bluuebunny/crossref_metadata_2025 huggingface dataset:
1026 Associations Between Physiological Arousal and Executive Function in Adults With Chronic Widespread Pain and Insomnia Complaints
Authors: Curtis A F , McGovney K , McCrae C S
Published: May 2020

Introduction

Individuals with chronic widespread pain (CWP) commonly experience increased physiological arousal, insomnia symptoms, and cognitive disturbance. Higher arousal (as measured by heart rate variability, HRV) is associated with worse executive function in healthy adults, suggesting that hyperarousal selectively disrupts prefrontal cortical activity. However, the HRV/cognition relationship in CWP, the moderating impact of insomnia severity, as well as the components of executive function affected, are unclear. The present study assessed independent associations between HRV and components of executive functioning in patients with CWP and insomnia complaints, and evaluated whether these associations depend on insomnia severity.

Methods

Forty-two adults (Mage=46.2, SD=13.7) with comorbid CWP and insomnia complaints (difficulty falling/staying asleep plus daytime dysfunction) underwent 5-minutes of Holter monitoring to assess resting HRV. The root mean standard deviation of successive normal to normal heartbeats (RMSDNN) was computed as the HRV index. Participants completed the Insomnia Severity Index (ISI). Participants also completed three computerized tasks measuring executive function: Stroop task (inhibition), Sternberg task (working memory), and the Balloon Analogue Risk Task (risk taking behavior). Multiple regressions examined whether RMSDNN independently predicted or interacted with ISI to predict cognition, controlling for age.

Results

RMSDNN independently predicted Stroop performance, with higher RMSDNN (lower arousal) associated with lower interference scores (better inhibitory function), B=-.003, SE=.001, p=.029, Full Model R2=.31. RMSDNN and ISI did not independently predict or interact to predict Sternberg/BART performance.

Conclusion

In patients with CWP and insomnia symptoms, reduced physiological arousal was associated with better inhibition, and this did not depend on insomnia severity. Findings highlight the potential underlying role of hyperarousal in a specific component of executive disruption in CWP. Results suggest that treatments aimed at reducing physiological arousal in comorbid CWP and insomnia (e.g., relaxation, HRV biofeedback) may selectively improve inhibitory function. Findings warrant further consideration in larger samples and prospective analyses.

Support

Research was supported by the National Institute of Nursing Research (NR017168; PI: McCrae). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN2) at the University of Missouri (PI: McCrae).
1031 Exploring the Impact of Cognitive Behavioral Therapy for Insomnia (CBT-I) on Daytime Productivity in Survivors of Breast Cancer
Authors: Kieley J , Walsh N , McCarthy J , Powell E , Garland S N
Published: May 2020

Introduction

Post-treatment insomnia disorder and fatigue symptoms can impair work and daytime productivity in breast cancer survivors. Cognitive Behavioral Therapy for Insomnia (CBT-I) significantly improves insomnia and daytime fatigue. This feasibility study examined whether improving insomnia and fatigue using CBT-I is associated with improved work and activity productivity in breast cancer survivors.

Methods

10 survivors of early stage breast cancer participated in 7 weekly individual CBT-I sessions. The primary outcome was the Work Productivity and Activity Impairment Questionnaire-General Health (WPAIQ-GH) questionnaire. Secondary outcomes were the Insomnia Severity Index (ISI) and the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Assessments were conducted at baseline and post-treatment. Paired samples t-tests examined the impact of CBT-I on productivity and fatigue. Linear regression assessed whether change in fatigue was associated with change in productivity.

Results

Participants had a mean age of 50.8 (range 42-63) and the majority were diagnosed with stage II (60%) cancer. There was a significant reduction in fatigue [t(9)= 2.43, p =.04] and activity impairment due to insomnia [t(9)= 3.105, p <.05] following treatment. Insomnia affected 52% of work productivity at baseline with a non-significant decrease to 15% following treatment [t(3)= 2.25 p= .110]. Reductions in fatigue were significantly associated with reductions in activity impairment [F(1,8)= 7.25, p =.03], accounting for 47.5% of the variability.

Conclusion

Treating insomnia with CBT-I significantly improved daytime productivity, activity impairment, and fatigue. Controlled research with larger sample sizes is warranted to confirm these preliminary results.

Support

Nyissa Walsh is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute (BHCRI). Dr. Sheila Garland is supported by a Scotiabank New Investigator Award from BHCRI.
1032 Auricular Point Acupressure for Sleep Disturbance in Women With Breast Cancer: A Pilot Randomized Controlled Trial
Authors: Wang Y , Wu J , Li J , Zhou J
Published: May 2020

Introduction

Sleep disturbance is reported in up to 60% of cancer patient. In traditional Chinese medicine, evidence suggests that auricular point acupressure (APA) improves sleep. However, little is known about APA’s effect on sleep disturbance in patients with breast cancer (BC). We tested the preliminary efficacy of APA on sleep in BC women undergoing chemotherapy.

