bluuebunny/crossref_metadata_2025 huggingface dataset:
0363 Sound vs. Sight: A Modality-Specific Preliminary Investigation of Sleep-Related Attentional Bias in Older Adults
Authors: Curtis Ashley , Costa Amy , Musich Madison , Nowakowski Lauren , Young Kobe , Rzeppa Chloe , McCrae Christina
Published: May 2023

Introduction

Increased attention to sleep-related stimuli (i.e., “sleep-related attentional bias”) may contribute to the persistence of insomnia symptoms. Despite high prevalence of insomnia disorder in older adults, studies investigating this phenomenon in this population are lacking. Additionally, it is unclear whether this bias occurs only for visual stimuli or more broadly, such as for auditory stimuli. This study examined whether auditory and visual sleep-related attentional bias differed as a function of insomnia disorder in older adults.

Methods

Sixty-one older adults (Mage=68.2±5.9; 41 women/) with (n=22) and without (n=39) insomnia (met DSM-5 criteria plus reported 6+nights/14 of >30 mins sleep onset latency or wake after sleep onset on daily diaries) completed modified Posner Cueing and Dot Probe tasks. Task cues included sleep-related auditory (e.g., alarm clocks, snoring), visual (e.g., clocks set to bedtimes, person awake in bed) and non-sleep (auditory: pure tones; visual: neutral images from the International Affective Picture system) stimuli. For Posner, valid [non-cued reaction time (RT) minus validly-cued RT] and invalid (non-cued RT minus invalidly-cued RT) sleep and non-sleep related visual and auditory cueing effects were calculated. For Dot Probe, valid (non-sleep/neutral cued RT minus sleep-related validly-cued RT) and invalid (non-sleep/neutral cued RT minus sleep-related invalidly-cued RT) visual cueing effects were computed. Independent t-tests examined whether auditory/visual mean cueing effects for sleep and non-sleep stimuli differed by insomnia status.

Results

Posner valid auditory sleep-related cueing effects were larger (p=.04) for those with insomnia (104.6±47.6ms) vs. without (80.7±57.3ms). Valid auditory non-sleep related cueing effects were also larger (p=.001) for insomnia (118.9±48.8ms) vs. without (67.9±77.2ms). For Dot Probe, there was a trending difference (p=.07) between visual sleep-related valid cueing effects for insomnia (14.7ms±6.7ms) vs. without (-1.8ms±7.1ms).

Conclusion

Preliminary findings suggest older adults with insomnia experience larger visual sleep-related attentional bias than those without insomnia. Further, greater auditory attentional bias in insomnia may reflect general auditory cortex hypervigilance. Aging adults with insomnia may benefit from stimulus desensitization towards insomnia triggers across sensory modalities to potentially facilitate sleep.

Support (if any)

This research project was made possible by an award (PI:Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.
0366 Understanding the mediating role of sleep improvement on anxiety symptoms using digital CBT for insomnia
Authors: Henry Alasdair , Miller Christopher , Emsley Richard , Sheaves Bryony , Freeman Daniel , Luik Annemarie , Espie Colin
Published: May 2023

Introduction

Insomnia has significant overlap with anxiety, and CBT for insomnia, in addition to improving sleep, leads to concomitant reductions in anxiety. Nevertheless, few studies have evaluated the anxiolytic effects of CBT for insomnia in individuals with insomnia and clinically significant anxiety symptoms or an anxiety disorder diagnosis. Large studies of digital CBT provide a prudent source to evaluate the transdiagnostic role of insomnia to reduce anxiety symptoms. Using data from two trials of dCBT for insomnia, we evaluated whether sleep is a transdiagnostic treatment target to reduce anxiety symptoms in individuals with insomnia and clinically significant anxiety.

Methods

Individual data from 2,172 participants with insomnia and clinically significant anxiety symptoms were extracted from two previously conducted randomised controlled trials of dCBT for insomnia. Participants received either dCBT or control (usual care or sleep hygiene education). Assessments were conducted at baseline, post-intervention (week 8 or 10), and follow-up (week 22 or 24). Insomnia symptoms were assessed using the Sleep Condition Indicator (SCI-8), and anxiety symptoms using the 7-item Generalized Anxiety Disorder scale (GAD-7). Mediation was evaluated using structural equation models.

Results

Compared with control, dCBT for insomnia was superior at reducing symptoms of insomnia (Hedges’ g range: 0.71-0.88; both p< 0.001) and anxiety (Hedges’ g range: 0.39-0.44; both p< 0.001). At post-intervention, participants in the dCBT group were significantly more likely to achieve remission (OR = 2.24 (0.30); < 0.001 (1.72, 2.91)) and reliable remission (OR = 2.24 (0.30); < 0.001 (1.73, 2.89)) of their anxiety. Improvements in sleep at post-intervention mediated 84% of the effect of dCBT on anxiety symptoms at follow-up.

Conclusion

Targeting insomnia symptoms via digital CBT for insomnia may be an appropriate means by which to reduce anxiety symptoms in individuals with insomnia and comorbid anxiety. These findings reinforce the transdiagnostic benefits of CBT for insomnia and digital CBT may offer an accessible first step intervention.

