bluuebunny/crossref_metadata_2025 huggingface dataset:
197 Refining the Subjective Assessment of Sleep: An SEM Approach
Authors: Sabet Sahar , Dzierzewski Joseph , Dautovich Natalie
Published: May 2021

Introduction

Given that sleep is multidimensional, the assessment of sleep requires an examination of a number of different domains. Accordingly, there is an abundance of self-report sleep questionnaires that are widely used for both research and clinical use. The surplus of available measures can be problematic, as it often leads to difficulties in selecting the best measure for a given purpose/context. In addition, the use of multiple measures to assess sleep may be an inefficient use of time and resources if they are not measuring unique constructs. The purpose of the current study is to evaluate the factor structure of five sleep measures. A confirmatory factor analysis (CFA) was initially used to evaluate whether each of these scales are measuring different factors of sleep, with follow-up exploratory factor analysis (EFA) as needed.

Methods

An archival analysis was performed using data from an online study, Investigating Sleep Across Normal Development (ISLAND Study). The sample consisted of 3,284 adults aged 18+. The following measures were utilized: RU SATED, PROMIS Sleep-Related Impairment, Sleep Self-Efficacy, Insomnia Severity Index, and the Sleep Regularity Questionnaire.

Results

As expected, the CFA model fit was determined to be poor and an EFA was then conducted to assess the factor structure of these scales. The EFA revealed a four-factor structure comprised of 25 items: Sleep-Related Daytime Impairment, Sleep Regularity, Sleep Disturbance, and Sleep-Related Daytime Enhancement.

Conclusion

The findings from the current study add to the literature supporting the multidimensionality of sleep, as well as the continued need to assess the various facets that comprise this construct. Although the literature supports the utility of these five measures, the present study found that within a community sample, these measures are not entirely unique. Further, the present study extends our knowledge and the literature by revealing a novel factor of sleep – Sleep-Related Daytime Enhancement. It may be worthwhile for researchers and clinicians to consider latent sleep factors that contribute to sleep disturbance and sleep health. Future work is needed to further confirm the observed factor structure and assess the psychometrics of this new scale.

Support (if any)

National Institute on Aging (K23AG049955, PI: Dzierzewski).
202 COVID-19 Pandemic Sleep Disturbances Related To Dietary Behavior at the US-Mexico Border
Authors: Valencia Dora , Ghani Sadia , Delgadillo Marcos , Madhivanan Purnima , Krupp Karl , Ruiz John , Seixas Azizi , Jean-Louis Giardin , Killgore William , Wills Chloe , Grandner Michael
Published: May 2021

Introduction

The COVID-19 pandemic has disrupted life at the US-Mexico border in many ways, including sleep and dietary behavior. Given the potential long-term impact of worsening sleep and metabolic health due to the pandemic, the present study examines whether changes to dietary behavior were associated with changes to sleep.

Methods

Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and were contacted about completing a COVID-19 sub-study (95% Hispanic/Latino). Participants reported the degree to which they experienced pandemic-related changes to sleep, including a more regular schedule, overall improvement, overall worsening, more initial insomnia, more middle-of-the-night insomnia, more daytime sleepiness, and more napping. They were also asked whether as a result of the pandemic they consumed an overall healthier diet, more homecooked meals, more processed meals, more regular meals, whether they enjoyed food more, and degree of overeating. Ordinal regressions with diet change as outcome and sleep change as predictor were adjusted for age, sex, education, and socioeconomics.

Results

Those who reported more regular sleep were more likely to report a healthier overall diet (oOR=3.12,p<0.0005), more homecooked meals (oOR=2.18,p=0.001), more enjoyment of food (oOR=1.71,p=0.028), and less likelihood of overeating (oOR=0.59,p=0.033). Similarly, those who reported more “improved” sleep reported healthier overall diet (oOR=7.42,p<0.0005), more homecooked meals (oOR=2.59,p=0.001), more regular diet (oOR=2.15,p=0.006), more enjoyment of food (oOR=2.92,p<0.0005), less consumption of processed foods (oOR=0.54,p=0.039), and less overeating (0.33,p<0.0005). Those whose sleep worsened reported eating more processed foods (oOR=1.78,p=0.030) and overeating (oOR=3.90,p<0.0005). Those who reported more initial insomnia reported eating more processed foods (oOR=1.93,p=0.016), more regular diet (oOR=1.65,p=0.042), and overeating more often (oOR=4.11,p<0.0005). More middle-of-the-night insomnia was associated with eating more processed foods (oOR=2.45,p=0.001), more regular diet (oOR=1.66,p=0.031), and overeating more often (oOR=3.68, <0.0005). Those with more daytime sleepiness also reported eating more processed foods (oOR=2.36,p=0.003), more regular diet (oOR=1.79, =0.019), and overeating more often (oOR=3.28,p<0.0005). More napping was associated with a more regular diet (oOR=1.90,p=0.011) and more overeating (oOR=3.53,p<0.0005).

Conclusion

Overall, worse sleep led to worse dietary behavior, especially eating more processed food and overeating.

