bluuebunny/crossref_metadata_2025 huggingface dataset:
0916 Sleep Diagnosis, Polysomnography Findings, and CPAP Adherence in People Living with HIV and Controls
Authors: DelRosso Lourdes , Walters Arthur S , Salamatina Alina , Yang Deacon , Mogavero Maria P , Ferri Raffaele
Published: April 2024

Introduction

Human Immunodeficiency Virus (HIV) infection remains a significant health challenge, particularly due to the global effects on health, social impact, and overall well-being. Studies on people living with HIV (PLWH) have identified that sleep disturbance interfere with quality of life, medication effect, comorbidities and disease progression, however, there is scarcity on sleep studies presenting objective polysomnographic (PSG) data and adherence to CPAP. In the current study we present clinical and PSG data in PLWH.

Methods

Observational, longitudinal study on PLWH and controls referred to a single sleep center due to suspicion of OSA. A home sleep apnea test (HSAT), full night PSG, or split night study. All PLWH were on combination antiretroviral therapy. Data obtained included clinical history, sleep study data, Epworth sleepiness and CPAP adherence at the first follow up visit.

Results

A total of 62 PLWH (48 male, 14 female) and 156 controls (91 male, 65 female) were included. In the PLWH, 30 patients underwent HSAT, 15 full diagnostic PSG, and 17 split night studies. In the PLWH group, 89% had OSA, 63% insomnia, 40% restless sleep and 21% restless legs syndrome. Data from the 32 lab studies showed statistically increased periodic limb movement index (PLMI) in PLWH (mean±SD) 33.8±31.73 than controls 10.7±17.41. A significantly higher number of PLWH had PLMI >15 hour than controls in the titration part of the study (64.7% vs. 35.5%, respectively; chi-square 3.85, p < 0.05). There were no other statistically significant differences in the sleep parameters. Adherence to CPAP was completed in 41 PLWH and 95 controls. Finally, pooling together all studies, PLWH showed lower adherence to CPAP (61.4±33.63% vs. 79.0±26.90%, respectively, t-value -3.248, p< 0.0015) and shorter time of its use (4.9±2.44 hours vs. 5.7±1.93 hours, respectively, t-value -2.038, p < 0.044) than controls.

Conclusion

This study shows that PLWH have elevated frequency of OSA, insomnia, restless sleep and restless legs syndrome. Objective data with in-lab studies surprisingly showed increased index of PLMS, not resolving with titration. Follow up on patients with OSA showed lower adherence to CPAP than controls.

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0918 A Cross-sectional Study on the Cytokine Profiles and Immunological Relationship Between Vitiligo and Sleep Quality
Authors: Xerfan Ellen , Facina Anamaria , Andersen Monica , Tufik Sergio , Tomimori Jane
Published: April 2024

Introduction

Vitiligo is an autoimmune skin disease. Psychological disruption can lead to clinical worsening and impact sleep quality of patients, in a bidirectional manner. Sleep regulates the immune system, and cytokines expression, including interleukin (IL)-6 and IL-17A (pro-inflammatory) and IL-4 and IL-10 (anti-inflammatory), which are linked to circadian rhythm and vitiligo immunopathogenesis. This study aimed to analyse cytokine profiles in a vitiligo sample; and verify any association with subjective sleep.

Methods

The study comprised 30 patients with vitiligo, and 26 healthy controls, following ethical guidelines. Quality of life and sleep questionnaires were completed: Dermatology Life Quality Index (DLQI), Short-Form Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Seven serum cytokines were measured through a 7-plex kit: IFN-γ, IL-4, IL-6, IL-10, IL-12 p40, IL-17A and TNF-α. Previous treatment with ultraviolet B phototherapy was registered. Generalized Linear Model test was used for statistical analysis.

Results

PSQI total score and domain 4 (sleep efficiency) were statistically worse in the vitiligo sample (both p=0.01). The PSQI means were 9.07 (vitiligo) and 6.66 (controls). Final scores of SF-36 and ISI were not statistically different between groups, although numerically worse in vitiligo group. The SF-36 domains “body pain”, “social aspects”, “physical limitation” and “emotional limitation” were statistically worse in vitiligo group. The DLQI mean (vitiligo group) indicated mild to moderate impact on quality of life (5.57). Cytokine levels were not different between groups, nor when analysed with PSQI. Regarding ISI, higher scores were related to increased IL-17A in vitiligo group (p=0.01). Increasing IL-4, IL-6 and IL-10 were associated with previous phototherapy (p=0.03; p=0.03 and p=0.04, respectively).

Conclusion

The vitiligo group presented worse sleep, as expected. Body pain predominated in vitiligo sample; hyperalgesia can occur in poor sleep, impairing quality of life. Emotional limitation can be enhanced by or aggravate physical limitation and pain. Elevated ISI scores (more severe insomnia) were related to increased IL-17A levels. The IL-4, IL-6 and IL-10, with circadian behaviour, were associated to phototherapy, which has immunomodulatory role. Poor sleep and impaired vitiligo may interact bidirectionally; cytokine regulation should be further investigated in this complex relationship.

