bluuebunny/crossref_metadata_2025 huggingface dataset:
612 Early Protective Factors of Child Sleep Quality Trajectory: Results from the Healthy Brain and Behavior Study
Authors: Dai Ying , Liu Jianghong
Published: May 2021

Introduction

Poor sleep quality is associated with many adverse health outcomes for children and adolescents. Recently, increasing knowledge has been gained for understanding risk factors for poor sleep, but there is little knowledge about early protective factors for sleep quality in young people. The purpose of this study was to investigate whether prenatal obstetric and psychosocial factors, and happiness during childhood would predict child sleep quality across time.

Methods

A total of 290/454 children aged 11–12 years in the Healthy Brain and Behavior Study were included in analysis. Prenatal obstetric and psychosocial factors were recalled by mothers through structured interviews. Childhood happiness and child sleep quality across 1, 3, 5, 11, and 12 years of age were reported by mothers through questionnaires. Two-level linear mixed-effects modeling was conducted.

Results

Overall, children’s average sleep quality increased from 1 to 5 years, followed by a decrease during 5 to 12 years. Prenatal care (β = 0.376, SE = 0.169, p = 0.027), better maternal psychosocial support during pregnancy (β = 0.045, SE = 0.016, p = 0.007), and higher childhood happiness (β = 1.333, SE = 0.274, p < 0.001) were associated with better sleep quality across childhood. Childhood happiness during previous developmental age predicts better sleep quality at later age (β = 1.526, SE = 0.350, p < 0.001). Other prenatal factors including prenatal gestation and parturition history, substance use during pregnancy, maternal labor and delivery complications, and neonatal conditions were not associated with child sleep quality trajectory.

Conclusion

Prenatal care, prenatal psychosocial support, and childhood happiness are protective factors of child sleep quality across 1–12 years of age. Future prospective longitudinal studies are needed to understand the causal relationship between early protective factors and sleep quality in childhood and adolescence.

Support (if any)

This study is supported by the Pennsylvania Department of Health (SAP# 4100043366), the Clinical & Translational Research Center, Perelman School of Medicine, University of Pennsylvania (grant number UL1-RR-024134).
614 The Development and Psychometrics of an Assessment of Children’s Sleep Environments
Authors: Peltz Jack , Rogge Ronald , Buckhalt Joseph , Elmore-Staton Lori
Published: May 2021

Introduction

Approximately half of school-aged children (ages 5–18) get either insufficient sleep during school nights or barely meet the required amount of sleep expected for healthy functioning (National Sleep Foundation, 2014).This percentage increases as children develop into adolescents (National Sleep Foundation, 2006). Accordingly, sleep problems and insufficient sleep are so pervasive that they could be considered an epidemic due to their adverse impact on children’s mental and physical health (Owens, 2015; Shochat et al., 2014). Fundamental to children’s sleep health is their sleep environment (Billings et al., 2019; Spilsbury et al., 2005). Despite its importance, however, there remains a noticeable absence of valid and reliable assessments of this construct. The current study sought to develop a measure of children’s sleep environments to support research and clinical work on youth’s sleep health.

Methods

A total of 813 parents (Mage = 40.6, SD = 8.6; 72% female) completed an online survey regarding their child’s (Mage = 10.5, SD = 3.8; 45% female) sleep environment and sleep-related behavior. The majority of families identified as Caucasian (approximately 80%). Parents reported fairly high annual incomes (Median = $75,000), but 28.2% of families reported incomes less than $50,000. A total of 18 items (total scale score; alpha = .74) were selected from a pool of 38 items developed from previous research that examined aspects of the sleep environment and were entered into an exploratory factor analysis from which 4 factors emerged: general sleep environment (10 items, alpha = .91), sleeping alone vs. with siblings (2 items, alpha = .78), presence of electronic screens (4 items, alpha = .75), and emotional environment (2 items, alpha = .80).

Results

The subscales demonstrated distinct patterns of correlations with related constructs, and unique predictive variance in explaining children’s daytime sleepiness even after controlling for children’s sleep hygiene, behavior problems, and sleep problems.

Conclusion

The current study is one of the first to demonstrate a valid/reliable assessment of children’s sleep environments. Not only will this measure provide researchers with an assessment of a fundamental influence on children’s sleep, but it will also enable clinicians to better measure this construct and support effective sleep health recommendations.

