bluuebunny/crossref_metadata_2025 huggingface dataset:
0348 The Mediating Role of Sleep Duration in the Link Between Night Shift Work and Inflammation in Nurses
Authors: Bates Amanda , Husein Danya , Feldman Emily , Slavish Danica , Taylor Daniel , Kelly Kimberly , Ruggero Camilo , Dietch Jessica , Messman Brett , Kohut Marian
Published: April 2024

Introduction

Identifying risk factors and mechanisms involved in heightened inflammation is critical for developing targeted interventions. Night shift work is a well-established factor contributing to disrupted and insufficient sleep, which is linked to heightened inflammation. This study aimed to assess the impact of night shift frequency and sleep duration on inflammatory biomarkers in a sample of nurses.

Methods

As part of a larger longitudinal study, 392 nurses (mean age = 39.54 years, 92% female; 23% night shift-working) completed daily sleep diaries and wore an actigraphy watch for 7 days. On day 7, nurses had blood drawn to measure inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1 beta (IL-1β). Mediation analyses were conducted to examine the mediating role of sleep duration on the links between night shifts worked in the past 7 days and inflammatory markers on day 7.

Results

Sleep duration did not mediate the effect of night shift work on inflammatory biomarkers. However, there were several significant direct effects. More night shifts worked was associated with lower actigraphy-measured sleep duration (b = -0.16, p < 0.001) and greater IL-6 (b = 0.03, p = 0.002). Similarly, more night shifts worked (b = 0.03, p = 0.003) and lower self-reported sleep time (b = -0.19, p < 0.001) were independently linked to greater IL-6. Fewer night shifts worked (b = -0.05, p = 0.02) and lower self-reported sleep duration (b = -0.19, p < 0.001) were associated with higher IL-1β.

Conclusion

Given the critical role that nurses play in the healthcare system, it is important to understand the potentially modifiable factors impacting their health and well-being. This study demonstrated that short sleep duration may explain how night shift work impacts physiological dysregulation in nurses, including elevated systemic inflammation. Promoting adequate sleep opportunity in shift workers may be a way to improve their long-term health outcomes, although additional future experimental work on this topic is needed.

Support (if any)

NIAID 1R01AI128359 (PIs: Taylor & Kelly)
0349 Differences in Sleep on Working and off Days in Shift Working Nurses
Authors: Nagy Samantha , Hackworth Katelyn , Lopez Nicole , Taylor Daniel
Published: April 2024

Introduction

Sleep deficiencies are common in nurses, with up to 89% of nurses working some form of shiftwork (i.e., working before 6am and/or after 9pm). It is estimated that approximately 34% of nurses report insomnia disorder and 14% report shift work sleep disorder. Nurses face unique physical, psychological, and occupational demands that disrupt their sleep quality and duration and may conflict with their natural circadian rhythm.

Methods

Nurses (N = 26, 88% female, 80% white, mean age = 36.16 years, SD = 8.56) were asked to wear an Actiwatch to measure objective sleep parameters, a daily adhesive sweat collection patch, provide two blood samples (at Day 1 and Day 7), and report daily subjective sleep parameters (total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency) via the Consensus Sleep Diary for 7 days. The sample was further divided into day shift (n = 14) and night shift (n = 12) nurses. Data collection and cleaning are ongoing and preliminary results of complete sleep diary data are presented.

Results

Results of the independent sample t tests suggest that total sleep time was significantly different on days on shift versus off shift (t(86) = 2.94, p = .002) for day shift nurses but not for night shift nurses (t(76) = .48, p = .317). There was no difference in total sleep time between day and night shift workers. Additional exploratory analyses will be completed by the conference, comparing additional parameters (e.g., timing) in individual sleep periods (i.e., 1st work day, 2nd work day; 1st off day, 2nd off day) both within (night & day shift), as well as between (night vs day shift) groups on the final sample (N=40; 20 day and 20 night shift).

Conclusion

The results may indicate that day shift nurses have more variable sleep than night shift nurses. Further analyses will help fill gaps in our understanding of the deficient (i.e., inadequate, interrupted, mistimed) sleep in nurses (i.e., within and between day and night working), as well as inform potential interventions (i.e., CBTI for shift workers) to improve the sleep of critical nursing staff.

Support (if any)
0352 Association Between Sleep and Cardiovascular Disease Risk Factors in Sedentary Desk Workers
Authors: Sanders Rachel , Gibbs Bethany Barone , Perera Subashan , Patel Sanjay , Cheruka Caitlin , Davis Kelliann , Kline Christopher
Published: April 2024

Introduction

Cardiovascular disease (CVD) is a leading cause of death in US adults. Elevated blood pressure (BP) and arterial stiffness are risk factors for CVD in adults. Unhealthy sleep behaviors, irregular sleep patterns, and sleep disorders have been associated with an increased risk of developing CVD. We sought to examine the associations of device-assessed and self-reported measurements of sleep and BP with carotid-femoral pulse wave velocity (cfPWV) in adult desk workers with elevated BP.

