bluuebunny/crossref_metadata_2025 huggingface dataset:
0658 Is Evaluating for Dreams and Nightmares during Clinically Indicated Polysomnography Useful?
Authors: Tchopev Zahari , Jacobus Brent , Hansen Shana , Mysliwiec Vincent , Brock Matthew
Published: May 2023

Introduction

The incidence of nightmares and dreams during clinically indicated polysomnography (PSG) is rarely reported. We sought to (1) describe the incidence of nightmares and dreams during PSG, (2) PSG characteristics of nightmares and dreams, and (3) identify clinical correlates.

Methods

Ninety-three patients undergoing an initial clinically indicated PSG had a post-PSG and initial intake questionnaire reviewed. Questionnaires included Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and Nightmare Disorder Index (NDI), as well as a structured post-PSG dreams and nightmares questionnaire. Dreams were self-reported, and a nightmare was differentiated from a bad dream if the former caused a patient-reported awakening.

Results

Overall, 87.1% were Active Duty and 89.2% reported the presence or absence of dreams. In total, 50.5% (47) reported no dreams, 22.6% (21) reported a dream, 2.2% (2) a bad dream, and 14% (13) a nightmare with 12/13 reporting details of their nightmare. The mean total NDI differed significantly between groups (6 ± 5 vs. 7 ± 6 vs. 12 ± 0 vs. 11 ± 5, respectively) (p=0.029). The groups were not significantly different based on sex, age, BMI, diagnosis of depression, anxiety, PTSD, TBI, chronic pain, being prescribed a sleep aid or psychoactive medication, or their ESS and ISI values. PSG characteristics including REM percentage did not differ significantly between groups. Of those reporting a nightmare 75% (9) reported associated autonomic symptoms and 5 (41.7%) reported a trauma related nightmare (TRN). Of those with a TRN, one was related to combat, one sexual assault, two an accident, and one related to death. Two patients with TRN reported their nightmare was an accurate replay of the trauma, 2 reported a mix of replay/non-replay events, and one did not answer.

Conclusion

Despite rare reports of nightmare capture in sleep labs, our cohort uniquely demonstrated that at least half of first time PSG patients at a military sleep center experience a dream or nightmare during their PSG. Higher NDI scores may predict who is more likely to suffer from a bad dream or nightmare in the sleep lab. Assessing for the occurrence of dreams or nightmares during PSG is likely indicated.

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0660 Identifying Patients at Risk of Acute Sleep Disturbances Within the Immediate Aftermath of Trauma
Authors: Reffi Anthony , Kalmbach David , Seymour Grace , Bayoneto Alec , Sagong Chaewon , Drake Christopher
Published: May 2023

Introduction

Acute sleep disturbances are a common, modifiable consequence of trauma that, if left untreated, increase risk of PTSD by nearly two-fold. This suggests acute sleep disturbances after trauma are an important contributor to the etiology of PTSD that could be targeted early to prevent the disorder. Yet, effective strategies to prevent PTSD cannot currently be implemented because we cannot identify who is most at risk of acute sleep disturbances after trauma, thus obstructing the ability to identify high-risk groups in need of early intervention. This study will test sleep reactivity – a trait predisposition to experience sleep disturbances after stress – as a predictor of posttraumatic sleep disturbances within one month following trauma exposure.

Methods

We recruited patients admitted to Henry Ford Hospital’s intensive care unit in Detroit for traumatic injury (e.g., gunshot wound) (N = 88, M age = 39.53, SD = 14.31). While hospitalized, patients reported their pre-trauma sleep reactivity (Ford Insomnia Response to Stress Test; FIRST) and insomnia symptoms from the past two weeks (Insomnia Severity Index; ISI). Patients then completed the ISI again one month later (n = 48). We tested high sleep reactivity (FIRST > 21) as a prospective predictor of clinically significant posttraumatic sleep disturbances (ISI > 10).

Results

Patients were mostly black men (67%), and nearly half reported an annual income < $20,000 (47.7%). Motor vehicle collisions were the most common trauma that precipitated patients’ hospital admission (42%), followed by assaults with a weapon (30.7%). While adjusting for age and pre-trauma sleep disturbance, high sleep reactivity predicted increased odds of sleep disturbances one month after trauma (b = 2.08, SE = .98, p = .033, OR = 8.01, CI = 1.19 – 54.15).

Conclusion

Individuals with high sleep reactivity are at increased susceptibility of clinically significant sleep disturbances after trauma. The 9-item FIRST is a brief and clinically useful indicator that offers providers the ability to predict the onset of acute sleep disturbances after trauma, which are novel targets for early intervention. This might enable the early identification of potentially vulnerable individuals who might develop PTSD, toward whom sleep-focused preventive efforts can be targeted.

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0662 Digital sleep-health surveillance: Population nightmare frequency is observable in social media
Authors: Mallett Remington , Sowin Laura , Carr Michelle
Published: May 2023

Introduction

Nightmares are a critical component of multidimensional sleep health. Frequent nightmare recallers suffer reduced sleep length, depressed mood, and are more likely to be diagnosed with a psychiatric disorder in the future. Reliable population estimates of nightmare frequency are difficult to obtain and often restricted to rigid timepoints (e.g., once per year). Thus, there is a need for low-cost methods to track population levels of nightmare frequency and their dynamic changes over time. In the current study, we tracked dream content and nightmare frequency using a popular new approach – digital health surveillance – that analyzes language of public and freely-accessible social media posts to track population characteristics.

