bluuebunny/crossref_metadata_2025 huggingface dataset:
0711 Health-Economic Implications of Tonic Motor Activation (TOMAC) therapy for RLS: An Exploratory Analysis based on the RESTFUL study
Authors: Ryschon Anne , Cao Khoa , Roy Asim , Pietzsch Jan
Published: May 2023

Introduction

Restless legs syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Recently, the RESTFUL study demonstrated significant improvement in RLS severity following treatment with a novel non-invasive neuromodulation treatment (Tonic Motor Activation; TOMAC). Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for the observed changes in symptom severity.

Methods

The RESTFUL study randomized n=133 subjects 1:1 to active TOMAC treatment and sham control, with change in International Restless Legs Scale (IRLS) scores reported at four weeks at the end of the randomization period. Functional relationships between IRLS and HRQoL and resource utilization were derived from two prior health-economic studies (Happe et al. 2009 and Durgin et al. 2015). Model-projected quality-adjusted life year (QALY) gain and events avoided at a five-year analysis horizon were calculated based on assumption of maintained treatment effect.

Results

From baseline of 25.2, change in IRLS at four weeks was -7.2 for the active and -3.8 for the sham group (between group difference -3.4, p< 0.01). Based on this effect size, TOMAC was projected to add 0.16 QALYs over 5 years (0.39 when considering reduction from baseline). Based on lower symptom severity, TOMAC was projected to avoid 3.80 (8.05) health care provider visits, 0.29 (0.62) ER visits, and 0.12 (0.26) hospitalizations over 5 years, resulting in a relative risk (RR) of composite healthcare utilization of 0.94 (0.88).

Conclusion

The findings of this exploratory analysis suggest TOMAC-associated improvements in RLS severity as observed in the RESTFUL study may lead to meaningful improvements in patient quality-of-life and concurrent reductions in healthcare utilization. Further investigation is warranted.

Support (if any)

Wing Tech Inc. (AMR, KNC, JBP) received consulting fees from Noctrix Health. AR is an investigator in the RESTFUL study.
0713 Long-term response to tonic motor activation (TOMAC) therapy for refractory restless legs syndrome
Authors: Roy Asim , Ojile Joseph , Kram Jerrold , Rosenberg Russell , Olin Jonathan , Hudson J Douglas , Bogan Richard , Charlesworth Jonathan
Published: May 2023

Introduction

There is a large population of patients who have become refractory to first-line treatments for Restless Legs Syndrome, partially due to augmentation to dopamine agonist medications. For patients with refractory RLS, tonic motor activation (TOMAC) is a noninvasive medical device therapy with promising short-term safety and efficacy. Here, we evaluated the response to TOMAC over a longer duration of >24 weeks.

Methods

In the RESTFUL study, 133 patients with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for weeks 1 to 4 followed by open-label TOMAC for weeks 5 to 8. The final 50 participants to complete the RESTFUL study were invited to continue TOMAC treatment for an additional 24 weeks (weeks 9 to 32) in an extension study. Participants were instructed to self-administer one 30-minute TOMAC session bilaterally over the peroneal nerve whenever RLS symptoms presented. Efficacy was assessed by comparing responses from baseline (RESTFUL study entry, week 0) to week 32 on Clinician Global Impressions-Improvement (CGI-I) responder rate, Patient Global Impressions-Improvement (PGI-I) responder rate, and International RLS Study Group Rating Scale (IRLS) total score. Additional analyses compared responses from week 8 (RESTFUL study completion) to week 32.

Results

Of the 50 eligible participants, 44 consented to the extension study and 42 completed. CGI-I responder rate relative to baseline increased from 64% at week 8 to 76% at week 32. PGI-I responder rate relative to baseline increased from 68% at week 8 to 77% at week 32. IRLS total score reduced from 24.5 at baseline to 17.1 at week 8 to 12.9 at week 32, a reduction of 11.6 points from baseline to week 32. There were no moderate or severe device-related AEs.

Conclusion

TOMAC resulted in substantial and clinically significant reduction in RLS symptom severity that was maintained through >24 weeks of treatment. Furthermore, there was a trend towards increased efficacy with continued use of TOMAC. These data suggest that TOMAC could represent a potential long-term treatment for the chronic condition of refractory RLS.

Support (if any)

Funding was provided by Noctrix Health, Inc.
0714 Machine learning model for Predicting phenoconversion in patients with Rem behavior disorder using clinical markers
Authors: Shin Yong Woo , Lee Seolah , Kim Han-Joon , Sunwoo Jun-Sang , Jung Ki-Young
Published: May 2023

Introduction

Idiopathic Rapid eye movement (REM) sleep behavior disorder is a condition that can be an early sign of alpha-synuclein-mediated neurodegenerative diseases, and the course of the disease can vary greatly from patient to patient. It is important to identify patients who are at risk of developing neurodegenerative diseases in the future for the purpose of future clinical trials and for patients to plan their lives accordingly. Previous research has identified various risk factors for phenoconversion in RBD patients, but these studies are not practical for use in clinical settings due to resource availability or the rarity of certain features. Additionally, most of these studies have been conducted on non-Asian populations, which may have different genetic backgrounds than Asian populations. This study aimed to develop a machine learning model to predict survival in RBD patients using clinical features commonly available in routine clinical settings.

