bluuebunny/crossref_metadata_2025 huggingface dataset:
0010 Functional Brain Connectivity Alterations in Restless Legs Syndrome are Modulated by Dopaminergic Medication
Authors: Tuovinen N , Stefani A , Mitterling T , Heidbreder A , Frauscher B , Gizewski E R , Poewe W , Högl B , Scherfler C
Published: May 2020

Introduction

Functional brain connectivity studies revealed alterations within thalamic, salience, and default mode networks in patients with restless legs syndrome. The objective of this study was to characterize functional connectivity and network topology in a large cohort of patients with restless legs syndrome compared to healthy controls, and to investigate the modulatory effect of dopaminergic treatment upon connectivity.

Methods

82 patients with restless legs syndrome (untreated, n=30; on dopaminergic medication, n=42; on alpha-2-delta ligands as mono- or polytherapy combined with dopaminergic medication, n=10) and 82 individually age and gender matched healthy controls were studied with resting state functional MRI. Connectivity of twelve resting-state networks was compared with independent component analysis, and among 410 brain regions with graph theoretical modeling.

Results

Patients with restless legs syndrome showed significantly higher connectivity within salience (P=0.029), executive (P=0.001), somatomotor (P=0.050), and cerebellar (P=0.041) networks, as well as significantly (P<0.05) lower cerebello-frontal communication compared to healthy controls. Untreated patients had significantly (P<0.05) lower cerebello-parietal communication compared to healthy controls and connectivity between the thalamus and frontal regions were significantly increased in patients on dopaminergic medication compared to untreated patients and healthy controls (P<0.05).

Conclusion

Networks with higher intra-network connectivity (i.e. salience, executive, somatomotor, cerebellar) and lower between regions connectivity (i.e. cerebello-frontal, cerebello-parietal) in restless legs syndrome correspond to regions associated with attention, response inhibitory control, and processing of sensory information. Dopaminergic medication normalizes the altered cerebello-parietal communication and increases thalamic connectivity to the prefrontal cortex suggesting that these regions are associated with the emergence of symptoms in restless legs syndrome.

Support

The study was funded by a Grant from Translational Research

Fund of the government of Tyrol, Austria, and in-kind resources

of the Medical University of Innsbruck.
0028 Sleep Duration Influences the Kinetics of Stress Granule Formation
Authors: Dougherty M K , Saul C , Carman L , Nelson M D , Tudor J C
Published: May 2020

Introduction

Stress granules are non-membrane bound aggregates of messenger ribonucleoproteins that are biomarkers of cellular stress. It has been shown in cells in vitro that suppression of the mammalian target of rapamycin (mTOR) pathway and its non-mammalian orthologue target of rapamycin (TOR) is associated with an increase in stress granule formation. It has also been shown that the mTOR pathway is suppressed in response to sleep deprivation in mice. Despite the possible connection via the TOR/mTOR pathway, there has not been any previous evidence linking sleep deprivation with stress granule formation.

Methods

Our present investigation uses the nematode Caenorhabditis elegans to model how stress granule formation and clearance are modified by sleep duration. We developed novel strains of C. elegans that model each type of sleep deprivation or enhancement and have RFP-labeled PAB-1 protein, a key component of stress granules. In addition to modifying sleep duration via genetic means, we also sleep deprived wildtype fluorescently labeled animals using mechanical disturbances.

Results

Animals with enhanced stress-induced sleep have stress granules that are smaller in size and cleared faster than wildtype, while sleep deprived animals have granules that are slower to clear (F11,473 = 7.752, ***p < 0.0001, one-way ANOVA). Animals that were manually deprived of stress-induced sleep were similarly slower to clear stress granules (F5,209 = 5.476 ***p < 0.0001, one-way ANOVA). Interestingly, animals genetically deprived of developmentally-timed sleep does not appear to have more stress granules in the middle of their sleep period than the sleeping wildtype stage (F2,42 = 2.659, p = 0.0729, one-way ANOVA).

Conclusion

This work demonstrates that the amount of sleep affects stress granule kinetics, which impacts the flow of genetic information inside cells.

Support

This work was supported by an R15GM122058 (NIH), John P. McNulty scholars program (SJU) and summer scholars program (SJU).
0041 Heart Rate Variability Differs in Resilient vs. Vulnerable Adults from Total Sleep Deprivation and Psychological Stress and Predicts Cognitive Performance
Authors: Yamazaki E M , Rosendahl-Garcia K M , MacMullen L E , Ecker A J , Kirkpatrick J N , Goel N
Published: May 2020

Introduction

There are substantial individual differences (resilience and vulnerability) in neurobehavioral performance from psychosocial stress and sleep loss. However, the time course of heart rate variability (HRV) across baseline, total sleep deprivation (TSD), the combination of TSD + psychological stress, and recovery has not been investigated; in addition, it remains unknown whether HRV and blood pressure (BP) differ in resilient vs. vulnerable individuals and predict individual differences in cognitive performance.

