bluuebunny/crossref_metadata_2025 huggingface dataset:
0629 Correlates of sleep quality among individuals with chronic pain after moderate to severe traumatic brain injury
Authors: Martin Aaron , Almeida Emily J , Hoffman Jeanne M , Pinto Shanti M , Walker William C , Douglas Megan E , Wittine Lara , Schwartz Daniel J , Takagishi S Curtis , Kane Georgia , Nakase-Richardson Risa
Published: May 2023

Introduction

Sleep disturbance and chronic pain are very common after moderate to severe traumatic brain injury (msTBI). Despite having a bidirectional and mutually exacerbating relationship, there is a dearth of literature examining factors involved in the sleep-pain relationship following msTBI. Psychiatric symptoms (e.g., post-traumatic stress, depression) are also prevalent following injury and know to be related to sleep, as well as poor adjustment to chronic pain. The purpose of this study was to examine associations between sleep, psychiatric symptoms, and pain-beliefs among msTBI survivors who have comorbid chronic pain.

Methods

This is a secondary analysis of TBI Model Systems study data of 1,567 individuals reporting chronic pain after msTBI (M=8.5 years, SD=7.1). Participants were 46.8 years old on average (SD=27.9), predominantly male (72.7%) and completed measures of sleep (Pittsburgh Sleep Quality Index; PSQI), post-traumatic stress disorder (PTSD Checklist; PCL-5), depression (Patient Health Questionnaire; PHQ-9), anxiety (General Anxiety Disorder; GAD-7), pain-related catastrophizing (Coping Strategies Questionnaire; CSQ) and self-efficacy (Pain Self-Efficacy Questionnaire; PSEQ-2). Measures were adjusted for overlapping constructs. Relationships between sleep, psychiatric symptoms and pain beliefs were examined through Pearson correlations.

Results

Average PSQI total score for our sample was 8.78 (SD=4.4), indicating poor sleep quality, with an estimated 6.40 (SD=1.9) hours of sleep on average. Over two-third (68.5%) of our sample attributed some of their sleep disturbance to chronic pain and nearly half (47.4%) met cutoff (>8) for clinically significant poor sleep quality. PSQI scores were positively correlated with PCL (r = .44, p <.0001), PHQ-9 (r = .12, p <.0001), GAD-7 (r = .08, p <.01), CSQ (r = .34, p <.0001) and negatively correlated with PSEQ-2 (r = -0.23, p <.0001).

Conclusion

Poorer sleep quality in individuals with chronic pain after msTBI is associated with more psychiatric symptoms, increased pain-related catastrophizing, and lower pain self-efficacy. Results highlight sleep quality as an important modifiable target for intervention in this at-risk clinical population and suggest that behavioral treatments to improve psychiatric comorbidities and adjustment to pain may be beneficial.

Support (if any)

National Institute on Disability, Independent Living, and Rehabilitation Research (NCT03033901).
0631 Overnight Emotional Memory in Insomnia versus Good Sleepers
Authors: Tse Katrina , Tamm Sandra , Maurer Leonie , Espie Colin , Kyle Simon
Published: May 2023

Introduction

“Sleep to forget and sleep to remember” model postulates that the content of emotional memory is strengthened during sleep while the arousal component is attenuated. Experimental sleep deprivation studies in healthy individuals have supported the model, but it is not known if sleep in individuals with insomnia, a condition of chronic poor sleep, provides the same effect on emotional memory.

Methods

Individuals reporting insomnia and good sleepers (n = 76 and n = 83 respectively; 83% female, mean age of 43.2 years) completed a picture-rating task to assess a) emotional valence ratings pre and post sleep and b) recognition accuracy post-sleep. In addition, an autobiographical memory task was completed during the day to assess a) the number of recalled memories in a 2-minute period for good and bad past events respectively, and b) emotional intensity ratings of the retrieved memories at the time the event occurred and how they feel now.

Results

Wilcoxon rank-sum test was used to assess group differences. Sleep diary variables on the experimental night showed that individuals with insomnia experienced a significantly more disrupted sleep than good sleepers (SOL: r = 0.537; WASO: r = 0.620; TST: r = 0.669). In the picture-rating task, there was no significant group difference for recognition accuracy (neutral stimuli: r = 0.016; negative stimuli: r = 0.018) or change in emotional valence pre-to-post sleep (neutral stimuli: r = 0.003; negative stimuli: r = 0.008). In the autobiographical memory task, individuals with insomnia remembered significantly fewer good days (r = 0.245) and rated their bad days at the time of its occurrence as significantly worse than good sleepers (r = 0.235). There was no significant group difference in the extent to which emotional intensity faded more for bad days than good days (r = 0.113).

Conclusion

We have shown that autobiographical memory is altered in insomnia which may have important influence on mental health. Our findings also suggest that overnight memory consolidation for negative stimuli is not affected in insomnia versus good sleepers. This may be a reflection of our one-night protocol; future work is needed across consecutive days.

