bluuebunny/crossref_metadata_2025 huggingface dataset:
0266 Sleep Spindle-Duration: A Potential Biomarker for Neurodegenerative Disorder Phenotyping
Authors: Levendowski Daniel , Walsh Christine , Boeve Bradley , Tsuang Debby , Salat David , Hamilton Joanne , Shprecher David , Lee-Iannotti Joyce , Westbrook Philip , Berka Chris , Mazeika Gandis , Neylan Thomas , Louis Erik St
Published: May 2022

Introduction

Decreased sleep spindle oscillations were previously associated with cognitive decline in older adults, increased tau levels, and phenoconversion to dementia in patients with Parkinson disease (PD). We analyzed quantitative sleep spindle measures to determine if this biomarker was associated with particular neurodegenerative disorder syndromes.

Methods

Sleep spindle oscillations ascertained in patients broadly characterized as presumed Parkinsonian-spectrum disorders (PSD), which included the subtypes dementia with Lewy Bodies/Parkinson Disease Dementia (DLB/PDD, n=16), PD (n=16), isolated REM sleep behavior disorder (iRBD, n=19), and progressive supranuclear palsy (PSP, n=13), were compared with non-PSD subtypes Alzheimer Disease dementia (AD, n=22), mild cognitive impairment (MCI, n=35), and normal cognition (NC, n=61). Sleep Profiler studies were conducted in all participants. The automated spindle detection algorithms recognized temporal excursions in the alpha (8-12 Hz) and sigma (12-16 Hz) power of 250 milliseconds or greater, with spindle duration being the sum of all spindle elapsed times. Night-to-night variability was assessed in PSP=13, PD=16, DLB/PDD=12, AD=17, MCI=25, and NC=53. Statistical analyses included intraclass correlations (ICC) and Bland-Altman plots for two-night data, and Mann-Whitney U-tests and multiple logistic regression applied to sleep-time weight-averaged spindle-durations.

Results

The night-to-night spindle-duration ICC was 0.95 (P<0.0001), with a Bland-Altman bias of 0.05+/-2.83 minutes. Spindle-duration was independently associated with PSD versus non-PSD groups (P=0.017, OR 1.08, 95%-CI 1.01-1.15), but not significantly associated with age (P=0.12, OR 1.03, 95%-CI 0.99-1.07) or sex (P=0.54). When stratified by subtype, age was associated with spindle-duration when NC were compared to AD and MCI (P=0.0003, OR 1.10, 95%-CI 1.04-1.16) and when iRBD were compared to DLB/PDD, PD and PSP (P<0.05, OR 1.00, 95%-CI 0.89-1.13)Spindle-durations were reduced in PSP (0.9+/-2.1) and DLB/PDD (2.0+/-5.1) when individually compared to AD (3.2+/-7.1), iRBD (3.3+/-3.4), PD (5.3+/-6.6), MCI (5.3+/-9.7), and NC (8.0+/-11.1) subtypes (all P<0.05). AD patients also exhibited lower spindle-durations than NC (P=0.03).

Conclusion

Auto-detected sleep spindle-durations exhibited excellent night-to-night reliability in both NC and patients with neurologic disorders. Decreased sleep spindle-duration was independently associated with PSP and DLB/PDD, and in AD. Reduced sleep spindle duration may be a distinct sleep biomarker for those disorders likely indicating thalamocortical dysfunction.

Support (If Any)

NIA grants: R44AG050326, R44AG054256, P30AG62677 and R34AG56639.
0271 Actigraphy Based Measures of Sleep Disruption and Circadian Rhythms in the WashU Biomarkers of Alzheimer’s Disease in Sleep and EEG (BASE) Cohort
Authors: Milman Noah , Madden Katherine , Reynolds Christina , Balba Nadir , Omar Tanya , Lim Miranda , Ju Yo-El
Published: May 2022

Introduction

Prospective studies of Alzheimer’s disease (AD) demonstrate sleep-wake disturbances may precede and accelerate with cognitive decline. Use of wrist-actigraphy in conjunction with overnight polysomnography (PSG) enables researchers to evaluate diverse characteristics of sleep and circadian rhythms. Though outcome measures from these devices have been implicated in the progression of AD, because of great individual differences, it is valuable to internally replicate within cohort. Here we demonstrate application of actigraphy in the context of healthy aging to identify patterns of activity that predict cognitive decline.

Methods

Participants were prospectively recruited at Washington University as part of the BASE study and wore an Actiwatch2 (Philips-Respironics) and cross-validated for sleep and wake using polysomnography. The watch was worn continuously for at least 5 consecutive nights to be included in the analysis (n = 68, age = 71.1 ± 4.5 years). Rest-activity rhythms were computed using compiled code from National Sleep Research Resource (actiCircadian) pipeline implemented in MATLAB R2021a (Mathworks). Clinical Dementia Rating (CDR) scales and cognitive tests were conducted on the first day of actigraphy recording.

