bluuebunny/crossref_metadata_2025 huggingface dataset:
0361 Sleep Disturbances in a Sample of Pregnant Military Mothers
Authors: Burns Rosemary Estevez , Kokonda Manasa , Williams Justin , Meers Jessica , Krunnfusz Andrea , Ellis Jordan , Aycock Chase , Jones John , Nowakowski Sara
Published: May 2023

Introduction

Pregnant civilians report poor sleep quality, insufficient nighttime sleep, sleep fragmentations, and significant daytime sleepiness. Sleep disturbances are associated with increased risk of adverse outcomes during pregnancy (e.g., pre-eclampsia) and labor and delivery outcomes (e.g., cesarean section). The military population is at increased risk of developing sleep disorders. The military population is at increased risk of developing sleep disorders. We aimed to identify the prevalence of insomnia symptoms in a sample of active duty and military dependent pregnant women.

Methods

Pregnant individuals (N=100) were recruited from large Military Treatment Facility in Texas. Participants were predominantly between ages 25-29 (32%), White (67%), Non-Hispanic (75%), in their second trimester (56%), Active Duty Air Force (48%), Enlisted (44%), and married (87%). In this cross-sectional study, participants completed a survey containing the Insomnia Severity Index (ISI), Pre/Peri pregnancy sleep, and obstetric care questions. Ordinal logistic regression was performed using SAS to determine if pregnancy trimester predicted outcomes including: insomnia, poor sleep quality, and perceived sleep-related impairment.

Results

Twenty percent presented with moderate/severe insomnia per ISI. The odds of having Insomnia (Severe vs No/absence) are 8.09x higher in the third trimester than first trimester (p=0.002). The odds of having poor sleep quality during pregnancy are 33.17x higher in the third trimester compared to first trimester (p<.0001). Mothers in the third trimester were 1.02x more likely to perceive other mothers as having significant sleep problems than those in the first trimester (p=0.02). Despite these reported sleep difficulties, 98% were not referred for a sleep consultation visit.

Conclusion

Findings suggested 20% of pregnant individuals associated with the U.S. Military experienced significant sleep concerns with no active plan for treatment. Individuals in their third trimester were more likely to have high ISI scores, report poorer sleep quality, and more likely to suspect significant sleep problems as common throughout pregnancy. Pregnancy is a critical period for intervention as chronic insomnia diminishes military readiness and compromises health. Insomnia prevention and intervention is greatly needed and could be integrated into obstetric clinics early in pregnancy.

Support (if any)

This work is supported by the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0365 The Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia, Fatigue, and Quality of Life in Cancer Patients
Authors: Miller Christopher , Waxmonsky Jeanette , Henry Alasdair , Emsley Richard , Espie Colin
Published: May 2023

Introduction

The emotional, psychological and financial challenges of a cancer diagnosis profoundly affect patients and contribute to sleep difficulties. Insomnia affects 31%-54% of those newly diagnosed or undergoing treatment, and persists up to 5 years after treatment for cancer. Cognitive behavioral therapy (CBT) for insomnia is effective for sleep and insomnia outcomes, with no difference in outcomes for in-person or self-help CBT. Trials of digital CBT (dCBT) have recruited breast cancer survivors from Denmark and past pilot work did not identify statistically significant effects for fatigue and quality of life in US cancer survivors with insomnia. This study examined the effectiveness of a fully automated digital therapeutic (Sleepio) for improving insomnia, fatigue, and quality of life in patients with cancer from the US, UK, and Australia.

Methods

This is a secondary analysis of participants (n=70) with insomnia who self-reported a cancer diagnosis before randomization in a large effectiveness trial of dCBT for insomnia. Participants were randomized to receive either dCBT or a sleep hygiene education control. Insomnia (SCI-8), fatigue (FFS), and global health-related quality of life (PROMIS-10) were evaluated at baseline, 8-weeks post treatment and 24-weeks follow-up. Effect estimates are mean group differences, adjusted for baseline scores estimated using regression models.

Results

Digital CBT was superior to control for reducing symptoms of insomnia and fatigue at both post-treatment and follow-up (all p< 0.05). For the dCBT group, global PROMIS-10 scores were improved, although not significantly, at post-treatment (p=0.076), but were significantly higher at follow-up (p< 0.05).

Conclusion

Digital CBT was effective for reducing symptoms of insomnia and fatigue in patients with cancer and results were maintained after five and a half months. Significant improvements in global health-related quality of life scores at follow-up suggest effects extend beyond improvements to sleep. Findings may benefit patients with cancer as dCBT may provide scalable access to an effective treatment without contraindications. Further research is needed to understand the mechanisms and value of improving sleep in those with cancer and sleep difficulty.

