bluuebunny/crossref_metadata_2025 huggingface dataset:
668 Utilizing Risk Score Assessment to Maximize Sleep Research Participant Safety During the COVID-19 Pandemic
Authors: Zamora Tania , Stepnowsky Carl , Deering Sean
Published: May 2021

Introduction

Research study recruitment has been profoundly affected by the COVID-19 pandemic, demonstrated by significant delays or pauses. Various guidelines pertaining to in-person visits have applied to research. Some call for exclusion of participants that the CDC has labeled “at increased risk”.1 For obstructive sleep apnea (OSA) studies, these guidelines have caused a sharp decrease in the number of new participants. This decrease is due to high rates of OSA comorbidities including obesity and diabetes. New evidence-based risk scores have been developed using individual- and community-level factors. The use of more refined COVID-19 risk scores can help protect patient safety while allowing research to continue.

Methods

The risk score assessment used for this study (COVID-19 Mortality Risk Calculator; Johns Hopkins University, Baltimore, MD)2 is evidence-based and uses a set of risk factors and community-level pandemic dynamics in the state of residence.3,4 It was compared to the list of CDC medical conditions that are considered to put an individual “at increased risk.” Both measures were calculated retrospectively on current participants to determine how many could safely attend in-person visits based on each risk assessment method.

Results

Sample characteristics of the 110 participants were: mean age: 49.5±13.7(24–76); mean BMI: 32.3±5.3(20.9–46.1); mean AHI: 24.3±21.4(5.1–110). Mortality Risk Calculator scores were: 91(82.7%) close to/lower than average [Level 1]; 12(10.9%) moderately elevated; 6(5.5%) substantially elevated; 1(0.9%) high; and 0(0%) very high [Level 5]. Using CDC guidance, 63 (57.3%) had at least one at-risk condition and 47 (42.7%) had 0. Using only Level 1 of the Risk Calculator would allow an additional 28 (25%) participants to attend in-person visits; using Levels 1 and 2 would allow an additional 40 (37%) participants.

Conclusion

Policies based on CDC at-risk conditions resulted in higher levels of participant exclusion in research during the COVID-19 pandemic than use of an evidence-based Mortality Risk Calculator. This analysis shows that researchers can use risk-adjusted scores to make informed decisions about study participation that balances both participant safety and research study progress.

Support (if any)

This project was supported in part by Department of Veteran Affairs VA HSRD IIR 16–277, VA RRD D2651-R, and VA San Diego Healthcare System Research Service.
701 Daily Associations Between Adolescent Sleep and Mental Health During the COVID-19 Pandemic
Authors: Palmer Cara , Oosterhoff Benjamin
Published: May 2021

Introduction

Sleep disturbances after a trauma forecast mental health difficulties such as post-traumatic stress symptoms (PTSS). COVID-19 has resulted in numerous stressors for youth (e.g., school closures, social isolation) that directly disrupt sleep and may have negative mental health consequences. However, investigations of sleep and adverse events in youth have primarily been limited to months or years after a trauma has occurred. How adolescent sleep patterns and mental health intersect during an ongoing adverse experience is unknown.

Methods

Adolescents from the United States (N = 503; 80.9% female; 13–18 years) participated in an online daily diary study within 3 weeks after COVID-19 was declared a national emergency. Participants completed one week of twice daily reports (5406 observations) on their nightly sleep (sleep timing, sleep quality, sleep onset difficulties, and nightmares) and daytime mental health symptoms (COVID-19 PTSS, positive affect, negative affect, and loneliness).

Results

Mixed models adjusting for age, sex, and socioeconomic status indicated that cyclical, bidirectional effects emerged, with daytime mental health symptoms predicting same-night sleep disturbances, and sleep disturbances predicting next-day mental health. Greater PTSS predicted sleep onset difficulties (Estimate = .02, SE = .004, t = 5.56 p < .001) and sleep onset difficulties predicted next-day PTSS (Estimate = .35, SE = .17, t = 2.04, p < .05). Greater daytime negative affect predicted greater nightmares (Estimate = .07, SE = .01, t = 4.97, p < .001), and nightmares predicted marginally more next-day negative affect (Estimate = .07, SE = .04, t = 1.66, p = .09). PTSS (Estimate = .01, SE = .003, t = 3.47, p < .001) and negative affect (Estimate = .05, SE = .03, t = 2.06, p < .05) both predicted poorer sleep quality the following night.

Conclusion

Findings suggest that mental health symptoms during the onset of the COVID-19 pandemic are associated with increased sleep disturbances. In turn, these sleep disturbances predict increased mental health symptoms. Overall, results provide a greater understanding of youth sleep patterns during COVID-19 and how sleep disturbances may inhibit resilience in the context of an ongoing stressor.

Support (if any)

Center for American Indian and Rural Health Equity
702 Patient Characteristics & Positive Airway Pressure Therapy Compliance During NYC’s 2020 COVID-19 Pandemic Stay-at-Home Orders
Authors: Nair Sunil , Rodriguez Alcibiades
Published: May 2021

Introduction

During the first surge of the COVID-19 pandemic in New York City, as New Yorkers were enjoined by authorities to stay-at-home, patient encounters were transitioned from office visits to telemedicine consultations. It was thought that increased stress during the pandemic would worsen rates of insomnia, and concerns regarding use of positive airway pressure (PAP) therapy during a respiratory pandemic would affect compliance. We sought to describe telemedicine success rates, the distribution of sleep problems evaluated remotely by telemedicine, and PAP compliance in our patient population.