Support (if any)

Dr-Mortimer-&-Theresa-Sackler-Foundation
0639 Delayed Presentation of Sleep Disruption and Depressive Symptoms in Males Post Mild Traumatic Brain Injury (mTBI)
Authors: Reich-Fuhrer Melissa , Hildebrand Lindsey , Franca Gabriela , Desai Shivani , Grandner Michael , Killgore William
Published: May 2023

Introduction

The relationship between sleep disruption and depressive symptoms is well established. Mild traumatic brain injury (mTBI) is commonly associated with emotional dysregulation and decreased sleep quality. Less is known about the course of mTBI and its association with mood symptoms over time. We hypothesized that those in acute stages of mTBI (2W; 1M) would significantly differ in sleep quality and depressive symptoms compared with healthy controls. As there are often sex differences in sleep and depression, we focused here exclusively on males with mTBI.

Methods

This study included 56 healthy males, split into six groups. The sample included 15 healthy males (Mage=23.67, SD=5.066) and 41 males (Mage=26.88, SD=8.509) with mTBI, at differing stages post-injury: 2 weeks and 1, 3, 6, and 12 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Index (BDI-II) to assess sleep disturbance and mood, respectively. Higher scores on both measures indicate a more severe presentation of disruptive symptoms. We conducted a one-way ANOVA to examine how the mean score for both measures varied at each time point.

Results

Compared to healthy controls there was no significant variance in average depression scores at 2W, 1M, 6M, and 12M (p>.05). However, at 3M post-mTBI males reported significantly higher depression scores than healthy controls M =9.8, SD=9.48, p=.035. Participants with mTBI reported greater sleep disruption when compared to healthy controls at 3M M =7.30, SD=3.16, p=.035 and 12M M=7.0, SD=3.39, p=.037, but not at other time points.

Conclusion

Contrary to our hypotheses, we found that males did not significantly vary from healthy controls for either measure in the acute stages of mTBI. These results indicate that males may not initially present depressive symptoms and sleep disruption post-mTBI, which could result in an inaccurate assessment of injury severity and an improper treatment plan moving forward in recovery. Further research conducted with a larger sample size would be useful in establishing that males suffering from mTBI experience the most severe presentation of symptoms roughly 3M after injury. Future work will need to examine whether these same trends are present among females.

Support (if any)

W81XWH-12-1-0386
0656 Evaluating the Interrelationship Between Insomnia, Sleep Apnea and Nightmares in Veterans With Posttraumatic Stress Disorder
Authors: Stuewe Elena , Malcolm Katherine , Woodward Steven H , Yack Leslie M , Metzler Thomas J , Baquirin David P G , Udupa Nikhila S , Staggs Emily J , Neylan Thomas C , Richards Anne
Published: May 2023

Introduction

Observational research demonstrates a strong association between nightmares, insomnia, and sleep apnea in veterans with posttraumatic stress disorder (PTSD), supportive of the notion of a “complex sleep disturbance”. Relations between sleep disturbances and PTSD are often bi-directional and disturbed sleep affects non-sleep PTSD outcomes. We aimed to examine relationships between nightmares, respiratory events, CPAP use, and insomnia in trauma-exposed veterans with frequent nightmares.

Methods

Three weeks of app-based daily sleep diaries and weekly insomnia severity index (ISI) reports were collected from 41 veterans with a history of trauma and frequent nightmares. Relationships between weekly nightmares (total number), CPAP use, sleep efficiency, and ISI scores were analyzed using linear regression with standard errors adjusted for clustering of weeks within participants. Of the 41 participants, a subset of 15 participants completed 6-9 nights of at-home objective sleep measurements (Sleep Profiler) to examine the relationship between apnea events and nightmare awakenings. Measurements involved EEG integrated with airflow, respiratory effort, oxygen saturation, and actigraphy with event marker for real-time reporting of nightmares preceding awakenings.

Results

41 veterans (mean age 48 (SD=16), 30% female) participated. Higher prior week ISI score predicted reduced CPAP adherence (β=-.53, p=.005). In turn, increased frequency and duration of CPAP use was associated with a significant increase in sleep efficiency the same week (β=.53, p=.018 and β=.56, p=.026, respectively). Analysis of respiratory events indicates that 20 of the 64 nightmare awakenings (31%) were preceded (i.e., within seconds of awakening) by apnea or hypopnea events. Of these 20, 11 events were reported by participants with a diagnosis of OSA and a CPAP device. Amongst these 11 events, 7 (64%) occurred on nights during which the participant reported use of their CPAP.

Conclusion

Analyses demonstrated statistically significant and clinically meaningful relationships among insomnia, nightmares, respiratory events and CPAP adherence in our sample, highlighting their interrelationships in trauma subjects. These data support the hypothesis that OSA contributes to nightmare experiences by demonstrating an immediate temporal relationship between apnea/hypopnea events and nightmare awakenings, and they underscore the importance of detecting and adequately treating sleep apnea for the treatment of nightmares in veterans.