Methods

This study recruited patients diagnosed with RBD based on polysomnography results and collected 34 features for each patient. Missing data were imputed and various models were applied to the data to improve performance. The model's predictive performance was evaluated using an integrated Brier score and the concordance index. Mean performance indicators were calculated from 5-fold cross-validation results. A web application hosting the final prediction model was developed and deployed on a server for use by physicians or patients.

Results

173 patients were included in the study. We used the likelihood ratio test to calculate the p-values of all variables and selected the following 8 variables with p-values less than 0.1: UPDRS part III, age, history of antidepressant use, history of alcohol use, MoCA (Montreal Cognitive Assessment), PSQI-TST (Pittsburgh Sleep Quality Index - total sleep time), AHI-REM (apnea-hypopnea index - REM sleep), and education level. The random survival forest model had the best mean IBS of 0.07 and the best C-index of 0.93

Conclusion

We showed that it is possible for a machine learning model to predict phenoconversion in patients with RBD using features that are commonly available in routine clinical settings

Support (if any)
0717 Restless sleep associated with low ferritin levels: A Retrospective Study in a Pediatric Sleep Center
Authors: Smith Sherrie , White Jay , Jambhekar Supriya
Published: May 2023

Introduction

A significant challenge in diagnosing Restless Leg Syndrome in children is the child’s inability to verbally describe their symptoms. In our pediatric sleep clinic, it has been recognized that restless sleep is a routine element of the clinical history for children presenting with a wide range of sleep disturbances. A literature review showed substantial literature about the prevalence and characteristics of restless sleep in children, but there is little showing the effect of ferrous sulfate on symptoms in children. A deficiency of brain iron stores results in a reduction of dopamine production and the clinical expression of RLS. Brain iron stores cannot be directly quantified for clinical purposes but can be evaluated indirectly by measuring serum ferritin. In the clinical framework of RLS, it is generally accepted that a serum ferritin < 50 ng/ml is too low, despite still being considered within normal range for most reference labs and replacing this with oral elemental iron should be considered the first line treatment.

Methods

A retrospective chart review was performed of patients seen in the Sleep Clinic at Arkansas Children's Hospital from 2018-2021 who had a report of restless sleep and a serum ferritin drawn. If the ferritin was lower than 50 ng/ml, they were treated with ferrous sulfate for a minimum of three months. After three months, patient’s symptoms were reevaluated, and ferritin levels drawn to determine if improvement had occurred.

Results

In total, 1,000 charts were reviewed. Ferritin levels < 50 ng/ml were found in 75.2% of the patients. Of the patients with a serum ferritin >50 ng/ml after treatment with ferrous sulfate, 62.8% reported an improvement in restless sleep and 37.2% reported no change in symptoms.

Conclusion

Low ferritin levels were found in a large number of our pediatric patients with restless sleep. The administration of ferrous sulfate in the patient population showed an improvement in symptoms of restless sleep in a majority of patients.

Support (if any)
0722 Sleep disturbances and subsequent mobility disability in chronic disease: Findings from the Nurses’ Health Study
Authors: Whibley Daniel , Shieu Monica , Dunietz Galit , Braley Tiffany
Published: May 2023

Introduction

Impaired mobility is the leading cause of disability in the U.S. Across chronic neurological, metabolic, and musculoskeletal conditions, mobility reductions are observed beyond expected effects of aging. Poor sleep health may be one common factor that drives accelerated reduction in mobility among people with chronic conditions. This study compared longitudinal associations between self-reported sleep disturbances and mobility disability progression among women with and without multiple sclerosis (MS), diabetes, and osteoarthritis (OA).

Methods

This prospective cohort study used data from four waves of the Nurses’ Health Study (2008, 2012, 2014, 2016). Logistic regression and the Kaplan-Meier method were used to quantify associations between baseline sleep-related variables and subsequent increase in mobility disability.

Results

Of 70,303 women (mean age 73), 392 had MS, 7,302 had diabetes, and 24,099 had OA. Between 2008-2016, mobility disability increased in 16.9% of the sample overall, 27.8% in the MS subgroup, 27.0% in the diabetes subgroup, and 23.7% in the OA subgroup. Between 2008-2016, known/suspected OSA was significantly associated with increased mobility disability in the overall sample (OR:1.4, 95%CI:1.2,1.5), and within the diabetes (OR:1.5, 95%CI:1.2,1.9) and OA subgroups (OR:1.2, 95%CI:1.0,1.4), but not the MS subgroup (OR:2.3, 95%CI:0.6,8.9); however, across 2012-2016, this association was significant for MS (OR:4.0, 95%CI:1.0,16.1). Suboptimal sleep duration was significantly associated with increased odds of mobility disability progression in the overall sample, but not within disease subgroups. Conversely, perception of adequate sleep was significantly associated with lower odds of mobility disability progression overall (OR:0.82, 95%CI:0.78,0.87) and for the OA subgroup (OR:0.83, 95%CI:0.76,0.91). Excessive daytime sleepiness was significantly associated with mobility disability progression overall (OR:1.2, 95%CI:1.1,1.4) and for the OA subgroup (OR:1.2, 95%CI:1.0,1.4).

Conclusion

Prevalent sleep disturbances could increase risk of disability progression among women, particularly in common chronic disease populations. Informed by these data, future research could offer new insight into sleep-based strategies to ameliorate mobility decline.