Results

Individuals with cognitive impairment (CDR Global Score > 0) had increased wake after sleep onset (WASO) and reduced sleep efficiency compared with individuals with no impairment (CDR = 0). (unpaired ttest: p = 0.02 and p = 0.02). Participants with cognitive impairment had a trend toward reduced relative amplitude (RA) (p = 0.06). Reduced (worse) RA was correlated with worse performance on the Trail Making Task A (Pearson r: -0.37, p = 0.002). Higher (better) interdaily Stability (IS) was associated with better responses on subjective questionnaires including Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index (Pearson r: -0.24 p = 0.051; r: 0.242, p = 0.047, respectively).

Conclusion

Actigraphically-derived rest-activity metrics are correlated with cognitive status, cognitive test performance, and subjective sleep questionnaires.

Support (If Any)

NIH R01 AG059507, ARCS Foundation Scholar
0276 Sleep EEG Changes in a Transgenic Mouse Model of Spinocerebellar Ataxia Type 3
Authors: Tsimpanouli Maria-Efstratia , Ghimire Anjesh , Barget Anna , Weston Ridge , Costa Maria do Carmo , Watson Brendon
Published: May 2022

Introduction

Spinocerebellar ataxia type 3 (SCA3) or Machado-Joseph disease is a fatal, incurable, dominantly inherited ataxia, typically of adult-onset, and the most frequent type of SCA worldwide. SCA3 patients show progressive neuronal loss in several brain areas reflecting a broad spectrum of motor and non-motor symptoms, including ataxia, parkinsonism, and sleep disorders. In other neurodegenerative diseases, sleep disturbances alter brain homeostatic mechanisms, including DNA repair, synaptic function, and network activity, leading to deterioration of neurologic function. Sleep research has provided insights into their pathophysiology, disease prediction, and symptom management. Such studies have not been performed in SCA3. The aim of this study is to characterize sleep EEG in an SCA3 transgenic mouse model.

Methods

We used homozygous, hemizygous, and wild-type YACMJD84.2 littermate mice. To confirm the expected disease phenotype, we assessed for locomotor and exploratory activity in the morning and evening when the mice were 22 to 31 weeks old. We then implanted 6 electrodes in the frontal, parietal, and cerebellar areas. About two weeks after, we recorded their sleep activity for 15 hours (ZT0-15) per day for three consecutive days. We analyzed the data from the open-field testing and the EEG from the third day of recordings using SPSS and Matlab and a p<0.05 was considered for statistical significance.

Results

As expected, homozygous SCA3 mice showed statistically significant decreased locomotor and exploratory activities compared with wild-type littermates. In terms of sleep architecture we did not observe any significant differences between the different genotypes. Moreover, compared with wild-type, homozygous SCA3 mice displayed increased β spectral power band activity during REM. They also had decreased θ band activity, β band activity, spindle activity, and γ band acitivity during wake.

Conclusion

Our data suggest that EEG spectral power is dysregulated in homozygous SCA3 mice. Changes in β band have been observed in SCA3 patients during wake, and in patients with REM sleep behavior disorder. Therefore, future studies analyzing the sleep EEG of SCA3 patients are needed to confirm whether our findings are translatable. Further studies should also investigate the causal relationship between the observed differences in sleep and disease progression. Gaining greater insight into the role of sleep in SCA3 could provide translatable biomarkers and lead to improved assessment of the disease progression and therapeutic interventions.

Support (If Any)

NHLBI 5T32HL110952
0281 Impact of chronic sleep disruption on glymphatic function, cognitive performance, and neuropathology in the 5xFAD mouse model
Authors: Pedersen Taylor , Keil Samantha , Agarwal Sanjana , Badran Mohammad , Gozal David , Iliff Jeffrey
Published: May 2022

Introduction

Recent studies suggest a bidirectional relationship between sleep disruption and Alzheimer’s disease, with mid-life sleep disruption associated with the development of Alzheimer’s-related amyloid and tau pathology. Yet, the mechanistic link between sleep disruption, particularly over chronic time scales, and the development of Alzheimer’s pathology remains unclear.

Methods

In this study, we evaluated the impact chronic sleep disruption has on the onset of cognitive impairment and neuropathologic disease progression using the 5xFAD amyloidosis mouse model. Chronic sleep disruption in male and female C57BL/6 and 5xFAD+ mice was performed in Lafayette sleep fragmentation cages from 10-18 weeks of age. Cognitive impairment was evaluated through behavioral tasks indicative of spatial memory, short-term memory, locomotion, anxiety, and activities of daily living. Upon completion of behavioral experiments, glymphatic function was assessed by measuring the influx of fluorescent cerebrospinal fluid tracers into brain tissue. Aquaporin-4 localization, amyloid plaque deposition, and markers of astroglial and microglial activation were assessed by immunofluorescence.

Results

We observed that chronic sleep disruption impaired cognitive performance and increased neuropathological outcomes in 5xFAD+ and littermate controls. The impact on glymphatic function was assessed in parallel and correlated with neuropathological and behavioral outcomes.

Conclusion

These findings highlight the critical association between dysfunctional sleep and the development of cognitive impairment and neuropathologic disease progression. They indicate that there is a potential interaction between inflammatory expression after chronic sleep disruption and neuropathologic disease progression.