Methods

A pilot randomized controlled trial was conducted in 41 BC patients (mean age=50±14) with self-reported poor sleep [Pittsburgh Sleep Quality Index (PSQI)≥7]. Participants were randomly assigned to an APA group (n=22) and a control group (n=19). All patients received sleep hygiene education. Additionally, for the APA group, magnetic pellets were attached to selected auricular points once a week for 3 weeks at the clinic, and the participants were instructed to self-press the pellets 4 times a day. Sleep were objectively measured by Actiwatch Spectrum and subjectively using PSQI at baseline and post-intervention. Paired t-tests and analyses of covariance using the variable baseline values were used to examine changes in sleep parameters.

Results

Twenty-one participants from the APA and sixteen from the control groups completed the study. Within the APA group, PSQI [mean difference (MD)=3.85, 95% Confidence Interval (C)=3.12~4.60] and sleep onset latency (MD=18.02, 95%CI=5.96~30.09) were significantly decreased, and the sleep duration (MD=-0.53, 95%CI=-0.99~-2.35) and sleep efficacy (MD=-5.00, 95%CI=-8.72~-1.28) were significant increased at post-intervention. Compared to the control group, participants in the APA group had significantly lower PSQI (F=30.77, p<0.001) and greater sleep efficacy (F=5.25, p=0.028) at post-intervention.

Conclusion

APA may be an inexpensive and effective approach to improve sleep in patients with BC. More rigorous research with larger samples is needed to further test the efficacy of APA on promoting sleep in BC patients.

Support

None
0106 The Effects of Caffeine on Blood Pressure and Cognitive Performance in Hypoxic Conditions on the Slopes of Mt. Everest
Authors: Sparks K , Wehling R R , Acharya S , Musliu T , Baniya S , Hackett P H , Ozuru Y , Jung C M
Published: May 2020

Introduction

140 million people live above 2,400m worldwide. High altitude (HA) exposure can lead to sleep disruption, impaired cognitive performance, acute mountain sickness (AMS), elevated blood pressure (BP) and an increase in cardiovascular events in healthy people. Because caffeine can also increase BP, caffeine might need to be avoided at HA. Caffeine is the most widely used drug in the world but has yet to be studied extensively in hypoxic conditions. Therefore, the aim of the current study was to examine the effects of caffeine on cardiovascular variables and cognitive function at HA.

Methods

We conducted a non-randomized, single-blind, mixed model design at 4,300m on Mt. Everest. Thirty-three trekkers (nine females), aged 29.5±10.4 (mean±SD), ingested the study drug (placebo or 200 mg of caffeine) 1.5 hours after awakening. To control for withdrawal effects of caffeine, participants that self-reported consuming less than 47 mg of caffeine per day received the placebo while those that consumed more than that received caffeine. Cognitive function was tested using the Stroop task before and after the pill administration. BP was measured by a trained clinician using auscultatory method prior to and 30, 60 and 90 min after the pill administration.

Results

Caffeine improved cognitive performance when compared to the pretreatment measurement but was worse in the caffeine group prior to the pill administration when compared to the pretreatment placebo group. Additionally, caffeine did not have any major effect on BP when compared to pretreatment measures or the placebo group.

Conclusion

Caffeine does not seem to have an additive effect on increasing BP with HA. Additionally, because cognitive performance was worse in the chronic caffeine users prior to the pill administration, caffeine users might be more dependent on caffeine to perform optimally at HA. Based off of these data, caffeine seems to be a safe and beneficial drug at HA.

Support

NIH BUILD EXITO, University of Alaska Faculty Development Grant
1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence?
Authors: Youngren W A , Miller K
Published: May 2020

Introduction

The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content.

Methods

Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests.

Results

Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p < 0.001).

Conclusion

Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course.

Support

None.
1068 Using Sleep to Avoid Inpatient PTSD Treatment
Authors: Woodward S H , Jamison A L , Souter T , Shin H J , Loew D E , Armontrout J A
Published: May 2020

Introduction

During inpatient psychiatric treatment, mattress actigraphy can be used to track nightly sleep in a zero-burden fashion to examine its relationships with other markers of treatment progress. We report here on associations between actigraphic sleep parameters and treatment markers in combat veteran engaged in inpatient treatment for posttraumatic stress disorder. We focus first on sleep scheduling, the best-validated outcome available from actigraphic data.

Methods

140 combat veteran inpatients provided between 5 and 164 nights of mattress actigraphy over the course of their inpatient psychiatric hospitalizations. The sample was characterized by multiple traumas and a high prevalence of comorbid mood and substance use disorders. Approximately one-half of the sample had undergone objective screening for OSA and for this subsample AHI < 20 was used as an inclusion criterion. Unscreened participants were required to have a BMI < 35. Inclusion also required mean actigraphic SE > 60%. The PTSD Checklist and Combat Exposure Scale were obtained at admission, from which a trauma load index was created by adding z-scores obtained from standardizing these scales.

Results

In a multiple regression analysis, after accounting for secular change in LOS, higher trauma loads (p < 0.001) and earlier bed times (p = 0.001) were both significantly associated with shorter lengths of stay (LOS; F(3,137) = 10.4, p < 0.001; adj. R-squared = 0.17). Trauma load and bed time did not interact (p = 0.7).

