bluuebunny/crossref_metadata_2025 huggingface dataset:
0099 The Effects of Sleep on the Consolidation of Fearful Memories
Authors: Arsic M , Heiss L , Chambers A M
Published: May 2020

Introduction

Previous research has found that emotionally intense stimuli are better remembered than neutral stimuli, especially after a period of sleep. However, few studies have examined memory for experienced emotional events, especially fearful ones. The purpose of the current study was to investigate the impact of sleep on memory consolidation using a fearful emotion induction task.

Methods

Thirty-three young adults (18.94±1.06 years; 64% female) were randomly assigned to either a fearful or neutral emotion induction condition. Participants were induced into their assigned emotion by visualizing each of eight emotion-congruent scenarios while corresponding music played in the background. Emotional state was measured using the Affect Grid before and after the emotion induction procedure. Twelve hours later, spanning either a day of wakefulness (wake group) or night of sleep (sleep group), participants were asked to recall the previously presented scenarios.

Results

A 2 x 2 ANOVA examined differences in the number of scenarios recalled between the conditions. A significant main effect of sleep was found, F(1,29)=8.41, p=.007, η 2p=.23, reflecting better recall in the sleep (3.21±1.78) vs. the wake group (1.79±1.72). There was also a main effect of emotion, F(1,29)=22.17, p<.001, η 2p=.43, reflecting better recall in the fear (3.58±1.54) vs. the neutral condition (1.29±1.44). However, there was no interaction. Results were similar for the number of details recalled between the conditions. The sleep group (12.74±9.09) recalled more details than the wake group (5.50±5.81), F(1,29)=8.05, p=.008, η 2p=.22. More details were also recalled in the fear condition (13.16±8.73) than the neutral condition (4.93±5.77), F(1,29)=10.54, p=.003, η 2p=.27. There was again no interaction.

Conclusion

Results demonstrate that both sleep and fearful emotion facilitate memory consolidation. This work both supports and extends existing research by examining emotional memory consolidation through the manipulation of experienced events, which may more closely approximate real world learning than previous methods.

Support

N/A
0101 Episodic Future Thinking Triggers Age-Related Differences in Spindles and Slow Oscillations
Authors: Diaz J , Fillmore P , Gao C , Scullin M K
Published: May 2020

Introduction

In young adults, sleep spindles are theorized to represent memory consolidation. Spindle density may be especially prominent when young adults encode information that has future relevance. Older adults, on the other hand, show reduced capacity for future thinking and deficits in sleep-dependent memory consolidation. To advance these literatures, we investigated whether the process of mentally simulating the future (versus remembering the past) was associated with subsequent alterations to sleep microarchitecture in young and older adults.

Methods

64 healthy adults aged 18–84 completed a polysomnography adaptation night followed by two in-laboratory experimental nights. On both nights, participants completed the Modified Future Crovitz Test (MFCT) in which they mentally simulated only future events or remembered only past events (night order counterbalanced). To quantify the extent of future/past thinking, we conducted linguistics analyses on tense (future/past) using LIWC 2015 software.

Results

On the future-thinking night, young adults with greater future-tense MFCT scores showed significantly greater spindle density across frontal, midline, and central sites (r=.42 to r=.51), even when controlling for age, gender, and total word count (all ps < .01). The opposite was true for middle-to-older aged adults; greater future-tense MFCT scores were associated with less spindle density across midline and central sites after controlling for age, gender, and word count (r=-.44 to r=-.46, ps<.05). However, while spindle density decreased, frontal slow oscillations increased in older adults with greater future-tense MFCT scores (r=.39, p<.05). On the past-thinking night, spindle density and slow oscillations were unrelated to past-tense or future-tense MFCT scores for either age group.

Conclusion

Age-related deficits in memory consolidation may be due to impaired tagging of information as having future relevance, or impaired physiological responses during sleep to wake-based tagging. Addressing encoding—spindle interactions may inform why cognitive functioning declines in some adults more than others.

Support

Sleep Research Society Foundation
1013 Cardiovascular Biomarkers and Pathophysiological Insights into Obstructive Sleep Apnea During Acute Coronary Syndrome
Authors: Cheong C S , Aung A T , Chan S , Lee C
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is prevalent and carries prognostic implication in patients with acute coronary syndrome (ACS). The relative contribution of pathophysiological mechanisms in ACS towards OSA is not well-studied. We examined the correlation between severity of OSA and myocardial necrosis, inflammation, wall stress, and fibrosis.

Methods

A total of 89 patients admitted with ACS underwent an overnight sleep study during index admission. Plasma levels of peak troponin I, high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and suppression of tumorigenicity 2 (ST2) were prospectively analyzed. Two patients diagnosed with central sleep apnea were excluded.