Methods

Thirty-one healthy adults (ages 27–53; mean±SD, 35.4±7.1y; 14 females) participated in a five-day experiment consisting of two 8h time-in-bed (TIB) baseline nights, 39h TSD, and two 8h-10h TIB recovery nights. A modified Trier Social Stress Test (TSST) induced psychological stress on the TSD day. Systolic and diastolic BP and HRV (derived from echocardiographic R-R interval) were obtained at six time points (pre-study, baseline, during TSD, during TSD after the TSST, after recovery, and post-study). Cognitively resilient (n=15) and vulnerable (n=16) groups were defined by a median split on 10-minute Psychomotor Vigilance Test (PVT) TSD performance [total lapses (>500ms response time) and errors]. Repeated measures ANOVA and post-hoc comparisons corrected for multiple testing, examined BP and HRV across time points between groups.

Results

HRV showed a significant time*group interaction: while resilient individuals had significantly lower HRV at pre-study compared to vulnerable individuals, their HRV increased above that of vulnerable individuals with TSD and with TSD + psychological stress. By contrast, systolic and diastolic BP did not show significant time*group interactions and did not predict cognitive vulnerability during TSD.

Conclusion

HRV differed between resilient and vulnerable individuals across TSD, psychological stress and recovery sleep and predicted individual differences in cognitive performance, whereby lower HRV during full-rested conditions predicted resilience to TSD and TSD + psychological stress. HRV, but not BP, is a reliable biomarker of sleep deprivation, psychological stress, and neurobehavioral vulnerability.

Support

NASA NNX14AN49G.
0047 The Change in Melatonin Rhythm Depending on Dementia Severity in Alzheimer’s Disease (AD) Patients
Authors: Lee J , Kim S , Lee S , Suh I , Jang J , Jhoo J
Published: May 2020

Introduction

In Alzheimer’s disease (AD), both sleep and circadian dysfunctions are commonly reported and these are associated with neurodegenerative change. Actually, it has been reported that changes in circadian rhythms in AD were apparently discrete from those seen in normal aging. Previous studies reported the delayed phase in the activity or core body temperature rhythms in severe AD patients compared to normal controls. However, it is unknown whether similar changes in melatonin rhythms occur in AD patients who were not severely demented. We aimed to compare melatonin rhythms depending on dementia severity in mild and moderate AD patients.

Methods

We recruited AD patients of mild or moderate degree who had the Pittsburgh Sleep Quality Index (PSQI) score of 5 or greater and/or complained insomnia symptoms more than 3 times a week for a month. The patients were classified according to their Clinical Dementia Rating (CDR) score into 3 groups (CDR=0.5, 1, 2). The dim light melatonin onset (DLMO) was determined from seven hourly saliva samples obtained in the laboratory prior to sleep onset measured by actigraphy. The phase angle between the DLMO and sleep onset (PA-SO), and that between the DLMO and midsleep time (PA-MST) were calculated. Each group included 13, 13 and 6 AD patients with the CDR score of 0.5, 1 and 2, respectively. The DLMO and PA were compared among the 3 groups, and correlation analyses of the DLMO and PA with the MMSE in the Korean version of CERAD Packet (MMSE-KC) scores were done in total patients.

Results

There was no significant difference in the DLMO and PA between the 3 groups. The MMSE-KC score was positively correlated with the DLMO and negatively correlated with the PA-MST.

Conclusion

There were no changes in melatonin rhythms according to dementia severity in mild and moderate AD patients with sleep complaints. However, our study showed that earlier melatonin phase was associated with more impaired cognitive function.

Support

Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1A2B4003493)
0073 Left Anterior Cingulate Hyperarousal During Sleep Anxiety-Inducing Emotional Tasks Performance in Patients with Insomnia Disorder
Authors: Kang S , Ma H , Cho S , Kang J , Kim N
Published: May 2020

Introduction

Patients with insomnia frequently experience sleep/insomnia-related anxiety; this anxiety has been associated with hyperarousal. We investigated the underlying brain function changes in patients with insomnia during emotional task performance that induced sleep/insomnia-related anxiety.

Methods

Functional magnetic resonance imaging (fMRI) was performed during emotional task performance in healthy individuals and patients with insomnia who met the diagnostic criteria of insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and had chronic insomnia for more than 6 months. The participants underwent fMRI scanning during three types of emotional task performance—insomnia-anxiety task, reading sentences that cause insomnia-related anxiety; general-anxiety task, reading sentences that cause anxiety for everyone; and neutral task, reading neutral sentences that do not cause emotional anxiety. The images obtained from fMRI and blood oxygen level-dependent (BOLD) signal changes were compared between patients with insomnia and healthy controls. Interim analysis was performed with the data of 13 patients with insomnia and 9 controls.

Results

The brain activity in the left anterior cingulate was higher during insomnia-anxiety task performance than that during general-anxiety task performance in the insomnia group (voxel-wise uncorrected p < 0.05; cluster size, 100). In the insomnia group, the brain activity during insomnia-anxiety task performance was not lower in any brain area than that during general-anxiety task performance.

Conclusion

We show that patients with chronic insomnia experience sleep anxiety related with hyperarousal in the left anterior cingulate area. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).
1004 Smith-<Magenis Syndrome (SMS) Circadian Abnormalities And Biological Rhythms
Authors: Brooks J , Gibson M , Kite K , Czeisler E , Fisher M , Xiao C , Polymeropoulos C , Polymeropoulos M
Published: May 2020

Introduction

SMS is a rare neurodevelopmental disorder that manifests with craniofacial abnormalities, behavioral disturbances, and a severe sleep disorder. It has been reported that many SMS patients have an inverted melatonin secretion pattern (peaking during the daytime) although a small minority have near normal patterns. The goal of this study was to better characterize the intra- and inter-patient variability of melatonin secretion patterns and investigate a potential relationship with sleep behavior in SMS patients.