Conclusion

Avoidance is a criterial symptom of PTSD. Early bed times and early exits from treatment may both reflect the impact of syndromal avoidance on treatment, limiting its dosage and benefit. If so, prescribing later bed times may have utility in inpatient treatment programming.

Support

Award W81XWH-15-2-0005 from the Department of Defense, Military Operational Medicine Research Program and the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Palo Alto VA Medical Center.
1077 The Association Between Sleep Problems And Risk-taking Behavior Differs Between Racial Majority And Minority Groups
Authors: Burns A I , Bullock A , Taylor E , Grandner M A , Alkozei A , Killgore W D
Published: May 2020

Introduction

Individuals with Post-Traumatic Stress Disorder (PTSD) often experience poor sleep quality and elevated self-destructive behaviors. Among healthy individuals, poor sleep quality can lead to increased risk-taking behavior through decreased inhibition and/or increased willingness to take risks. However, it is unclear whether racial/ethnic background may influence this relationship, in particular among individuals with PTSD. We examined whether the relationship between sleep quality and risk propensity would differ between majority and minority racial groups in individuals with PTSD.

Methods

Seventy-six individuals (61.8% female; mean age=31.7, SD=8.8) with a clinical diagnosis of PTSD were administered the Functional Outcomes of Sleep Questionnaire (FOSQ) as a measure of sleep-related functional impairment of daily activities, and the Evaluation of Risk (EVAR) Scale as a measure of risk-taking propensity. Forty-seven individuals identified with the majority racial group (Caucasian) and 29 individuals identified themselves within the minority.

Results

There were no significant group differences for FOSQ and total EVAR risk-taking scores. However, the strength of association between measures differed significantly between groups (Z=1.95, p=.051). For the racial/ethnic majority, functional impairments due to lack of sleep were positively associated with risk-taking propensity (r=.460, p=.001); this relationship was not present for the minority group (r=.016, p=.936).

Conclusion

Self-reported functional impairments due to sleep loss significantly correlated with risk-taking propensity for those who identified themselves as part of the majority racial group but not for individuals who identified as part of a racial minority. Findings suggest that broad conclusions regarding the association between sleep disruption and risk-taking may not apply equally across racial/ethnic groups and such factors should be considered when evaluating studies of sleep and risk behaviors. Whether these differing effects are due to cultural factors or stable differences in biology is not known and will require additional research.

Support

W81XWH-14-1-0570
1089 Water Intake Moderates the Relationship Between Sleep Quality and Depressive Symptoms: The Latino Health and Well-Being Study
Authors: Blanc J , Williams N , Jean-Louis G , Lemon S , Rosal M
Published: May 2020

Introduction

This study examined the relationships between sleep quality and depressive symptoms, and whether this relationship is moderated by frequency of water intake in a sample of Latino adults.

Methods

Participants in this community-based study were 574 Latino adults from Lawrence, Massachusetts. Assessments included surveys and anthropological measures. Variables in this study included sleep quality (Pittsburgh Sleep Quality Index- PSQI), depressive symptoms (Center for Epidemiologic Studies Depression Scale -CES-D) and frequency of water intake in the previous three months (investigator-developed question). Covariates included demographics, stress (Perceived Stress Scale-PSS), and body mass index (BMI). Multiple linear regression analyses were conducted to explore associations between sleep and depressive symptoms. Potential moderating effect of frequency of water intake was assessed using hierarchical, moderated, multiple regression analysis.

Results

The sample was 51.2% female, with a mean age of 46.6 years (SD=15.4) and mean BMI of 29.6 (SD=5.9); 31% of the sample had CES-D scores > 22 (cut off for elevated depressive symptoms), the mean PSQI score was 13.11(SD=3.4) and 92% reported water intake two or more times daily. Sleep quality correlated positively with depression (r=.558; p=.000). After adjusting for covariates, sleep quality was strongly associated with depression (B = .417; SE=13; p =.000). The relationship between sleep quality and depressive symptoms was moderated by frequency of water intake (B= -.186, SE =1.107; p= 0.11).

Conclusion

This study is among the first to examine the association between sleep quality and depressive symptoms among Latino adults, and to show that frequency of water intake may moderate this association in this population.

Support

This study was supported by funding from the NIH: R01 MH085653; 1U48DP006381; and T32HL129953.
1093 Population-level Suicide Ideation: Impact Of Combined Roles Of Sleep Duration, Sleep Disturbance, And Daytime Sleepiness
Authors: Jajoo A , Tubbs A , Perlis M L , Chakravorty S , Seixas A , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Poor sleep has been shown to be related to suicide ideation and depressed mood, but population-level studies have not been done to explore the specific issues within sleep that effect mood, specifically leading to suicide ideation.

Methods

Data from adults 18 and older in the 2015-2016 National Health and Nutrition Examination Survey (NHANES) who provided complete data were used (N=5,123). Suicide ideation was recorded as the presence of thinking that “you would be better off dead” in the past 2 weeks. Sleep duration was recorded in half-hour increments and transformed to represent absolute distance from 7 hours (to model u-shaped association). Sleep disturbance was recorded as presence of “difficulty falling asleep, staying asleep, or sleeping too much” non, several days, or more than half the days of the past 2 weeks. Sleepiness was frequency feeling “overly sleepy during the day” in the past 12 months. Covariates included age, sex, race/ethnicity, and presence of depressed mood in the past 2 weeks. Additional impact of difficulty thinking/concentrating in the past 2 weeks was explored. NHANES sample weights were used in analyses.

