bluuebunny/crossref_metadata_2025 huggingface dataset:
0106 Cognitive-Emotional Features of Insomnia Phenotypes Based on Objective Sleep Duration in Young Adults
Authors: Atha Raegan , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio
Published: April 2024

Introduction

The association of insomnia with adverse mental health outcomes is well-established. Prior research has suggested that cognitive-emotional predisposition to mental health disorders is shared across insomnia phenotypes. However, no study to date has examined this association in insomnia phenotypes based on objective sleep duration in young adults.

Methods

We studied 270 young adults (median 25 years, 53% female, 24% racial/ethnic minority) from the Penn State Child Cohort who underwent a 9-hour polysomnography (PSG) recording, clinical history, and self-report surveys. Insomnia symptoms were defined as difficulties initiating or maintaining sleep, an insomnia diagnosis or complaint, and/or sleep medication use. PSG-measured short sleep duration was defined by the median of the sample (i.e., < 7-h), identifying normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and insomnia with short sleep duration (ISSD). Participants completed the Ford Insomnia Response to Stress Test (FIRST), Arousal Predisposition Scale (APS), Personality Inventory for DSM-5 (PID-5-BF), Pre-Sleep Arousal Scale (PSAS), and Depression, Anxiety, and Stress Scale (DASS). A multivariate general linear model tested mean differences in cognitive-emotional outcomes across the four groups, while adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, medication and substance use.

Results

Compared to NSD or SSD, both INSD and ISSD showed significantly higher FIRST (Ps< 0.001), APS (Ps< 0.05), PID-5-BF (Ps< 0.01), PSAS (Ps< 0.001), and DASS (Ps< 0.05) scores, except in the PID-5-BF antagonism and disinhibition trait domains. SSD showed significantly higher FIRST scores compared to NSD (P< 0.05), but no other significant differences were observed on any other scale between SSD and NSD.

Conclusion

Sleep reactivity, cognitive-emotional arousability, internalization, and negative affectivity are trait features of insomnia, which help perpetuate its chronicity and put all phenotypes at risk of adverse mental health outcomes. These data also suggest that sleep reactivity may be a trait present in a subset of short sleepers at risk of developing insomnia.

Support (if any)

NIH (R01 HL136587, R01 MH118308, UL1 TR00127)
1061 Improving Access to Pediatric Sleep Service by Utilizing Unique Electronic Medical Record Based Informatic Tools
Authors: Shah Vaishal , Sulaj Holta , Hane Caprielle
Published: April 2024

Introduction

Fragmented scheduling processes, workforce shortage and limited resources affected patient care and hindered access to pediatric sleep services. Between 40-60% pediatric sleep consult orders remained unscheduled at the Cleveland Clinic's Sleep Disorder Center every month in 2019 and 2020. We aimed to reduce unscheduled pediatric sleep consult orders and improve access by utilizing unique automated electronic medical record (EMR) based informatics tools.

Methods

Several key steps were implemented via a systematic A3 project charter utilizing continuous improvement methods. Unique informatics tools including ticket schedule via my chart patient portal, automated calling and messaging system for scheduling prompts, simplified scheduling templates and efficient electronic monitoring system was developed and implemented via Epic Hyperspace EMR system between 2020-2022.

Results

Key outcomes accomplished: 1. Visual scheduling report system/dashboard 2. Electronic workflow for schedulers 3. Automated patient driven ticket scheduling via patient record portal and embedded EMR questionnaire. 4. By December, 2022, 88% of consult orders were scheduled at a scheduling rate of >80% every month 5. By October 2023, 93% of order were scheduled per month 6. Up to 52% of all patients scheduled visits via automated scheduling system 7. Several patients/families subjectively reported positive experience and high satisfaction utilizing automated system or traditional scheduling 8. Significant amount of time spent on scheduling for patient and health care team was saved.

Conclusion

Despite several challenges during COVID pandemic including loss of personnel, limited resources, frustrating processes, and constant changes in the course this continuous improvement project achieved very high level of scheduling in unique and innovative manner and helped significantly improve access to much needed pediatric sleep care. Such tools can be replicated within and at other health care organizations with exponential impact on access to pediatric sleep services.

Support (if any)

None
1063 Predictors of Insufficient Treatment Response to Digital CBT-I: Results from the RESTING Study
Authors: Solomon Natalie , Gumport Nicole , Tully Isabelle , Simpson Norah , Manber Rachel
Published: April 2024

Introduction

Triaged stepped-care approaches start patients in either lower or higher intensity of treatment based on participant characteristics, switching patients who demonstrate insufficient progress in lower intensity treatment to higher intensity treatment. The purpose of the present study was to investigate characteristics of participants who were predicted to benefit from lower intensity treatment (digital CBT-I [dCBT-I]) and made insufficient progress following two-months of dCBTI, compared to similar participants who made sufficient progress.