Methods

Telemedicine encounters from March 16th through May 31st, 2020, were reviewed for show-rates, patient characteristics and clinician impressions, and were compared to administrative data from the 2.5 months prior to the stay-at-home period (the “control period”). PAP compliance was analyzed for forty randomly selected patients established on PAP therapy between January 1st and October 1st, 2019, and whose machines transmitted data to a digital management system between October 1st and December 31st, 2019. Compliance reports and AHI were compared between the stay-at-home- and control- periods for this randomly selected group of patients.

Results

The telemedicine show rate was 89.37% (compared to a 91.91% in-office show-rate during the control period); all these encounters were successfully completed. Sleep apnea was the predominant diagnosis during the stay-at-home period (44.33% of encounters), followed by insomnia (23.16%). Insomnia complaints were significantly higher during the stay-at-home period compared to the control period (23.16% versus 14.6% of encounters; p < .05), and among new- versus follow-up- patients (41.76% versus 35.99%). PAP compliance and AHI, however, were not statistically different for forty randomly selected patients between the control and stay-at-home periods.

Conclusion

Most stay-at-home period telemedicine encounters were successful. Sleep apnea, then insomnia, were common findings among new and follow-up patients during the stay-at-home period, and insomnia rates increased during the pandemic. PAP compliance and AHI were similar in a random cohort when compared between the stay-at-home and control periods.

Support (if any):
710 Association of Social Isolation, Perceived Stress, and CPAP Use in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Nowakowski Sara , Arentson-Lantz Emily , Debian Ahmad , Kokanda Manasa , Shaib Fidaa
Published: May 2021

Introduction

Due to the COVID-19 pandemic, many individuals are likely experiencing increased stress and social isolation. This study aimed to examine the effect of perceived stress and social isolation on self-reported continuous positive airway pressure (CPAP) use and treatment adherence among sleep medicine clinic patients during the pandemic.

Methods

Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9y, 44% male, 69% Caucasian) completed an online survey that included self-reported changes in CPAP use and using CPAP as advised; and PROMIS Social Isolation and Perceived Stress Scale (PSS). CPAP measures were categorized based on reported changes during the pandemic. Stepwise logistic regression was performed using SAS to determine if Social Isolation and PSS predicted change in CPAP measures.

Results

Among participants, 53% reported using CPAP. Out of those, 61% reported change, 16% reported no change, and 23% reported they do not know if there is a change in using CPAP as advised during the pandemic. Social Isolation predicted an increase in odds of CPAP use by a factor of 1.15 (p=0.024). PSS predicted a decrease in odds of using CPAP therapy as advised by a factor of 0.86 (p=0.049).

Conclusion

Increases in perceived stress predicted lower odds of utilizing CPAP as advised. Increases in self-reported social isolation predicted greater odds of CPAP use in sleep medicine clinic patients during the COVID-19 pandemic. Addressing stressors/coping and social isolation/support as part of routine clinical care in sleep medicine clinic patients is advised.

Support (if any)

This work is supported by National Institutes of Health Grant # R01NR018342 (PI: Nowakowski) and 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).
715 Insomnia as a Risk for PTSD During the COVID-19 Pandemic
Authors: Killgore William , Cloonan Sara , Taylor Emily , Grandner Michael , Dailey Natalie
Published: May 2021

Introduction

The COVID-19 pandemic and associated attempts to curb its spread have led to a significant increase in mental health issues. Evidence suggests that sleep provides a protective resilience against the adverse effects of stress. Moreover, sleep disruption is often considered the “hallmark symptom” of posttraumatic stress disorder (PTSD). Here we hypothesized that insomnia would increase during the first six months of the pandemic, and that higher insomnia would be associated with elevated rates of PTSD.

Methods

A total of 6,190 adults ranging in age from 18 to 84 years (53.6% female), completed an online cross-sectional survey at one of six time points between April and September 2020 (~1,000 per administration). Instruments included the Insomnia Severity Index (ISI), Primary Care PTSD Checklist (PC-PTSD), and the PTSD Checklist-5 (PCL-5). Standard clinical cutoffs were used for ISI (≥10) and PCL-5 (≥38). Data were analyzed with analysis of variance, chi-square contingency tables, and bivariate correlations.

Results

Over the first six-months of the pandemic, PTSD increased with each passing month on both the PC-PTSD (p=.001) and PCL-5 (p<.0001). Similarly, ISI scores increased month-by-month (p<.0002). Insomnia scores were highly correlated with PCL-5 PTSD scores (r=.62, p<.0001), even when sleep items on the scale were excluded (r=.60, p<.0001). Finally, the rate of PTSD remained below 5% across all months for those without insomnia, but among those with insomnia, the prevalence of PTSD increased between May (26% positive) and September (40% positive), representing an increase of 56% over the data collection period (interaction p=.0004).

Conclusion

Both insomnia and PTSD have increased dramatically over the first six months of the COVID-19 pandemic. Moreover, insomnia appears to be highly linked with the emergence of PTSD during this time. While it is not possible to make causal attributions from these cross-sectional findings, the steadily increasing rates of PTSD over time only among those with insomnia, raise the possibility that sleep disruption could act as a diathesis for the development of PTSD symptoms in response to the pandemic. Addressing insomnia during the pandemic may be an important aspect of maintaining psychological resilience in the populace.