Results

The recruited patients were divided into no (AHI <5 events/hour, 9.2%), mild (5-<15, 27.6%), moderate (15-<30, 21.8%), and severe (≥30, 41.4%) OSA. The respective Epworth Sleepiness Scale scores were 3.8±3.7, 5.3±4.9, 4.0±2.8, and 5.5±4.5 (p=0.734). Compared to the no, mild and moderate OSA groups, the severe OSA group had a higher body mass index (p=0.005). They were also more likely to present with ST-segment elevation ACS (vs non-ST-segment elevation ACS) (p=0.041), have undergone previous coronary artery bypass grafting (p=0.013), demonstrate complete coronary occlusion during baseline coronary angiography (p=0.049), and have a larger left atrium diameter measured on echocardiography (p=0.029). Likewise, the severe OSA group had higher plasma levels of troponin I (10584±13078, 11699±20130, 19280±30670, 37571±31269 µg/L; p=0.017), hs-CRP (8.1±9.2, 23.1±52.3, 9.3±17.1, 39.4±44.7 mg/L; p=0.004), and NT-proBNP (667±604, 765±856, 636±728, 1395±1220 pg/mL; p=0.004), but not ST2 (p=0.10). After adjusting for the effects of the confounding variables, severe OSA was independently associated with troponin I (i.e., myocardial necrosis; OR 1.00003, 95% CI 1.000013-1.000048; p=0.001) and NT-proBNP (i.e., myocardial wall stress; OR 1.00081, 95% CI 1.00021-1.00141; p=0.008).

Conclusion

Severe OSA during the acute phase of ACS was associated with extensive myocardial necrosis and myocardial wall stress, but not with inflammation and myocardial fibrosis.

Support

Nil
1015 Sleep Duration and Physical and Mental Health Among Adult Survivors of Childhood Cancer: Results from the St. Jude Lifetime Cohort
Authors: Lubas M M , Mandrell B N , Ehrhardt M J , Ness K K , Srivastava D , Robison L L , Hudson M M , Krull K R , Brinkman T M
Published: May 2020

Introduction

Sleep disturbances are prevalent among adult survivors of childhood cancer, though little is known about associations between sleep and health in this vulnerable population.

Methods

Survivors recruited from the St. Jude Lifetime Cohort (n=911; 52% female; mean age 34 years; 26 years post-diagnosis) completed surveys assessing habitual sleep patterns and mental health and underwent comprehensive physical examinations. A subset of survivors (n=491) completed sleep actigraphy. Short sleep duration was defined as sleeping <7 hours per night, assessed via self-report or actigraphy. Clinically-assessed health outcomes were defined as grade ≥2 using modified CTCAE criteria for cardiac, pulmonary, and renal conditions. Anxiety and depression were defined as scores ≥90th percentile on the Brief Symptom Inventory-18. Covariates included childhood cancer treatment exposures, demographics, body mass index, and physical inactivity. Separate logistic or modified Poisson (common outcomes) regression models were computed for each health category to estimate odds ratios (OR) or relative risks (RR) and 95% confidence intervals (CI).

Results

Self-report and actigraphy-assessed short sleep was identified in 44% and 42% of survivors, respectively. However, these measures were weakly correlated (r=0.23). In adjusted multivariable models, self-reported short sleep was associated with higher risk of pulmonary conditions (RR=1.3, 95% CI=1.1-1.7), depression (OR=2.6, 95% CI=1.4-5.1) and anxiety (OR=3.4, 95% CI=1.6-6.8), while associations with cardiac (RR=1.10, 95% CI=0.94-1.30) and renal conditions (OR=1.30, 95% CI=0.79-2.13) were not significant. There were no significant associations between actigraphy-assessed short sleep and any of the health outcomes.

Conclusion

Habitual self-reported short sleep was associated with clinically ascertained adverse health outcomes. Although the temporality of these associations cannot be determined in this cross-sectional study, sleep is a modifiable health behavior and improving sleep may improve health in survivors. Measures of self-reported sleep may have unique value when assessing the relationship between sleep and health.

Support

CA225590, K. Krull Principal Investigator; CA195547, M. Hudson and L. Robison Principal Investigators; CA21765, C. Roberts, Principal Investigator
1035 Sleep Duration and Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis
Authors: Li Y , Xie J , Chen B , Basta M , Vgontzas A
Published: May 2020

Introduction

To systematically examine the association between sleep duration and metabolic syndrome (Mets) risk in cross-sectional and prospective cohort studies.

Methods

Data were collected from 36 cross-sectional and 9 longitudinal studies with a total of 164799 MetS subjects and 430895 controls. Odds ratios (ORs) for MetS in cross-sectional studies and risk ratios (RRs) for incident MetS were calculated through meta-analyses of adjusted data from individual studies. Subgroup analyses were performed to investigate the association between MetS and the duration of short-and-long sleep.

Results

Short sleep duration was significantly associated with increased prevalent MetS (OR= 1.11, 95% CI =1.05-1.18) and incident MetS (RR= 1.28, 95% CI =1.07-1.53,) in cross-sectional and longitudinal studies, respectively. Furthermore, long sleep duration was significantly associated with increased prevalent MetS in cross-sectional studies (OR= 1.14, 95% CI =1.05-1.23), rather than incident MetS (RR= 1.16, 95% CI =0.95-1.41) in longitudinal studies. Interestingly, the association between long sleep and prevalent MetS was found in sleep duration defined by 24-hour sleep (including naps) rather than nighttime sleep. In cross-sectional studies, pooled odds for MetS were 1.36 (95% CI=1.04-1.78, I2=83.3%) in ≤ 5 hours, 1.09 (95% CI=1.02-1.16, I2=67.8%) in ≤6 hours, 1.01 (95% CI=0.93-1.10, I2=24.9%) in <7 hours, 1.11 (95% CI=1.02-1.21, I2=67.0%) in ≥9 hours and 1.31 (95% CI=1.22-1.40, I2=0%) in ≥10 hours, respectively. The association of short sleep and MetS was stronger in young and middle age adults, but lost in adults age >60 years.

