bluuebunny/crossref_metadata_2025 huggingface dataset:
0736 Association of Excessive Sleepiness with All-cause Mortality Among Older Adult US Veterans
Authors: Maghsoudi Arash , Ramezani Amin , Sharafkhaneh Amir , Razjouyan Javad
Published: April 2024

Introduction

The association between excessive daytime sleepiness (EDS) and all-cause mortality remains uncertain. We investigated the relationship between EDS and all-cause mortality along with other factors including comorbid conditions.

Methods

We included patients who had visited the Veterans Health Administration (VHA) between FY 1999 and the end of 2022; and those who had been assigned ICD codes 9/10 of any sleep disorders or CPT codes of sleep studies. We developed and validated a Natural Language Processing (NLP) algorithm to extract Epworth sleepiness scale (ESS) from unstructured free-form text from physician notes. We assessed the NLP pipeline's performance using 470 patient notes that were manually annotated. We defined EDS as an ESS≥11. We categorized the patients into two groups: normal (ESS ≤10) and sleepy (ESS >10). Control factors were the most important variables determined through a machine learning algorithm. We reported adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models using most important factors. The process was separately applied to two distinct groups of veterans: those younger than 50 years and those aged 65 years or older.

Results

Out of 423,087 unique patients with ESS, 116,581 (27.6%) were older adults where 71,913 were grouped as normal and 44,668 as sleepy. Among young adults, only depression considered as the most important factor for all-cause mortality and all-cause mortality rates did not differ between normal and sleepy groups. For older adults, 33 factors including ESS were considered as the most important variables. The aOR of all-cause mortality was 21% higher in Sleepy compared Normal (aOR,1.21;95%CI:1.17,1.24). Among the comorbid conditions, the prevalence of diabetes, depression, heart failure, renal disease, PTSD, and cerebrovascular disease were higher in Sleepy compared to the Normal.

Conclusion

In sharp contrast to younger adults, excessive daytime sleepiness, as measured by ESS, predicted higher mortality in older adults. The presence of important comorbid conditions in older adults most likely plays a causal role. Chronic comorbid conditions may disturb sleep and result in excessive daytime sleepiness.

Support (if any)

Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), MEDVAMC.
0737 Retirement, Health-Related Quality of Life, and Sleep in Older Adult Veterans
Authors: Erickson Alexander , Kelly Monica , Fung Constance H , Stepnowsky Carl , Zeidler Michelle , Song Yeonsu , Dzierzewski Joseph , Mitchell Michael , Barretto Bronson , Partch Lisa , Rodriguez Ariana , Pearson Lori , Josephson Karen , Martin Jennifer , Alessi Cathy
Published: April 2024

Introduction

Retirement is a major life transition. Prior evidence suggests that retired individuals have better sleep quality than working individuals, though may also exhibit worse physical and mental health-related quality of life (HRQOL). Few studies have examined how retirement can impact the relationship between sleep and HRQOL, particularly among veterans who often face greater impairments in sleep and health.

Methods

Secondary analyses were conducted in a sample of 346 older veterans (mage=64, 47% white) with suspected co-morbid sleep apnea and insomnia. Measures included retirement status (retired/not retired), the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Short-Form Health Survey (SF-12) encompassing both physical (SF-P) and mental health-related (SF-M) quality of life. Multiple regression analyses were conducted, with each model containing one sleep variable (ex. ISI), retirement status, and statistical interactions predicting SF-M or SF-P.

Results

All models were statistically significant. Retirement status was a significant predictor of SF-P across models (-4.52< b<-4.22, p≤.001), but was not a predictor of SF-M. When coupled with PSQI, the relationship between PSQI and SF-P was moderated by retirement status (b=-.68, p=.02), with retired individuals endorsing lower SF-P with poorer sleep quality compared to non-retired individuals. PSQI was also a significant predictor of SF-M (b=-1.27, p<.001). ISI was a significant predictor of both SF-P (b=-.41, p=.01) and SF-M (b=-.9, p<.001).

Conclusion

Poor sleep and being retired are associated with poor physical HRQOL, with physical HRQOL being particularly impacted by sleep quality in veterans who are retired. In contrast, only poor sleep functioning appeared to impact mental HRQOL. Findings from this study highlight the importance of sleep-related factors in maintaining HRQOL as well as the role retirement can play in physical HRQOL.

Support (if any)

Support: Support provided by the Veterans Administration (VA) HSR&D (Award #: HX003221), VA Greater Los Angeles GRECC, and the National Heart, Lung and Blood Institute (NHLBI)
0738 Differences in Perception in Sleep in Individuals with Dementia and Cognitive Impairment
Authors: Singh Jasmin , Vaughn Brad , Fan Zheng , Roth Heidi
Published: April 2024

Introduction

Normal aging is associated with changes in an individual’s sleep. Individuals with dementia and cognitive impairment have greater dysregulated sleep. These patients may have difficulty reporting sleep problems reliably or may have a distorted perception of their sleep quality. In this study, we examined how older patients with and without cognitive impairment compared with respect to objective and subjective measures of sleep, with a focus on perception of sleep onset latency (SOL) and total sleep time (TST).