Support (if any):
716 Loneliness and Lockdowns: The Effects of the COVID-19 Pandemic on Insomnia Symptoms
Authors: Cloonan Sara , Grandner Michael , Killgore William
Published: May 2021

Introduction

Insomnia is a critical health issue that has serious consequences for both psychological and physical health. These consequences have become even more exacerbated during the course of the ongoing COVID-19 pandemic, as fears of the virus continue to grow and community lockdowns persist. Loneliness has also become a growing mental health concern as a result of the pandemic, and previous research has identified COVID-19 loneliness as a contributing factor to higher rates of insomnia. The current study aimed to investigate the relationship between insomnia, loneliness, and lockdown orders across the first 6-months of the pandemic. We hypothesized that being lonely and under lockdown would lead to greater insomnia, even after controlling for anxiety, and this would become more pronounced over the course of the pandemic.

Methods

6,101 English-speaking adults from across the U.S. (18–84 years old; 53.6% female) completed an online, monthly, cross-sectional (~1000 participants per month), battery of assessments that included the Insomnia Severity Index (ISI), UCLA Loneliness Scale – Version 3, Generalized Anxiety Disorder-7 scale (GAD 7), demographic questions, and a COVID-19 questionnaire between April 2020 and September 2020. A 2 (lonely vs. not lonely) x 2 (lockdown vs. no lockdown) x 2 (Time 1 April-June vs. Time 2 July-September) ANCOVA was conducted to determine the effects of these variables on insomnia, while also controlling for anxiety symptoms.

Results

Significant main effects of lockdown status, F(1,8) = 22.72, p < .001, time, F(1,8) = 4.94, p = .026, and loneliness, F(1,8) = 65.18, p < .001, were observed, as a well as a significant interaction effect between lockdown status and time, F(1,8) = 8.47, p = .004, after controlling for anxiety.

Conclusion

Overall, lonely people under lockdown had the highest levels of insomnia at both Time 1 and Time 2. Non-lonely people consistently had lower levels of insomnia than lonely people across the 6-month period; however, being under lockdown also contributed to higher levels of insomnia regardless of loneliness, which increased with each passing month of the pandemic. Loneliness and lockdowns each appear to be independently associated with elevated insomnia during the COVID-19 pandemic.

Support (if any):
728 Sleep Apnea Screening in Inpatients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A feasibility study
Authors: Lastra Alejandra , Esmero Veronica , Herdegen James , Durkin Colleen
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) and Chronic obstructive airway disease (COPD) affect millions of Americans. The combination (overlap syndrome) results in increased morbidity, mortality and associated healthcare costs. Type III sleep testing via portable monitoring (PM) is not recommended for patients with COPD, and there is little guidance in regards to inpatient testing. We aim to determine the feasibility of inpatient PM for diagnosing OSA in patients admitted with acute exacerbation of COPD (AECOPD) and hypercapnic respiratory failure requiring noninvasive positive pressure ventilation (NIPPV).

Methods

This is a retrospective review of prospectively collected data. Inpatients 40 year-old and older admitted with AECOPD and PaCO2≥52mmHg on arterial blood gas (ABG) testing requiring NIPPV were included for analysis. One patient died and one withdrew consent. The remaining patients underwent overnight PM (ApneaLink Airtm by ResMed®) once clinically stable, off NIPPV, on oxygen when needed to sustain oxygen saturation at or above 88%. Patients were discharged on volume-assured pressure support ventilation (VAPS) for nightly use at home and followed for 6 months.

Results

Five patients were included. Average age was 60 years, majority were African-American males, former smokers (average 31.2 pack-years), with moderate to severe airflow obstruction (FEV1 24–52 %Pred). Except for one (BMI 17 kg/m2), patients had concomitant morbid obesity (average BMI 39.7 kg/m2). Four out of 5 patients had overlap syndrome (AHI 19.4/h -75/h). Follow-up objective download data demonstrated AHI <10 in all patients with available data (3/5 at 6 months). One patient required in-sleep center VAPS titration.

Conclusion

This pilot study suggests portable monitoring is feasible in diagnosing OSA in this complex patient population admitted for AECOPD, despite concomitant oxygen use during PM testing. Despite the small number of patients, 4/5 were diagnosed with moderate to severe OSA and objective data on VAPS demonstrated effective treatment. Further studies using PM for screening of OSA in inpatients with COPD and obesity and impact on patient-centric outcomes are needed.

Support (if any):
730 Prevalence and impact of sleep problems in active duty military personnel receiving Cognitive Processing Therapy for PTSD
Authors: Pruiksma Kristi , Taylor Daniel , Wachen Jennifer Schuster , Straud Casey , Hale Willie , Mintz Jim , Young-McCaughan Stacey , Peterson Alan , Yarvis Jeffrey , Borah Elisa , Dondanville Katherine , Litz Brett , Resick Patricia
Published: May 2021

Introduction

Sleep disturbances are common in active duty military personnel and play a key role in the development and maintenance of posttraumatic stress disorder (PTSD). Research indicates that although insomnia and nightmares improve with successful PTSD treatment, they may remain clinically significant. Few previous PTSD studies have assessed sleep disorder constructs using validated instruments. The objectives of this study were to examine the proportion of active duty military personnel seeking treatment for PTSD who reported clinically significant insomnia, nightmares, sleep duration, and excessive daytime sleepiness and to examine the impact PTSD treatment had on these sleep constructs using validated self-report questionnaires.