Methods

To evaluate whether social media could detect known changes in population sleep health, we extracted posts from r/Dreaming, a popular subreddit dedicated to dream sharing. Prior survey studies have shown a reliable increase in nightmare frequency during the first wave of the COVID-19 pandemic. Thus, we quantified the amount of nightmares posted on Reddit surrounding the World Health Organization’s (WHO) declaration of a COVID-19 as a global pandemic. Nightmares were identified using a word-search algorithm that identified nightmare-related words in a post title. Nightmare frequency was compared before and after the WHO declaration using a chi-squared analysis.

Results

The percentage of dreams posted on Reddit that were identified as nightmares was higher after the WHO declaration than before (p < .05). Additionally, the amount of anxiety in all dreams posted on Reddit was higher after the WHO declaration than before (p < .05). Weekly change in dream anxiety was positively correlated with the percentage of COVID-19 news headlines (p < .05).

Conclusion

We observed an increase in nightmares shared on Reddit immediately following the WHO’s declaration of COVID-19 as a global pandemic. This novel approach to tracking nightmares might offer the field of sleep medicine a low-cost and real-time system for monitoring population sleep health. Other recent work suggests this method might be viable for tracking other components of sleep health.

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0663 Rates and Predictors of Rapid Eye Movement Sleep Behavior Disorder Symptoms in Post-9/11 Veterans
Authors: Jones Melissa , Tea Juliann , Meyers Matthew , Li Ruosha , Agrawal Ritwick , Villalon Audri , Aloor Fuad , Jorge Ricardo
Published: May 2023

Introduction

Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), both prevalent conditions in post-9/11 Veterans, have been linked to rapid eye movement sleep behavior disorder (RBD). We administered a validated screening instrument for RBD to post-9/11 Veterans enrolled in the Houston branch of the Translational Research Center for TBI and Stress Disorders (TRACTS) to investigate rates of RBD symptoms and clinical predictors of positive screens in this cohort.

Methods

In this cross-sectional analysis, the English translation of the Rapid Eye Movement Behavior Disorder Questionnaire - Hong Kong (RBDQ-HK) was administered with the standardized TRACTS battery. A systematic chart review was performed to assess for known sleep disorders. Fisher’s exact and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively. Multivariable logistic regression was conducted, including as covariates the most significant clinical variables from univariable analyses. A p-value < 0.05 was considered statistically significant.

Results

Of the 119 subjects with available RBDQ-HK screens, 71 (59.66%) scored above the recommended total cut-off of ≥21 for psychiatric RBD. When positive screens were defined as a cut-off of ≥8 on Factor 2 of the RBDQ-HK, 65 of 119 (54.62%) subjects screened positive. Univariable analyses indicated that global sleep quality, number of TBI exposures, and current PTSD severity were most consistently associated with positive screens. Multivariable logistic regression analysis using a total cut-off score of ≥21 showed that PTSD severity (OR 1.06, 95% C.I. 1.02-1.10, p=0.003) and number of lifetime TBIs (OR 1.63, 95% CI 1.16-2.41, p=0.01) were independent predictors of positive screens, whereas global sleep quality was no longer significant (OR 1.10, CI 0.97-1.26, p=0.149). Multivariable logistic regression analyses were repeated using a cut-off score of ≥8 on Factor 2 and showed similar results.

Conclusion

Given the high positive screening rates for RBD in our cohort, future efforts are needed to validate RBD screening instruments; enhance interdisciplinary sleep assessments; and investigate pathophysiological relationships between PTSD, TBI, and parasomnias.

Support (if any)

Center for Alzheimer's and Neurodegenerative Diseases, Baylor College of Medicine; RR&D Veterans Administration (B9268-X)
0671 Identifying Disruptive Nocturnal Behaviors in Trauma Associated Sleep Disorder with Video-Polysomnography on Consecutive Nights
Authors: Jacobus Brent , Tchopev Zahari
Published: May 2023

Introduction

Trauma associated sleep disorder (TSD) manifests with trauma-related nightmares, disruptive nocturnal behaviors (DNB), and autonomic hyperactivity. Although patients with TSD frequently report DNB, events are infrequently identified during in-lab polysomnography (PSG), possibly due to a sense of safety imparted by a monitored environment. It is unknown if patients with TSD acclimate to the lab environment if studied on consecutive nights. Given the infrequent and potentially subtle nature of DNB and REM sleep abnormalities, the objective of this study was to compare self-reported and PSG characteristics from two consecutive nights of PSG in patients with TSD.

Methods

Individuals were initially screened for TSD with the Pittsburgh Sleep Quality Index Addendum. Those reporting trauma-related nightmares and DNB underwent a structured clinical interview to confirm the diagnosis. Patients with TSD completed 2 consecutive nights of attended in-lab PSG with post-PSG dream/nightmare questionnaire. Video-PSG analysis was performed including detailed review of movements, excluding epochs with sleep disordered breathing. REM sleep analysis included quantifying “any” electromyographic (EMG) activity as an objective measurement for REM without atonia. ANOVA was used for statistical analysis.