Support (if any)

AFIP, CAPES, CNPq and FAPESP.
0920 Sleep Health and Cognitive Symptoms in Adults with Inflammatory Bowel Disease
Authors: Al-Saleh Stacy , Kamp Kendra , Kane Sunanda , Redeker Nancy , Conley Samantha
Published: April 2024

Introduction

Inflammatory bowel disease (IBD) is a chronic immune-mediated disease that includes Crohn’s disease and ulcerative colitis. People with IBD experience poor sleep health, including short and highly fragmented sleep and extraintestinal manifestations including alterations to cognitive functioning; however, the relationships between sleep health and cognitive symptoms have not been evaluated in this population. The purpose of this study was to identify the associations between sleep health and perceived cognitive impairments in adults with IBD.

Methods

We conducted a descriptive, correlational study of adults (18 to 59 years old) with IBD. We used the Pittsburgh Sleep Quality Index (PSQI) to obtain self-reported data on sleep health, the FACT-Cog Perceived Cognitive Impairments questionnaire to elicit cognitive symptoms, and the Manitoba IBD Index to describe IBD disease activity. Descriptive statistics, point-biserial correlations, and Pearson’s correlations were used to describe relationships.

Results

Of the 59 participants [Mean age 40.8 (SD 10.5), 71.2% female, 94.9% white], 67.8% (n=40) had clinically active IBD. 79.7% (n=47) had a PSQI total score >5, indicating poor sleep health. The most common cognitive symptoms, occurring two or more times a week, were trouble concentrating (55.9%), walking into a room and forgetting an intended task (44.1%), and forgetting the names of people soon after being introduced (44.0%). PSQI total score was positively and significantly correlated with 12 of 13 questions on the FACT-Cog. The strongest correlations included trouble concentrating (r = .497, P<.001), slower thinking (r = .450, p<.001), trouble forming thoughts (r=.550, p<.001), and difficulty finding the right words to express oneself (r=.546, p<.001). Longer self-reported sleep latency was associated with higher frequency of 12 out of 13 cognitive symptoms, while sleep efficiency was associated with 4 and sleep duration was associated with 2. Having clinically active IBD was associated with trouble forming thoughts (r=-.261, p=.046), slower thinking (r=-.307, p=.018), and trouble concentrating (r=-.346, p=.007).

Conclusion

Cognitive symptoms are common among people with IBD, highly correlated with sleep health, and not fully explained by IBD disease activity. Future studies should include objective measures of sleep health and cognition to further elucidate these relationships.

Support (if any)

Mayo Clinic Bonner Fund
0922 Associations Between Sleep Disturbances and PTSD Symptoms in Young Adults
Authors: Schenker Maya , Cherian Darshana , Felmingham Kim , Jordan Amy
Published: April 2024

Introduction

Post-traumatic stress disorder (PTSD) and sleep are bi-directionally linked. Past research on the association between sleep and PTSD has largely focussed on older military populations aged 30 or above, which created a gap in understanding this relationship in younger civilian populations. In addition, individual and trauma-related factors in this demographic have been mostly overlooked. In this study, we addressed this gap by examining the association between sleep disruptions and PTSD symptoms in a young university student cohort with diverse, non-military trauma histories. In addition, we explored moderating factors such as biological sex, chronotype, and trauma chronicity and investigated the link between sleep disturbances and PTSD symptom clusters (re-experiencing, hyperarousal, avoidance, and negative mood).

Methods

A total of 634 university students (female: 491, male: 143) with a mean age of 19.83 years (SD = 4.71) completed the study. Among them, 283 students reported experiencing at least one traumatic event. Participants completed an online questionnaire to assess trauma history, PTSD symptom severity, sleep disturbances (sleep quality, insomnia, and sleepiness), chronotype, and levels of depressive and anxiety symptoms.

Results

There was a significant positive association between sleep disturbances and PTSD symptom severity, F(3, 279) = 48.68, p < .001, R2 = .34 in trauma-exposed adults with and without likely PTSD. However, this relationship was not moderated by any of the hypothesised factors (p >.05). Nonetheless, there was a significant positive relationship between sleep disturbances and all four PTSD symptom cluster: re-experiencing (b =0.32, p <.001), hyperarousal (b =0.34, p <.001), avoidance (b =0.53, p <.001), and negative mood (b =0.24, p <.001).

Conclusion

The association between sleep and PTSD in this young adult population with mixed-trauma exposures aligned with the previously observed findings in older military veterans. The increasing severity of sleep disturbances as a predictor for PTSD symptom severity further suggests that sleep is a potential etiological factor contributing to the onset and persistence of PTSD. These results bear significant treatment implications, emphasizing the potential to address sleep-related issues in interventions targeting PTSD.

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0923 Prospective Bidirectional Relationship Between Sleep Duration and PTSD Symptoms Following Acute Coronary Syndrome
Authors: Shechter Ari , Cornelius Talea , Abdalla Marwah , Scott Allie , Sedano Brandon Fernandez , Hiti David , Sullivan Alexandra , Schwartz Joseph , Kronish Ian , Edmondson Donald
Published: April 2024

Introduction

Sleep disturbance is a “hallmark” symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD when PTSD is induced by an acute health-related event. We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year following hospital evaluation for acute coronary syndrome (ACS).

Methods

Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration (“During the past month, how many hours of actual sleep did you get at night?”) and PTSD symptoms related to the cardiac event/hospitalization (PTSD Checklist; PCL) were assessed at 1-, 6-, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms.