Methods

Sleep was evaluated in 223 active duty service members participating in a randomized clinical trial comparing group and individual Cognitive Processing Therapy (CPT) for PTSD. Sleep constructs were assessed using the Insomnia Severity Index (ISI), Trauma-Related Nightmare Survey (TRNS), Self-Assessment of Sleep (SAS), and Epworth Sleepiness Scale (ESS) at baseline and 2 weeks posttreatment.

Results

At baseline, 82% of participants reported clinically significant insomnia and 75% reported at least 1 moderately severe nightmare per week. Participants reported averaging 4.76 hours of sleep per night, and 65% reported excessive daytime sleepiness. Over the course of PTSD treatment, there were statistically significant improvements in insomnia, nightmares, and excessive daytime sleepiness, but scores remained in clinically significant ranges. Minimal increases were seen in sleep duration. Of the participants who no longer met criteria for PTSD at posttreatment, 50% continued to report clinically significant insomnia, 52% continued to report clinically significant nightmares, and 44% continued to report excessive daytime sleepiness.

Conclusion

Consistent with previous research, sleep problems persisted for a significant number of service members who completed treatment for PTSD. Insomnia, nightmare, and sleep extension interventions are likely an important part of comprehensive PTSD treatment plans.

Support (if any)

Funding for this work was made possible by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program awards W81XWH-08-02-109 (Alan Peterson), W81XWH-08-02-0116 (Patricia Resick), W81XWH-10-1-0828 (Daniel Taylor), and W81XWH-08-02-0114 (Brett Litz).
751 Heart Rate and Heart Rate Variability During Sleep As Biomarkers for Depression
Authors: Grassi Massimiliano , Caldirola Daniela , Daccò Silvia , Perna Giampaolo , Defillo Archie
Published: May 2021

Introduction

Evidence suggests a high prevalence of depression in subjects with Sleep-Wake Disorders, with impaired sleep being both a risk factor and a symptom of depression. However, depression currently remains for the most undiagnosed in this population, which can lead to a lack or delay in the treatment, and ultimately contribute to chronicity, recurrence of depression, and increase risk of suicide. Depression is characterized by alteration in sleep architecture and imbalanced autonomic nervous system function, and specific alteration may serve as biomarkers to identify ongoing depression in subjects with Sleep-Wake Disorders undergoing polysomnography. Thus, the aim of this study is to investigate differences in sleep architecture and autonomic modulation, measured by heart rate and heart rate variability throughout sleep stages, in subjects undergoing polysomnography in a sleep clinic.

Methods

A preliminary sample of forty subjects undergoing polysomnography was recruited in three different sleep clinics. The Patient Health Questionnaire–9 was administered to participants before the beginning of the sleep study. A cut-off of 10 was applied to identify subjects with possible current depression. The polysomnography recordings were processed with the MEBsleep software (Medibio Limited) which automatically calculats sleep architecture indices, and heart rate and heart rate variability parameters throughout sleep stages. The Mann-Whitney U test was used to investigate differences between the depressed and non-depressed groups.

Results

Possible current depression was found in fourteen subjects (35%). These Subjects had statistically significant higher heart rate (median depressed=78.01, median non-depressed=64.61, p=0.01) and lower Root Mean Square of the Successive Difference (RMSSD; median depressed=18.41 ms, median non-depressed=26.52 ms, p=0.02), number of pairs of successive NN intervals that differ by more than 50 ms (pNN50. Median depressed=1.62%; median non-depressed=5.64%; p=0.03), and High Frequency (absolute power) in REM (median depressed=104.17 ms2; median non-depressed=214.58 ms2; p=0.03) than those without depression. No significant differences resulted in the sleep architecture indices.

Conclusion

These results preliminary indicates a decreased parasympathetic activity in subjects with possible depression during REM, suggesting that heart rate and heart rate variability during sleep may be used as biomarkers to identify current depression in subjects undergoing polysomnography in sleep clinics.

Support (if any):
752 Associations Between Sleep Neurophysiology and Personality Functioning Support Dimensionality in Mental Health
Authors: Wild Salome , Fontanellaz-Castiglione Chiara , Markovic Andjela , Salvatore Vanessa , Kaess Michael , Tarokh Leila
Published: May 2021

Introduction

Most psychiatric disorders in adolescence are linked to alterations in sleep behavior and neurophysiology. Similar but less pronounced changes to sleep have been reported in healthy adolescent and sub-clinical samples, suggesting that the association between sleep and mental health may lie on a continuum. The current study takes a dimensional approach to better understand the link between personality functioning as assessed using the alternative DSM-5 approach to assess personality (AMPD) and brain activity measured with the sleep electroencephalogram (EEG).

Methods

The current study included 26 medication free participants (10 with Major Depressive Disorder (MDD) and 16 healthy controls; aged 14 to 17 years (mean = 15.2 (±1.1); 14 girls) recruited as part of a longitudinal study on sleep and depression. All night high-density (58 channel) sleep EEG recordings were conducted and power in the delta (0.6 to 4.6 Hz) and sigma (11 to 16 Hz) bands, corresponding to slow waves and sleep spindles respectively, was computed. Dimensions of personality were assessed using the PID-5, which consists of the five trait domains: detachment, psychoticism, antagonism, disinhibition, and negative affect. Stepwise regression analysis was performed to examine the association between PID-5 dimension and delta and sigma power. The Benjamini-Hochberg procedure was used to correct for multiple comparisons.