Support (if any)

This work was supported in part by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
0377 Sleep Health Disparities Among U.S. Military Personnel and Veterans Registered on the Burn Pit Registry
Authors: Nowakowski Sara , Razjouyan Javad , Kokonda Manasa , Christie Israel , Helmer Drew
Published: May 2023

Introduction

Disparities are underrecognized factors for sleep health. Additionally, there are concerns about sleep health among Veterens with exposure to burn pit smoke. This study aimed to examine the association between sex, race, and ethnicity and self-reported insomnia and sleep apnea symptoms in Veterans and active duty personnel.

Methods

Using items from the online health questionnaire of the VA/DoD Airborne Hazards and Open Burn Pit Registry administered between April 2014 and August 2022 to 320,231 Veterans and active duty personnel (age 40.1±9.2 y, 11% female, 75% white), we examined the association between sociodemographic variables (sex, race, and ethnicity) and self-reported sleep complaints (insomnia, sleep duration, sleep apnea events and snoring) in separate logistic regression models.

Results

Female sex predicted higher odds of insomnia (OR 1.3), where as male sex predicted higher odds of sleep apnea events (OR 2.6) and snoring (OR 2.4), p’s<.0001. African American race predicted higher odds of sleep apnea events, snoring, insomnia and shorter sleep duration (ORs1.5-3.2, p’s<.0001). Hispanic ethnicity predicted higher odds of sleep apnea events, snoring, insomnia and shorter sleep duration (ORs 1.2-1.6, p’s<.0001).

Conclusion

We observed a higher prevalence of self-reported sleep complaints among Black and Hispanic compared to White Veterans and active duty personnel who completed the burn pit registry. We also found a higher prevalence of insomnia in females compared to males, while snoring and sleep apnea events were more common in males compared to females. Future research will focus on sleep health dispartities of objective sleep data extracted from polysomnography reports in the Veteran Affairs electronic medical records in Veterans on the burn pit registry.

Support (if any)

This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); Michael E DeBakey VAMC Bridge Grant (PI: Nowakowski); and VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).
0379 A Scoping Review of Validation Studies for Commercially Available CBT-i Smartphone Applications
Authors: Mak Michael , Rahmani Armin
Published: May 2023

Introduction

Cognitive behavioral therapy for insomnia (CBT-I) remains the first line treatment for insomnia. CBT-I in comparison with sedative-hypnotics has similar efficacy, but with treatment durability and almost no adverse effects. Despite CBT-I being recognized as the best insomnia treatment, access remains limited. Digital CBT-I hopes to address the problem of scale, so as to deliver therapy to the masses. There are now multiple mobile applications available both on smartphone app stores, which claim to deliver evidence based CBT-i. These applications largely come at a cost and patients have to pay to access their services. The goal of this study is to review CBT-i smartphone applications to see if they are indeed validated.

Methods

We performed a search on the two most popular smartphone application platforms: Google Play and Apple Store. We used search terms: sleep, insomnia and CBT-I. We then searched for validation studies for those smartphone applications on Google Scholar. We included studies conducted in the past 10 years. Our second search consisted of reviewing PubMed and Google Scholar for validation studies for CBT-I applications. Our search terms consisted of CBT-I and smartphone, CBT-I and application and CBT-I and digital.

Results

Of the 9 validation studies that we initially found, 6 met our inclusion criteria. 3 were excluded as they did not solely use CBT-I in their applications. All 6 applications reported significant improvement in important sleep quality metrics such as sleep onset latency and total sleep time. 4 studies also reported on a subjective improvement in quality of sleep. 2 studies looked at populations with comorbidities including cannabis use disorder and epilepsy. Both studied again found improvement in sleep quality in those specific populations. There were concerning patterns of bias found amongst the reviewed studies. 3/6 investigators had direct relationships with companies which designed and marketed the applications.

Conclusion

dCBT-I offers an opportunity to increase accessibility to therapy. There are only a limited number of studies which have examined the effectiveness of the applications on the market. There remains serious concerns about the risk of bias and the quality of validation studies which claim to confirm the effectiveness of these applications.

Support (if any)
0381 Adverse Childhood Experiences Associated with Adult Sleep Duration, Control Over Sleep, and Daytime Sleepiness
Authors: Rasmussen Elizabeth , Ricketts Emily , Joyce Daniel , Mensah-Osman Taylor , Gorovoy Suzanne , Granados Karla , Prather Aric , Hale Lauren , Branas Charles , Rojo-Wissar Darlynn , Grandner Michael
Published: May 2023

Introduction

Adverse childhood events have been linked with many mental and physical health risks, but less work has explored nighttime and daytime sleep problems, especially inability to control sleep.

Methods

Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults aged 22-60 years recruited from communities in southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Habitual sleep duration was assessed in hours, daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS), and control over sleep was assessed with the Brief Index of Sleep Control (BRISC). Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9.

Results

History of child abuse was associated with 23 fewer minutes of nighttime sleep (p=0.001), and parent anxiety was associated with 15 fewer minutes (p=0.048). When depression was added to the model, the effects for sleep duration were attenuated (15.3 minutes, p=0.03). No other relationships were observed. Regarding control over nighttime sleep, decreased sense of control was reported by those who experienced child abuse (B=-0.4, p< 0.0005), parent divorce (B=-0.1, p=0.035), and parent depression (B=-0.2, p=0.02). After adjusting for depression, the relationship with child abuse was attenuated but maintained (B=-0.2, p< 0.0005). Elevated ESS scores were seen in those who reported child abuse (B=4.7, p< 0.0005), parent depression (B=4.3, p< 0.0005), and parent anxiety (B=3.9, p< 0.0005). After adjusting for depression, relationships were attenuated but maintained for child abuse (B=2.0, p=0.02), parent depression (B=2.2, p=0.004), and parent anxiety (B=2.2, p=0.017).

