bluuebunny/crossref_metadata_2025 huggingface dataset:
0907 Sleep Disturbances in Lung Cancer Patients Based on Patient Reported Outcomes and Polysomnography
Authors: Chan Kathy , Kaous Maryam , Sargsyan Lilit , Balachandran Dave , Bashoura Lara , Sheshadri Ajay , Faiz Saadia
Published: April 2024

Introduction

Sleep disturbances are common in lung cancer patients, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) is lacking. Earlier studies described significant insomnia in this cohort. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders.

Methods

A retrospective review of lung cancer patients undergoing formal sleep evaluation from 4/1/2009 to 7/31/2014 was performed. Clinical characteristics, PROs using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and PSG data were reviewed.

Results

128 patients (58% men, median age 63 years, median BMI 29.9 kg/m2) were identified. Lung cancer stage was 40% early, 22% locally advanced and 38% metastatic disease, and most (48%) were undergoing active treatment. Comorbidities included hypertension (60%), COPD (42%), depression (16%) and anxiety (13%), and 59% were ever smokers. The majority (94%) were referred for sleep-related breathing disorder (SRBD). While 50% did not know when sleep disruption started in relation to their cancer, 33% report symptoms prior to cancer diagnosis, and 14% associate sleep disturbance after cancer diagnosis. Sleep aid use was reported by 26%, and pain medication use in 41%. In the 116 with ESS, daytime sleepiness was noted 56%. In the 101 with PSQI, 65% reported poor sleep. PSG was performed in 52%. Daytime sleepiness was inversely correlated with anxiety (OR 0.3, 95% CI 0.8 to 0.84). Poor sleep was associated with anxiety and COPD, but it was not significant. PROs did not have an impact on overall survival.

Conclusion

Sleep disturbances can contribute to symptom burden in lung cancer patients. Daytime sleepiness and poor sleep based on PROs was prevalent in our cohort. Although not significant, anxiety and COPD were associated with poor sleep, whereas daytime sleepiness was inversely associated with anxiety. Most of our patients had sleep-related breathing disorder while only a few had insomnia. Education about sleep health and proactive screening for sleep symptoms would be beneficial in lung cancer patients.

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0925 A Multilevel Time-lagged Mediation of Nightmare and PTSD Symptom Severity Across Time in a Combined Treatment
Authors: Paquet Caitlin , Rhudy Jamie , Davis Joanne
Published: April 2024

Introduction

This study sought to contribute to understanding the role of sleep disturbances as a potential hallmark of PTSD through examining the relationship between changes in post-trauma nightmare (PTNM) severity (nightmare frequency and distress) and symptoms of PTSD over time during a combined treatment for PTSD and PTNMs.

Methods

Individuals diagnosed with PTSD and having at least weekly nightmares (n = 84) were randomized into one of three treatment conditions: 12-session Cognitive Processing Therapy (CPT) only (n = 31), CPT followed by 5-session Exposure, Relaxation, and Rescripting Therapy (ERRT) condition (n = 29; CPT+ERRT), or ERRT followed by CPT (n = 24; ERRT+CPT). Multilevel time-lagged mediation models were analyzed to examine if nightmare severity (frequency and distress) measured at an earlier time point (t1; baseline, week 6, week 12) mediated the change in PTSD symptom severity at a later time point (t2; week 6, week 12, or week 17). The reverse relationship was also explored. An exploratory aim focused on examining if the order of treatment (CPT+ERRT or ERRT+CPT) moderated the mediated relationships.

Results

Across all three treatment conditions, there were statistically significant reductions in PTSD symptom and nightmare severity over time. In the unmoderated mediation models, there were no significant indirect effects detected. When treatment order was included as a moderator, there was a conditional effect of treatment order on the indirect effects of time on nightmare severity at t2 through PTSD symptom severity at t1. Only in the ERRT+CPT condition was there a statistically significant negative relationship of time on nightmare and PTSD symptom severity at t1 (ps < .05). Furthermore, only in the ERRT+CPT condition, there was a statistically significant negative relationship between nightmare severity at t1 and PTSD symptom severity at t2. Therefore, only in the ERRT+CPT condition did PTSD symptom severity at t1 mediate the relationship between time and nightmare severity at t2.

Conclusion

These results suggest that earlier increases in PTSD symptom severity are an important mediator of change for the improvement of nightmares specific to receiving ERRT first. Clinicians may glean insight from this study that can impact shared decision making with patients on treatment planning.

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0927 Shining Light on Nightmare Treatment: Expert Panel Recommendations for Cognitive Behavioral Therapy for Nightmares
Authors: Pruiksma Kristi , Miller Katherine , Davis Joanne , Taylor Daniel , Dietch Jessica , Gehrman Philip , Nadorff Michael , Brim William , Campbell Rebecca , Tyler Hannah , Price William , Peterson Alan
Published: April 2024

Introduction

Few providers are trained to deliver Cognitive Behavioral Therapy for Nightmares (CBT-N) despite the impact of nightmares on physical and mental health. Reduced access to treatment is partially due to limited training opportunities. Web-based training resources are valuable because they are easily accessible, are cost-efficient, and can be reviewed by providers as needed. This presentation describes the development, testing, and launch of a web-based provider training for CBT-N.