Results

Greater negative affect was associated with diminished delta power for 28 electrodes over frontal, temporal, central and parietal regions (0.03 < p < 0.04). No associations between sigma power and any of the PID-5 dimensions were found.

Conclusion

In a sample of adolescents with and without depression, we find associations between negative affect and delta power independent of other dimensions of personality functioning. Using a dimensional approach, our findings are in line with previous literature showing diminished delta power in those with MDD compared to healthy controls. Our findings provide neurophysiological support for the notion that personality functioning in youth is accurately conceptualized on a continuum.

Support (if any)

This research was supported by the Interfaculty Research Cooperation Grant “Decoding Sleep: From Neurons to Health and Mind” from the University of Bern and the Swiss National Science Foundation Grant 32003B_184943 (to L.T.).
755 A Novel Modularized Intervention to Improve Sleep in Older Hospitalized Veterans
Authors: Li Yihan , Miller Megan , Torrence Nicole
Published: May 2021

Introduction

Disturbed sleep in hospitalized patient populations is a highly prevalent phenomenon, with patients commonly reporting problems with shorter sleep duration, more frequent awakenings, and overall poorer sleep quality during hospital stay compared to at home. Sleep disturbance during hospitalization is especially problematic as sleep is associated with both physical and psychological well-being. Poorer sleep has been found to impact recovery outcomes in a number of patient populations including mild traumatic brain injury, chronic pain, and most recently, in hospitalized COVID-19 patients. The current analyses examined pilot data from a novel brief modularized sleep intervention implemented with older adult Veterans living on a subacute rehabilitation unit.

Methods

Participants were screened for sleep problems upon admission to the unit. Veterans who screened positive were invited to participate in the sleep intervention. Components of the intervention were selected based on screener responses and included group sleep hygiene psychoeducation, environmental accommodations (e.g. ear plugs, eye mask, soothing music), and CPAP use education. Measures completed at pre- and post- intervention assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), global health functioning (PROMIS Global Health Scale), and depressive symptoms (Patient Health Questionnaire, PHQ-9). Pre- and post- scores were compared using paired sample t-tests. Two samples t-tests compared change scores in PHQ-9 between groups.

Results

A total of 33 Veterans were included in the analyses (Mage = 69.6, 3 female, intervention group n = 21). Participants showed a trend toward decreased PHQ-9 scores following the intervention (t(16) = 1.58, p = 0.100). There were no significant effects of the intervention on sleep quality or global health. Compared to the non-intervention group, the intervention group showed greater decrease in PHQ-9 scores at the time of post-intervention (t(25) = .828, p = .025).

Conclusion

Preliminary data suggests that a brief modularized sleep intervention may benefit depressive symptoms for older adults during hospitalization. Additional research is needed to better understand the impact of a brief intervention on self-reported sleep quality during the hospitalization period.

Support (if any)

This project was funded by a VISN 20 Seed Grant as a Whole Health promotion in alignment with the National VA Office of Patient Centered Care & Cultural Transformation.
773 The relationship between personality and sleep: Subjective cognition as a mediator
Authors: Schmiedeler Anthony , Connell Maggie , Curtis Ashley
Published: May 2021

Introduction

Research has found relationships between sleep quality and personality traits. Poor subjective sleep quality has been observed within individuals scoring high in Neuroticism and low in Conscientiousness. Personality traits have also been associated with cognitive functioning and the link being worse cognition and poor sleep quality is established. However, less is known regarding the role of cognitive functioning in the relationship between personality and sleep quality, particularly in aging populations. This study investigated whether subjective cognition acted as a mediator between individual personality traits and subjective sleep quality in middle-aged and older adults.

Methods

Middle-aged and older adults (N=269; Mage= 64.5, SD=7.8; 123 women/146 men) who were cognitively healthy completed an online survey through Qualtrics measuring demographics, personality (Big Five Inventory-10; BFI-10), self-reported sleep (Pittsburgh Sleep Quality Index; PSQI), and subjective everyday cognition (Cognitive Failures Questionnaire; CFQ). Separate mediation analyses using SPSS PROCESS macro [and testing for indirect effects using 5,000 bootstrapped samples and 95% Confidence Interval (CI) and controlling for conditional associations among all pathways] examined whether subjective everyday cognition (CFQ scores) mediated the relationship between different personality traits (BFI-10 Conscientiousness and Neuroticism scores) and self-reported sleep (PSQI-Total Score), controlling for age and sex.

Results

Neuroticism and PSQI-Total Score was partially mediated by CFQ. There was a significant association between Neuroticism and total PSQI (total effect=0.588, SE=0.110, p<0.001). There were positive associations between Neuroticism and CFQ (a-path effect=2.765, SE=0.383, p<0.001) and CFQ and PSQI (b-path effect=0.068, SE=0.017, p<0.001). The indirect effect was significant (effect=0.187, SE=0.054, 95% CI=0.088 to 0.301). There was no association between Conscientiousness and PSQI-Total Score (total effect=-0.123, SE=0.133, p=0.358), therefore mediation analysis (testing of CFQ as a mediator) was discontinued.