Methods

In this observational study, sleep behaviors of patients (N=8, 1 female, ages: 7 - 35) with SMS were characterized through caretaker surveys. On 3 separate occasions, patients had hourly serum melatonin levels sampled for 36 hours. From these data, peak serum melatonin concentration and time of peak concentration were determined. Inter- and intra-patient variability was characterized by zero lag correlation of the melatonin concentration timeseries across and within patients, respectively. The relationship between peak melatonin concentration, peak time, and sleep latency was analyzed by a generalized linear model, GLM.

Results

Peak melatonin concentrations varied across SMS patients with a range of 3.55pg/ml - 49.65pg/ml (mean 14.18 ± 15.19pg/ml). Time of peak melatonin concentrations ranged from 0400h-2100h (mean 1422 ± 6h). Correlation coefficients characterizing intra-patient variability ranged from -0.0098 to 0.89 (mean 0.55 ± 0.2533). Correlation coefficients characterizing inter-patient variability ranged from -0.75 to 0.79 (mean of 0.18 ± 0.52). Sleep latency ranged from 8.4min - 36.35min (mean of 21.99 ± 9.77 min). GLM analysis demonstrated a significant, positive effect of peak time with sleep latency (p=0.022).

Conclusion

Consistent with previous findings, our study confirms that SMS patients have abnormal circadian rhythms. Our work extends this body of literature by demonstrating a significant degree of inter-patient variability with relatively stable intra-patient variability. Preliminary evidence suggests that the timing of melatonin peak may be related to sleep onset latency.

Support

This work was supported by Vanda Pharmaceuticals Inc.
1007 Sociodemographic, Lifestyle and Dietary Correlates of Actigraphy-Measured Irregular Sleep Schedules in the Multi-Ethnic Study of Atherosclerosis
Authors: Huang T , Chung J , Reid M , Johnson D A , Billings M E , Klerman E B , Redline S
Published: May 2020

Introduction

Increasing evidence links daily variability in sleep schedules to increased cardiometabolic risk. Little is known, however, regarding sociodemographic and behavioral correlates of irregular sleep schedules that may help identify causes or consequences of irregular sleep.

Methods

Among 1,946 participants from the Multi-Ethnic Study of Atherosclerosis, we examined the cross-sectional associations of irregular sleep schedules with sociodemographic, lifestyle, dietary factors, and actigraphy-based indices of rest-wake rhythms using multiple linear regression with adjustment for age, sex, race/ethnicity, education, income, marital status and work schedules. Sleep regularity was assessed using standard deviations (SD) in actigraphy-measured sleep duration and sleep onset timing across 7 days.

Results

Compared to Whites, the 7-day sleep duration SD (95% CI) was 17.4min (12.6, 22.2) higher in African-Americans, 10.4min (4.8, 16.0) higher in Hispanics and 7.9min (1.3, 14.4) higher in Chinese. Shift versus regular work was associated with 11.4min (5.1, 17.7) higher sleep duration SD. Irregular sleep duration was associated with lower income (p=0.006), higher depressive symptoms (p<0.0001), higher BMI (p=0.004) and current smoking (p=0.06). Higher sleep duration variability was associated with lower Alternative Healthy Eating Index (p=0.01), mainly due to suboptimal intakes of fruits, whole grains and nuts/legumes. No associations were observed for age, sex, education, marital status or number of meals per day. While sleep duration variability was not associated with self-reported physical activity level or actigraphy-measured 7-day mean activity count, sleep duration SD was inversely associated with relative amplitude (difference between the most versus the least active period; p<0.0001) and inter-daily stability (synchronization between rest-activity patterns and environmental zeitgebers; p<0.0001) of 24-h rest-activity patterns. Similar results were observed for sleep onset timing SD.

Conclusion

Substantial differences by sociodemographic factors exist regarding the consistency of day-to-day sleep schedules. Irregular sleep schedules are associated with overall circadian disruption across the day and some unhealthy lifestyle behaviors. Future studies are needed to understand temporal relationships of the observed associations.

Support

NIH grants K01HL143034, R35HL135818
1019 Subjective Sleep Quality and Sleep Recommendations Received by Patients with Cancer and Depression
Authors: Price S N , Trejo J I , Halaby L M , Guzman D , Liu Y , Verlaque R , Hamann H A , Weihs K L
Published: May 2020

Introduction

Diagnoses of cancer and depression are independent predictors of poor sleep, but less is known about subjective sleep quality among patients with both of these potential risk factors or about recommendations made by physicians for improving sleep among this population. This study examines correlates of poor subjective sleep quality and sleep recommendations received by patients with cancer enrolled in the Collaborative Oncology Project to Enhance Depression Care (COPE-D), a collaborative care intervention to treat depression among patients with cancer.

Methods

Participants were 74 adult cancer survivors. Demographic and clinical characteristics, subjective sleep quality, and provider sleep recommendations were obtained by patient self-report prior to intervention. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the PROMIS Global-10, and depressive symptoms were measured using the PHQ-9.