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0659 Nightmares in the acute aftermath of trauma predict later suicidal ideation in trauma survivors
Authors: Seymour Grace , Reffi Anthony , Moore David , Mahr Gregory , Drake Christopher
Published: May 2023

Introduction

Nightmares are a common occurrence after experiencing a traumatic event and are a symptom of post-traumatic stress disorder (PTSD). Additionally, nightmares are associated with higher levels of suicidal ideation, attempt, and death from suicide. Nightmares may be an early sign of suicide risk in populations that have experienced trauma, however, there are no studies that have investigated this potential link. This study aims to determine whether more severe nightmares in the aftermath of trauma will prospectively predict later suicidal ideation, independent of comorbid insomnia.

Methods

We recruited adults that were admitted to the intensive care unit at Henry Ford Hospital in Detroit after experiencing a DSM-5 Criterion A traumatic event (N = 76, Mage = 38.39, 65.8% male). Participants completed study surveys at three time points: T1 (an average of 6 days after trauma), T2 (two weeks after T1), and T3 (1 month after T1). Nightmare and insomnia severity were measured at T2 with the Nightmare Disorder Index (NDI) and Insomnia Severity Index (ISI), respectively. Suicidal ideation was measured at T3 using item nine on the Patient Health Questionnaire (PHQ-9).

Results

More severe nightmares in the acute aftermath of trauma (T2) predicted more severe SI two weeks later at T3 (β = 0.49, SE = .17, p = .004, R2 = .22). This association remained even after adjusting for T1 SI, T2 ISI, age, and sex (β = 0.36, SE = .18, p = .044, R2 = .31).

Conclusion

More severe nightmares in the acute aftermath of trauma predicted more severe SI one month after trauma, independent of comorbid insomnia symptoms and baseline suicidal ideation. These findings suggest that the onset of nightmares immediately after trauma may confer a unique risk for SI. In clinical practice, it may be useful to detect nightmares in the aftermath of trauma using brief measures such as the NDI. Trauma survivors that develop frequent and severe nightmares within the acute recovery phase could then be given targeted nightmare treatment to reduce the risk of later SI.

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0664 Association of Nightmares with Predisposing and Perpetuating Factors in an Outpatient Behavioral Sleep Medicine Clinic
Authors: Paquet Caitlin , Lenker Kristina , Calhoun Susan , Fernandez-Mendoza Julio
Published: May 2023

Introduction

While nightmares are well known to be associated with greater sleep disturbance and psychopathology relative to insomnia, this has primarily been observed in experimental samples and not well-studied in outpatient clinical samples. Several theories for the etiology and maintenance of nightmares have identified the roles of both hyperarousal and emotion dysregulation in explaining the association of nightmares to adverse psychiatric outcomes. Given that insomnia is also associated with similar predisposing and perpetuating factors such as greater trait arousability and sleep reactivity, it is important to understand how these factors compare between nightmares and insomnia.

Methods

A total of 445 patients (45.6±18.4 years old, 66.5% female, 13.0% minority) with diagnoses of nightmare disorder (n=32), insomnia disorder (n=274) and any other sleep disorder (n=139) were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center. To measure symptoms of depression, anxiety, stress, hyperarousal, sleep reactivity, and dysfunctional beliefs about sleep, all patients completed the Depression Anxiety Stress Scale (DASS), Arousal Predisposition Scale (APS), Ford Insomnia Response to Stress Test (FIRST), Pre-sleep Arousal Scale, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS), respectively. Analysis of variance (ANOVA) examined between-group differences in patient-reported outcomes.

Results

There were no significant between-group differences on sleep reactivity, pre-sleep cognitive arousal, dysfunctional beliefs and attitudes about sleep or depression scores (all ps>0.12). However, patients with nightmare disorder showed greater arousability, in both trait anxiety and emotional reactivity, pre-sleep somatic symptoms, anxiety and perceived stress than patients with insomnia disorder or with any other sleep disorder (all ps< 0.05).

Conclusion

While patients with nightmare disorder share predisposing and perpetuating factors common to patients with insomnia disorder, they do present with more severe forms of cognitive-emotional arousability, trait-anxiety, and somatic symptoms of anxiety that impact nighttime sleep. These data suggest that clinical evaluations for sleep disruption should include a thorough gathering of history to include the onset, course, and perpetuating factors. Cognitive-behavioral therapies for nightmares and insomnia should be tailored to target these specific factors in order to prevent relapses.

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0666 Need a novel method to reduce anger after combat? Treat sleep apnea
Authors: Miles Shannon , Martindale Sarah , Flanagan Julianne , Troyanskaya Maya , Reljic Tea , Gilmore Amanda , Wyant Hannah , Nakase-Richardson Risa
Published: May 2023

Introduction

Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep.

Methods

The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1,263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets.

Results

Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for associations between PTSD and pain interference with anger.

Conclusion

Treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM.

Support (if any)

This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC and with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED
0667 A digital prescription therapeutic device to treat nightmare disorders: A case series
Authors: Robertson Brian , Liem Andre
Published: May 2023

Introduction

Introduction: Nightmare disorder and post-traumatic stress disorder (PTSD)-associated nightmares can be treatment-resistant in many patients. There are no recommended treatments for these conditions currently.