Methods

We performed a retrospective review of diagnostic and PAP Titration polysomnograms from 2022 that were performed for patients ages 60-95 with a diagnosis of dementia or cognitive impairment (impaired group). An age-matched control group was also found in this fashion (control group). These polysomnograms were performed and scored in accordance with the AASM guidelines. Data regarding sleep time, SOL, Apnea-Hypopnea Index (AHI) and perceptions on TST and SOL were collected. A student T-test was used to compare measures in these groups.

Results

We identified 35 patients who were in the cognitively impaired group (mean age = 73) and 35 age-matched controls (mean age = 71). The average objective sleep latency for the impaired and control groups did not differ (26 minutes and 24 minutes, p=0.73), neither the average total sleep time (312 minutes and 309 minutes, p=0.86) nor the average AHI (12.9 and 17.5, p=0.34). The impaired group more frequently overestimated their perceived sleep latency (+62 minutes versus +22 minutes, p=0.02); however, the groups did not differ in their estimation of TST (p=0.16).

Conclusion

Our study found that patients with cognitive impairment overestimate how long it takes them to fall asleep compared to objective measures and their age match controls. Although many factors may contribute to this discrepancy, these findings suggest more thorough screening of sleep problems should be considered prior to initiation of interventions in individuals with cognitive impairment.

Support (if any)
0742 Sleep and Cognition in Older Adults: The Role of Subjective Cognitive Beliefs
Authors: Nielson Spencer , Dzierzewski Joseph
Published: April 2024

Introduction

Sleep is vital for an individual’s cognitive functioning and changes in sleep and cognition are common as individuals age. In older adults, subjective cognitive beliefs are a robust predictor of subsequent objective cognitive decline. Although sleep is consistently associated with subjective cognitive beliefs, its association with objective cognitive functioning is less well defined. This study aimed to examine whether sleep may be associated with objective cognitive functioning through its association with subjective cognitive beliefs in community-dwelling older adults.

Methods

Participants (N=365) were middle-aged and older adults (Mage=62.8, 59.7% female) who participated in an online study including questionnaires (Insomnia Severity Index, RU-SATED sleep health questionnaire, Karolinska Sleepiness Scale, and the Everyday Cognition Scale) and objective cognitive testing assessing the following domains: impulsivity, executive function, memory, and attention. Bivariate correlations and linear regression analyses examined direct associations between variables. Mediation was examined via SPSS PROCESS macro to determine whether subjective cognitive beliefs mediated the associations among sleep characteristics and objective cognitive functioning.

Results

Better sleep (i.e., less insomnia symptoms and sleepiness, better sleep health) was associated with more positive subjective cognitive beliefs (all p’s<.05). Additionally, less insomnia symptoms (impulsivity, executive functioning, memory), less sleepiness (impulsivity, executive functioning, memory, attention), and better sleep health (executive functioning, memory) were associated with better objective cognitive functioning (all p’s<.05). Mediation analyses revealed that subjective cognitive beliefs fully mediated the associations between the following: (1) Insomnia and impulsivity and memory (2) Sleepiness and impulsivity, memory, and executive functioning (3) Sleep health and memory and executive functioning. Subjective cognitive beliefs only partially mediated the associations between the following: (1) Insomnia and executive functioning and (2) Sleepiness and attention.

Conclusion

Subjective cognitive beliefs play an important role in linking sleep behaviors to objective cognitive functioning in older adults. In fact, many of the sleep—cognitive functioning associations were found to be fully mediated by subjective cognitive beliefs. As beliefs about cognitive functioning are an important predictor of pathological cognitive aging, interventions aimed at improving both sleep and cognitive functioning that utilize social learning principles, such as self-efficacy, may be particularly efficacious.

Support (if any)
0743 Association of Circadian Timing with Incident Dementia: The Korean Genome and Epidemiology Study
Authors: Kim Soriul , Kim Hyeon Jin , Lee Seung-Ku , Kim Hyun , Siddiquee Ali , Lee Min-Hee , Hwang Yoon Ho , Thomas Robert , Westover M Brandon , Shin Chol
Published: April 2024

Introduction

Circadian rhythm disruption is common in neurodegenerative disorders such as dementia. Especially, preference for circadian timing (e.g., chronotype) mainly affects cognitive and memory function. Previous studies reported that individuals with earlier chronotype may be useful predictor of poor neurocognitive outcomes and accelerated brain aging, but there is still not adequate strong evidence regarding the relationship between chronotype and dementia. The aim of the present study is to examine the associations between different chronotype and incident dementia through middle-aged to older general population.

Methods

A total 9541 participants of the Korean Genome and Epidemiology Study – Ansan and Ansung (mean age, 52.2±8.9), who have been linked to the Health Insurance Review and Assessment Service national database to assess incident all-cause and sub-type of dementia were analyzed. The mid-point sleep (MST) was defined as the midpoint between bedtime and wake time and used to categorize the participants into three groups (earlier-, intermediate-, and later-type). In multivariate Cox regression analysis, we adjusted for age, sex, area, marital status, education level, body mass index, smoking and drinking status, regular exercise, hypertension, diabetes, depression, hyperlipidemia, heart, and cerebrovascular disease at baseline.