Support (if any)

Big Health Inc.
0368 Vulnerability to influenza-like illness is associated with insomnia severity
Authors: Guzenko Dmytro , Winger Trevor , Chellamuthu Vidhya , Barr Shawn , DeFranco Susan , Gorski Brandon , Molina Gary Garcia
Published: May 2023

Introduction

Decreased immune function is associated with sleep disorders, including insomnia. Our goal was to evaluate the vulnerability to influenza-like illness (ILI) in insomnia as quantified by the insomnia severity index (ISI). To evaluate ILI vulnerability, we leveraged a published model that estimates the daily probability of ILI symptoms from a smart bed using ballistocardiograph sensors.

Methods

A longitudinal IRB-approved study was conducted with Sleep Number customers between November 2021 and April 2022 to assess the longitudinal course of insomnia. Four surveys incorporating the ISI were administered at six-week intervals. Individuals responding to at least three surveys were included in the analysis (n=3117). ISI changes were modeled using linear regression to identify respondents with quasi-constant ISI for which ILI vulnerability was quantified. For each respondent, the mean ISI (μI) was calculated and categorized into two levels: no insomnia (μI ≤ 14) and insomnia (μI > 14). Bed data, including daily and restful sleep duration, sleep latency, sleep quality, heart rate, breathing rate, and motion level, were queried for 2019 (pre-COVID) and 2021 to evaluate the daily probability of experiencing ILI symptoms.

Results

Respondents with quasi-constant ISI (n=1680) included no-insomnia (1431) and insomnia (249). For 2019, the no-insomnia group had 1.23 (SD 1.82) ILI episodes on average which was significantly lower (p< 0.01) than the insomnia group, 1.49 (SD 1.77). The ILI-risk odds ratio for insomnia was 1.15 (CI 0.99-1.32). The mean ILI episode duration for the no-insomnia group was 4.29 (SD 7.19) days, which was significantly lower (p< 0.01) than the insomnia group 6.06 (SD 8.90) days. For 2021, similar results were obtained, with the no-insomnia group having significantly (p< 0.01) lower ILI episodes 1.22 (SD 1.63) on average compared to the insomnia group 1.49 (SD 1.67). The mean ILI episode duration for the no-insomnia group, 4.98 (SD 8.22) days, was significantly lower (p< 0.01) than the insomnia group, 6.14 (SD 7.93) days.

Conclusion

Insomnia may be significantly associated with more and lengthier ILI episodes per year. This was found for both 2019 and 2021 data. Additional research is needed to evaluate causality.

Support (if any)

Sleep Number Corporation funded this study.
0369 Zero-time Exercise on Physically Inactive Adults with Insomnia Disorder: A Randomized Controlled Trial
Authors: Yeung Wing Fai , Chen Shu Cheng , Lai Yuen Kwan , Lam Tai Hing
Published: May 2023

Introduction

Exercise is a potential treatment for insomnia. However, lack of time is a major barrier to starting and maintaining exercise. Therefore, a brief exercise training program, called Zero-time Exercise (ZTEx), was developed to relieve insomnia. ZTEx is a simple exercise that can be incorporated into habitual daily routines, requiring no extra time or equipment. This study examined the effectiveness of a ZTEx intervention program on sleep and related outcomes in inactive adults with insomnia disorder.

Methods

This randomized controlled trial (RCT) included 140 physically inactive adults (mean age: 46.7 years, SD: 14.0; 82.1% female) with insomnia disorder from the community. They were randomly assigned to ZTEx training or sleep hygiene education (SHE) group. Subjects received two 2-hour ZTEx training or SHE lessons according to their group allocation. They were told to practice ZTEx or follow sleep hygiene instructions for 24 weeks. The primary outcome measure was the Insomnia Severity Index (ISI) at weeks 8, 16, and 24. The secondary outcomes included sleep parameters by subjective sleep diaries and objective actigraphy; objective physical activity levels assessed by waist-worn accelerometers; and anxiety, depression, and fatigue levels evaluated by questionnaires.

Results

Compared with the SHE group, a significantly greater reduction of ISI was observed in the ZTEx group at week 24 (d = 0.60, P = 0.005). No significant between-group difference was observed in sleep parameters measured by sleep diary or actigraph at all study visits, except that sleep-diary-derived wake time after sleep onset was significantly lower in the ZTEx group at week 8 (d = 0.24, P = 0.035). The ZTEx group showed a significant improvement in the Multidimensional Fatigue Inventory (MFI) reduced-activity subscore (d = 0.27, P = 0.036) and reduced-motivation subscore (d = 0.33, P = 0.013) at week 8, but also a higher MFI physical fatigue (d = -0.58, P = 0.008).

Conclusion

The ZTEx training program improves physically inactive individuals’ insomnia severity and daytime impairment.