Methods

Using baseline data from RESET BP trial, 175 desk workers with elevated BP were included in analyses (85.2% White; 58.3% female; age 45.5±10.8 y; body mass index [BMI]=31.1±6.7 kg/m2; resting systolic BP [SBP] 128±8 mmHg, resting diastolic BP [DBP] 83±7 mmHg). Participants wore an Actiwatch Spectrum accelerometer on their nondominant wrist for approximately 7 days, from which mean and standard deviation [SD] of sleep midpoint, mean daytime napping duration, mean wake after sleep onset (WASO), and mean sleep duration were obtained. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) provided self-reported perceptions of sleep quality, insomnia severity, and sleepiness, respectively. Resting PWV was captured via tonometry from the right carotid and femoral arteries. Blood pressure was assessed using 24-hour ambulatory monitoring, with separation into daytime and nocturnal BP based upon diary entries. Multivariable regression models adjusting for gender, age, and BMI were fitted; p-values were adjusted for multiplicity with the Benjamini-Hochberg procedure.

Results

WASO was associated with greater nocturnal BP; for every 30 additional minutes of WASO, nocturnal SBP was 3.0 mmHg (SE=0.72, p=0.048) greater and DBP was 2.9 mmHg (SE=1.1, p=0.008) greater. Poor sleep quality was associated with greater nocturnal SBP, but the association became nonsignificant after multiplicity adjustment. No other actigraphy-assessed or self-reported sleep variables were associated with 24-hour BP or cfPWV.

Conclusion

Our findings suggest greater time spent awake after initial sleep onset may influence nocturnal blood pressure. The relationship between WASO and nocturnal BP should be further explored as targeting decreasing time spent awake after sleep onset could potentially lower nocturnal BP in desk workers.

Support (if any)

Research supported by NIH grants R01HL134809 and R01HL147610
0354 Early to Bed and Early to Rise? A Comparison of Actigraphy-derived Sleep and Circadian Timing Across Chronotypes
Authors: Reis Daniel , Bahraini Nazanin
Published: April 2024

Introduction

Evening chronotype is associated with increased risk for depression and suicide-related outcomes. This may be due to circadian-sleep misalignment, as previous studies have found chronotype-related differences in the relative timing between circadian phase (i.e., dim light melatonin; DLMO) and sleep. However, such differences may be attributable to variation in intrinsic circadian period length across chronotypes, rather than reflect actual circadian misalignment among those with an evening chronotype. The present study sought to compare predicted circadian and sleep timing across chronotypes using a light-based mathematical model of the human circadian pacemaker that controlled for intrinsic period length.

Methods

This was a secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep and the Hispanic Health Study / Study of Latinos (HCHS/SOL) Sueño datasets. Scores on the Reduced Morningness-Eveningness Questionnaire were grouped into “morning,” “intermediate,” and “evening” chronotypes. Sleep timing was determined by actigraphy and DLMO was predicted (pDLMO) from light and sleep/wake states using the extended Kronauer model. Circadian-sleep alignment was calculated as the timing between pDLMO and either sleep onset or offset (i.e., phase angles). Multivariate analyses of covariance (MANCOVAs) were used to evaluate the associations between chronotype and the timing/alignment of circadian and sleep variables, with post-hoc comparisons conducted using non-parametric bootstrapping.

Results

MANCOVAs identified chronotype differences in sleep onset, pDLMO, and pDLMO-sleep onset phase angles in both datasets. Chronotype was associated with pDLMO-sleep offset phase angles in MESA Sleep only. pDLMO and sleep onset were ~1-2 hours later for participants with an evening chronotype (p < .001 for all). In MESA Sleep, participants with an evening chronotype had a pDLMO-sleep onset phase angle that was ~30 minutes (95% CI: 13.5, 46.9; p = .002) shorter than those with a morning chronotype; in HCHS/SOL Sueño, it was ~17 minutes (95% CI: 3.6, 29.1; p = .033) shorter.

Conclusion

Assuming equal intrinsic periods, participants with an evening chronotype had a light exposure profile that predicted sleep onset at an earlier circadian phase than those with a morning or intermediate chronotype. These findings provide further evidence that an evening chronotype may be associated with chronic circadian-sleep misalignment.

Support (if any)

None
0356 Lunch with a Side of Light: Can Afternoon Bright Light Shift Circadian Phase Earlier in Older Adolescents?
Authors: Monterastelli Allison , Poole Elaine , Eastman Charmane , Crowley Stephanie
Published: April 2024

Introduction

Previous work shows an association between afternoon bright light exposure and early circadian phase in adults (Van der Maren et al, 2018; Wilson et al, 2018). Our phase response curve (PRC) to bright light in adolescents also suggests a novel phase advancing region in the afternoon (Crowley & Eastman, 2017). Here, we examined phase shifts in response to bright light timed in the afternoon.

Methods

So far, 30 older adolescents (15F) aged 18.3-20.9 years completed a 13-day protocol during the academic year. On days 1-7 (baseline), participants kept a 9-h individualized sleep schedule at home and then lived in the lab on days 8-13. On day 8, baseline Dim Light Melatonin Onset (DLMO) was measured. After one night (day 9) on their individualized 9-h sleep schedules, sleep/dark advanced by 1h each day on days 10-12. The afternoon bright light (ABL) group (n=18) received 3h of bright intermittent light (four 45-min bright light exposures (8512±795 lux) alternated with 15-min room light exposures (43±24 lux)) in the afternoon on 3 days (days 10-12). Day 10 bright light began 5h after baseline wake time, with the goal of timing bright light 4-7h before baseline DLMO. Subsequent exposures were advanced by 1h daily. The room light (RL) group completed the same protocol, except they remained in room light throughout. Final DLMO was assessed on day 13.