Conclusion

Adverse childhood events may lead to sleep/wake dysregulation, including less sleep at night, more sleepiness during the day, and decreased sense of control over sleep ability. Future efforts might focus on increasing control over nighttime sleep and reducing daytime sleepiness.

Support (if any)
0387 Burden of insomnia among Alzheimer's patients: variations in comorbidities and healthcare utilization in Medicaid enrollees
Authors: Chekani Farid , Sharma Manvi , Goswami Swarnali , Mirchandani Kirti
Published: May 2023

Introduction

Sleep disturbance contributes to the burden of Alzheimer’s disease (AD), specifically among vulnerable patients with behavioral symptoms and multiple comorbidities. Limited information exists regarding the characteristics associated with insomnia among patients with AD. This study describes medical conditions and healthcare utilization among patients with AD and insomnia.

Methods

This retrospective cohort study used MarketScan® Multi-State Medicaid Database 2016-2020 and included adults aged ≥ 50 with newly diagnosed AD. Index date was the earliest medical or pharmacy claim date for insomnia within 3 months prior to 12 months post AD date. For comparison, non-insomnia cohort was selected based on propensity score 1:1 matching. Comorbid conditions and behavioral symptoms (BS) - including agitation aggression, psychotic symptoms, and mood disorders – and delirium were measured in the 12-month baseline period and were compared across insomnia and non-insomnia cohorts using chi-square tests. Healthcare utilization was assessed in 12-month post-index date (follow-up period).

Results

Among patients with incident AD, significantly higher proportions of individuals with comorbidities were detected in insomnia (N=3,904) vs. non-insomnia (N=3,904) cohorts in 12-month baseline period, i.e., hypertension (76.2% vs. 71.2%, p < 0.001), diabetes (35% vs. 32.9%, p=0.05), valvular disease (11.6% vs. 9.8%, p=0.01), delirium (5.1% vs. 3.7%, p=0.002) and BS (62.4% vs. 46%, p< 0.0001). The proportion of patients with BS during follow-up was higher in the insomnia cohort (76.18%) in comparison to the non-insomnia cohort (53.53%). In the follow-up, proportion of inpatient, emergency room and physician office visits were 34.5%, 49.8%, 45.6% in insomnia and 30.7%, 42.5%, 41.2% in non-insomnia cohorts respectively. Mean (SD) inpatient length-of-stay was 3.2 (9.62) days for insomnia and 2.6 (8.52) days for non-insomnia cohorts respectively.

Conclusion

The study results indicate that major comorbidities and behavioral symptoms are highly prevalent among insomnia patients with AD. Insomnia is associated with higher utilization rates when healthcare use is compared between insomnia and non-insomnia patients. Optimization of insomnia treatment is crucial for the disease management in AD patients.

Support (if any)

Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
0397 Efficacy of second-stage clinician-led CBTI in non-responders to digital CBTI: Is alleviation of cognitive arousal a mechanism?
Authors: Sagong Chaewon , Kalmbach David , Cheng Philip , Fellman-Couture Cynthia , Iqal Justin , Ruprich Melissa , Bayoneto Alec , Peterson Edward , Roth Thomas , Drake Christopher
Published: May 2023

Introduction

Cognitive-behavioral therapy for insomnia (CBTI) is first-line treatment for insomnia, but a provider shortage limits access. eHealth technology can increase access to behavioral interventions, and digital CBTI (fully automated programs) are effective. However, >50% of digital CBTI patients do not remit, and non-remission is linked to undertreated cognitive arousal, a central feature of insomnia. In a randomized controlled trial, we randomized digital CBTI non-remitters to second-stage clinician-led CBTI or control. We evaluated whether second-stage CBTI effectively reduced insomnia and depression, and tested whether reductions in cognitive arousal mediated these effects.

Methods

207 patients whose insomnia did not remit with digital CBTI presented to second-stage therapy. Patients were randomized to clinician-led CBTI or sleep education control via telemedicine. Study outcomes included insomnia (insomnia severity index, ISI), depression (quick inventory of depressive symptomatology self-report 16-item survey, QIDS-SR16), and three indices of cognitive arousal (pre-sleep arousal scale’s cognitive factor [PSASC], perseverative thinking questionnaire [PTQ], and daytime insomnia symptoms response scale [DISRS]).

Results

Before second-stage therapy, all patients reported clinically significant insomnia (ISI≥10), 13.0% reported moderate depression, and 69.5% reported high cognitive arousal. Step 2 CBTI patients, relative to Controls, reported larger decreases in ISI (-6.43±4.31 vs -2.58±4.83, t=6.05, p<.001, Cohen’s d=.84). At posttreatment, 56.3% of Step 2 CBTI patients remitted (ISI≤7) relative to just 16.3% of Controls (Χ2=35.77, p<.001, RR=3.45). CBTI patients reported larger reductions in depression relative to control, which was a small-to-medium effect (-2.63±3.11 vs -1.11, t=3.15, p=.002, Cohen’s d=.44). Contrary to hypotheses, Step 2 CBTI did not reduce cognitive arousal relative to Control as measured by the PSASC (p=.195), PTQ (p=.840), and DISRS (p=.643).