Support (if any):
619 Electronic Media Use and Sleep Among Children in Foster Care with Anxiety
Authors: Kim Josephine , Rigos Priscilla , Valentine Madeline , Nogales Josefina Muñoz , KIm Jinu , McGlinchey Eleanor , Alfano Candice , Ripple Carol , Wolfson Amy
Published: May 2021

Introduction

Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of EM may also be related to emotional distress – anxiety being one of the more prevalent issues, which has been tied to sleep-related problems as well (e.g., Fors & Barch, 2019; Alfano et al., 2007). Children in foster care have often been victims of trauma, which can lead to significant emotional and sleep difficulties (e.g., Kovachy et al., 2013). The Fostering Sleep study examined the association between EM use and sleep among children in foster care; and the additional influence of anxiety.

Methods

Participants were caregivers of foster care children recruited from private Facebook foster care support groups across the United States. The study used a cross-sectional design examining sleep patterns and behaviors, EM use and mental health among children in foster care. An online survey, hosted by Qualtrics, was distributed to caregivers via Facebook. The data of 443 foster care children between the ages of four and 11 (M=6.37, SD=2.21) were included in the analyses.

Results

Children in foster care using EM at bedtime go to bed later than those who are not (p<.001), and their sleep quality was better than those who did not use EM around bedtime (p<0.01). Additionally, 33.3% reported anxiety as a primary diagnosis by a mental health professional. Children without anxiety as their primary diagnosis were found to be more likely to use EM around bedtime (p=.038).

Conclusion

This preliminary analysis indicates the prevalence of EM use close to bedtime may not necessarily be detrimental to sleep for this population; perhaps activities such as watching one’s favorite programming or talking to a loved one online can be comforting and therefore helpful to sleep onset (Eggermont & Van den Bulck, 2006). However, examination of other factors such as type of technology, content of media, and duration of use is warranted. Moreover, children with anxiety as a primary diagnosis may be using less EM at bedtime because EM use may trigger symptoms of anxiety (i.e., Fors & Barch, 2019).

Support (if any):
622 Bedtime, Sleep Duration, and Sleep Quality as Predictors of Externalizing Symptoms in Children in Foster Care
Authors: Rigos Priscilla , Kim Josephine , Nogales Josefina Muñoz , Valentine Madeline , KIm Jinu , McGlinchey Eleanor , Alfano Candice , Ripple Carol , Wolfson Amy
Published: May 2021

Introduction

A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care.

Methods

Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s overall sleep quality over the last two weeks”), and sleep onset (e.g. “On weekdays, how long does it usually take for your child to fall asleep?”). Child behavioral issues were assessed via the Eyberg Child Behavior Inventory (ECBI) Parent Rating Form.

Results

A linear regression model was utilized to assess if child weekday bedtime, weekday total sleep duration, and overall sleep quality were unique predictors of externalizing symptoms when controlling for age. Results suggest that weekday sleep duration and bedtime were not significant unique predictors of child behavioral issues, though were significantly and positively correlated at the bivariate level (p=.02, p=.04). Sleep onset and overall sleep quality, irrespective of child age, were found to be significant unique predictors of child behavioral issues and accounted for 1% and 11% of the total variance, respectively.

Conclusion

Results suggest that delayed sleep onset and poorer sleep quality were predictive of increased behavioral issues for children in foster care. Findings persisted when controlling for age, which suggests that children in foster care experiencing sleep disturbances may benefit from more behaviorally focused sleep interventions to improve externalizing behaviors and increase sleep health.

Support (if any):
623 Melatonin Use in the Pediatric Intensive Care Unit: 5 year single center experience
Authors: Jacobson Jessica , Tylka Joanna , Glazer Savannah , Cosme Rosario , Patwari Pallavi
Published: May 2021

Introduction

Pediatric patients requiring intensive care are at risk for unavoidable sleep and circadian disturbances because of the frequency and nature of delivering care for severe illness in this setting. There is growing appreciation for sleep as an essential component for neuropsychological and physical health. While exogenous influences (light and noise) and endogenous evaluation (melatonin levels) have been evaluated in this setting, there has not yet been investigation of current practice for exogenously administered melatonin in the pediatric intensive care unit (PICU). We aimed to evaluate baseline practice and changes in melatonin administration after implementation of delirium education.