Support (if any)

Supported by T32HL007249, R01MD011600, R01DA051321
207 Sociodemographic, Behavioral, and Health-Related Factors Associated with Sleep Among Native Hawaiians and Other Pacific Islanders
Authors: Barker Madison , Gilles Allyson , Ghani Sadia , Killgore William , Knowlden Adam , Wills Chloe , Grandner Michael
Published: May 2021

Introduction

Previous studies have suggested that Native Hawaiians/Pacific Islanders show different associations between sleep and health risks, compared to other groups. The present study evaluated sleep and health risk factors in a nationally-representative sample.

Methods

Data from the Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI-NHIS), collected by the CDC in 2013, was used for analysis. A total of N=2,124 individuals provided complete data on all variables. Sleep outcomes included hours of sleep (3-12h), days/week difficulty falling asleep, difficulty maintaining sleep, and nonrestorative sleep (ordinal). Weighted regression analyses (linear or ordinal logistic) evaluated whether sleep outcomes were associated with cancer, diabetes, hypertension, stroke, obesity, poor health, depression, anxiety, smoking, alcohol, activity, functional limitations, foregoing medical care due to cost, frequent healthcare utilization, health insurance, and difficulty paying medical bills, in models that also included age, sex, immigrant status, multiracial status, education, employment, income, and relationship status.

Results

Shorter sleep was associated with older age, earning <$20,000, and being divorced/widowed/separated, and longer sleep was associated with being female and less than high school education. Shorter sleep was also associated with fair health and current drinking. Difficulty falling asleep was positively associated with older age, earning <=$44,999, being divorced/widowed/separated, obesity, worse health, depressed mood, anxiety, daily smoking, former and current drinking, functional limitations, foregoing care, frequent care, and difficulty with bills. Difficulty falling asleep was negatively associated with immigrant status and being retired. Difficulty maintaining sleep was associated with older age, being unmarried but partnered, obesity, worse health, depression, anxiety, daily smoking, current or heavy drinking, being inactive, functional limitations, foregoing care, frequent care, and difficulty with medical bills. Nonrestorative sleep was associated with non-immigrant status, employment, being a homemaker, disability, being unmarried, obesity, worse health, depression, anxiety, daily smoking, former, current, or heavy drinking, inactivity, functional limitations, foregoing care, frequent care, and difficulty with medical bills.

Conclusion

Short sleep was not significantly associated with common health risk factors seen in other groups. Sleep difficulties, though, were related to a constellation of sociodemographic, socioeconomic, behavioral, and cardiometabolic risks. Further research regarding insomnia as a health risk factor in this population is warranted.

Support (if any)

R01MD011600, R01DA051321
217 Sleep in heavy marijuana users after smoking differing THC doses compared to controls
Authors: Sibai Mohammad , Roehrs Timothy , Koshor Gail , Verkler Jelena , Lundahl Leslie
Published: May 2021

Introduction

Sleep disturbances are commonly reported by chronic marijuana (MJ) users and often identified as reasons for MJ relapse and/or other drug use. In the current study we compared the sleep architecture of 12 heavy MJ users to 11 normal controls.

Methods

Participants in the marijuana group met DSM-V criteria for cannabis use disorder but were otherwise healthy individuals. On the first study day, individuals smoked (1330-1400 hr) 11 puffs from a cannabis cigarette (7% THC). During the next four days, under varying experimental contingencies participants smoked an average of 4.58 (±3.48) day 1, 4.92 (±3.62) day 2, 4.75 (±3.52) day 3, and 4.17 (±3.56) day 4 puffs from cannabis cigarettes (7% THC). Their sleep was recorded the first four study nights using standard polysomnography procedures at Henry Ford Sleep and Research Center Hospital, under an 8-hr fixed time in bed (2300-0700 hr). Controls (n=11) had no history of illicit drug use or medical illness and were not shift workers. Neither group reported a history of sleep-related disorders. PSG recordings were scored using Rechtschaffen and Kales standard criteria. Sleep measures included sleep efficiency (total sleep time/time in bed * 100), latency to persistent sleep, and percent of time spent in Stage 1, 2, 3/4, and rapid eye movement (REM).

Results

PSGs taken across all four nights of inpatient stay showed that MJ users spent significantly more time in REM sleep compared to controls (means 24.91, 24.64, 24.42, 24.13 vs 18.81, p<.001) and less time in stage 3/4 sleep (means 4.33, 4.79, 4.53, 6.91 vs 15.68, p<.001). MJ users showed reduced sleep efficiency compared to controls on night 4 (means 82.03 vs 90.32, p=0.039), and increased latency to persistent sleep on night 1 (means 6.04 vs 17.77, p=0.026).

Conclusion

These data show reduced sleep efficiency, lightened sleep (reduced stage 3/4), as well as an increased duration during REM sleep in heavy MJ users during decreased use, findings that are predictive of relapse in other drug abuse populations.

Support (if any)

NIH/NIDA R21 DA040770 (LHL)
221 Social Integration and Sleep Quality during the COVID-19 Pandemic: Prospective Evidence from a Study of Retired Older Adults
Authors: Chin Brian , Tracy Eunjin , Lehrer H Matthew , Carroll Lucas , Lacey Precious , Kimutis Sarah , Buysse Daniel , Hall Martica
Published: May 2021

Introduction

Growing evidence has documented the adverse impact of the global coronavirus pandemic on sleep quality. Older adults may be especially susceptible to declines in sleep quality for multiple reasons, including their elevated risk of social isolation and loneliness during the pandemic. Given the adverse health consequences of poor sleep, there is a need to identify resilience factors that help protect older adults against decreased sleep quality. Social integration is a plausible resilience factor because involvement in a broad range of social relationships is thought to promote psychological well-being (e.g., meaning, purpose in life), as well as reduce the intensity and duration of negative psychological states. Social integration may also assume increased importance during the coronavirus pandemic because of normative declines in overall social contact. This prospective study assessed the impact of the coronavirus pandemic on older adults’ sleep quality and tested whether social integration moderated the impact of the pandemic on sleep quality.