Methods

Nightmare, trauma, and sleep disorder experts collaborated to develop material for the web-based CBT-N training. Next, 17 providers tested a first draft of the web-site. After feedback was integrated, 50 providers were recruited to complete the updated draft of the website and will complete feedback in January 2024. To assess learning, providers completed multiple-choice questions before and after each of the 10 training modules. Item Response Theory (IRT) analyses were used to identify items of low discrimination and difficulty for further refinement.

Results

Overall, testers had positive reactions to the training content and website. The training content was improved by adding more figures, animations, and therapy demonstration videos and integrating more cultural considerations. Usability was improved by addressing bugs and enhancing intuitive site navigation. Based on IRT analyses of multiple-choice questions, 40 (out of a total 80) items were replaced and will be re-evaluated at the conclusion of beta testing.

Conclusion

Launching in June 2024, CBTnightmares.org is a comprehensive, engaging, and accessible training after two phases of development and feedback from almost 70 licensed providers. The final phase of testing, to be conducted in April 2024, will examine the equivalence of online training compared to a live virtual workshop (Target N = 100). Providers will complete questionnaires and a mock session with a standardized patient to examine therapist proficiency and fidelity. The hypotheses are that this web-based course will be equivalent to a live virtual workshop. This project directly addresses the dissemination and implementation cliff of empirically supported treatment for nightmares.

Support (if any)

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Review Medical Research Program under Award No. W81XWH-21-1-0576.
0935 Sleep Disturbances Correlate Significantly with PTSD and Emotional Exhaustion in Humanitarian Aid Workers
Authors: Jou Yuwen Cynthia , Pace-Schott Edward
Published: April 2024

Introduction

International humanitarian aid workers (iHAWs) are professionals often exposed to considerable stress and trauma while delivering humanitarian support to populations in distress. Many studies support the deleterious association between sleep disturbances, alcohol use, posttraumatic stress symptoms (PTSS), and emotional exhaustion (EE). Considering the lack of research on this topic among iHAWs, we conducted an exploratory study to examine relationships among the aforementioned variables in iHAWs.

Methods

One hundred participants reflected on their on-mission experiences retrospectively while completing the Pittsburgh Sleep Quality Index (PSQI), the PSQI addendum for PTSD (PSQI-A), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Maslach Burnout Inventory (MBI), and the quantity-frequency measure for alcohol. Questionnaire completion rates ranged from 33% to 55%. Stepwise regression models were used to analyze the association between two outcome variables, PCL-5 daytime symptoms and EE measured by the MBI, and predictor variables, alcohol use, and PSQI global, and PSQI-A scores. Spearman regressions were used to examine the association between aid worker career length and PSQI global score. False Discovery Rate was adopted to adjust for alpha inflation.

Results

Stepwise regression analyses indicated a significant association between PCL-5 daytime symptoms and PSQI global score after accounting for alcohol use (ΔR2 = 0.139, p = 0.039). Furthermore, PCL-5 daytime symptoms were significantly correlated with PSQI-A score after controlling for PSQI global score and alcohol use (ΔR2 = 0.320, p < 0.000). Additionally, EE was significantly correlated with PSQI after accounting for alcohol use (ΔR2 = 0.140, p = 0.034). Finally, based on Spearman regression, the aid-working career length was significantly associated with the PSQI component five, sleep disturbance (ρ = 0.451, p = 0.003).

Conclusion

Our results corroborate previous findings on the association between sleep disturbances, EE, and PTSS among populations such as first responders, medical professionals, and military personnel. Aid workers and their mental health could benefit from further attention among the research community, especially given the recent increase in conflicts worldwide. While the humanitarian community works on shifting mental health stigmas, sleep health optimization could be an interim step in encouraging iHAWs to seek care.

Support (if any)

R21MH128619
0936 Associations Between Sleep, Cognitive Flexibility, and Attention in Trauma-Exposed Veterans
Authors: Lanthier Malika , Tavakoli Paniz , Higginson Caitlin , Richard-Malenfant Claude , Leveille Chloe , Porteous Meggan , Kaminsky Zachary , Shlik Javok , Robillard Rebecca
Published: April 2024

Introduction

Post-traumatic stress disorder (PTSD) triggers disturbances in sleep such as prolonged sleep onset latency, decreased REM latency, higher amounts of REM sleep and lighter sleep. The impacts of these sleep difficulties on cognitive performance are clear. However, there is a limited understanding on how they may contribute to cognitive challenges that are affecting people living with PTSD. This study aimed to explore how attention and cognitive flexibility relate to sleep architecture in veterans with PTSD.

Methods

A group of thirty-six trauma-exposed veterans underwent psychiatric interviews, including the Clinician-Administered PTSD scale for DSM-5. Polysomnography was recorded on two nights: the first recording was used as an adaptation night and the second one was used for final analysis. On the morning following the experimental night, participants completed the Trail Making Test A and B, a task known to involve complex attention, visuospatial processing, working memory, and psychomotor coordination.

Results

Slower performance on the Trail Making Test A (i.e., attentional component of the task) correlated with longer sleep onset latency (r=.35, p=.037), higher amounts of light sleep (NREM1 and NREM2; r>.35, p<.037), and tended to correlate with longer REM sleep latency (r=.32, p=.056). In addition, non-significant trends suggested that higher number of errors committed on the Trail Making Test A were associated with longer sleep onset latency and higher amounts of NREM1 sleep (r=.30, p=.070). Slower performance on the Trail Making Test B (i.e., cognitive flexibility component of the task) tended to correlate with longer REM sleep latency (r=.33, p=.051) and lower sleep efficiency (r=-.31, p=.065).