Methods

In 2018, pediatric delirium education was implemented and included identification of sleep disturbance. A 5-year retrospective chart review (3-years baseline and 2-years after delirium education) was completed based on a pharmacy database that identified all patients who had melatonin administration while in PICU. Each admission was counted as an unique encounter. Data collection included patient age, date of admission, and length of stay (LOS). Data for melatonin included dose, starting date, duration of treatment (number of days), and indication. Indications for melatonin were (1) delirium, (2) insomnia, (3) circadian sleep wake disorder, (4) previous home medication, and (5) unable to determine from chart review.

Results

Over 5 years (2015 – 2020), 182 (6.0%) patients admitted to PICU (average age 9.3 +/- 5.8 years, average LOS 24.9 +/- 56.3 days) were given melatonin (average dose 4.0 +/- 2.3 mg). The most frequent indication for melatonin administration was continuation as a home medication (45.9%) and least frequent was sleep-wake disturbance (3.9%). The percentage of patients given melatonin as compared to total PICU admissions, nearly doubled from 4.4% in baseline group to 8.2% in post-delirium-education group. Further, “delirium” as indication for melatonin increased from 5.2% (baseline) to 15.4% (post-education). There were no notable changes for administration indication “insomnia” (18.2% vs 19.2%) or “unknown” (22.1% vs 19.2%).

Conclusion

This is the first exploratory study to evaluate frequency and indication of melatonin use in the PICU and changes in practice after implementing delirium education. Delirium education that includes sleep disturbance has had significant impact on frequency of melatonin administration.

Support (if any):
625 The association between circadian rhythms and psychosocial functioning in children with attention deficit hyperactivity disorder
Authors: Li Xiao , Shea Ka Sin Caroline , Lau Lok Fan , Dino Wong Ching Kwong , Chiu Waiyan Vivian , Mandy Yu Wai Man , Martin Li Albert , Wing Y K , Kelly Lai Yee Ching , Xin Li Shirley
Published: May 2021

Introduction

Circadian rhythm disturbances, including delayed circadian rhythm and increased motor activity, are commonly seen in attention-deficit hyperactivity disorder (ADHD). Previous research suggested a link between circadian rhythm disturbances and poor psychosocial functioning in children, but such a relationship has not been examined in children with ADHD. This study aimed at examining the association between circadian-related parameters and psychosocial functioning in children with ADHD.

Methods

Seventy-nine children with ADHD were recruited into this study (age range: 6–12 years, 75.9% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale, SWAN), and psychosocial functioning (Strengths and Difficulties Questionnaire, SDQ). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. The relationship between circadian parameters and psychosocial functioning was analyzed using multiple regression while controlling for age, sex, ADHD medication, total sleep time, and CSHQ total score.

Results

Later acrophase was significantly associated with higher scores on SDQ emotional problems (St. β = 0.30, p = 0.03) and SWAN inattention subscale (St. β = 0.27, p = 0.043). Lower relative amplitude was associated with higher scores on SDQ hyperactivity symptoms (St. β = -0.29, p = 0.045) and SDQ total difficulties (St. β = -0.31, p = 0.036). Higher levels of mean activity level during the least active 5-h period (L5) were related to higher scores on SDQ peer problems (St. β = 0.38, p = 0.021), SDQ internalizing problems (St. β = 0.38, p = 0.020) and SDQ total difficulties (St. β = 0.33, p = 0.036). Later onset of L5 was associated with increased SDQ emotional problems (St. β = 0.26, p = 0.046).

Conclusion

Circadian rest-activity rhythm disturbances (delayed phase, blunted rest-activity rhythms, higher level of nocturnal activity, and later onset of nocturnal rest) were associated with poor psychosocial functioning in children with ADHD. Further longitudinal studies are needed to examine the effects of circadian disruption on psychosocial functioning in children with ADHD.

Support (if any)

This work was supported by the Health and Medical Research Fund (Project No.: 30160604).
630 Longer Sleep Duration Reduces the Odds of Hypertension in Children Referred to Nephrology for Elevated Blood Pressure
Authors: Kogon Amy , Masqood Anam , LoGuidice Jillian , Myers Kevin , Mitchell Jonathan
Published: May 2021

Introduction

Lifestyle modification is often prescribed as first line-therapy for hypertension in childhood. We aimed to determine if there was an association between sleep duration and hypertension in children referred for evaluation to Nephrology for elevated blood pressure (BP). We hypothesized that, longer sleep duration would be associated with a reduced likelihood of a hypertension diagnosis.