Methods

A sample of 115 retired older adults (mean age = 68.6, 58% female, 89% white) completed self-report assessments of their social integration (number of roles on Cohen’s Social Network Index) and sleep quality (global score on Pittsburgh Sleep Quality Index) before and after the onset of the coronavirus pandemic (mean duration of follow-up = 2.3 years).

Results

Multilevel analyses indicated that social integration moderated the impact of the coronavirus pandemic on sleep quality; there was no main effect of time. Older adults with low social integration had reduced sleep quality from Time 1 to Time 2 (b=.94, p=.02), whereas older adults with high social integration showed no changes in sleep quality over time (b=-.38, p=.37).

Conclusion

Broader social networks confer resilience against pandemic-related declines in sleep quality among older adults. The level of social integration should be addressed when studying or treating sleep complaints during the coronavirus pandemic. Additional research is warranted to determine whether psychosocial interventions targeted towards older adults with low social integration can reduce observed differences in sleep quality.

Support (if any)

This research was supported by R01AG047139, T32HL007560, T32HL082610, T32MH019986.
222 COVID-19 Related Stress Intensify the Impact of Child Maltreatment on Sleep Quality
Authors: Zhang Linhao , Cui Zehua , Sasser Jeri , Oshri Assaf
Published: May 2021

Introduction

Child maltreatment (CM) is a significant stressor that is associated with sleep problems in children and adolescents. The COVID-19 pandemic introduces new psychosocial stressors, which may be particularly harmful to youth already experiencing stress in the home environment. Using multi-dimensional (threat vs deprivation) assessments of CM, the present study aimed to test whether COVID-19 related stress intensified the association between maltreatment (abuse vs neglect) and sleep problems among youth.

Methods

This study utilized data from a longitudinal sample of youth (N=126; Mage at T1=12.9) assessed between January 2019 and March 2020 (T1) and after the beginning of the COVID-19 pandemic (May 2020; T2). Latent factors for COVID-19 related stress included three questions asking about negative changes, uncertainty about the future, and stress-induced by disruptions. CM at T1 was measured with the Childhood Trauma Questionnaire (CTQ). Multidimensional aspects of CM included a threat factor (sum of Emotional, Physical, and Sexual Abuse) and a deprivation factor (sum of Emotional and Physical Neglect). Sleep-related problems at both T1 and T2 were assessed using the Pittsburgh Sleep Quality Index (PSQI) global score. Structural equation modeling was conducted in Mplus 8.1 to test direct and interaction effects of CM and COVID-19 related stress on sleep problems at T2 while controlling for sleep problems at T1 and demographic covariates.

Results

Threat-related abuse was significantly associated with increased sleep problems at T2 (β =.43, p < .01) but neglect was not (β =.03, p = .85). Additionally, COVID-19 related stress significantly intensified the link between abuse and sleep problems (β =.14, p < .05) as well as between neglect and sleep problems (β =.43, p < .01) at T2. Among youth who experienced higher levels of CM, increased COVID-19 related stress exacerbated sleep problems.

Conclusion

These results bolster extant research on the negative impact CM bears on youth sleep health and indicates that COVID-19 stress may exacerbate sleep problems. Our findings inform future prevention and intervention efforts that aim to reduce sleep problems among youth who experience CM during the COVID-19 pandemic.

Support (if any)

NIH/NIDA K Grant 1K01DA045219-01
226 Changes in sleep amount and sleep quality due to the COVID-19 pandemic confinement associate with ratings of health and stress
Authors: Jones Christopher , Kaizi-Lutu Marc , Cordoza Makayla , Mange Ami , Dinges David
Published: May 2021

Introduction

In March 2020, an unprecedented number of individuals were confined to their homes in an effort to stem the spread of the novel Coronavirus (Covid-19), however the impact of this confinement on health and behavior is unknown. Long-duration confinement studies have found effects on homeostatic biology and neurobehavioral functions, including reduced sleep durations. This study evaluated how confinement due to Covid-19 has impacted health and stress through changes in sleep.

Methods

The Anonymous Survey on Confinement during the COVID-19 Pandemic was available online to any individual ≥18 years of age through the Penn Medicine Clinical Research webpage on May 14, 2020 and the data presented are through October 24, 2020. The survey collected self-reported information on demographics, the amount and quality of sleep, as well as ratings of health and stress. To determine the impact of confinement on these domains, participants were asked to answer questions relative to pre-confinement levels. To test associations between sleep amounts and sleep quality on health and stress, generalized linear models were used and adjusted for age, sex, and race.