Results

The sample included 1,145 participants. Mean (SD) age was 61.4 (12.6) y and 46.5% were female. Mean sleep duration was ~6.1 hours, with ~57% of participants reporting short sleep duration (i.e., < 7 hours). Mean PCL score was ~24.19, with ~16% of participants screening positive for probable PTSD related to the cardiac event/hospitalization (PCL score ≥33) at each assessment (17.2%, 16.3%, and 15.7% at 1-, 6-, and 12 months). Higher PTSD symptoms predicted shorter sleep duration at the next timepoint (i.e., 1 to 6 months and 6 to 12 months), B=-0.14 hours/10-point difference, se=0.03, p<.001. Shorter sleep duration was associated with higher PTSD symptoms at the next timepoint, B=-0.25 points/hour, se=0.12, p=.04. Results were similar when insomnia and nightmare items were removed from the PCL. Higher dream-related PTSD symptoms (i.e., nightmares) had a marginally significant association with shorter sleep at the following assessment, B=-0.09 hours/point, se=0.05, p=.057. Shorter sleep was significantly associated with higher dream-related PTSD symptoms at the next timepoint, B= 0.03 points/hour, se=0.01, p=.001.

Conclusion

Short sleep duration and PTSD symptoms are mutually reinforcing across the year following ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

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0926 Dreaming Big: Launching a Web-Based Provider Training for Cognitive Behavioral Therapy for Nightmares
Authors: Pruiksma Kristi , Wilkerson Allison , Taylor Daniel , Dietch Jessica , Tyler Hannah , Price William , Campbell Rebecca , Davis Joanne , Wardle-Pinkston Sophie , Young-McCaughan Stacey , LoSavio Stefanie , Peterson Alan
Published: April 2024

Introduction

Few providers are trained to deliver Cognitive Behavioral Therapy for Nightmares (CBT-N) despite the impact of nightmares on physical and mental health. Reduced access to treatment is partially due to limited training opportunities. Web-based training resources are valuable because they are easily accessible, are cost-efficient, and can be reviewed by providers as needed. This presentation describes the development, testing, and launch of a web-based provider training for CBT-N.

Methods

Nightmare, trauma, and sleep disorder experts collaborated to develop material for the web-based CBT-N training. Next, 17 providers tested a first draft of the web-site. After feedback was integrated, 50 providers were recruited to complete the updated draft of the website and will complete feedback in January 2024. To assess learning, providers completed multiple-choice questions before and after each of the 10 training modules. Item Response Theory (IRT) analyses were used to identify items of low discrimination and difficulty for further refinement.

Results

Overall, testers had positive reactions to the training content and website. The training content was improved by adding more figures, animations, and therapy demonstration videos and integrating more cultural considerations. Usability was improved by addressing bugs and enhancing intuitive site navigation. Based on IRT analyses of multiple-choice questions, 40 (out of a total 80) items were replaced and will be re-evaluated at the conclusion of beta testing.

Conclusion

Launching in June 2024, CBTnightmares.org is a comprehensive, engaging, and accessible training after two phases of development and feedback from almost 70 licensed providers. The final phase of testing, to be conducted in April 2024, will examine the equivalence of online training compared to a live virtual workshop (Target N = 100). Providers will complete questionnaires and a mock session with a standardized patient to examine therapist proficiency and fidelity. The hypotheses are that this web-based course will be equivalent to a live virtual workshop. This project directly addresses the dissemination and implementation cliff of empirically supported treatment for nightmares.

Support (if any)

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Review Medical Research Program under Award No. W81XWH-21-1-0576.
0928 Sleep, Mediating the Risk of Cognitive Impairment in Post-traumatic Stress Disorder via Noradrenalin Dysregulation
Authors: Cho Yeilim , Iliff Jeffrey
Published: April 2024

Introduction

There is growing evidence that Post Traumatic Stress Disorder (PTSD) increases the risk of dementia, and sleep impairment in PTSD may contribute to this link. Increased cerebrospinal fluid (CSF) norepinephrine (NE) is associated with glymphatic dysfunction and poor neurocognitive outcomes. To understand the role of sleep in mediating the increased risk of dementia in PTSD, we investigated whether sleep-specific symptoms of PTSD are related to CSF NE level and cognitive function.

Methods

We analyzed a prospective study of combat Veterans with repetitive blast mild traumatic brain injury (mTBI). All underwent CSF sampling and the PTSD and DSM checklist 5 for military (PCL-M), a 17-item self-report measure reflecting DSM-IV symptoms of PTSD. We derived a sum score of each symptom cluster; Questions 1-5: “Re-Experiencing”, 6-12: “Avoidance and Negative Cognition and Mood” and 13-17: “Hypervigilance”. Among the 17 items, questions 2 and 13 are sleep-related symptoms. We calculated correlations of the sum score of each category with CSF NE level with and without sleep-specific questions (2: nightmare and 13: sleep disruption) with CSF NE levels. Trails A (attention and visual motor function) and Trail B (executive function) tests were performed.