Methods

Medical record data were retrospectively extracted from patients referred to the Children’s Hospital of Philadelphia’s pediatric nephrology clinic for the evaluation of elevated BP, without a prior hypertension diagnosis. Ambulatory blood pressure monitoring (ABPM) data collected between December 2015 to December 2018 were extracted. Hypertension was defined by ABPM according to American Heart Association recommendations for pediatric ABPM and we evaluated BP indexed to sex and height. Sleep duration was calculated as the difference between self-reported time of sleep onset and offset. Regression models were adjusted for age, sex, race, body mass index, and weeknight status.

Results

Our sample included 249 patients, with a mean age of 14.5 (SD: 3.1) years. Of these, 29% were obese and 42% met criteria for hypertension. Mean sleep duration was 9.3 (SD: 1.6) hours per night and duration was shorter with increasing age in years (β=-0.11, 95% CI: -0.18, -0.05) and on week vs. weekend nights (β=-0.62, 95% CI: -1.05, -0.24). Each additional hour of sleep was associated with lower daytime systolic BP Index Z-score (β=-0.12, 95% CI: -0.20, -0.05), lower daytime diastolic BP Index Z-score (β=-0.11, 95% CI: -0.19, -0.03) and 19% reduced odds of daytime hypertension (OR=0.81, 95% CI: 0.67, 0.98). Each additional hour of earlier timing of sleep onset was associated with lower daytime systolic BP Index Z-score (β=-0.10, 95% CI: -0.19, -0.01), lower daytime diastolic BP Index Z-score (β=-0.16, 95% CI -0.25, -0.06) and 16% reduced odds of daytime hypertension (OR=0.84, 95% CI: 0.68, 1.05).

Conclusion

In children referred for the evaluation of elevated BP, longer sleep duration and earlier sleep onset were associated with a reduced likelihood of being diagnosed with hypertension. Targeting improvements in sleep should be further investigated as part of first line therapy to treat pediatric hypertension.

Support (if any)

NIH/NHLBI K01HL123612
634 Impact of Changing School Start Times on Drowsy Driving and Teen Motor Vehicle Crashes: A Longitudinal Examination
Authors: Meltzer Lisa , Rizvi Sarah , Chapman Julie
Published: May 2021

Introduction

Early high school start times are associated with insufficient adolescent sleep, which in turn is associated with motor vehicle crashes [MVC]. This analysis examined the impact of a 70-minute delay in high school start times on student-reported drowsy driving and department of transportation MVC rates before and for 2 years after start time changes.

Methods

Self-reported sleep duration and drowsy driving data were drawn from a longitudinal study of changing high school start times (n=2099–4092/year) in the Cherry Creek School District (Arapahoe County [AC]). The Colorado Department of Transportation provided frequency/timing of weekday MVC data for teen (16–18 years) and adult drivers in AC and four neighboring counties in metro Denver (Other Counties [OC]). MVC rates per 1000 licensed drivers were calculated. Outcomes are reported for three school years: 2016–17 (pre-change), 2017–18 (post change), and 2018–19 (follow-up). Chi-square analyses examined drowsy driving frequency (at least once/week vs. less than once/week) by sufficient weeknight sleep duration (<8 hours vs. 8+ hours). Two-proportion z-tests compared MVC rates by county, as well as teens vs. adults.

Results

Compared to pre-change (29.3%), fewer students reported drowsy driving at post-change (20.3%) and follow-up (23.7%). Students who reported insufficient sleep also reported more frequent drowsy driving across all years (p’s<0.001 to 0.037). AC’s teen crash rate decreased from 78.9/1000 to 76.6/1000 post-change, with a further reduction to 68.7/1000 at follow-up. Pre-change crash rates did not differ between counties (p=0.444); however, they were significantly lower in AC vs. OC at both post-change (p=0.048) and follow-up (p=0.046). Adult crash rates remained consistent over three years in both counties. Morning crash rates per hour did not differ pre-change; at both post-change and follow-up OC’s morning crash rates peaked one hour earlier than AC’s (7:00-7:59am vs. 8:00-8:59am).

Conclusion

This study extends previous reports by finding that later school start times are associated with decreased drowsy driving and fewer teen motor vehicle crash rates for up to 2 years post-change. Early school start times is an important public policy that benefits adolescent sleep, health, and well-being through decreased drowsy driving and motor vehicle crashes.