Results

We diagnosed 15 individuals (11 males; 14 service members, 1 Veteran; average age 32.2 years) with TSD. Traumatic exposures were combat-related in 40% and physical or sexual assault related in 60%. There was a significant difference between proximal limb movements on night 1 vs night 2 (1.0 ± 1.73 vs 10.3 ± 4.04; p=0.02). There was a significant difference in the amount of increased EMG tone using 3 second REM mini epochs between the 2 nights (153 ± 147.8 mini epochs vs 417 ± 35.1; p=0.04). No difference was detected between nights for vocalizations or sleep parameters including total REM sleep time and percentage. Nightmares were reported by 33% during their first night PSG vs 66% during their second PSG.

Conclusion

In patients with TSD, there was an increase in the number of proximal limb movements, total mini epochs of “any” REM EMG activity, and nightmares during the second night of consecutive in-lab PSG testing. More than one night of in-lab PSG evaluation is likely required to best characterize the severe nocturnal disruptions of TSD.

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0672 Nightmare Disorder & Insomnia Severity in Complex Posttraumatic Stress Disorder
Authors: Christian Regan , Slavish Danica
Published: May 2023

Introduction

Most adults experience a traumatic event at some point in their lifetime, and some also go on to develop posttraumatic stress disorder (PTSD). Sleep disorders such as insomnia and nightmares are common in PTSD, which may be due to hyperarousal and distressing memories that disrupt the sleep-wake cycle. Complex PTSD (C-PTSD) is a new distinct diagnosis of PTSD that includes three new symptom domains: emotional dysregulation, negative self-cognitions, and interpersonal hardships. Despite evidence linking PTSD and sleep disturbances, this work has yet to be extended to C-PTSD. To address this gap, the current study examined the association between nightmares, insomnia, and C-PTSD symptoms, as well as explored gender and the time elapsed since the traumatic event as moderating variables.

Methods

Data were obtained from a sample of 243 trauma-exposed participants recruited online. Most participants identified as White (n = 207; 85%), non-Hispanic (n = 219; 90%), and female (n = 135; 56%), with an average age of 37.26 years (SD = 11.39). The Complex Trauma Inventory (CTI) and International Trauma Questionnaire (ITQ) were utilized to measure C-PTSD symptoms.

Results

Greater C-PTSD symptoms measured via the CTI were associated with greater insomnia symptoms (b = 3.22, 95% CI [2.46, 3.97]) and nightmare disorder symptoms (b = 2.14, 95% CI [1.57, 2.72]). Similarly, greater C-PTSD symptoms measured via the ITQ were also associated with greater insomnia symptoms (b = 0.28, 95% CI [0.22, 0.34]) and nightmare disorder symptoms (b = 0.18, 95% CI [0.13, 0.23]). No moderating effects of gender or time elapsed since trauma were found.

Conclusion

Results underscore that C-PTSD symptoms are strongly linked to nightmares and problems falling asleep, staying asleep, and waking up too early—regardless of a person’s gender identity or how long ago they experienced a traumatic event. Findings may inform more targeted, sleep-focused cognitive-behavioral treatments for C-PTSD.

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0674 The role of PTSD symptoms in the relationship between sleep quality and pain following Moderate-to-Severe Traumatic Brain Injury
Authors: Martin Aaron , Rudd Robert , Luongo Kristen , Almeida Emily J , Hoffman Jeanne M , Pinto Shanti M , Walker William , Douglas Megan E , Wittine Lara , Schwartz Daniel J , Takagishi S Curtis , Kane Georgia , Nakase-Richardson Risa
Published: May 2023

Introduction

Poor sleep quality and chronic pain are common after moderate-to-severe traumatic brain injury (msTBI). Prior studies have not examined the role of PTSD symptoms in the relationship between sleep quality and chronic pain experience (i.e., severity and pain-related interference) in those with msTBI. Yet, PTSD is known to be associated with both sleep and pain. The purpose of this analysis is to determine the role of PTSD symptoms in the sleep-pain relationship among this at-risk clinical population.

Methods

Secondary analyses were performed on data (n=1537) from the TBI Model Systems follow-up study. Participants were an average age of 46.21 years old, predominantly male (72.61%), and followed at an average of 8.5 years post injury. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index; PSQI), pain severity and interference (Brief Pain Inventory; BPI), depression (Patient Health Questionnaire-9; PHQ-9) and PTSD symptoms (PTSD Checklist, PCL-5). Analysis of covariance (ANCOVA) was used to examine differences in pain outcomes controlling for relevant covariates, adjusting for item redundancy prior to analyses.

Results

Sleep quality and pain interference are associated such that “good sleepers” (PSQI≤8, mean=4.92±2.17) have lower pain interference scores than “poor sleepers” (PSQI>8, mean=12.63±2.87), with a mean pain interference of 3.41±2.32 vs 5.26±2.45 (p< 0.0001). “Good sleepers” also had lower pain severity (4.22±1.78 vs 5.28±1.84, p< 0.0001), lower PTSD symptoms (14.62±13.46 vs 28.35±17.82, p< 0.0001), and less depression symptoms (5.32±4.97 vs 10.57±6.22, p< 0.0001) when compared to “poor sleepers.” Pain interference and severity were significantly related to all covariates at a <.001 level. Further, a significant effect of PSQI score cut-off (“good” v “poor sleeper”) in both pain interference and severity remained after controlling for the effect of age, depression, and PTSD symptom scores.