Results

In adjusted analyses, increase likelihood of suicide ideation was associated with distance from 7hrs (OR=1.24/hr, p=0.008), sleep difficulties most of the time (OR=2.46, p=0.001), but not sleepiness. When both sleep variables were adjusted for each other, results remained significant for U-shaped sleep duration (OR=1.21/hr, p=0.02) and sleep disturbance (OR=2.31, p=0.003). These were attenuated but remained significant when difficulty thinking/concentrating was introduced; a significant sobel test (p<0.0001) suggested partial mediation, with this variable accounting for approximately 13% of the variance of the relationship to sleep.

Conclusion

In the population, improper and poor sleep was associated with a greater risk of suicide ideation.

Support

Dr. Grandner is supported by R01MD011600
1094 Depression Is Not Associated With The Presence Of Or The Severity Of Obstructive Sleep Apnea: Retrospective Study Of 841 Polysomnography Subjects
Authors: Im K , Kim L , Immen R
Published: May 2020

Introduction

Both depression and obstructive sleep apnea (OSA) are very common medical conditions. Studies showed a co-occurrence of depression and OSA with a higher prevalence of one if the other is present. However, there is relative paucity of studies assessing the rate of depression based on the OSA severity.

Methods

Retrospective analysis of data collected from patients undergoing polysomnography (PSG) at an academic sleep disorders center was performed. A total of 841 subjects were included and stratified into four groups using AHI. A Chi-square analysis was applied to assess the association of varying levels of AHI and the presence of depression.

Results

Although a significant proportion of patients with AHI greater than 5 endorsed depression (60/165 in group with AHI 15 or greater and 115/278 in group with AHI between 5 and 15), this finding was also replicated in patients with AHI less than 5 (86/202 in AHI between 1 and 5 and 88/196 in those with AHI less than 1). As there was significant difference in rate of depression among women (54.1%) and men (26.1%) (p <0.0001), Chi-square analysis was performed for the rate of depression based on the level of AHI, adjusted for gender. In women the rate of depression from the most severe AHI to less severe AHI group were 0.48, 0.53, 0.60, and 0.53 respectively and in men it was 0.30, 0.27, 0.20, and 0.27 respectively, with no statistical difference between any groups.

Conclusion

Among patients who seek PSG assessment, depression appears to be more prevalent than the general public. Rate of depression is much higher among women than men in this group. However, the presence of OSA or severity of OSA does not have any correlation with the rate of depression in both women and men. These findings might be suggestive of the complexity of the association between depression and OSA. One limitation of this study is the dichotomous nature of depression (presence or absence of). The finding from this study warrants a future study utilizing a numerical rating scale of depression for severity measure to correlate it with the severity of OSA.

Support

NA.
1099 Sleep Restriction Leads To Greater Next-day Anxiety: The Moderating Role Of Anxiety And Depression
Authors: Bean C A , Ciesla J A
Published: May 2020

Introduction

Evidence from both experimental and daily-diary studies suggests that a single night of sleep restriction leads to higher levels of anxiety the following day. Depressive symptoms also increase the next day in healthy populations, although sleep restriction has demonstrated short-term antidepressant properties in depressed populations. Relatively little research has examined symptoms of anxiety and depression separately on days following naturally-occurring sleep restriction and whether any change from the previous day might be moderated by baseline levels of anxiety or depression.

Methods

Undergraduates completed electronic daily diaries twice per day for 14 days (N = 96). Upon waking, participants answered questions assessing their sleep, and every evening, before going to bed, completed the Mood and Anxiety Symptom Questionnaire - Short Form to assess daily levels of general distress, anxious arousal, and anhedonic depression. The State-Trait Anxiety Inventory - State and the Center for Epidemiologic Studies Depression Scale provided baseline measures of anxiety and depression, respectively. A night of sleep restriction was operationally defined as one for which participants reported obtaining 4 hours of sleep or less.

Results

Multilevel modeling revealed that anxious arousal was higher following sleep restriction (β =.92, z=2.40, p=.017). This was moderated by baseline anxiety (β =.09, z=2.89, p=.004) and baseline depression (β =.09, z=3.39, p=.001) so that anxious arousal was even higher the next day for individuals reporting a high number of anxious and depressive symptoms. These effects remained significant after controlling for lagged anxious arousal, gender, baseline anxiety and depression, substance use, and napping. Conversely, no significant results were found when next-day general distress or anhedonic depression were examined.

Conclusion

Our results suggest that naturally-occurring sleep restriction is accompanied by increases in anxiety, but not depressive symptoms, the following day. This effect is heightened in individuals with higher baseline levels of anxiety and depression.