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0300 Early Life Sleep Fragmentation Impairs Hippocampal-Dependent Learning and Sleep-Dependency in Hippocampal Calcium Transients
Authors: Zamore Zachary , Chou Allison Tzu-Han , Schifman Naomi , Fenik Polina , Pullum Keelee , Slinger Michelle , Veasey Sigrid
Published: May 2022

Introduction

Sleep deprivation impairs hippocampal-dependent memory, and hippocampal-dependent memory impairments occur in some dementias, including Alzheimer’s disease. As our population continues to age, understanding the molecular basis for memory impairments is increasingly important. We hypothesized that early life sleep fragmentation would result in lasting increases in hippocampal calcium transient activity.

Methods

B6 mice were randomized to 12wk of sleep fragmentation or rested control conditions at age 8wk. Mice were microinjected with AAV9-CamKII-GCamp6F into the hippocampus and later implanted with a GRIN Lens into CA1 secured to a baseplate along with chronic EEG/EMG electrodes and recording connector. Calcium recordings were obtained two to three months after injection and recordings were obtained across sleep-wake cycles>4mins of wake and NREM sleep. Individual cells across animal were combined into sleep fragmented (n = 521 cells) or rested (n = 443 cells) groups during wake or sleep. Average FFx was analyzed by group and condition by T-tests, paired for within and unpaired across groups. A spatial object recognition assay was also performed on all mice (n=16 for both groups) and performance across group was analyzed by paired T-tests.

Results

Rested mice showed normal spatial object recognition (n = 16, p<0.05). In contrast, SF mice showed impaired spatial object recognition (n = 16, N.S.). There were no differences across sleep conditions in calcium transient FFx for waking (p>0.05). However, in sleep, cells in SF mice had significantly higher average FFx values than cells in rested mice (p<0.0001).

Conclusion

Early-life sleep fragmentation has long-lasting impacts on memory. Since spatial memory is dependent on hippocampal function, the calcium transient FFx data suggests that a driver of this hippocampal memory impairment may be higher firing rates in sleep and/or greater calcium exposure in hippocampal CamKII neurons in sleep, both of which may perturb microglial maintenance of synapses. Understanding the molecular drivers behind this calcium dysfunction will be essential in our understanding of neurodegeneration, dementia, and Alzheimer’s disease.

Support (If Any)

NIH AG054104; AG064231
0303 The Effects of Latitude on Sleep at 4300m
Authors: Wehling Richard , Jung Christopher
Published: May 2022

Introduction

Worldwide, 140-million people live above 2400m and even more visit high altitudes (HA) annually. Exposure to HA is associated with hypoxia-related cognitive impairments and sleep disruptions. Additionally, both planetary axial tilt, solar gravity, and planetary spin distort the earth’s atmosphere pulling the equator’s atmosphere further from the earth’s surface when compared to the poles. These forces may have additional impacts on physiology at HA. There has yet to be a study to determine these effects of latitude on physiology at HA. Therefore, the aim of the current study was to determine if latitude exacerbates the effects of HA on sleep.

Methods

Similar testing protocols were utilized at 4,300m at Camp-14 on Denali at a latitude of ~63° and in the village of Dingboche on the route to Mount Everest at a latitude of ~28°. Exclusion criteria included 18-65 years, self-reported drug use, cigarette-smoking, sleep disorders, abnormal body mass index (BMI), falling asleep more than one hour or awakened more than an hour during the night. Wireless sleep recording devices recorded the sleep architecture of qualified participants. Twenty-two climbers (3 females) participated in the Denali study (age 34.0±9.7 mean±SD) and twenty-five climbers (6 females) participated in the Everest study (age 28.0±9.7 mean±SD). Participants were instructed to go to bed and wake up at their habitual bedtimes and wake times.

Results

Independent t-tests revealed a statistically significant decrease in total sleep (p<0.05) on Denali when compared to Mt. Everest. There were nonsignificant trends for a decrease in rapid eye movement (REM) and sleep onset latency on Denali. Other sleep stages appear relatively unaffected by latitude.

Conclusion

Our findings indicate that a decrease in total sleep time occurs at higher latitude with comparable altitude. Prior research has linked a decrease in total sleep time to decreased cognitive impairments and physiologic disruptions. Our findings suggest that latitude should be considered when venturing into HA environments, designing research protocols, analyzing results, and clinical applications or military operations.

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0312 Sleep and fear of falling, is there a relationship? A cross-sectional study in older adults
Authors: Kakazu Viviane , Andersen Monica , Pinto Rafael , Dokkedal-Silva Vinícius , Fernandes Guilherme , Gobbi Cynthia , Tufik Sergio , Pires Gabriel , Morelhão Priscila
Published: May 2022

Introduction

Excessive daytime sleepiness is a common problem in older people. This population is at higher risk of falls that lead to injuries, which explains the high prevalence of fear of falling among them. The relationship between sleep disturbances and concern about falling is unclear. The aim of this study was to identify whether poor sleep quality and excessive daytime sleepiness are associated with fear of falling in older adults.

Methods

This is a cross-sectional study. Data on age, sex, body mass index, alcohol consumption, mental status, depression, single-leg stance, excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality, comorbidities, and fear of falling (assessed through the Falls Efficacy Scale), were collected from participants aged 60 years and over. Univariable and multivariable linear regression were performed. Logistic regression evaluated the association between excessive daytime sleepiness and high fear of falling.