Support (if any)

This work was supported in part by a Michigan Institute for Clinical and Health Research Pilot Grant (UL1TR002240). Dr. Shieu was supported by a T32 grant from National Heart, Lung, and Blood Institute (T32HL110952).
0724 Objectively Regular Sleep of Optimal Duration and Mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Sofer Tamar , Bertisch Suzanne , Purcell Shaun , Castro_Diehl Cecilia , Chen Jarvis , Redline Susan
Published: May 2023

Introduction

Irregularly timed sleep, inconsistent duration, and non-optimal sleep duration have been implicated in the etiology of cardiovascular disease and premature mortality. These dimensions of sleep map behaviorally to regular bed and wake times. Our aim was to estimate the association of regular sleep of optimal sleep duration with all-cause mortality in a diverse US sample.

Methods

We used data from the Multi-Ethnic Study of Atherosclerosis Sleep Study (2010-2013) at Exam 5. Sleep was measured by 7-day wrist actigraphy, concurrent with at-home polysomnography and validated sleep questionnaires. We used K-means clustering on wrist-actigraphy regularity and duration data to assign individuals to categories of ‘regular-optimal’ or ‘irregular-insufficient’ sleep, labels describing sleep tendencies in each group. Using proportional hazard models with multi-variate adjustment for socio-demographics (age, female sex, race/ethnicity, marital status, and day vs non-day work schedules), lifestyle (moderate-vigorous physical activity, smoke status), health status (depressive symptoms, body mass index, total medications, prevalent cardiovascular disease), and measures of major sleep disorders (the Apnea-Hypopnea Index, insomnia severity, restless legs), we estimated all-cause mortality associations with sleep patterns. Sensitivity analyses additionally adjusted or, via propensity scores, matched on income, education, prevalent chronic lung disease, prevalent cancer, hypertension, diabetes, and diet.

Results

Among 1,726 participants who were followed for a median of 7.0 years (Q1-Q3, 6.4-7.4 years,) there were 171 deaths. The ‘regular-optimal’ group had 42% lower mortality risk compared to the ‘irregular-insufficient’ sleep group (Hazard Ratio [95% Confidence Interval]: 0.58 [0.43, 0.80]), in the fully adjusted model and was robust to sensitivity analyses.

Conclusion

Individuals characterized by a sleep pattern of ‘regular and optimal’ duration sleep had significantly lower mortality compared to those with an ‘irregular and less sufficient’ sleep pattern. The regular and optimal duration phenotype maps behaviorally to regular bed and wake times, suggesting potential health benefits of adherence to recommended sleep practices.

Support (if any)

JC was supported by the American Academy of Sleep Medicine’s Foundation Grant: 269-FP-22 This work was also supported by the following National Institute of Health (NIH) grants: 5T32HL007901-19, 5K01HL138211-05, K01HL143034, R01HL098433. SR was partly funded by the NIH National Heart, Lung, and Blood Institute (NHLBI) R35HL135818.
0725 Self-reported sleep quality and sleep architecture are associated with plasma neurofilament light in older adults without dementia
Authors: Li Junxin , Huang Jing , Li Mengchi , Gooneratne Nalaka , Gill Jessica , Spira Adam
Published: May 2023

Introduction

Sleep disruption is common in older adults with multiple chronic conditions and can occur before the clinical onset of Alzheimer’s disease (AD). Sleep disruption plays an important role in AD pathology and has been associated with neuro-imaging evidence of AD, and cerebrospinal fluid elevations of amyloid, tau, and neurodegeneration (ATN) biomarkers. Plasma ATN biomarkers are increasingly used in AD research. We examined the associations of self-reported sleep quality and electroencephalogram (EEG) sleep architecture with plasma ATN biomarkers in sedentary older adults without dementia.

Methods

We used baseline data from an ongoing randomized controlled trial that examines the effect of physical activity on sleep and cognition in community-dwelling sedentary older adults without dementia (Montreal Cognitive Assessment [MoCA]>17, n=102). Participants reported demographics, completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and provided blood samples to measure plasma ATN biomarkers [amyloid-beta (Aβ)42/42, total-tau (T-tau), and neurofilament light (NFL)]. Two-night home-based sleep EEG measures (Sleep Profiler) were collected from 56 of the 102 participants. Multiple regression models were conducted to test the associations between sleep measures and plasma ATN biomarkers.

Results

Participants were aged 69.9 ± 6.0 years, 80% were women, and they had 3.1±1.7 chronic conditions. Most had intact cognitive function (68.6% MoCA≥ 26) and 28.6% of the sample had mild cognitive impairment (17< MoCA< 25). In models adjusted for age, sex, race, education, and number of comorbidities, higher PSQI scores (β=0.84, 95% confident interval (CI)= [0.12,1.62]), longer non-rapid eye movement (NREM) N3 duration (β=4.43, 95% CI= [0.48,8.18]), and higher REM latency (β=0.04, 95% CI= [0.02, 0.05]) were associated with higher NFL. Longer REM sleep duration (β=-11.13, 95% CI= [-20.55, -1.71]) was associated with lower NFL. There were no other significant associations of sleep measures with other ATN biomarkers.

Conclusion

Self-reported sleep quality and sleep architecture were associated with plasma NFL among older adults with intact cognition and mild cognitive impairment. Plasma NFL may be a sensitive and promising biomarker that links sleep disruption and AD-related outcomes in older adults without dementia. Future research with a larger sample is needed to further test this association.