Conclusion

Clinician-led CBTI is effective for alleviating symptoms of insomnia and comorbid depression in insomnia patients who do not initially remit with digital CBTI. Contrary to hypotheses, reducing cognitive arousal did not mediate treatment effects. As most insomnia non-remitters present to second-stage therapy with high cognitive arousal, alternative approaches that better target cognitive arousal symptoms may represent viable second-stage therapy options for insomnia.

Support (if any)

This RCT (NCT03322774) was supported by NIMH R01-MH122636.
0398 Efficacy of Suvorexant for Insomnia Disorder in Patients with Poorly-Controlled Type 2 Diabetes
Authors: Winkelman John , Wipper Benjamin , Zackon Jordana , Hoeppner Bettina
Published: May 2023

Introduction

Sleep disturbance is a common and underappreciated feature of diabetes and sleep may contribute to glycemic control in patients with type two diabetes (T2D). We conducted a randomized placebo-controlled 3-month trial to examine the efficacy of suvorexant in improving sleep and other aspects of health in patients with suboptimally-controlled type 2 diabetes and insomnia.

Methods

This double-blind, randomized placebo-controlled 3-month trial was conducted using the sequential parallel comparison design (SPCD). Sixty-nine poorly-controlled T2D patients (HbA1c≥6.5) were randomized to placebo and/or suvorexant (10-20 mg). The primary outcome was subjective total sleep time (STST), and secondary outcomes were Insomnia Severity Index (ISI) score and wake time after sleep onset (WASO). Exploratory outcomes included sleep efficiency, hemoglobin A1c (HbA1c), and C-reactive protein (CRP). Exploratory analyses were conducted on relationships of sleep and diabetes outcomes.

Results

There were no significant improvements in STST, ISI, or WASO among patients taking suvorexant compared to those taking placebo. There were also no significant changes in any of the exploratory endpoints. Improvements in sleep were associated with improvements in both objective (i.e. HbA1c) and subjective (i.e. Diabetes Distress Scale) measures of diabetes, across treatment assignments.

Conclusion

Our negative findings for suvorexant efficacy for insomnia in poorly-controlled T2D may be related to inadequate sample size or due to the complex and multiple contributions to insomnia in this patient population. The associations of improved sleep with improvements in diabetes-related metrics across groups highlights the importance of identifying and treating sleeping difficulties in this population.

Support (if any)

This research was funded by an investigator-initiated grant from Merck Pharmaceuticals.
0402 Factors associated with subjective sleep problem and treatment willingness in sleep clinic patients
Authors: Bae Hyoeun , Lee Sujin , Kim Jee Hyun , Joo Eun Yeon
Published: May 2023

Introduction

Insomnia clinic physicians often encounter patients with discrepancy between subjective and objective sleep problem. This study aimed to investigate factors that attributed to patients’ perception of sleep disturbances and treatment willingness, which were practical in determining diagnostic and treatment direction.

Methods

This study was a cross-sectional study, data collected from November 2018 to October 2022 in sleep clinic of tertiary university-affiliated hospital. Adults older than 19 who underwent sleep questionnaires and polysomnography (PSG) were included (n=3,239). Demographic data and sleep-related factors (alcohol, caffeine, exercise, education, job, marital status, comorbidity) were collected. Subjects were categorized into four groups by questionnaire answers (Do you think you have sleep problem? Do you want treatment for sleep problem? -group 1, neither; group 2, no sleep problem but want treatment; group 3, yes sleep problem without treatment willing; group 4, both yes.) and compared.

Results

Group 2 had higher percentage of job, snoring, witnessed apnea, worry about sleep, sleep maintenance problem than group 1. Group 3 had less job, sleep maintenance problem, daytime dysfunction, worry about sleep than group 4 (p< 0.05). Majority of no sleep problem groups were revealed to be normal (group 1: 28.0%, 2: 28.5%) or OSA (group 1: 63,7%, 2: 63.1%), while yes sleep problem groups were relatively higher combined insomnia and OSA (COMISA) (group 3: 20.0%, 4: 23.8%) or insomnia (group 3: 11.1%, 4: 15.3%) by PSG. OSA patients in group 2 showed more witnessed apnea and worry about sleep than group 1. COMISA patients in group 3 had less daytime dysfunction than group 4. However, PSG parameters were not significantly different among groups.

Conclusion

This study found that social need and subjective sleep maintenance problem are key factors that lead patients to regard their sleep as problematic or seek for treatment. In particular, patients with suspected OSA need to be instructed to get sleep study since sleep apnea severity do not affect treatment willingness and they had the lowest insight of their sleep problem. For those complaining of no or mild problem yet seeks for treatment, focusing on relieving misperceived worries about sleep is needed.

Support (if any)
0408 Insomnia, hypersomnia, and depression in buprenorphine treated opioid use disorder subjects
Authors: Krishnamurthy Venkatesh , Freet Christopher , Yadav Sanjay , del Tredici Sonya , Vgontzas Alexandros , Bixler Edward , Fernandez-Mendoza Julio
Published: May 2023

Introduction

Sleep disturbances and depression are highly prevalent in Opioid use disorder subjects treated with buprenorphine. However, the association between sleep disturbances such as insomnia/hypersomnia and depression in the above patient population is not known. The aim of the study is to examine the association between sleep disturbances including insomnia and hypersomnia with depressive disorders in buprenorphine treated opioid use disorder (OUDB) subjects.