Results

504 participants were analyzed. The chance of an older person having high concern of falling was 3 times bigger among those with excessive daytime sleepiness when compared to those without excessive daytime sleepiness. The final model, multivariable linear regression showed that excessive daytime sleepiness score was able to predict fall efficacy scale scores (Beta coefficient=0.26; 95%CI: 0.07 to 0.45) adjusted by the following variables: age, single-leg stance, comorbidities, and depression. Our results showed that for each point increase on the Epworth Sleepiness Scale there was an average increase of 0.26 points in the Falls Efficacy Scale, indicating that sleepiness was related to fear of falling.

Conclusion

Having excessive daytime sleepiness increased the chance of older adults showing a high fear of falling. Healthcare workers should be aware that drowsiness can increase the fear of falling among older patients, and this may influence treatment.

Support (If Any)

The study was supported by Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Nível Superior (CAPES, Finance Code 001 to GLF). ST, MLA and RZP received fellowships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). GLF receives funding from CNPq (#141445/2021-1)
0316 Actigraphy-Derived Sleep Health Profiles and Mortality in Older Men and Women
Authors: Wallace Meredith , Lee Soomi , Stone Katie , Hall Martica , Smagula Stephen , Redline Susan , Ensrud Kristine , Ancoli-Israel Sonia , Buysse Daniel
Published: May 2022

Introduction

To identify actigraphy sleep health profiles in older men (Osteoporotic Fractures in Men Study; N=2,640) and women (Study of Osteoporotic Fractures; N=2.430), and to determine whether the identified profiles predict mortality.

Methods

We applied a novel and flexible clustering approach (Multiple Coalesced Generalized Hyperbolic mixture modeling) to identify sleep health profiles based on actigraphy midpoint timing, midpoint variability, sleep interval length, continuity, and napping/inactivity. Adjusted Cox models were used to determine whether profile membership predicts time to all-cause mortality.

Results

We identified similar profiles with different prevalences in men and women: High Sleep Propensity [HSP] (20% of women; 39% of men; high napping and high continuity); Adequate Sleep [AS] (74% of women; 31% of men; average actigraphy levels); and Abnormal Continuity/Timing [ACT] (6% of women; 30% of men; low continuity and late/variable midpoint). In women, ACT was associated with increased mortality risk (Hazard Ratio [HR]=1.59 for ACT vs. AS; 1.75 for IS vs. HSP). In men, ACT and AS were associated with increased mortality risk relative to HSP (1.19 for IS vs. HSP; 1.22 for AS vs. HSP).

Conclusion

These findings suggest several considerations for sleep-related interventions in older adults. For instance, interventions may be developed to target the combination of low continuity with late/variable midpoint. Findings also indicate that high napping/inactivity co-occurs with high sleep continuity in some older adults. Although high napping/inactivity is typically considered a risk factor for deleterious health outcomes, our findings suggest that it may not be inherently problematic when occurring in combination with high sleep continuity.

Support (If Any)

The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH grants U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, UL1 TR000128, R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Study of Osteoporotic Fractures (SOF) is supported by NIH grants R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. This study is also supported by NIH grants R01AG056331 and RF1AG056331 (PI: Wallace), R56AG065251 (PI: Lee), K01MH112683 (PI: Smagula), and R35HL135815 (PI: Redline).
0318 Subjective Sleep and Cognition in Middle-aged and Older Adults: Chronotype and Sex as Moderators
Authors: Musich Madison , Costa Amy , Salathe Victoria , McCrae Christina , Curtis Ashley
Published: May 2022

Introduction

Associations between sleep and cognition are well studied in aging populations. However, less is known regarding the moderating impact of chronotype (morningness vs. eveningness) and sex on these relationships. We aimed to determine the sex-specific moderating impact of subjective chronotype on the association between subjective sleep and subjective cognition in middle-aged and older adults.

Methods

Participants (N=260, 142 men/118 women) aged 50+ completed surveys measuring subjective sleep [Pittsburgh Sleep Quality Scale (PSQI)], chronotype [Morning-Evening Questionnaire (MEQ)], and everyday subjective cognition [Cognitive Failures Questionnaire (CFQ)]. Moderated regressions determined independent and interactive roles of subjective sleep (PSQI-total, sleep disturbances, sleep efficiency), chronotype (MEQ total), and sex on everyday subjective cognition (CFQ scores: total, memory, distractibility, and blunders). Analyses controlled for age, education, depressive/anxiety symptoms, and sleep medication use.

Results

Sex moderated the interactive associations of chronotype and PSQI-total on CFQ-total (p=.005) and CFQ-memory (p<.001). Specifically, higher PSQI-total was associated with higher CFQ-total (B=0.87, SE=0.38, p=.02) and CFQ-memory scores (B=0.33, SE=0.13, p=.009) in men with a tendency for eveningness. Sex also moderated the interactive associations of chronotype and PSQI-sleep disturbances on CFQ-memory (p=.04) and CFQ-blunders (p=.02). In men with a tendency for eveningness, greater PSQI-sleep disturbances were associated with worse CFQ-memory (B=2.65, SE=.84, p=.002) and CFQ-blunders scores (B=1.85, SE=0.83, p=.03). In women with a tendency for morningness, greater PSQI-sleep disturbances were associated with worse CFQ-memory (B=2.65, SE=.81, p= .001) and CFQ-blunders scores (B=2.37, SE=0.81, p=.004).