Conclusion

Our findings suggest 1) a “U-shape” relationship between sleep duration and MetS in cross-sectional studies and 2) association between short sleep duration, but not long sleep duration with incident MetS. Future studies should shed light on the underlying mechanisms related to the association between sleep duration and MetS and examine if normalizing sleep duration reduces MetS risk in the general population.

Support

This study was supported by National Natural Science Foundation of China (No. 81600068 & 81970087), the Young Elite Scientists Sponsorship Program by CAST (No. YESS20160072), Medical Science Foundation of Guangdong Provence (A2018296) and Grant for Key Disciplinary Project of Clinical Medicine under the Guangdong High-level University Development Program.
1044 Adequate Sleep is Associated with Improved Diabetes Knowledge and HbA1c
Authors: Pandey A , Cooper L , Zrebiec J , Spadola C , Bennett R L , Rosenthal M M , Littlewood K
Published: May 2020

Introduction

Although 55 % of the people with T2DM have low quality of sleep that may affect their physical and emotional wellbeing, and present challenges to the management of their condition, many Diabetes Self-Management Education Programs (DSME) that aim to improve knowledge of T2DM, don’t include information on healthy sleep. This study will examine the relationship between adequate sleep on improved T2DM knowledge and diabetes maintenance (HbA1c).

Methods

The Sleep Integrated with Diabetes Education (SLIDE) Trial tests whether including four brief healthy sleep hygiene sessions within an existing traditional Diabetes Self-Management Education Program improves healthy sleep, motivation for change, and biopsychosocial outcomes for 50 patients with DM who are under and uninsured. This study uses descriptive and ANOVAs to examine the relationship between adequate sleep and change in diabetes knowledge (Diabetes Knowledge Test) using self-report. EMR was used to link HbA1c and other biological measures.

Results

Fifty patients with T2DM (mean HbA1c = 8.79 ± 2.42) participating in a DSME Program at a southern urban community nonprofit hospital were randomly assigned to DSME classes or DSME classes + four 15-minute presentations (video and powerpoint) highlighting healthy sleep hygiene practices. The majority of these patients were obese (mean BMI=38.56±8.20). Only 11% reported normal sleep, with 41% reporting short sleep (<6 hours) and 7% long sleep (>8 hours). Patients who reported adequate sleep were more likely to improve diabetes knowledge (81% score vs. 68% score, p<.001) and HbA1c (1.1 vs. -.03, p<.001).

Conclusion

There is a relationship between adequate sleep and improving diabetes knowledge and maintenance for patients with T2DM. Future research could further explore this relationship and determine barriers and facilitators to adequate sleep and what role adequate sleep plays in improving T2DM knowledge and maintenance.

Support

Bon Sequor Foundation
1055 Cardiometabolic Disease Risk And Sleep Difficulty: Associations With Diet, Physician Support, Proactive Health Behaviors, And Family Risk Knowledge
Authors: Gilles A , Delgado G
Published: May 2020

Introduction

Research relating sleep impairment and cardiometabolic disease supports exercise and diet in improving both conditions. The role of self- and other-informed knowledge on self-care behaviors is unknown. This study investigated how proactive health behaviors, physician support, and familial disease awareness are related in this comorbid population.

Methods

National Health and Nutrition Examination Survey (NHANES) data from 2015-2016 was used. For this study, U.S. adults (N=9,971;49.3% female) with dietary, sleep, cardiometabolic disease risk, proactive health behavior, physician-informed, and familial knowledge of cardiometabolic disease data were selected. Self-reported sleep difficulty was defined as ever telling a doctor/health professional of trouble sleeping. Kendall’s tau-b correlations and multinomial regression were performed. Covariates included race, gender, weight control, dietary efforts, and exercise.

Results

Statistically significant associations between comorbid cardiometabolic disease/sleep difficulty (CMD/SD) and efforts to control/lose weight(X2(6)=63.956,p>0.0001), reduce dietary salt(X2(6)=69.702,p>0.0001), and reduce dietary fat(X2(6)=70.666,p>0.0001) were found. Despite having comorbid CMD/SD, most participants (51%) reported no history of receiving physician-informed health improvement methods. However, statistically significant associations between comorbid CMD/SD and physician-informed methods and weight loss efforts(X2(4)=76.873,p>0.0001), increased exercise(X2(4)=72.713,p>0.0001), reduced dietary salt(X2(4)=96.892,p>0.0001), and reduced dietary fat(X2(4)=104.231,p>0.0001) were found. Statistically significant associations between comorbid CMD/SD and knowledge of close relative with heart attack(X2(9)=23.905,p=0.004) or diabetes(X2(9)=129.705,p>0.0001) were found. Participants with comorbid CMD/SD were more likely to reduce dietary fat(X2(1)=4.575,p< 0.032) than participants with comorbid sleep difficulty/cardiovascular disease or comorbid sleep difficulty/metabolic disease. Although no association between age of cardiometabolic diagnosis onset and proactive health behaviors was found, the regression model showed that male gender(p=0.008) and reducing dietary fat was predictive of comorbid CMD/SD(p=0.032).

Conclusion

Participants with comorbid CMD/SD directed proactive health efforts towards eating behavior (less food/decreasing salt and fat). With physician-informed support, participants additionally increased exercise level. Further exploring the role of familial disease knowledge, gender-specific support, and innovative efforts by health professionals in treating/preventing comorbid CMD/SD is warranted.