Support (if any)

Robert Wood Johnson Foundation’s Evidence for Action Program
643 Rest Activity Rhythms, Symptom Burden, and Glucose Variability in Young Adults with Type 1 Diabetes
Authors: Griggs Stephanie , Strohl Kingman , Margevicius Seunghee , Grey Margaret , Hickman Ronald
Published: May 2021

Introduction

Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and diabetes physical symptom burden) and glucose variability in young adults with T1D.

Methods

Using convenience sampling, young adults with T1D underwent concurrent actigraphy and continuous glucose monitoring for 6–14 days to generate the following RAR parameters: (MESOR, amplitude, acrophase, and circadian quotient) and glucose variability indices (coefficient of variation and time in range). Participants completed the 8-item Epworth Sleepiness Scale, 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, and 34-item Diabetes Symptom Checklist-Revised. Cosinor analysis was used to compute the RAR parameters and linear regression modeling procedures were performed to determine the associations among the study variables.

Results

The sample included 46 young adults (mean age 22.3±3.2; 32.6% male; 84.8% non-Hispanic White, A1C mean 7.2±1.1%, BMI 27.0±4.4 kg/m2). A more robust rhythm (higher amplitude) was associated with a lower diabetes symptom burden (ß=-0.31, p=.035). A higher circadian quotient was associated with less daytime sleepiness (ß=-0.41, p=.004). All associations between the RAR parameters and symptom measures remained statistically significant (p<.05) after adjustment for sex and BMI. The associations between the RAR parameters and glucose variability indices were not significant.

Conclusion

RAR was associated with daytime sleepiness, as well as symptom burden in young adults with T1D even after consideration of sex and BMI. Future investigators should clarify the causality of these associations and the potential for improving the strength and stability of RAR in the mitigation of daytime sleepiness and symptoms.

Support (if any)

This research is or was partially supported by grants from the American Academy of Sleep Medicine (220-BS-19), National Institute of Nursing Research (K99NR018886 & T32NR0008346), Sigma Theta Tau International, and Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have a device.
645 Acute Insomnia Disorder in Health Care Workers Before and During COVID-19: Rates and Predictive Factors
Authors: McCall William , Mensah-Bonsu Demetra , Withers Allison , Gibson Robert
Published: May 2021

Introduction

Pandemics such as COVID-19 create population-wide stressors that create a natural laboratory for acute insomnia research. This study investigated risk factors and estimated rates of acute insomnia disorder in health care workers at the onset of the COVID-19 pandemic.

Methods

A Qualtrics survey of more than 2300 health care providers was conducted in a single academic health system on May 15th 2020, comprised of practicing attending physicians, residents and fellows in training, advanced practice providers, and nurses. Six hundred and sixty eight responded (29% response rate). The Research Diagnostic Criteria for Insomnia Disorder was used to diagnose Acute Insomnia Disorder.

Results

573 respondent had no missing data pertaining to sleep, with a mean age of 43.4 + 12.5 years and 72% women. The rate of Insomnia Disorder before COVID-19 was 44.5%, while after COVID-19 it was 64.0% - a statistically significant increase. 10.2% of persons with Insomnia Disorder before COVID-19 stated it had resolved during COVID-19, while 43.4% of persons who did not have Insomnia Disorder before COVID-19 developed Acute Insomnia Disorder during COVID-19 (χ2=145.2; df=1; P<0.0001). New cases of Acute Insomnia Disorder increased with female gender, advancing age, and less time spent in direct patient care.

Conclusion

Insomnia Disorder showed high baseline prevalence before COVID-19, followed by a striking increase in incidence in this sample of tertiary care health care workers. The effects of gender and age were similar to what has been previously published as risk factors for insomnia. The surprising finding that less time spent in direct patient care was associated with more cases of Acute Insomnia Disorder might be related to the poorly understood stresses of working from home during COVID-19.

Support (if any):
663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic
Authors: O’Hora Kathleen , Lopez Mateo , Morehouse Allison , Cordero Andrea , Osorno Raquel , Manber Rachel , Goldstein-Piekarski Andrea
Published: May 2021

Introduction

The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown.

Methods

At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework.

Results

There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102).

Conclusion

This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample.