Results

A total of 49 mTBI participants were included. A sum score of symptoms related to re-experiencing (r=0.34, p=0.001) and hyperarousal (r=0.3, p=0.03) were weakly correlated with elevated CSF NE. Excluding the sleep-specific symptom questions from these two categories attenuated the correlation (re-experiencing r=0.31, p=0.03; hyperarousal r=0.2, p=0.1). The scores of sleep-specific symptoms were separately examined, the correlation with CSF NE was (nightmare r=0.37, p=0.0009; sleep impairment r= 0.35, p=0.001). The symptom cluster related to avoidance and negative cognition and mood was not associated with NE level (r=0.15, p=0.9). Elevated CSF NE was strongly associated with lower Trials B performance (r=0.34, p=0.001). Trails A performance was not associated.

Conclusion

PTSD-associated sleep symptoms of nightmares and sleep disruption are most strongly associated with CSF NE. CSF NE is associated with worsening executive function measured by Trails B. Sleep symptoms may be the driver of the poor neurocognitive outcomes in patients with PTSD. Traditional symptom clusters of PTSD may not accurately reflect the risk of cognitive function.

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0930 Trauma-Specific and Nonspecific Predictors of Sleep-State Misperception Among Trauma-exposed Women
Authors: So Christine , Harmouch Sirine , Alfano Candice
Published: April 2024

Introduction

Sleep disturbances are highly prevalent following trauma exposure but tend to persist following trauma-focused treatment, which brings into question the relevance of trauma-specific factors in these sleep problems. Sleep assessment can include subjective methods, like sleep diaries, and/or objective methods, like actigraphy. However, these methods tend to result in low-moderate concordance, and it has been hypothesized that clinical samples report greater sleep disturbance than objective methods record (i.e., sleep-state misperception). This may be due to greater overall distress or bias from experiencing clinical symptoms. This study examined trauma-specific and nonspecific predictors of sleep-state misperception in trauma-exposed women.

Methods

N=55 cis-gendered women with a self-reported history of sexual abuse in childhood (between ages 6-11) completed baseline surveys assessing sleep and mental health, and one week of sleep monitoring via actigraphy and sleep diaries as part of a larger study. Cohen’s d was calculated to estimate the degree of sleep-state misperception between sleep diary and actigraphy.

Results

Participants tended to overestimate total sleep times (TST) and sleep onset latencies (SOL) when reported on sleep diary compared to actigraphy. In contrast, participants underestimated wake after sleep onset (WASO) via sleep diary compared to actigraphy. In examining clinical correlates of sleep-state misperception, we found that TST Cohen’s d was significantly correlated with baseline depressive symptoms (r=.295, p=.029) and pre-sleep cognitive arousal (r=.269, p=.047). PTSD hyperarousal symptoms (minus the sleep item) were positively correlated with TST Cohen’s d (r=.358, p=.007) but negatively correlated with SOL Cohen’s d (-.279, p=.039).

Conclusion

While we observed both trauma-specific (i.e., hyperarousal) and nonspecific (i.e., depression, cognitive arousal) to be associated with sleep-state misperception, it is possible that these variables have similar underlying transdiagnostic factors. For example, rumination (a form of perseverative cognition focused on negative content) underlies both depression and PTSD. Future work should further probe contributing factors to sleep-state misperception to better understand this phenomenon.

Support (if any)

This study was funded by the University of Houston Small Grants Program (PI: CAA). CJS was supported by the Department of Veterans Affairs, Office of Academic Affiliations, Advanced Fellowship in Mental Illness Research and Treatment, and the University of Houston Dissertation Completion Fellowship.
0931 COMISA-MARES: Comorbid Insomnia and Obstructive Sleep Apnea with and Without Nightmares in US Military Personnel
Authors: Bolstad Courtney , Pruiksma Kristi , Mysliwiec Vincent , Li Xueying , Gerwell Kelsi , Young-McCaughan Stacey , Peterson Alan , Straud Casey , Brock Matthew
Published: April 2024

Introduction

Comorbid insomnia and obstructive sleep apnea (OSA), also called COMISA, has deleterious effects on mental and physical health. Limited research has examined the occurrence of nightmares in patients with COMISA. In a sample of service members seen in a US military sleep disorders clinic, this study examined the impact of nightmares among participants with insomnia, OSA, and COMISA and how sleep and mental health symptoms differed by sleep disorder (i.e., insomnia only, OSA only, COMISA) among those with nightmares.

Methods

In this observational study, 372 participants completed video-polysomnography and received a primary sleep disorder diagnosis (i.e., insomnia, OSA, COMISA). Participants with nightmares 1 ≥ week that woke them up at least “sometimes” were counted as having nightmares. Participants also completed measures of insomnia, anxiety, depression, and posttraumatic stress disorder (PTSD). General linear and mixed effects models were used to test our research questions.

Results

Nightmares were endorsed by 30% (n = 111) and were significantly more likely to be reported by those in the insomnia (36%, n = 42) and COMISA (38%, n = 52) groups than in the OSA group (14%, n = 17; p <.0001). Among the sleep diagnostic groups (i.e., insomnia, OSA and COMISA), participants with nightmares had significantly increased insomnia, anxiety, depression and PTSD symptoms compared to those without nightmares. Participants with COMISA and nightmares (i.e., COMISA-MARES) had the worst overall symptoms.