Support

None
1057 Evaluating Differences In Upper Airway Anatomy Between Diabetic And Non-diabetic OSA Patients
Authors: Ihemeremadu N , Lavi-Romer N , Zang Y , Keenan B , Schwab R
Published: May 2020

Introduction

Studies show that OSA is linked to impaired glucose tolerance, insulin resistance, and the onset of diabetes. We hypothesized that diabetic OSA patients will have higher apnea-hypopnea index (AHI) values than OSA patients without diabetes after adjusting for age and body mass index (BMI) and that this difference can be explained through increases in upper airway structures between diabetic and non-diabetic OSA patients.

Methods

This study evaluated differences in upper airway and craniofacial dimensions and volume of the pharyngeal soft tissues between diabetic and non-diabetic patients with obstructive sleep apnea (OSA) using magnetic resonance imaging (MRI). Airway sizes, soft tissue volumes and craniofacial dimensions were quantified using three-dimensional MRI in OSA patients without diabetes (n=237) and OSA patients with diabetes (n=64). Comparisons in upper airway measures among diabetics and non-diabetics were performed using linear regression models controlling for age, sex, BMI, race, and AHI.

Results

Among study participants, diabetic OSA patients were older than non-diabetic OSA patients (54.2±10.1 vs. 47.3±11.1 years; p<0.0001). No significant differences were found between diabetic and non-diabetic OSA patients with respect to BMI (39.8±7.0 vs. 38.4±8.8 kg/m2; p=0.207) or AHI (45.0±31.0 vs. 38.8±27.8 events/hour; p=0.154). In covariate adjusted models, non-diabetic OSA patients also had smaller RP minimum airway area (adjusted difference [95% CI] = -3119 [-5359, 879] mm2; p=0.0066) and RP minimum AP distance (-16.0 mm [-29.6, -2.5]; p=0.021) compared to diabetic OSA patients. No differences were observed in soft tissue volumes or craniofacial dimensions.

Conclusion

While diabetics had higher average AHI, we observed no significant differences in AHI between diabetic and non-diabetic patients with sleep apnea. In general, upper airway anatomy was similar between diabetic and non-diabetics apneics, controlling for demographic factors and AHI. Future studies should examine dynamic changes, in addition to static upper airway anatomy, in diabetic and non-diabetics apneics.

Support
1074 Fear Reactivity And Sleep In Trauma-Exposed Males And Females With And Without PTSD
Authors: Dukes C , Inslicht S , Hubachek S Q , Straus L , Ruoff L , Huie R , Felmingham K , Woodward S , Neylan T C , Richards A
Published: May 2020

Introduction

Sleep disturbance is considered central to mechanisms of PTSD development and maintenance, and fear learning protocols have been used as laboratory models to understand PTSD disease mechanisms. Some research indicates that fear learning may influence subsequent sleep, especially REM sleep, and that sleep may influence subsequent extinction. In this study, we examined the relationship of startle reactivity during conditioning and later extinction with objectively-measured sleep in PTSD-positive and negative subjects.

Methods

These analyses were performed as part of a larger study of PTSD and sleep. Thirty-four (34) trauma-exposed male and female participants with and without PTSD completed a fear-potentiated startle conditioning procedure at 9:45am, followed by a PSG-monitored nap (13:30-15:30), followed by an extinction protocol at 4:30pm. All visits were preceded by an adaptation nap visit at least 7 days prior. Eye-blink EMG was used to measure startle reactivity. Mixed-model analyses were performed in SPSS.

Results

PTSD-positive subjects had higher REM sleep duration (p<.05) and a trend towards shorter REM sleep latency (p=.06). There were no other group or sex effects on standard PSG sleep parameters. During conditioning, PTSD-positive status was associated with higher startle reactivity across stimulus types (p<.01), driven by increased reactivity in PTSD-positive vs. PTSD-negative females. A PTSD x sex interaction effect on startle reactivity showed the opposite effect in males (p<.01). Higher startle reactivity during conditioning predicted longer sleep latency during the subsequent nap (p<.05), but reactivity during conditioning and extinction did not otherwise show a relationship to standard PSG sleep measures.

Conclusion

These findings are consistent with previous research indicating REM sleep abnormalities as well as heightened fear responses in PTSD. While the observed relationship between higher startle and longer sleep latency is consistent with studies indicating that stress affects subsequent sleep, further research in larger samples is needed to understand causal mechanisms and to advance our understanding of sleep-PTSD mechanisms.

Support

VA Career Development Award-5IK2CX000871-05
1080 Self-reported Hyperarousal Predicts Lower Parasympathetic Activity During Slow-Wave Sleep In Trauma-exposed Individuals
Authors: Ragas T L , Oliver K I , Daffre C , Seo J , Gannon K , Pace-Schott E F
Published: May 2020

Introduction

Hyperarousal and abnormal autonomic functioning are among the core manifestations of posttraumatic stress disorder (PTSD). In this study, we examined the association of parasympathetic activity during slow wave sleep (SWS) with self-reported hyperarousal measures in recently traumatized individuals.

Methods

Individuals exposed to a PTSD Criterion-A trauma within the past 2 years (N=76) aged 18-40 (mean 24.06, SD 4.76), of whom 43% met DSM-5 criteria for PTSD, underwent a night of ambulatory polysomnography (PSG) following an acclimation night. ECG recordings during SWS-sleep periods of at least 5 min were analyzed for 2 parasympathetic indices: Root Mean Square of the Successive Differences (RMSSD) and High Frequency (0.14-0.4Hz) power (HF power) using Kubios software. Hyperarousal indices included the hyperarousal items from the PTSD Checklist for DSM-5 (PCL-5) excluding the sleep item #20 (PCLhyp), those from the Clinician-Administered PTSD Scale (CAPS-5) including sleep items (CAPShyp), as well as a published Hyperarousal Scale (HAS) and Hypervigilance Questionnaire (HVQ). In addition, a Composite Hyperarousal Index (CHI) was computed from combined hyperarousal items on the PCL-5 and the CAPS-5 as well as the HAS total score.