Support (if any)

National Institute of Nursing Research R00NR016484
0728 Does Short Sleep Duration Increase Risk for Postpartum Weight Retention?
Authors: Ryan Jeanna , Day Heather , Egger Marlene , Depner Christopher , Shaw Janet
Published: May 2023

Introduction

About 75% of mothers in the United States have postpartum weight retention (PWR), which increases risk for adverse health outcomes in mother and child. Short sleep duration is an important health behavior linked to risk of weight gain in the general population. Although short sleep duration is common in postpartum, findings from the few studies examining sleep duration and PWR are mixed. Thus, we aimed to examine whether sleep duration at 6 months postpartum is associated with PWR at 12 months. We also explored agreement between self-reported and actigraphy-derived sleep duration.

Methods

This is a secondary analysis from a prospective cohort study investigating postpartum pelvic floor outcomes. Participants were healthy, age ≥18 years, and primiparous with a singleton birth. We measured sleep duration by triaxial, wrist accelerometer (Actigraph GT3X+) and by self-report using the Pittsburgh Sleep Quality Index (PSQI). Excessive PWR was defined as ≥7% of pre-pregnancy weight. Log-binomial regression assessed the relationship between sleep duration and PWR, adjusted for pre-pregnancy body mass index, gestational weight gain, and breastfeeding. We analyzed agreement between self-reported and actigraphy-derived sleep duration using Bland-Altman analysis and paired t-test.

Results

Participants (N=467; mean age=29.5±4.78 years; pre-pregnancy BMI= 24.4±5.03 kg/m2) were mostly White (91%) and educated (93%). After adjustment, sleep duration by actigraphy (Risk Ratio (RR)=0.96, 95% confidence interval (CI)=(0.87,1.06), p=0.44,) and by PSQI (RR=0.95, 95%CI=(0.84,1.07), p=0.38) was not associated with PWR. There was a statistically significant correlation between sleep duration by actigraphy and by PSQI (r=0.19, 95% CI=(0.10,0.28), p< 0.001). The limits of agreement were wide (-3.41 to 3.57 hours), and self-reported versus actigraphy-derived sleep duration was not statistically different (bias=0.08 hours, p=0.3313) indicating no pattern of underestimating or overestimating.

Conclusion

In contrast to some previous findings, sleep duration at 6 months postpartum was not associated with PWR at 12 months. The assessment of additional sleep dimensions, such as timing or efficiency, may further refine our understanding of how sleep affects PWR. Self-reported and actigraphy-derived measures of sleep duration evidenced wide discrepancies in postpartum women, suggesting that the method of sleep measurement may contribute to mixed findings related to sleep in this population.

Support (if any)
0731 Salivary Cortisol and Sleep in Grandparents Raising Grandchildren and Non-Caregiving Grandparents
Authors: Stearns Melanie , McGovney Kevin , Curtis Ashley , Lee Soomi , Haley William , Szalacha Laura , Beversdorf David , McCrae Christina
Published: May 2023

Introduction

Caregivers often exhibit unhealthy/dampened cortisol profiles and sleep problems due to high stress. Grandparent caregivers (GP-CG) may be particularly vulnerable with caregiving burden and age-related changes in sleep/health. Yet there is lack of empirical evidence examining baseline cortisol and reactivity in GP-CG and how they are associated with sleep. We examined differences between GP-CG and non-GP-CG in cortisol levels pre- and post-stress tasks and the moderating role of caregiving status in the relationship between cortisol and sleep.

Methods

486 participants in the second wave of the 2009 MIDUS biomarkers project were characterized as GP-CG who cared for their grandchild for at least 1 year (n=63, Mage=61.80, 64% female) and non-GP-CG (n=423, Mage=62.98, 56.2% female). T-tests and multiple regressions (SPSS PROCESS) examined group differences and moderation by caregiving status in the associations between salivary cortisol (Salivette®; measured before and after Stroop and MATHTurner tasks) and sleep (work-day and non-work-day total sleep time-TST; frequency of Sleep Onset Latency problems-SOLfreq; 1-never to 5-always) over the past month. Analyses controlled for age, gender, cortisol collection time.

Results

GP-CG had lower baseline cortisol (M=10.35, SD=6.02) than non-GP-CG (M=12.15, SD=7.70; t(485)=2.03, p=.045). GP-CG had lower post-task cortisol reactivity (M=10.99, SD=5.83) than non-GP-CG (M=13.21, SD=7.73; t(485)=2.06, p=.040). Only non-GP-CG had a significant cortisol increase from baseline to post-task (t(1,422)=3.00, p=.001)). Caregiving status interacted with baseline cortisol (t(1, 484)=3.81, p=.04) in its association with SOLfreq (R2=.16, p=.03). Higher baseline cortisol was associated with less SOLfreq in GP-CG with no relationship in non-GP-CG. Additionally, caregiving status interacted with post-task cortisol (t(1,484)=7.79, p=.006) in its association with non-work-day TST (R2=.17, p=.04). Cortisol and TST had a positive relationship in GP-CG but a negative relationship in non-GP-CG.

Conclusion

GP-CG may have lower baseline cortisol and reactivity compared to non-GP-CG, consistent with previous literature examining individuals with prolonged stress compared to healthy controls. GP-CG’s reduced cortisol reactivity may be adaptive given that the positive relationship between cortisol and sleep in this group, contrary to the negative association found among healthy controls. Future research should utilize longitudinal data to determine the temporality of these relationships.