Conclusion

In middle-aged and older adults, subjective everyday cognition mediates the relationship between Neuroticism personality trait and self-reported sleep quality. Individuals scoring higher in Neuroticism report worse subjective sleep quality as their subjective cognitive failures increase. Findings underscore the interacting roles of personality and everyday cognition on perceived sleep. Clinicians should consider individual personality profiles (via personality assessments) and subjective everyday cognitive ratings for a better understanding of the factors impacting middle-aged and older adults’ sleep profiles.

Support (if any):
774 Insomnia precedes suicidal ideation in a national longitudinal study of sleep continuity (NITES)
Authors: Tubbs Andrew , Morales Knashawn , Grandner Michael , Ellis Jason , Vargas Ivan , Fernandez Fabian-Xosé , Perlis Michael
Published: May 2021

Introduction

Suicide is the 10th leading cause of death among US adults, and disrupted sleep significantly increases suicide risk. It is unclear, however, how quickly changes in sleep can affect suicidal thoughts and behaviors. Therefore, the present study explored whether insomnia, sleep continuity, and nightmares predicted subsequent suicidal thinking.

Methods

Data were drawn from N=1,248 individuals 35 years and older who were part of a 1-year prospective study of the natural history of insomnia. Suicidal ideation was measured biweekly from the Patient Health Questionnaire – 9 and dichotomized (Score = 0, No; Score > 0, Yes). The primary predictors were Insomnia Severity Index (ISI) score and total wake time, total sleep time, difficulty initiating/maintaining sleep, and nightmares (from daily sleep diaries). Predictors were averaged over the previous 2 weeks and measured 2 nights prior to measuring suicidal ideation. Data were modeled using generalized estimating equations to account for within-subject correlations and adjusted for age, sex, and race/ethnicity.

Results

A total of N=124 individuals (65% female) reported suicidal ideation during the study. In unadjusted models, no sleep variable was associated with subsequent suicidal ideation. However, after adjusting for age, sex, and race/ethnicity, insomnia severity was associated with subsequent suicidal ideation when averaged over the preceding 2 weeks (OR 1.09 per point on the ISI, 95% CI [1.03–1.16]) and measured 2 days prior (OR 1.11 per point on the ISI, 95% CI [1.01–1.22]). Stratified analyses showed that this effect was driven by age, with insomnia predicting suicidal ideation in individuals 55–64 and 65 and older.

Conclusion

Insomnia is a significant, proximal risk factor for suicidal ideation, particularly in older adults. Consequently, treatment of insomnia may represent an effective suicide risk reduction strategy.

Support (if any)

K24AG055602 R01AG041783
790 Adaptive Body Awareness Mediates the Relationship between Quality of Sleep and Symptoms of Central Sensitization
Authors: Colgan Dana Dharmakaya , Lim Miranda , Marshall Lynn , Oken Barry
Published: May 2021

Introduction

Sleep disturbance is associated with chronic pain. Central sensitization (CS), defined as the amplification of neural signaling within the central nervous system that results in pain hypersensitivity, may be one pathway through which sleep disturbance contributes to chronic pain. Sleep disturbance and CS are both associated with maladaptive body awareness, characterized by increased hypervigilance and catastrophizing in response to body sensations. Impaired sleep, increases maladaptive body awareness, which then contributes to CS. Less is known about the relationship between quality sleep, adaptive body awareness (i.e., increased attention to and awareness of body sensations, devoid of negative evaluations of sensations), and CS. Primary aims were to evaluate mediational pathways through which (1) sleep disturbance might be related to increased pain intensity via CS-related symptoms and (2) quality sleep might be related to lower CS-related symptoms via adaptive body awareness.

Methods

In a cross-sectional study, online surveys were administrated to 301 individuals with chronic pain. Pearson’s correlations characterized overall relationship between self-reported sleep quality (PROMIS-Sleep), adaptive body awareness (Multidimensional Assessment of Interoceptive Awareness; MAIA-2), and CS-related symptoms (Central Sensitization Inventory; CSI). Two path analyses using PROCESS were conducted.

Results

Results revealed that a one-unit increase in sleep disturbance was associated with a 1.7 unit increase in pain intensity, which was partially explained by CS-related symptoms [point estimate=.16; 95% bootstrap confident intervals (CI)=0.10 to 0.22]. In a separate path analysis, a one-unit decrease in sleep disturbance was associated with a 3.5 unit decrease in CS-related symptoms, which was partially explained via adaptive body awareness [point estimate=.25; 95% CI=0.03 to 0.52].

Conclusion

Novel findings provide greater understanding into pathways through which sleep might contribute to chronic pain. Results support longitudinal studies to explore effects of sleep and adaptive body awareness on self-reported symptoms and biological markers of CS within chronic pain populations.

Support (if any):
792 Sleep and Daytime Function in Patients with Multiple Sclerosis
Authors: Aljundi Nawar , Arvai Kelsey , Mitchell Michael , Pandya Nishtha , Zeineddine Salam , Salloum Anan , Sankari Abdulghani , Martin Jennifer , Badr Safwan
Published: May 2021

Introduction

Fatigue is a core symptom of Multiple Sclerosis (MS) and impairs function and quality of life. Studies show that sleep-disordered breathing (SDB) is also common in persons with MS and may exacerbate fatigue. Within a larger study of patients with spinal cord injuries and disorders, we evaluated the relationships among sleep-disordered breathing severity, sleep quality, and functional outcomes in patients with MS. Our objective was to examine the impact of SDB severity and sleep quality on the severity of fatigue and functional impairment in this population.