Methods

Methods: NightWare is a novel FDA-approved class II medical device which improves sleep in patients with nightmare disorder and PTSD-associated nightmares. It uses data from a smart watch to determine when nightmares are happening using heart rate and movement sensors, and then intervenes to interrupt the nightmare and improve overall sleep quality. We report the 14 consecutive cases of patients using NightWare and the Clinical Global Impression (CGI) of Severity and Change in their sleep and reduction of nightmare burden.

Results

Results: Of the 14 patients in this series, 10 patients used the device for more than 7 days. 1 discontinued due to perceived lack of efficacy, 2 stopped in part due to a skin rash, and one stopped because he did not want to wear a watch to sleep. At baseline, the 10 patients included in the analysis had a mean CGI Severity score of 4.7 (SD 1.25), which indicates moderate to severe nightmares and daytime dysfunction. Improvement in the CGI Change score with NightWare exceeded that of prazosin for this group of patients. The patients in this series that used the device had a mean score of 2.20 (SD 0.79) on the CGI Change scale, which indicates there was significant improvement from baseline. Six of the 10 patients using NightWare were also taking prazosin prior to starting NightWare. The prazosin dose ranged from 1-8 mg nightly for these patients. These 6 patients had minimal improvement with prazosin alone (CGIC of 3.16 (SD 0.41).

Conclusion

Conclusion: In this case series, NightWare significantly improved the symptoms of nightmare disorder in 10 of the 14 patients in this series. Patient selection for sympathetic nervous system activation is important to ensure the device’s effectiveness.

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0668 Adverse Childhood Experiences Associated with Adult Insomnia and Nightmares
Authors: Rasmussen Elizabeth , Ricketts Emily , Joyce Daniel , Mensah-Osman Taylor , Gorovoy Suzanne , Granados Karla , Prather Aric , Hale Lauren , Branas Charles , Rojo-Wissar Darlynn , Grandner Michael
Published: May 2023

Introduction

Adverse childhood experiences can increase likelihood of hyperarousal, especially around periods of vulnerability. Survivors of trauma also experience more nightmares. These data explore whether adverse childhood events are associated with adult insomnia severity and nightmares.

Methods

Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults 22-60 years recruited from southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Insomnia severity was assessed using the Insomnia severity Index (ISI), evaluated both as a continuous variable and categorical: None (0-7) vs Mild (8-14) or Moderate-Severe (15+). Nightmares were assessed ordinally using the following anchors: Never, Seldom, Sometimes, Often, or Frequently. Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9.

Results

Child abuse was associated with an additional 2.9 points on the ISI, and parental divorce, death, depression, and anxiety were associated with an additional 1.2, 1.7, 1.8, and 1.8 points, respectively (all p< 0.005). After adjustment for depressed mood, relationships remained for child abuse, parent divorce, and parent death. In evaluating categorical insomnia, child abuse was associated with both mild (RRR=2.64, p< 0.0005) and moderate-severe (RRR=3.37, p< 0.0005) insomnia. Parent death was associated with an increased likelihood of moderate-severe insomnia (RRR=1.94, p=0.007). Parent divorce, depression, and anxiety were all associated with increased mild (RRR=1.44 [p=0.03], RRR=1.85 [p=0.001], and RRR=1.85 [p=0.004], respectively) and moderate-severe (RRR=1.50 [p=0.03], RRR=2.24 [p< 0.0005], and RRR=2.40 [p< 0.0005], respectively) insomnia. More frequent adult nightmares were reported by those who reported a history of child abuse (oOR=1.9, p< 0.0005), parent death (oOR=1.6, p=0.007), parent depression (oOR=1.6, p< 0.0005), and parent anxiety (oOR=1.8, p< 0.0005). After adjustment for depression, relationships with child abuse and parent death were maintained. Child poverty was not associated with insomnia or nightmares.

Conclusion

Adverse childhood events may contribute to later risk for insomnia and nightmares. Further efforts are needed to establish causality and develop interventions, which may have residual effects on mental and physical health.

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0669 Disruptive Nocturnal Behaviors in PTSD Patients are Associated with More Severe Psychiatric Pathology
Authors: Gupta Madhulika , Anello Carmelina
Published: May 2023

Introduction

The similarities and differences between trauma associated sleep disorder (TASD) and REM sleep behavior disorder (RBD) are unclear. However, both REM sleep parasomnias are associated with disruptive nocturnal behaviors (DNB) that manifest as episodes of sleep-related vocalizations, and/or complex motor behaviors. Patients who have more DNB are more likely to have a higher prevalence of PTSD.