Results

During the mean follow-up of 17.7 years, dementia was diagnosed in 1236 participants (588 with Alzheimer's disease (AD)). Among total participants at baseline, 13.0% were 65-69 years of age and 52.9% were women. Compared to the intermediate-type (-1SD (1.3 h) ≤ MST ≤ +1SD (3.6 h)), adjusted hazard ratio (HR) of all-cause dementia were 1.19 (95% CI, 1.04-1.36) in the earlier-type (<-1SD). In addition, earlier-type was associated with greater risk of AD (HR = 1.22; 95% CI, 1.02-1.47). However, these associations were not shown in later chronotype (>+1SD).

Conclusion

Our findings suggest that early mid-point of sleep was prospectively associated with an increased risk of all-cause dementia and Alzheimer’s disease among middle-aged or older adults.

Support (if any)

This study was supported by the Korea Centers for Disease Control and Prevention (2001-347-6111-221, 2002-347-6111-221); Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2020R1I1A1A01071011 and NRF-2022R1I1A1A01065700); National Institutes of Health (NIH) (RF1NS120947); Health Insurance Review and Assessment Service research data (NHIS-2023-1-600).
0745 Prevalence of Sleep Disorders in Dementia Patients- a Demographic Analysis
Authors: Tallavajhula Sudha
Published: April 2024

Introduction

The prevalence of sleep complaints in the general population far surpasses that of sleep disorders, mainly due to under-recognition. In patients with dementia, the prevalence of sleep disorders is even more vague, despite growing interest in the association between neurodegeneration and sleep disturbances. This project aims to understand the prevalence of sleep disorders in dementia patients, overall and across demographics.

Methods

Data was analyzed from the outpatient EMR in the UTHealth Neurosciences clinic from January 1, 2022-December 18, 2023. 12,187 patients with a dementia diagnosis were selected. ICD-10 codes identified patients with concomitant sleep-related diagnoses. The cohort was analyzed by race and gender. Percentages of patients with sleep apnea and insomnia were also identified.

Results

The sample of dementia patients included 5354 white, 2846 black, 2273 other, 663 Hispanic, 489 unknown, 455 Asian, and 25 American Indian or Alaska natives. Among these, 22% white, 21% black, 20% other, 24% Hispanic, 18% unknown race, 17% Asian, and 36% American Indian or Alaska Native patients carried a sleep disorder diagnosis. We note that a comparatively small number, only 25 American Indian or Alaska Native patients were included in the analysis, which might account for the disproportionate sleep disorder prevalence in that group. Regarding gender, the patients consisted of 1069 female and 5108 male patients with dementia. Of these, 20% of female and 22% of male patients carried sleep-related diagnoses. 13.4% were given a diagnosis of insomnia and 7% of sleep apnea. 5% of female and 9 % of male patients had sleep apnea. 14% of female and 12% of male patients were diagnosed with insomnia. Other sleep disorders were not separately identified. The overall percentage of dementia patients with sleep-related diagnoses was 21%.

Conclusion

The prevalence of sleep disorders in patients with dementia was about 20%. Similar to the general population, the most common sleep disorder diagnosis was insomnia, with sleep apnea being a close second. Also, similar to the general population, insomnia was more common in female patients and sleep apnea in male patients. There were no significant differences in the frequencies of sleep-related diagnoses among dementia patients in racial and gender groups.

Support (if any)

None
0746 Rested and Connected: An Exploration of Sleep Health and Loneliness Across the Adult Lifespan
Authors: Nielson Spencer , Boyle Julia , Dzierzewski Joseph
Published: April 2024

Introduction

The 2023 U.S Surgeon General’s Advisory identified loneliness as a major public health concern. Growing research in this area has identified a relationship between loneliness and poor sleep outcomes in different age groups; however, few studies have explored the relationship between loneliness and sleep health. As such, the present study evaluated the association between loneliness (including social and emotional loneliness subtypes) and sleep health across the adult lifespan.

Methods

Participants included adults across the lifespan (N=2297, Mage = 44 years, 49% female) who completed an online study which included the RU-SATED sleep health questionnaire and the Gierveld Loneliness scale. Correlation and linear regression analyses were utilized to examine direct associations between sleep health, age, and loneliness. The total score and the subscales (emotional and social loneliness) of the Gierveld Loneliness scale were examined to investigate if components of loneliness were differentially associated with sleep health. Moderation analyses examined whether the link between sleep health and loneliness differed by age. Separate moderation models were constructed for each loneliness outcome (i.e., total, emotional, or social), with sleep health, age, and their interaction as predictors.

Results

Better sleep health and younger age were associated with significantly lower loneliness total and subscale scores (all p’s <.05). Age significantly moderated the association between sleep health and total loneliness scores and emotional loneliness scores (b = 0.01, t = 2.63, p = .009; b = 0.04, t = 3.15, p = .002, respectively); but did not moderate the association between sleep health and social loneliness (b = 0.02, t = 1.54, p = .124). Specifically, while better sleep health was associated with lower loneliness across ages, this association was stronger at younger ages.