Methods

Twenty-five subjects (average age=57(11), min=35, max=79; 80% male; average AHI=27(20) min=3, max=70; and 67% with AHI > 15) 24 completed in-laboratory polysomnography (PSG) to measure apnea-hypopnea index (AHI) and sleep efficiency (SE) and questionnaires about sleep and function: Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), PHQ-9 depression scale (excluding sleep item), Brief Pain Inventory (BPI) and World Health Organization Quality of Life (WHOQOL). Relationships between sleep measures (AHI and SE from PSG, ISI and PSQI) and daytime function (ESS, FFS, PHQ-9, BPI and WHOQOL) were assessed by bivariate correlation.

Results

At the baseline visit, we assessed participant’s daytime sleepiness, fatigue, sleep quality, and depression. The mean scores on questionnaires: ESS was 8.0(5.6), ISI was 11.5(6.7), PSQI was 9.3(4.4), FFS was 17.3(8.7), BPI severity was 3.4 (3.13), BPI interference was 3.5 (3.5), PHQ-9 was 7.3(5.8). There were significant relationships between ISI and FFS (r=0.78, p<0.001), PSQI and FFS (r=0.68, p=0.001), ISI and WHOQOL Physical Domain (r=-0.64 p=0.001), as well as SE and FFS (r=-0.45, p=0.041). There was no significant correlation between AHI and FFS (p=0.395).

Conclusion

In veterans with MS, insomnia symptom severity was associated with daytime fatigue and decreased quality of life (QOL). Insomnia may represent a modifiable cause of daytime fatigue in patients with MS. Recognition and management of insomnia may improve outcomes in this population. Further research should evaluate whether insomnia interventions may benefit daytime fatigue and improve QOL.

Support (if any)

VA Rehabilitation Research and Development Service, (RX002116; PI Badr); VA HSR&D RCS20-191 and NIH/NHLBI K24 HL143055 (PI Martin).
794 Contribution of sleep disorders to dementia incidence following traumatic brain injury: A decade-long retrospective cohort study
Authors: Mollayeva Tatyana , Hurst Mackenzie , Escobar Michael , Colantonio Angela
Published: May 2021

Introduction

We aimed to examine the association between sleep disorders and dementia risk in a population-based cohort of adult male and female patients with traumatic brain injury (TBI).

Methods

We studied a province-wide retrospective cohort of all adult patients (≥ 18 years) free of dementia at the admission to the emergency department or acute care hospital with diagnoses of TBI between May 2003 and April 2013. All patients were followed through until May 2016. The primary exposure was a sleep disorder, and the primary outcome was dementia, both defined by the International Classification of Diseases, tenth revision diagnosis. Associations of sleep disorders with dementia were analyzed in multivariate Cox Proportional Hazard modeling.

Results

In total, 712,708 patients with TBI of all severities were included in this study. Their median age was 44 years, 59% were males. Over a median follow-up of 52 months (interquartile range, 19–86 months), 32,834 (4.6%) developed dementia. Controlling for age, sex, income level, injury severity, and known comorbidity risks, diagnosed sleep disorder was a significant predictor of incident dementia: hazard ratio (HR), 1.250 [95% CI, 1.146–1.363]. When results were stratified by sex, the association of sleep disorder with dementia remained significant in male: HR 1.255 [95% CI, 1.112–1.415] and in female patients: HR 1.234 [95% CI, 1.088–1.400]. Sensitivity analyses on Alzheimer’s disease case definition and using Fine and Gray competing risk models confirmed the association between sleep disorder and dementia in both sexes.

Conclusion

In both sexes, sleep disorders were independently associated with dementia onset (adjusted HRs>1.2). Thus, screening for sleep disorders should be part of regular care for TBI patients, as with the steady increase of TBI survivorship and life expectancy, undiagnosed sleep disorders can initiate a new cascade of cognitive deficits independent from TBI.

Support (if any)

This work was supported by the postdoctoral research grant from the Alzheimer’s Association (AARF-16-442937) to T.Mollayeva. The authors were also supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R21HD089106 and the Canadian Institutes for Health Research Grant–Institute for Gender and Health (#CGW-126580).
799 Automated Detection of Slow Wave Coherence in Sleep EEG: A potential neurophysiological correlate of cognitive decline
Authors: Lim Miranda , Reynolds Christina , Jones Carolyn , Lambert Sophia , Balba Nadir , Elliott Jonathan , Ju Yo-El
Published: May 2021

Introduction

A bidirectional relationship exists between sleep disruption and neuropathology in Alzheimer’s disease (AD). The sleep electroencephalogram (EEG) is a highly stereotyped, direct neurophysiological window into brain function; prior studies have identified abnormalities in EEG slow waves in early AD. EEG coherence across channels during sleep, a normally highly coherent brain state, could be an indicator of network coordination across brain regions. Accordingly, altered slow wave coherence during sleep may be an early indicator of cognitive decline.