Support

N/A
1102 Relationship Between Emotional Distress And Sleep Duration Among Hispanics Using The 2018 National Health Interview Survey Dataset
Authors: Garcia J , Moore J , Payano L , Rogers A , Poke P , Casimir G , Jean-Louis G , Seixas A
Published: May 2020

Introduction

Although Hispanics experience a high level of shorter sleep duration (< 7 hrs./24 period), a clear mechanism or cause is lacking. Previous research indicate that emotional distress may explain the burden of shorter sleep among blacks. Applying these findings to Hispanics, we investigated whether emotional distress explains the burden of short sleep duration (< 7 hrs.) among Hispanics and if this relationship varies by sex

Methods

We used data from the 2018 National Health Interview Survey (NHIS) dataset, a nationally representative sample, in which only Hispanic ethnicity participants (N=3,091) were analyzed. Average sleep duration was self-reported and measured in hours. Emotional distress was measured using Kessler 6, which measures how an individual felt over the past 30 days: nervous, hopeless, restless/fidgety, depressed, effortful and worthless. To assess the association between short sleep duration and emotional distress, we performed Pearson correlation, hierarchical regression analyses, and stratified this relationship by sex to determine if this relationship differed between males and females, adjusting for covariates.

Results

Of the total sample of 3,091 Hispanics, 1,762 were female, and 1,329 were male. Sleep duration and emotional distress were negatively correlated among females (r = -.27, p <.001) and males (r=-.18, p <.001). Among Hispanic females, sleep duration significantly predicted emotional distress, β = -.27, t = -11.60, p <.001, and explained a significant portion of variance in emotional distress, R2 = .07, F= 134.63, p <.001. While, among Hispanic males, sleep significantly predicted emotional distress (β = -.18, t =-6.5, p <.001) and explained a significant portion of the variance in emotional distress (R2 = .03, F= 42.37, p <.001).

Conclusion

Our findings indicate that a negative sleep-ED relationship, suggesting that shorter sleep was predictive of higher levels of emotional distress among Hispanics and that this relationship is greater among Hispanic females, compared males.

Support

K01HL135452, R01MD007716, R01HL142066, and K07AG052685
1112 Mental Health And Sleep Disorders Are Associated With Elevated C-reactive Protein In Returning Veterans
Authors: Straus L D , Colvonen P J , Bertenthal D , Neylan T C , O’Donovan A
Published: May 2020

Introduction

Mental health disorders and sleep disorders are associated with systemic inflammation, which may be a key element linking these highly co-occurring conditions to negative health outcomes. This study used national VA medical records to examine C-reactive protein (CRP) levels in Iraq/Afghanistan veterans based on presence of mental health and/or sleep disorder diagnoses.

Methods

We examined medical records for 16,576 Iraq/Afghanistan veterans under age 55 who had high-sensitivity CRP results reported. ICD diagnostic codes were used to compare CRP values for: a) veterans without sleep disorders or mental health diagnoses, b) veterans with mental health disorders only, c) veterans with sleep disorders only, and d) veterans with both conditions. In generalized linear models controlling for demographics, we examined the impact of diagnostic category on continuous CRP value as well as the risk of elevated CRP (>3mg/L).

Results

Veterans with mental health disorders (coeff=.14, p<.001) and comorbid sleep and mental health disorders (coeff=.21, p<.001) had higher continuous CRP values compared to veterans without either condition. Veterans with comorbid sleep and mental health disorders had higher continuous CRP values than veterans with sleep disorders alone (coeff=.22, p<.041); however, there were few patients in the current sample who were diagnosed with sleep disorders alone (n=401, 2.4%). Additionally, veterans with mental health disorders (ARR=1.12, p=.004) and comorbid sleep and mental health disorders (ARR=1.15, p=.001) were more likely to have CRP values >3mg/L compared to veterans without either condition.

Conclusion

Sleep disorders were highly likely to co-occur with mental health disorders in this sample of Iraq/Afghanistan veterans. Mental health disorders and comorbid mental health/sleep disorders were associated with elevated C-reactive protein, indicating these patients are at highest risk for negative health outcomes. Future studies should investigate directionality of relationships among sleep disruption, mental health symptoms, and inflammation.

Support

VA Advanced Fellowship Program in Mental Illness Research and Treatment
1115 Sleep Misperception, Anxiety, And Sleep Quality
Authors: Weathers J , Moran E , Stiver J , Zimmerman M
Published: May 2020

Introduction

Sleep misperception is a phenomenon often identified in insomnia literature, in which individuals subjective reporting does not match objective measurements of their own sleep. Research indicates that anxiety symptoms may play a role in sleep misperception. This study assessed the relationship between sleep misperception, sleep quality, and anxiety in a young adult population with sub-clinical insomnia and anxiety symptoms. Linear regression models examined the relationships between sleep quality, anxiety symptoms, and sleep misperception.

Methods

This sample consisted of 130 young adults recruited from a University in the Bronx, NY. Anxiety was assessed using the Beck Anxiety Inventory (BAI), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective measures of sleep were collected via wrist-based actigraphy over a period of 7-14 days. Subjective sleep measures were collected via an online sleep diary. A misperception index was calculated to determine the discrepancy between subjective and objective sleep measures based on a formula established in previous research.