Results

Both the RL and ABL group displayed a phase advance (0.8±0.6; 0.9±0.6, respectively), but groups did not differ [t(27)=0.13, p=0.90]. Post-hoc analysis revealed that participants whose day 10 light exposure ended within the target afternoon phase advancing region (4-7h before baseline DLMO) advanced more (1.0±0.2, n=13) than individuals whose day 10 bright light ended closer in time to baseline DLMO (0.4±0.1, n=5) [t(16)=2.11, p=0.05].

Conclusion

Gradually shifting sleep/dark earlier over 3 days advanced circadian phase by ~1h, and the administration of afternoon bright light did not significantly increase the magnitude of this advance. Afternoon bright light timing, however, may have been too late in some adolescents. Ambient light history and sleep quality will be examined as other potential causes for the insignificant difference.

Support (if any)

R01HL151512 (Crowley)
0357 Older Adults' Sleep Quality: Navigating the Impact of Daily Lighting and Thermal Conditions in Living Environments
Authors: Son Seonghyuk , Sharp Nina , Yeom Dongwoo , Lamp Sophia
Published: April 2024

Introduction

Epidemiological studies have revealed that sleep complaints are prevalent among older adults. Poor sleep quality in older adults is linked with higher levels of depression, anxiety, agitation, and falls as well as diminished cognitive and memory performance. Previous inquiries reported lighting and thermal conditions in residential spaces as important environmental factors impacting sleep in various populations. This study aims to explore how daily lighting exposure and thermal conditions within the residences of older adults influence their sleep quality.

Methods

A three-day cross-sectional study was conducted. Participants were 18 older adults (age > 54 years old) living independently in a senior living facility in Phoenix, AZ. Data collection was conducted in the participants’ residence unit in the facility without any intervention. Non-invasive wearable devices, including actigraphs and light trackers, were employed to measure sleep quality (duration and efficiency) and daily light exposure (intensity, correlated color temperature (CCT), and Melanopic Equivalent Daylight Illuminance (MEDI)) over the course of three consecutive days. In addition, sensors installed in living rooms and bedrooms continuously monitored indoor temperature and light intensity. The data underwent rigorous analysis, employing statistical tools such as ANOVA and correlation, executed using software platforms like SPSS, Minitab, and SAS. Predictive models were developed utilizing machine learning algorithms and deep learning techniques within Python's TensorFlow framework.

Results

The results revealed that average daytime MEDI predicted total sleep time significantly. Average daytime CCT and nighttime bedroom temperature had no significant impact on sleep duration. Higher average nighttime bedroom temperature was associated with reduced sleep fragmentation (b = -.493, t(8.52) = -.314, p = .0128) and improved sleep efficiency (b = .025, t(11.6) = 2.89, p = .0141). In terms of temperature and sleep duration, nighttime temperature displayed a significant negative correlation with sleep hours. The regression model explained 31% of the variance in sleep hours, highlighting the significance of nighttime temperature in sleep duration.

Conclusion

This study underscores the importance of optimizing bedroom temperature and increasing daytime light exposure to enhance sleep quality. These findings offer practical strategies for improving the sleep patterns and overall well-being of older adults in residential settings.

Support (if any)

National Science Foundation (Grant Number:R-23-0018)
0358 Effects of Chronotype-tailored Bright Light Intervention on Post-Treatment Symptoms in Breast Cancer Survivors
Authors: Wu Horng-Shiuann , Gao Feng , Given Charles , Davis Jean
Published: April 2024

Introduction

Many cancer-related symptoms emerge or amplify during cancer treatment and persist long after treatment terminates. Bright light therapy holds promise for reducing symptoms, e.g., sleep disturbance, that are commonly experienced by individuals with cancer. This study aimed to examine the effects of a chronotype-tailored bright light intervention on sleep disturbance, fatigue, depressive mood, and cognitive dysfunction among post-treatment breast cancer survivors.

Methods

Thirty women with stage I-III breast cancer 1-3 years post-completion of chemotherapy and/or radiation (mean age= 52.5 ± 8.4 years, 93% White) participated in this two-group randomized controlled trial. Participants were randomized to receive either 30-minute bright blue-green light at 12,000 lux (intervention; n=15) or dim red light at 5 lux (control; n=15) daily for 14 consecutive days. Timing of light exposure, either between 19:00-20:00 hours or within 30 minutes of waking in the morning, was tailored based on individuals’ chronotypes (by Horne-Ostberg Morningness-Eveningness Questionnaire). Self-reported symptom outcomes (e.g., sleep disturbance measured by Pittsburgh Sleep Quality Index) and in-lab overnight polysomnography sleep study were assessed before (pre-test) and after the 14-day light intervention (post-test). Linear mixed models (for continuous outcomes) or generalized estimating equations with cumulative log link function (for ordinal outcomes) were fitted to examine between-group differences, while adjusting for correlation among repeated measures.