Conclusion

In patients with msTBI, sleep quality and pain interference are positively associated such that better sleep quality corresponds with lower pain interference, a relationship which remains when controlling for PTSD and multiple covariates. Addressing the sleep needs of patients with msTBI through behavioral intervention (e.g., cognitive behavioral therapy for insomnia), even in the presence of additional psychiatric comorbidities, may assist those who experience chronic pain following injury.

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0675 Levels of Depression Differentially Affect Sleep in People Who Have Had Cancer: Findings from the National Health Interview Survey
Authors: Moore Jesse , Carrasco Mary , Hollimon Laronda , Fiegenbaum Rachel , Landron Leo , Taylor Kayla , Rogers April , Jean-Louis Girardin , Seixas Azizi
Published: May 2023

Introduction

Cancer survivors experience an increased stress burden. Twenty-five percent (25%) of cancer survivors experience persistent depressive and anxiety symptoms and 40% are afflicted with chronic sleep problems. Analysis of this relationship between survivors’ mental health and sleep may elucidate components of stress burden in a particularly vulnerable population. This study examined the relationship between anxious and depressive symptoms and frequency predicting sleep patterns, comparing individuals with a cancer history versus those without.

Methods

Data emanated from the 2020 National Health Interview Survey dataset (n=31,568). Six percent (n=1936) of respondents reported a cancer history. The primary outcome was sleep duration, based on the average hours of sleep per night an individual reported over the past month, which was coded into “healthy” (7-8 hrs.) vs “unhealthy” (< 7 hrs. or > 9 hrs.) sleep. Level of anxiety and depression as well as frequency of reported symptoms were included in the models as predictors. Binary logistic regression models were performed to determine the discrete impact of depression and anxiety on sleep duration among individuals with and without a cancer history. Adjusted models included the demographic covariates of age, sex, education, household income, and race.

Results

In adjusted models, frequency of anxious feelings (OR = 1.19, p<.01,), frequency of depressive feelings (OR =1.29, p<.01,), level of anxious feelings (OR = 1.38, p<.01,), and level of depressive feelings (OR=1.15, p<.01) significantly predicted unhealthy sleep in the full sample. However, among individuals with a cancer history, frequency of anxious feelings (OR =1.16, p<.01,), level of anxious feelings (OR = 1.28, p<.01,) and frequency of depressive feelings (OR = 1.23, p<.01,) significantly predicted unhealthy sleep duration, but level of depressive feelings did not (OR = 1.08, p=.13,).

Conclusion

Mental health and sleep are closely and bidirectionally connected in the general population, but among individuals with a history of cancer the link between level of depression and healthy sleep were not significant. Further research is needed to understand the complex relationship between mental health and sleep among people with a cancer history.

Support (if any)

K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007.
0676 Sleep medication prescribing among patients receiving opioid use disorder treatment with comorbid insomnia
Authors: Martin Caitlin , Patel Hetal , Dzierzewski Joseph , Moeller Frederick , Bierut Laura , Grucza Richard , Xu Kevin
Published: May 2023

Introduction

People initiating treatment for opioid use disorder (OUD) report insomnia to be a high priority, and insomnia is associated with compromised OUD treatment outcomes. However, insomnia treatments have yet to be investigated in the OUD clinical setting. Knowledge of prescribing patterns for sleep medications among OUD treatment patients is an essential first step to advance therapeutic development at the insomnia-OUD comorbidity. This retrospective cohort study used administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases (2006-2016) to investigate the prevalence of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. In doing so, we assess sex differences in prescription receipt within this unique patient population, given the known sex-based disparities in insomnia among other adult populations.

Methods

We included people aged 12-64 years with diagnoses of insomnia and OUD initiating buprenorphine during the study timeframe. The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g., hydroxyzine, trazodone, and mirtazapine). Descriptive analyses present prescription prevalence for the total sample as well as separately for males and females. Lastly, associations between sex and insomnia medication prescription receipt were estimated using Poisson regression models.

Results

Our sample included 9,510 individuals (female n=4,637; male n=4,873) initiating buprenorphine for OUD who also had insomnia, of whom 6,569 (69.1%) received benzodiazepines, 3,891 (40.9%) Z-drugs, and 8,441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR=1.17 [1.11-1.23]), Z-drugs (RR=1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR=1.07, [1.02-1.12]).

Conclusion

Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment, especially females. These findings juxtapose the known increased overdose risk with benzodiazepine use and lack of efficacy data for these pharmacologic insomnia treatments in this growing patient population in the opioid crisis.

Support (if any)

National institute of Drug Abuse: K23 DA053507 (CEM), UG1DA050207 (FGM). National Institutes of Health: R25 MH112473-01 (HP), T32 DA015035 (KYX), R21 DA044744 (RAG and LJB). National Center for Advancing Translational Sciences: UL1 TR002345 (Washington University), UL1TR002649 (Virginia Commonwealth University)
0678 Consequences of following the herd: Perceptions drive a vicious cycle of poor student sleep habits at an elite university
Authors: Marquardt Matthew , Pontis Sheila
Published: May 2023

Introduction

Poor sleep health is widespread among undergraduate university students. This study sought to understand the contributors to poor sleep quality at an elite undergraduate university in the United States. In particular, we were interested in uncovering the social influences on sleep regularity, which is increasingly regarded as a critical determinant of overall sleep quality.