Results

81% of patients reported significantly poor sleep quality (PSQI global scores >8) and 75.3% reported poor sleep efficiency (<85%). The strongest correlates of poor sleep quality were worse global mental (r=-.431, p<.01) and physical health (r=-.40, p=<.01). 63% reported pain interference with sleep at least once per week. Cancer type and stage, current cancer treatment, and depressive symptoms were not significantly associated with poor sleep quality (p’s>.05). 12% of those reporting sleep disturbances since their cancer diagnosis had not discussed these problems with a medical provider. Among those who talked to their provider, 41.8% reported receiving sleep hygiene recommendations, 40.5% anti-depressants, 14.9% sedative-hypnotic medication (e.g. zolpidem, benzodiazepines), 10.8% cognitive behavioral therapy, 9.6% antihistamines, 6.8% melatonin, and 4.1% were recommended meditation or hypnosis.

Conclusion

Cancer patients seeking treatment for depression report very high rates of poor subjective sleep quality, which was most strongly associated with global mental and physical health. Improved screening and patient-provider communication about sleep may be especially beneficial for this at-risk population.

Support

Merck Foundation Alliance to Advance Patient-Centered Cancer Care
0104 The Effect of Time, Sleep, and Wake on Motor Memory Consolidation: A Partial Replication of Walker, Et Al. (2002)
Authors: Tucker M , Wani I
Published: May 2020

Introduction

Findings from Walker, et al (2002) ‘Practice with Sleep Makes Perfect: Sleep-Dependent Motor Skill Learning’ demonstrate that performance on a widely used motor memory task (motor sequence task (MST)) benefits from a 12hr period of sleep (and not wake) even if the sleep period does not occur for approximately 12hrs after task acquisition, suggesting that sleep is crucial for motor memory consolidation. Using a larger sample, we attempted to replicate this finding, which is derived from Groups B & D from Walker et al (2002).

Methods

Participants (64 medical students: Age 21.2±0.8; N=33 females) were trained on the MST in the morning (10am; N=40) or evening (10pm; N=24) and then returned 12 and 24hrs later to be retested. The MST is a simple typing task that requires participants, at training, to type a 5-digit sequence (e.g., 4-1-3-2-4) as fast and accurately as possible over a series of 12 30-second trials with a 30-second break between each trial. At each retest, participants performed three 30-second trials.

Results

With 75% of the data collected we have found that when sleep follows training in the evening (first 12hr interval), the number of correctly typed sequences increased by 19.1% (cf. 20.5% in Walker (2002)). After a subsequent day of wake (second 12hr interval) performance increased by an additional 7.3% (cf. 2.0%). However, when a day of wake spanned the first 12hrs following training, performance increased by 14.5% (cf. 3.9%) followed by another 14.5% increase over the subsequent night (cf. 14.4%). Performance differences between sleep and wake participants were nonsignificant over the first 12hrs (p=0.38) and second 12hrs (p=0.49).

Conclusion

With most of data collection complete, our findings only partially replicate those of Walker et al (2002), and may draw into question the robustness of sleep for the processing motor memory.

Support

None
1029 Objectively-Measured Sleep Following a Time Restricted Eating Intervention in Adults With Obesity
Authors: Simon S L , Fleischer J G , Manoogian E N , Panda S , Mashek D G , Chow L
Published: May 2020

Introduction

Time-restricted eating (TRE), limiting food intake to a consistent daily window, is emerging as a novel weight loss intervention but impact of TRE on sleep remains unclear. Prior studies reported mixed results but are limited by subjective sleep measurements and lack of a randomized control group. Thus, we examined changes in actigraphy-measured sleep following a 12-week TRE protocol.

Methods

Participants were 20 adults ages 18-65 years with BMI ≥24kg/m2. Participants were randomized to either TRE (8-hour eating window) or non-TRE (typical eating). At baseline and follow-up, all participants had anthropometric measurements, oral glucose tolerance test, logged eating occasions in a smartphone application, and wore an ActiGraph Link for two weeks. Independent samples t-tests compared groups on actigraphy-estimated sleep variables. Pearson correlations examined associations between sleep variables with health outcomes.

Results

The TRE (N=11) and non-TRE groups (N=9) were predominantly female and had a baseline eating window of approximately 15 hours. There were no differences in actigraphy-assessed sleep variables at baseline or follow-up between groups. Participants did not significantly change their sleep from baseline to follow-up. Median weekday sleep duration was 6.2 hours at follow-up for all participants, suggesting insufficient sleep compared to the recommended 7-9 hours of sleep. Participants who obtained greater than the median weekday sleep duration at follow-up had significantly lower BMI, better insulin sensitivity (HOMA and Matsuda Index), and greater percent improvement in insulin sensitivity.

Conclusion

Our data show that TRE does not significantly alter sleep behaviors in participants with obesity. However, longer sleep duration at follow-up was associated with lower BMI, better insulin sensitivity, and greater improvement in insulin sensitivity, indicating that sleep may be an important variable to consider in dietary interventions. Future research examining behavioral sleep strategies in combination with TRE is needed to evaluate whether improved sleep leads to better weight loss and glycemic outcomes for individuals with obesity.