Methods

Participants were 101 adults aged 50 or older who were triaged to begin treatment with dCBT-I as part of the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Specifically, these participants had to have taken sleep medications < 4x/week, score below clinical cutoffs for moderate-severe mental health comorbidity and daytime sleepiness, and sleep >4.5hrs/night on average. T-tests were used to compare baseline characteristics of participants who made insufficient progress after two months of dCBT-I to those who made sufficient progress. Sufficient progress was defined as ISI ≤ 10 or reduction of at least 50% in sleep medication use.

Results

Those with insufficient progress in dCBT-I (N= 74) had higher insomnia severity index (ISI) scores at baseline than those with sufficient progress in dCBT-I (p=.002, d=.70). There were no significant differences in terms of baseline Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scores (p=.39), chronotype (Morningness-Eveningness Questionnaire: MEQ; p=.32) or sleep medication use (p=.39); effect sizes for the differences were small (d=.19-.23). Further, there was no significant difference in the number of digital modules completed (p=.13, d= .35) between those who did and those who did not make sufficient progress.

Conclusion

Only greater insomnia severity at baseline was a significant predictor of insufficient treatment response among participants who were triaged to begin treatment with dCBT-I. Further research is needed to determine if insomnia severity alone or when combined with the RESTING study triage algorithm will improve the identification of those likely to benefit optimally from dCBT-I.

Support (if any)

R01AG057500
1065 Preliminary Findings of a Pilot Clinician Training Program to Integrate Digital CBTi into Routine Therapy
Authors: Gumport Nicole , Tully Isabelle , Stirman Shannon Wiltsey , Manber Rachel
Published: April 2024

Introduction

Many patients who enter treatment for mental health problems experience insomnia symptoms that may hinder their response to general mental health treatment. There is also a shortage of CBTi providers in the United States and worldwide. One method to address the paucity of CBTi providers is to integrate digital CBTi (dCBTi) into general psychotherapy, which, on its own, does not sufficiently address insomnia symptoms. This approach is likely to improve sleep and potentially also mental health outcomes. Integrated dCBTi provides the patient with support around adherence and engagement. This study aims to pilot test and refine a program for training licensed therapists to support their patients undergoing dCBTi. This integrated approach is novel and yet to be tested.

Methods

Licensed therapists participate in a 4-hour training. Therapists subsequently enroll 1-2 patients with insomnia symptoms and comorbid depression and/or anxiety to receive integrated dCBTi. Therapists complete measures evaluating the training. At each psychotherapy session, therapists complete a checklist documenting which elements of the integrated dCBTi support they provide and how much time they spend doing so. Patients complete the Insomnia Severity Index, the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders, and qualitative measures about their experience of integrated dCBTi after receiving integrated dCBTi.

Results

As of December 2023, 11 therapists are enrolled and patient enrollment is ongoing. After the training, therapists rated that they were “well-prepared” to integrate dCBTi into their routine practice, and 100% indicated that they would recommend this training. Regarding the content of dCBTi, therapists expressed understanding of the value of time in bed restriction and importance of monitoring the patient’s engagement and progress continuously. Therapists also noted an improved ability to present the rationale for CBTi components and to answer patient questions about dCBTi. Post training data, including patient data, will be available by June 2024.

Conclusion

The integration of dCBTi in general psychotherapy through brief training of licensed therapists may be a viable approach to improve access to CBTi for patients with comorbid depression and/or anxiety.

Support (if any)

Sleep Research Society Foundation Career Development Award 035-JP-22 and T32MH019938
1068 Sleep Education and Awareness Among Social Workers: A Nationwide Study
Authors: Spadola Christine , Raval Minjaal , Zhou Eric
Published: April 2024

Introduction

Social workers are frontline behavioral health clinicians and comprise the majority of the mental health workforce. As poor mental health often co-occurs with inadequate sleep and sleep disorders, social workers can play a pivotal role in promoting sleep health among their patients as well as provide referral and treatment options if a sleep disorder is suspected. However, the Council on Social Work Education (CSWE) does not mandate sleep education in the social work curricula. There is little knowledge about how much training social workers have received about sleep. This study aims to investigate the state of sleep health education and sleep health awareness among social workers.

Methods

Recruitment emails were sent to licensed social workers across the US, through national social work organizations and faculty listservs. Eligibility criteria included being a licensed social worker in the US and ability to read and write in English. Respondents were queried about the extent of their sleep health training and clinical practice in this domain using QuestionPro software.

Results

A total of 363 social workers, predominantly female (72.4%) and non-Hispanic white (76.2%) participated. Most (62.0%) reported not receiving any sleep education during their formal social work training. Among those reporting sleep education during their graduate studies, the average duration was 3.3 hours (SD=2.8). Many social workers (67.9%) reported receiving formal sleep education post-licensure (mean=7.0 hours; SD=6.5). Few participants (2.8%) reported confidence in recognizing insomnia disorder, and only half (50.2%) were aware that CBT-I is an evidence-based treatment for insomnia. Despite this, a majority (80.0%) reported discussing sleep with their patients during treatment. Most social workers (84.0%) reported interest in learning more about sleep health.