Support (if any)

The study was supported by the Research Grants Council, General Research Fund, Hong Kong SAR (Project no.: 15100419)
0378 A Randomized, Sham-Controlled Pilot Trial of a Novel Near-Infrared Phototherapy Device on Sleep and Daytime Function
Authors: Kennedy Kathryn E R , Wills Chloe C A , Holt Catie , Grandner Michael
Published: May 2023

Introduction

Near-infrared (NIR) light delivered transdermally exhibits several therapeutic properties, likely through stimulation of parasympathetic activity. This may aid in relaxation. However, little is known about the benefits to sleep and next-day daytime function. The purpose of this study was to investigate the effects of NIR exposure before bed on sleep and next-day function.

Methods

Thirty adults (30-60 y) with a self-reported sleep complaint but without a sleep disorder participated in a randomized, sham-controlled study for a duration of five weeks. After a two-week baseline period, participants wore a cervical NIR-emitting collar (combined 660nm, 740nm, 810nm, and 870nm) every other night before bed for three weeks. Physical symptoms (including sleep-related experiences) were assessed with the Systematic Assessment of Treatment Emergent Effects (SAFTEE). Insomnia Severity Index (ISI), daily sleep diaries, Oura rings (v2), daily ratings of overall sleep quality and feeling refreshed, and general ratings (0-100) of perceived changes to sleep, relaxation, daytime function, overall performance, and energy levels were also used to examine group differences.

Results

Significant group differences in change scores were seen for SAFTEE total score (-9.4 vs +13.8, p=0.036), SAFTEE sleep-related symptoms (-2.9 vs +4.1, p=0.005). No differences were seen in ISI scores. No differences were seen for Oura recordings or sleep diary data. Upon examining within-group changes, most instances were consistent (change or no change), with some exceptions: The active group showed decreased sleep latency (-6mins, p=0.001), decreased REM% (-0.9%, p=0.034), increased average sleep quality (+0.6pts, p=0.003) and feeling refreshed (+0.7pts, p< 0.0005), and a perceived increase in relaxation (17.5pts, p=0.003) and daytime function (17.5pts, p=0.003), while the sham group did not. The sham group reported decreases in perceived overall performance (18.7pts, p=0.047) and energy level (26.0pts, p=0.023), while the active group did not.

Conclusion

NIR exposure to the head and neck before bed may offer potential therapeutic benefits to sleep and daytime function, but further work needs to be done to determine optimal dose parameters, wavelengths, and power level.

Support (if any)
0380 Adults with and without Mild Cognitive Impairment Show Similar Treatment Adherence and Sleep Improvement after Insomnia Therapy
Authors: Morehouse Allison , O’Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Goldstein-Piekarski Andrea
Published: May 2023

Introduction

Non-pharmacological Insomnia Therapies are robustly effective in improving sleep in cognitively intact (CI) older adults. However, it remains unknown whether older adults with mild cognitive impairment (MCI) can engage in insomnia therapy to experience similar sleep improvements.

Methods

We leveraged an existing dataset derived from a randomized clinical trial (NCT02117388) in older adults with and without MCI to examine differences in treatment adherence and sleep improvements after completing six sessions of insomnia therapy. Healthy older adults with insomnia (n=127, Mage= 69.18, 34.4% male, MCI: n=38 determined by Montreal Cognitive Assessment score< 26) completed a one-week sleep diary at pre-treatment (BL), post-treatment (ET), and six-months post-treatment (6M). Wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) were calculated from sleep diaries. Treatment consisted of either the behavioral, cognitive, or combined components of Cognitive Behavioral Therapy for Insomnia (CBT-I). Participants rated their treatment adherence at the final treatment session. Linear mixed effects models were used to determine the effect of MCI status, time, and an MCI status-by-time interaction on each sleep outcome while covarying for age and sex. A Benjamini-Hochberg correction was applied to correct for multiple comparisons. Linear regression models controlling for age and sex were used to test group differences in treatment adherence scores.

Results

Both groups showed significant improvements in all sleep measures from BL to ET and sustained these improvements at 6M (padj’s< 0.016). There were no significant MCI status-by-time interactions for any sleep measure (padj’s > 0.29), suggesting individuals with and without MCI similarly improved their sleep. Further, there were no differences in treatment adherence scores between the CI and MCI groups (b=0.131, p=0.432), suggesting the MCI group engaged in therapy similarly to the CI group.

Conclusion

These preliminary findings suggest older adults with MCI may be capable of engaging in insomnia therapy to improve their sleep to the same degree as CI older adults. These findings also highlight the need of future research investigating the efficacy of non-pharmacological insomnia therapy on sleep and cognitive outcomes in older adults with MCI.