Support

This work was support by the Healthy Foods Healthy Lives program (17SFR-2YR50LC to LC) and the National Institutes of Health (NIH National Center for Advancing Translational Sciences, UL1TR002494).
1061 Problems During Daytime Due To Poor Sleep Are Associated With Indicators Of Poor Dental Health In A Largely Non-smoking Population
Authors: Postolache T T , Wadhawan A , Daue M L , Dagdag A , Reynolds M A
Published: May 2020

Introduction

Growing evidence connects periodontal disease, a major and modifiable cause of local and systemic inflammation, with metabolic and cardiovascular morbidity and mortality, as well as mental illness. Sleep has been previously predictively associated with metabolic and psychiatric morbidity and mortality, and has recently been linked with periodontal disease. We are now evaluating associations between self-reported insomnia measures and surrogate indicators of periodontal disease in a population with a very low prevalence of smoking — a major confounder in previous studies.

Methods

Dental and sleep questionnaires (Pittsburgh Sleep Quality Index) were obtained from 3881 Old Order Amish from Lancaster county. Difficulty falling or staying asleep, sleep quality, problems during the day due to poor sleep, and sleepiness during daytime were related to self-reported loose teeth, partial dentures, full dentures and any dentures using linear models with adjustment for age and sex.

Results

Significant associations emerged between problems falling asleep and loose teeth (p<0.05), problems staying asleep and any dentures (p<0.05), sleep quality with loose teeth and partial, as well as complete dentures (p<0.05 for both). Problems during daytime due to poor sleep were associated with loose teeth (p<0.05), any dentures (p<0.003) and full dentures (p<0.0001 — the only associations resisting Bonferroni correction). Sleepiness during daytime, which is the most important marker associated with sleep apnea was not associated with any dental health measures.

Conclusion

Limitations include not accounting for family aggregation, limited generalizability, not fully differentiating between respiratory versus non-respiratory sleep impairment, and periodontal versus traumatic dental pathology. Yet, the results of our study, which minimizes the strong potential confounding by smoking, confirm associations between sleep-related problems and periodontal disease, and justify future longitudinal and interventional research to dissect causality and identify multi-target treatment modalities.

Support

This work was supported by the Mid-Atlantic Nutrition Obesity Research Center Preliminary Developmental NORC grant (Postolache, PI), a sub-award of the parent grant P30 DK072488 (Mitchell, PI), and intramural funds from the University of Maryland, Baltimore.
1069 Posttraumatic Stress Disorder is Associated With Poorer Sleep Specific Quality of Life, but Not With Sleep Apnea
Authors: Holty J C , Pandey A , Ho J Q
Published: May 2020

Introduction

The degree that posttraumatic stress disorder (PTSD) contributes to obstructive sleep apnea (OSA) or sleep specific quality of life (QOL) remains uncertain.

Methods

We evaluated consecutive military veterans (n=3,155) with suspected OSA using multivariable regressions to test associations between sleep and QOL measures including the apnea-hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI) and Short-Form-12 mental component score (MCS). A mental health expert determined PTSD presence with severity measured utilizing the PTSD Checklist (PCL). Subjects were evaluated with prospectively collected questionnaires, sleep studies, and detailed electronic medical record reviews.

Results

Current-PTSD (n=1,172, 37%) were younger, more likely single, unemployed on disability, report non-white ethnicity or have current alcohol or drug dependence, report past suicide attempt, have current insomnia, restless sleep or nightmares, report lower MCS or higher Epworth Sleepiness, Fatigue Severity, Beck Depression Inventory-II (BDI) and PSQI scores than non-PTSD (n=1,880) or past-PTSD (n=103) veterans. Among current-PTSD, instigating trauma was 75% combat and 13% sexually related. In multivariable regressions, male gender (OR 4.5, p<0.001), age >65 years (OR 2.3, p<0.001), BMI ≥35 kg/m2 (OR 3.5, p<0.001), prior stroke (OR 1.8, p<0.006), current hypertension (OR 1.4, p<0.001), neck circumference >40 cm (OR 1.3, p=0.032), and non-white ethnicity (OR 1.2, p=0.034) were associated with moderate-severe OSA (AHI ≥15/h), however current (OR 0.9, p=0.06) or past-PTSD (OR 1.2, p=0.41) were not. PCL (p=0.937) was not associated with AHI. Factors most associated with lower MCS included current-PTSD (scaled standardized beta[SSB]=0.09, p=0.001), depression (SSB=0.09, p=0.001), age <50 years (SSB=0.09, p<0.001), non-white ethnicity (SSB=0.07, p=0.004), female gender (SSB=0.06, p=0.007) or single/no-partner (SSB=0.05, p=0.03). Likewise, factors most associated with a higher PSQI included depression (SSB=0.19, p<0.001), current-PTSD (SSB=0.15, p<0.001), unemployed on disability (SSB=0.14, p<0.001), non-white ethnicity (SSB=0.13, p<0.001) or age <50 years (SSB=0.10, p=0.001). Among current-PTSD, higher PSQI was associated with BDI ≥20 (SSB=0.31, p<0.001), PCL ≥50 (SSB=0.24, p<0.001) and non-white ethnicity (SSB=0.11, p=0.034), but not with moderate-severe OSA (SSB= -0.09, p=0.095).