Support (if any):
665 Insufficient sleep and mortality among persons who inject drugs (PWID)
Authors: Sun Jing , Maher Brion , Spira Adam , Mehta Shruti , Rabinowitz Jill , Sosnowski David , Kirk Gregory
Published: May 2021

Introduction

Insufficient sleep is associated with all-cause mortality in the general population. Illicit drugs have pronounced effects upon sleep, and insomnia symptoms are common among people with HIV (PWH), suggesting persons who inject drugs (PWID) with HIV may be at higher risk of adverse outcomes from insufficient sleep.

Methods

Participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, a cohort of PWID with or without HIV, completed the Sleep Adequacy subscale of the Medical Outcomes Study (MOS) semi-annually from 2005-present. Two questions queried participants about the frequency over the past four-weeks of: 1. getting sufficient sleep to feel rested on awakening; 2. obtaining needed amount of sleep. Six-Item responses ranged from “all of the time” to “none of the time”. Participants with mean subscale scores below the sample median were considered to have insufficient sleep. Mortality data were obtained through the National Death Index through 2018. Hazards of all-cause and cause-specific mortality were evaluated using Cox-regressions accounting for repeated measurements of insufficient sleep, respectively. Models were adjusted for sociodemographics, HIV and HCV infection, severe depressive symptoms (Center for Epidemiological Studies Depression [CESD]≥23), number of comorbidities (0, 1, ≥2), active injection drug use, current tobacco and alcohol use.

Results

Of 2612 participants (33% HIV+), mean age at baseline was 45.8 years, 32.4% were female, 75% Black, 45% had ≥high school education, and 33% had an annual income >$5,000. At baseline, the majority were current smokers (84%), alcohol drinkers (59%), or actively injecting drugs (56%), while 25% had severe depressive symptoms and 21% had ≥2 comorbidities. After adjustment for covariates, insufficient sleep was associated with a 37% increased hazard of all-cause mortality (HR: 1.37, 95% confidence interval [CI]: 1.13–1.65). Insufficient sleep was associated with a 93% increased hazard of death from HIV or infectious disease-related deaths (HR: 1.93, 95% CI: 1.26–2.97).

Conclusion

Insufficient sleep was independently associated with all-cause mortality and specifically with death from HIV or infectious diseases-related causes among PWID. Interventions consider targeting sleep behaviors among PWID hold promise for improving health and longevity in this population.

Support (if any)

National Institutes of Health grants: U01-DA-036297; R01-DA-047064; R01-HL-90483; K24-AI-118591; T32-DA007292; R01-DA039408.
678 Predictors of Sleep Health among Older Adults During the Initial Months of the Covid-19 Pandemic
Authors: Lorenz Rebecca , Stallings Devita , Palmer Janice , Lach Helen
Published: May 2021

Introduction

Since the first COVID-19 case was reported in January 2020 in the United States, there have been more than 18.8 million cases and 330,000 deaths. In order to minimize the risk of potential COVID-19 transmission, many states instituted stay at home orders and closed churches, gyms, and other places that older adults often participate in social gatherings. Little is known about sleep health among older adults during this time. The purpose of this study was to examine the relationship between older adult’s personal factors, health behaviors, and sleep health during the initial months of the Covid-19 pandemic.

Methods

Adults age 60 and older participated in an online anonymous survey recruited through email lists of community senior organizations and university alumni using a snowball approach. Personal factors included age (years), gender (female=0, male=1), living situation (living alone=0, living with others=1), education (≤12 years = 0, >12 years = 1), and income (75000=1), and depressive symptoms (CESD-10). Health Behaviors included moderate physical activity (0=none, 1=yes), smoking (0=no, 1=yes), drinking (number of drinks). Sleep Health was assessed using the multidimensional SATED scale (Satisfaction, Alertness, Timing, Efficiency, and Duration). Backward stepwise regression analysis was used to test if personal factors and health behaviors significantly predicted participants’ sleep health.

Results

Participants included 509 adults (392 Females; mean age=75.6 years; SD=5.0; range 63–93 years). The majority were white (n=466; 92%) and 93% (n=471) had a college education. Seventy-four percent (n=71) participated in moderate exercise, 94% (n=478) did not smoke, and 58% (n=286) did not report drinking alcohol. Sleep Health was variable with 179 (36%) reporting poor sleep health (mean=7.4; SD=2.1). Regression results indicated that gender, years of education, living situation, income, depressive symptoms and moderate exercise explained 17% of the variance in sleep health (R2=0.169, F,6=14.4, p=0.000).