Conclusion

These preliminary findings display some of the common abnormalities seen in people living with PTSD and how they relate to the severity of the cognitive challenges they are facing. Recognizing the active role of sleep for attentional processes and cognitive flexibility stresses the relevance of exploring whether sleep restoration may mitigate some of the debilitating symptoms of PTSD on cognition.

Support (if any)

This project was funded by a competitive grant from the Canadian National Defence (Innovation for Defence Excellence and Security (IDEaS)).
0943 Bidirectional Relationships Between Daily Sleep and Depression: How Does Shiftwork and Sleep Variability Factor In?
Authors: Kim Kelly , Taylor Daniel , Messman Brett , Dietch Jessica , Slavish Danica , Kelly Kimberly , Ruggero Camilo
Published: April 2024

Introduction

Prior research has established that sleep disturbances and depression are associated. However, notable limitations exist across past studies, including the heavy use of between-person analyses that are often based on single time point measures, use of general “sleep disturbance” over well-defined facets of sleep, overreliance on self-reported sleep, and lack of attention to within-person effects and their interactions with group-level characteristics (e.g., shiftwork). To address these limitations, the current study examined relationships between daily sleep facets and depression in nurses across measurements (self-report, actigraphy) and moderators (shiftwork, intraindividual variability of sleep midpoint).

Methods

Participants were 349 nurses (90.83% female; 76.50% White; 89.20% non-Latinx; Mage = 39.13 years) who wore an Actiwatch and completed the Consensus Sleep Diary and Patient Health Questionnaire-2 for 14 days. Multilevel models examined the bidirectional associations between daily depression and sleep (i.e., sleep efficiency [SE], quality [SQ], duration, midpoint) across self-report and actigraphy measures. Shiftwork (day vs. night shift worker) and intraindividual standard deviation (iSD) of sleep midpoint were included as moderators in models.

Results

Daily depression and subjective SQ and SE were bidirectionally associated after covarying for gender, age, race, and ethnicity. On days when nurses experienced higher depression than their average, they experienced worse subjective SQ (b = -0.10, SE = 0.02, p < .001) and SE (b = -0.47, SE = 0.18, p = .008) on the same day. In turn, when nurses experienced worse subjective SQ (b = -0.07, SE = 0.02, p < .001) and SE (b = -0.01, SE = 0.00, p = .012) than their average, they experienced higher depression on the next day. Daily actigraphy-based sleep facets were not significantly associated with depression. Neither shiftwork nor iSD of sleep midpoint were significant moderators.

Conclusion

Results reveal bidirectional, daily associations between subjective, but not actigraphy-based, sleep and depression. This suggests one's perception of sleep may be more influential on and impacted by depression than how one more objectively slept. Intensive longitudinal approaches to understanding sleep and depression should continue to be utilized to allow for the establishment of temporal precedence and bidirectionality across granular time scales.

Support (if any)

NIAID R01AI128359-01 (PIs: Taylor & Kelly)
0944 National Sleep Foundation’s 2024 Sleep in America Poll: Sleep Health and Depressive Symptoms in Teenagers
Authors: Dzierzewski Joseph , Nielson Spencer , Lopos John
Published: April 2024

Introduction

A mental health crisis has been recognized among US teenagers, highlighted by high rates of mood disturbances. While a well-documented connection exists between sleep and mood, evidence largely comes from convenience samples of adults. Much less is known about the link between sleep and mental health in teenagers and even less is known about this important connection among the general teenage population. The overarching goal of the present study was to examine the associations among sleep health and depressive symptoms in teenagers.

Methods

A random sample of 1,124 US teenagers aged 13 to 17 years were recruited to complete surveys online in English or Spanish, including the Sleep Health Index, the Sleep Satisfaction Tool, and the Patient Health Questionnaire-9 for adolescents, a commonly employed screening tool assessing the presence and frequency of depressive symptoms in adolescents. Data were weighted via iterative proportional fitting to approximate population distributions. Analyses included both z-tests and t-tests to examine depressive symptom differences between individuals with varying levels of sleep health. Results have a margin of sampling error of plus or minus 4.1 percentage points.

Results

Thirty-seven percent of 13- to 17-year-olds reported symptoms consistent with at least mild levels of depression and just 8 percent of teens reported achieving nightly sleep durations recommended by the National Sleep Foundation (i.e., 8-10 hours). Teens with minimal or no depressive symptoms reported significantly more weekday sleep (7.4 hours) compared to those with mild (7.0 hours) and moderate-to-severe depressive symptoms (6.6 hours; p’s<.05). Teens who were dissatisfied with their sleep were 22 percentage points more apt than sleep-satisfied teens to report moderate-to-severe depressive symptoms (27 vs. 5 percent, p<.05). Seventy-three percent of teens reported their emotional well-being was negatively impacted when they slept less than usual.

Conclusion

Sleep health and mental health are strongly linked in teens. When considering avenues to curb the teen mental health crisis, sleep health education should be a priority. Public health campaigns aimed at improving sleep health in teens should include efforts to start school later, reduce nighttime electronic use, and encourage family prioritization of sleep health.