Methods

We studied 92 OUDB (38±11.2y, 49% female, 9% minority) at the Recovery, Advocacy, Empowerment and Service program (RASE) and Internal Medicine clinics of Wellspan (York, PA). Subjects completed the Patient Health Questionaire-9 (PHQ-9), Insomnia Severity Index (ISI), Epworth sleepiness scale (ESS), and opioid craving scale (OCS). Depression was defined as a PHQ 9 score ≥ 10, insomnia with an ISI score of >15 and excessive daytime sleepiness (EDS) with an ESS score of >10. Binary logistic regression analysis evaluated the likelihood of OUDB subjects having depression in relation to insomnia, excessive daytime sleepiness (EDS), opioid craving, duration of opioid use, duration since last use of any illegal substance, number of rehabilitation treatments and buprenorphine dosage.

Results

No differences between in OUDB subjects with (n=47) and without (n=34) depression were observed in age, duration of opioid dependence, duration of buprenorphine treatment, number of rehabilitation treatments or time since last use of any illegal substance. Subjects with depression had significantly higher ISI (18.2±4.2 verus11.8±6.6, p< 0.01), ESS (11.2±4.7 versus 8.2±4.1, p< 0.01 ) scores and a trend towards higher OCS score (3.2±4.1 verus1.9±2.2, p=0.056) as compared to those without depression. The odds of depression associated with Insomnia and EDS were 8.5 (95%CI=2.3-31.2) and 4.4 (95%CI=1.1-17) times respectively in this patient population.

Conclusion

Insomnia and hypersomnia are highly associated with depression in buprenorphine treated OUDBs patients. Insomnia and hypersomnia needs to be evaluated early and receive targeted treatment during early abstinence in order to prevent relapse in this patient population.

Support (if any)

This project is supported by the Junior Faculty Development Program, Penn State College of Medicine
0411 Long-term efficacy of lemborexant on objective sleep measures in clinical practice
Authors: Miyata Seiko , Iwamoto Kunihiro , Okada Ippei , Fujimoto Akihiro , Kogo Yuki , Amano Manabu , Matsuyama Nao , Ozaki Norio
Published: May 2023

Introduction

In the treatment of insomnia, both subjective and objective evaluations are essential. The orexin receptor antagonist, lemborexant, has a favorable profile in terms of efficacy, acceptability, and tolerability for adults diagnosed with insomnia. To date, the long-term efficacy of lemborexant has been evaluated solely on a subjective basis, with no long-term objective measures under natural sleeping conditions. Therefore, a small, lightweight sleep electroencephalograph monitor was used to evaluate sleep objectively at home after 4 and 12 weeks of lemborexant treatment.

Methods

Adults and elderly subjects with insomnia disorder per DSM-5 were enrolled in an open-label, single-arm, single-center trial. Participants took lemborexant (5/10 mg) at bedtime for 12 weeks. In addition, they underwent a home-based sleep study at baseline and weeks 4 and 12. Sleep ­efficiency (SE), total sleep time (TST), latency to persistent sleep (LPS), and wake after sleep onset (WASO) were ­evaluated at home. Sleep disturbance (Pittsburgh sleep quality index: PSQI), ­sleepiness (Epworth sleepiness scale: ESS), and depressive symptoms (Beck depression index: BDI) were examined.

Results

31 subjects completed the 4-week and 29 completed the 12-week assessments. Subjects showed significant improvements in objective SE at weeks 4 and 12 of treatment compared to untreated baseline. Objective TST tended to increase with the treatment at week 12. Mixed-effects linear analysis revealed that the poorer the sleep measures (SE, TST, LPS, and WASO) were at baseline, the more these measures improved with lemborexant. Scores of PSQI, ESS, and BDI significantly decreased (improved) with lemborexant treatment compared to those at baseline.

Conclusion

The findings from the analyses demonstrate objective improvement of SE with lemborexant treatment across 12 weeks and support the previously reported benefit of lemborexant using polysomnography.

Support (if any)
0414 Pain in Your Day? Get Sleep Treatment Anyway! The Benefits of Behavioral Treatments for Insomnia Despite Pain Symptoms
Authors: Erickson Alexander , Ravyts Scott , Mitchell Michael , Dzierzewski Joseph , Alessi Cathy , McGowan Sarah Kate , Carlson Gwendolyn , Kelly Monica , Lee Diane , Song Yeonsu , Fung Constance , Martin Jennifer
Published: May 2023

Introduction

Sleep-related problems and pain affect millions of U.S. adults. Sleep-focused interventions improve both sleep and pain-related outcomes. However, pain can be a barrier to insomnia care due to perceptions that insomnia treatment may not be as effective in the presence of ongoing pain. This study evaluated whether pain severity and pain interference in daily life moderate the effects of behavioral treatments for insomnia on sleep outcomes (e.g., insomnia symptoms, perceived sleep quality, sleep effort, daytime sleepiness).