Results

There were no significant between-group differences in any of the symptom outcomes (all p>0.05). However, within each group, self-reported sleep disturbance, fatigue, depressive mood, and cognitive dysfunction showed significant improvements over time (all p< 0.05); especially, the extent of improvement for fatigue and depressive mood was clinically relevant. Polysomnography sleep findings showed that number of awakenings significantly decreased (p=0.011) among participants receiving bright light, while stage 2 sleep significantly increased (p=0.015) among participants receiving dim-red light.

Conclusion

The findings support using light therapy to manage post-treatment symptoms in breast cancer survivors. In contrast to our hypothesis, the study results are equally favorable to bright light and dim light condition. The unexpected symptom improvements among dim-red light controls remain unexplained and requires further investigation.

Support (if any)

NIH R15NR016828
0365 Failure to Reduce Glutamate Levels in Medial Prefrontal Cortex During NREM Sleep Could Cause Transient Insomnia
Authors: Yamada Takashi , LaBonte-Clark Theodore , Khan Shazain , Sage Peter , Kalyan Pooja , Berhe Hana , Hopkins Sophia , Cheng Yu-Ang , Nakashima Yusuke , Watanabe Takeo , Sasaki Yuka
Published: April 2024

Introduction

While the social burden of insomnia is substantial, neurochemical mechanisms underlying it are poorly understood. Animal studies suggest the involvement of the medial prefrontal cortex (mPFC) in sleep-wake regulation through glutamatergic and GABAergic signaling. However, the specific roles of these neurotransmitters in human insomnia remain unclear. This study utilized the First-Night Effect (FNE)—a transient sleep disturbance observed during initial sleep experiments— as an insomnia model using healthy participants. To achieve this, we compared the concentrations of glutamate and GABA in the mPFC observed during the first and second sleep sessions using functional Magnetic Resonance Spectroscopy (MRS).

Methods

Twenty healthy adults (12 females), aged 18-30, participated in the experiment involving two afternoon-nap sessions (Day-1 and Day-2), separated by approximately one week. It was anticipated that sleep would be affected by the FNE on Day-1, but not on Day-2. During each session, participants slept inside the MRI while 90-min polysomnography was conducted. Within this period, nine 10-min MRS scans were performed to measure the glutamate (Glx) and GABA concentrations in the mPFC. The Changes in Glx and GABA concentrations during NREM sleep were calculated relative to wakefulness baseline, following the temporal co-registration between MRS data and sleep stages. Sleep onset latency (SOL) served as a sleep quality indicator.

Results

The SOL was significantly longer on Day-1 than Day-2, indicating poorer sleep on Day-1. On Day-2, a significant Glx level decrease from wakefulness to NREM sleep was observed, strongly correlating with SOL. This relationship suggests a close association between reduced Glx levels and shorter SOL. Conversely, there was no substantial Glx level decrease during NREM sleep on Day-1, although a significant correlation between Glx reduction and SOL was present. Mediation analysis revealed that glutamate levels mediated SOL differences between the two sessions. In contrast, GABA levels remained unchanged during NREM sleep from baseline with no significant correlation with SOL on each session.

Conclusion

These findings suggest that the failure to reduce glutamate concentrations, rather than the failure to increase GABA is linked to the FNE. A similar mechanism might contribute to the development of certain types of transient insomnia.

Support (if any)

NIH (R01EY031705, R01EY019466, R01EY027841), KAKENHI (JP20KK0268).
0367 The Independent and Interactive Effects of Insomnia Symptoms and Short Sleep on Sleep Physiology
Authors: Larson Olivia , Lee Ruda , Younes Magdy , Gerardy Bethany , Pack Allan , Keenan Brendan , Gehrman Philip
Published: April 2024

Introduction

The presence of subjective insomnia complaints with objective short sleep duration (total sleep time [TST] < 6 hours/night) has been associated with more severe health outcomes compared to insomnia or shortened sleep alone. The differential and possibly interacting effects of insomnia and shortened sleep on sleep physiology have not yet been comprehensively characterized.

Methods

1,014 participants from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) without sleep apnea (apnea-hypopnea index < 5 events/hour) were included. Participants were categorized as having insomnia or good sleepers based on self-reported symptoms and as short (< 6 hours/night) or normal (≥6 hours/night) sleepers based on in-laboratory TST. Analysis of variance models adjusted for age and sex assessed the effects of insomnia, shortened sleep, and their interaction on traditional sleep architecture (percent of TST in each sleep stage), EEG power metrics, and novel odds ratio product (ORP; indexes sleep depth ranging from 0 [deep sleep] to 2.5 [full wakefulness]) metrics (average ORP in each sleep stage and ORP-9 [speed with which sleep deepens following arousal]).

Results

Neither insomnia status, sleep duration, nor their interaction had significant effects on the percent of TST spent in any sleep stage. The interaction between insomnia status and sleep duration was not significant for any ORP or EEG metrics. However, individuals with insomnia demonstrated lighter sleep (higher NREM ORP [p=0.02, η2=0.01], REM ORP [p =0.002, η2=0.02], and ORP-9 [p=0.0002, η2=0.03]), cortical hyperarousal (higher beta power in 14-20 Hz [p=0.0003, η2=0.03] and 20-35 Hz [p=0.001, η2=0.02]), and higher sigma power (12-16 Hz [p=0.04, η2=0.01]) compared to good sleepers. Short sleepers also demonstrated lighter REM sleep (higher ORP [p=0.0004, η2=0.03]) and cortical hyperarousal (higher beta power in 14-20 Hz [p< 0.0001, η2=0.04] and 20-35 Hz [p< 0.0001, η2=0.04]) as well as lower delta power (1-4 Hz [p=0.0009, η2=0.02]) and theta power (4-7 Hz [p< 0.0001, η2=0.05]) relative to normal sleepers.