Conclusion

In the largest PTSD sleep cohort to date, PTSD is associated with insomnia, restless sleep, poorer sleep specific QOL, and greater daytime sleepiness and fatigue, but is not associated with OSA.

Support

None
1076 Self-referential Language In Trauma Narratives Predicts Shorter Sleep Duration In Women With Ptsd
Authors: Bullock A , Burns A , Taylor E , Grandner M , Miller M , Alkozei A , Killgore W
Published: May 2020

Introduction

The use of self-referential language, defined as first-person singular pronouns (e.g. I, me, my), in trauma narratives has been found to predict post-traumatic stress disorder (PTSD) severity. Additionally, taking a self-immersed perspective correlates with higher blood pressure reactivity than a self-distanced perspective. Given this relationship between self-immersed perspectives and physiological processes, we investigated the relationship between self-referential language and sleep in people with PTSD, as dysfunctional sleep is a major treatment target in this disorder.

Methods

Seventy-five participants (49 females; Mage=31.8, SDage=8.8) meeting DSM-5 criteria for PTSD were administered the PTSD Checklist for the DSM-5 (PCL-5) and the Pittsburg Sleep Quality Index (PSQI). Sleep duration was assessed with the PSQI. Participants provided typed descriptions of their traumatic event, which were then analyzed using the Linguistic Inquiry and Word Count 2015 software to count instances of first-person singular pronouns (“I” words). Linear regression, with PCL-5 scores and “I” words entered stepwise, was used to predict scores on the PSQI sleep duration subscale. Use of “I” words between the sexes was also compared.

Results

For females but not males, PTSD severity significantly predicted sleep duration (R2=.207, p=.001). Additionally, the number of “I” words in the trauma narratives predicted an additional 8% of the variance in sleep duration for females (R2 change=.083, β=.288, p=.029) but not males. Females used significantly more self-referential language in their narratives (M=11.84, SD=8.42) compared to males (M=5.25, SD=6.10, p=.001).

Conclusion

After controlling for PTSD severity, self-referential language in trauma narratives significantly predicted shorter sleep duration in females. While speculative, this finding suggests that treatment approaches for PTSD may benefit from a focus on targeting self-referential processes to improve sleep and PTSD in females but not males. As dysfunctional sleep is a hallmark of PTSD, further investigation into this relationship may illuminate a new treatment avenue for this disorder.

Support

W81XWH-14-1-0570
0112 Lucid Dreaming Associated with Positive Waking Mood
Authors: Carr M , Stocks A , Mallett R , Konkoly K , Freegard M , Hicks A , Crawford M , Pigeon W , Schredl M , Bradshaw C
Published: May 2020

Introduction

Lucid dreaming (being aware that one is dreaming) is typically a positive experience that may enhance positive mood even after waking. There is concern, however, that lucid dreaming may interfere with sleep quality. In the current experiment, participants practiced common lucid dream induction techniques over the course of a week, and kept a daily sleep and dream diary. The study objective was to assess relationships between dream lucidity and subjective sleep quality, dream emotional content, and subsequent waking mood.

Methods

There were 32 participants aged 19–33 in this open label, single arm study (mean=22.63±3.48; 6 males, 24 females). All participants completed a sleep and dream diary for 7 days that included scaled items (1–7 scale) concerning subjective sleep quality, negative and positive emotional intensity of a dream (if recalled). Participants also completed a 19-item lucidity questionnaire, and the Positive and Negative Affect Schedule. Average scores for the week were computed for all measures and Pearson’s correlations conducted between lucidity and all other measures. Participants with no dream recall (n=5) were excluded. Within-subjects analyses were undertaken by selecting each participant’s highest and lowest lucidity night (n=22; 5 participants with only minimum lucidity excluded).

Results

Positive correlations were found between lucidity and dream positive emotion (r=.490, n=27, p=.009) and positive waking mood (r=.638, n=27, p<.001); there were no other significant correlations (all p>.1). Higher lucidity was associated with more positive dream content (t(21)= -3.214, p=.004) and positive waking mood (t(25)=-4.568, p<.001); no other significant differences were observed.

Conclusion

These data indicate that lucidity is associated with positive dreams and waking mood, with no detriment to self-reported sleep quality. The findings provide preliminary support of lucid dreaming as an intervention to improve wellbeing and mood in the short term.

Support

N/A
1130 Insomnia Short Sleep Phenotype is Associated With Frailty in Patients With Mild Cognitive Impairment (MCI)
Authors: Basta M , Vgontzas A , Koutentaki E , Zaganas I , Fernandez-Mendoza J , Belogianni C , Panagiotakis S , Puzino K , Simos P
Published: May 2020

Introduction

Insomnia short sleep phenotype is associated with cardiometabolic morbidity and mortality and neuropsychological impairment. In elderly untreated insomnia is associated with worse cognitive performance. The goal of the study was to examine the association between insomnia, objective sleep duration and physical and mental health in elderly patients with Mild Cognitive Impairment (MCI).

Methods

A sub-sample of 105 patients with MCI (mean age: 75.9 years, males 36%) were recruited from a large population-based cohort (Cretan Aging Cohort) in the island of Crete, Greece of 3,140 elders (≥ 60yrs). All participants underwent a complete medical history/ physical examination, extensive neuropsychiatric and neuropsychological evaluation and 3-day 24hr actigraphy. Insomnia was defined based on a question “do you have insomnia for more than a year”. Frailty was assessed with the Simple “Frail” Questionnaire Screening Tool. Comparisons between patients with insomnia and without insomnia were made using ANOVA controlling for age, gender and BMI.