Conclusion

These findings suggest that many older adults experienced poor sleep health associated with depressive symptoms and exercise participation during the initial months of the pandemic. Future studies should examine the long-term effects of the pandemic on the sleep health of older adults.

Support (if any)

Saint Louis University COVID-19 Rapid Response Fund (OpenWater 1804).
683 Comparison of Telemedicine and In-Person Psychotherapy for CPAP Adherence in a population of Veterans
Authors: Keer Nikky , Sharma Pralhad , Shrestha Rabin , Freire Amado , Robinson Katie , Morris Katherine
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions.

Methods

We identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran’s average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts.

Results

Compared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p<0.001).

Conclusion

In a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.

Support (if any):
684 Contribution of Pulmonary Diseases to COVID-19 Mortality in a Diverse Community of New York City
Authors: Jean-Louis Giardin , Seixas Azizi , Cejudo Jaime Ramos , Osorio Ricardo , Avirappattu George , Reid Marvin , Parthasarathy Sairam
Published: May 2021

Introduction

New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID-19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID-19-related mortality independent of other medical conditions, health risks, and sociodemographic factors.

Methods

We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white; cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease); pulmonary disease (e.g., COPD, sleep apnea, or asthma); autoimmune disease; and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses.

Results

Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05; 95%CI:1.04–1.05), ethnic minority (HR=1.26; 95%CI:1.10–1.44), low household income (HR=1.29; 95%CI:1.11, 1.49), and male sex (HR=0.85; 95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27; 95%CI:1.02–1.58), obesity (HR=1.19; 95%CI:1.04–1.37) and peripheral artery disease (HR=1.33; 95%CI:1.05–1.69). We observed a significantly higher rate of COVID-19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01).

Conclusion

Patients with COPD had the highest odds of COVID-19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

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K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
689 Objective Assessment of Inpatient Sleep Patterns and Quality: A Pilot Study
Authors: Sussman Sarah , Ananth Ashwin , Fares Elie , Boon Maurits , Huntley Colin , Fast Zhanna
Published: May 2021

Introduction

Sleep disruption is common among hospitalized patients due to psychological, physiological, and environmental reasons including illness, pain, anxiety, invasive interventions, frequent monitoring, and stimuli, especially noise and light. The AASM has published guidelines for the use of actigraphy in the outpatient setting, but there is a paucity of literature evaluating the validity of actigraphy in inpatients. The aim of this study is to evaluate sleep in hospitalized general medicine patients undergoing sleep medicine consultation using actigraphy and qualitative surveys.

Methods

A single-site prospective study in hospitalized medicine patients. Patients were observed with a Fitbit® Charge3 wrist actigraphy device overnight, then administered 7 surveys: Richards-Campbell Sleep Questionnaire (RCSQ), qualitative questionnaires assessing sleep history, sleep hygiene, barriers to sleep, STOP-BANG, Epworth Sleepiness Scale (ESS), and Patient-Health Questionniare-2 (PHQ-2). Actigraphy data including total sleep time, slow wave sleep time, and number of awakenings was compared with patient-reported data.

Results

In preliminary analysis, six patients met inclusion criteria and underwent sleep medicine consultation, overnight actigraphy, and completed 7 surveys. Based on subjective sleep history questionnaires, average total sleep time was 437 + 215 minutes. Actigraphy revealed average total sleep time was 228 + 80 minutes with an average of 3.6 nocturnal awakenings. Increased number of awakenings on actigraphy was not correlated with increased number of awakenings by survey. The most frequently reported barriers to sleep on patient surveys were pain and being woken up for labs or vital signs. The average STOP-BANG score was 6 out of 8 and average ESS was 14 out of 24.

Conclusion

Restorative sleep warrants consideration alongside complex medical care during hospitalization. Patients experience decreased total sleep time and increased number of awakenings while in the hospital compared with their subjective estimates of sleep at home. Actigraphy provides a non-invasive and reliable way to monitor some sleep parameters in the inpatient setting. An elevated STOP-BANG score could represent sleep disordered breathing and impact perceptions of sleep quality. Patient-identified barriers to sleep are targets for quality improvement. Future studies should compare inpatient actigraphy data to polysomnographic data and the effect of sleep-directed interventions on sleep quality in the hospital.