Methods

Secondary data analysis was conducted on a sample of 149 women veterans with insomnia disorder who completed either Cognitive Behavior Therapy for insomnia (CBT-I) or Acceptance and Behavioral Changes to treat Insomnia (ABC-I) treatment, both of which showed overall benefit in treating insomnia in women veterans. In the original study, sleep outcomes (ISI, PSQI, GSES, ESS), pain factors (BPI), and other outcomes were measured at baseline, posttreatment, and at 3-months follow-up. Linear and quadratic mixed effects models with random intercepts (subject-level) were conducted to examine the influence of treatment phase, pain-related severity and interference, and their interaction on sleep outcomes.

Results

All models were statistically significant (92.13≤Χ2≤519.55). No significant interactions were present between treatment phase and pain severity or interference in relation to sleep outcomes. Across analyses, treatment phase, both from baseline to posttreatment (-2.22≤b≤-8.31, p<.001) and from baseline to 3-month follow-up (-2.67≤b≤-8.17, p<.001), illustrated significant improvement of sleep quality outcomes.

Conclusion

Neither pain severity nor pain interference had a significant impact on outcomes of behavioral treatments for insomnia in women veterans. Findings have clinical implications in that they support the encouragement of individuals with co-morbid chronic pain and insomnia symptoms to engage in non-pharmacological interventions for insomnia disorder. Future research could expand on this study by including pain-related interventions concurrent with behavioral interventions for insomnia disorder.

Support (if any)

Data used was from an original project funded by VA/HSR&D IIR-HX002300 (PI: Martin), NIH/NHLBI K24HL143055 (PI: Martin). Dr. Erickson was supported by the VA Office of Academic Affiliations through the Advanced Fellowship Program in Geriatrics. Support was also provided by the VA Greater Los Angeles Geriatric Research, Education and Clinical Center.
0415 Predictors of treatment response and remission after CBT-I among adolescents with insomnia and eveningness
Authors: Sit Hao Fong , Cheung Forrest Tin Wai , Chan Ngan Yin , Chan Joey , Zhang Jihui , Li Albert Martin , Gradisar Michael , Espie Colin , Wing Yun Kwok , Li Shirley Xin
Published: May 2023

Introduction

Despite the efficacy of cognitive behavioural therapy for insomnia (CBT-I) for treating youth insomnia, there remain individual differences in treatment outcomes. Previous studies found that demographic (e.g., age) and clinical features (e.g., depression, anxiety) could potentially affect treatment responses in adults but there has been limited research conducted in youth. This study aimed to identify potential predictors of treatment response and remission of insomnia following CBT-I in a sample of adolescents with insomnia and eveningness.

Methods

The sample consisted of 57 adolescents with insomnia with eveningness (Age: 20.21 ± 1.95, 15-24, female: 56.14%) who had completed a 6-session group-based cognitive behavioural therapy (CBT-I) with (n = 27) or without bright light therapy (n=30). Assessments were conducted at baseline and one-week post-intervention. Insomnia Severity Index (ISI) was used to measure self-reported insomnia symptoms. Treatment response was defined as a reduction in ISI score ≥ 6 after treatment, and remission was defined as an ISI score < 9 at post-treatment. Backward stepwise logistic regression was conducted to explore baseline demographic and clinical factors (e.g., comorbid depression or anxiety, suicidality) that might contribute to treatment response and remission of insomnia.

Results

About 64.9% and 68.4% of the participants achieved treatment response and remission of insomnia, respectively. There was no significant difference in response (60.0% vs. 73.4%) and remission (63.3% vs. 74.1%) rates between participants with and without adjunctive light therapy. Treatment response was significantly predicted by lower suicidality (p<.05) and less eveningness (p<.05), while being male (p=.09) and having greater insomnia symptoms (p=.06) were associated with treatment response at a marginal significance. Participants with older age (p<.05) and greater insomnia symptoms (p<.05) were more likely to achieve a remission. Moreover, greater anxiety symptoms (p=.09) and adjunctive bright light therapy (p=.07) predicted insomnia remission with a trend towards significance.

Conclusion

CBT-I is more effective in adolescents with less eveningness, elevated insomnia symptoms, and less suicidality. Future research should explore whether addressing these factors in the delivery of CBT-I could improve treatment outcomes in youths with insomnia.

Support (if any)

This work was funded by General Research Fund (Ref. 17608918), Research Grants Council, University Grants Committee, Hong Kong SAR, China.
0420 Sleep onset misperception in youths with insomnia: Correlates and implications for treatment
Authors: Wang Ran , Chan Ngan Yin , Cheung Forrest Tin Wai , Chan Joey , Zhang Jihui , Li Albert Martin , Espie Colin , Wing Yun Kwok , Li Shirley Xin
Published: May 2023

Introduction

Individuals with insomnia often show subjective-objective sleep discrepancy, especially an overestimation of their sleep onset latency (SOL) while the factors associated with such discrepancy remained unclear. Whilst cognitive behavioral therapy for insomnia (CBT-I) has been recommend as the first-line treatment for insomnia, there has been limited research to investigate the effects of CBT-I on sleep onset perception in youths with insomnia. The present study aimed to identify potential variables related to sleep onset misperception and explore the effects of CBT-I on sleep onset misperception among youths with insomnia.