Conclusion

Results suggest that younger age groups may be more prone to the positive effects of better sleep health on loneliness, especially emotional loneliness, compared to older age cohorts. Promoting sleep health may be an untapped avenue to support efforts and programs that aim to reduce loneliness and increase engagement in all age groups, but especially in younger ages. Future research should consider monitoring sleep health in programs or interventions that address loneliness.

Support (if any)
0748 Sleep Value Profiles–Which Type Are You?
Authors: Ward Levi , Sherriff Dustin , Yang Chongming , Wright Andrew , Duraccio Kara , Calvin Danika , Klingonsmith Bryce , Kay Daniel
Published: April 2024

Introduction

Sleep value, the worth placed on sleep, is an important dimension of sleep health. Using the Sleep Valuation Item Bank (SVIB) we have previously found associations between sleep value factors and demographic, sleep, and psychological variables. The patterns of sleep value hint that there may be distinct sleep value profiles. In a nationally representative sample of 454 participants, we sought to identify these profiles and explore whether they differ in demographic features.

Methods

Participants ages 18-85 (M = 45) completed an online Qualtrics survey that included demographic variables and the SVIB. The factor structure of the SVIB was confirmed using factor analysis. Latent profile analyses with the confirmed factors were conducted and multiple models were compared to identify the best-fitting sleep value profiles. Multiple regression was used to explore whether these profiles differed in age, gender, marital status, income, education, having dependents, and race.

Results

Five sleep value factors were confirmed: sleep wanting, liking, devaluing, prioritizing, and preferring. Latent profile analysis found evidence for 5 classes, or sleep value profiles: (1) an indifferent profile who neither valued nor devalued their sleep who made up 25% of the sample, (2) sleep prioritizers who scheduled their lives around sleep made up 27% of the sample, (3) sleep devaluers made up 26%, (4) an ambivalent profile who highly valued and devalued sleep made up 15%, and (5) on 7% were sleep valuers. Those with the indifferent profile tended to be older (p < .001). Those with the ambivalent profile were more likely to be working-age adults (p < .001) and male (p < .05).

Conclusion

This study found distinct profiles of sleep value that differ in terms of demographics. Only 7% of our nationally representative sample had a profile suggesting they value sleep. The vast majority had an indifferent, ambivalent, or devaluing profile. Understanding how the patterns of sleep value develop and inform sleep-related behavior is an important avenue for future research. These findings may help personalize messaging for sleep health promotion.

Support (if any)
0750 Association Between Physical Activity and Sleep Quality in Older Adults and the Mediation of Pain
Authors: Liu Sofia , Li Mengchi , Li Qiwei , Calderon Russell , Lukkahatai Nada , Li Junxin
Published: April 2024

Introduction

Sleep disturbances are more prevalent in older adults. Both physical inactivity and pain have been linked to sleep disturbances in older adults, but the intricate interplay between these mechanisms is underexplored. This study investigates the associations between physical activity (PA) and sleep with both subjective and objective measures and the potential mediation of pain among community-dwelling older adults.

Methods

This cross-sectional study used baseline data of 125 community-dwelling older adults without dementia (Mean age = 70.45±6.18 years, 82.40% female, 57.60% White) who participated in a randomized controlled trial. PA and sleep were assessed objectively using ActiGraph Link and Actiwatch 2, and subjectively using Physical Activity Scale for the Elderly (PASE) and Pittsburgh Sleep Quality Index (PSQI). Pain intensity, interference, and behavior were assessed using PROMIS Pain Scales. Multiple linear regressions examined associations between PA and sleep quality, and Baron and Kenny’s approach was used to explore the mediation of pain.

Results

Adjusted for age, sex, race, and comorbidities, higher PASE correlated with lower PSQI (β = -0.169, 95% Confidence Interval [CI]: -0.284, -0.053). Pain intensity (indirect effect: -0.039, 95% CI: -0.078, -0.001), pain interference (indirect effect: -0.042, 95% CI: -0.082, -0.002), and pain behavior (indirect effect: -0.035, 95% CI: -0.071, -0.002) were significant mediators. Objective PA was associated with shorter sleep onset latency (SOL) and reduced wake after sleep onset. Specifically, the association between objective PA and SOL was partially mediated by pain intensity (indirect effect: -0.076, 95% CI: -0.173, 0.022). Pain interference and behavior mediated the relationships between objective PA and self-reported sleep quality (indirect effects: -0.022, 95% CI: -0.045, 0.001 for interference; -0.017, 95% CI: -0.037, 0.003 for behavior).

Conclusion

Our findings reinforce the association between PA and better sleep quality using both self-reported and objective measures and validate the mediation role of pain measures. These results suggested a critical role of pain in shaping the dynamics links between PA and sleep quality. Given the cross-sectional nature of our data, future longitudinal studies are necessary to further explore these findings.

