-minutes/week). Combining all participants, an increase in sleep duration correlated with a decrease in fatigue (r= -.62, p=0.04) and anxiety symptoms (r= -.69, p=0.02).

Conclusion

Sleep extension through coaching and use of remote monitoring is feasible in women with a history of GDM. It appears to decrease fatigue and may improve glucose metabolism and physical activity.

Support (if any)

NIDDK P30 DK092949
672 COVID-19 Anxiety and Sleep in Middle-aged and Older Adults: Impact of Age and Sex
Authors: Jagannathan Sadhika , Rodgers Mikayla , McCrae Christina S , Miller Mary Beth , Curtis Ashley
Published: May 2021

Introduction

COVID-19 is an infectious respiratory illness that was declared a pandemic in March 2020. During the course of COVID-19, studies have demonstrated worsening sleep quality and anxiety. No studies have examined age-related and sex-specific associations between COVID-19 anxiety and sleep in aging populations. We examined associations between COVID-19 anxiety and sleep, and evaluated age and sex as moderators, in middle-aged/older adults.

Methods

Two hundred and seventy-seven middle-aged/older adults aged 50+ (Mage=64.68, SD=7.83; 44% women) living in the United States who were cognitively healthy (no cognitive impairment/dementia/neurological disorders) completed an online Qualtrics survey in July/August 2020 measuring sleep (Pittsburgh Sleep Quality Index; PSQI) and COVID-19 anxiety (Coronavirus Anxiety Scale; CAS). Multiple regressions examined whether CAS was independently associated with or interacted with age or sex in its associations with PSQI total score/subscores (sleep quality, sleep duration, sleep efficiency, daytime dysfunction), controlling for age, education, number of medical conditions, sleep/pain medication use, and COVID-19 status.

Results

CAS interacted with age (B=-.008, SE=.003 p=.02, R-squared=.02), not sex (p=.31), in its association with sleep duration. Higher CAS was associated with shorter sleep duration in oldest-older adults (~73 years old; B=.12, SE=.05, p=.01) and younger-older adults (~65 years old; B=.07, SE=.03, p=.02), not middle-aged adults (~57 years old, p=.47). CAS interacted with age (B=.01, SE=.004, p=.02), not sex (p=.56), in its association with sleep efficiency. Higher CAS was associated with worse sleep efficiency in oldest-older adults (B=.14, SE=.05, p=.009) and younger-older adults (B=.08, SE=.04, p=.03), not middle-aged adults (p=.60). Higher CAS was associated with greater daytime dysfunction (B=.26, SE=.07, p<.001) and higher PSQI total score (B=.82, SE=.33, p=.01), and did not interact with age or sex (ps>.05).

Conclusion

Increased COVID-19 anxiety is associated with several aspects of worse sleep (shorter sleep duration, sleep efficiency) in older adults but not middle-aged adults. Generally, in middle-aged/older adults, higher COVID-19 anxiety is associated with worse daytime dysfunction and overall sleep quality. Sex does not moderate these associations. Increased COVID-19 morbidity and mortality in aging populations may translate to increased anxiety and subsequent sleep disruptions. Interventions aimed at mitigating negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults.

Support (if any):
674 Changes in Objectively-Measured Adolescent Sleep and Light Exposure During the COVID-19 Pandemic
Authors: Simon Stacey , Vetter Celine , Hunt Larissa , Bowen Anne , Rynders Corey , Higgins Janine , Melanson Edward , Nadeau Kristen , Wright Kenneth
Published: May 2021

Introduction

U.S. adolescents have high rates of insufficient sleep. School closures and stay-at-home orders were implemented to mitigate disease spread during the Coronavirus 2019 (COVID-19) pandemic. Without the restriction of imposed early school start times, we hypothesized that adolescents would have longer, later, and less variable sleep compared to pre-COVID-19. We further hypothesized these changes would be associated with increased and later light exposure.

Methods

High school students age 14–19 years with <7h sleep on school nights completed two weeks of at-home monitoring. The Pre-COVID-19 week took place between October 2018-February 2020 and the COVID-19 week occurred in May 2020 during state-wide stay-at-home orders. Participants wore an accelerometer to assess sleep and light exposure while completing a concurrent sleep log. Paired-samples t-tests examined differences in sleep and light between Pre-COVID-19 and COVID-19. Pearson correlations assessed associations between change in sleep and change in light.