Support (if any)

NIA (P01AG020166, R37AG027343; McCrae, PI: R01AG061976)
0732 Sleep multi-trajectories of couples up to 36 months postpartum and their covariates: the SEPAGES cohort study
Authors: Kim Mihyeon , Lyon-caen Sarah , Pin Isabelle , Bayat Sam , Slama Rémy , Philippat Claire , Plancoulaine Sabine
Published: May 2023

Introduction

Parents reported degraded sleep outcomes up to several years after child birth. Most published studies were cross-sectional, in early post-partum and focusing on maternal-child dyads. We aimed at identifying sleep multi-trajectories (SMT) including night (NSD) and daytime (DSD) sleep duration and subjective sleep loss (SSL) between 3 and 36 months postpartum in couples from the SEPAGES cohort.

Methods

From 484 mothers and 410 fathers included in the SEPAGES cohort, sleep information was collected by self-reports at 3, 18, 24 and 36 months postpartum. Couple SMT were modelled using Group-Based Trajectory Modelling method. Each couple was assigned to the group of SMT with the highest probability of belonging to. Multinomial logistic regression assessed sociodemographic, parental and child covariates associated SMT

Results

Three groups SMT were identified in couple who reported sleep data at least 2 times across the 4 time-points (N=188). In G1 (29.3%), couples had 8-9hr of mean NSD and a stable and relatively short mean maternal and paternal DSD (≈10min and ≈5min, respectively) while SSL was decreasing for mother (58% to 31%) but stable for father (≈30%) between 3 and 36 months postpartum. In G2 (27.7%), they had a stable but relatively short mean NSD (7-8hr), a maternal DSD decreasing by 20min between 3 and 18 months then being stable at 23min, a stable paternal DSD (≈10min) and high but decreasing SSL from 90% to 86% for mothers and 76% to 61% for fathers. In G3 (43.0%), couples had a stable mean NSD (8-9hr), a relatively long mean DSD, decreasing from 54 to 41min for mothers but increasing from 28 to 39min for fathers, and a stable but relatively high SSL (≈70% for mothers and ≈55% for fathers). From logistic regression, belated paternal chronotype increased odds for belonging to G2 while having a first child and born in autumn decreased odds to belong to G2 compared to G1.

Conclusion

We identified 3 different SMT between 3 and 36 months postpartum for the first time. We found several factors associated with each SMT. Studies are still warranted to investigate further interrelation with the child sleep patterns.

Support (if any)

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0737 Age, menstrual phase, and circadian preference impact sleep in menstruating individuals
Authors: Meers Jessica , Bower Joanne , Nowakowski Sara , Alfano Candice
Published: May 2023

Introduction

An eveningness chronotype is generally associated with reduced sleep continuity and quality, as well as social jetlag. Changes in hormones and menstrual phase similarly impact sleep, although research on the chronobiological effects of these changes are equivocal. This study aimed to examine the role of menstrual cycle in daily self-report and actigraphy-assessed sleep in two consecutive menstrual cycles.

Methods

Participants (n=51; 43% Caucasian), 18-35 years (23.67±4.68) completed actigraphy and daily sleep diaries over two menstrual cycles (m days=51.29). Four menstrual phases were identified via dates of menstrual bleeding and urinary ovulation testing: perimenstrual (±3 days of bleeding), mid-follicular, periovulatory, and mid-luteal. Relationships between menstrual phase and sleep parameters were estimated using multistep hierarchical linear modeling. Subjective and objective measures yielded the following sleep variables: Total Wake Time (TWTsub and TWTobj), Sleep Efficiency (SEsub and SEobj), and mid-sleep point (MSP). Participants completed the Morning-Eveningness Questionnaire (MEQ) at baseline.

Results

Mean cycle length was 28.61 days±2.69. Age was significantly associated with TWTobj (r=-.32, p <.001); SEobj (r=.34, p <.001), and MSP (r=-.42, p <.001) such that older participants had shorter TWT, higher SE, and earlier MSP. TWTobj was 4-7 minutes lower during the mid-follicular (61.54±3.37) and mid-luteal phases (63.11±3.29) compared to the perimenstrual phase (67.54±3.37; p <.001). SEobj was higher in the mid-luteal phase (82.50±0.79) vs. the perimenstrual phase (80.71±0.82, p =.006). Perimenstrual women reported 8-16 minutes longer awake (TWTsub=52.23±5.01, p <.001) and had 1-3% reduction in SEsub (89.70±0.10, p <.001). MEQ negatively predicted TWTobj (p=.004) and SEobj (p=.003), but did not vary across menstrual phase. In morning-type individuals, TST was significantly higher in the periovulatory (b =1.81, p=.01) and mid-luteal phases (b=2.03, p<.001) compared to the perimenstrual phase.

Conclusion

With increasing age, women experienced reduced time awake, higher sleep efficiency, and earlier sleep timing. Eveningness predicted greater total wake time and lower sleep efficiency. With menstrual phase considered, disturbed sleep was highest in the perimenstrual phase and women reporting a stronger preference for eveningness reported shorter TST during the perimenstrual phase. These findings highlight the importance of considering the menstrual cycle in the sleep health of menstruating individuals.