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0952 Subjective Sleep Improvements Following Daily Theta-burst Stimulation for Treatment-resistant Depression
Authors: Cuda Jennifer , Smith David , Chaves Arthur , Taylor Reggie , Drodge Jessica , Shim Stacey , Nasr Youssef , Fonseca Karina , Brender Ram , Antochi Ruxandra , McMurray Lisa , Robillard Rebecca , Tremblay Sara
Published: April 2024

Introduction

Sleep disturbances are commonly observed in individuals with depression, and are associated with severity of depression, treatment outcomes, and risk of relapse. Repetitive transcranial magnetic stimulation, including newer optimized theta-burst stimulation (TBS) protocols, is recognized as a safe and effective intervention for treatment-resistant depression (TRD). Presently, little is known about the impact of TBS treatments on sleep in individuals with depression. We examined changes in subjective sleep and depression in individuals with TRD receiving daily TBS treatments, and the relationship between changes in these symptom domains.

Methods

50 participants (50% female, mean age 46.82 years) with TRD received four or six weeks of daily TBS treatments targeting the left or bilateral dorsolateral prefrontal cortex while participating in a randomized, double-blind clinical trial. Sleep disturbances and depression severity were measured at baseline, session 20 and session 30 using the Leeds Sleep Evaluation Questionnaire and 17-item Hamilton Rating Scale for Depression (HRSD-17), respectively. Linear mixed models examined whether scores changed significantly throughout treatment. Spearman’s correlations investigated whether changes in depression and sleep were associated.

Results

HRSD-17 scores improved significantly from baseline to weeks 4 and 6 (p< 0.001). We also observed significant improvements in quality of sleep (QOS), ease of awakening from sleep (AFS), and behaviour following wakefulness (BFW) after 4 and 6 weeks of TBS (p< 0.001). After 4 weeks of TBS, improvements in HRSD-17 significantly correlated with BFW scores (p= 0.008). After 6 weeks of TBS, improvements in HRSD-17 scores significantly correlated with improvements in both AFS and BFW scores (p< 0.005).

Conclusion

Participants reported improvements in depression, sleep quality, ease of waking, and daytime alertness following TBS. Furthermore, improvements in several aspects of sleep and depression were correlated. These findings suggest that TBS may be an effective intervention for individuals experiencing comorbid depression and sleep disturbances. This also strengthens the view that sleep enhancement may contribute to better mental health outcomes.

Support (if any)

Support was provided by the Royal’s Institute of Mental Health Research’s Emerging Research Innovators in Mental Health award, the Fonds de Recherche en Santé – Québec Research Scholar Junior 1 grant (grant number 297133), and an anonymous donation.
0957 Multidimensional Sleep Health Is Associated with Affective Instability in Stroke Survivors
Authors: Lau Stephen C L , Connor Lisa Tabor , Ford Andria , Landsness Eric
Published: April 2024

Introduction

Affective instability, a form of emotion dysregulation, is defined by rapid and intense shifts in affect and a known precursor of affective disorders. Poor sleep health leads to emotional dysregulation and affective instability. Poor sleep health is common after stroke, but which specific aspects of sleep health are important is unclear. We hypothesized that a multidimensional assessment of sleep health would identify specific factors that contribute to affective instability in stroke survivors.

Methods

Forty community-dwelling stroke survivors underwent multidimensional sleep health assessment with sleep diaries, the Pittsburgh Sleep Quality Index and ecological momentary assessment of affect and alertness eight times daily for seven days. Sleep health was quantified into 6 domains of the Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU-SATED) framework. Affective instability was quantified using probability of acute change (PAC) and mean squared successive difference (MSSD). Multivariable linear regressions were used to identify sleep health factors associated with affective instability, adjusting for age, sex, and race.

Results

Instability of depressed affect was associated with lower alertness (MSSD: B=.55, p=.001; PAC: B=.76, p<.001), lower sleep efficiency (B=.35, p=.036), and longer sleep latency (B=.38, p=0.30). Instability of cheerful affect was associated with less regular mid-sleep time (MSSD: B=.57, p<.001; PAC: B=.48, p=.004), less regular sleep duration (B=.43, p=.012), and longer sleep latency (MSSD: B=.39, p=.020; PAC: B=.39, p=.021).

Conclusion

Lower sleep efficiency, longer sleep latency, lower alertness, and irregular sleep contribute to affective instability among stroke survivors. Future intervention efforts managing these specific factors of sleep health to stabilize affective changes and prevent affective disorders after stroke are needed.

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0964 Depression Moderates the Effect of Repetitive Negative Thinking on Set-shifting Ability in Youth with Insomnia
Authors: Wong Yee Lok , Sit Hao Fong , Li Shirley Xin
Published: April 2024

Introduction

Repetitive negative thinking (RNT), a perpetuating factor of insomnia, is often associated with adverse outcomes (e.g., depression). According to the Attentional scope model of rumination, RNT is associated with a narrowed attentional scope. As such, individuals with more RNT tend to exhibit stable attention toward task-relevant information. Previous research has also shown that RNT is linked to better set-shifting ability in adolescents. However, the evidence was mainly based on the research on mood disorders and remained limited and inconclusive in the context of insomnia. The study aimed to examine the relationship between set-shifting ability and RNT and explore the role of depression in this relationship among adolescents with insomnia.