Conclusion

The majority of social workers did not receive sleep education during their formal graduate studies, with many seeking to address this deficit following professional licensure. Only a small fraction of social workers report confidence in recognizing sleep disorders, which can impact proper referral and treatment of sleep disorders. Considering the relationship between sleep and mental health, promoting sleep health education and awareness in educational programs for behavioral health clinicians can have important implications for overall health promotion.

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1069 The Effects of Formal Sleep Medicine Didactics on Family Medicine Residents’ Confidence with Sleep Disorders
Authors: Tripathi Poulomee , Gottschalk Ginny , Wani Anna , Alla Rupini
Published: April 2024

Introduction

Exposure to sleep medicine education in ACGME accredited parent specialties of sleep medicine is scarce and varied. Literature states sleep-related didactics average 4.75 hours per year; less than 10% of programs have graduates pursuing sleep medicine fellowship. In the last five years at University of Kentucky’s Family and Community Medicine residency (UK FM), only 4 of 1200 hours of didactics (less than 1%) have been dedicated to sleep. Lack of sleep education during residency leads to patient care gaps, and deficiency of exposure to this field dissuades trainees from pursuing sleep fellowship. To understand UK FM residents’ opinions of sleep medicine, a survey was distributed before and after a formal lecture series.

Methods

Google surveys were disseminated via text message to residents. Submissions remained anonymous. The pre- and post-lecture surveys had congruent questions about sleep education, sleep disorder management, and tested knowledge about sleep disorders. The lecture series had three one-hour lectures during didactics. One week after the last lecture, the post-survey was disseminated. Results were then compared.

Results

The current cohort is comprised of 17 residents. Response rate was 94% for the pre-survey and 76% for the post-survey. After lectures, 46% agreed they had adequate education and understanding of sleep medicine compared to 0% before. Regarding managing specific disorders, more residents answered they had higher comfort after the lectures. Majority of the residents (>50%) answered 2/3 knowledge questions correctly after the lecture series. Overall trends indicated increased confidence and knowledge after the lectures.

Conclusion

By simply increasing sleep education didactics by 3 hours through this project, the total percentage of sleep didactics in resident education was tripled. This increased confidence and competency of residents in sleep education. Our study highlights the current gaps in resident education related to sleep, the need to increase sleep didactics in sleep medicine feeder residencies, and ultimately how this education increases resident confidence and competency in sleep management.

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0107 Bedtime Procrastination Mediates the Association Between Repetitive Negative Thoughts and Insomnia Symptoms
Authors: Carlson Steven , Williams Paula
Published: April 2024

Introduction

Introduction. Several studies have demonstrated that bedtime procrastination, or the tendency to delay bedtime in the absence of external obligations, is associated with insomnia. However, there is a lack of research on the role of bedtime procrastination in the development of insomnia symptoms. Consistent with the cognitive model of insomnia, bedtime procrastination may serve the purpose of avoiding repetitive negative thoughts associated with bedtime. Accordingly, the present study sought to evaluate the role of bedtime procrastination in the association between proneness to repetitive negative thoughts and insomnia using data from a daily diary evaluation of sleep in young adults.

Methods

Methods. 521 young adult participants (Mage = 24.6, SD = 6.9) completed baseline measures of worry (Penn State Worry Questionnaire) and rumination (Rumination-Reflection Questionnaire) tendencies, in addition to the Insomnia Severity Index. Participants additionally completed 14-days of experience sampling assessment, including self-report measures of nightly pre-sleep arousal and morning sleep diaries and ratings of prior-night bedtime procrastination. Structural equation models were constructed to identify the serial-mediation effect of worry and rumination on insomnia symptoms through pre-sleep arousal and bedtime procrastination.

Results

Results. Bedtime procrastination partially mediated the associations between rumination (β = 0.03, p = 0.006), worry (β = 0.02, p = 0.021), pre-sleep arousal (β = 0.06, p < 0.001), and insomnia symptoms. Furthermore, pre-sleep arousal and bedtime procrastination serially mediated the associations between worry (β = 0.02, p = 0.001), rumination (β = 0.02, p = 0.001), and insomnia symptoms. Secondary analyses suggest that repetitive negative thought tendencies are associated with poor subjective sleep quality, whereas bedtime procrastination was associated with longer sleep onset latency, wake after sleep onset, and shorter sleep duration.

Conclusion

Conclusion. The current findings suggest that bedtime procrastination may be a relevant behavioral mechanism underlying the association between propensity for repetitive negative thoughts and insomnia symptoms. In these models, ESM-assessed bedtime procrastination, but not proneness to repetitive negative thoughts, was associated with poorer daily self-reported sleep outcomes. Individuals may procrastinate their bedtime to avoid sleep-related repetitive negative thoughts. Further research is needed to elucidate the role of bedtime procrastination in the development of insomnia symptoms.

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1072 Pulmonary Fellows Need More Sleep: A Sleep Disordered Breathing Curriculum for Pulmonary Fellows
Authors: Stone Blair , Newitt Jennifer , Strollo Patrick , Ali Mazen El , Maximous Stephanie
Published: April 2024

Introduction

Sleep medicine training in pulmonary and critical care (PCCM) fellowships varies widely. The lack of formal curriculum and local pilot data demonstrating limited mastery of sleep medicine concepts via typical clinical exposure prompted us to develop, implement, and evaluate a sleep disordered breathing curriculum for first year PCCM fellows.