Results

Higher anxiety symptoms were associated with greater sleep disturbance. Higher sleep misperception was not associated with greater sleep disturbance. There was a significant, positive relationship between sleep misperception and anxiety symptoms (r=0.18, p=0.000). Gender emerged as an important covariate, with males exhibiting significantly higher sleep misperception and underestimating TST (M=-0.31, SD=0.22) compared to females (M=-0.18, SD=0.12).

Conclusion

Sleep misperception was not related to sleep quality, but was strongly related to anxiety symptoms in this population. In a sub-clinical young adult sample, sleep misperception is associated with anxiety but not sleep quality, and has significant gender differences. These findings contribute to sleep misperception literature with potential applications in diagnosis and treatment of insomnia and anxiety.

Support

n/a
0114 Morning Stimulant Administration Reduces Sleep and Overnight Working Memory Improvement
Authors: Tselha T , Whitehurst L N , Tina V , Benjamin Y D , Mednick S C
Published: May 2020

Introduction

The goal of cognitive enhancement is to improve mental functions using interventions including cognitive training, brain stimulation and pharmacology. Indeed, psychostimulants, commonly used for cognitive enhancement purposes, while preventing sleep, have been shown to increase working memory (WM) and attention. WM is widely believed play a core role in cognitive ability, and has been shown to correlate with broad measure of cognitive ability and fluid intelligence. Sleep, however, is also important for cognitive function; thus, understanding the interaction between stimulants, sleep and cognition may inform current approaches to cognitive enhancement.

Methods

We used a double-blind, placebo controlled, repeated-measure design to investigate the effect of morning administration (9am) of stimulant, dextroamphetamine (DEX, 20 mg), on within-day and overnight WM performance, and sleep in 46 (22 female) healthy young adults. We tested WM using an operation span task (OSPAN) as it engages and captures both the memory retention and online processing capacity of WM. WM was tested at 75 minutes post drug, 12 h post drug, and 24 h post drug over a night of sleep.

Results

Compared with placebo, DEX showed no changes to WM performance at 75min or 12-hr post-drug. After sleep, DEX performed worse than PBO and the overnight improvement in performance in the PBO condition was absent in the DEX condition. Moreover, sleep quality was negatively affected by DEX administration.

Conclusion

In summary, we found no cognitive boost from psychostimulants across a day of wake and a blockade of overnight WM increases with the stimulant, compared to PBO. Given the growing non-medical use of stimulants in young adults, these findings have important implications for assessing their benefit for cognitive enhancement.

Support

Office of Naval Research N00014-14-1-0513 (S.M.) and DoD Young Investigator Prize (S.M.)
1133 The Recovery of Sleep Oscillations in Acute to Chronic Traumatic Brain Injury
Authors: Sanchez E , Duclos C , Van Der Maren S , El-Khatib H , Arbour C , Baril A , Blais H , Carrier J , Gosselin N
Published: May 2020

Introduction

Slow waves and spindles are essential oscillations occurring during NREM sleep that may be disrupted by moderate to severe traumatic brain injury (TBI). We investigated these oscillations in the acute and chronic trauma stage.

Methods

Four groups were tested with whole-night polysomnography: hospitalized patients with acute TBI (n=10, 29.7±13.8y) or severe orthopedic injuries (n=15, 39.9±17.1y), chronic TBI including 9 returning from the acute TBI group (n=43, 31.9±13.5y), and healthy controls (n=36, 30.5±12.7y). Characteristics for slow waves (density, amplitude, slope, frequency, duration) and spindles (density, amplitude, frequency, duration) were quantified over N2 and N3 sleep for the first three sleep cycles, and groups were compared using one-way ANOVAs.

Results

One-way ANOVAs showed group effects only for slow wave density (F=4.11 to 6.04, p=0.009 to 0.0008)) and spindle density (F=3.3 to 8.8, p=0.02 to 0.00003). These effects were present for the 2nd and 3rd sleep cycles, but not the 1st. More specifically, slow wave density in acute TBI was higher than in controls, and returned to normal levels in the chronic stage. Conversely, spindle density in acute TBI was lower than in controls and returned to normal levels in the chronic stage. No group difference was observed for the orthopedic group.

Conclusion

Our results suggest that immediately after a severely disruptive event such as a TBI, the brain needs additional deeper sleep to recover, resulting in more slow waves but also in less spindles. These changes are only present in the 2nd and 3rd sleep cycles, reflecting an absence of the expected dissipation of slow waves, which may suggest increased homeostatic sleep pressure due to the brain injury. Limits to interpretation include the hospital environment and medication, but the absence of changes in the orthopedic group under similar conditions emphasizes the effect of the brain injury itself.