Methods

An exploratory, mixed-methods study was designed combining a week-long diary study (n=5) and in-depth contextual interviews (n=5) to better understand undergraduate students’ college experience and sleep behaviors, followed by a student survey (n=181) to uncover primary macro trends and factors related to those sleep behaviors.

Results

A significant irregular sleep schedule emerged as highly common among students. Sleep irregularity was strongly influenced by students’ perceptions about their peers’ sleep and working habits. These perceptions combined with a personal desire to keep pace with their peers and the prioritization of academic work implicitly stated by the university culture influenced when and how students went about their lives, even if those behaviors meant acting against their knowledge and judgment. The convergence of perceptions and behaviors generates a vicious cycle of sleep deprivation and low productivity. The cycle stems from students’ desire to match their peers, which leads to late nights and sleep deprivation. The resulting impaired executive functioning contributes to subsequent inefficient scheduling and lack of concentration. As concentration drops, students multi-tasked more often and incomplete tasks piled up, necessitating further sleep deprivation to get it all done.

Conclusion

Poor sleep regularity in college is influenced by a set of interconnected factors derived at both the level of the individual student and at the student-body level. Interventions should consider a dual approach to break the vicious cycle, targeting the harmful beliefs among students about the sleep and working habits of their peers, and the prioritization of academic work.

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0684 Effects of Transcranial Magnetic Stimulation (TMS) on Treatment of Intrusive Thinking in Insomniac Populations
Authors: Reich-Fuhrer Melissa , Hildebrand Lindsey , Jankowski Samantha , Henderson-Arredondo Kymberly , Trapani Christopher , Franca Gabriela , Desai Shivani , Patel Salma , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie , Killgore William
Published: May 2023

Introduction

Patients with clinical insomnia commonly report intrusive thinking (IT) as a common contributor to delayed sleep onset. Evidence suggests that the default mode network (DMN) may contribute to this intrusive thinking. Therefore, we employed continuous theta burst (cTBS) repetitive transcranial magnetic stimulation (rTMS) to modulate DMN activation, and thus reduce IT before sleep.

Methods

In a counterbalanced cross-over design, active or sham cTBS was administered to 20 participants with clinical insomnia, 8 males (Mage=31.63, SD=6.74) and 12 females (Mage=23.75, SD=4.29), with sessions separated by at least 5 days. To assess intrusive thoughts prior to sleep, participants took the Glasgow Content of Thoughts Inventory (GCTI). We utilized the subscale of the GCTI measuring sleep and wakefulness. Higher scores indicate more persistent intrusive thoughts. We conducted a mixed ANOVA to examine effects of sham and active cTBS conditions on intrusive thoughts.

Results

There was a medium effect size (ηp2 =.087) but no significant variance (p>.05) in average IT scores between participants sham cTBS (M=19.100, SD=5.349) and active cTBS (M=18.200, SD=4.502) Post-TMS sessions. There was a significant interaction between sex, TMS, and administration (F(1,18)= 4.697; ηp2=.207; p=.044). We then conducted a simple effects analysis between males and females. There was no significant effect of cTBS condition on reported intrusive thinking post-TMS administration (F(1,7)= .628; ηp2=.082; p=.454). However, there was a significant interaction of cTBS condition on intrusive thoughts post-TMS administration for females (F(1,11)= 5.894; ηp2=.349; p=.034). Post-hoc pairwise comparison revealed that females reported significantly greater intrusive thinking post-TMS administration (M=20.167, SD=5.68) compared to pre-TMS administration (M=17.5, SD=5.73) during their sham cTBS session (p=.042). This was not present post-TMS administration during active cTBS (p>.05).

Conclusion

There was a decrease in intrusive thoughts relating to sleep and wakefulness in females, but not males, following active TMS. Interestingly, we also observed an increase in intrusive thoughts for the sham condition, suggesting that participants may have developed expectations of improvement and been sensitized to these cognitions when sleep was not improved. These findings are encouraging suggesting that cTBS may improve IT, although preliminary data suggest this may differ between males and females.

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W81XWH2010173
0693 Rest-activity rhythm in Methadone and Buprenorphine-maintained patients
Authors: Zhang Rui , Manza Peter , Tomasi Dardo , Shokri-Kojori Ehsan , Demiral Sukru , Wang Gene-Jack , Volkow Nora
Published: May 2023

Introduction

Opioid use disorder (OUD) is a chronic relapsing disorder with a high overdose death rate. In OUD, sleep and circadian disruptions are highly prevalent, interfere with retention in opioid maintenance treatment (OMT) and increase relapse. Growing evidence suggests a link between sleep/circadian disruptions and dopaminergic (DA) signaling which accounts for addictive properties of drugs of abuse. The current study investigated rest-activity rhythm in Methadone and Buprenorphine-maintained patients and how it relates to DA changes in patients.

Methods

To access rest-activity rhythm, twenty-five OUD patients (9 Females; age 44.34±11.97; 60% White, 32% Black; 18 Methadone; 7 Buprenorphine) and thirty-four age, sex, race and BMI-matched healthy controls wore wrist accelerometers for one-week and completed questionnaires for sleep and chronotype. Among OUD patients, sixteen of them completed [11C]NNC112 and [11C]raclopride PET scans for the assessments of D1R and D2R availability, respectively. Negative mood was accessed as secondary outcomes.