Results

Participants (N=16) were 16.5 ±1.2-years-old at Pre-COVID-19, 70.6% female, 68.8% White, and 25.1% Hispanic. Youth were participating in online learning due to in-person school closures and only 2 participants (14.3%) had a set start time, while the remainder reported learning per their own schedule. Youth obtained approximately one hour more weekday sleep per night during the COVID-19 week compared to Pre-COVID-19 (p<0.001). Bed and waketimes were significantly delayed on weekdays and weekends during COVID-19 compared to Pre-COVID-19 (p< 0.01). The greatest change was a delay in weekday waketime of 2.9□0.9h (p<0.001). Social jetlag during COVID-19 was reduced by 1/3 compared to Pre-COVID-19 (p=0.02). Average 24h lux levels were 2.5x higher during the COVID-19 week compared to Pre- COVID-19 (p=0.008). Change in average lux and timing of light were not significantly associated with change in sleep duration or timing.

Conclusion

An unintended effect of the switch to online learning may have been affording adolescents the opportunity to obtain longer and more regular sleep. Understanding the impact of these changed sleep behaviors on daytime functioning, academic performance, and health outcomes is particularly urgent as schools plan for the remainder of the academic year and eventual return to in-person learning.

Support (if any)

K23DK117021 to SLS
676 Age is only a number: Treatment modality preferences in a randomized controlled trial of CBTI in older adults
Authors: Simpson Norah , Tully Isabelle , Dietch Jessica , Tutek Joshua , Manber Rachel
Published: May 2021

Introduction

Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed.

Methods

Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods.

Results

Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s >.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s<.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s<. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s <.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003).

Conclusion

These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults.

Support (if any)

1R01AG057500
677 Impact of Remote Continuous Positive Airway Pressure Set-up on Treatment Usage and Effectiveness
Authors: Donovan Lucas , Parsons Elizabeth , Epler Eric , McCall Catherine , He Ken , Sharma Rahul , Duan Kevin , Spece Laura , Feemster Laura , Kapur Vishesh , Au David , Palen Brian
Published: May 2021

Introduction

Initiating treatment with continuous positive airway pressure (CPAP) traditionally relies on in-person visits with trained therapists to provide hands-on instruction regarding CPAP usage and mask fit. To overcome geographic barriers and reduce COVID-19 transmission, health systems increasingly rely on remote set-ups of mailed equipment. Despite a strong rationale for the mailed approach, relative effectiveness is unclear.

Methods

Our VA medical center shifted from in-person to mailed CPAP dispensation during the COVID-19 pandemic in March 2020. Using VA administrative and wireless CPAP usage data, we assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP for the first time from July 2019 to August 2020. Our primary outcome was mean nightly usage over the first 90 days. We compared patients with in-person vs. mailed CPAP dispensation using generalized linear models adjusted for age, gender, race, and Charlson Comorbidity Index. Among patients with >1 hour of overall usage, we compared secondary outcomes of leak, apnea hypopnea index (AHI), and obstructive/central apnea indices.

Results

We identified 693 patients with newly diagnosed OSA whose CPAP was provided in-person and 296 who had CPAP mailed. Nightly usage in the first 90 days was modest in both groups (in-person: 149.7, mailed: 152.9 min/night), and we did not detect a difference in adjusted models (+7.6 min/night, 95%CI -13.6–28.8). We also did not detect a difference in 95th percentile leak (-1.2 liter/minute, 95%CI -3.3-0.9). Device-detected AHI was relatively low overall (in-person: 3.2, mailed: 4.1 events/hour), but was greater in the mailout group (+1.0/hour, 95%CI 0.2–1.7). AHI differences appeared to be driven by obstructive (+0.5/hour, 95%CI 0.2–0.8) but not central events (-0.1, 95% CI -0.2–0.4). Risk of AHI>5 was comparable between groups (in-person: 17.3%, mailed: 19.0%, OR 1.2, 95%CI 0.8–1.7).

Conclusion

We were able to switch from an in-person to a mail-based system of CPAP initiation without a change in CPAP adherence or mask leak. While AHI was slightly greater in the mailed group, the clinical significance of this finding is unclear. Future work will need to evaluate the impact of remote CPAP dispensation on patient-centered outcomes.

Support (if any)

VA Health Services Research and Development, CDA 18–187
679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis
Authors: Sun Yishi , Laksono Isabelle , Selvanathan Janannii , Saripella Aparna , Nagappa Mahesh , Pham Chi , Englesakis Marina , Peng Philip , Morin Charles , Chung Frances
Published: May 2021

Introduction

In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI).

Methods

Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain >3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of > 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores.

Results

The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p < 0.05).