Methods

This educational study utilizes a historical control pre-test post-test model. The intervention arm consists of first-year PCCM fellows (n = 7) who completed a 10-question evaluation prior to fellowship-level education. They participated in a novel curriculum and are completing the same test upon conclusion of the curriculum. The curriculum is based on five case vignettes covering obstructive sleep apnea, obesity hypoventilation and sleep disordered breathing in COPD, heart failure, and neuromuscular disease. The control arm is comprised of PCCM fellows (n = 6) who have not had exposure to the SDB curriculum. They completed the evaluation at the conclusion of first year and at the beginning of their third year of fellowship. The evaluation was developed by local and national pulmonary and sleep medicine educators with expertise in question-writing.

Results

Test scores amongst the control group remained low at the end of first year of fellowship, with a mean score of 6/10 (60% +/- 8.9) and have remained low at the beginning of their third year of fellowship with a mean score of 5/10 (50% +/- 11.5%). When asked using a 5 point Likert scale (1=totally uncomfortable, 5=totally comfortable), to assess their comfort with the diagnosis and management of obstructive sleep apnea, the overall average response of 3.08 +/- 0.63 suggests limited comfort with these concepts. In regards to the intervention group, the mean pre-test score prior to beginning the curriculum was 3.71/10, (37.1% +/- 26.3%). Post-curriculum testing and data collection is ongoing with the intervention group, but preliminarily suggests an improvement in comfort level.

Conclusion

We suspect that the intervention group will demonstrate improved knowledge and comfort in the management of SDB. These results would suggest that our curriculum offers an opportunity to increase the number of pulmonologists who are able to care for the growing population of patients with SDB.

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1074 The Relationship Between Blood Glucose and Sleep Consistency in Surgeons: Results from a Pilot Study
Authors: Leahy Nicholas , Kang Ellison , Marquardt Matthew , Orr Morgan , Emerson Angela , Hagen Josh , Quatman Carmen
Published: April 2024

Introduction

Both sleep and blood glucose are vital, interconnected health metrics. These parameters are yet to be explored in surgeons, who often suffer from poor sleep hygiene and thus risk poor glucose handling. This study examines the interplay between surgeons’ sleep consistency and fasting blood glucose levels on both operative and non-operative days.

Methods

Ten surgeons were recruited from a large midwestern academic center’s Department of Orthopedics. Surgeons were given commercially available Oura rings to track sleep and continuous glucose monitors to measure minute-by-minute blood glucose levels over a 14-day period. Fasting glucose levels were calculated by taking the average glucose levels over the 75-to-15-minute period before waketime. Unpaired T-tests were used to analyze the data, and statistical significance was considered for p-values < 0.05.

Results

Seven residents and three faculty surgeons were a part of this pilot study’s cohort, four of whom were female and six were male. Of the 140 total nights in the study, 88 (62.9%) had both glucose and sleep data fully recorded. In 22 of these, fasting glucose levels exceeded 100 mg/dL, six of which were operating days. When surgeons went to bed more than an hour earlier or later than usual before operating, their fasting glucose levels the next morning increased to 95.9 mg/dL compared to 85.7 mg/dL when they went to bed closer to their regular bedtime before operating (p = 0.128). Additionally, there was a statistically significant difference (p=0.012) in fasting glucose levels in days surgeons woke up more than an hour earlier or later from their average waketime, resulting in an increase from 84.0 to 98.8 mg/dL in these days, although whether they were operating was not significant.

Conclusion

The strong association between poor wake time regularity and elevated fasting glucose adds to the current body of work demonstrating the importance of sleep regularity—in particular wake time regularity—on overall health. Impaired glucose handling due to poor sleep habits in this population can have consequences ranging from daily fatigue to increased intra-operative mistakes. In future studies, intra-operative glucose levels could be correlated with sleep metrics to better correlate glucose handling in this novel population.

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1075 The Impact of Operating on the Sleep Consistency of Surgeons: Results from a Pilot Study
Authors: Kang Ellison , Marquardt Matthew , Leahy Nicholas , Orr Morgan , Emerson Angela , Hagen Josh , Quatman Carmen
Published: April 2024

Introduction

It is well known that sleep is essential for health, but not as much attention is given towards aspects of sleep like sleep timing or regularity, both of which are important characteristics of sleep quality. In medicine, surgeries may not always be planned. As a result, many surgeons suffer from poor sleep consistency. This study explores surgeons’ sleep habits and compares sleep regularity on operating days to non-operating days.

Methods

Ten surgeons were recruited from a large midwestern academic center’s Department of Orthopedics. Each surgeon was given an Oura ring for a 14-day period to track their sleep. After the 14-day study period, overall average bedtimes and wake times, and bedtime and wake time regularity were compared for operating and non-operating days. Regularity was calculated by taking the absolute change in bedtime or wake time compared to the previous day. Paired T-tests were used to analyze the data; statistical significance was considered for p-values ≤0.05.