Results

MCI patients with insomnia (n=23) compared to those without insomnia (n=82), had significantly shorter objective total sleep time (TST: 377 vs. 410 min, p=0.05) and significantly higher scores on the Geriatric Depression Scale and the Hospital Anxiety Scale (both p <0.001). Furthermore, total frailty score, as well as scores in individual items, were significantly lower in MCI patients with insomnia (p<0.01). This association remained significant after controlling for demographics, depression and anxiety. Finally, there was a statistical trend of association between insomnia and hypertension (p= 0.1).

Conclusion

In MCI patients, insomnia is associated with objective short sleep duration, and frailty. Improving insomnia and lengthening sleep duration may decrease frailty, a major problem associated with morbidity, disability and mortality in elders with cognitive decline.

Support

National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant: MIS 377299).
1145 Longitudinal Association Between Circadian Activity Rhythms And Risk Of Incident Parkinson’s Disease In Older Men
Authors: Leng Y , Blackwell T , Cawthon P M , Ancoli-Israel S , Stone K , Yaffe K
Published: May 2020

Introduction

Disruption in circadian activity rhythms are very common in older adults, particularly among those with neurodegenerative diseases. However, the longitudinal association between circadian disruption and subsequent risk of developing neurodegenerative diseases, including Parkinson’s disease (PD), is unclear.

Methods

We examined rest-activity rhythms in 2930 community-dwelling older men (mean age 76.3 ± 5.5 years) without PD and followed them for incident PD over the next 11 years. 24-h rest-activity rhythm parameters (amplitude, mesor, robustness, acrophase) were generated by wrist actigraphy-extended cosinor analysis. Incident PD cases were identified based on physician-diagnosed PD between 2005 and 2016. Logistic regression was used to determine the association between quartiles of rest-activity parameters and risk of incident PD.

Results

78 (2.7%) men developed PD during 11 years of follow-up. The risk of PD increased with decreasing circadian amplitude (strength of the rhythm), mesor (mean level of activity) or robustness (how closely activity follows a cosine 24h pattern); p for trend across quartiles <0.05. After accounting for demographics, clinic site, education, depressive symptoms, body mass index, physical activity, benzodiazepine use, alcohol, caffeine, smoking, comorbidities and baseline cognition, those in the lowest quartile of amplitude, mesor or robustness had approximately three times the risk of developing PD compared to those in the highest quartile of amplitude [ORs (95% CI)= 3.11 (1.54-6.29)], mesor [3.04 (1.54-6.01)] and robustness [2.65 (1.24-5.66)]. The association remained after further adjustment for nighttime sleep disturbances and sleep duration. These associations were somewhat attenuated, but the pattern remained similar after excluding PD cases developed within 2 years after baseline. Acrophase was not significantly associated with risk of PD.

Conclusion

Older men with reduced circadian rhythmicity had an increased risk of incident PD over 11 years. Circadian disruption in the elderly may represent an important prodrome or risk factor for PD. Randomized trials should evaluate whether strategies to improve circadian function impact risk of PD.

Support

This work was supported by the NIA, NIAMS, NCATS, NIH Roadmap for Medical Research and the NHLBI under the grant numbers: U01AG027810, U01AG042124, U01AG042139, U01AG042140, U01AG042143, U01AG042145, U01AG042168, U01AR066160, UL1TR000128, R01HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, and R01HL070839.
1150 Obstructive Sleep Apnea-dependent Racial/ethnic And Sex-specific Mechanisms Underlying Alzheimer’s Disease Risk: A Retrospective Cohort Analysis Of In-lab PSG Sleep Study Data
Authors: Bubu O M , Turner A D , Parekh A , Mullins A , Kam K , Umasabor-Bubu O Q , Mbah A K , Williams N J , Varga A W , Rapoport D M , Ayappa I , Jean-Louis G , Osorio R S
Published: May 2020

Introduction

We examined race and sex-specific biologic mechanisms of the relationship between obstructive sleep apnea (OSA) and incident AD.

Methods

Retrospective cohort analysis utilizing in-lab PSG sleep study data conducted among older adults between 2001 and 2005. OSA was defined using AHI4%. Participants had no history of cognitive decline or AD at baseline and included 663 (284 Non-Hispanic White (NHW), 207 Black/African-American (AA) and 172 Hispanic) OSA-patients matched on age, sex, race, BMI, 1:1 ratio to 663 (unexposed cohort I from sleep clinic) and 1:4 ratio to 2652 (unexposed cohort II from non-sleep clinics) non-OSA individuals. Incident AD was assessed annually from 2001-2013 with ICD-9-CM code 331.0. Adjusted cox proportional hazard regression models examined race and sex-specific biologic mechanisms including hypoxia, fragmentation and duration measures of OSA and AD risk.