Conclusion

There are sex-specific patterns regarding the moderating impact of chronotype on associations between sleep and everyday cognition in middle aged and older adults. In men prone to eveningness, worse overall sleep quality and sleep disturbances may exacerbate negative perceptions of overall and memory specific cognitive function. However, in women prone to morningness, greater sleep disturbances may exacerbate negative perceptions of memory and task execution. Further investigating chronotype on objective sleep and cognition in prospective studies may help further explain underlying mechanisms of the impact of sleep on cognition, in addition to sex-specific sleep interventions to mitigate cognitive decline in aging populations.

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0331 Intersectional discrimination and sleep health among women veterans: a pilot study
Authors: Agrawal Alpna , Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Lee Diane , Mitchell Michael , Zeidler Michelle , Alessi Cathy , Sung Yeonsu , Hamilton Alison , Bean-Mayberry Bevanne , Yano Elizabeth , Washington Donna , Martin Jennifer
Published: May 2022

Introduction

Structural inequalities perpetuate poor health outcomes. Sleep inequality, which is the disproportionate burden of sleep problems among marginalized groups compared to historically advantaged groups, is poorly understood. While racial discrimination is associated with chronic health outcomes, few studies have examined the health impact of discrimination stemming from multiple social vulnerabilities. The current study assessed women veterans’ experiences of intersectional discrimination, specifically the combined impact of gender and racial/ethnic discrimination on sleep health.

Methods

Data were from the WISE (Women Improving Sleep through Education) study. Participants were women veterans with a previous diagnosis of sleep apnea or 1 or more risk factors for sleep disordered breathing (n=39). Data collection was from 3/2021–11/2021. The 9-item Major Discrimination Scale (MDS) and 10-item Everyday Discrimination Scale (EDS) were employed. The MDS included items such as “have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?” and the EDS, “how often on a day-to-day basis are you treated with less courtesy than other people?”. Items were adapted to assess discrimination related to respondents' gender and race/ethnicity separately. Major intersectional discrimination (MDS-gender + MDS-race/ethnicity) and everyday intersectional discrimination (EDS-gender + EDS-race/ethnicity) were computed. Sleep health was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Descriptive statistics and correlational analyses were performed.

Results

Racial/ethnic minority women veterans comprised 54% of the study sample. Prevalence of major intersectional discrimination was 67% and everyday intersectional discrimination, 92%. Compared to other racial/ethnic groups, the proportion of Black women veterans reporting major intersectional discrimination was highest (78%). Major intersectional discrimination was positively correlated with ISI (p=0.04) and PSQI (p=0.01). Everyday intersectional discrimination was not correlated with sleep health (p>0.05).

Conclusion

Pilot study findings highlight the potential role of discrimination on sleep health, particularly multiple forms of discrimination. High prevelence of intersectional discrimination related to women veterans' gender and racial/ethnic identities was observed. Major intersectional discrimination, not everyday intersectional discrimination, was associated with higher insomnia severity and poorer sleep quality.

Support (If Any)

LIP VA HSRD IIR16-244, RCSA20-191, LIP65-177, NIH/NHLBI K24HL143055, VAGLAHS GRECC, VAGLAHS CSHIIP, RCS 21-135, CIN 13-417, RCS 05-195
0335 Sleep patterns and experiences in older night shift nurses
Authors: Zhang Yuan , Murphy Audra , van der Holst Heidi Lammers- , Barger Laura , Swaminathan Neha , Granfield Catherine , Palacios Arturo Arrona , Duffy Jeanne
Published: May 2022

Introduction

Working at night can lead to misalignment between the timing of the biological clock and the work/sleep schedule, resulting in sleepiness, inattention, and impaired performance during the night shift and poor quality, shortened sleep during the day. These adverse effects are reported to be worse in older workers due to their decreased ability to sleep during the daytime. Although numerous quantitative studies have examined these associations, there are few qualitative studies to describe the sleep patterns and experiences from older night workers’ perspectives.

Methods

Four virtual focus groups were conducted with 12 nurses aged 50-65, working regular 8-hr night shifts, to learn about their sleep patterns and experiences, and factors affecting their sleep and non-sleep activities before, between, and after consecutive night shifts. Two facilitators and two research assistants reviewed and coded the focus group transcripts for consistent themes among participants.

Results

Eight common themes were identified: (1) sleep patterns are self-selected based on family and childcare responsibilities; (2) sleep timing switches between nights and days from before- to between- to after-consecutive night shifts; (3) frequent extended (24+ h) wake before and after consecutive night shifts; (4) difficulty maintaining long and sound sleep during daytime; (5) family, social, health, and environmental disturbances interrupt daytime sleep; (6) more satisfaction with sleep quantity and quality in participants with split sleep than those with one episode; (7) sleep is considered less important compared to childcare, family, and social activities; (8) better on-shift alertness and performance when the main sleep episode or a nap immediately precedes night shift.

Conclusion

Sleep patterns and experiences reported by older night shift nurses are helpful in understanding their priorities and challenges to obtaining adequate sleep. This information is critical for the future design and implementation of feasible and acceptable interventions to improve sleep in this occupational group.