Results

Of the 10 surgeons recruited, 7 were residents and 3 were faculty; 4 were female, and 6 were male. Through the 14-day period, a total of 95 (67.9%) of the possible 140 nights were recorded, 41 (43.2%) of which were OR days, and 54 (56.8%) were non-operating days. Average bedtimes (p = 0.185) and regularity (p =0.731) between operating and non-operating days showed no statistically significant difference. However, both average wake-up time (p = 0.024) and regularity (p = 0.006) illustrated statistically significant changes. Furthermore, when comparing the number of days wake-up times changed by more than 1 hour on OR days to non-OR days, a significant difference was appreciated (p = 0.016), while that of bedtime regularity remained insignificant (p = 0.082).

Conclusion

The significant changes in wake-up times support the idea that many surgeons have poor sleep regularity. While doctors and research stress the importance of maintaining a robust sleeping schedule to their patients, the structure of our healthcare system complicates surgeon’s ability to maintain regular sleep themselves. Future studies should explore how poor sleep consistency impacts the physiological processes of surgeons and other healthcare workers.

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1077 Home Transcutaneous Carbon Dioxide Tracking for Optimizing Care of Chronic Respiratory Failure
Authors: Hiranrattana Anunya , Campbell Kimberly , Holzer Rena Schrier , Anaka Kufre , Ramos Amy , Thomas Robert , Ahn Anjali , Heckman Eric , Chang Jacqueline
Published: April 2024

Introduction

Hypoventilation is a key component of respiratory failure, yet both in the clinical sleep laboratory and in the home ventilation care pathway, oximetry is often only measured. Thus, the degree of hypercapnia remains undocumented. Optimal home ventilation should reasonably target both oxygenation and ventilation. The Sleep Respiratory Failure program at the Beth Israel Deaconess, Boston, is a dedicated service managing nocturnal respiratory failure. In collaboration with a home care company, home ventilation tracking program was established.

Methods

Home testing/tracking of transcutaneous carbon dioxide (TcCO2) using the Sentec device was performed by Regional Home Care, a local DME company during 2021-2023. A respiratory therapist went to the patient’s home and set up the device (pulse oximetry and TcCO2). A report was then sent to the ordering sleep medicine practitioner. TcCO2 tracking was not routine, and ordered only when there was concern for inadequate therapy.

Results

We included 45 TcCO2 testing (with 34 complete data) from 37 subjects, mean age 61.2 years old (31-84, SD 15.1), mean BMI 33.9 (16.8-58.5, SD 10), female 60% vs male 40% (mean age 63.6 and 57.7, respectively). COPD, OHS and CHF were the key diseases in 8, 5 and 10 subjects and out of those, 9 subjects had 2 combined diseases. 51.5% of subjects were on a ventilator, 30.3% on CPAP, 6% on BiPAP. 9.1% on O2 NC and 3% on room air with 30.3% on both PAP therapy and O2. Overall, average minimal saturation was 77.9% (51-92, SD 11.5) and average % of time with TcCO2 above 50 mmHg (Tover50P) was 30% (0-100, SD 38.2). Male and female subjects demonstrated Tover50P of 41.7% (95% CI 14.2-61.9) and 23.6 (95% CI 8.4-38.9), respectively.

Conclusion

Home TcCO2 is feasible and informative regarding the state of ventilation in patients with chronic respiratory failure. While oximetry is useful, knowing the actual TcCO2 allows critical decision making, including adjustment of ventilator settings or planning a sleep laboratory titration. It was revealing that residual hypoxia and hypercapnia were very common in this high risk group, despite substantial management effort including a dedicated respiratory failure clinic.

Support (if any)

Institute for Personalized Sleep Health, Beth Israel Deaconess, Boston
1079 Robust Automated Sleep Staging Using Only EEG Signals
Authors: Chan Alexander , Cakir Ahmet , Josephs David , Kleinschmidt Dave , Pathmanathan Jay , Donoghue Jacob
Published: April 2024

Introduction

Automated algorithms for assisting sleep technologists and clinicians in the staging of sleep have the potential to significantly speed the scoring of PSGs, reduce inter-rater variability, and improve the reliability of diagnosis of sleep disorders. Here, we describe an automated sleep staging machine learning algorithm that scores PSG using only EEG signals.

Methods

We describe a convolutional neural network-based sleep staging algorithm, SleepStageML™, that was trained on a database of >19,000 polysomnography recordings from a heterogeneous patient population within the Beacon Clinico-PSG Database. The algorithm was evaluated on 100 held-out recordings from 5 clinical institutions across 11 sites, comprising a highly diverse population representative of patients evaluated in sleep clinics. Each recording was independently staged by 3 registered polysomnographic technologists to generate consensus ground-truth sleep staging for each recording.