Results

N=228 participants (n=180 female [79.0%]) were on average 45.0±17.1 years of age. During confinement relative to pre-confinement, 41.7% of participants reported sleeping more, 37.3% reported sleeping the same amount, and 21.0% reported less sleep, while 14.0% reported better sleep quality, 47.4% the same, and 38.6% worse quality of sleep relative to pre-confinement. Ratings of worse health during confinement were associated with both reduced sleep amount (β=0.695; P<0.0001) and worse sleep quality (β=0.532; P=0.0002). Lower stress ratings were associated with increased sleep amount (β=0.734; P=0.034), better sleep quality (β=1.396; P=0.0002), better health ratings (β=-0.079; P=0.0045). Conversely, worse sleep quality was associated with higher stress ratings (β=-1.086; P=0.0007).

Conclusion

The confinement resulting from the COVID-19 pandemic has impacted the amount and quality of sleep and good sleep may help to reduce stress and maintain health. These findings highlight the need to further examine how long-term confinement influences human health and behavior and warrant examining what factors or life-style behaviors promote resilience to the negative effects of confinement.

Support (if any)

CWJ supported by NHLBI NRSA (T32 HL007713).
230 Association Between Chronotype and Subjective Cognitive Functioning: Population-Based Study
Authors: Hwang Inha , Oh Dana , Yoon Jee-Eun , Kim Daeyoung , Yang Kwang Ik , Chu Min Kyung , Park Seong-Ho , Yun Chang-Ho
Published: May 2021

Introduction

Increasing research suggests that subjective cognitive decline (SCD) in the absence of objective cognitive dysfunction may be a forerunner of non-normative cognitive decline and eventual progression to dementia. We investigated the association between chronotype and subjective cognitive functioning in the representative sample of the adult population.

Methods

We included subjects who participated in a nationwide cross-sectional survey of sleep and headache in 2018 in the Republic of Korea. A total of 2136 subjects (age 19-92, mean 48.3 ± 16.5 years old, 1062 male) was included in the analysis. To assess subjective cognitive functioning, we adopted the Mail-In Cognitive Function Screening Instrument (MCFSI). The MCSFSI is a brief, self-administered potential outcome measure developed by the Alzheimer’s Disease Cooperative Study (ADCS) to detect early changes in cognitive and functional abilities in individuals without clinical impairment. MCFSI scores ≥5 were considered abnormal for this study. As an indicator of chronotype, we adopted the “midpoint of sleep on free days corrected for sleep extension on free days (MSFsc).” MSFsc was calculated as follows: MSFsc = midpoint of sleep on free days − 0.5 × (sleep duration on free days − [5 × sleep duration on workdays + 2 × sleep duration on free days]/7). Participants whose MSFsc occurred before 04:00 AM, between 04:00 and 04:59 AM, and after 05:00 AM were classified as early, intermediate, and late chronotype, respectively. The associations between chronotype and subjective cognitive functioning were analyzed with logistic regression models adjusted for potential confounders.

Results

Subjective cognitive functioning was abnormal in 381 subjects (17.8%). A late chronotype was significantly associated with abnormal subjective cognitive functioning compared with an early chronotype independent of age, sex, average sleep duration, alcohol, smoking, regular exercise, anxiety, depression, body mass index (BMI), education years, and income status (OR 1.619, 95% CI 1.03 - 2.55, p=0.038). Abnormal subjective cognitive functioning was significantly associated with older age, female sex, lower education, higher BMI, anxiety, and depression.

Conclusion

This survey cohort results provide evidence at the population level that late chronotype is associated with abnormal subjective cognitive functioning.

Support (if any):
233 COVID-19 Related Worries and Sleep Disturbances in Patients Previously Hospitalized with COVID-19 Illness
Authors: Shechter Ari , Abdalla Marwah , Raju Datla , Kronish Ian , Liyanage-Don Nadia
Published: May 2021

Introduction

In patients hospitalized for COVID-19 illness, sleep disturbances after discharge may impact quality of life and prognosis. We examined the relationship of COVID-19-related worries with sleep disturbances in patients three months after COVID-19 hospitalization.

Methods

Patients hospitalized for COVID-19 illness completed a survey three months post-discharge (n=153). We measured COVID-19-related worry along two domains: worry directly related to the disease (COVID-illness worry) and worry related to the socioeconomic impact of the pandemic (COVID-impact worry). COVID-illness worry included worry regarding: 1) getting COVID again, 2) dying from COVID, 3) family members getting COVID, 4) losing a loved one to COVID, 5) unknowingly infecting others with COVID, 6) having significant financial burdens because of COVID. COVID-impact included worry regarding: 1) employment loss, 2) not having enough food, 3) not having access to medical care/medications, 4) not having access to mental health care/medications, 5) reduction in interactions with other people, 6) separation from family members, 7) being lonely. Patients rated how much they worried about each item on a 4-point scale (not at all, a little, moderately, extremely). Scores on each domain were summed to reflect overall severity. Past month sleep was assessed for insomnia symptoms (none, mild, moderate, severe, very severe) and self-reported sleep duration. Binary logistic regression was used to evaluate the association of COVID-illness worry and COVID-impact worry, separately, with sleep measures, adjusting for age, sex, race/ethnicity, and presence of persistent COVID-related symptoms.