Support (if any)
0740 Factor Structure of Sleep in Older Adults Differs when Nearing End-of-Life
Authors: Klingman Karen , Sullivan Suzanne
Published: May 2023

Introduction

Adults aged 65 and older in the last year of life are at risk for experiencing non-beneficial hospitalizations, adversely effecting their quality-of-life. Reasons for undesired hospitalizations include the need to manage symptoms of progressing chronic illnesses, many of which are exacerbated by poor sleep. Given the complexity of sleep, especially as end-of-life (EOL) nears, it is imperative to understand if the myriad of variables traditionally used to describe sleep can be simplified. Insight gained by such knowledge could be used to guide assessment of sleep at EOL and identification of sleep-related interventions to improve EOL care.

Methods

Exploratory factor analyses (EFAs) were performed using data from rounds of the National Health and Aging Trends Study (NHATS) that included in-depth sleep modules. One EFA was performed for individuals who died before the next round, and another for those who did not. Ten variables were considered for each EFA, and comprised sleep disorders symptoms, sleep quality, and daytime consequences.

Results

There were three unique constructs each for the died and not-died groups. Among NHATS participants who had died, sleep experience (>30 mins falling asleep, try falling back asleep, time falling back asleep, sleep hours, and quality of sleep), tiredness (difficulty staying awake, how often nap), and EOL symptoms (sleep meds, breathing, and pain) explained 47.5% of the variability in sleep (n=122). Among NHATS participants who had not died, sleep disorder symptoms (>30 mins falling asleep, try falling back asleep, time falling back asleep, sleep hours, breathing, and quality of sleep), discomfort (pain, difficulty staying awake, how often nap), and sleep medication explained 40.9% of the variability in sleep (n=124).

Conclusion

Older adults nearing the EOL have different factor structures describing their sleep than those who are not near EOL. Napping and daytime sleepiness as well as pain, medication, and breathing for sleep have important implications for those nearing EOL that could be addressed by palliative care interventions.

Support (if any)

No support was provided for this study. Dr. Klingman is funded, in part, by NINR Award Number R01 NR018979. Dr. Sullivan is funded, in part, NIA Award Number R03 AG067159.
0741 Gender Differences in the Association of Household Burden with Sleep Disturbance
Authors: Eldridge-Smith E Devon , Holm Kristen , Edinger Jack , Depew Ann
Published: May 2023

Introduction

The emotional, mental, and physical labor inherent to family and household management may help explain gender differences in insomnia. Research suggests that managing multiple roles and responsibilities within the household can lead to sleep disruption. However, the sleep consequences of acting as “household manager,” which has been shown to negatively impact wellbeing, remains untested. The current study evaluated the association of household burden with sleep disturbance among both women and men.

Methods

Participants were recruited to complete an online survey from both the general population and the National Jewish Health Sleep Clinic. Eligibility criteria included being in a cohabitating relationship, currently employed, and having at least one child/dependent under the age of 18 residing in the household. The sample for this analysis (n = 558; mean age = 38; 62% men) had complete data on the primary measures of sleep (PROMIS Sleep Disturbance scale) and household burden (Household Management Measure; HMM). The HMM has three subscales (Household Routines, Child Adjustment, and Household Finances), with higher scores indicating greater personal responsibility. Bivariate correlations were utilized to assess the association of household burden with sleep disturbance among both men and women.

Results

Among females, increased levels of sleep disturbance were associated with higher rates of overall household burden (r(208) = .22, p < .01), as well as child (r(208) = .18, p < .05), and financial (r(208) = .22, p < .01) responsibility. Conversely, among males, lower levels of sleep disturbance were associated with higher rates of overall household burden (r(344) = -.20, p < .01), as well as household routine (r(344) = -.14, p < .01), child (r(344) = -.17, p < .01), and financial (r(344) = -.20, p < .01) responsibility.

Conclusion

The association between household burden and sleep disturbance differs between women and men. Among men, increased perceived household responsibility was associated with less sleep disturbance, while the opposite was found for women. Additional research is warranted to better understand the differing effects of household responsibility on sleep by gender.

Support (if any)

Funding support from the Natalie V. Zucker Research Center for Women Scholars Award.
0748 Using daily wearable cardio fitness and sleep data to predict obesity in early adolescence
Authors: Kiss Orsolya , Smith Natalia , Dooley Erin , de Zambotti Massimiliano , Baker Fiona C , Gabriel Kelley Pettee , Nagata Jason
Published: May 2023

Introduction

Obesity, and its co-morbidities, is a serious health risk currently facing adolescents in the US, with increased risk for adult obesity and cardiovascular health problems. Sleep is crucial for energy restorative processes and insufficient sleep influences food intake and appetite regulation. Adolescents are at risk for poor/insufficient sleep, which could, therefore, contribute to obesity risk. Given multifactorial risk factors, there is a need to identify the most salient predictors of adolescent obesity. Predicting adolescent obesity using objective Fitbit data has not previously been investigated and is the aim of the current study.

Methods

We used data collected with the Fitbit Charge 2 device from 2491 participants (Year 2, Mean-age=11.95 years, SD=0.65, 49.5% female) in the Adolescent Brain Cognitive Development (ABCD) Study®. We trained machine learning models (Gradient Boosted Trees and Regularized Logistic Regression) to identify the most important measures that predict obesity (>95 BMI percentile). In addition to sleep (timing, efficiency, duration, and regularity across the week) and cardio fitness (step counts, resting heart rate) Fitbit measures, averaged across seven days, we included socio-demographic characteristics. We ran a grid search embedded in a 2x5 fold cross-validation and we evaluated the performance based on the area under the curve-AUC and accuracy-ACC metrics.