Support

Canadian Institutes of Health Research (CIHR) and Fonds de Recherche Québec-Santé (FRQS)
1138 OSA In A Patient With PFO, Is It The “Perfect Storm” For A Stroke? A Case Series Of 3 Patients With Stroke At Young Age, Due To PFO And Comorbid OSA
Authors: Wong J , Gupta D , Nadhim A
Published: May 2020

Introduction

Approximately 25% of all strokes are cryptogenic in nature, and about 50% of all young patients with cryptogenic stroke are found to have patent foramen ovale (PFO), which is known to be the most common cause of right-to-left shunting (RTLS). Studies have shown a 2.2-fold increase in right-to-left shunt in patients with OSA and PFO, compared to patients with PFO alone. Hence, increasing the risk of cardio-embolic stroke in such patients. We present a case series of 3 patients with PFO that had embolic stroke at a young age and were found to have comorbid OSA, the likely exacerbating factor of a RTLS.

Methods

A 38-year old female, a 59-year old male, and a 27-year old female presented with stroke-like symptoms without clear vascular pathology. Upon further work-up, all were found to have PFO with RTLS. Subsequently, these patients were referred for sleep evaluation, and each one was found to severe REM-related OSA with prominent oxygen desaturations. All three patients were started on PAP therapy for control of their OSA. Two out of the 3 patients opted for PFO closure, and the 3rd patient opted for anti-platelet therapy alone. He has had no recurrence of TIA/stroke after 12 years so far.

Results

These cases illustrate a correlation between right-to-left shunting and severe REM-related OSA, through possible elevation of right-sided pressure due to nocturnal desaturations/hypoxemia. Hence, it is worth consideration that the increased right-sided pressure induced by apneic events in sleep may be a potential exacerbating factor in producing stroke-like symptoms sooner in patients with PFO than in patients with PFO who are without OSA.

Conclusion

It may be beneficial to assess young patients with stroke due to PFO, for comorbid OSA as a cause of the RTLS. This would help to prevent recurrent stroke in such patients and improve quality of life.

Support

No financial support.
1139 Sleep Disturbances In Chronic Stroke Patients: Emotional And Cognitive Impact
Authors: Howell S N , Robinson S E , Griesbach G S
Published: May 2020

Introduction

The objective was to investigate the impact of sleep-wake disturbances (SWD) on cognition and quality of life in the post-acute phase of stroke.

Methods

Adult stroke (n=92) patients were assessed for SWD via overnight polysomnography. The mean age was 52 ± 1 years and mean latency from injury was 117 ± 10 days. Sleep measures included total sleep time (TST), sleep and REM latency, percent time in sleep stages, apnea/hypopnea index (AHI), wake after sleep onset (WASO), and arousal index. The primary cognitive/outcome measures were: Montreal Cognitive Assessment (MoCA), California Verbal Learning Test (CVLT-II), Neuro-QoL and Mayo Portland Adaptability Inventory (MPAI).

Results

Women had lower AHI (F(1,88)=9.360, p<.01), fewer arousals (F(1,90)=4.53, p<.05), and spent significantly more time in SWS (F(1,90)=11.525, p<.001) than men; however, SWS was reduced in both sexes. SWS made up < 3% of TST in 60% of patients and was not correlated with higher AHI. SWDs negatively impacted subjective quality of life (NeuroQOL). Longer latencies to sleep were associated with increased depression (p<.05) and decreased positive affect (p<.01). Increased sleep efficiency led to improved positive affect (p<.05) and decreases in emotional/behavioral dyscontrol (p<.05). Increased time in REM sleep decreased emotional/behavioral dyscontrol (p<.05), while increasing satisfaction with social roles and activities(p<.01). SWDs also negatively impacted cognitive/outcome scores. Increased TST and sleep efficiency led to higher scores on CVLT-II list B and long delay free recall (p<.05), while higher AHI led to poorer performance on long delay and forced choice recognition trials (p<.01). Additionally, non-REM AHI negatively impacted MPAI adjustment scores (F(1,69)=4.036, p<.05).

Conclusion

Male stroke patients displayed significantly more arousals and spent less time in SWS than females. For both sexes, better sleep indicated improved quality of life. Sleep measures were correlated with cognitive/outcome measures. Non-REM AHI significantly predicted outcome at discharge from rehabilitation facility.

Support
1157 Comparison Of Polysomnography Total Sleep Time In Veterans With A Dementia Diagnosis, Incipient Dementia, And No Dementia
Authors: Razjouyan J , Nowakowski S , Naik A D , Sharafkhaneh A , Kunik M E
Published: May 2020

Introduction

Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined the total sleep time derived from overnight polysomnography (PSG) studies in veterans with a current dementia diagnosis at the time of PSG study (dementia), future diagnosis of dementia following the PSG study (incipient dementia), and no diagnosis of dementia at any time point (no dementia) over a 19-year period.

Methods

We identified 69,847 PSG sleep studies using CPT code 95810 and all-cause dementia diagnosis using ICD 9/10 codes (e.g., F03.90) from 2000-19 in the US Department of Veteran Affairs (VA) national database. To be included patients must have ≥ 1 VA visits in 12 months leading up to PSG. Dementia diagnosis must be documented on two separate visits between 12 months prior to 6 months following PSG for current dementia group and anytime after the PSG for incipient dementia. We used natural language processing to extract TST values from the patient free-text notes. Analysis of variance was used to compare PSG TST of the three groups.