Results

The prevalence of insomnia (moderate, severe, or very severe symptoms) and short sleep duration (<6 h/day) was 47.0% and 39.2%, respectively. COVID-illness worry severity was significantly associated with presence of insomnia (OR: 1.91, 95% CI: 1.13-3.23, p=0.016) and short sleep (OR: 2.20, 95% CI: 1.25-3.86, p=0.006). In a separate model, COVID-impact worry severity was significantly associated with presence of insomnia (OR: 1.98, 95% CI: 1.23-3.19, p=0.005) and short sleep (OR: 2.11, 95% CI: 1.26-3.55, p=0.005).

Conclusion

Sleep disturbances are common among patients previously hospitalized with COVID-19 illness, and COVID-19 related worries are associated with insomnia and short sleep. Additional research is needed to determine whether addressing COVID-19 related worries reduces sleep disturbance, which in turn may promote post-COVID recovery.

Support (if any):
234 Sleep quality during the coronavirus pandemic in a Brazilian family-based cohort
Authors: Taporoski Tamara , Beijamini Felipe , Ruiz Francieli , Ahmed Sabrina , von Schantz Malcolm , Pereira Alexandre , Knutson Kristen
Published: May 2021

Introduction

Early in the COVID-19 pandemic, Brazil adopted measures to minimize the spread of the virus, including quarantine orders where people only left home for essential business. This practice could negatively impact sleep by reducing exposure to daylight and physical activity. We examined subjective sleep quality in Baependi, a small rural town in Brazil during the COVID-19 quarantine order.

Methods

This sample is from the Baependi Heart Study, a family-based cohort of adults. Participants (n=800, 71% women, mean age 51.6±15.6 years) completed the Pittsburgh Sleep Quality Index (PSQI) early in the COVID pandemic (April-May, 2020). They were also asked about their compliance to the quarantine order (yes/no). We compared sleep between quarantined (QT) and not-quarantined individuals (NQT). Longitudinal data was obtained from a subsample of 417 individuals who also completed a pre-COVID PSQI between January, 2010 and September, 2014.

Results

Individuals compliant with the quarantine had worse sleep quality than non-quarantined individuals [QT PSQI= 6.1 (±3.9), NQT PSQI= 5.0 (±3.5), p<0.01]. Stratified analysis showed that differences in PSQI scores between QT and NQT was greater for women [QT = 6.4 (±4), NQT = 5.2 (±3.7), p<0.01] and older people [QT = 6.6 (±0.1), NQT = 5.5 (±3.3), p=0.02]. Associations were attenuated after adjusting for age and gender. PSQI components demonstrated a higher sleep latency for the QT group in the full sample (p=0.02), women (p<0.01) and young (<50 years, p=0.03). Sleep duration was shorter in the QT young subsample (p=0.03). QT women also reported lower sleep efficiency (p=0.01) and greater use of sleep medication than NQT women (p<0.01). In the longitudinal subsample, PSQI scores were significantly higher during COVID than pre-pandemic [COVID= 5.7 (±3.8), pre-COVID= 5 (±3.3), p<0.01]. The significant change in PSQI was only observed in the QT participants [COVID= 5.9 (±3.7), pre-COVID= 5.2 (±3.4), p<0.01] and not NQT [COVID= 5 (±3.7), pre-COVID= 4.5 (±3), p=0.12.

Conclusion

Individuals who quarantined during COVID-19 had worse sleep quality than individuals who did not quarantine. Longitudinal comparison demonstrated that participants who quarantined had worse sleep quality during COVID compared to before to the pandemic.

Support (if any)

NIH 1R01HL141881
235 Age and Chronotype Associated with Sleep Timing Changes During COVID-19-Related Lockdowns in the US
Authors: Bottary Ryan , Fields Eric , Kensinger Elizabeth , Cunningham Tony
Published: May 2021

Introduction

Global lockdowns implemented to reduce spread of the Coronavirus Disease 2019 (COVID-19) have offered unique insight into how sleep patterns change when typical social obligations are significantly reduced. Here, we aimed to replicate findings of sleep timing delays and reduced social jetlag during lockdown using a large, regionally-diverse sample of participants from the United States (US). Further, we conducted exploratory analyses to determine if observed sleep changes were associated with age and self-reported chronotype.

Methods

A sample of 691 US adults (age 18-89) completed the Ultrashort Munich Chronotype Questionnaire twice during the same assessment: once querying retrospective memory for sleep patterns in the 6-weeks prior to February 1, 2020 (Pre-Lockdown) and a second time for sleep patterns in the 6-weeks prior to ~May 20th (Peak-Lockdown in the US). Participants also completed the abbreviated Morningness-Eveningness Questionnaire to assess chronotype. We compared sleep duration (SDur), sleep onset time (SO), sleep end time (SEnd), social jetlag (SJL; difference between work-day and free-day sleep midpoint) and social sleep restriction (SSR; difference between work-day and free-day sleep duration) Pre- to Peak-Lockdown. We conducted exploratory analyses to determine whether Pre- to Peak-Lockdown changes in these sleep metrics were associated with age or chronotype. Main analyses were preregistered with Open Science Framework (https://osf.io/4a3fx).

Results

During the Peak-Lockdown period, participants, on average, reported significantly later SO and SEnd times and significantly reduced SJL and SSR compared with the Pre-Lockdown period. Change in SJL and SSR Pre- to Peak-Lockdown was significantly positively associated with age and chronotype such that SJL and SSR decreased more during lockdown in younger participants and those with an evening chronotype.