Methods

Adolescents diagnosed with DSM-5 insomnia disorder were recruited. Participants completed self-reported questionnaires, including the Perseverative Thinking Questionnaire (PTQ) for the measure of RNT, the Insomnia Severity Index (ISI) and the Beck’s Depression Inventory-Short Form (BDI-SF) and were administered Wisconsin Card Sorting Test (WCST). A score ≥ 10 on BDI-SF indicated the presence of depression. The number of Perseverative Responses (PR) and Perseverative Error (PE) on WCST were used to reflect set-shifting ability.

Results

Of 115 recruited participants with insomnia (Age: 18.34 ± 1.56, 14-20, female: 65.22%), the prevalence of depression was 51.30%. PTQ scores were significantly associated with PR and PE. The effect of PTQ on PR, but not PE, was moderated by the presence of depression. Among the participants with depression, lower PTQ scores were associated with greater PR, but such association was not observed in those without depression. Insomnia symptoms, presence of depression, age, and gender were not found to be associated with PR and PE, respectively.

Conclusion

RNT is associated with better performance in set-shifting among adolescents with insomnia. The result may be explained by the attentional scope model, which suggests that RNT enhances the ability to ignore irrelevant information to the tasks, thus exerting greater set-shifting ability. Further exploration with neuroimaging is needed to understand the relationship between RNT and set-shifting ability in the context of insomnia and psychopathology.

Support (if any)

This work was funded by General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.
0971 Repetitive Transcranial Magnetic Stimulation for Depression Changes Sleep Architecture: Preliminary Results
Authors: Fonseca Karina , Smith David , Higginson Caitlin , Shim Stacey , Cuda Jennifer , Drodge Jessica , Lanthier Malika , Porteous Meggan , McMurray Lisa , Tremblay Sara , Robillard Rebecca
Published: April 2024

Introduction

There is a bi-directional relationship between sleep and depression, with sleep difficulties contributing to the risk of treatment resistant depression. The existing literature regarding the influence of repetitive transcranial magnetic stimulation (rTMS) treatment on sleep is limited. The present study seeks to investigate changes in brain activity during sleep in individuals with treatment resistant depression undergoing rTMS treatment.

Methods

As part of an ongoing randomized, double-blind clinical trial, participants underwent four or six weeks of daily rTMS sessions targeting the left or bilateral dorsolateral prefrontal cortex. Sleep was monitored at home with an ambulatory EEG device (Muse-S, Interaxon) or in the laboratory with standard polysomnography (N7000, Embla) for two consecutive nights before starting rTMS (the first night serving as an adaptation night) and one night after up to four weeks of rTMS.

Results

Our preliminary sample consisted of eight participants (25% females, age range: 31-64 years, M = 47.4, SD = 12.3). At baseline, all participants scored at least 15 on the Hamilton Rating Scale for Depression which corresponds to mild depression severity. On average, total sleep time did not change significantly from pre-intervention (6.2 + 1.3 hours) to after the last rTMS session (6.1 + 1.6 hours, p>.050). After the last rTMS session (M=4.6, SD = 3.1), the percentage of NREM1 sleep shortened significantly relative to what was observed before the intervention (M=5.9, SD = 2.8; p = .042) . Changes in other sleep stages did not reach statistical significance.

Conclusion

These preliminary findings suggest that rTMS treatment may reduce light sleep without affecting overall sleep duration in individuals with treatment resistant depression. If replicated in larger samples, such findings may highlight rTMS as a potential means of alleviating poor sleep commonly linked to depression.

Support (if any)

This work was supported by the Royal’s Institute of Mental Health Research’s Emerging Research Innovators in Mental Health award, the Research Scholar Junior 1 grant (grant number 297133) from the Fonds de Recherche en Santé – Québec, and an anonymous donation.
0972 Rest-activity Rhythm Profiles in Major Depressive Disorder: A Cluster Analysis in Chinese Population
Authors: Poon Chun Yin , Ho Fiona Yan-Yee
Published: April 2024

Introduction

Previous research has demonstrated that rest-activity rhythm (RAR) profiles, formed by individual RAR characteristics, were linked to the severity of depressive symptoms. Further investigation into RAR profiles could potentially facilitate the identification of depression and validate its role in depression. This study aimed to identify the RAR profiles in samples with and without major depressive disorder (MDD).

Methods

Actigraphy data were collected from 70 Chinese adults (34 with current MDD and 36 age- and gender-matched healthy controls) aged between 18 and 64. RAR measures were computed based on the collected 7-day actigraphy data, and a data-driven cluster analysis was performed to identify distinct RAR profiles. The associations between the actigraphy-derived RAR profiles and various psychiatric symptom/health-related measures, including anxiety and depressive symptoms, insomnia severity, fatigue, and quality of life, were examined.

Results

Two distinct groups with different RAR features (“earlier/robust” group: n = 63, 90%; “later/irregular”; n = 7, 10%) were identified from the sample using cluster analysis. The “later/irregular” group exhibited later activity onset and acrophase, along with lower levels of robustness and regularity compared to the “earlier/robust” group. Regarding psychiatric symptom/health-related measures, the “later/irregular” group displayed significantly higher levels of depressive symptoms [t(8.77) = -3.36, p <.05], insomnia severity [t(15.3) = -6.85, p <.05], fatigue [t(8.80) = -2.68, p <.05], and a higher percentage of participants with current MDD [χ2(1) = 4.30, p <.05] relative to the “earlier/robust” group. However, insignificant differences in health-related quality of life [t(7.71) = 2.27, p =.054] were found between two groups.