Methods

In a cross-sectional study, we examined the relationship between DNB severity and the severity of psychiatric symptoms in PTSD patients. 73 civilian patients with histories of complex developmental trauma (age 47.0 ±13.3 years; 89.6% female) met the DSM-5 criteria for moderate-to-severe PTSD. PTSD Checklist for DSM-5 (PCL-5) was used to obtain an index of current PTSD severity (37.41 ± 19.84; PCL-5 >30 cutoff for PTSD). DNB was defined as the sum of the two items 1f and 1g in the Pittsburgh Sleep Quality Index PTSD Addendum (PTSD-A). The participants rated how often during the past 1 month they had trouble sleeping because of the following: (PTSD-A Item1f) “Had episodes of terror or screaming during sleep without fully awakening” and (PTSD-A Item1g) “Had episodes of ‘acting out’ their dreams, such as kicking, punching, running or screaming”. We used a stepwise multiple regression analysis with DNB as the dependent variable and the variables described below as independent variables.

Results

We determined the following relationships: 1. PCL-5 (r=0.359, p=0.002); 2. Brief Symptom Inventory which includes Somatization (r=0.476,p< 0.001);Obsessive-compulsiveness (r=0.429, p< 0.001); Interpersonal Sensitivity (r=0.337, p=0.004); Depression (r=0.398, p< 0.001); Anxiety (r=0.449,p< 0.001); Hostility (r=0.577, p< 0.001); Phobic Anxiety (r=0.353, p=0.002); Paranoid Ideation (r=0.412, p< 0.001); and Psychoticism (r=0.414, p< 0.001); 3. Insomnia Severity Index (r=0.363, p=0.002); 4. Beck Suicide Scale or BSS (r=0.268, p=0.025); 5.Beck Anxiety Inventory (r=0.472, p< 0.001); and 6. Fear of Sleep(r=0.493,p< 0.001). Fear of Sleep Inventory (FOS) (Beta=0.442, t=4.258, p< 0.001) and Beck Scale for Suicidal Ideation (BSS) (Beta=0.300, t=2.887, p=0.005) emerged as the significant predictors of DNB.

Conclusion

DNB was correlated with a wide range of psychiatric pathology in PTSD. This suggests that DNB could be an integral feature of severe PTSD. To our knowledge, this has not been previously reported.

Support (if any)

None
0670 Examination of neighborhood disadvantage and sleep in a sample of PTSD-diagnosed Veterans with trauma nightmares
Authors: Miller Katherine , So Christine , Brownlow Janeese , Gehrman Philip , Woodward Steven H
Published: May 2023

Introduction

The nature of sleep can leave sleepers vulnerable to environmental threats, requiring a balance between the demands for vigilance and the physiological requirement for sleep. Understanding the sleeping context is particularly relevant to understanding the dynamics of sleep disturbance observed in individuals with posttraumatic stress symptoms (PTSS) because of subsequent increased vigilance to threats. This study examined the associations between neighborhood disadvantage, sleep respiratory sinus arrhythmia (RSA), fear of sleep, and nightmare frequency in a sample of trauma-exposed Veterans.

Methods

Baseline data from an ongoing study examining sleep with trauma nightmares using ambulatory sleep measurement in a sample of U.S. military Veterans were analyzed. Participants completed assessments of nightmare frequency and fear of sleep, and slept on a mattress actigraphy system for at least seven nights, which captured sleep-period RSA as an index of autonomic activation. Neighborhood disadvantage was assessed with the Area Deprivation Index (ADI), a census-based socioeconomic index. For this study, participants’ zip codes were linked to 2020 ADI scores using the Neighborhood Atlas, and the census-block groups were ranked into state-level 1 to 10 deciles (split into halves- low and high). Higher ADI scores indicate greater disadvantage. The differences between the least and most disadvantaged groups were analyzed with binary logistic regression models.

Results

Data were available from 33 Veterans. The mean state-level ADI was 6.2 (SD = 2.7). Low and high state-level ADI scores were 4.3 (SD = 2, n = 19) and 8.7 (SD = 0.8, n = 14), respectively. Residing in zip codes with greater neighborhood disadvantage was associated with elevated fear of sleep (OR = 1.2, p = 0.04), and a trend for reduced sleep-period RSA (OR = 0.4, p = 0.05). No differences were observed for past week nightmare frequency.

Conclusion

In this sample of Veterans, living in the most disadvantaged neighborhoods was significantly associated with greater fear of sleep, and may be associated with reduced RSA. Sleep context may increase hypervigilance in turn serving as a mechanism by which trauma-induced sleep disruptions are maintained.

Support (if any)

Funded by the U.S. Department of Veterans Affairs, Veterans Health Administration Clinical Science Research and Development Service - IK2 CX001874.
0673 Sleep in PTSD: A Subjective Concern
Authors: Jacobus Brent , Brock Matthew
Published: May 2023

Introduction

Sleep complaints are a hallmark of posttraumatic stress disorder (PTSD). Prior studies examining sleep abnormalities in PTSD are inconsistent, with some reporting objective sleep changes including associated obstructive sleep apnea (OSA), possibly due to moderating variables including advancing age, traumatic brain injury (TBI), and medications. We sought to compare sleep disorders and objective and subjective sleep metrics in service members with and without PTSD while controlling for these potential confounders.

Methods

Case-controlled observational cohort study performed at an academic military sleep center. Detailed sleep history, sleep-related questionnaires, trauma history, and video-polysomnography was performed. Patients with a history of TBI, abnormal neuroimaging, or psychoactive medication use (antidepressants, antipsychotics, anxiolytics) were excluded.