Support (if any)

R00NR016484
0754 Sleep Sightlines and Soundwaves: Exploring Sex Differences in Sleep-Related Attentional Bias in Older Adults
Authors: Curtis Ashley , Costa Amy , Musich Madison , Nowakowski Lauren , Young Kobe , Rzeppa Chloe , McCrae Christina
Published: April 2024

Introduction

Insomnia disorder affects 12-20% of older adults, with 2x higher prevalence in women than men. Persistent insomnia symptoms may be influenced by excessive sleep pre-occupation and biases toward sleep-related stimuli (“sleep-related attentional bias”). Whether this bias is sex- and/or modality-specific remains unexplored. This study examined whether there are sex differences in visual/auditory sleep-related attentional bias in older adults.

Methods

Older adults (Mage=68.2±5.9) with (n=31; Women:20/Men:11) and without (n=50; Women:28/Men:22) insomnia (DSM-5 criteria plus reported 6+nights/14 of >30 mins sleep onset latency or wake after sleep onset) completed modified Posner Cueing tasks. Cues included sleep-related auditory (e.g., alarms, snoring), visual (e.g., clocks set to bedtimes, person awake in bed) and non-sleep (auditory: pure tones; visual: neutral International Affective Picture system images) stimuli. Valid [non-cued reaction time (RT) minus validly-cued RT] and invalid (non-cued RT minus invalidly-cued RT) sleep/non-sleep visual/auditory cueing effects were calculated. Two-way ANOVAs examined whether insomnia status interacts with sex it its impact on mean cueing effects.

Results

For visual valid (F=4.39, p=.039) and invalid (F=4.78, p=.03) sleep-related cueing effects, there were significant interactions between insomnia status and sex. Pairwise comparisons revealed insomnia men had larger (trending/p=.06) valid sleep-related cueing effects (122.0±20.0ms) than non-insomnia men (71.0±10.0ms). Invalid sleep-related cueing effects for insomnia men (123.0±23.0ms) were larger (p=.02) than insomnia women (56.0±16.0ms) and larger (p=.02) than non-insomnia men (57.0±15.0ms). For auditory valid cueing effects, there were main effects of insomnia status for sleep-related (F=4.39, p=.04) and non-sleep-related (F=6.32, p=.003) stimuli. Larger effects were observed in insomnia for valid sleep-related cues (insomnia:145.0±18.0ms; non-insomnia:89.0±12.0ms; p=.009) and valid non-sleep-related cues (insomnia:152.0±19.0ms; non-insomnia:81.0±13.0ms; p=.003) cues.

Conclusion

Visual sleep-related attention bias in older adults with insomnia may be sex-dependent, with men more likely to experience this phenomenon. Possible underlying sex-specific mechanisms include contributions of circulating testosterone to spatial attention and sleep-stimuli valence and/or threat detection. Visual stimulus desensitization towards insomnia triggers may be particularly beneficial in older men to facilitate sleep. Auditory attentional bias in insomnia may not be sex-dependent and reflect general auditory cortex hypervigilance.

Support (if any)

This research was made possible by an award (PI:Curtis) from the American Academy of Sleep Medicine Foundation.
0757 Association of Insomnia with Objective Short Sleep Duration and Other Phenotypes with Mortality in Older Persons
Authors: Miner Brienne , Pan Yulu , Cho Gawon , Knauert Melissa , Yaggi Henry , Gill Thomas , Stone Katie , Ensrud Kristine , Zeitzer Jamie , Yaffe Kristine , Doyle Margaret
Published: April 2024

Introduction

The association of insomnia with objective short sleep duration (ISSD) and mortality has not been studied in older persons.

Methods

In 3,601 men from the Osteoporotic Fractures in Men Sleep Study (average age 76±6 years) and 3,295 women from the Study of Osteoporotic Fractures (average age 84±4 years), we used Cox proportional hazards models to examine the association of ISSD (trouble getting to sleep within 30 minutes, waking up in the middle of the night or early morning, and/or taking a medication to help with sleep ≥3 times/week and actigraphy-estimated sleep duration< 6h) with mortality. We also examined whether other sleep phenotypes (insomnia with normal sleep duration [INSD; insomnia and sleep duration 6-9h], asymptomatic short sleep [AS; no insomnia and sleep duration< 6h], long sleep [LS; self-reported or actigraphic sleep duration>9h]) were associated with mortality. Persons with normal sleep (no insomnia and actigraphic sleep duration 6-9h) served as the reference group. Follow-up times were 6,538 and 2,953 days in men and women, respectively. Adjusted models included age, race, education, obesity, depression, diabetes, COPD, stroke, hypertension, myocardial infarction, and heart failure. In analyses for men, we also adjusted for severe sleep disordered breathing (apnea-hypopnea index >=30).

Results

Prevalence rates in men/women for ISSD, INSD, AS, and LS were 19.9%/11.5%, 41%/34.8%, 10.6%/10.4%, and 7.7%/17.9%, respectively. Mortality rates for men and women were 65.2% and 35.7%. Compared to men with normal sleep, ISSD (OR 1.32 [1.16, 1.52]) and LS (OR 2.22 [1.58, 3.12]) in men were associated with increased mortality risk in unadjusted models. In adjusted models, only LS vs. normal sleep conferred higher mortality risk (adjOR 1.49 [1.03, 2.14]). Similarly, ISSD (OR 1.32 [1.07, 1.62]) and LS (OR 4.65 [3.49, 6.19]) in women were associated with increased mortality risk in unadjusted analyses, but only women with LS had a higher mortality risk in adjusted models (adjOR 2.30 [1.60, 3.31]). Compared to normal sleepers, neither INSD nor AS in older men or women were related to mortality risk.