Conclusion

In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain.

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682 How doctors sleep during the COVID-19 pandemic: A survey
Authors: Khara Nimit
Published: May 2021

Introduction

Sleep deprivation is known amongst doctors (working hours of doctors in developing countries are long and not tightly regulated) and the COVID-19 pandemic may make it worse. We conducted this survey to assess the quantitative and qualitative effects of this pandemic on the sleep of doctors.

Methods

A survey was created on Google Forms and it was circulated / sent through WhatsApp for voluntary participation amongst several groups of doctors and individually as well.

Results

We received 304 responses from doctors of various specialties, cadres and background. Our results showed that 52% of them were involved in direct clinical care of COVID-19 patients. 55.8% doctors reported changes in sleep pattern and 37.2% reported reduced duration of sleep, as compared to the time before the pandemic. More than 50% of them slept for less than 7 hours a night since the beginning of the pandemic. 37% had difficulty falling asleep and maintaining sleep. 30% had difficulty in concentration and functioning during day-time. Non-refreshing sleep was experienced by 36.3% of them and 18.8% of physicians had recollected having COVID-19 related dreams. 33% doctors’ last thought before sleep and first thought after waking up were about COVID-19. 36% doctors looked for information about COVID-19 on media immediately before going to sleep and immediately after waking up. More than 60% doctors started meditation, exercise, yoga or relaxation techniques for getting better sleep.

Conclusion

A further decline in duration and quality of sleep due to the COVID-19 pandemic amongst already sleep-deprived doctors may be detrimental not only to their own health but for patient-care also.

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685 Sleep Latency, Pre and Peri-COVID-19 Experiences and PTSD Symptoms: Results from the NYU COVID-19 Mental Health Study
Authors: Rogers April , Blanc Judite , Seixas Azizi , Nunes Joao , Casimir Georges , Jean-Louis Giardin
Published: May 2021

Introduction

An effective response to the COVID-19 pandemic has been the decision to subject individuals residing in New York City to quarantine rules in order to reduce the spread of the virus. As might have been expected, restriction of usual daily activities would affect individuals’ sleep-wake patterns. It is also known that exposure to traumatic experiences can also engender sleep disturbances, most notably in their ability to initiate sleep. This study investigated the associations between sleep onset latency (SOL), pre and peri-COVID-19 exposure and symptoms of posttraumatic stress disorder (PTSD) among New Yorkers.

Methods

541 individuals (female = 373(69%); mean age=40.9) were recruited during the summer and fall of 2020 in New York City to participate in the NYU-COVID-19 Mental Health Study. Participants provided sociodemographic data and were also asked to respond to the COVID-19 quarantine experiences, comprised of seven binary questions, the PTSD Checklist-PCL-5, and the Pittsburg Sleep Quality Index. Descriptive and linear regression analysis were performed to explore associations of scores on the COVID-19 quarantine experience with PTSD and sleep data. All analyses were performed using SPSS 25.0

Results

Regression analyses revealed that SOL emerged as the strongest independent predictor of PTSD symptoms [B(t) = −.630(12.7); p < .001]; factors adjusted in the model included pre and peri-covid-19 factors such as age, sex, job type, and quarantine experience. Analyses assessing potential interaction effect revealed that quarantine experience did not affect the relationship between SOL and PTSD [B(t) = .086(.831); p = >.005]. The other sleep factors in the model did not yield significance. sleep duration had a weak correlation with quarantine, it was not found to be a predictor of PTSD.

Conclusion

We observed that SOL was the most important determinant of PTSD symptoms among individuals exposed to COVID-19. This is consistent with other findings suggesting that a sizable proportion of individuals exposed to pandemics are likely to experience sleep disturbances. It is plausible that quarantine might lead to increased daytime naps, which may impact SOL. Further research is needed to better understand the association of SOL and PTSD as a result of Covid-19.

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K07AG052685, R01MD007716, R01HL142066, T32HL129953, K01HL135452, R01HL152453
686 Sleep Education and Sleep Outcomes in the Time of Covid-19 in Mexico
Authors: Baldwin Carol , Gamiño Sergio Marquez , de la Cruz Carolina Cabrera , Quan Stuart
Published: May 2021

Introduction

This study examines computer-mediated sleep education for health providers enrolled in a certified diabetes educator program in November 2020 in Mexico.