Support (If Any)

This study was supported by NIH grant R01 AG044416.
0339 A possible role for the circadian system in aggression in dementia
Authors: Van den Bulcke Laura , Vaessens Rebecca , Van Den Bossche Maarten
Published: May 2022

Introduction

Growing evidence suggest a bidirectional relationship between circadian and sleep regulation, and the pathology and progression of dementia. Behavioral and psychological symptoms of dementia (BPSD) are very prevalent, and lead to an enormous disease burden in patients, families and caregivers. Indications for a possible disruption of circadian regulation of emotions and behavior in dementia, can be found in the phenomenon known as ‘sundowning’, exacerbation of neuropsychiatric symptoms during the late afternoon and early evening. Aggression in particular can be a very debilitating symptom of dementia, and previous animal and human studies point to a possible role of the circadian rhythm in the propensity for aggressive behavior. Therefore, we examine here the timing of aggression in a dementia cohort.

Methods

We studied the timing of aggression incidents on a university psychiatric hospital unit treating patients with dementia and additional behavioral problems. During a 6-month period (November 2020 - April 2021) 84 patients were admitted to the ward. Data of these patients were retrospectively analyzed. During this period 335 individual incidents of aggression (verbal and/or physical) were reported by the nursing staff.

Results

Among the 84 subjects, 42 (50%) had at least one aggression incident during hospital admission. 41% of all incidents occurred between 4-10pm. (5-9pm (36.4%), 9pm-1am (11.6%), 1-5am (5.7%), 5-9am (22.7%), 9am-1pm (10.7%), 1-5pm (12.8%)). In every investigated month, a peak in number of incidents could be seen between 7 and 8pm. Aggression incidents were most likely to occur in Alzheimer’s dementia (OR: 3.75). Patients who exhibited aggression had worse cognitive impairment (difference in mean MMSE: 4.57 ± 2.1 , p=0.034).

Conclusion

Aggression incidents were most prevalent during the late afternoon and evening. Furthermore, the severity of cognitive impairment and type of dementia negatively impacted the prevalence of aggression.Our study thus confirms a possible role of the circadian rhythm in aggression. The role of the circadian rhythm in the pathophysiology of neurodegenerative disorders, and specifically in their neuropsychiatric symptoms, warrants further research.

Support (If Any)

Supported by the Funds Malou Malou, Perano, Georgette Paulus, JMJS Breugelmans and Gabrielle, François and Christian De Mesmaeker, Managed by the King Baudouin Foundation of Belgium, No. 2021-J1990130-222081.
0345 Comforter Designed for Warm Sleepers Improves Objectively-Measured Sleep for Adults in Midlife and Older
Authors: Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Rodriguez Rodolfo , Gavrilova Larisa
Published: May 2022

Introduction

Bedding can aid in maintaining a comfortable thermal state in the sleep environment. Research is needed to bring scientific rigor to document these benefits and their potential for promoting better sleep. This study examined effects of a comforter designed for warm sleepers used at home.

Methods

Healthy adults (96% female, ages 23-74) who reported sleeping hot, experiencing night sweats, or having hot flashes during the night participated in a 6-week field study, using a pre-post intervention design. Intervention consisted of using a comforter designed for warm sleepers, made of 300 thread count viscose from bamboo fiber with Tencel/polyester fill. During the 3-week baseline period, participants used their regular bedding. During the 3-week intervention period, they used the comforter without a top sheet to have direct contact with the comforter. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

There were over 1,000 nights of tracked sleep across all participants. In the full sample (n=31), self-reported sleep (e.g., perceived sleep quality, feeling well-rested) but not objectively-measured sleep showed improvements. Therefore, and given that this type of product may provide the most benefit for sleepers in midlife or older, additional analyses were conducted for the subgroup of participants who were 45 years old and above (n=15). Results indicated increased time in bed (+11 minutes, p=.017), total sleep time (+12 minutes, p=.010), and deep sleep (+6 minutes, p=.005) during the intervention compared to baseline. Improvements also were observed in SleepScore, a measure of overall sleep quality (p=.002), and BodyScore, a measure of deep sleep (p=.002).

Conclusion

Self-reported but not objectively-measured sleep improved among healthy adults using a comforter designed for warm sleepers. However, looking specifically at those aged 45 and older, objectively-measured time in bed, total sleep time, deep sleep, and overall sleep quality all increased significantly when using the comforter compared to baseline.

Support (If Any)

Blue Ridge Home Fashions
0346 Differentiation of Naturalistic Sleep in Chronic Insomnia vs. Healthy Controls Using a Non-Contact Measurement Device
Authors: Hansen Devon , Finlay Myles , Peterson Mary , Gottlieb Elie , Raymann Roy , Buchwald Dedra , Van Dongen Hans , Watson Nathaniel
Published: May 2022

Introduction

Individuals with insomnia report poor sleep quality and non-restorative sleep, and often exhibit irregular sleep patterns over time. First night effects and logistical challenges make it difficult to accurately measure these sleep characteristics in the laboratory. Also, sensitivity to sleep disruption from obtrusive devices confounds sleep measurements in people with insomnia in their naturalistic setting. Non-contact devices (NCDs) may address these issues and enable ecologically valid, longitudinal and unobtrusive characterization of sleep in individuals with insomnia. We present results from a NCD, previously validated against polysomnography, – SleepScore Max (SleepScore Labs) – assessing the sleep of individuals with chronic insomnia, compared to healthy sleeper controls, in their home setting.