Conclusion

While insomnia and shortened sleep did not influence traditional sleep architecture, they were differentially associated with alterations in sleep physiology. These more granular metrics may be useful in future investigations of potentially separable mechanisms that underlie adverse health consequences in insomnia versus shortened sleep.

Support (if any)
0369 Mortality in Veterans with Insomnia, Sleep Apnea and Comorbid Insomnia and Sleep Apnea (COMISA): A Cohort Study
Authors: Sharafkhaneh Amir , Razjouyan Javad , Crew Earl , Wallace Douglas , Azarian Mehrnaz , Melaku Yohannes , Sweetman Alexander
Published: April 2024

Introduction

Insomnia and Sleep Apnea (SA), the two most prevalent sleep disorders, can occur separately or concurrently as comorbid insomnia and sleep apnea (COMISA). This study utilized a large national Veterans Health Administration (VA) database to compare all-cause mortality among them.

Methods

We constructed a cohort of veterans who used any sleep services in the VA from 10/1999 to 10/2023. Using ICD 9/10 codes and a VA-validated algorithm, we identified veterans with confirmed diagnoses of insomnia and/or SA. For insomnia, we required the presence of relevant medications or CBT-I. We extracted mortality data for three groups: insomnia-only, SA-only, and COMISA. We estimated the association of these conditions using multivariable logistic regression, adjusting for age, sex, race, ethnicity, Charlson Comorbidity Index (CCI), and exposure time (time from the initial insomnia or SA diagnosis).

Results

Out of 4,722,693 veterans who used VA sleep services, we identified 2,159,412 participants with a confirmed diagnosis of either SA or insomnia, who had ≥2 specialty visits in the past three years. We observed 518,574 (24%) with insomnia-only (mean age 58.5, 77.2% male, 71.4% white, 22.6% with CCI > 2), 1,343,035 (63%) with SA-only (mean age 57.6, 93.5% male, 70.1% white, 25% with CCI > 2), and 297,803 (13.8%) with COMISA (mean age 52.5, 89.2% male, 68.3% white, 18.5% with CCI > 2). All-cause mortality rates were 33.2%, 23.3%, and 16.2% for insomnia-only, SA-only, and COMISA, respectively. Compared to the SA-only group as a reference, the insomnia-only group was associated with a 73% increased risk (adjusted Odds Ratio [aOR] 1.73; 95% Confidence Interval [CI]: 1.72, 1.75) and the COMISA group with a 12% decreased risk of mortality (aOR 0.88; 95%CI: 0.87, 0.89).

Conclusion

In a cohort referred to VA sleep centers, SA, insomnia, and COMISA were prevalent. Mortality was highest in the insomnia-only group, compared to the SA-only and COMISA groups. Further studies are needed to explore the causes of this increased mortality.

Support (if any)

Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0373 Moderating Factors in the Relationship Between Insomnia and Alcohol Use
Authors: Verlinden Justin , Moloney Mairead , Weafer Jessica
Published: April 2024

Introduction

Insomnia and Alcohol Use Disorder are highly comorbid and share a bidirectional relationship. However, little research has examined which factors contribute to this alarming relationship. Contributing factors may include circadian preference (specifically eveningness), depression symptom severity, and global stress levels. Here, we used cross-sectional baseline data from two randomized control trials of an online CBT-I treatment program in samples of heavy drinkers with insomnia in order to elucidate whether these factors moderate the relationship between drinking behaviors and sleep.

Methods

Heavy drinking men and women with insomnia (n = 238) completed measures of drinking behaviors (Alcohol Use Disorder Identification Test), insomnia severity (Insomnia Severity Index), circadian preference (Composite Morningness Scale), depression (CESD-R), and global stress (Perceived Stress Scale) during the baseline phase of an online insomnia treatment study. Baseline data from two randomized control trials were pooled together for these analyses. Hierarchical linear regressions were used to examine the interactive effects of circadian preference, depression, and stress on the relationship between insomnia and drinking behaviors. Significant interactions were probed using bootstrapped estimates of simple slopes.

Results

Evening preference was associated with higher ISI scores (p = .02), and a trend level association with higher AUDIT scores (p = .07). However, no significant interactive effect was found between CSM and ISI scores on the AUDIT (p = .86). In contrast, significant interactions were found between the CESDR and ISI (p = .02) and PSS and ISI (p = .02) on the AUDIT. Specifically, there was a positive relationship between the ISI and AUDIT for those with either high or moderate CESDR or PSS scores (ps ≤ .05) but not for those with low CESDR or PSS scores (ps ≥ .77).

Conclusion

These findings suggest that the relationship between insomnia and drinking behaviors are strong among those with high to moderate levels of depression or stress but not among those with low levels. In contrast, circadian preference does not appear to impact the relationship between insomnia and drinking behaviors. Future longitudinal and treatment studies should further investigate the role of depression and stress on this problematic relationship.