Results

Our preliminary data showed that compared to healthy participants, OUD patients undergoing OMT reported greater sleep problems and showed greater sleep irregularity measured by actigraphy, but no differences in other parameters such as sleep duration, rhythm timing or physical activity. Among patients, greater eveningness and irregularity were associated with higher level of negative mood including depression and anxiety. There is a tendency of a positive correlation between later phase and greater D1 receptor availability and a negative association between sleep irregularity and D2 receptor availability.

Conclusion

Our finding suggests that a link between altered rest-activity rhythm and DA signaling in OUD patients. Circadian/sleep interventions that regulate rest-activity rhythm might benefit mood improvement and promote OUD recovery by normalizing DA transmission.

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0697 The Relationship Between Anger Expression and Sleep
Authors: David Michelle , Sedano Brandon Fernandez , Shurovi Sumayya , Yurgel Tyla , Cornelius Talea , Schwartz Joseph , Abdalla Marwah
Published: May 2023

Introduction

Increased anger expression (AE) is linked to worse health outcomes. Short sleep duration and poor sleep quality are linked with increased anger. However, few data have examined whether increased AE may lead to disturbed sleep. We examined if AE is associated with objectively and subjectively-assessed sleep measures in two cohort studies.

Methods

The Masked Hypertension Study (MHTN, n=888) is a multi-site study of the prevalence and predictors of masked hypertension. Participants completed the Spielberger Anger Expression Scale (SAES) and the Pittsburgh Sleep Quality Index. Sleep duration and percent of time awake after sleep onset (%waso) during a 24-h period were derived from wrist-worn actigraphy (ActiWatch; Phillips Respironics), supplemented by diary reports. The Worksite Blood Pressure study (WSBPS, n=472) is a multi-site study of psychological factors and ambulatory blood pressure. Participants completed the SAES and a sleep quality questionnaire. In MHTN, linear regression models were estimated for each sleep outcome with age, sex, race/ethnicity, and anxiety as covariates. In the WSBPS, the analysis was conducted for sleep quality only, controlling for age, race/ethnicity, anxiety, sleep apnea , and study site.

Results

Participants in MHTN (n=782) were 59.5% female, 11.5% Hispanic/Latinx. Mean age was 45.5 years (SD = 10.4). Mean AE was 34.7 (SD = 6.6 ). Mean sleep duration was 6.3 hours (SD = 1.1), mean %waso was 7.1% (SD = 4.0), and mean sleep quality was 5.6 (SD = 3.2). AE was not significantly associated with sleep duration, B = 0.01, 95% CI -0.01, 0.02, p = .30, waso, B = 0.02, 95% CI -0.03, 0.07, p = .43, or sleep quality, B = 0.01, 95% CI -0.03, 0.05, p = .71. Participants in WSBPS (n=278) were 23.7% female, 6.1% Hispanic/Latinx and mean age was 53.1 years (SD = 8.5 ). Mean AE was 46.8 (SD = 5.0). Mean sleep quality was 8.4 (SD = 4.4). AE was not significantly associated with sleep quality, B = -0.014, 95% CI 0.14, 0.07, p = 0.50.

Conclusion

AE was not associated with objective or subjectively-assessed sleep measures. Our findings may suggest that clinicians should focus on other factors rather than AE to improve sleep.

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P01HL47540
0698 Contrasting Painful and Painless Restless Legs Phenotypes: An Adult Twin Family Study
Authors: Champion David , Bui Minh , Aouad Phillip , Ng Georgia , Joyce Emily , Teng Arthur , Karroum Elias , Walters Arthur , Jaaniste Tiina , Hopper John
Published: May 2023

Introduction

Several studies characterized painful and painless restless legs syndrome (RLS) phenotypes based on clinical, topographical, polysomnographic, and genetic background. One pediatric twin family study demonstrated a clear contrast between these two forms of RLS. The painful pediatric RLS being familial, probably genetically influenced, and associated with primary pain disorders (non-migraines headaches; recurrent abdominal pain), the painless pediatric RLS being familial but probably not genetically determined, and associated with iron deficiency, female gender, and persistent/chronic pain disorders. The current study investigated these contrasting painful and painless RLS phenotypes in the adult population.

Methods

The Twins Research Australia database was used to recruit adult twins and their families. The subjects were surveyed and responded to questions related to their demographics, the Cambridge-Hopkins diagnostic questionnaire for RLS diagnosis and categorization into painful and painless RLS subgroups, the history of physician-confirmed iron deficiency, the presence of selected chronic and primary pain disorders, and also other medical, non-pain conditions associated with RLS. Association analyses, using logistic regression with application of generalized estimating equations to control for twin influences, and adjusting for gender and age, were conducted.

Results

A total of 1449 adult subjects responded to the RLS diagnostic questionnaire and to pain related and other medical conditions questions (64.4% females). A total of 1327 adult subjects responded to the iron deficiency pertinent questions (65.7% females). Numbers of dizygous twins and painful RLS subjects were insufficient for heritability testing and for association analyses with medical conditions. Painless RLS was associated with iron deficiency (OR= 1.59; p=0.003), while painful RLS was not (OR=1.26; p=0.444). Painful RLS was associated with migraine (OR=2.35; p=0.004), recurrent abdominal pain (OR=1.96; p=0.026), growing pains (OR=2.13; p=0.050), diverse chronic pain (OR=2.88; p=0.017), chronic spinal pain (OR=3.65; p=0.001) and dysmenorrhea (OR=2.46; p=0.009). Painless RLS was not associated with any pain disorder.