Conclusion

ISSD and LS represent high risk phenotypes in older persons. Future work should examine causal pathways and determine whether sleep improvements decrease mortality risk.

Support (if any)

AASM Foundation, NIA
0758 Associations Between Actigraphy-Assessed Step Activity and Sleep in Older Adults Following Acute Hospitalization
Authors: Arentson-Lantz Emily , Deer Rachel , Kokonda Manasa , Meers Jessica , Carreon Samantha , Boyle Julia , Fisher Steve , Hommel Erin , Baillargeon Jacques , Volpi Elena , Nowakowski Sara
Published: April 2024

Introduction

Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Clarifying the relationship between sleep and the recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between step activity and sleep parameters after an acute hospitalization in community dwelling older adults.

Methods

Patients (n=52; age 71.3 ± 6.8y, 75% female, 94.2% white), were recruited during an acute hospitalization. Participants completed sleep questionnaires including PROMIS Sleep-Related Impairment and Sleep Disturbance during acute hospitalization (baseline) and at 4-weeks post-discharge (follow-up). Participants were also given an ankle-worn accelerometer (Modus Stepwatch®) to continuously record the steps and active minutes in the hospital and the 4-week period following discharge. A subset of participants (n=26) also received an actigraphy device (Philips Actiwatch-2®) to measure number of awakenings and wake after sleep onset (WASO). Separate multivariate regression analyses were performed to determine whether steps activity predicted sleep parameters.

Results

An increase in active minutes was inversely associated with number of awakenings (-0.09±0.04, p=0.04), although the association with WASO was not significant. The average number of active minutes was inversely associated with PROMIS Sleep Disturbance score at follow-up (-0.12±0.06, p=0.04) and change in PROMIS Sleep-Related Impairment score (-0.12±0.05, p=0.03) from baseline to follow-up.

Conclusion

Together, these results demonstrated that increase in the number of minutes when steps are taken following hospitalization decreased the number of awakenings, sleep disturbance and sleep-related impairment.

Support (if any)

This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi). Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0761 The Influence of Sex on Sleep Characteristics in the Older Adult Population: Findings from the EPISONO Sleep Study
Authors: Silva Mayra , Tempaku Priscila , Andersen Monica , Tufik Sergio , Poyares Dalva
Published: April 2024

Introduction

Sleep plays an important role in the prevention and development of several chronic diseases. However, there are significant differences between female and male sleep characteristics, some of which can be lifelong. Thus, the objective of this study was to analyze, according to sex, the polysomnographic findings of adults and older adults who participated in 2 editions (2007 and 2015) of EPISONO, an ongoing Brazilian, population-based sleep study.

Methods

The baseline randomized sample included 1,042 volunteers in 2007, of these 688 were reassessed in 2015. There were 574 women and 468 men in 2007, and 380 women and 308 men in 2015. All examinations and tests were undertaken using the same protocols at both times. All participants completed an institutional questionnaire to collect socioeconomic data, and a range of other questionnaires on health and sleep parameters, and underwent full-night polysomnography (PSG) and peripheral blood collection for biochemical and hematological measurements. In both editions (2007 and 2015) physical and anthropometric assessments were made. The exclusion criteria were: pregnant and nursing women, individuals with self-care limitations (physical or mental), and shift workers.

Results

We observed that adult (p=0.003) and older adult women(p=0.001) spent more time in N3 than men, with a greater number of awakenings (p=0.001), and an increased periodic leg movement index in older adult women (0.012), but only adult women in the follow-up presented greater sleep efficiency (p=0.047). Men (adults and older adults) remained longer in N1 and adult men (p=0.001) had a higher apnea-hypopnea index (p=0.001).

Conclusion

This study prospectively evaluated with full-night PSG the sleep of the general population and reported significant findings according to sex and age, suggesting that some aspects of sleep change differ with age and according to sex.

Support (if any)

acknowledgments: This work was supported by grants from the Associação Fundo de Incentivo à Pesquisa (AFIP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) and and São Paulo Research Foundation (FAPESP, #20/13467-8 to MLA)
0762 Assessing Sleep Health Literacy in Older Adults: Dysfunctional Beliefs About Napping
Authors: Berkley Amy
Published: April 2024

Introduction

Many older adults have false, or inaccurate beliefs about sleep and insomnia that lead them to adopt coping strategies that are frequently counter-productive. People who are sleep-deprived frequently take naps to compensate for fatigue, and ‘power naps’ are frequently recommended for stress reduction. Research has shown some correlations between older adults’ napping habits and increased medical comorbidities and risks of dementia, but it has also shown that napping enhances memory consolidation and broader aspects of cognition in younger adults. Guidance against napping has centered around the possibility of detrimental effects on nighttime sleep duration and quality, and/or possible links to cognitive impairment. But much previous research has neglected to differentiate between daytime sleepiness, a complex phenomenon associated with medical comorbidities, and to regulate nap timing and duration. With greater sleep-oriented health literacy, older adults, their families, and caregivers could overcome many of these dysfunctional beliefs and learn to use intentional napping as effective compensation for a poor night’s sleep.