Conclusion

We propose COMISA-MARES as the combination of three sleep disorders that manifests with the worst overall sleep and mental health symptoms in military personnel. Given the high diagnostic rate, military and veteran sleep clinics should incorporate insomnia and nightmare assessments in efforts to better characterize this disorder. COMISA is significantly more burdensome than OSA alone and insomnia alone, and nightmares pose an even greater additive element of burden. Research is needed to guide treatment.

Support (if any)

This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).
0934 Self-Compassion, Bedtime Procrastination, Sleep, and Mental Health in Individuals Exposed to Trauma
Authors: Bistricky Steven , Kenigsberg Zara , Klein Paige , Feliciano Leilani
Published: April 2024

Introduction

Though it is increasingly evident that bedtime procrastination (delaying going to bed after one’s intended bedtime) significantly interferes with health-promoting sleep, effects of bedtime procrastination have scarcely been studied in relation to trauma. Because sleep can be persistently problematic following trauma, even after completion of trauma-focused therapies, understanding and intervening with relevant malleable factors might improve trauma survivors’ sleep and mental health. Although adherence to sleep hygiene practices has long been indicated for insomnia and downstream psychological effects, accumulating research is suggesting that sleep behaviors and other health behaviors can be further improved through self-compassion practice amidst personal shortcomings, struggles, and failures. Self-compassion can be conceptualized as an orientation toward increased awareness and acceptance of one’s experiences—positive or negative, extending self-kindness during times of suffering, and feeling connection with the common human experience of life challenges. Functionally, self-compassion may promote effective self-regulation and curb emotional or behavior dysregulation, such as impulsivity or procrastination.

Methods

In this presentation, we discuss our cross-sectional and intervention studies (2 completed, 2 ongoing; respective N’s = 25, 74, 235+, collecting) examining circadian rhythm and psychological factors linked to bedtime procrastination and potential mechanisms of reducing bedtime procrastination, improving sleep, and reducing PTSD symptom severity, such as emotion regulation and procrastinatory cognition. We review promising effects of a brief virtual group psychosocial intervention focusing on self-compassion and expanded sleep hygiene on bedtime procrastination, sleep, and mental health, and we describe how this intervention has been tailored to address the common daily and nightly experiences of trauma-exposed individuals (e.g., nightmares). Correlation analysis as well as moderation and mediation analyses are presented.

Results

Our findings with trauma survivors indicate that the relation between self-compassion and healthier sleep can be mediated through bedtime procrastination and sleep self-efficacy, one’s belief that they can get healthy sleep. Further, we have found that the positive association between self-compassion and sleep self-efficacy is strengthened by sleep hygiene adherence.

Conclusion

In sum, bedtime procrastination appears salient to the sleep, emotional health and well-being of trauma-exposed individuals, and it can be reduced through intervention. Limitations, future directions for research, and scalable intervention development will be discussed.

Support (if any)

N/A
0937 Development of the Affective Neuroscience Dream Rating Scale
Authors: Drake Christopher , Mahr Greg , Reffi Anthony , Son Kimberly , Seymour Grace , sagong Chaewon , Jankowiak Lily , Pawirosetiko Joy , Hehr Aneesh , Cheng Philip , Kalmbach David , Roth Thomas , Moore David
Published: April 2024

Introduction

Methods for quantifying emotional dream content have been developed. These approaches have yielded significant insights into dream content, their relation to waking cognition, and mental health. The current dream rating scale was developed to improve upon previous approaches by conceptualizing the scale based on the known fundamental affective neuronal circuits within the brain.

Methods

Seventy-seven items were developed representing fundamental emotions (SEEKING, RAGE, FEAR, LUST, CARE, GRIEF and PLAY). One-hundred dreams were randomly selected from a dream database (www.dream-bank.net). To determine interrater agreement, two raters scored all 77-items for each of the 100 dreams based on if the emotional content was present or not. Items with an interrater agreement (kappa) below .5 were excluded. Nightmares (i.e., extremely unpleasant or disturbing dreams) were independently identified by a sleep-trauma expert and compared to non-nightmares for the 7 scales.

Results

Thirty-three items (kappa > 0.5; range .5-.82) were retained for the final scale. Of the items retained, 29 (85%) were endorsed in 10% or more of dreams. The most frequently identified items in the final scale were danger (44%) and fear (45%). Seven emotional dream scales were apriori identified with 3-9 items each being retained in the final scales. Scales were significantly correlated between raters (r = .54 to .88, p< .001). Across the 100 dreams FEAR was the highest endorsed emotion scale while GRIEF was lowest. As expected, nightmares had significantly elevated scores compared to non-nightmares on the FEAR, RAGE, SEEKING and GRIEF scales (p< .001) but not CARE, LUST, or PLAY.

Conclusion

This dream rating scale based on mammalian emotional circuits previously identified through affective neuroscience shows promise for quantifying and understanding the emotional content of dreams. Future studies will need to further validate this preliminary affective dream content scale using different populations including individuals exposed to trauma and those with mental health and sleep disorders to determine its clinical utility.

Support (if any)

N/A
0938 Exploring Nightmares Among US Veterans, Implications of Depression and Antidepressants
Authors: Shukri Ghaith , Wallace Douglas , Wohlgemuth William
Published: April 2024

Introduction

Nightmares are a frequent concern among US veterans, often linked to prevalent mental health conditions like depression and PTSD. Antidepressant medications are commonly used to manage these conditions, yet the association between their usage and the frequency of nightmares remains unclear.