Methods

A total of 112 individuals participated in an at-home sleep monitoring study including 83 with chronic insomnia (ages 19-65, 58 females) and 29 healthy sleeper controls (ages 19-54, 21 females). Enrollment criteria included being 18-65 years of age and, for the insomnia group, meeting International Classification of Sleep Disorders (3rd edition; ICSD-3) criteria for chronic insomnia with no other clinically relevant condition contributing to sleep disturbance. Participants used the NCD to record their sleep periods each night for 8 weeks. Sleep measurements were analyzed for group differences in both means (characterizing sleep overall) and within-subject standard deviations (characterizing night-to-night sleep variability), using mixed-effects regression controlling for systematic between-subject differences.

Results

On average, individuals with chronic insomnia exhibited increased total wake time, wake after sleep onset, and decreased sleep efficiency relative to healthy sleeper controls (F>6.8, p<0.01). Additionally, they demonstrated greater night-to-night variability in time in bed, total sleep time, sleep latency, total wake time, wakefulness after sleep onset, sleep interruptions, sleep efficiency, and light and deep sleep (F>4.4, p<0.05).

Conclusion

In our sample of individuals with chronic insomnia, a NCD naturalistically detected differences from healthy sleeper controls in multiple sleep parameters, both on average and in terms of night-to-night variability. Capturing night-to-night variability in the home setting adds an important dimension to our understanding of poor sleep and provides a more comprehensive, ecologically valid characterization of chronic insomnia as experienced in daily life.

Support (If Any)

NIH grant KL2TR002317; research devices provided by SleepScore Labs
0355 Which hospitals are the quietest at night? It’s not The US News Top 20 Institutions
Authors: Gulati Jasmine , Arora Vineet , Orlov Nicola , Mason Noah , Affini Murtala , McDaniel Lauren
Published: May 2022

Introduction

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey distributed by The Center for Medicare and Medicaid (CMS) services measures patient perceptions of hospital experience and impacts annual CMS reimbursement. This study focuses on the “Quiet at Night” variable, to identify the top box institutions and identify the key characteristics that enable their success.

Methods

Using the Linear Mean Scores and the Star Ratings’ inherent clustering algorithm and RStudio™, the top box scorers amongst the 5 Star Rated hospitals were isolated and grouped together as CMS Top Rated “Quiet at Night” Hospitals. These Star Ratings and the key characteristics of these institutions were compiled and compared to the US News Honor Roll Hospitals (2019-2020) to ascertain trends and determine the predictive value of the HCAHPS “Quiet at Night”' hospitals' characteristics.

Results

The mean Star Rating for CMS Top Rated “Quiet at Night” Hospitals was 5.00 compared to that of the US News Honor Roll Hospitals which was 2.67. An unpaired t-test of this data found a two-tailed P value of less than 0.0001, which is considered statistically significant under all conventional significance levels (Table 1). In comparing the key characteristics for these two lists documented by the American Hospital Directory a stark difference emerged between these groups with those that scored well on the “Quiet at Night'' question identifying as predominantly privately controlled, specialized, surgical facilities with very few total hospital beds.

Conclusion

This study was the first of its kind to critically analyze hospitals that score well on the CMS “Quiet at Night” and compare them to the US News Honor Roll Best Hospitals. With the knowledge that these scores impact CMS reimbursement, it is important to determine the cultural and organizational shifts that enable hospitals to be top performers on the “Quiet at Night” metric. A greater understanding of how top CMS hospitals so efficiently provide care in a sleep protective way may help inform larger institutions about Best Practices.

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0358 Defining Existing Practices to Support the Sleep of Hospitalized Patients: A Mixed-Methods Study of Top-Ranked Hospitals
Authors: Affini Murtala , Arora Vineet , Gulati Jasmine , Mason Noah , Klein Aviva , Clarke Karen , Cho Hyung , Lee Vivian , McDaniel Lauren , Orlov Nicola
Published: May 2022

Introduction

While sleep is critical for health, the hospital is not conducive to patient sleep and few efforts have been made to improve. The current practices to promote hospitalized inpatient sleep at highly-ranked hospitals are unknown.

Methods

A mixed-methods study of Hospital Medicine Section Chiefs at the 2020 US News and World Report Honor Roll pediatric and adult hospitals was conducted to understand the current practices and attitudes towards inpatient sleep between June and August 2021. An anonymous, quantitative survey was disseminated to quantify current practices and satisfaction with sleep-friendly institutional efforts. Survey participants were invited to share their institutions’ progress and potential ways to further improve inpatient sleep during structured, qualitative interviews.