Methods

Semi-structured, audio-recorded interviews were conducted with residents of 2 senior living communities in the Midwest who self-reported sleep problems. The interviews were supplemented by self-report instruments, including the PSQI, along with the Dysfunctional Beliefs About Sleep Scale (DBAS) and a questionnaire about napping and daytime sleep. In the second phase, a subset of participants took part in a sleep health literacy educational intervention, in which they practiced intentional napping under recommended guidelines.

Results

Insomnia symptoms ranged from 6 months - 20+ years in duration. Mean PSQI score = 9 (5+ is considered indicative of sleep problem). 5 participants reported napping in qualitative interviews but denied daytime sleep on standard sleep assessments. Others expressed dread of napping because of perceived links to functional and cognitive decline.

Conclusion

Participants expressed optimism and relief upon learning that napping could be beneficial to their sleep.More research is needed into the ways napping can improve physical and cognitive function, and more education is needed for older adults, their families and caregivers, and long-term care staff about the importance of sleep for older adults.

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0765 Comparative Analysis of Sleep Measurement Methods: PSG vs. Actigraphy in Cognitively Normal Elderly Patients
Authors: Figueredo Luisa , Cesar Justin Oliver , Arthur Matthew , Jacobs Tovia , Gonzalez Moses , Gills Joshua L , Bernard Mark A , Bubu Omonigho , Osorio Ricardo
Published: April 2024

Introduction

Polysomnography (PSG) is the gold standard for sleep measurements, requiring individuals to sleep in a controlled environment. In contrast, actigraphy is more naturalistic, allowing at-home monitoring. While most studies comparing actigraphy to PSG have focused on healthy adults and individuals with sleep disorders, there has been limited research involving a well-characterized, healthy older adult population. Although actigraphy is convenient, it has been noted to differ from PSG in some aspects. Our study aims to assess the correlation between PSG and actigraphy in cognitively healthy older adults participating in NYU research on sleep, aging, and memory.

Methods

PSG recordings were conducted overnight at the bedside, while wrist-based data were collected on separate nights from individuals' homes. Actigraphs were worn on the non-dominant hand for seven consecutive days, validated by sleep logs. Statistical analyses, including t-tests, chi-square tests, and sensitivity-specificity assessments, were performed.

Results

Of the 151 subjects, 97 (64.2%) were female, 54 (35.8%) were male, 43 (28.5%) were Black/African American, and 108 (71.5%) were White. Mean age was 66 years (61-71). Mean Epworth Sleepiness Score was 5 (3-8) for women and 6 (3-9) for men. Total sleep time for PSG was 376 (332-418) with a mean difference with actigraphy of -67.4, 26, and 121 minutes (minimum, median, and maximum thresholds respectively, p< 0.0001 for all) Sleep efficiency (%) was higher in the actigraphy group (mean difference 11.2 [SD12.7]) and sleep latency was shorter in the actigraphy group (p< 0.001 for all). Sensitivity for short sleepers(< 5h) was 0.7, increasing to 0.9 in females and 0.86 in Black or African Americans. Specificity corresponded to 0.95, decreasing to 0.87 in males, and to 0.48 in whites, while increasing to 0.96 in black patients. Both sensitivity and specificity for long-sleepers(< 9h) corresponded to 0.5. Positive predictive value for short sleepers was 0.9, and 0.76 for long sleepers.

Conclusion

Overall, the study highlights the complexity of sleep measurements and the potential impact of conducting PSG and actigraphy on different nights. It underscores the need to consider nightly variability in sleep studies, the different diagnostic methods used, and the influence of sex and ethnicity on sleep patterns.

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0766 Current Sleep Hygiene Status in Non-clinical Population in Korea
Authors: Kim Jee Hyun , Kim Dongyeop , Lee Hye Ah , Yun Ji Young
Published: April 2024

Introduction

This study examines the difference in sleep hygiene status according to age and sex and the relationship between sleep hygiene and insomnia in the non-clinical Korean population using the Sleep Hygiene Practice Scale in Korean (SHPS-K), validated through this study.

Methods

We recruited non-clinical adults (Aged 18-65) without a history of neurologic, psychiatric, or medical disorders and diagnosed sleep disorders. An online survey was done using SHPS-K, the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS). The first survey enrolled 484 participants (242 women, mean age of 43.8 years), among whom 322 completed the second survey. SHPS-K was compared between each age group, sex, and group with or without insomnia symptoms (ISIS-K 15). Using receiver operating characteristic analysis in different age groups, we also determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K > 5 and ISI-K 15).