Methods

The sample consisted of veterans at risk for sleep apnea at the Miami VA Sleep Center evaluated over one year. Veterans underwent home polysomnography (PSG) and completed questionnaires including demographics and the Munich Parasomnia Screening (MUPS). The frequency of nightmares was assessed using the nightmare item in MUPS. Electronic Medical Records were reviewed to obtain active medical and psychiatric diagnoses and active medication orders (including most common antidepressants: SSRIs, SNRIs, mirtazapine and bupropion) contemporaneous with the sleep evaluation.

Results

The study involved 649 veterans, predominantly male (84%) with mean age of 50 ± 14 years. Within this cohort, 49% were diagnosed with depression and 33% with PTSD. Regarding reported nightmare frequency, 16% indicated nightmares “never”, 9% “less than once a year”, 22% “once or several times a year”, 22% “once or several times a month”, 21% “once or several times a week” and 8% “almost every night.” Multiple regression was used to predict nightmares. In model 1, depression was positively associated with nightmares (p=0.001), independent of PTSD and AHI. In model 2, using an antidepressant versus not was positively associated with nightmares (p=0.05). However, depression was no longer significant (p=0.102). In model 3, type of antidepressants was evaluated, but only SSRIs were significant (p=0.04) while depression remained non-significant.

Conclusion

The findings highlight the prevalence of nightmares among veterans. Although depression was initially associated with increased nightmare frequency, when treatment for depression was considered, depression no longer predicted nightmares. Instead, antidepressants and specifically SSRIs predicted nightmares. Considering the type of antidepressant may be crucial when patients report nightmares. Further research is needed to investigate the impact of mental health conditions and medication effects on nightmares in this population.

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0939 Exposure to Neighborhood Violence and Sleep-Related Fears Predicts PTSD Symptoms Among Community-Dwelling Adults
Authors: Aliu Grace , Miller Katherine , Gehrman Philip , So Christine , Brownlow Janeese
Published: April 2024

Introduction

Living in neighborhoods with high levels of stress can have a profound impact on an individual’s sleep quality and mental health. Both chronic insufficient sleep and posttraumatic stress disorder (PTSD) have been linked to a variety of adverse health outcomes. Data indicates that PTSD interferes with sleep in part due to its relationship with sleep-related fears. However, limited research has investigated the contribution of neighborhood stress and sleep-related fears experienced within an individual’s sleep environment. This study aimed to explore associations among exposure to neighborhood violence, sleep-related fears, and PTSD symptomatology.

Methods

Baseline data were obtained from participants who completed self-report measures as part of a larger study (N=45; Mean age=35.04 (SD=12.95); 62.2% Females). The Fear of Sleep Inventory (FoSI) assessed for past-month sleep-related fears within the sleep environment. The City Stress Inventory (CSI) assessed for exposure to neighborhood violence in the past year, and the PTSD-Checklist-5 (PCL-5) evaluated current PTSD symptom severity. A linear regression model identified the relationships between exposure to violence and sleep-related fears on PTSD symptoms.

Results

Data showed positive associations between exposure to neighborhood violence and sleep-related fears (r=.298, p=.047). There were also significant correlations between PTSD symptoms and violence exposure (r=.396, p=.007) and sleep-related fears (r=.613, p<.001), respectively. A linear regression model indicated that exposure to violence and sleep-related fears were significant predictors of PTSD symptoms (R2=.426, p<.001). Regression coefficients suggested that sleep-related fears (β=.543, p<.001) were a stronger predictor of PTSD symptoms than exposure to violence (β=.234, p=.062).

Conclusion

There results indicate that living in an environment characterized by higher exposure to violence may lead to greater fear of going to sleep, likely due to perceived increases in vulnerability during sleep. The results, although cross-sectional, also suggest that greater fear of sleep is predictive of worse PTSD symptomatology. Based on study findings, sleep health screenings may be useful for those individuals experiencing trauma-related stress.

Support (if any)

This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
0945 Sleep Health and Suicide Ideation in the US: Data from the National Sleep Foundation Sleep in America Poll
Authors: Saravanan Pranav , Gorovoy Suzanne , Fernandez Fabian-Xosé , Killgore William , Dzierzewski Joseph , Grandner Michael
Published: April 2024

Introduction

Previous studies have shown that poor sleep is generally associated with suicide ideation. But few studies have examined this relationship in the general population across many dimensions of sleep health, and it is not clear which sleep variables are most salient.

Methods

Data were collected as part of the National Sleep Foundation Sleep In America Poll. The population-based sample (N=1,042) provided data on a range of sleep questions, as well as each item of the PHQ9 depression scale. For the present analyses, PHQ item 9 (suicide ideation) was examined as a binary outcome, with population-weighted regression analyses adjusted for age, sex, race/ethnicity, education, income, and PHQ2 depression score. Independent variables included sleep satisfaction, feeling refreshed, daytime energy, difficulty falling asleep, frequent nighttime awakenings, difficulty resuming sleep, satisfaction with weekday and weekend sleep duration, ability to feel relaxed, overall sleep quality, weekday and weekend bedtime, waketime, time in bed, sleep duration, perceived sleep need, and days/week (0-7) of: feeling well-rested, having trouble falling or staying asleep, sleep impacts functioning, daytime sleepiness, and sleep medication use. Bonferonni correction (0.05/26) was used.