Conclusion

Our results support lockdown-associated sleep timing delays and reduced SJL and SSR. Younger age and evening chronotype were associated with greater reductions in SJL and SSR during lockdown. These findings suggest that individuals, particularly young individuals and those with an evening chronotype, experience greatest desynchrony between intrinsic and social sleep timing when conforming to typical pre-pandemic social schedules.

Support (if any)

Harvard Medical School Division of Sleep Medicine T32 HL007901 (RB and TJC); Brandeis University NIH NRSA T32 NS007292 (ECF)
236 The association between recent cannabis use and nightly sleep duration in adults in the USA from 2005-2018
Authors: Diep Calvin , Tian Chenchen , Won Christine , Ladha Karim , Singh Mandeep
Published: May 2021

Introduction

Shifts in medicolegal attitudes towards cannabis, coupled with widespread legalization, have led to North America having the highest prevalence of cannabis use worldwide. Amongst other known physiologic effects, regular cannabis use can cause changes to sleep duration and quality. The purpose of this study was to examine the relationship between recent cannabis use and sleep duration using a nationally representative data set.

Methods

A cross-sectional analysis of adults was undertaken using the National Health and Nutrition Examination Survey (NHANES) data from 2005–2018. Respondents were dichotomized by whether or not they had used cannabis in the past 30 days. The primary outcome was inadequate nightly sleep duration, defined as self-reported sleep duration less than 6 hours per night. Secondary outcomes were related to self-reported issues with sleep. Multiple logistic regression was used to adjust for potential confounders and survey sample weights were considered in the model.

Results

Compared to those with no recent cannabis use (n=18,631), recent users (n=3,135) were more likely to report less than 6 hours of sleep per night (aOR 1.33 95% 1.13–1.57, p<0.001). Recent users were also more likely to report difficulty falling asleep, staying asleep, or sleeping too much in the past two weeks (aOR 1.21, 95% CI: 1.09–1.35, p<0.001), and having ever mentioned these issues to a physician (aOR 1.21, 95% CI: 1.07–1.37, p=0.003). Respondents using cannabis at least 20 of the past 30 days were characterized as heavy users, and were even more likely than moderate users to report insufficient sleep. These results did not significantly differ between years of survey administration.

Conclusion

Recent cannabis use was associated with inadequate nightly sleep duration in adults and demonstrates a dose-dependent relationship. Although this relationship is complex and our findings cannot suggest directionality, they highlight the need to further characterize the sleep health of regular cannabis users in the general population. This is especially prudent as cannabinoids are becoming widely accepted for recreational use and increasingly prescribed as medical therapy.

Support (if any):
238 Adolescent Sleep Variability, Social Jetlag, and Mental Health during COVID-19: Findings from a Large Nationwide Study
Authors: Wong Patricia , Wolfson Amy , Honaker Sarah , Owens Judith , Wahlstrom Kyla , Saletin Jared , Seixas Azizi , Meltzer Lisa , Carskadon Mary
Published: May 2021

Introduction

Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health.

Methods

Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) for each instructional format and for weekends/no school days. Sleep opportunity (SlpOpp) was calculated from BT and WT. Weekday night-to-night SlpOpp variability was calculated with mean square successive differences. SJL was calculated as the difference between the average sleep midpoint on free days (O/A, no school, weekends) versus scheduled days (IP, O/S). Participants also completed the PROMIS Pediatric Anxiety and Depressive Symptoms Short Form. Data were analyzed with hierarchical linear regressions controlling for average SlpOpp, gender, and school-level (middle vs high school).

Results

Mean reported symptoms of anxiety (60.0 ±9.1; 14%≧70) and depression (63.4 ±10.2; 22%≧70) fell in the at-risk range. Shorter average SlpOpp (mean=8.3±1.2hrs) was correlated with higher anxiety (r=-.10) and depression (r=-.11; p’s<.001) T-scores. Greater SlpOpp variability was associated with higher anxiety (B=.71 [95%CI=.41-1.01, p<.001) and depression (B=.67 [.33-1.00], p<.001) T-scores. Greater SJL (mean=1.8±1.2hrs; 94% showed a delay in midpoint) was associated with higher anxiety (B=.36 [.12-.60], p<.001) and depression (B=.77 [.50-1.03], p<.001) T-scores.

Conclusion

In the context of system-wide education changes during COVID-19, students on average reported at-risk levels of anxiety and depression symptoms which were associated with greater variability in sleep opportunity across school days and greater social jetlag. Our findings suggest educators and policymakers should consider these sleep-mental health associations when developing instructional formats and school schedules during and post-pandemic.

Support (if any)

T32MH019927(P.W.)
245 Sleep and cortical thickness are influenced by surgical menopause
Authors: Gravelsins Laura , Gervais Nicole , Brown Alana , Nicoll Gina , Ramana Shreeyaa , Li Alisa , Almey Anne , Reuben Rebekah , Karkaby Laurice , Perovic Mateja , Einstein Gillian
Published: May 2021

Introduction

Early loss of 17β-estradiol (E2), as experienced by women with bilateral salpingo-oophorectomy (BSO; removal of ovaries and fallopian tubes), is associated with increased prevalence of sleep disorders and greater Alzheimer’s disease (AD) risk. In older adults, poor sleep heightens AD risk; hypoxia increases markers for incipient AD, including circulating Aβ, and is linked to prefrontal cortical thinning. Thus, we wondered: 1) if this at-risk population of middle-aged women with BSO had sleep hypoxia, measured by oxygen desaturation, and 2) whether this related to decreased prefrontal cortical thickness in women taking and not taking estradiol therapy (ET).