Results

15% percent of the sample were classified as having obesity. Both classification models performed acceptably high, with the LogReg having better performance (AUC-LogReg=0.76, ACC=85%) than the GBT model (AUC-GBT=0.75, ACC=0.69). Shorter sleep duration, more day-to-day variability in sleep measures, low number of steps with low variability over the week, and higher resting heart rate, with high day-to-day variability, were important predictors. Sociodemographic factors (Hispanic/Latinx ethnicity, African American race, low access to food) were also important predictors.

Conclusion

Results show that there are socio-economic disparities in obesity risk and that shorter sleep duration and more variable sleep patterns, as detected with a wearable, are important predictors of obesity risk. Results highlight the clinical utility of wearable measures and the importance of continuous monitoring of sleep, physical activity, and cardio fitness in adolescents.

Support (if any)

NIH U01DA041022
0752 Later chronotype, insufficient and disturbed sleep are linked to menstruation problems in early adolescent girls
Authors: Kiss Orsolya , Arnold Anne , Alzueta Elisabet , Harkness Anya , Kerr Erin , Arra Nicole , Durley Ingrid , Camacho Leticia , Tager Lucas , Fan Ruby , Perez-Amparan Evelyn , Nagata Jason , de Zambotti Massimiliano , Muller-Oehring Eva , Baker Fiona C
Published: May 2023

Introduction

Adolescence in girls is a vulnerable transitional period, characterized by substantial hormonal and physical development, the onset of menarche, dramatic brain development and changes in behavior, including sleep. Menstrual problems, including painful menses, are common among female adolescents, and contribute to school absenteeism. They may also be symptoms of gynecological conditions, which can negatively affect reproductive and general health of women. Limited work has linked sleep disturbances and menstrual problems in adolescents. Here, we examined the association between sleep behavior and menstrual problems in a large sample of adolescent girls in the Adolescent Brain Cognitive Development (ABCD) Study®.

Methods

We fitted linear mixed effect models to examine the associations between sleep behavior and menstrual problems in 1837 post-menarcheal girls (Year 3, Mean-age = 13.03, [12-15] years), assessed as part of the ongoing ABCD Study®. Sleep was assessed with the Munich Chronotype questionnaire (youth-report) and the sleep disturbance scale for children (caregiver-report). Girls answered questions about menstrual cycles and associated problems. We considered age, time since menarche, BMI, use of hormonal contraceptives, and socio-demographic characteristics in the models.

Results

Short sleep duration was related to higher menstrual pain intensity (p<.01), irregular menstrual cycles (p<.01) and more premenstrual symptoms (p=.01). Higher total sleep disturbance score (caregiver-reported) was also associated with higher menstrual pain intensity (p<.01) and greater impact of menstrual pain on usual activities (p<.01). Participants with a later chronotype (p=.04) and later wake-up time (p=.02) were more likely to experience an irregular menstrual cycle. Later wake-up time was also related to higher menstrual pain intensity and impact on daily life (p<.01). Girls with recent menarche reported heavier menstrual flow (p=.02), higher menstrual pain intensity, more premenstrual symptoms, and a greater overall impact of menstrual pain on their usual activities (p<.01).

Conclusion

Our results indicate multiple associations between sleep behavior and menstrual problems in adolescent girls. Both menstrual problems and insufficient sleep/sleep disturbances are important for female adolescent health and should be routinely screened for by healthcare providers and school health education providers. Future work is needed with longitudinal analyses to determine directionality of the associations we found between sleep and menstrual problems.

Support (if any)

NIH U01DA041022
0756 Amount and Timing of Sedentary Behavior and Physical Activity following Experimental Sleep Extension in Adolescents
Authors: Davidson Jordan , Simon Stacey , Cree-Green Melanie , Nadeau Kristen , Wright Kenneth , Creasy Seth , Cooper Emily , Bowen Anne , Melanson Edward
Published: May 2023

Introduction

Short sleep and sedentary behavior (SB) are both associated with negative health outcomes including increased risk of metabolic syndrome and obesity. Adolescence is a period characterized by decreased physical activity (PA), increased SB, and chronic short sleep. Literature about the impact of sleep duration on PA in adolescents is limited. The goal of this study was to examine changes in the amount and timing of PA and SB following a one-week sleep extension manipulation.

Methods

The sleep, PA, and SB of 34 short-sleeping (≤7h on school days) and habitually sedentary (< 3h of physical activity per week) healthy-weight adolescents (age=16.4±1.1 years; 68% female; 73% non-Hispanic White) were objectively measured in a randomized cross-over study during the academic year. Participants completed one week of Typical Sleep (usual school schedule) and one week of Sleep Extension (≥1h time in bed each school night). Sleep was estimated using wrist-worn actigraphy; PA and SB were measured using a thigh-worn accelerometer. Paired t-tests compared total minutes and time blocks of PA and SB during each condition.

Results

Total SB decreased from 750.4±109.08 to 699.32±91.76 min/day during Sleep Extension compared to Typical Sleep (p= 0.018). Specifically, SB significantly decreased during Sleep Extension in the 6PM-12AM (Typical Sleep=223.1±66.6, Sleep Extension=193.8±46.2 min; p=0.04) and 12AM-6AM (Typical Sleep=22.2±36.9, Sleep Extension=5.8±9.5 min; p=0.02) time frames. There were no significant changes in light, moderate, or vigorous PA between conditions (p>0.05).