Results

The automated algorithm achieved human-level sleep staging performance with per-stage positive-percent-agreements (PPA) of 89% for W, 65% for N1, 81% for N2, 90% for N3, and 92% for R. Negative-percent-agreements (NPA) were 98% for W, 95% for N1, 95% for N2, 94% for N3, and 98% for R. The algorithm achieved a macro-average F1-score of 0.77. In addition, the algorithm’s median absolute error in estimating total sleep time (TST) was 12 minutes, wake after sleep onset (WASO) was 7 minutes, latency to persistent sleep (LPS) was 2 minutes, and REM latency was 1 minute. The algorithm was also able to stage recordings with the minimum number of AASM recommended EEG electrodes without a statistically significant reduction in performance. The sleep staging model was able to generate sleep stages for all 100 recordings within 26 minutes on a computer with an available GPU.

Conclusion

We demonstrate a model trained on large amounts of highly diverse PSG data that is capable of automatically staging EEG channel data from the PSG to achieve performance matching human experts. An automated staging algorithm that operates on EEG alone has the potential to rapidly provide accurate diagnostic information in a variety of neuropsychiatric conditions with a reduced testing burden, and greatly accelerate the development of novel therapies.

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0108 Sleep Deprivation Impairs the Ability to Reappraise Negative Situations
Authors: Campbell Rebecca , Nguyen Annamarie , Gournay L Riley , Vargas Ivan , Williams Parker , Assar Arash , Leen-Feldner Ellen
Published: April 2024

Introduction

Sleep and emotion regulation are linked components in the development and maintenance of mental health disorders. Reappraisal is a commonly used emotion regulation strategy that may be impacted by sleep loss. Importantly, the literature to date primarily focuses on sleep-restricted adolescence when discussing the relation between sleep loss and reappraisal.

Methods

This study aimed to examine the relation between sleep deprivation and emotion regulation by asking 76 undergraduate students (39 men, Mage = 19.14; SD = 1.26) to reappraise a series of vignettes translated from the Script-Based Reappraisal Test (SBRT) before and after a randomly assigned night of sleep deprivation or normal sleep. Participants completed Self-Assessment Manikin (SAM) ratings of valence and arousal after each script presentation. At-home sleep deprivation was confirmed with hourly check-ins via Qualtrics and a subset of 10 participants in the sleep deprivation group also wore actigraphy.

Results

Factorial ANOVAS with repeated measures were conducted to examine within-subjects effects, between-subjects effects, and interactions. With regards to valence, sleep-deprived participants struggled to reappraise as indicated by a significant effect of time (F(1, 74) = 11.23, p = 0.001), condition (F(1, 74) = 6.55, p = 0.012), and significant interaction (F(1, 74) = 13.83, p < 0.001). Pairwise contrasts demonstrate that sleep-deprived participants at post-manipulation reported more negative valence compared to their baseline (t(148) = 4.19, p < 0.001) and the control group at post-manipulation (t(148) = 4.27, p < 0.001). Additionally, there was a decrease in arousal, as indicated by a significant effect of time (F(1, 74) = 18.93, p < 0.001), condition (F(1, 74) = 5.08, p = 0.027), and significant interaction (F(1, 74) = 8.31, p = 0.005). Pairwise contrasts demonstrate that sleep-deprived participants at post-manipulation reported less arousal compared to their baseline (t(148) = 3.80, p = 0.001) and the control group at post-manipulation (t(148) = 3.43, p = 0.004).

Conclusion

This study expands the current literature on sleep loss and reappraisal. Findings may help inform mental health providers when working with patients that may struggle with emotion regulation concepts such as reappraisal.

Support (if any)

Internally funded Howells Student Research Grant (Grant Number: 2110.01S)
1081 A Randomized Controlled Trial of ISLEEP: Impact on Inpatient Disruption and Sleep
Authors: Sunderrajan Aashna , Cursio John , Martinez Maylyn , Orlov Nicola , Mason Noah , Byron Maxx , Press Valerie , Knutson Kristen , Mokhlesi Babak , Meltzer David , Arora Vineet
Published: April 2024

Introduction

Hospitals often contribute to acute sleep deprivation in patients through modifiable disruptions. Although staff-directed interventions have proven beneficial, research exploring direct patient education and empowerment in reducing disruptions and enhancing inpatient sleep is lacking.

Methods

Patients were randomly assigned to either the I-SLEEP or standard care arm. Patients in the I-SLEEP arm received a 5-minute video emphasizing sleep hygiene and empowering them to advocate for reduced sleep disruptions. Both groups received a sleep kit. The Potential Sleep Disruptions Questionnaire measured patient-reported disruptions (vitals, tests, medications) and wrist actigraphy measured nightly sleep duration in minutes. Mixed-effects models, controlling for study day, age, gender, race, BMI, apnea risk, comorbidities (COPD or asthma, diabetes, chronic heart failure, end-stage renal disease), and subject random effects tested the effectiveness of I-SLEEP on outcomes.