Methods

Sixty treatment-seeking youths with insomnia (mean: 19.74 ±2.42, female: 55%) were recruited to assess for their sleep and clinical characteristics using self-report questionnaires and 7-days sleep diary and actigraphy (T1). A subset of the sample (N=19) further completed an 8-week CBT-I programme and assessed at one-week post-treatment (T2) and 6-month follow-up (T3). Sleep misperception index was computed by subtracting actigraphy-measured SOL from sleep diary reported SOL, where a higher value indicates a higher degree of SOL overestimation. Demographic, clinical and sleep-related variables were compared between high versus low sleep onset misperception groups as divided by the mean of the sample. Changes in sleep onset misperception after CBT-I were analyzed using repeated measures ANOVA.

Results

High sleep onset misperception group demonstrated a significantly higher degree of anxiety symptoms (t(28)=-3.92, p<.01) and pre-sleep cognitive arousal (t(28)=-0.49, p<.05) as compared to low sleep onset misperception group. Participants who completed CBT-I showed a significant decrease in subjective-objective SOL discrepancy (T1=19.52, T2=6.96, T3=-1.37). A post-hoc pairwise comparison using the Bonferroni correction suggested a significant decrease in subjective-objective SOL discrepancy from T1 to T3 (p<.05). Significant improvement in pre-sleep cognitive arousal was found from T1 to T3 (<.001) and such an improvement was found to be significantly correlated with the reduction in sleep onset misperception (r=0.16, p<.05).

Conclusion

Sleep onset misperception is associated with anxiety symptoms and pre-sleep cognitive arousal in youths with insomnia. Preliminary evidence supports that CBT-I is effective in improving sleep onset misperception in youths with insomnia. Future research should explore the neurophysiological mechanism underlying sleep onset misperception and the changes of such a discrepancy upon intervention.

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0423 The Role of Fear of Sleep in Cognitive Behavioral Therapy for Insomnia and Cognitive Processing Therapy
Authors: Youngren Westley , Heffner Kathi , Bishop Todd , Cerulli Catherine , Gallegos Autumn , Crane Hugh , Pigeon Wilfred
Published: May 2023

Introduction

Fear of sleep (FoS) is linked to symptoms of PTSD. Additionally, cognitive behavioral therapy for insomnia (CBTi) can reduce FoS. Utilizing data from a randomized controlled trial of CBTi followed by Cognitive Processing Therapy for PTSD (CPT), this secondary data analysis sought to examine the relationship between FoS and PTSD symptoms, and how FoS is impacted by CBTi, in individuals exposed to interpersonal violence with PTSD. Additionally, we sought to extend the literature by examining whether FoS predicts the effect of subsequent CPT on PTSD severity or if CPT further reduces FoS.

Methods

A sample of 83 participants were randomly assigned to either receive sequential delivery of four weekly sessions of CBTi, which included modules to address FoS, followed by 12 weekly sessions of CPT (Group 1: CBTi+CPT) or receive four weekly phone check-ins (CTRL) followed by CPT (Group 2: CTRL+CPT). Participants were assessed at baseline (T1), after CBTi/CTRL (T2), and after CPT (T3). Relevant measures included the Fear of Sleep Inventory (FoSI) and Clinician Administered PTSD Scale (CAPS). Analyses included correlations, mean differences tests, and regression-based analyses.

Results

At T1 FoSI and CAPS were positively correlated (r = 0.47, p < 0.001). At T2 a significant reduction in FoSI scores was observed after CBTi/CTRL for Group 1 (t = 4.81, p < 0.001), but not Group 2, and a significant difference in FoSI scores between Group 1 and Group 2, all while controlling for baseline differences (F (1, 80) = 3.99, p < 0.05). Lastly, for the entire sample lower T2 FoSI scores predicted lower T3 CAPS scores (B = 0.42, p < 0.01) and FoS was not further reduced following CPT.

Conclusion

Results replicate previous work by demonstrating a positive relationship between FoS and PTSD severity. Additionally, FoSI was significantly reduced after CBTi. Lastly, lower levels of FoS predicted reduced PTSD symptoms following CPT, although CPT was not associated with significant reductions in FoS. Results highlight that CBTi that explicitly addresses FoS may reduce FoS, and findings also suggest that effectively reducing FoS prior to PTSD treatment may improve treatment outcomes.

Support (if any)

NIH/NINR R01 NR013909; VA Center of Excellence for Suicide Prevention
0439 Patient-Reported Experience with Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea – Influence of symptom improvements
Authors: Braun Marcel , Schoebel Christoph , Wollny Mathias
Published: May 2023

Introduction

Hypoglossal Nerve Stimulation (HNS) is routinely used as an alternative treatment for patients with obstructive sleep apnea (OSA). Significant and clinically relevant improvements in disease severity and OSA symptoms such as daytime sleepiness as well as overall quality of life have been reported in randomized-controlled trials and large real-world cohort studies. However, so far little data exists on patient-relevant experience with the treatment.

Methods

A structured survey with 22 questions was constructed using five-level Likert scales (1 = no agreement, 5 = complete agreement) to evaluate patient experience with HNS in the dimensions “Overall experience with therapy”, “Experience with treatment process” and “Side effects”. Additional data was collected on current symptom status and OSA disease history.