Results

SWS RMSSD was negatively associated with PCLhyp (R = -.244, p = 0.035), CAPShyp (R = -.250, p = 0.03), CHI (R = -.280, p = 0.014), and HAS (R = -.229, p = 0.049). SWS HF power was negatively associated with CHI (R = -.227, p = 0.049).

Conclusion

The hyperarousal (Criterion E) symptoms of PTSD are associated with lowered parasympathetic tone during SWS across the spectrum of posttraumatic severity from resilient individuals to those diagnosed with PTSD.

Support

R01MH109638
0110 Fluctuations Across the Menstrual Cycle in Cardiac Autonomic Activity During Sleep and Wake May Affect Memory Consolidation
Authors: Sattari N , Simon K , Mednick S
Published: May 2020

Introduction

Prior studies have shown that benefits of sleep for memory consolidation may be influenced by menstrual phase. Menstrual phase also impact autonomic regulation during sleep, and autonomic activity has been recently shown to play a role in sleep-dependent memory consolidation.

Methods

We investigated the interaction of menstrual cycle and autonomic activity measured by heart rate-variability (HRV) on sleep-dependent memory consolidation among 18-healthy females. Using a within-subjects design, we investigated episodic memory improvement with a nap paradigm during two phases of women’s menstrual cycle: 1) perimenses: −5 to +5 days from menses-onset, and 2) non-perimenses: window outside of perimenses. Subjects completed the memory test before (Test1) and after (Test2) a 90-minute polysomnographically (PSG)-recorded nap. We recorded sleep and HRV during 5-minutes of wake, and during the nap. Next, we compared sleep, HRV (RMSSD and HFnu), and memory performance between the two menstrual phases.

Results

Sleep architecture did not differ between perimenses and non-perimenses. Women performed similarly on the memory task at Test 1 (all ps>.061), but at Test 2, non-perimenses showed better performance (p = 0.02). Autonomically, perimenses had higher parasympathetic activity during wake (RMSSD-p = 0.04) and REM-sleep (HFnu-p = 0.04), compared with non-perimenses. Using bivariate correlations, we found positive associations between wake-HFnu and memory improvement (p = .02) during perimenses. In contrast, non-perimenses’ memory improvement was negatively correlated with wake-RMSSD (p <.001). In perimenses, memory improvement was also positively associtated with REM-HFnu (p = .04). No associations were found between autonomic sleep activity and memory in non-perimenses phase.

Conclusion

Our findings indicate a role for autonomic activity in memory improvement in both sleep and wake that is modulated by the menstrual cycle. HRV measures of parasympathetic activity were higher during perimenses phase in wake and REM-sleep. Interestingly, the HRV measures showed opposing relations with memory improvement based on the phase of the menstrual cycle. In sum, women’s cardiac autonomic activity fluctuates by menstrual phase and it is possible that these fluctuations affect the magnitude and direction of sleep-related memory consolidation.

Support

Sattari et al., 2017; Genzel et al., 2012; de Zambotti et al., 2013; Whitehurst et al., 2016.
1086 Non-Linear Associations Between Depression and Sleep Duration in an International Sample of 16,997 Respondents
Authors: Bender A M , Babins-Wagner R , Laughton A
Published: May 2020

Introduction

Abnormal sleep duration is common in people with depression and can be both a risk-factor and a symptom of depression. Here we determine the prevalence of depression likelihood and assess associations between long and short sleep duration in an international convenience sample.

Methods

N=16,997 respondents (age range: 8-98y, mean age 39.7y ±13.1 SD; 43% female) completed the 10-item Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS) online from October 7 to October 13, 2019. Higher total scores on the HANDS indicate higher likelihood of major depressive episode with scores >8 indicate the presence of a major depressive disorder is likely. Additional questions were added to the survey including the question “During the past two weeks, how many hours of actual sleep did you average at night?” Answer choices ranged from “less than 5 hours” to “more than 10h” in half-hour increments.

Results

Respondents came from 115 different countries with the majority of respondents from Canada (48%) and the United States (38%). Sixty-four percent of the sample were recommended for further evaluation for depression. Of those recommended, 66% reported <7h of sleep per night and 3% reported >9h. Those who reported 7-9h of sleep per night had the lowest depression scores (9.2 points) compared to those who reported <7h (11.8 points) and >9h (13.7 points), F(2,15366)=434.81, p<0.001. The amount of sleep associated with the lowest depression scores was 7.5h (8.6 points) with <5h associated with the highest depression scores (15.5 points).

Conclusion

We found a high prevalence of depression likelihood in 64% of an international convenience sample, with 69% of those not meeting the recommended 7-9h of sleep per night. Both short and long sleep were associated with higher levels of depression with 7.5h of sleep associated with the lowest depression scores. Future research on depression should focus on sleep interventions aimed at improving both short and long sleep duration.