Methods

Sleep and percent oxygen desaturation (SPO2%) were measured via at-home polysomnography (TEMEC). Prefrontal cortical thickness was obtained from T1-weighted structural scans using the CIVET pipeline. We recruited middle-age women with BSO, some of whom were taking ET (BSO+ET; n=15), and some not (BSO; n=15). We compared their sleep and cortical thickness with that of age and education-matched premenopausal controls (AMC; n=18).

Results

Women with BSO (BSO, BSO+ET) had lower minimum SPO2% values than AMC, and thinner right medial orbitofrontal (rmOF) cortices. There was a trend for women with BSO to have lower average SPO2% than AMC. Analyses separating groups based on ET therapy status (BSO vs BSO+ET vs AMC) revealed only trending differences between groups, such that women with BSO tended to have lower minimum SPO2% and thinner rmOF cortices than AMC.

Conclusion

These preliminary results suggest early loss of E2 due to BSO may drive greater drops in SPO2% in middle-age women, and may be related to reduced prefrontal cortical thickness. This study is the first to show hypoxia in women with BSO.

Support (if any)

Ontario Graduate Scholarship Award (to LG), Alzheimer’s Association Research Fellowship (co-sponsored by Brain Canada Foundation; AARF-17-504715 to NJG), Alzheimer’s Society Canada Postdoctoral Fellowship (to AA), Canadian Institutes of Health Research (CIHR) Masters Award (to LG, AB, and RR), Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging (from the Posluns Family Foundation, CIHR, Ontario Brain Institute, and Alzheimer Society of Canada; WJP-150643 to GE)
246 Maintenance of Circadian/Daily Activity Patterns and Cognitive Resilience to Alzheimer’s Pathology in Late Life
Authors: Li Peng , Gao Lei , Yu Lei , Fan Wengqing , Lim Andrew , Buchman Aron , Schneider Julie , Bennett David , Hu Kun
Published: May 2021

Introduction

Many individuals remain free from dementia despite substantial plaque and tangle deposits, the hallmarks of Alzheimer’s disease (AD). Understanding of this cognitive resilience is poor. Evidence suggests that circadian disturbances predict increased risk of incident AD, and that circadian regulation deteriorates as clinical AD progresses. We hypothesize that circadian robustness protects against dementia, and the effect is stronger in individuals with AD pathology than those without.

Methods

We studied 575 deceased participants (age at death: 91.1□6.2; female: 414) in the Rush Memory and Aging Project who underwent brain autopsy at death, had clinical diagnostic opinion of dementia and motor activity assessments with actigraphy of ~10 days before death. Using actigraphy proximate to death, we calculated four circadian metrics: amplitude, acrophase, interdaily stability, and intradaily variability. Logistic regressions, stratified by postmortem pathologic AD diagnosis, were used to examine associations of circadian metrics with odds of dementia, and separately cognitive impairment (CI, including both dementia and mild cognitive impairment [MCI]), adjusting for age at death, sex, education, and time-lag between actigraphy and death.

Results

Based on postmortem assessment, 378 participants met the NIA-Reagan criteria for high/intermediate likelihood AD (AD group), including 197 clinically diagnosed with dementia, 86 MCI, and 85 cognitively intact. Non-AD group consisted of the remaining 197 participants, including 36 with clinical dementia, 47 MCI, and 114 cognitively intact. In the AD group, greater amplitude, greater interdaily stability, and lower intradaily variability were associated with lower odds of CI and dementia, i.e., odds ratios [OR] for CI corresponding to 1-SD changes were 0.54 (95% CI: 0.40-0.71), 0.70 (0.54-0.91), and 0.63 (0.47-0.84), and were 0.46 (0.35-0.60), 0.55 (0.43-0.70), and 0.61 (0.48-0.78) for dementia. In the non-AD group, only amplitude was associated with the odds of CI or dementia, i.e., the ORs corresponding to 1-SD increase was 0.61 (0.42-0.88) and 0.50 (0.31-0.82), respectively.

Conclusion

Better preserved circadian function, as characterized by more pronounced, more stable and less fragmented rest-activity rhythms, links to lower risk of CI or dementia in older people, especially those with pathological AD.

Support (if any)

NIH RF1AG064312, RF1AG059867, R01AG017917, R01AG56352; and the BrightFocus Foundation A2020886S.
248 Behavioural Biometrics: Using Smartphone Keyboard Activity as a Proxy for Rest-Activity Patterns
Authors: Druijff-van de Woestijne Gerrieke , McConchie Hannah , de Kort Yvonne , Licitra Giovanni , Zhang Chao , Overeem Sebastiaan , Smolders Karin
Published: May 2021

Introduction

Rest-activity patterns are important aspects of healthy sleep and may be disturbed in conditions like circadian rhythm disorders, insomnia, insufficient sleep syndrome, and neurological disorders. Long-term monitoring of rest-activity patterns is typically performed with diaries or actigraphy. Here, we propose a fully unobtrusive method to obtain rest-activity patterns using smartphone keyboard activity. This study investigated whether keyboard activities from habitual smartphone use are reliable estimates of rest and activity timing compared to daily self-reports within healthy participants.