Results

A total of 175 patients were randomized (95 I-SLEEP patients for 265 nights; 80 standard patients for 174 nights). Both groups were similar with respect to baseline characteristics. In unadjusted analyses, I-SLEEP patients reported fewer disruptions from vitals (63% vs. 74%), medications (49% vs. 60%), and tests (57% vs. 69%) compared to standard patients (p=0.02 for all). In adjusted analyses, I-SLEEP patients reported significantly lower odds of disruptions due to medications (OR 0.50 [0.27, 0.94], p=0.03) and tests (OR 0.44 [0.21, 0.91], p=0.026). In unadjusted analyses, although sleep duration was greater on I-SLEEP nights compared to standard nights (334 minutes vs. 309 minutes), this difference was not statistically significant (p=0.16). Adjusted analyses confirmed these results. However, an interaction between I-SLEEP and study night revealed that patients in I-SLEEP gained an additional 15 minutes of sleep per night during the intervention, although this difference was just shy of significance (p=0.06).

Conclusion

I-SLEEP is linked to decreased patient-reported sleep disruptions from medications and tests, and a trend towards greater objective inpatient sleep for each day in the intervention. Given the importance of improving sleep in hospitalized patients, I-SLEEP emerges as a patient-centered intervention with the potential to empower patients in advocating for improved sleep quality in the hospital.

Support (if any)

1K24HL136859-05
1087 Recognizing Sleep Disorders in the US Military Health System: Differences Between On-base and Private Sector Care
Authors: Capaldi Vincent , Williams Scott , Thomas Connie , Herrin Jeph , Hong Allison , Funk Wendy , Collen Jacob , Stryckman Benoit , Albrecht Jennifer , Wickwire Emerson
Published: April 2024

Introduction

Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are common and costly in the US Military Health System (MHS). Further, demand for sleep specialty care greatly exceeds available supply. Many MHS beneficiaries are referred off-base to the TRICARE network to access private sector care. The purpose of this study was to compare military, demographic, and clinical characteristics between MHS beneficiaries newly diagnosed with either insomnia or OSA on-base (direct care) and off-base (private sector care).

Methods

We identified MHS beneficiaries with a first diagnosis of insomnia or OSA between years 2016-2021 within the Military Data Repository (MDR). This large data repository includes encounter, procedure, medication, and durable medical equipment information for Active Duty personnel, dependents, National Guard, and Reserves. Demographic and military information was obtained from the MDR. Sleep disorders and medical and psychiatric comorbidities were defined based on ICD-10 diagnostic codes. Determination of direct vs private sector care was based on an indicator in the MDR.

Results

235,823 MHS beneficiaries were diagnosed with either insomnia (n=143,877) or OSA (n=91,946). Of beneficiaries with insomnia, the majority (n=119,923, 83.4%) were diagnosed in direct care. Of beneficiaries with OSA, the majority (n=51,014, 55.5%) were diagnosed in private sector care. Between-groups differences (direct vs private sector care) were observed in service branch (standard mean difference [SMD]=0.46) and beneficiary category (i.e., Active Duty, dependent, National Guard, or Reserve; SMD=0.37), with most Active Duty (n=131,321, 81.6%) and dependent (n=26,987, 53.5%) beneficiaries being treated via direct care. No between-groups differences were observed in medical and psychiatric comorbidities. In terms of comorbid sleep disorders, of beneficiaries diagnosed with hypersomnia (n=12,403), the majority (n=10,055, 81.1%) were diagnosed in private sector care.

Conclusion

Differences in service branch and beneficiary category were observed between individuals diagnosed with insomnia or OSA in direct and private sector care. Insomnia was more likely to be diagnosed in direct care, and OSA was more likely to be diagnosed in private sector care. Future research should examine health and economic outcomes associated with direct and private sector sleep care and identify opportunities (e.g., telehealth) to bring sleep care back into the MHS.

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DoD HT94022210006.
0109 A Gender Disparity in the Experience of Fear in Dreams
Authors: Wells Mallory , Baber Garrett , Hamilton Nancy
Published: April 2024

Introduction

Determining whether gender differences exist in dream experiences is crucial for understanding potential disparities in offline emotional processing. Women tend to experience more nightmares (i.e., dreams characterized by fear) than men, which could indicate a failure of overnight fear extinction. Yet, there is mixed evidence as to whether gender differences in dream emotions exist. To resolve this ambiguity, our study employed a novel natural language processing (NLP) tool on a large dataset to explore potential gender disparities in the experience of fear in dreams.

Methods

Data utilized in this study were sourced from Cunningham et al.'s (2020) sleep and mental health daily survey conducted at Boston College, involving 667 participants (Female = 569, Male = 98). Dream reports and sleep efficiency calculations were surveyed across several days and self-reported gender, age, and neuroticism scores were surveyed once. We applied a deep learning NLP model to dream reports to estimate a regression value representing fear intensity from the text. Mean values per participant were computed for dream fear, dream report word count, and sleep efficiency. We fitted a general linear regression model to test whether mean dream fear could be predicted using binary self-reported gender while controlling for mean dream report word count, mean sleep efficiency, neuroticism, and age.