Support

N/A.
1096 Morning Wakefulness is Associated with Reduced Suicidal Ideation in a Nationally-Representative US Sample
Authors: Tubbs A , Khader W S , Fernandez F , Perlis M L , Chakravorty S , Grandner M A
Published: May 2020

Introduction

Nocturnal wakefulness is a unique risk factor for suicidal ideation in clinical as well as community samples. Preliminary data suggest that morning wakefulness may also be a protective factor against such thinking. However, these associations have not been explored in a nationally-representative dataset.

Methods

Data were collected from the 2015-2016 wave of the National Health and Nutrition Examination Survey. Participants reported typical bedtimes and waketimes. From these values, wakefulness during the night (00:00 to 05:59), morning (06:00 to 11:59), afternoon (12:00 to 17:59), and evening (18:00 to 23:59) was determined. Suicidal ideation was assessed by a question about “thoughts that you would be better off dead, or thoughts of hurting yourself in some way.” Ordinal logistic regression estimated the association between the number of hours awake at particular times of day and the frequency of suicidal ideation. Additional analyses adjusted for demographic factors and depressed mood.

Results

Out of 5133 respondents with available data, 125 reported suicidal ideation several days a week, 36 reported suicidal ideation more than half the days, and 29 reported suicidal ideation nearly every day. When controlling for demographics, morning wakefulness was associated with reduced frequency of suicidal ideation (OR: 0.69, 95% CI: [0.59,0.8]). Controlling for depressed mood attenuated, but did not eliminate, this association. Nocturnal wakefulness was not associated with suicidal ideation in this sample.

Conclusion

Using data from a nationally representative sample, morning wakefulness was associated with less frequent suicidal ideation. However, previous findings regarding nocturnal wakefulness were not replicated. The limited number of individuals in the sample endorsing both suicidal ideation and nighttime wakefulness may have insufficient power to detect an association.

Support

Dr. Grandner is supported by R01MD011600.
1100 Self-Monitoring Of PVT Performance In Healthy Adults And Individuals With MDD
Authors: Galli O , Goel N , Basner M , Detre J , Thase M , Sheline Y , Rao H , Dinges D , Gehrman P
Published: May 2020

Introduction

Negativity bias in depression has been repeatedly demonstrated in the judgment and decision-making literature. Research investigating the impact of sleep deprivation on self-evaluation of performance in healthy or depressed populations is limited. We examined 1) whether individuals with Major Depressive Disorder (MDD) exhibit a negativity bias in subjective ratings of performance on the Psychomotor Vigilance Task (PVT) as compared with healthy adults, and 2) the impact of total sleep deprivation (TSD) on these ratings.

Methods

N=33 individuals with MDD and n=9 healthy adults completed a 5-day study protocol including two baseline nights (B1-B2, 9h TIB), 36 hours of TSD, and one night of recovery sleep opportunity (Rec). The PVT was administered every 2-4 hours. A brief questionnaire was administered immediately prior to (PRE) and following (POST) the PVT, asking participants to estimate their average reaction time (RT) using a 9-point Likert-type scale. Mixed-effects models examined the impact of group (MDD, Control), protocol day (B1, B2, SD, Rec), and their interaction on objective PVT performance (mean RT) and subjective performance estimates (PRE and POST ratings).

Results

Mean RT was significantly slower during TSD (p<0.001) for all participants. Individuals with MDD and healthy adults did not differ in objective PVT performance (p=0.25) across days. There was no significant interaction between group and protocol day (p=0.96). Both groups predicted slower RTs during TSD as compared with baseline or recovery days (PRE-PVT, p=0.006). Individuals with MDD anticipated slower RTs as compared with healthy adults (p=0.001). On POST-PVT estimates, all participants reported subjective poorer performance during TSD (p<0.008). Individuals with MDD reported slower RTs as compared with healthy adults (p=0.002). Interaction effects between group and protocol day on PRE- and POST- performance ratings were not significant.

Conclusion

This project is the first to investigate subjective estimates of PVT performance in healthy and depressed individuals. Individuals with MDD subjectively reported slower response times as compared with control participants, despite similar objective performance. Depressive symptoms may be a potential confounder of subjective, but not objective, PVT performance.

Support

5R01MH107571
1103 Understanding the Role of Sleep as a Risk Factor for Suicidal Ideation in Active Duty Service Members
Authors: Paxton Willing M M , Pickett T C , Tate L L , Rhodes C , DeGraba T
Published: May 2020

Introduction

Suicide is an important public health concern with many factors contributing to increased risk. Sleep is one such factor that may elevate risk, yet this association is not well understood. By identifying the strongest sleep-related predictors of suicidal ideation (SI), providers may be able to better intervene and reduce risk of suicide.

Methods

Data were obtained from the clinical database at the National Intrepid Center of Excellence (NICoE). Patients were active duty service members, predominantly male, and with a mean age of 38. As part of standard care, patients receive a polysomnography sleep study and complete a battery of intake measures offering a comprehensive view of sleep. Individual symptoms were analyzed in an effort to understand the role of each sleep symptom within the context of the many other factors that may contribute to SI in service members.

Results

Of the many data points collected during polysomnography, only rapid eye movement (REM) sleep latency and minimum sleeping heart rate were related to SI. REM latency was associated with increased odds of SI, while minimum sleeping heart rate was related to decreased odds. Subjective reports of bad dreams, trauma-specific bad dreams, sleepiness, and sleep quality were related to increased odds of SI. Notably, subjective reports of sleep were associated with greater odds than objective measures. Traumatic nightmares had the greatest odds, with these patients being much more likely to have SI.