Support (if any)

NIAAA R21 AA029201 & T32 AA027488
0375 Predictors of Insomnia and Depression in a Randomized Controlled Insomnia Treatment Trial in the COVID-19 Pandemic
Authors: Osorno Raquel , Ahmadi Maryam , Solomon Natalie , O'Hora Kathleen , Morehouse Allison , Lopez Mateo , Kim Jane , Manber Rachel , Goldstein-Piekarski Andrea
Published: April 2024

Introduction

The COVID-19 Pandemic resulted in increases in insomnia risk factors, including elevated sleep reactivity, perceived stress, loneliness, and screen time. Here, we test whether these factors predicted worse subsequent insomnia and depression symptoms as part of a randomized controlled feasibility trial of a brief insomnia intervention early in the pandemic.

Methods

Forty-nine participants with acute pandemic-onset insomnia symptoms were randomized to receive telehealth Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Participants completed baseline measures of sleep reactivity, perceived stress, loneliness, and screen time. Outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 (minus the sleep item) collected at 12 and 28 weeks. As described in the protocol paper, two likelihood ratio tests (one for insomnia and one for depression) were used to test the hypothesis that the risk factors collectively contribute to subsequent insomnia and depression. Specifically, for each outcome, likelihood ratio tests compared a linear mixed effect model containing the 4-baseline risk factor measures and treatment arm as predictors against a model containing only treatment arm. Considering our joint hypothesis test does not address the significance of individual risk factors, we tested whether each risk factor was predictive in isolation using post-hoc mixed effects models (one for each risk factor across insomnia and depression while still controlling for treatment arm). Benjamini-Hochberg adjustment for multiple comparisons was used across the 8 post-hoc models.

Results

Collectively, the insomnia risk factors did not predict subsequent insomnia or depression (p’s>0.25, marginal ΔR2’s< 0.518) above what would be predicted by receiving CBT-I or waitlist control. However, when considered in individual models, perceived stress and loneliness were significant predictors of both outcomes (b’s>0.22, adjusted-p’s< 0.012) above and beyond treatment arm. Screen time and sleep reactivity were not significant predictors of either outcome (b’s< 0.13, adjusted-p’s>0.149).

Conclusion

Although this study was conducted in a relatively small sample, these results suggest that increased loneliness and perceived stress may be associated with worse insomnia and depressive symptoms several months later. Thus, loneliness and perceived stress may represent early intervention targets during periods of acute stress and disruption, like the COVID-19 pandemic.

Support (if any)
0377 Associations of Evening-type and Insomnia Symptoms with Depressive Symptoms Among Adolescents and Young Adults
Authors: Que Jianyu , Chen Si-jing , Chan Ngan Yin , Wu Suying , Zhang Li , Chen Yaoyi , Liu Jingrou , Chen Mingxuan , Chen Lixia , Li Shirley Xin , Lin Duoduo , Liu Farong , Wing Yun Kwok
Published: April 2024

Introduction

Evening-type and insomnia symptoms are closely related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese young people, with a specific focus on the joint effects of the two conditions on depressive symptoms.

Methods

Participants aged between 12 to 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. The reduced Morningness and Eveningness Questionnaire, Insomnia Severity Index, and Patient Health Questionnaire-9 were used to evaluate chronotypes, insomnia and depressive symptoms, respectively. Multivariate logistic regression models were used to examine the independent associations of chronotypes and insomnia symptoms with depressive symptoms, while additive interaction models were used to further explore the joint effects of chronotypes and insomnia symptoms on depressive symptoms.

Results

Of the 6145 eligible participants, the prevalence of evening-type and insomnia symptoms were 24.9% and 29.6%, respectively. Both evening-type (adjusted odds ratio [AdjOR]: 3.62, 95% CI: 3.19-4.11) and insomnia symptoms (AdjOR: 11.75, 95% CI: 10.26-13.47) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk of interaction [RERI]: 12.39, 95% CI: 3.62-21.17). In the subgroup analyses for adolescents (RERI: 10.37, 95% CI: 5.44-15.30) and young adults (RERI: 15.48, 95% CI: 5.49-25.46), positive interactions between evening-type and insomnia symptoms on depressive symptoms remained.

Conclusion

The present study provided additional evidence demonstrating the independent and joint contributions of evening-type and insomnia symptoms to depressive symptoms among young people. In particular, there is an interaction effect of evening-type and insomnia symptoms, further increasing the risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.

Support (if any)

This study was supported by grants from Fujian Provincial Health technology project (No. 2022GGB015 and 2022CXB019) and Natural Science Foundation of Xiamen City (No. 3502Z20227148).
0378 Improvements in Prenatal Insomnia Predict Lower Depression Severity During Postpartum in Low- and High-Income Women
Authors: Carmona Nicole , Gumport Nicole , Solomon Natalie , Manber Rachel
Published: April 2024

Introduction

Low socioeconomic status increases the risk of prenatal and postpartum depression. Additionally, women of low-income status are disproportionately impacted by insomnia and poor sleep during pregnancy, which could contribute to poorer mental and physical health. Treating insomnia during pregnancy has the potential to reduce the risk of postpartum depression. We examined whether after accounting for baseline and psychosocial risk of depression, improvements in prenatal insomnia predicted lower postpartum depression in low- and high-income women.