Results

Patients (N=169, 124 males) were active duty service members (median age 37.1 years) reporting a sleep complaint. Of these, 43 (25.4%) had PTSD vs 126 (74.6%) without PTSD. In patients with PTSD vs no PTSD, there was no significant difference in the rate of OSA, mean total sleep time, sleep efficiency, mean apnea-hypopnea index, sleep stage percentage, or any other polysomnogram (PSG) variable. Stage N3 sleep was non-significantly increased in patients with PTSD (18% vs 14%, p=0.078). Subjective sleepiness was similar between those with and without PTSD (Epworth Sleepiness Score 12.9 vs 11.9, p=0.35). However, subjective insomnia symptoms (Insomnia Severity Index 20.4 vs 15.2, p< 0.0001) and perceived sleep quality (Pittsburgh Sleep Quality Index 15.4 vs 11.1, p< 0.0001) were worse in those with PTSD vs no PTSD.

Conclusion

In a relatively young active duty cohort with no history of psychoactive medication use or TBI, patients with PTSD had more subjective sleep complaints than those without PTSD but objective sleep parameters, including PSG variables and OSA rate, did not differ significantly. The higher stage N3 (slow wave) sleep percentage, though not statistically significant, suggests that PTSD patients sleep better in a monitored sleep lab than in their habitual sleeping environment.

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0680 Does Impulsivity Mediate the Association Between Sleep Disturbance and Binge Eating?
Authors: Lampe Elizabeth , Muench Alexandria , Seewald Mark , Boyle Julia , Perlis Michael , Grandner Michael , Tubbs Andrew , Manasse Stephanie
Published: May 2023

Introduction

It has been suggested that sleep continuity disturbance and/or short sleep duration is associated with increased impulsivity across clinical populations (i.e., The Mind After Midnight Theory). Consistent with this theory are the findings showing that sleep disturbance is associated with increased binge eating (BE; a subjective sense of loss of control over one’s eating) both cross-sectionally and longitudinally. To date, no study has examined whether impulsivity mediates the association between sleep disturbance and BE. Further, the extant literature has relied on retrospective self-report assessment of impulsivity which is subject to recall and social desirability biases. The aim of the present study was to examine whether performance on a behavioral measure of impulsivity (Go/No-Go task) mediated the association between sleep quality (SQ), sleep efficiency (SE%), and daytime dysfunction (DD), as measured by the PSQI, and BE frequency.

Methods

The parent study was a sample of 63 individuals (85.9% female; X̅age=40.6 years) seeking treatment for BE. Of note, individuals with extremely low levels of impulsivity were excluded from the parent study. Mediation models using the lavaan package in R (version 4.1.3) examined the effect of sleep disturbance on impulsivity and whether DD mediated this association.". The current analyses included the full available sample and all models co-varied for depressive symptoms.

Results

A negative direct effect of DD on impulsivity was observed (B=-55.43, S.E.=22.06, p=.01) and impulsivity did not significantly mediate the association between SQ (B=0.20, S.E.=0.59, p=0.73), SE (B=-0.02, S.E.= 0.14, p=0.92), or DD (B= 0.160, S.E.=1.14, p=0.51) and BE frequency.

Conclusion

While impulsivity did not mediate the association between sleep disturbance and BE in our sample, the current study may have been under-powered to detect even large effects due to its moderate sample size and low levels of insomnia symptoms. Future studies should evaluate these associations in large samples, using prospective measures of sleep continuity and do so in samples with clinical levels of insomnia. Further, such studies should take into account time of day considerations.

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0681 The Relationship between Safety Behaviors and Insomnia in individuals with Post-Traumatic Stress Disorder
Authors: Bui Brendan , Mills Audrey , Krouse Ryan , Hayes Kimberly , Pardes Adam , McGeoch Ellen , Chakravorty Subhajit
Published: May 2023

Introduction

Safety behaviors may perpetuate anxiety, maintain an individual’s perception of threats, and may lead to psychosocial impairment. Safety behaviors are commonly seen in those suffering from insomnia and post-traumatic stress disorder (PTSD). Despite their prevalence and associated impairments, there exists no data on the relationship between insomnia and safety behavior in those suffering from PTSD. The aim of this study is to evaluate the relationship between safety behavior and insomnia in those with PTSD. If such a relationship is seen, does the severity of nightmares or overall PTSD mediate this relationship between insomnia and safety behaviors?

Methods

The study extracted data from baseline assessments of a treatment study conducted at the VA Medical Center at Philadelphia. The subjects were treatment-seeking patients with PTSD (N =43). Safety behavior was evaluated using the 12-item brief Safety Behavior Assessment Form (SBAF), PTSD was evaluated using the PTSD checklist for DSM-5 (PCL-5), and insomnia with Insomnia Severity Index (ISI) scales. Bivariate analyses evaluated the relationship between SBAF total score and age, education, income, PCL-5, and ISI total scores. Nightmare severity was evaluated using item number 2 from the PCL-5 questionnaire. An analysis evaluated the role of the severity of nightmares or PTSD (PCL-5 total score after excluding the sleep and safety items) as independent mediators in the relationship between SBAF and ISI total scores.