Results

Population-weighted analyses adjusted for age, sex, race/ethnicity, education, income, and PHQ2 depression score showed that elevated likelihood of suicide ideation was associated (all p< 0.0019) with days/week: feeling well rested (OR=0.80/day), trouble falling asleep (OR=1.26/day), trouble staying asleep (OR=1.18/day), and sleep impacts functioning (OR=1.46/day). Weekday sleep duration (OR=0.73/hr), weekend sleep duration (OR=0.75/hr), “Very Dissatisfied” with sleep (OR=6.92), “Not energized at all” (OR=7.46), “A great deal” of trouble falling asleep (OR=6.91), “Very often” waking during the night (OR=5.75), “Very dissatisfied” with weekday (OR=6.95) and weekend (OR=7.81) sleep duration, and “Very difficult” to relax before bed (OR=10.04) were also associated. Stepwise analyses revealed that the variables that explain the most unique variance are (in order) days/week that sleep impacts functioning (R-squared 0.089) and satisfaction with weekend sleep duration (R-squared 0.012).

Conclusion

Many indicators of sleep health were associated with suicide ideation, implicating sleep duration, quality, efficiency, and daytime effects of sleep. Efforts might ideally focus on the daytime impacts of sleep as well as nighttime experiences.

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0946 Examining the Directional Effects of Insomnia, Anxiety, and Depression Symptoms: Results from a Longitudinal Study
Authors: Walker Jamie , Vargas Ivan , Muench Alexandria , Perlis Michael
Published: April 2024

Introduction

Although there is evidence supporting high comorbidity rates among insomnia, anxiety, and depression, the temporal relationship among them is less clear. Prior research supports that the onset of depression is often preceded by symptoms of anxiety and insomnia, but the current study is the first to look at the temporal relationship among all three symptoms in an adult sample representative of the general population. Determining the temporal progression of these problems is important for prevention and intervention efforts, in that early treatment for insomnia and anxiety may reduce the risk of developing depression.

Methods

2,666 adult participants (Mage = 47.0, 79.0% female, 84.1% white) were recruited for an online study on health, resulting in a nationally representative sample. Well-validated instruments were used to measure symptoms of depression (CES-D), anxiety (STAI), and insomnia (ISI). Data was collected via Qualtrics surveys administered online at two time points (i.e., baseline and follow-up), with assessments conducted twice daily for two weeks in the morning and evening. Auto-regressive cross-lagged models were used to provide the best representation for how these data were collected, and allowed for temporal ordering at every pathway by examining the longitudinal relationship between each variable.

Results

Auto-regressive cross-lagged models revealed an indirect effect of anxiety symptoms on depression symptoms through insomnia symptoms. Tests of indirect effect were performed in two ways, using both insomnia T1 and insomnia T2 to provide temporal ordering between all three variables. The indirect effect of anxiety T1 on depression T2 through insomnia T1 was significant (β = 0.253, p < 0.001). The indirect effect of anxiety T1 on depression T2 through insomnia T2 was also significant (β = 0.265, p < 0.001). The almost-identical values for the two tests of indirect effect provide support for the presence of the temporal relationship between these three variables.

Conclusion

Results support the theory that insomnia may be one mechanism by which individuals with anxiety are at greater risk for developing depression. This is the first study to empirically evaluate a model in which insomnia symptoms explain the indirect effect of anxiety symptoms on depression symptoms in adults.

Support (if any)

Vargas: K23HL141581
0949 Sleep Quality and Self-Perceived Flourishing in Life
Authors: Killgore William , Hildebrand Lindsey , Henderson-Arredondo Kymberly , Reich-Fuehrer Melissa Melissa , Franca Gabriela , Wellman Camryn , Grandner Michael , Negelspach David , Huskey Alisa
Published: April 2024

Introduction

Sleep disruption has a significant effect on emotional wellbeing. Prior research suggests that poor sleep or insufficient sleep can impair mental health, emotional intelligence, mood, and life satisfaction. However, little is known about how sleep problems contribute to an individual’s self-perceived success in critical areas of interpersonal relationships, purpose, optimism, and self-esteem. Here we examined the associations between sleep quality and self-perceived flourishing in life using the Flourishing Scale. It was hypothesized that better sleep quality would be associated with increased flourishing.

Methods

125 healthy participants (86 female; age=24.1, SD=6.0 years) completed an online set of questionnaires about emotional skills and sleep. These included the Pittsburgh Sleep Quality Index (PSQI), which measures several dimensions of sleep disturbance, and the Diener et al. Flourishing Scale (FS), and 8-item scale that measures several dimensions of purpose/meaning and satisfaction with life, optimism, competence, and interpersonal relationships. Individual scales of the PSQI were correlated with the construct of Flourishing.

Results

FS was significantly correlated with Total PSQI (r=-.42, p<.001). Subscale analysis revealed that this association was driven by several facets of the PSQI, including subjective sleep quality (r=.26, p=.003), sleep latency (r=-.35, p<.001), sleep duration (r=-.30, p<.001), sleep efficiency (r=-.18, p=.04), sleep disturbances (r=-.31, p<.001), and daytime dysfunction (r=-.47, p<.001). Sleep medications were unrelated to FS.