Methods

We selected low- (< $55,000/year; n=35) and high-income (≥$100,000/year; n=59) participants drawn from a randomized, multi-site, controlled trial of CBT-I for perinatal insomnia. The study excluded women with depressive disorders. Treatments consisted of five sessions during pregnancy and one at 6 weeks postpartum. Participants completed the Insomnia Severity Index (ISI), Edinburgh Postpartum Depression Scale (EPDS), and Perinatal Risk Questionnaire (PRQ) at baseline. ISI and EPDS were additionally completed 8 weeks after randomization and at 8, 18, and 30 weeks postpartum. Separate generalized estimating equation models were conducted for each group. Women were included if they completed at least one postpartum assessment.

Results

After accounting for baseline ISI, a 1-unit reduction in ISI at post-treatment was associated with a reduction of .18 units in the average postpartum EPDS scores among participants in the low-income group (p=.048) and .21 units among the high-income group (p=.008). Baseline EPDS was a significant predictor of the average postpartum EDPS in the low-income group, such that a 1-unit increase in baseline EPDS increased postpartum EPDS by .32 units (p=.015), but was not a predictor in the high-income group. Baseline ISI and PRQ and time were not significant predictors (ps>.05).

Conclusion

Predictors of postpartum depression severity were different for low- and high-income pregnant women with insomnia. We found that the effect of treating prenatal insomnia on reducing postpartum depressive symptom severity was stronger for high- versus low-income women and that baseline depression symptoms predicted postpartum depression symptoms among low- but not high-income women. The results suggest that to optimally reduce postpartum depressive symptoms among low-income women, treatment will need to address additional risk factors beyond insomnia.

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NR013662
0379 TADEIC-UNAM: Screening Scale to Identify Insomnia, Depression and Anxiety Among Sleep Clinic Patients in Mexico
Authors: Santana-Miranda Rafael , Barrera-Medina Andrés , De la López Diana Orta , Vargas Ángel Daniel Santana , Sánchez Uriel Peñaloza , Rosenthal Leon
Published: April 2024

Introduction

Insomnia is among the most prevalent symptoms in patients evaluated for sleep disorders. When chronic, it is frequently associated with Depression and Anxiety. This study assessed the "Tamizaje de Ansiedad, Depresión e Insomnio Crónico" (TADEIC) as a screening scale to evaluate insomnia and possible comorbid depression and anxiety.

Methods

Two hundred thirty-three patients with chronic insomnia completed the TADEIC at the UNAM Sleep Disorders Clinic (age: 50.3±15.7; females: n=132 [56.7%]). The internal consistency was evaluated with Cronbach's Alpha, and structural equation modeling was computed to conduct a confirmatory factor analysis (CFA). Convergent validity was assessed with Beck's anxiety and depression inventories (BAI, BDI). The scales were completed at the time of initial consultation.

Results

CFA revealed four factors with moderate model fit: "Insomnia (two items), "Anxiety" (five items), "Dysthymia" (three items), and "Melancholy" (three items). After two adjustments, seven of the initial twenty items were discarded to support a good model fit. The model was assessed with the Comparative Fit Index of 1.683, Standardized Root-Mean-Square Residual (SRMR).044, Root-Mean-Square Error of Approximation (RMSEA)=.035. The internal consistency was high (α= .859). Anxiety intercorrelations with insomnia, dysthymia, and melancholy were moderate to high (r=.44-.65*, p<.001), insomnia intercorrelations with dysthymia and melancholy and were low to moderate (r=.27-.45, p<.01), Dysthymia and Melancholy intercorrelations were moderate (r=.55, p<.001). Convergent validity of the anxiety factor was moderate with the BAI (r=.587, p<.01) and moderate (.4-.64, p<.01) for the melancholy and dysthymia factors with the BDI.

Conclusion

The TADEIC showed adequate internal reliability and external validity. It consists of four dimensions that allow clinicians to identify insomnia, anxiety dysthymia, and melancholy. The availability of such a screening tool will facilitate identifying psychiatric morbidity among patients with chronic insomnia.

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0383 Common Pathways Between Distress and Impairment Related to Insomnia, Pain, and Stress
Authors: Dickens Harrison , Vance Abi , Phelps Claire , Floyd Veronica , Walker Jamie , Egeler Mara , Assar Arash , Vargas Ivan
Published: April 2024

Introduction

Insomnia, chronic pain, and stress are highly comorbid, contributing to significant distress and impairment. Research on measures of insomnia, such as the Insomnia Severity Index, have revealed a two-factor structure consisting of both severity of insomnia symptoms and perceived distress and impairment. Prior research suggests that this perceived distress and impairment factor may represent a cognitive vulnerability that may impact other domains, including experiences of pain and stress. Pain catastrophizing, “a negative cognitive–affective response to anticipated or actual pain” and sleep reactivity, a trait-like degree to which stress exposure disrupts sleep, are both constructs that tap into similar elements of perceived distress and impairment. This study aimed to examine associations between perceived distress and impairment from insomnia, pain catastrophizing, pain interference, and sleep reactivity.

Methods

Participants from an online database were asked to complete the Insomnia Severity Index (ISI), Pain Catastrophizing Scale, McGill Pain Questionnaire, PROMIS Pain Interference Questionnaire, and the Ford Insomnia Response to Stress Test. Participants (n =398) were predominantly female (79%) and White (74%). The ISI was analyzed as two separate factors (i.e., F1 or the insomnia symptoms factor = items 1-3 and F2 or the insomnia-related impairment factor = items 4-7).