Methods

First-year students (n = 51) used a custom smartphone keyboard to passively and objectively measure smartphone use behaviours, and filled out the Consensus Sleep Diary for one week. The time of the last keyboard activity before a nightly absence of keystrokes, and the time of the first keyboard activity following this period were used as markers.

Results

Results revealed high correlations between these markers and user-reported onset and offset of resting period (r ranged 0.74 - 0.80). Linear mixed models could estimate onset and offset of resting periods with reasonable accuracy (R2 ranged 0.60 - 0.66). This indicates that smartphone keyboard activity can be used to estimate rest-activity patterns. In addition, effects of chronotype and type of day were investigated.

Conclusion

Implementing this monitoring method in longitudinal studies would allow for long-term monitoring of (disturbances to) rest-activity patterns, without user burden or additional costly devices. It could be particularly useful in studies amongst clinical populations with sleep-related problems, or in populations for whom disturbances in rest-activity patterns are secondary complaints, such as neurological disorders.

Support (if any):
253 Better and faster automatic sleep staging with artificial intelligence
Authors: Grassi Massimiliano , Caldirola Daniela , Daccò Silvia , Perna Giampaolo , Defillo Archie
Published: May 2021

Introduction

Sleep staging of polysomnography (PSG) is a time-consuming task, it requires significant training, and significant variability among scorers is expected. A new software (MEBsleep by Medibio Limited) was developed to automatically perform sleep scoring based on machine learning algorithms. This study aimed to perform an extensive investigation of its agreement with expert sleep technicians.

Methods

Forty polysomnography recordings of patients that were referred for sleep evaluation to three sleep clinics were retrospectively collected. Three experienced technicians independently staged the recording complying with the scoring rules of the American Academy of Sleep Medicine guidelines. Positive Percent Agreement (PPA), Positive Predictive Value (PPV), and other agreement statistics between the automatic and manual staging, among the staging performed by the three technicians, and their differences were calculated. Bootstrap resampling was used to calculate 95% confidence intervals and statistical significance of the differences.

Results

Automatic staging took less than two minutes per PSG on a consumer laptop. The automatic staging resulted for the most comparable (PPA difference of N1, N3, and REM; PPV difference of N1, N2, N3, and REM) or statistically significantly more in agreement with the technicians’ staging than the between-technician agreement (PPA difference of N2: 3.90%, 95% bootstrap CI 1.79%-6.01%; PPV difference of Wake: 1.16%, 95% bootstrap CI 0.64%/1.67%), with the sole exception of a partial reduction in the positive percent agreement of the Wake stage (PPA difference of Wake -7.04%, 95% bootstrap CI -10.40%/-3.85%). The automatic staging also demonstrated very high accuracy in an indirect comparison with other similar software.

Conclusion

Given these promising results, the use of this software may support sleep clinicians by improving efficiency in sleep scoring.

Support (if any):
258 Blue Blockers’ Ability to Block Circadian-Active Light Emitted from a Tablet
Authors: Bobadilla Vanessa , Mason Brooke , Tubbs Andrew , Fernandez Fabian-Xosé , Killgore William , Grandner Michael
Published: May 2021

Introduction

Short-wavelength light emitted from electronic devices in the evening can harm circadian health by suppressing endogenous melatonin and phase-delaying the timing of the wake-sleep cycle. Blue-blocking glasses are one possible intervention to reduce this exposure. The present study evaluated the differential ability of commercially available blue-blockers to filter out the blue range of visible-spectrum light emitted by a common electronic device.

Methods

A calibrated spectroradiometer (Ocean Insight), cosine corrector, optic fiber, and software package were used to measure the absolute irradiance (uW/cm^2/nm) emitted from a commercially-available computer tablet (iPad) displaying a blank white screen in a closeted dark room. Thirty-one commercially-available blue-blockers were individually placed between the cosine corrector and the tablet. At a standardized distance and angle, the resulting intensity profile was measured and analyzed. Each lens was evaluated individually relative to the light source and then evaluated across subtypes, including red-tinted lenses (RTL), orange-tinted lenses (OTL), orange-tinted lenses with blue reflectivity (OBL), brown-tinted lenses (BTL), yellow-tinted lenses (YTL), and clear reflective blue lenses (RBL).

Results

There was significant variation in tablet-generated light-blocking across the full spectrum (one-way ANOVA, p < 0.0001) and for the 440-530nm range in particular (one-way ANOVA, p < 0.0001). RTL blocked 99%, OTL blocked 81%, OBL blocked 75%, BTL blocked 83%, YTL blocked 33%, and RBL blocked 17% of broadspectrum light (380-780nm). In the 440nm-530nm range, RTL, OTL, and OBL blocked 100% of the emission, while BTL blocked 81%, YTL blocked 47%, and RBL blocked 18% of it.

Conclusion

When using a popular tablet device, RTL, OTL and OBL blocked the most circadian photosensitive parts of the light exposure, indicating they can best preserve the timing of endogenous melatonin secretion in the presence of tablet light at night. By contrast, RBL demonstrated very little efficacy.

Support (if any)

R01MD011600, R01DA051321