Results

Female identity was significantly associated with higher mean dream fear independent of mean sleep efficiency, mean dream report word count, trait neuroticism, and age, β = -0.03, SE = 0.01, 95% CI: [-0.05, -0.01], p < .001. All variables except for age were significantly related to mean dream fear.

Conclusion

We found that those who experienced greater fear in dreams were more likely to be female identifying, after controlling for other variables. Mean sleep efficiency, mean dream report word count, and neuroticism were significantly related to higher mean dream fear. Word count may be related to dream fear due to a bias in the NLP model. Future research should investigate differences in dream fear among other gender identities, collect a more representative sample, and include measures of stress and trauma as possible explanatory variables of gender disparities in dream fear.

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1091 "If You Sleep, You Have Missed It": Perceptions of Sleep Among Long-distance Drivers in Ile-Ife, Nigeria
Authors: Komolafe Deborah , Olorunmoteni Oluwatosin , Afolabi Hannah , Akinwale Oluwatobiloba , Idowu Ahmed , Sanusi Ahmed , Akanji Jamiu , Edu Benita , Eziyi Josephine , Amusa Yemisi , Komolafe Morenikeji
Published: April 2024

Introduction

Road Traffic Accidents (RTAs) are a major cause of mortality and disability in developing countries. Previous studies suggest that one-third of road traffic accidents are due to drowsy driving. The frequency and causes of drowsy driving in Nigeria are unknown as there is limited data and publication on the subject. Hence, this study was carried out as part of an awareness program for the 2023 World Sleep Day to explore the perceptions and determinants of poor sleep among long-distance drivers in Ile-Ife.

Methods

A cross-sectional qualitative study was conducted with a focus group conducted among 12 leaders of drivers in Ile-Ife. Ethical approval and consent were obtained beforehand. Participants were asked about their perception of sleep with a pre-developed interview guide. Their responses were recorded and transcribed verbatim, and ATLAS.ti 22.3 was used to manage the data. Thematic analysis was done, and sample quotes were documented.

Results

All respondents were male aged 45 to 52 years. The drivers described their sleep as not sufficient as they leave for work early and return late. A recurrent response was; “sleep is very important, but for people like us, sleep is not sufficient.” Four factors were identified that affect sleep quality: financial debt, responsibilities, drinking alcohol for recreation, and distance traveled. Participants reported that they work longer hours to be able to pay for the hired buses they drive, alongside responsibilities such as payment of children’s school fees, as described; “Had it been that one has a basic salary; one can sleep conveniently till 9 am.” The drivers also added that they prefer to drink alcohol and have fun after work, which affects their sleep. Additionally, drivers who travel intra-state return early and sleep more.

Conclusion

Commercial drivers are at an increased risk for drowsy driving and, consequently, are at risk for RTAs. This study highlights the multifactorial and socioeconomic challenges that influence sleep quality among long-distance drivers in South West Nigeria. Further studies are required, and educational and economic measures are recommended to be implemented to reduce this risk.

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1093 TikTok Made Me Do It: An Analysis of the Scientific Evidence Supporting TikTok’s Recommendations for Better Sleep
Authors: Gillis Brian , VanAntwerp Joycelyn , Scott Emily , Peltz Jack
Published: April 2024

Introduction

Like it or not, the public looks to social media for health advice. In one large survey, adults listed social media as their second place for health information following their primary care provider, and most individuals reported that they do not verify the accuracy of information with a healthcare provider. Given the public’s apparent confidence in health advice shared on social media, it is important that content creators share medically sound advice. To that end, we sought to understand the scientific evidence supporting sleep tips shared on TikTok.

Methods

We transcribed the most-viewed TikTok videos on November 15-16, 2023, that used the tag #sleephacks, #sleephygiene, or #sleeptips. Two researchers coded each video to identify all sleep tips; a third researcher coded >25% of videos for validity. A total of 295 sleep tips (including repeated recommendations) were coded across 58 videos. Tips were then organized by theme and were compared to findings from empirical articles in peer-reviewed journals on Google Scholar. Research-based evidence in support of sleep tips was defined as shorter sleep latency, longer sleep duration, more slow-wave or rapid eye movement sleep, higher sleep satisfaction, or less daytime sleepiness in randomized or non-randomized controlled trials or correlational (cross-sectional regression) associations.

Results

N = 35 unique sleep tips were identified, grouped around 7 themes: calming activities (e.g., breathwork prior to bed), use of electronics (e.g., limiting screen time before bed), environment (e.g., sleeping in a cool, dark room), foods/substances to avoid (e.g., caffeine before bed), foods/substances to use (e.g., magnesium), schedule (e.g., consistent bed and wake times), and other sleep-related behaviors (e.g., mouth taping). Of the 35 tips, we found empirical support for 33, of which 26 had evidence from randomized controlled trials, 2 were supported by controlled trials without randomization, and 5 were backed by correlational associations.

Conclusion

Most sleep tips shared on TikTok are supported by empirical evidence. While much of the health advice shared on the platform remains unregulated and unreviewed by health professionals, current information about sleep hygiene and sleep environment is generally backed by scientific support.

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