Conclusion

This study further confirmed contrasting associations in adults with painless and painful phenotypes of RLS (association with iron deficiency and multiple pain disorders, respectively).

Support (if any)

This work was supported by the School of Women's and Children's Health, Medicine, University of New South Wales, Kensington 2052, NSW, Australia; Private donors.
0701 Perceptions of People with Restless Legs Syndrome on the Effect of Exercise on Symptoms: Results of a Nationwide Survey
Authors: Cederberg Katie , Sikes E Morghen , Mignot Emmanuel
Published: May 2023

Introduction

Restless legs syndrome (RLS) is a prevalent, sensorimotor sleep disorder that significantly disrupts sleep and is associated with increased risk of cardiovascular disease, hypertension, stroke, depression and anxiety, and causes overall poorer health. As two key diagnostic features of RLS include the worsening of symptoms at rest and relief by movement, there is increasing interest in utilizing physical activity and exercise to manage symptoms. The present study describes personal perceptions of the effects of exercise on symptoms of RLS.

Methods

Participants (N=528) completed a mixed-methods, nationwide survey including items assessing personal experiences with exercise and RLS (both positive and negative) as well as RLS diagnosis, RLS severity, and demographic and clinical characteristics.

Results

Most respondents (72%) perceived that exercise improves RLS symptoms with only a small proportion (13%) perceiving exercise only makes symptoms worse. Participants described any abrupt change in exercise would almost always elicit RLS symptoms (e.g., hiking for a long time, stopping an exercise routine) and that a consistent pattern of exercise seemed to be associated with improvements in RLS symptoms and an overall beneficial effect on frequency of symptomatic bouts. Most (55%) perceived exercise in the morning (4AM to noon) improved their symptoms and 56% perceived exercise in the afternoon/evening (4PM to 11 PM) made symptoms worse. Participants described several questions that they wanted answered regarding the evidence for exercise in RLS and specific exercise prescription recommendations.

Conclusion

Our results suggest that there is individual variation in the response to exercise, whereby some people experience improvements in symptoms with exercise, while others experience worsening of symptoms with exercise. Such individual differences and specific attributes should be considered in exercise-based management to further optimize personalized treatment plans to prevent and manage symptoms in people with RLS.

Support (if any)

This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952].
0704 A PSG Study of the Effect of Clonazepam and Melatonin on REM Sleep without Atonia in Isolated REM Sleep Behavior Disorder
Authors: Mogavero Maria , Ferri Raffaele , Marelli Sara , Castelnuovo Alessandra , Lanza Giuseppe , DelRosso Lourdes , Schenck Carlos , Ferini-Strambi Luigi
Published: May 2023

Introduction

Although very few prospective clinical trials are available assessing the benefits of drugs in isolated REM sleep behavior disorder (iRBD), clonazepam and melatonin are considered as the first-line treatment options. However, while evidence supporting the efficacy of these two compounds on the clinical behavioral outcomes seems to be clear, it is not clear if they are able to significantly modify the main polysomnographic (PSG) feature of iRBD, i.e. REM sleep without atonia (RSWA). For this reason, we carried-out an observational cross-sectional retrospective PSG study of the effects of clonazepam and melatonin on RSWA.

Methods

A total of 83 iRBD patients (70 males and 13 females, age range 50.9-83.2 years) were enrolled in this study: 43 drug-free, 21 patients taking at bedtime chronically (>6 months) clonazepam (0.5-2 mg), seven patients taking melatonin extended-release alone (2-3 mg), and 12 taking a combination of clonazepam and melatonin extended-release (same doses as above). PSG studies were assessed for all subjects, including the measurement of the automatic REM sleep atonia index (RAI) and periodic leg movements during sleep, as well as a series of demographic and clinical variables, such as age, age at onset, disease duration, clinical global impression scale (severity and improvement), mini-mental state evaluation, and RBD severity scale.

Results

None of the outcomes considered in this study showed significant differences between the groups considered. All showed low average values of RAI, as expected, and there were no differences between patients taking clonazepam, melatonin, or a combination of them (drug-free 0.778±0.184, clonazepam 0.797±0.183, clonazepam+melatonin 0.692±0.224, melatonin 0.673±0.228; ANOVA F = 1.329, p = 0.271), despite the clinical global impression scale-improvement was reported to be “much improved” or “minimally improved” in all treated patients.

Conclusion

This study confirms our previous findings in smaller patient series taking only clonazepam and suggest that both clonazepam and melatonin might be beneficial on some clinical manifestations of iRBD but are unable to modify its underlying neurophysiology. This might also indicate that these agents do not seem to interfere with the core mechanisms of this disease and other disease modifying drugs need to be discovered for iRBD.

Support (if any)
0706 Sleep Related Bruxism, Headaches and Cardiovascular Diseases
Authors: Luco Ken
Published: May 2023

Introduction

Sleep-related bruxism is a movement-type sleep disorder affecting 10-12% of the population. It affects men and women equally and has been shown to be a risk factor for cardiovascular disease, tension, and migraine-type headaches (without auras). This disorder is very destructive to the dentition, reduces deep sleep, and can result in significant pain and dysfunction.