Results

45 patients from Germany that received a breathing-synchronized HNS system were enrolled (mean age 57.8 years, 78% male). Two-thirds of participants had an OSA history of 5 years or longer (67%). Of all patients, 76% had normalized OSA symptoms at time of the study (ESS: 6.4 ± 5.0) and 97.6% reporting every night use of stimulation therapy. Patients with normalized daytime sleepiness, reported significantly more positive experience across all major domains investigated, compared to patients with residual daytime sleepiness (ESS ≤ 10 versus ESS > 10). HNS therapy was well tolerated in all patients, though patients with higher ESS values reported significantly less improvements of sleep quality and more often waking up from therapy. Only 2.2% of participants though had side effects that made them reduce or even discontinue stimulation therapy.

Conclusion

Overall patient-reported experience with HNS therapy is positive and high satisfaction with the treatment process was observed. Subjective experience is influenced by residual daytime sleepiness under stimulation. Side effects occur, but rarely impact subjective therapy use. Additional studies are warranted to confirm the findings from this evaluation in larger cohorts.

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0445 Real-world Evaluation of Upper Airway Stimulation system survival using post-market surveillance data
Authors: Huntley Colin , Chio Eugene , Soose Ryan , Huyett Phillip , Steffen Armin , Heiser Clemens , Boon Maurits
Published: May 2023

Introduction

Upper airway stimulation (UAS) has become a viable treatment alternative for well selected patients with moderate to severe obstructive sleep apnea (OSA) who struggle to tolerate positive pressure (PAP) therapy. Post-market surveillance is required of medical device manufacturers to assess treatment outcomes, complications, and device failure. We aim to utilize this surveillance data to assess rates of revision and removal of the Inspire (Minneapolis, MN) UAS system in a real-world setting.

Methods

Post market surveillance data was compiled from manufacturer’s complaint handling system for explants and revisions of the hypoglossal nerve stimulator. Data collection began in January 2018 and was available through September 30 2022 at the time of analysis. Implant procedures from January 2018 through September 2021 were analyzed for events within one year of implant. Events were classified into categories. A subset of these devices implanted before September 30 2019 were analyzed for events between one and three years after implant.

Results

Between Jan 01 2018 and Sep 30 2021, 15282 devices were implanted. Within one year of the implant, 121 devices (0.8%) were explanted for: infection (66), elective (32), MRI (10), other (10), and twiddler syndrome (3). Surgical revisions were required for 245 patients (1.6%) for: surgical correction (139), device defect (81), other (21), cardioversion (2), twiddler syndrome (1), and MRI (1). A subset of 5080 of these devices were implanted prior to September 30 2019. Between one year and three years following implant 119 devices (2.3%) were explanted for: elective (58), MRI (35), infection (15), Other (9), and twiddler syndrome (2). Surgical revisions were performed for 160 patients (3.1%) for: surgical correction (64), device defect (57), other (32), twiddler syndrome (5), and cardioversion (2).

Conclusion

As with any implantable medical device, a certain rate of revision and explant is expected for device, patient, and medical indications. The rate of UAS revision and explantation is low at both the 1 year and 3 year time points. UAS implantation is a safe alternative to CPAP for well selected patients with a low rate of unexpected reoperation for either revision or hardware explantation.

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Inspire Medical
0447 Study of PAP response and compliance in patients with ILD and OSA: A case-control single center cohort
Authors: Herberts Michelle , Vadiyala Mounika , Bryan Kelly , Moua Teng , Escalante Patricio
Published: May 2023

Introduction

Interstitial lung disease (ILD) is a heterogenous group of parenchymal lung disorders with multiple etiologies. ILD often affects the quality of life and survival of patients. OSA is commonly diagnosed among ILD patients with reported prevalences of 50-90%, and a prevalence of moderate to severe OSA as high as 65%. There is also concern that patients with ILD may be less tolerant of PAP therapies. We aim to identify differences in PAP treatment response and adherence in patients with ILD and OSA compared with a group of matched OSA controls.

Methods

A retrospective cohort analysis was conducted on patients ≥ 18 years-old that were evaluated at Mayo Clinic Center for Sleep Medicine between July 2012 to June 2022. Inclusion criteria were patients with a diagnosis of ILD per ATS criteria also diagnosed with OSA by HSAT or PSG. Control OSA patients were matched to ILD/OSA patients by age, BMI, and AHI ranges. Exclusion criteria included comorbid conditions of asthma or COPD. Patients with early non-adherence to CPAP or those who didn't have sleep follow up were also excluded. Follow-up sleep visits were assessed to determine CPAP adherence, change in PAP pressure, addition of oxygen, and change in Epworth sleepiness scale.

Results

We compared 51 patients with ILD/OSA and 51 OSA matched-controls. Twenty-five ILD/OSA patients were diagnosed by PSG and 26 by HSAT. Median treatment follow-up for the ILD group was 7 months (IQR of 3 to 18 months). Baseline characteristics, including oxygen desaturation index (ODI), oxygen saturation, time spent below 89% during overnight oximetry, and baseline Epworth scale, were similar between ILD/OSA and non-ILD OSA patients. Importantly, there was no statistically significant difference in PAP adherence, median PAP levels, PAP pressure change, residual AHI, or change in Epworth after treatment

Conclusion

There was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence in ILD patients with OSA compared with matched non-ILD OSA controls. Outcome assessment may be limited by sample size and the shorter follow-up period. Future studies should include longer-term follow-up with a larger ILD cohort to assess the impact of ILD progression on PAP adherence over time.

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