Results

The mean±standard deviation of their age was 56.1±11.6 years and 13.1±2.1 years of education. They were mostly males (86.0%), black (61.9%) and unemployed over the past month (76.8%). The mean total score was 17.1±5.7 on the SBAF, 17.3±7.4 on the ISI, and 52.5±14.5 on the PCL-5. Bivariate analysis demonstrated that SBAF total score was associated with the ISI (β=0.32, p=0.0005 and PCL-5 (β=0.22, p=0.0004) total scores. Mediation analysis demonstrated a significant mediation effect of nightmares (R2=24.6%) and PTSD severity (R2=33.3%) on the association between safety behaviors and insomnia.

Conclusion

About sixty percent of the variance in safety behaviors was explained by insomnia and its association with PTSD or nightmare severity. Treatment of underlying insomnia, PTSD, or nightmares may improve the safety behaviors associated with PTSD.

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1IK2CX000855 (S.C.), and 1 I01 CX001957 (S.C.).
0683 Sleep disturbance, social functioning, and suicidal ideation among preadolescent children admitted to intensive psychiatric care
Authors: Buitron Victor , Gianukakis Ariel , Saletin Jared , Spirito Anthony , Walters Anne , Parent Justin
Published: May 2023

Introduction

Research on preadolescent childhood suicidality is sparse, with recent population-based studies providing support for sociodemographic and diagnostic correlates of preadolescent suicidal ideation. Sleep disturbance is of particular interest in the examination of preadolescent suicidal ideation because sleep health is interlinked with childhood psychosocial functioning; further, there are changes in preadolescent homeostatic regulation of sleep-wake and intrinsic circadian rhythm (i.e., delayed sleep onset), and psychosocial pressures in preadolescence, such as bedtime autonomy, that are increasingly manifested. There is a need to test models that begin to delineate associations between sleep disturbance and childhood suicidal ideation, specifically among youth with early-onset psychopathology. One possible explanatory factor in the association between sleep disturbance and suicidal ideation, grounded in existing theoretical frameworks of suicide, is social functioning (e.g., developmentally appropriate peer interactions and connectedness). The current study tested an indirect effects model in which sleep disturbance is associated with suicidal ideation via social functioning.

Methods

223 children (ages 7–12) with severe psychopathology who presented for intensive hospital-based treatment and their caregivers completed an assessment battery at admission, including the parent-reported sleep disturbances via the Children’s Sleep Habits Questionnaire, and child-reported dysregulated negative affect, social functioning, and suicidal ideation. Indirect effects were examined via the PROCESS macro for SPSS Version 4.0. Binary logistic regression was used when suicidality served as the dependent variable. All models controlled for youth age and dysregulated negative affect.

Results

Higher levels of parent-reported youth sleep disturbances were related to lower levels of youth-report social functioning. Further, lower levels of social functioning and higher levels of sleep disturbances were associated with higher odds of endorsing suicidal ideation. Indirect effects analyses indicated that higher levels of sleep disturbances was associated with increased odds of reporting suicidal ideation via the detrimental impact of sleep disturbances on social functioning.

Conclusion

The findings support the novel extension of explanatory models of suicide to children and highlight the possible role of sleep disturbance in the etiology of early suicidality. Documenting these associations provides the impetus for fine-grained examination of sleep health and social functioning among children who experience suicidal ideation and severe psychopathology.

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0685 Emotion Regulation Moderates the Relationship between Sleep and Social Participation
Authors: Hammer Lillian , Springfield Cassi , Tighe Caitlan , Bonfils Kelsey
Published: May 2023

Introduction

While poor sleep quality has been tied to worse social functioning, this relationship is complex and other variables likely play a role. For instance, emotion regulation and alexithymia are both related to sleep quality and to social functioning. Yet, the impact of these emotional processes on the relationship between sleep and social functioning remains unexplored. This study aimed to fill this gap by assessing whether alexithymia or two emotion regulation strategies –reappraisal and suppression—moderate the relationship between sleep and one aspect of social functioning (participation in social activities). We hypothesized that the relationship between sleep and social participation would be stronger for those who had greater difficulties in these emotional processes (high alexithymia, high suppression, or low reappraisal).

Methods

Data for this study came from the Pittsburgh Cold Study 3, a publicly available dataset (N = 213). Participants completed measures of self-reported sleep, emotion regulation, alexithymia, and social participation. Objective sleep data was also collected via actigraphy.

Results

The Reappraisal subscale significantly moderated the relationship between sleep quality and social participation. For participants with high reappraisal scores, worse sleep quality was related to lower social participation scores. Additionally, the Suppression subscale significantly moderated the relationship between actigraphy sleep duration and social participation. For participants with lower suppression scores, greater sleep duration was related to higher social participation. Alexithymia did not significantly moderate these relationships.