Results

Multiple adjusted regressions revealed that perceived insomnia distress and impairment (i.e., F2) was significantly related to pain catastrophizing (t = 2.18, p = .03) and pain interference (t = 3.55, p <.001), independent of insomnia and pain severity. Sleep reactivity was also significantly related to pain catastrophizing (t = 3.71, p > .001), even after adjusting for insomnia and pain severity.

Conclusion

Results suggest that the perceived distress and impairment resulting from insomnia, pain, and stressful events may represent a transdiagnostic vulnerability. Future research is needed to determine whether this pattern of distress and impairment extends to objective measures, such as actigraphy. This pattern of perceived distress and impairment could represent a viable intervention target.

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0386 Feasibility of a Hypnosis Intervention for Sleep Quality in Caregivers of Individuals with Alzheimer's Disease
Authors: Elkins Gary , Padilla Victor , Sanford Keith , Benge Jared , Stevens Alan , Scullin Michael , Corlett Christopher
Published: April 2024

Introduction

Poor sleep quality is a common health issue in caregivers of adults with Alzheimer’s Disease and Related Dementias (ADRD). Nonpharmacological treatment options such as hypnosis have been proposed for improving sleep in this population since pharmacological measures can impair their ability to wake up readily to provide care. The present study aimed to determine the feasibility of a hypnosis intervention program for improving sleep quality in caregivers of individuals with ADRD.

Methods

A sample of 21 eligible adults were randomly assigned to either a self-administered hypnosis or a sham hypnosis group.

Results

The findings indicated feasibility of accrual, randomization, and intervention delivery. The mean satisfaction rating scores were 8.75 (SD = 1.28) and 7.50 (SD = 1.77) in the treatment and control groups, respectively, on a 0-to-10 numerical rating scale (0 = highly dissatisfied, 10 = highly satisfied). The mean ease of use rating was 8.50 (SD = .93) in the treatment condition and 8.75 (SD = 1.39) in the control condition. There was good adherence to actigraphy and self-report measures of sleep duration and sleep quality. Although the study was not powered for efficacy testing, trends indicated significant improvements in sleep quality (t(4) = 3.500, p = .025, d =1.57) and sleep duration (t(4) = -4.648, p = .010, d = 2.08) for the hypnosis intervention.

Conclusion

These findings are encouraging and indicate a need for a fully powered randomized clinical trial for efficacy testing.

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0387 Sleep-SMART for Veterans with Mild Cognitive Impairment (MCI) and Insomnia: A Pilot Study
Authors: Mack Abigail , Orff Henry , Twamley Elizabeth , Pittman James O E , Almklov Erin
Published: April 2024

Introduction

Mild cognitive impairment (MCI) is an important public health concern for aging Veterans as it is a known risk factor for progression to dementia. Insomnia is common in MCI occurring in up to 60% of patients. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended treatment for insomnia, however, cognitive impairments experienced by individuals with MCI may limit the ability of some individuals to adequately understand and actively participate in CBT-I. In this study a modified CBT-I treatment Sleep-SMART (Sleep Symptom Management and Rehabilitation Therapy) was developed and pilot tested with Veteran input. Sleep-SMART incorporates supportive cognitive strategies into a CBT-I protocol to enhance CBT-I learning and adherence.

Methods

14 Veterans completed the 6-week Sleep-SMART intervention. Each participant was assessed on the Insomnia Severity Index (ISI) and the Pittsburgh Quality Sleep Index (PSQI) at pre- and post-treatment (Weeks 0 and 6 respectively). Veterans also completed weekly sleep diaries for the duration of the 6-weeks of treatment. Independent t-tests were performed comparing pre and post-treatment scores for the ISI, PSQI, and sleep diary variables (sleep efficiency [SE], total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], and early morning awakening [EMA]). Treatment acceptability was examined using the average rating on the Acceptability of Intervention Measure (AIM; 1–5-point Likert type scale, with higher scores indicating greater acceptability).

Results

Participants (11M/3F, age=71.8+/-6.9yrs) showed significant symptom improvement on both ISI (pre=18.25/post=10.83,p<.001) and PSQI (pre=11/post=8.73,p=.034) total scores. This improvement was further illustrated in the sleep diary measures which showed significant improvement across all metrics: SE (pre=70%/post=89%,p<.001), TST (pre=5.40hrs/post=6.49hrs,p=.007), WASO (pre=50.53mins/post=20.73mins,p<.001), and EMA (pre=61.29mins/post=15.16mins,p=.003). Importantly, the Sleep-SMART treatment protocol was viewed as acceptable to Veterans (AIM; M=4.46,SD= 0.62).

Conclusion

The Sleep-SMART intervention was viewed as acceptable and produced significant improvements in insomnia symptoms. These findings suggest that Sleep-SMART has the potential to be an effective modified form of CBT-I treatment that is uniquely tailored to aging Veterans with cognitive challenges. Future randomized controlled trials are warranted to investigate the efficacy of Sleep-SMART more broadly.

Support (if any)

This research supported by SPiRE Award 1 I21 RX003721-01A1 (D3721-P) from Department of Veterans Affairs Rehabilitation Research and Development Service.