Results

Of the 3,978 participants, 2,148 (54%) were women. Mean age at baseline was 72.6 (7.3) years. Over a mean follow-up time of 8.6 (1.4) years, 358 (9%) individuals (212 female) developed AD (119 NHW, 134 AAs, and 105 Hispanics). Relative to non-OSA individuals, OSA-patients had a higher risk of incident AD, with AAs and females showing stronger risk estimates (aHR: 2.24, 1.83, and 1.73, P <.001 for all, for AAs, Hispanics and NHW respectively; and aHR: 2.38, and 1.37, P <.001 for all, for female and male respectively). Measures of hypoxia, sleep fragmentation and sleep duration were associated with increase AD risk (P <.01 for all). Relative to NHW, AAs and Hispanics demonstrated up to 20% stronger effects/estimates on hypoxia and sleep duration measures. Relative to males, females demonstrated up to 25% stronger effects/estimates on sleep fragmentation measures, and 15% weaker effects/estimates on hypoxia measures (P <.01 for all).

Conclusion

Among OSA-patients, mechanisms related to hypoxia, sleep fragmentation and duration measures increase AD risk and may underlie race/ethnicity and sex disparities in AD.

Support

NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01HL118624, R21AG049348, R21AG055002, R01AG056031, R01AG022374, R21AG059179, R01AG056682, R01AG056531, K07AG05268503, K23HL125939)
1168 Preliminary Impact of a Sleep Health Educational Module for Social Work Students
Authors: Spadola C , Groton D , Lopez R , Burke S L , Hilditch C J , Pandey A , Littlewood K , Zhou E S , Bertisch S M
Published: May 2020

Introduction

Social workers are well-positioned to promote healthy sleep behaviors among underserved populations; however sleep health training is rarely integrated into social work curriculums. To address this gap, our interdisciplinary team developed a 2-hour online sleep health educational module for social work students. The module was grounded in best e-learning pedagogical principles, and based on qualitative formative research. We tested the initial impact and acceptability of the module.

Methods

We recruited 32 social work students at a Florida University via a departmental listserve. Pre- to post-intervention changes in the Sleep Beliefs Scale (SBS) and the Sleep Practices and Attitudes Questionnaire (SPAQ) were assessed using Wilcoxon Signed-Rank tests. We conducted qualitative research to assess intervention acceptability,and to inform future iterations of the program.

Results

Mean age was 29.5±11.6 yrs, 100% were female, and primarily Non-Hispanic White (41.9%), followed by African American/Black (35.5%), and Hispanic/Latino (22.6%). Results showed pre/post intervention improvements in both the Sleep Beliefs Scale (14.7±2.2 vs.16.9±2.6 [p=.002]; higher score=higher knowledge) and SPAQ (2.1±0.6 to 1.5±0.6 [p=.001]; lower score=higher importance of sleep) indicating improvements in knowledge surrounding healthy sleep behaviors and the importance of sleep for overall health (respectively). Qualitative data supports the intervention’s acceptability and utility. When asked what participants liked best about the module, responses included: “I was educated and am better prepared to offer some insight to my clients and staff”; “..they offer resources we can use for ourselves and our clients;” and “easy to navigage, and full of useful information.” Suggestions for improvement included shortening the module’s length.

Conclusion

Assessment of an online sleep health educational module indicates a promising impact on sleep health knowledge. A larger study is planned to more definitively evaluate the module’s impact and acceptability among social work students.

Support

American Academy of Sleep Medicine Foundation
1189 Recruiting, Training, And Implementing Sleep Health Educators In Community-based Research To Improve Sleep Health
Authors: Aird C , Seixas A , Moore J , Nunes J , Gyamfi L , Garcia J , Blanc J , Williams N , Zizi F , Jean-Louis G
Published: May 2020

Introduction

Adherence to OSA assessment and treatment is low among racial/ethnic minorities, particularly among blacks. Navigating patients along the continuum of care from assessment to treatment adherence requires motivation, social support, and self-efficacy. Previous studies indicate that community health educators can provide motivation, social support, and skills to patients to better navigate the complex OSA care continuum. However, recruiting, training, and implementing sleep health educators in clinical or research settings is complex. For the current study, we describe how we recruit, train, and implement sleep health educators in research and clinical settings and assess what makes a sleep health educator successful.

Methods

We recruited and trained twenty-five self-identified black sleep health educators for a randomized clinical trial (R01MD007716) focused on increasing OSA assessment and treatment adherence among blacks. During recruitment, we assessed key personality attributes that translate to being an effective sleep health educator, via behavioral and personality surveys, focused groups, and process forms filled out by educators. Sleep health educators underwent an 8-week training program on sleep health and motivational interviewing. In order to be certified, sleep health educators had to pass a written and scenario-based assessment. During the implementation phase of the trial, we assessed how many interviews each health educator conducted and whether individual characteristics were related to how many interviews.

Results

Of the trained educators, 80% were female, ranging from 25 to 58 years old. They all completed at least high school. All educators rated the program highly and were very satisfied with dispensing tailored sleep health education. Educators who displayed the highest knowledge about sleep health, provided frequent emotional and strategic support, committed to helping their assigned participants, and who rated their rapport highly with their assigned participants were most effective in getting their participant to adhere to OSA assessment and treatment.

Conclusion

Sleep health educators can be vital to increasing OSA assessment and treatment adherence among blacks. In order to ensure success, sleep health educators must undergo a thorough recruitment, training, and implementation and dissemination process.

Support

K01HL135452, R01MD007716, R01HL142066, K01HL135452,and K07AG052685