Conclusion

The current findings contribute further evidence on the association between RAR profiles and MDD, suggesting that RAR profiles could potentially be a biological marker for identifying depression. The observed associations between RAR profiles and other related symptoms demonstrated the utility of RAR profiles in detecting other health-related concerns. However, it is important to note that confirmatory studies with larger sample sizes and longitudinal designs are necessary to validate these findings and reveal the underlying mechanisms and temporal relationship between circadian rhythms and depression.

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0980 Circadian Patterns of Aggressive Behaviors in a Mental Health Care Facility
Authors: Leveille Chloe , Oksit Defne , Fonseca Karina , Al-Hassan Niendow , Robillard Rebecca
Published: April 2024

Introduction

There are indications that circadian rhythms regulate certain aspects of emotions and behaviors. Yet, little is known about the potential diurnal rhythm of behavioral problems in individuals at risk for both circadian and emotional deregulation. This study investigates whether the frequency of aggressive behaviors among individuals receiving mental health care in a tertiary psychiatric facility follows a circadian pattern.

Methods

The timing of all “code white” alerts, emergency notifications of aggressive behavior, were documented from the hospital occupational safety team during 2022 and collated for secondary data analysis. A repeated measures ANOVA was performed on the hourly frequency of code white alerts across 24-hours and a Fourier series model was fitted to the data to extract parameters of a putative circadian curve.

Results

Preliminary results reveal a significant time of day effect on code white alerts (F(23, 8349) = 9.58, p <.001). Visual inspection show a sinusoidal pattern in the hourly counts of code white alerts, with an acrophase between 2 PM and 3 PM and a nadir between 3AM and 4AM. This was confirmed by the curve fitting (Adjusted R-square =.91).

Conclusion

These initial findings suggest a circadian modulation in the occurrence of aggressive behaviours in people receiving mental health care. While further work is required to understand underlying mechanisms, this phenomenon may be linked to the decrease in alertness and energy levels in the afternoon, which may make emotional regulation and decision-making more challenging. Better understanding of the influence of circadian factors on aggressive behaviors may facilitate self-regulation strategies and guide healthcare teams in preventing and better tailoring their responses to behavioral emergencies.

Support (if any)

NA
0989 Examining the Relation Between ADHD Symptoms and Poor Sleep Quality: The Role of Household Chaos and Sleep Hygiene
Authors: Flannery Jamie , Ehret Natalie , Gondoli Dawn
Published: April 2024

Introduction

When compared to typically developing youth, adolescents with ADHD exhibit greater sleep disturbances (Becker et al., 2019). While research supports a link between ADHD and sleep disturbances, less is known about potential contextual mechanisms underlying this relation, and this gap hinders development of prevention and intervention efforts. Families of youth with ADHD are at higher risk of exhibiting poor sleep hygiene (Nikles et al., 2020) and of living in chaotic households, characterized by low structure, excessive noise, and instability (Agnew-Blais et al., 2022). Furthermore, sleep hygiene has mediated the relation between household chaos and adolescent sleep quality among those not assessed for ADHD (Billows et al., 2009). Therefore, we hypothesized that household chaos and sleep hygiene would sequentially mediate the relation between ADHD symptoms and sleep quality among adolescents.

Methods

A community sample of 259 mother-adolescent dyads (adolescent M age = 15.2 years; SD age = 1.18; 54.9% female) was recruited from across the United States via Facebook ads. Mothers rated adolescent ADHD symptom severity with the ADHD Rating Scale V (DuPaul et al., 1998). Adolescents completed the Pittsburg Sleep Quality Index (Buysse et al., 1989), Confusion, Hubbub and Order Scale (Matheny et al., 1995), and Adolescent Sleep Hygiene Scale (LeBourgeois et al., 2005).

Results

Utilizing structural equation modeling, we tested a model in which household chaos and sleep hygiene mediated the relation between ADHD symptoms and poor sleep quality after controlling for adolescent age and gender. All hypothesized direct pathways were significant and in the expected directions. Results examining indirect pathways indicated that the relation between ADHD symptoms and sleep quality was partially mediated through chaos (β = 0.08; p =.001), sleep hygiene (β = 0.06; p =.036), and sequentially mediated through chaos and sleep hygiene (β = 0.04; p =.003).

Conclusion

The results suggest that improving daily structure and stability of the household may not only improve sleep hygiene but may also help improve sleep in adolescents with ADHD symptoms. Furthermore, behavioral sleep interventions with components of sleep hygiene may benefit from targeting the routine and structure of the whole household rather than just the individual.

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0998 Sleeping It Off: Alcohol, Cannabis, and Alterations in Bedtime and Waketime in Women with Sleep and Pain Complaints
Authors: McGovney Kevin , Ohley Austin , Stearns Melanie , Curtis Ashley , Craggs Jason , Miller Mary Beth , McCrae Christina
Published: April 2024

Introduction

Alcohol and cannabis are among the most used psychoactive substances. Many people use alcohol and cannabis with the belief that they will promote sleep, but both substances are linked to sleep problems. However, the relationships between alcohol and cannabis consumption and fluctuations in circadian rhythm are less clear. Hence, we examined the intraindividual associations between alcohol and cannabis consumption on a given day and subsequent deviations from typical bedtime and waketime.