Methods

Review of the literature as well as clinical findings.

Results

Sleep-related bruxism affects the trigeminal cardiac reflex resulting in a significant sympathetic stimulation of the cardiovascular system.

Conclusion

Sleep-related bruxism is a risk factor for cardiovascular disease as well as tension and migraine-type headaches (without auras).

Support (if any)
0707 Spinal Cord Stimulation for Restless Legs Syndrome: Case Report and Scoping Review
Authors: Carvalho Diego , Pagani-Estévez Gabriel , Kissoon Narayan , Silber Michael , Tippmann-Peikert Maja
Published: May 2023

Introduction

Restless legs syndrome (RLS) can dramatically impair sleep quality and quality of life. Some patients have insufficient treatment response or intolerance to available pharmacological options. Exploration of novel therapeutic approaches is needed.

Methods

We report a case of spinal cord stimulation (SCS) providing benefit in RLS. We also performed a scoping review of SCS in RLS with comprehensive literature search of MEDLINE, EMBASE, Cochrane, and Scopus.

Results

A 77-year-old woman with DM2, OSA (on ASV), depression, familial RLS and iron deficiency with typical RLS symptoms for all of her adult life presented for management in 2000. In 2011 she developed intractable painful peripheral neuropathy and chronic back pain. Levodopa, pramipexole, oral/intravenous iron, gabapentin, pregabalin, tramadol, oxycodone, and methadone were ineffective or poorly tolerated. A 7-day percutaneous SCS trial resulted in RLS symptoms improvement initially by 50%. A Medtronic stimulator with lead placement at T8-T9 was implanted. 6 months later, the patient toggled between a tonic program (2.1-4.6 mA, 200 us, 50 Hz) and a sub-perception, differential target multiplexed program duty-cycled to 1:2 on:off (3.7 mA, 170 us, 300 Hz). She reported 75% improvement in RLS symptoms. Pain improved by 50%. Total daily dose of Oral Morphine Equivalents was reduced from 48.75mg/day to 37.5mg/day, with a stable once daily dose of 400 mg gabapentin at night. Uninterrupted sleep went from 2-5 hours to 6 hours. RLS worsened when the device was off. Our case corroborates the current evidence of benefit of SCS for RLS from the literature. We identified other 16 unique patients from case reports and series who had undergone SCS for RLS. Leads were most often implanted in mid or low thoracic levels. Stimulation waveforms were high frequency in 4 patients, tonic in 3 patients, burst stimulation in 1 patient, and undescribed in the others. All patients had RLS symptom reduction. Comorbid pain was reported in 14 patients, which also improved with SCS. Complication with lead erosion was reported in one case.

Conclusion

SCS remains a promising therapeutic approach for refractory RLS that deserves further investigation. SCS may reduce hyperexcitability seen in RLS by modulating dysfunctional spinal, subcortical, and cortical networks.

Support (if any)
0710 Effects of tonic motor activation (TOMAC) therapy on sleep quality for refractory restless legs syndrome
Authors: Bogan Richard , Roy Asim , Kram Jerrold , Ojile Joseph , Hudson J Douglas , Rosenberg Russell , Scheuller H Samuel , Charlesworth Jonathan
Published: May 2023

Introduction

Tonic motor activation (TOMAC) is a noninvasive medical device therapy that has been shown to reduce symptoms of refractory restless legs syndrome (RLS). Here, we evaluated the effects of TOMAC on subjective sleep quality.

Methods

One hundred and thirty-three adults with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for 4 weeks. Participants were instructed to self-administer a 30-minute TOMAC session bilaterally over the head of the fibula to electrically stimulate the peroneal nerve whenever RLS symptoms presented. Sleep quality was assessed through prespecified analysis of changes to Medical Outcomes Study Sleep Scale (MOS-Sleep) Sleep Problems Index I (MOS-I) and II (MOS-II) scores from baseline to Week 4. Post hoc t-tests were conducted on each MOS-Sleep item included in the MOS-I or MOS-II.

Results

MOS-I score changed by -11.8 points (48.5 to 36.7) for TOMAC and -2.8 points for sham (44.5 to 41.7), a difference of -9.0 points (p< 0.001). MOS-II score changed by -13.7 points (52.5 to 38.9) for TOMAC and -4.0 points for sham (48.3 to 44.3), a difference of -9.7 points (p< 0.001), which exceeds the proposed minimal clinically important difference (MCID) of 6 points. Post hoc analysis demonstrated statistically significant reductions in trouble falling asleep (item #7; -34.0% for TOMAC vs. -5.8% for sham; p< 0.01) and trouble staying awake during the day (item #9; -33.6% for TOMAC vs. -2.1% for sham; p< 0.05), which exceeded the standard MCID threshold of 30% relative to baseline.

Conclusion

For adults with refractory RLS, TOMAC improved subjective sleep quality, sleep latency, and daytime somnolence relative to sham control. Each of these improvements represented clinically important improvements. These data demonstrate that TOMAC can provide meaningful improvements to sleep quality and daytime functioning for patients with refractory RLS.

Support (if any)

Funding was provided by Noctrix Health, Inc.