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693 Sleep Health in the Young Adult Clinic: A retrospective observational cohort study
Authors: Eissa Mohamed , Bansal Shikha , Bosma Rachael , Sheffe Sarah , Law Yen Shuang , Mcloone Mary , Di Renna Tania , Singh Mandeep
Published: May 2021

Introduction

The Toronto Academic Pain Medicine Institute (TAPMI) Young Adult Clinic (YAC) was developed to offer transition services for clients aged 17–25 with persistent pain. It was noticed that YAC patients had significant problems with their sleep and the program was expanded in January 2019 by including a sleep medicine specialist for systematic evaluation of sleep health. Long-term sleep disruption has been associated with increase sensitivity to pain, prolonged pain duration, and predicts chronic pain. The degree of pain relief can directly impact the quality and disruption of sleep.

Methods

After approval from institutional review board, we reviewed YAC medical charts from March 2018 to April 2019 and extracted information pertaining to demographics, chronic pain and sleep. We present here the preliminary data of our multidisciplinary clinic

Results

55 medical charts were reviewed which included 40 females, 13 males, 2 nonbinary individuals, with a mean age of 20.3±2.4 years. 53% of the patients had chronic widespread pain. Symptoms of or disorder of sleep were reported in 72.7% of the patients. The various nighttime disorders of sleep were trouble falling asleep, insomnia, problems with sleep initiation, difficulty in maintaining sleep, poor sleep continuity, frequent night awakenings due to pain, restless leg syndrome (RLS), obstructive sleep apnea, parasomnic behavior, circadian rhythm disorder such as delayed sleep phase disorder. As assessed by Epworth Sleepiness scale, 7% of the patients had mild, 7% had moderate and 2% had severe daytime sleepiness. 42% of the youths demonstrated a low self-efficacy score as per Pain Self Efficacy Questionnaire (PSEQ). Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression which showed that 5.5%, 27%, 18%, 14.5%, 22% of the YAC patients suffered from minimal, mild, moderate, moderately-severe and severe depression respectively. The information collected on Pain Catastrophizing scale (PCS) suggested that 24%, 29% and 31% were at low, moderate, and high risk respectively in having catastrophizing thoughts and feelings related to pain. There was no statistical difference in the means PSEQ, PHQ-9 and PCS scores of young adults.

Conclusion

Sleep disturbances may be an important modifiable risk factor for alleviating distress in young adults with chronic pain.

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698 Sleep quality, depression and anxiety in a community sample of Habana, Cuba during the 2020 COVID-19 pandemic
Authors: González Justa , Rodriguez Alcibiades
Published: May 2021

Introduction

The 2020 Coronavirus disease 19 (COVID-19) pandemic has infected and killed millions of persons. To avoid virus spread, stay-at-home orders and social distancing measures were implemented worldwide. These measures have caused changes in work schedules and, subsequently, sleep habits. This study aims to examine sleep disturbances, anxiety and depression in a random community in Havana, Cuba during the pandemic lockdown period.

Methods

This a descriptive cross-sectional study performed in a randomly selected neighbourhood, via direct door-to-door survey. We applied four different surveys:1) Pittsburgh Sleep Quality Index (PSQI);2) Insomnia Severity Index (ISI);3) Epworth Sleepiness Scale (ESS) and 4) Hospital Anxiety and Depression Scales (HADS) questionnaire. Descriptive statistics will be applied using StatSoft, Inc. (2011) STATISTICA (data analysis software system), version 10. HYPERLINK “http://www.statsoft.com” www.statsoft.com

Results

A total of 366 adult subjects were surveyed and abnormal values were observed in the following percentages: 60.65% in the PSQI, 34.51% in the ISI, 14.74% in the ESS and 36.61% in the HADS for depression and 40.43% in the HADS for anxiety. Poorer sleepers and depression were more common women and elderly (p<0.05 for all comparisons). Anxiety and insomnia were seen mostly in subjects with higher education and working during this period (p<0.05 for all comparisons). Poor sleep correlated with insomnia, depression and anxiety (p < 0.001 for all comparisons).

Conclusion

There were sleep quality disruption in large percentage of subjects during the COVID-19 pandemic lockdown. Poor sleep and depression were worse in women and the elderly. Insomnia and anxiety were seen more in younger subjects that continue to work during this time.

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