Conclusion

These results support the importance of considering sleep factors when evaluating SI in service members. Subjective sleep reports, specifically, appear to be particularly important, as they were associated with increased odds of SI. These findings focus on the role of individual sleep factors in increasing the odds of SI and suggest it is important to evaluate sleep in combination with comorbid conditions when conducting risk assessments.

Support

N/A
1109 Broadly Assessing Sleep Complaints In A Sample Of Patients With ADHD
Authors: Seewald M , Alio C , Rosenfield B , DiTomasso R , Muench A L , Rostain A L , Ramsay J , Klingman K , Perlis M L
Published: May 2020

Introduction

It is commonly observed in clinical settings that patients with ADHD regularly present with comorbid “sleep disturbances”. In the absence of broad based sleep disorders assessments, it is thought that this represents Delayed Sleep Phase Disorder (DSPD). Recently, a surveillance study was undertaken in a university-based, outpatient specialty clinic for adults with ADHD, by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain which sleep disorders symptoms are common in this clinical cohort.

Methods

SDS-CL-25 data were collected in 150 subjects (93/57 male/female, mean age 32.8, age range 18-79). The SDS-CL-25 is a 25 item instrument developed to screen for 13 sleep disorders at one time (Sleep Dx symptoms are endorsed on Likert-scales; 0 [never] 4 [>5x/week]). For the purposes of this study, the percentage of subjects endorsing frequent symptomatology (sum of the percent of endorsements for columns 3 & 4)was calculated per symptom. Sums of >20% were considered, a priori, to be of clinical significance.

Results

Patients endorsed: increased fatigue (59%); SL or WASO or EMA’s >30 minutes (40%; 26%; 21%, respectively); late preferred time to bed (31%); work & school limits sleep opportunity (30%); variable time to and out of bed (27%); and snoring (21%). The average percent endorsement was 15% (range 0-59%).

Conclusion

These results suggest that, consistent with clinical observations, adult patients diagnosed with ADHD frequently endorse late preferred time to bed, variable sleep wake schedules, work/school limitations on sleep opportunity, and sleep onset problems that are accompanied by daytime fatigue. This constellation of symptoms is consistent with the notion that patients with ADHD tend to have comorbid DSPD. The high prevalence of middle and late insomnia was unexpected and suggests that Insomnia Disorder (proper) may also be a feature of ADHD.

Support

No support was provided for this abstract.
0113 Evaluating Closed-Loop Auditory Stimulation During Sleep as an Intervention to Improve Memory Consolidation Deficits in Schizophrenia
Authors: Baxter B , Kwok K , Talbot C , Zhu L , Mylonas D , Stickgold R , Manoach D
Published: May 2020

Introduction

Converging evidence supports the hypothesis that reduced sleep spindles and spindle-slow oscillation (SO) coordination contribute to cognitive deficits in schizophrenia. Closed-loop auditory stimulation in healthy adults increases sleep spindles and improves declarative memory consolidation. Here we investigated whether closed-loop auditory stimulation also improves sleep-dependent procedural memory consolidation as a first step towards an intervention in schizophrenia.

Methods

Thirteen healthy adults participated in two nap sessions (stimulation or detection only) with polysomnography in a counterbalanced order. Participants were trained on the finger tapping Motor Sequence Task (MST), which measures sleep-dependent motor procedural memory consolidation, prior to napping and were tested after awakening. We detected the negative peak of SOs during non-REM sleep and, in the stimulation condition, delivered 50ms of pink noise during the SO up-state.

Results

Auditory stimulation increased SOs and spindles during the SO up-state in a frontocentral cluster of electrodes 800-1200ms after stimulation compared to detection only (p<0.05). Stimulation also showed promise for improving memory consolidation (33% increase in MST overnap improvement from detection-only) but this did not reach significance in this small sample and data collection is ongoing.

Conclusion

Auditory stimulation evoked coordinated spindle-SO events that mediate memory consolidation, but more subjects are needed to evaluate whether it also improves memory. If it does, we will test the effects of stimulation on sleep-dependent memory deficits in patients with schizophrenia. Closed-loop auditory stimulation shows promise as a safe, scalable intervention for cognitive deficits that can be implemented at home with commercially available devices.

Support

R01 MH67720 (DSM & RS), NIH-NHLBI 5T32HL007901-17 (BB), K24MH099421 (DSM), and Simons Foundation (DSM).
1118 Examining the Role of Serum and Exosomal Biomarkers in Symptoms of Fatigue and Daytime Sleepiness Following Traumatic Brain Injury
Authors: Leete J J , Pattinson C L , Guedes V A , Lai C , Devoto C , van der Merwe A , Lippa S , Shahim P , Moore B E , Chan L , Gill J
Published: May 2020

Introduction

Fatigue and daytime sleepiness are two of the most common chronic symptoms reported after traumatic brain injury (TBI). However, there is limited understanding of the pathophysiological mechanisms following TBI that result in these symptoms. Previous research has observed elevations in peripheral blood levels of proteins in TBI patients versus controls, including neurofilament light chain (NFL)—predominantly expressed in long myelinated subcortical axons—and glial fibrillary acidic protein (GFAP)—predominantly expressed in reactive astrocytes responding to central nervous system injuries. This study examines the relationship between serum and exosomal NFL and GFAP, and symptoms of fatigue and daytime sleepiness in TBI patients 1-year after injury.