Methods

Two hundred and fifty-one adults with sleep and pain complaints (Mage = 42.14 yrs, SD = 13.75 yrs, range = 18-81 yrs, 100% female) completed two weeks of daily sleep diaries. Mean bedtimes and waketimes were calculated in minutes, and daily calculations were performed to determine one’s daily deviation from mean bedtime and waketime. Multi-level models examined associations between the number of alcoholic drinks per day, the number of times consuming cannabis per day, and daily deviation from mean bedtime and waketime. Analyses controlled for daily usage of sleep medications (yes/no) and weekends (yes/no).

Results

Greater numbers of alcoholic drinks on a given day were associated with later waketimes on the following day (B = -8.15, SE = 1.77, p <.001), and greater numbers of alcoholic drinks were trending significance (p = .07) with daily deviation in bedtime. In context, every additional drink for an individual on a given day was associated with a nearly 8-minute delay in that individual’s waketime on the following morning. Number of times using cannabis was not associated with deviations from typical bedtime (p = .80) nor waketime (p = .90).

Conclusion

Our daily level analyses conducted in a large sample of women suggest that more alcoholic drinks on a given night are linked to later waketimes. Results are dose dependent such that heavier drinking is linked to a larger shift in waketimes (5 drinks = 40 minutes) relative to lighter drinking (1 drink = 8 minutes). Future research could include experimental techniques like alcohol administration and polysomnography to better understand the relationship between alcohol and circadian rhythm.

Support (if any)

National Institute of Nursing Research (NR01768; Clinical trial: NCT03744156; PI: McCrae).
A dynamic, multilevel process evaluation of a produce prescription program at a federally qualified health center: 2017–2021 description, implementation, and infrastructure
Authors: Ylitalo Kelly R , Cox Wendy , Janda-Thomte Kathryn M , Walter Katie , Gill John , Hess Burritt
Published: April 2024

The “Food as Medicine” (FAM) movement encourages public health and medical professionals to recognize the importance of dietary patterns and food access. The purpose of this work was to describe patient and physician engagement with a produce prescription (PRx) program to improve access to fresh vegetables in a healthcare setting. A Federally Qualified Health Center, regenerative farm, and academic institution partnered for the PRx program (2017–21). During harvest seasons, patients redeemed “prescriptions” for initial and “refill” produce boxes. Baseline food insecurity surveys were embedded in electronic medical records. Refill surveys assessed satisfaction and confidence. Electronic surveys to prescribing physicians assessed program knowledge, expectations, and motivations. Across 8 biannual harvests generating 9986 produce boxes, 8046 patients received prescriptions, 6227 redeemed prescriptions for ≥1 box, and 720 redeemed for ≥2 boxes. Seasonally, initial redemption rates ranged from 64.5% to 82.7%; refill rates ranged from 6.8% to 16.7%. Among participants, 70.8% sometimes/often worried food would run out and 66.7% sometimes/often ran out of food. Among those with refills, there was high satisfaction with food quality (95.8%) and variety (97.2%), and 94.2% were confident preparing meals from produce. Among physicians (n = 22), 100% self-reported adequate knowledge about PRx for patient recommendations, and 100% believed PRx had benefit for patients. Chronic conditions (77%), low socioeconomic status (64%), and food insecurity (59%) were common motivating factors for prescriptions. We demonstrated the feasibility of implementing a cross-sector, seasonal PRx program within a multisite healthcare system. More research is needed to refine implementation toward greater patient refill rates.
Chronic exposure to Zearalenone leads to endometrial hyperplasia in CD-1 mice by altering the inflammatory markers
Authors: Singh Varsha , Mandal Payal , Chauhan Shweta Singh , Saifi Ishrat Jahan , Marhaba  , Sandeep P V , Jagdale Pankaj , Ayanur Anjaneya , Ansari Kausar Mahmood
Published: April 2024

Background

Zearalenone (ZEA), a natural food contaminant, is reported to act as a mycoestrogen due to its estrogen-mimicking properties. According to studies, ZEA has a greater potential for estrogenic activity compared to any other naturally occurring non-steroidal estrogen. ZEA has been found in the endometrium of individuals with reproductive problems and the serum of children facing early puberty. These studies suggested a possible link between ZEA exposure and endometrial toxicity; nonetheless, no thorough research has been done. This study assessed the endometrium’s response to chronic ZEA exposure.

Methods

Four groups of CD-1 female mice were exposed to control, estradiol (E2), and two different doses of ZEA for 90 days. At the end of treatment, blood and uterus were collected, and samples were used for inflammatory cytokines level, immunochemical, histopathological, and biophysical analysis.

Results

Our data indicated that the uterus showed a change in body/organ weight ratio, while other organs did not have any notable changes. Immunochemical and histological studies showed hyperplasia and a higher number of glands in the endometrium after ZEA and E2 exposure. Similarly, proliferation markers such as proliferative cell nuclear antigen (PCNA), Ki-67, and inflammatory cytokines such as interleukin 6 (IL-6), interleukin 8 (IL-8), and interferon-gamma (IFN-?) levels were found to be higher in the E2 and ZEA-exposed groups.