Results

Patients had a mean age of 55.4±13.8 at the time of PSG study, 91.5% were male, and 64% were Caucasian. TST of dementia patients (N=1,031) was m=257±110m (d=0.33, p<.05), incipient dementia (N=1,875) was m=253±116m (d=0.35, p<.05) versus no dementia (61,871) m=292±104mins.

Conclusion

Patients with a diagnosis of dementia at the time of PSG study and patients that went on to receive a diagnosis following their PSG study had a significantly lower total sleep time compared to patients that have never received a dementia diagnosis. This is an important study that compares sleep duration during overnight PSG studies and dementia diagnosis across 19 years in the largest integrated healthcare system in the US.

Support

This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).
0119 The Role of Aging and Working Memory in Emotional-Long Term Memory Formation
Authors: Sattari N , Whitehurst L , Vinces K , Mednick S
Published: May 2020

Introduction

It is widely accepted that “offline” processes during sleep contributes to memory. Working Memory (WM) capacity, which reflects “online” memory processing, is an important factor influencing cognitive functioning, which declines with age. In younger individuals, a positive association is reported between WM-capacity and declarative memory improvement.

Methods

We examined the relation between WM and long-term memory consolidation, among younger [N=105, 18-25yr] and older adults (N=119, 60-85yr). Subjects completed an OSPAN WM task, encoded a Word-Paired Association (WPA) task in the morning (Test1), and were tested on the WPA in the afternoon (Test2) after a 90-minute polysomnographically-recorded nap or wake. Half of the subjects were exposed to negatively valenced word-pairs (EWPA) while the other half were exposed to neutral word-pairs (NWPA). Subjects rated valence of the word-pairs at Test1 and Test2. We compared the four groups (young-EWPA, young-NWPA, old-EWPA and old-NWPA) on WM and WPA in both wake and sleep.

Results

In both wake and sleep, in the WPA, ageXword-condition interaction was found (p=.004). Post-hoc analysis revealed that in wake, younger-EWPA had higher performance (p=.03) than younger-NWPA, however, older-EWPA had lower performance (p=.03) than older-NWPA. Additionally, we found an ageXword-condition interaction whereby youngers showed no change in ratings, while older adults rated word-pairs more positively both in wake (p=.03) and sleep (p=.002) at Test 2. Youngers had higher WM performance (p=.007), also their WM performance was positively associated with WPA both for Neutral (p=.03) and Emotional (p=.01). WM and WPA among older adults was not related. In younger-EWPA, Stage2-sleep-minutes was positively associated to WPA improvement (p=.03) where this association was negative among older-EWPA (p=.02). In older-NWPA, Stage2-sleep-minutes was positively associated with WPA (p=.004).

Conclusion

Our findings indicate an association between WM and emotionally-salient memory formation that is modulated by age. Older adults, but not younger, showed the emotional bias previously reported. WM was higher in younger adults related to memory improvement. Stage2-sleep was related to memory improvement in both groups, but in opposite directions. In sum, the role of sleep in memory consolidation changes with aging and WM may play a role in this process.

Support

Fenn et al.,2012
1186 Developing And Testing A Web-based Provider Training For Cognitive Behavioral Therapy Of Insomnia
Authors: Taylor D , Bunnell B , Calhoun C , Pruiksma K , Dietch J , Wardle-Pinkston S , Milanak M , Rheingold A , Simmons R , Peterson A , Morin C , Ruggiero K , Brim W , Dolan D , Wilkerson A
Published: May 2020

Introduction

Chronic insomnia is a common, debilitating disorder and a risk factor for significant medical morbidity, mental health problems, and workplace difficulties. Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia. However, few providers are trained in CBT-I, in part due to a bottleneck in training availability and the time and cost associated with current training platforms. To address this training deficit, our team developed and evaluated CBTIweb.org, a web-based provider training course for CBT-I.

Methods

Feedback from alpha- and beta-testing of CBTIweb.org was collected and used to optimize course content and functionality. Then, a comparison study was conducted in which licensed providers were randomized to complete either the online CBTIweb.org course (n=21) or an in-person CBT-I training (n=23). During all phases of development, providers completed a Computer System Usability Questionnaire (CSUQ), investigator-developed website usability and content questionnaires, and pre/post-training competency assessments.

Results

Independent samples t-tests indicated significant improvements in CSUQ, and website usability and content questionnaires responses from alpha- to beta-testing (all ps < .05). Linear mixed-effects modeling revealed significant within-subject increases in knowledge acquisition (F(34.7) = 65.4, p < 0.001; baseline = 69% correct, post-training = 92% correct) when collapsed across in-person and web-based groups. The interaction group by time interaction was non-significant (F(34.7) = 1.7, p = 0.204), indicating similar gains in knowledge (i.e., equivalence) between the in-person and the CBTIweb.org training formats.

Conclusion

Alpha and beta testers of CBTIweb.org reported high levels of satisfaction while also noting areas for improvement, which were used to update the site. Findings suggest the final CBTIweb.org product successfully trained clinicians compared to an in-person workshop, given knowledge acquisition improvements. CBTIweb.org is an efficient and effective training platform for clinicians to gain knowledge and competence in the most effective treatment for insomnia.

Support

W81XWH-17-1-0165