Results

Pediatric (n=10) and adult (n=20) section chiefs were queried. Survey response rate was 77% (n=23/30; pediatric n=8/10; adult n=15/20). While 96% (n=22) of hospitalist leaders rated sleep as important, only 43% (n=10) were satisfied with their institution’s efforts to improve patient sleep. Although 91% (n=21) of hospitalist leaders rated sleep equity as important, one institution (4%) had practices in place to address the issue. Less than half (n=11) of institutions reported having sleep-friendly practices. Among these institutions, the most common practices included: reducing overnight vital sign monitoring (91%, n=10), decreasing ambient light in the wards (91%, n=10), adjusting lab and medication schedules (73%, n=8), and implementing quiet hours (64%, n=7). Twenty-seven percent of hospitalist leaders (n=8/30; pediatric interviews=3/10; adult interviews=5/20) participated in interviews. Themes included: the importance of having a sleep-friendly culture, environmental changes, modified hospital practices, and external incentives to improve patient sleep.

Conclusion

Hospitalists recognize the importance of improving patient sleep, but few institutions have sleep-friendly practices in place. Most institutions have no sleep health equity practices in place in their hospital. Building sleep-friendly hospital cultures and establishing best practices should be a priority for clinicians.

Support (If Any)

The authors thank the Society of Hospital Medicine and the Pritzker School of Medicine for funding support.
0367 Novel 3D-Printed Custom Oral Appliance Therapy: A Pilot Study
Authors: Glick Aaron , Abbassi Elham , Farach-Carson Mary
Published: May 2022

Introduction

Oral appliance (OA) therapy protrudes the jaw in a more anterior position during sleep to treat obstructive sleep apnea. OA therapy can be used in combination or as an alternative to positive airway pressure (PAP) therapy. Most custom oral devices are fabricated with expensive manufacturing equipment or individually hand-made increasing treatment costs that prevent access to care for patients. Previous studies report concerns of cost-effectiveness of OA therapy and surveys of sleep physicians with cost concerns leading to barriers in prescribing OA therapy. More recent technological advancements in additive technology have allowed low-cost, custom fabrication of digitally designed OA. To date there have been no clinical studies that the authors are aware of that have investigated the feasibility of offering 3D printed custom OA therapy.

Methods

A novel OA was designed specifically for 3D-printing with additional features to improve clinician efficiency, patient comfort, and patient safety. A review of 3D-printed materials was completed to ensure biocompatibility requirements prior to clinical testing. Approval from the Committee for Protection of Human Subjects of University of Texas Health Science Center at Houston was obtained. Five participants had novel OA digitally designed based on scans of upper and lower teeth in addition to a bite registration recorded using a George Gauge. Participants were surveyed based on comfort of device and safety monitoring.

Results

Participants found the novel OA generally comfortable. Comfort questions were presented on a scale of 1 – 10, where ten is the highest level of comfort. On average participants found that the novel OA had comfort levels of 9.0 ± 0.77 on gums, 8.2 ± 0.92 on teeth, and 9.8 ± 0.20 of the jaw joints. No major adverse events were reported and the most common minor adverse event reported was increased salivation.

Conclusion

This pilot study illustrates the clinical feasibility of a novel 3D printed OA. Future studies will further investigate patient outcomes and clinician efficiency during clinical implementation of this novel OA. Though the use of 3D-printing technologies OA therapy has the potential to be offered at lower cost and delivered to the patient in one visit representing a paradigm shift.

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0372 Patient Perspectives of Sleep Disturbances on a Neurology Inpatient Unit
Authors: Poulakis Alexander , Ibarra Michael , Lin Jennifer , Wielgus Oskar , Eisner Lauren , McGauley David , Kadura Sullafa
Published: May 2022

Introduction

Sleep is a process critical to our daily physical revitalization, but sleep in the hospital is often very disruptive and is associated with poorer health outcomes during recovery. We aimed to assess patient and staff perceptions on sleep disturbances on a neurology inpatient unit in order to minimize sleep disturbances during hospitalization.

Methods

From April 2021 to November 2021, patients on a neurology inpatient unit completed Karolinska Sleep logs, Berlin questionnaires, and the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Surveys were administered three times a week to patients oriented, available to participate, and slept on the unit for at least one whole night. Responses were dichotomized and compared to previously-surveyed dichotomized disturbance perceptions by the unit staff. We used chi-square tests to analyze disturbances across both groups for statistical significance.

Results

One hundred twenty-nine patient surveys were collected, and of the disturbances listed, bed comfort, general noise, vital signs, and toileting were the most significant disruptors to sleep. Staff agreed that noise was a top disruptor but ranked testing, pain, and medications higher than patients.High-risk patients for sleep apnea were more likely to be disturbed by medication administration than low-risk patients (19% vs. 7%, p=0.0288), with trends also nearing significance in neuro checks (17% vs. 7%, p=0.059) and light (17% vs. 7%, p=0.059).Overall, there were significant differences across almost all sleep disturbances when comparing the groups, with staff ranking noise, medications, testing, vital sign checks, neuro checks, anxiety, pain, light, and bed comfort significantly higher than patients (p<0.0001). Temperature was not statistically significant. While survey collecting, we found that patients reported specific interventions disrupted their sleep but later ranked them lower than we expected on PHSDNQ. Upon further questioning, patients thought those interventions were required by inpatient teams.

Conclusion

There is undoubtedly room to minimize the top-ranked disruptors and identify discrepancies between high and low-risk sleep apnea patients. We found that patients typically expect certain sleep disturbances during hospitalization, and are generally unaware that we can modify them. Future studies should involve empowering patients to minimize sleep disruptions.

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