Conclusion

Our finding conclude that ZEA targets the uterus and cause inflammation due to increased levels of inflammatory cytokines and proliferation mediators, as well as systemic toxicity denoted by a strong binding affinity with serum proteins.
The beneficial and toxic effects of selenium on zebrafish. A systematic review of the literature
Authors: Lin Yuanshan , Hu Liyun , Li Xinhang , Ma Jie , Li Qipeng , Yuan Xiaofan , Zhang Yuan
Published: April 2024

Selenium is an important and essential trace element in organisms, but its effects on organisms are also a “double-edged sword”. Selenium deficiency or excess can endanger the health of humans and animals. In order to thoroughly understand the nutritional value and toxicity hazards of selenium, researchers have conducted many studies on the model animal zebrafish. However, there is a lack of induction and summary of relevant research on which selenium acts on zebrafish. This paper provides a review of the reported studies. Firstly, this article summarizes the benefits of selenium on zebrafish from three aspects: Promoting growth, Enhancing immune function and anti-tumor ability, Antagonizing some pollutants, such as mercury. Then, three aspects of selenium toxicity to zebrafish are introduced: nervous system and behavior, reproductive system and growth, and damage to some organs. This article also describes how different forms of selenium compounds have different effects on zebrafish health. Finally, prospects for future research directions are presented.
The Role of Long Noncoding RNAs in Vascular Smooth Muscle Cell Phenotype and the Pathogenesis of Cardiovascular and Cerebrovascular Aneurysms
Authors: Deng Hao-wei , Ye Zi-ming , Hu Rui-ting , Qin Chao
Published: April 2024

Aneurysms are localized dilations of blood vessels, which can expand to 50% of the original diameter. They are more common in cardiovascular and cerebrovascular vessels. Rupture is one of the most dangerous complications. The pathophysiology of aneurysms is complex and diverse, often associated with progressive vessel wall dysfunction resulting from vascular smooth muscle cell death and abnormal extracellular matrix synthesis and degradation. Multiple studies have shown that long noncoding RNAs (lncRNAs) play a significant role in the progression of cardiovascular and cerebrovascular diseases. Therefore, it is necessary to find and summarize them. LncRNAs control gene expression and disease progression by regulating target mRNA or miRNA and are biomarkers for the diagnosis and prognosis of aneurysmal cardiovascular and cerebrovascular diseases. This review explores the role, mechanism, and clinical value of lncRNAs in aneurysms, providing new insights for a deeper understanding of the pathogenesis of cardiovascular and cerebrovascular aneurysms.
Combined Double-breasted Full-thickness Abdominal Flap Plication and Acellular Dermal Matrix in Prune-belly Syndrome Reconstruction
Authors: Baccarani Alessio , Pappalardo Marco , Ceccarelli Pier Luca , Starnoni Marta , De Santis Giorgio
Published: April 2024

Background:

Reconstruction of the abdominal wall in patients with prune-belly syndrome (PBS) following previous intra-abdominal procedures is a challenging problem with a high incidence of revision due to persistent bulging or herniation. The abdominal wall flaccidity not only produces a severe psychological and aesthetic discomfort for the patient but often determines functional disabilities, including inability to cough properly, impaired bowel and bladder function, and delay in posture and balance.

Methods:

The authors describe three cases of reconstruction of abdominal wall using a modified double-breasted abdominoplasty fascial plication with additional acellular dermal matrix interposition and review the literature for innovations in the use of abdominal repair for reconstruction of these difficult cases.

Results:

Three children with PBS at a mean age of 7.3 years achieved successful reconstruction of the abdominal wall, using the modified double-breasted abdominoplasty fascial plication with acellular dermal matrix interposition. Patients underwent previous procedures, including orchiopexy in two patients and bilateral nephrectomy in one patient. No postoperative complications have been found, apart from superficial skin dehiscence along the abdominal incision treated conservatively in one child. At mean follow-up of 42 months (range 28–56 months), no patient presented incisional hernia, persistent or recurrent fascial laxity with abdominal bulging. All patients achieved significant aesthetic and functional improvements, including children’s ability to cough, spontaneous gain of abdominal tonus, balance, and ambulation.

Conclusion:

Modification of the original vertical, two-layer plications of the deficient abdominal interposing biological mesh has the purpose of improving strength, aesthetics, and function of the abdominal wall in pediatric patients with PBS.
Connecting human behaviour, meaning and nature
Authors: Anderies J. M. , Folke C.
Published: April 2024

Much of the discourse around climate change and the situation of diverse human societies and cultures in the Anthropocene focuses on responding to scientific understanding of the dynamics of the biosphere by adjusting existing institutional and organizational structures. Our emerging scientific understanding of human behaviour and the mechanisms that enable groups to achieve large-scale coordination and cooperation suggests that incrementally adjusting existing institutions and organizations will not be sufficient to confront current global-scale challenges. Specifically, the transaction costs of operating institutions to induce selfish rational actors to consider social welfare in their decision-making are too high. Rather, we highlight the importance of networks of shared stories that become real—imagined orders—that create context, meaning and shared purpose for framing decisions and guiding action. We explore imagined orders that have contributed to bringing global societies to where they are and propose elements of a science-informed imagined order essential to enabling societies to flourish in the Anthropocene biosphere.

This article is part of the theme issue ‘Bringing nature into decision-making’.