Methods

Sixty-seven patients with TBIs ranging from mild to severe were included in this study. Blood samples were collected from all participants 1-year post TBI, with concentrations of GFAP and NFL measured in serum and exosomes using Single Molecule Array technology (Simoa), an ultrasensitive assay. Participants reported fatigue using the Fatigue Severity Scale (FSS), and daytime sleepiness using the Epworth Sleepiness Scale (ESS).

Results

A linear regression model of fatigue symptoms and exosomal NFL controlling for age revealed that fatigue was negatively associated with exosomal NFL concentrations (β = -.317, p = .041, ηp2 = -.343) and accounted for 20.2% of the change in NFL. Serum NFL concentrations were not associated with fatigue, nor were GFAP serum or exosomes. No significant associations were found between NFL, GFAP, and daytime sleepiness.

Conclusion

Our findings suggest that exosomal NFL may be related to mechanisms underlying TBI-related fatigue and the potential of NFL as a biomarker of fatigue. To our knowledge, this study is the first to examine the relationship between post-TBI NFL levels and fatigue symptoms. Further investigation into serum and exosome biomarkers of TBI-related fatigue and daytime sleepiness is warranted.

Support

National Institutes of Health and Center for Neuroscience and Regenerative Medicine
1128 Sleep Apnea and Periodic Limb Movements are Highly Prevalent in Patients With Multiple Sclerosis
Authors: Palotai M , Weiner H L , Chitnis T , Duffy J F , Guttmann C R
Published: May 2020

Introduction

The pathogenesis of multiple sclerosis (MS)-related fatigue is multi-factorial, including neurogenic, inflammatory, endocrine, metabolic, mood, as well as sleep disorder-related mechanisms. The confounding effect of sleep disorders on the association between fatigue and neurodegenerative changes in the brain has not been investigated. Our objectives were to assess the prevalence of sleep apnea and periodic limb movements in the framework of a prospective study which investigates the neurogenic causation of treatment-resistant fatigue in MS.

Methods

MS patients enrolled in a National MS Society-funded prospective study (grant identifier RG-1501-03141) underwent a one-night at-home sleep test (HST) using a NOX T3 portable monitor. HST recordings were scored by a registered polysomnographic technologist. Respiratory Event (REI) and Periodic Limb Movement (PLMI) Indices were calculated for each patient.

Results

Out of 36 patients, 7 (20%) had mild (REI=5-14), 1 (3%) had moderate (REI=15-29), and 1 (3%) had severe sleep-disordered breathing (REI≥30). Fourteen (42%) of the patients had mild (PLMI=5-24), 4 (11%) had moderate (PLMI=25-49), and 7 (19%) had severe periodic limb movements (PLMI≥50). Overall, 81% of the patients had at least mild sleep-disordered breathing and/or periodic limb movements.

Conclusion

Sleep abnormalities (i.e., sleep apnea and periodic limb movements) are highly prevalent in patients with MS. We plan to compare the MRI exams of subgroups of MS patients with fatigue, to test the hypothesis that fronto-striatal circuitry is more affected by lesions in patients without sleep apnea compared to those with sleep apnea.

Support

This investigation was supported by a grant from the National Multiple Sclerosis Society (grant identifier RG-1501-03141). The home sleep test equipment was provided by a DURIP grant from the Office of Naval Research (grant N00014-15-1-2917).
1147 Sleep Correlates With Improved Functional Outcome In The Intensive Care Unit
Authors: Markun L C , Sampat A , Dutta R , Palchik G A , Chow M , Park K J , Yee A H
Published: May 2020

Introduction

Disruption of sleep may have significant implications in acute brain injury, functional recovery, and critical illness. Few data exist characterizing sleep architecture in patients admitted to an intensive care unit (ICU). We aim to describe sleep and clinical characteristics in patients with acute brain injury and critical illness.

Methods

Retrospective analysis was performed in ICU patients who underwent continuous electroencephalographic (EEG) monitoring from 2018-2019. Sleep was scored based on AASM-defined EEG criteria. Clinical variables, EEG characteristics, and modified Ranking Scale (mRS) were collected. Good outcome was defined as mRS<3. Differences were assessed using chi-square analysis and t-test.

Results

205 patients were reviewed with a mean age of 57 years (range 18-91) and a majority (57%) were male. Patients carried a primary neurologic/neurosurgical (61%) or medical/surgical (39%) diagnosis. Status epilepticus, subdural hemorrhage, traumatic brain injury, encephalopathy and cardiac arrest accounted for the majority of diagnoses encountered. Only 58 patients (28%) achieved N1 sleep; of these 76.4% achieved N2, 2.8% N3, and none achieved REM. Of those achieving any sleep, 43% had good outcomes versus only 23% in those who did not (t=-7.45, p<0.001). Neurological patients were more likely to attain sleep compared to those with other primary diagnoses (χ 2 (1)=7.08, p=0.008). Centrally acting anesthetics did not account for sleep differences between neurologic and non-neurologic patients (χ² (1)=2.01, p=0.16). However, those with primary brain injury reached sleep more often in the absence of anesthetic use (χ 2 (1)=4.82, p=0.03). The overall mortality was 32% in this cohort.

Conclusion

Most critically ill patients do not achieve electrophysiologic sleep. Of those who do, N1/N2 stages are seen most often. Neurological patients were more likely to sleep, and achieving any sleep was associated with improved functional outcome. Further studies are needed to determine whether sleep augmentation in the critically ill impacts functional outcome.

Support

N/A.