Conclusion

Adolescents significantly decreased time spent in SB by nearly 1h per day during Sleep Extension with no change in PA, similar to prior research. Notably, the decrease in SB occurred during the 6PM-6AM time frame, suggesting that the additional sleep displaced time otherwise spent in SB. Reallocation of time spent in SB to PA is associated with positive health outcomes, but no research has examined reallocation to sleep time. Additional studies are needed to identify the related health effects of increased sleep duration and reduced SB in adolescents.

Support (if any)

NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1 TR002535
0761 Differences in Sleep Barriers Between Summer and School in Adolescents with Type 1 Diabetes
Authors: Cobry Erin , Fivekiller Emily , Jaser Sarah , Karami Angela , Meltzer Lisa , Rasmussen Cristy Geno
Published: May 2023

Introduction

Sleep is recognized as an important component of health for people with type 1 diabetes (T1D), with significant associations identified between sleep quality, glycemic outcomes, and diabetes self-management. Adolescents, who are particularly vulnerable to insufficient sleep and have difficulty meeting glycemic targets, typically experience differences in sleep during the summer versus school months. We examined barriers to sufficient sleep during summer and fall months amongst adolescents ages 11-17 with T1D.

Methods

Adolescents (n=10, mean age 14.1 years, 40% female, 80% non-Hispanic White) with T1D participated in qualitative, semi-structured interviews to explore seasonal differences in barriers to sleep. Interviews were audio and video recorded, transcribed using Otter-AI software with manual review for accuracy, independently coded by two trained research staff, and themes were identified.

Results

Interviews were completed by five adolescents during the summer and five during school months. Barriers to achieving sufficient sleep for both time periods included diabetes-related issues (e.g. hypoglycemic episodes, glucose variability, fear of hypoglycemia, and device use), peers, activities, and family factors. School, activities, family and diabetes disruptions were equally prominent barriers during the school year, whereas diabetes disruptions were the most common barriers during the summer. While device alarms disrupted sleep at both times, adolescents reported that diabetes technologies had an overall net positive impact on sleep during the school year due to reduced worry, but a neutral impact during the summer. Adolescents agreed it would be helpful to talk about sleep concerns or ways to improve sleep.

Conclusion

Diabetes management is a consistent reason for insufficient sleep duration in adolescents with T1D. In addition, similar to adolescents without T1D, academic, social, and family obligations were barriers to obtaining sufficient sleep during the school year. While some sleep disruptors may not be modifiable, assessment by a clinician who can provide guidance on methods to improve sleep health may be beneficial and well received. Because diabetes health care providers have frequent contact, routine visits provide an opportunity to identify sleep concerns and provide both diabetes and non-diabetes guidance to address sleep health. Further exploration of sleep behaviors and barriers in adolescents with T1D is warranted.

Support (if any)

5-ECR-2022-1179-A-N, JDRF and Helmsley
0766 Qualitative Development of the Pediatric Narcolepsy Patient-Reported Outcomes (PNPROS) Questionnaire
Authors: Meltzer Lisa , Heckler Gillian , Revette Anna , Worhach Jennifer , Maski Kiran
Published: May 2023

Introduction

There is a significant need to reflect patient needs and values in healthcare outcome measures. In pediatric narcolepsy, there are no patient-reported outcome measures to assess disease burden, determine treatment efficacy, and guide future drug development. The aim of this study was to develop items for pediatric narcolepsy patient-reported outcomes (PNPROS) measure.

Methods

A standardized approach for the development of patient-reported outcome measures was used to develop the PNPROS items, including domain and facet definitions; a systematic, comprehensive literature review; in-depth interviews with pediatric narcolepsy experts (n=3); and qualitative interviews with children and adolescents with narcolepsy ages 9-17 years (n=15) and parents of children/adolescents with narcolepsy (n=15). Once the preliminary item bank was created, iterative refinement was completed through another round of qualitative interviews with children/adolescents (n=11) and parents (n=11), as well as experts in pediatric sleep, narcolepsy, and measure development.

Results

The literature review and expert interviews contributed to the final conceptual framework, which included two domains. The first, Narcolepsy Symptoms, included 13 facets (behavior, brain fog, cataplexy, cognitive difficulties, difficulty waking, disrupted nighttime sleep, daytime sleepiness, hallucinations, mood, nightmares, parasomnias, sleep paralysis, and tired/fatigue). The second, Functioning Impairment, included 11 facets (bothered, brain fog, emotional/mood, home/family, lack of understanding, life satisfaction, safety, school/academic, social, weight gain, work/extracurriculars). The literature review identified 714 items from 27 measures; after redundancies or irrelevant items were removed, the 337 remaining items were assigned a domain and facet through team consensus. Qualitative interviews resulted in a further reduction of items due to lack of clarity or redundancy, resulting in the final 55 items to be included in field testing.

Conclusion

This rigorous qualitative approach to the development and evaluation of content validity for the PNPROS item pool resulted in 25 items that assess Narcolepsy Symptoms and 35 items that capture Functional Impairment. Once the psychometric properties are established, through field testing in a diverse, national sample of pediatric patients ages 9-17 years with narcolepsy, the measure will be useful for evaluating disease burden and treatment efficacy in both clinical and research settings.

Support (if any)

American Academy of Sleep Medicine Foundation