Methods

EEG was collected during an attended overnight polysomnogram (PSG) from a community-based cohort of older subjects (n=44, average age = 71), approximately 25% of whom met criteria for mild cognitive impairment or early AD. Files were exported to EDF and a slow wave peak detector was implemented in MATLAB to count the number of slow wave oscillations, with automated artifact rejection, across 6 EEG leads standard for PSG (C3, C4, F3, F4, O1, and O2). Slow wave coherence was inferred when slow waves occurred in temporal synchrony across channels within 100 ms.

Results

Subjects with cognitive impairment showed significantly reduced total sleep time and time spent in rapid eye movement (REM) sleep compared to age-matched controls. EEG slow wave coherence was reliably quantified during wake, non-REM stages N1, N2, N3, and REM vigilance states as well as during transition periods between sleep stages. Using this algorithm, specific signatures of slow wave propagation during sleep were identified, including increased variability in slow wave activity and coherence, that appeared more prominent in subjects with impaired cognition.

Conclusion

EEG slow wave coherence during sleep and wake states can be calculated by applying automated algorithms to PSG data, and may be associated with cognitive impairment.

Support (if any)

NIH R01 AG059507
808 Sleep and Fatigue Mitigation: Paving The Way For Training Health Care Trainees
Authors: Fatima Zara , Haider Sharez , Nelson Kaz , Irfan Muna
Published: May 2021

Introduction

The health care workforce is undoubtedly prone to fatigue and sleep deprivation due to extensive hours, shift work and intense demands of the training. The physical and behavioral effects of sleep deprivation can compromise well being and also negatively impact clinical performance. ACGME has been actively engaged in efforts to promote protection of health care trainees from the deleterious effects of sleep deprivation but the grass root level educational efforts towards teaching trainees to mitigate sleep deprivation are lacking.

Methods

We conducted a 60 minute long “Sleep and Fatigue Training Session” with the goals of increasing the understanding of effects of sleep deprivation and training in countermeasures. The session was conducted as a part of the annual GME orientation session for all the incoming learners. 274 trainees (residents & fellows) participating from all the departments were divided into 25 small groups of 7–12 members each. Clinical vignettes, brief presentation and moderator facilitated interactive discussion were utilized as teaching tools. Handouts with strategies and resources for the trainees were disseminated. Pre and post session surveys were designed to assess trainees baseline understanding of sleep impairment, impact on performance, recognition of impact, possible countermeasures and the impact of module on the aforementioned parameters after the intervention.

Results

Based on the cumulative trend of participant’s responses obtained on a Likert scale of 1 to 5, results showed improvement in all the parameters including access to training (3.67 to 4.44), awareness (4.31 to 4.46), recognition (4.04 to 4.36), strategies (3.6 to 4.36), and resource availability (3.24 to 4.33). Attendees reported a cumulative score of 4.23/5 in terms of beneficial impact of the module. The resource availability parameter demonstrated the highest average increase (33.6%) after the intervention. The lowest increase in the cumulative trend was displayed (3.5%) in the self-awareness parameter.

Conclusion

The feedback from learners demonstrated that the interactive model of sleep training session was very favorably received with improved scores in all the parameters assessed. Our model paves the way for other institutes to adopt similar training sessions for learners.

Support (if any):
811 Lessons from a Pandemic - Streamlining Sleep Apnea Care; is the future here?
Authors: Akinnusi Folu , Rifkin Daniel
Published: May 2021

Introduction

Ready access to optimal care for sleep-related breathing disorders (SRBD) remains a major barrier to the vast majority of an estimated 25 million Americans with undiagnosed obstructive sleep apnea. This barrier includes lack of readily available sleep medicine expert contact, health care insurance navigation challenges and difficulties with continuity of care. Chronic pervasive gaps in sleep medicine care were exacerbated by the COVID-19 pandemic in 2020. While numerous models were previously proposed to bridge SRBD care gaps, sustained and quantifiable success has been elusive.

Methods

Deploying interactive technology and artificial intelligence, we designed and implemented a novel, user-friendly integrated medium named Ognomy - the Sleep Apnea App, to mitigate widespread SRBD care access gaps. Multi-faceted but unified open access was made widely available, allowing bidirectional patient-provider interaction through a Web App. Individuals or surrogates who suspect that they or dependents suffer from SRBD are able to readily establish secure access to Ognomy. Patients can independently download and interact with the application on-demand and around the clock.

Results

From April 2020 to date, more than seven thousand (7,726) Ognomy App downloads have been documented. Over a thousand (1,169) patient registrations have occurred on Ognomy. Five hundred seventy-four (49.1%) of Ognomy App registrants have since been provided hitherto difficult, cumbersome access to full care, by a board-certified Sleep Medicine provider. Four hundred eighty-nine (85.2%) of the 574 patients managed via Ognomy’s care provision chain proceeded to complete sleep diagnostic testing and follow up.

Conclusion

Availability of a readily accessible and affordable multi-faceted platform for care of sleep-related breathing disorders will mitigate the burden of untreated SRBD in the United Sates and worldwide. Ognomy, a Sleep as a Software service, is a novel integrated tool, bridging chronic gaps in sleep apnea care. Measures that significantly alter the trajectory of Sleep Medicine care now and in the future, have the potential to systematically close existing SRBD care gaps worldwide. Innovative tools such as algorithmic scheduling, Blockchain utility for platform interoperability, facilitating insurance benefit verifications, deployed in tandem with delivery drone systems for home sleep testing, should enhance turnaround time and improve care currently available for SRBD.

Support (if any):