Conclusion

Our results suggest that the ability to effectively regulate one’s emotions may be important to consider in the link between sleep and social participation, as the relationship varies depending upon one’s use of emotion regulation strategies. Importantly, this sample included only individuals who had no recent mental health treatment. Future work should extend these findings by including a wider range of participants, including those with relevant diagnoses– such as borderline personality and schizophrenia-spectrum disorders.

Support (if any)

The data were collected by the Laboratory for the Study of Stress, Immunity, and Disease at the Carnegie Mellon University under the directorship of Sheldon Cohen, PhD; and were accessed via the Common Cold Project website (www.commoncoldproject.com; grant number NCCIH AT006694).
0686 High prevalence of sleep apnea in mental disorders – a need for use of sleep evaluation tools in psychiatric health care
Authors: Wichniak Adam , Sikorska Olga , Szaulińska Katarzyna , Wierzbicka Aleksandra , Smułek Daria , Gustavsson Katarzyna
Published: May 2023

Introduction

Sleep apnea is a prevalent disorder but it is frequently overlooked in diagnosing mental disorders. The aim of the present study was to screen for sleep apnea in a group of patients referred for diagnosing mental disorders or non-restorative sleep and to assess the accuracy with which such testing can be replaced with commonly used screening questionnaires for sleep apnea.

Methods

104 patients were investigated – 58 with mental disorders (26 with affective disorders, 26 with schizophrenia spectrum disorders, 3 with anxiety disorders, 3 with neurocognitive disorders; mean age 37.5±9.5 years, 24% females, BMI 32.8±6.5 kg/m2) and 46 with non-restorative sleep (mean age 41.2±14.6, 39% females, BMI 26.3±4.8 kg/m2). The patients were screened for sleep apnea with a home sleep apnea test (HSAT) based on peripheral arterial tonometry (PAT) and were asked to fill in the Sleep Apnea Scale from Sleep Disorders Questionnaire (SDQ-SA), the STOP-BANG and the Berlin questionnaires (BQ), and the Epworth Sleepiness Scale (ESS).

Results

Apnea-Hypopnea Index of > 5/h was found in 57 (55%) patients: 36 (62%) patients with mental disorders and 21 (45%) patients with non-restorative sleep. An increased risk for sleep apnea was found in 45 patients (43.3%) using SDQ-SA, 64 (61.5%) using BQ, 80 (76.9%) patients using STOP-BANG with the cut-off of 3 points and 30 (28.8%) with the cut-off of 5 points. Positive predictive values were: 65.9% for SDQ-SA, 71.0% for BQ, 68.8% for STOP-BANG with the cut-off of 3 point and 75.9% with the cut-off of 5 points. Negative predictive values were 49.1%, 63.0%, 83.3% and 51.4% respectively. Diagnostic accuracy was highest for STOP-BANG with the cut-off of 3 points – 72.3% and lowest for SDQ-SA – 56.6%. Excessive Daytime Sleepiness was found in 44 (42.3%) of patients. Three patients (2.9%) refused or did not complete the HSAT.

Conclusion

Inclusion of HSAT in the diagnostic process revealed high prevalence of sleep apnea in patients with mental disorders. Psychiatrists should be encouraged to include HSAT in evaluation of patients. Such testing is patient-friendly and using only screening questionnaires does not provide high enough diagnostic accuracy.

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0687 Loneliness, Sleep, and High Risk Alcohol Use in College Students Before and During the COVID-19 Pandemic
Authors: Cutrer Caleb , Prichard J Roxanne
Published: May 2023

Introduction

The aim of this study is to determine what behavioral and psychological factors were predictive of high-risk drinking in students with and without a Substance Use Disorder (SUD) diagnosis. We also compared how these relationships differed between Fall 2019, before the COVID-19 pandemic, and Fall 2020, a period of increased financial stress, distance learning, and social isolation.

Methods

We used factor analysis to extract a wide range of behavioral and psychological predictor variables from the Fall 2019 and Fall 2020 American College Health Association’s National College Health Assessment III (ACHA-NCHA). Next, we used structural equation modeling to identify significant drivers of high-risk alcohol use (ASSIST alcohol subscale) in students with (n = 577) and without (n = 50,926) SUD diagnosis.

Results

When compared to 2019, both students with and without SUD diagnosis showed lower levels of high-risk drinking, more difficulties falling asleep, and longer sleep duration. In students without SUD, short sleep duration and loneliness were the primary predictors of past year high risk alcohol use. In students with SUD, long sleep latencies and loneliness (UCLA Loneliness Scale) were the primary predictors, and sleep factors predicted more variance in high-risk alcohol use than in the general college population. Students with SUD diagnosis who also had sleep latencies >30 minutes were significantly more likely to report binge drinking (>5 drinks in one sitting) than those with shorter sleep latencies.

Conclusion

Sleep factors and loneliness are large predictors of problematic alcohol use in both students with and without diagnoses of Substance Use Disorder. In the first year of the COVID-19 pandemic, students sleep patterns changed with students reporting longer sleep, but also greater symptoms of insomnia.

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