Results

The average total SHPS-K score was 71.2, with no sex difference. Mean ISI-K, PSQI, and ESS were not different between sex and age groups. The older participants had lower SHPS-K than the younger groups, with a significant trend for ages ( =-3.01, p< 0.001). This trend was significant in both men and women. Men had poorer eating and drinking behaviors among the four domains, and women had poorer sleep scheduling and timing behaviors. Young adults with insomnia symptoms showed the highest SHPS-K than other age groups with insomnia (p < 0.001). A cutoff value of 76, 74, and 66 identified poor sleepers with insomnia (area under the curve = 0.818, 0.837, 0.849) in young, middle-aged, and older adults, respectively.

Conclusion

This study showed that sleep-disturbing behaviors were different between age groups and sex. The group with insomnia symptoms showed worse sleep hygiene practices. Furthermore, young adults had significantly worse sleep hygiene than middle-aged or older adults. Sleep hygiene education could contribute differentially to improving sleep quality in non-clinical populations.

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0768 Poor Sleep Quality Increases Mortality Risk. a Population-based Longitudinal Prospective Study in Adults
Authors: Khalil Melissa , Brutto Oscar Del , Mera Robertino , Rumbea Denisse , Sedler Mark , Castillo Pablo
Published: April 2024

Introduction

Sleep-related symptoms have been associated with adverse health outcomes, including increased mortality risk. Studies that analyzed the correlation between sleep and mortality focused on the single effect of self-reported sleep duration or relied on nonstructured questionnaires about sleep. In order to evaluate the detrimental effects of sleep disorders, studies should be based on well-structured and validated questionnaires that inquire about different components of sleep, including sleep quality. In addition, taking into consideration the fluctuations in sleep duration over the study period is essential. We aimed to assess the association between sleep quality and all-cause mortality in community-dwelling adults living in rural Ecuador.

Methods

Individuals aged ≥40 years enrolled in the prospective population-based Three Villages Study cohort were included. Sleep quality was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). Study participants were evaluated at baseline and at every annual door-to-door survey until they remained enrolled in the study. Mixed models Poisson regression for repeated PSQI determinations and multivariate Cox-proportional hazards models were fitted to estimate mortality risk according to sleep quality.

Results

Analysis included 1494 individuals (mean age: 56.6 ± 12.5 years; 56% women) followed for a median of 6.3 ± 3.3 years. At baseline, 978 (65%) individuals had good sleep quality and 516 (35%) had poor sleep quality. The effects of PSQI scores changing over time on mortality was confounded by the impact of the SARS-CoV-2 pandemic on both. One hundred ninety-five individuals (13%) died during the follow-up, resulting in a crude mortality rate of 1.58 per 100 person years (95% C.I.: 1.27-1.88) for individuals with good sleep quality, and 3.18 (95% C.I.: 2.53-3.82) for those with poor sleep quality at baseline. A multivariate Cox-proportional hazards model showed that individuals with poor sleep quality at baseline were 1.38 times (95% C.I.: 1.02-1.85) more likely to die compared to those with good sleep quality; in this model, increased age, poor physical activity, and high fasting glucose remained significant.

Conclusion

Poor sleep quality is associated with increase mortality risk among middle-aged and older adults.

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0769 Sleep Quality in Midlife Is Associated with Mobility and Balance in Later Life in the Wisconsin Sleep Cohort
Authors: Green Edith-Marie , Peppard Paul , Ravelo Laurel , Plante David , Hagen Erika
Published: April 2024

Introduction

Cross-sectional studies suggest that poor sleep quality predicts worse performance on tests of mobility in older persons; however, little is known about how objectively-assessed sleep quality in midlife is associated with declines in mobility and balance later in life. We examined the association of three objectively-assessed sleep quality measures in midlife adults as predictors of measures of mobility and balance assessed, on average, 8 years later in participants of the Wisconsin Sleep Cohort study.

Methods

Wisconsin Sleep Cohort participants (n=576, 47% female) had sleep (in-laboratory polysomnography) studies to assess sleep quality at midlife and, on average 8 years later, Timed Up and Go (TUG) tests to assess mobility and balance. There were some participants with repeat visits (n=378) yielding a total data set of 945 data points. Mean age (SD) at the baseline sleep study visits was 61(8) years. Sleep quality variables include percent N3 and percent REM sleep and sleep efficiency. The Timed Up and GO (TUG) test measures time in seconds to complete a walking task with 4 different variations: walking only, walking with an obstacle at midpoint, walking while counting backwards by 3’s, and walking with both an obstacle and while counting backwards by 3’s. Models were adjusted for age, sex, body mass index, total sleep time, and self-reported habitual sleep time. PROC MIXED in SAS was used to account for repeated measures.

Results

Less percent N3 sleep at baseline was significantly associated with reduced performance (greater time to complete) on 3 of the 4 variations of the TUG test, performed on average, 8 years after sleep assessment (all p< 0.05 in adjusted models). A similar pattern of associations was observed with REM and sleep efficiency (less REM sleep and lower sleep efficiency were associated with reduced TUG performance), although these associations did not reach statistical significance.

Conclusion

Adequate sleep quality across midlife years may be an important modifiable contributor of improved mobility and balance in later life.

Support (if any)

This work was supported by the National Heart, Lung, and Blood Institute (R01HL62252) and the National Institute on Aging (R01AG058680) at the US National Institutes of Health.