Methods

Data derived from pre/post ratings assessed knowledge of obstructive sleep apnea (OSA), insomnia, restless legs syndrome (RLS), short sleep duration (SSD), circadian rhythm disorders (CRD), and drowsy driving (DD) on a 5-point Likert-like scale, and five true/false questions regarding misconceptions about sleep. Outcomes included self-reported sleep problems among providers since the onset of the March 2020 Covid-19 surge in Mexico. Pre/post means were compared with paired t-tests using SPSS (V25) with significance set at p<0.05.

Results

Volunteer participants (N=23; 83% women; 52% nutritionists; 48% health providers) were recruited from the fall semester 2020 diabetes educator certificate program. Means with standard deviations showed significant learning for all sleep disorders following the training (OSA: 3.1±1.0 to 4.4±0.78; Insomnia: 3.2±0.85 to 4.3±0.82; RLS: 2.1±1.2 to 4.2±0.95; SSD: 2.7 ±1.1 to 4.4±0.72; CRD: 2.6±1.2 to 4.4±0.73; DD: 2.6±1.1 to 4.4±0.78, all p<.0001). The total pre- to post-scores (Range=0 to 30) for sleep disorders moved from 16.3±5.7 to 26.3±4.4, p<.0001. Participants demonstrated improved, but borderline significant findings regarding misconceptions about sleep from pre-to post-testing, p=.07. Of the 23 respondents, 18 (78%) reported sleep problems specific to the onset of the Covid-19 pandemic in Mexico. Of the 18 providers, 13 reported insomnia symptoms, while five indicated short sleep due to double shift work, anxiety and depression, or poor sleep quality.

Conclusion

Participants (78%) reported sleep problems; particularly insomnia associated with anxiety, depression, poor sleep quality and extended shift work since the onset of the Covid-19 pandemic. Findings are consistent with global studies of Covid-19 and sleep of health care workers. Online participants’ significant learning for all sleep disorders was coherent with in-class learners (N=173). Pre-to-post analyses of misconceptions about sleep, particularly sleep needs for adults and that daytime sleep can make up for lack of nighttime sleep, however, were not significant for these learners compared to the in-class learning groups.

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N/A
694 Insufficient sleep linked with higher COVID-19 infection cases and deaths in the United States
Authors: Seixas Azizi , Pantaleo Nicholas , Adhikari Samrachana , Grandner Michael , Jean-Louis Giardin
Published: May 2021

Introduction

Causes of COVID-19 burden in urban, suburban, and rural counties are unclear, as early studies provide mixed results implicating high prevalence of pre-existing health risks and chronic diseases. However, poor sleep health that has been linked to infection-based pandemics may provide additional insight for place-based burden. To address this gap, we investigated the relationship between habitual insufficient sleep (sleep <7 hrs./24 hr. period) and COVID-19 cases and deaths across urban, suburban, and rural counties in the US.

Methods

County-level variables were obtained from the 2014–2018 American community survey five-year estimates and the Center for Disease Control and Prevention. These included percent with insufficient sleep, percent uninsured, percent obese, and social vulnerability index. County level COVID-19 infection and death data through September 12, 2020 were obtained from USA Facts. Cumulative COVID-19 infections and deaths for urban (n=68), suburban (n=740), and rural (n=2331) counties were modeled using separate negative binomial mixed effects regression models with logarithmic link and random state-level intercepts. Zero-inflated models were considered for deaths among suburban and rural counties to account for excess zeros.

Results

Multivariate regression models indicated positive associations between cumulative COVID-19 infection rates and insufficient sleep in urban, suburban and rural counties. The incidence rate ratio (IRR) for urban counties was 1.03 (95% CI: 1.01 – 1.05), 1.04 (95% CI: 1.02 – 1.05) for suburban, and 1.02 (95% CI: 1.00 – 1.03) rural counties.. Similar positive associations were observed with county-level COVID-19 death rates, IRR = 1.11 (95% CI: 1.07 – 1.16) for urban counties, IRR = 1.04 (95% CI: 1.01 – 1.06) for suburban counties, and IRR = 1.03 (95% CI: 1.01 – 1.05) for rural counties. Level of urbanicity moderated the association between insufficient sleep and COVID deaths, but not for the association between insufficient sleep and COVID infection rates.

Conclusion

Insufficient sleep was associated with COVID-19 infection cases and mortality rates in urban, suburban and rural counties. Level of urbanicity only moderated the relationship between insufficient sleep and COVID death rates. Future studies should investigate individual-level analysis to understand the role of sleep mitigating COVID-19 infection and death rates.