Conclusion

Flourishing, the self-perceived success in managing life and relationships competently was associated with multiple facets of self-perceived sleep quality. While these findings are limited by the self-report nature of the study, they do suggest that interventions to address sleep quality could affect broader aspects of mental health and emotional functioning that contribute to living a richer and more satisfying life.

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USAMRAA: W81XWH-16-1-0062
0951 Stress Mediates the Relationship Between Discrimination and Sleep in Middle Eastern and North African Americans
Authors: Rastegar Pedram , Zendels Philip , Peterman Amy
Published: April 2024

Introduction

Discrimination is clearly associated with a number of poor health outcomes and emerging research demonstrates the possibility of a similarly negative relationship with sleep. Stress is posited as a mediator of the discrimination-sleep link, but this has not been explored among Middle Eastern and North African Americans (MENA). The current study explores the mediating role of stress in the relationship between discrimination and two sleep outcomes (sleep-related impairment and sleep disturbance) among MENA.

Methods

This sample included 126 participants who completed online Qualtrics surveys through Prolific. Participants completed self-report measures of discrimination (Brief PEDQ-CV; Brondolo et al., 2005), stress (Perceived Stress Scale; Cohen et al., 1983) and sleep. The latter was measured using the well-validated PROMIS short form sleep-related impairment and sleep disturbance scales (Yu et al., 2012). Process Macro Model 4 (Hayes, 2012) was run to examine the mediating role of stress on discrimination and sleep outcomes. Generational status and sexual orientation were used as covariates, as they were significantly correlated to focal variables.

Results

Discrimination predicted stress (b =2.61, SE = 0.75, p < .01). Stress significantly both sleep-related impairment (b =0.67, SE = .08, p < .001) and sleep disturbance (b =0.55, SE = 0.10, p < .001). There was no direct effect of discrimination predicting sleep-related impairment (b =1.14, SE = 0.70, p =0.11) or sleep disturbance (b =0.98, SE = 0.85, p =0.25). However, there was a significant indirect effect of discrimination predicting sleep disturbance (b = 1.44; CI: 0.63-2.38) and sleep-related impairment (b = 1.75; CI: of 0.83-2.83) through stress as indicated by non-zero confidence intervals. These results indicate a full mediation effect of stress between discrimination and sleep-related impairment and discrimination and sleep disturbance.

Conclusion

Discrimination in MENA is associated with poor sleep through increased stress. These findings have implications for research and treatment in MENA. Immediate and short-term interventions for the effects of discrimination may include improving stress management to promote better sleep. Future research should continue to explore how to reduce discrimination and reduce its effects to promote sleep and overall health.

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0953 The Interaction Between Insomnia and Excessive Daytime Sleepiness on Cognitive and Somatic Depressive Symptoms
Authors: Roeper April , Ji Xiaopeng , Covington Lauren , Brownlow Janeese
Published: April 2024

Introduction

Sleep and mental health are Healthy People 2030 Public Health priorities. Emerging adults experience a combination of biosocial and environmental changes that contribute to increased susceptibility to sleep disturbances and poor mental health during the college years. Excessive daytime sleepiness and insomnia represent distinct sleep disturbances, and both have been linked to depressive symptomatology. However, few studies have examined their interactions on specific mood symptoms. This study explored the moderating effect of excessive daytime sleepiness on the relationship between insomnia and cognitive and somatic depressive symptoms.

Methods

Emerging adults (N=104, Mean age=20.22± .78, 81.7% Female) completed self-report measures on sleep and depressive symptoms. The insomnia severity index assessed for the nature, severity, and impact of insomnia symptoms, with higher scores indicating greater symptom severity. Excessive daytime sleepiness was assessed using the Epworth sleepiness scale. The Beck depression inventory (BDI-II) assessed for the presence and intensity of overall depressive symptoms, with cognitive and somatic depressive symptoms derived from subscales. Higher scores represented greater depressive severity. All statistical analyses were conducted using IBM SPSS version 29, along with Hayes PROCESS macro for moderation analyses.

Results

Data showed a positive correlation between insomnia severity and excessive daytime sleepiness (r=.24, p=.01). We also found significant associations between insomnia severity and overall depressive symptoms (r=.52, p<.001), cognitive depressive symptoms (r=.42, p<.001) and somatic depressive symptoms (r=.58, p<.001). Findings indicated significant main effects of insomnia (b=.95 ±.24, p<.001) and excessive daytime sleepiness (b=.72 ±.31, p=.02) on cognitive depressive symptoms, and excessive daytime sleepiness significantly attenuated the association between insomnia and cognitive depressive symptoms (b=-.05 ±.02, p=.03). Results also indicated a significant main effect of insomnia, but not excessive daytime sleepiness (b=.05 ±.22, p=.81) on somatic depressive symptoms (b=.49 ±.17, p=.01). Additionally, there was no interaction between insomnia and excessive daytime sleepiness on somatic depressive symptoms (b=-.001 ±.02, p=.96).

Conclusion

Data indicates that sleep disturbances are risk factors that need to be considered and addressed when treating depressive symptoms among emerging adults.

Support (if any)

This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).