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NIH (K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
697 Sleep Quality After COVID-19 Infection
Authors: Hackett Benjamin , Badami Varun , Sharma Sunil , Stansbury Robert
Published: May 2021

Introduction

COVID-19 has proven to be a novel virus with significant complications to an expanding number of body systems. Hallmark characteristics of COVID-19 include substantial inflammatory response which has been linked to sleep dysregulation in previous studies. We examined the change in sleep quality after acute COVID-19 infections requiring hospitalization.

Methods

We performed a retrospective, single-center observational study of 20 patients with acute COVID-19 infection requiring hospitalization. Eligible patients were contacted and completed telephone surveys of the Pittsburgh Sleep Quality Index (PSQI) prior to and 1 month after hospital discharge. A score of ≥5 was indicative of poor sleep quality. Secondary data were collected from EMR.

Results

The mean PSQI prior to COVID-19 infection was 6.1, worsening to 10.3 one month after acute infection, denoting a delta-PSQI of 4.2 (p = 0.0004). There were noted statistically significant differences in certain components of the PSQI including: subjective sleep quality 0.8 to 1.7 (delta 0.9, p = 0.0003), sleep latency 1.25 to 1.85 (delta 0.6, p = 0.03), sleep disturbance 1.05 to 1.5 (delta 0.45, p = 0.0009), and daytime dysfunction 0.3 to 1.45 (delta 1.15, p = 0.0005). Sleep latency and daytime dysfunction accounted for the most change. Two groups declared themselves with 6 of the 20 patients having improvement/no change in PSQI, and 14 having worsening. Between these groups certain differences were seen including: Pre-infection PSQI 9.67 vs 4.57 (p = 0.009), delta global PSQI -0.83 vs 6.36 (p < 0.001), delta subjective sleep quality 0.17 vs 1.2 (p = 0.002), delta sleep latency -0.3 vs 1 (p = 0.01), delta sleep duration -0.3 vs 0.93 (p = 0.02), delta sleep efficiency -0.3 vs 0.71 (p = 0.02), and delta daytime dysfunction 0.17 vs 1.57 (p = 0.006).

Conclusion

In our study of patients hospitalized for COVID-19 infection specific components of sleep were different following infection. Sleep latency and daytime dysfunction contributed the most to PSQI change. Two groups declared themselves based on PSQI improvement vs worsening. Those with poor sleep prior to infection continued to have poor sleep, while those without prior sleep troubles developed worsened sleep quality.

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706 Sleep and Mental Health in College Students Before and During the Initial COVID-19 Shutdown
Authors: Okun Michele , Walden Allison , Feliciano Leilani
Published: May 2021

Introduction

The COVID-19 pandemic has had an unparalleled impact on college students. Following the initial and abrupt shutdown of campuses in March 2020, several investigators assessed the immediate effects on University students. Early reports found that college students reported a higher prevalence of anxiety and depression, sedentary behavior, and sleep problems. Most were conducted outside the U.S. Data from U.S. college students are critical to identify which areas are should receive resources and interventions as the U.S. continues to experience exponential COVID cases along with continued remote learning, social restrictions and/or lockdowns.

Methods

Students enrolled in the Spring 2020 semester (18 years of age +) were invited to participate in an online survey (April – May 2020). A final sample of 491 completed the entire survey (length ~45 minutes) which asked about sleep quality, psychological stress, depression, and exercise.Paired t-tests were conducted to compare pre-COVID and during COVID data.

Results

There were significant differences in sleep onset latency (26.44 ± 23.53 min vs 32.06 ± 26.88 min; t = -3.81, P < .001), sleep duration (7.30 ± 1.45 hours vs 7.63 ± 2.07 hours; t = -2.23, p = 0.027) and overall sleep quality (6.29 ± 3.29 vs 7.44 ± 3.86; t = -7.26, p < .001), as well as depression scores (IDS no sleep questions) (5.61 ± 4.18 vs 17.59 ± 5.45; t = -54.9, P < .001). There was no difference in perceived stress (28.03 ±5.27 vs 28.39 ±5.53, t = -1.49, p = .138). Exercise (vigorous, moderate and walking) all decreased with regards to days and time spent, (all P’s < .001), whereas minutes sitting significantly increased (426.50 ± 239.88 vs 542.26 ± 249.63, p < .001).

Conclusion

These data empirically support the claim that the pandemic is having a significant negative impact on physical and mental health among college students. In the best of times, college students have irregular sleep patterns and significant depression, but these behaviors are worsened under government restrictions. These findings underscore the need to prioritize prevention and intervention of modifiable behaviors, especially if the pandemic extends into 2021.

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