Support (if any)

NIMHR01MH101468-01; Mental Illness Research, Education, and Clinical Center (MIRECC) at VAPAHCS
0382 Age at Onset in Adults with Insomnia: A Latent Profile Analysis
Authors: Ricketts Emily , Kircanski Katharina , Rissman Ariel , Joyce Daniel , Ottenberg Juliet , Soehner Adriane
Published: May 2023

Introduction

Research has sought to understand insomnia through identification of subtypes, yet age at onset (AAO) has received limited empirical attention. Across psychiatric disorders, early AAO is associated with higher clinical severity and burden, more persistent course, and greater familiality, whereas late AAO is associated with comorbid psychiatric and physical illness. We sought to detect clinically distinct AAO subgroups in adults with insomnia utilizing latent profile analysis (LPA).

Methods

Participants were 618 adults aged 18 to 71 years (M=28.94, SD=11.06) with insomnia, recruited through Prolific Academic. Participants completed an internet survey of demographics, medical/psychiatric history, family history, insomnia onset acuity, and course, causal attributions surrounding insomnia onset, and current insomnia severity and sleep-related impairment. LPA was performed on AAO of clinically significant insomnia (i.e., causing distress or daytime impairment and occurring 3 days per week for at least 3 months). Independent samples t-test and chi-squared test of independence were performed to compare resulting AAO subgroups on clinical outcomes.

Results

A two-class model (Class 1: n=547, 88.5%, Monset=19.2 years; Class 2: n=71, 11.5%, Monset=43.5 years) was optimal for forming insomnia AAO subgroups. The late onset group had higher relative insomnia severity, t=-2.78, p=.006, and sleep-related impairment, t=-3.75, p<.001. There were no group differences in lifetime prescription sleep medication, p=.569, lifetime diagnosis of psychiatric disorder(s), p=.189, family history of insomnia, p=.159, or insomnia onset acuity (i.e., sudden vs. gradual), p=.140. Late onset was associated with higher relative endorsement of hormonal factors, Χ2=12.81, p<.001, bodily arousal, Χ2=8.57, p=.003, scheduling, Χ2=9.08, p=.003, and childhood experiences and traumatic events, Χ2=5.67, p=.017). There were group differences in insomnia course, Χ2=16.35, p<.001, such that early onset was associated with higher relative endorsement of persistent insomnia and late onset was associated with higher relative endorsement of seasonal insomnia.

Conclusion

Findings suggest the presence of an early onset group with higher persistence, but not increased severity and impairment as anticipated, and a late onset group with more seasonal course, numerous causal attributions, and higher insomnia severity and impairment. Future replication is needed to determine the validity and treatment applications of these subgroups.

Support (if any)

NIMH K23MH113884
0383 Amygdala Resting State Functional Connectivity Change Correlates with Sleep EEG Beta Power in Chronic Insomnia Disorder Patients
Authors: Kweon Woojin , Lee Kyung Hwa , Choi Sang Ho , Shin Jiyoon , Seo Min Cheol , Jeon Jeong Eun , Lee Ha Young , Park Cho Won , Kim Sun-Young , Lee Yu Jin
Published: May 2023

Introduction

Physiological hyperarousal is suggested as a core feature of insomnia and resting-state functional magnetic resonance imaging (rs-fMRI) studies have examined the neurobiological basis of the hyperarousal theory. However, few have investigated the associations between rs-fMRI and the biomarkers of physiological hyperarousal. We aimed to investigate (1) the differences in the resting-state functional connectivity (RSFC) between chronic insomnia disorder (CID) patients and good sleepers (GS), and (2) the relationships between altered RSFC and the hyperarousal biomarkers including electroencephalogram (EEG) and heart rate variability (HRV).

Methods

Fifty CID patients (37 females, 45.8±12.7 years old) and 52 GS (32 females, 37.0±13.2 years old) completed self-report questionnaires, and underwent nocturnal polysomnography and rs-fMRI. We analyzed RSFC in the amygdala (AMYG) and anterior insula (AI), which were core regions of the salience network probably associated with hyperarousal. We also analyzed EEG relative beta power at central derivations and frequency domain HRV parameters (e.g., low frequency and high frequency) in ECG lead ll during sleep. We then tested differences in the RSFC between CID and GS and examined the correlations between RSFC, EEG beta power, and HRV.

Results

Compared with GS, CID showed more negative RSFC between the right AMYG and left supramarginal gyrus (SMG), but less positive RSFC between the left AI and bilateral lateral prefrontal cortex (LPFC). The right AMYG-left SMG RSFC was positively correlated with EEG beta power in non-rapid eye movement (NREM) stage 3 sleep measured on central regions (C3: r=-0.336, p=0.012; C4: r=-0.314, p=0.024). We did not find any significant correlations between RSFC and HRV parameters.

Conclusion

Decreased RSFC between the AMYG and SMG in insomnia patients may reflect a difficulty in the cortical top-down regulation of the amygdala, indicating hyperarousal during daytime. We also found a significant correlation between the AMYG-SMG RSFC and EEG beta power. This result suggests that altered AMYG connectivity during daytime is associated with cortical hyperarousal during sleep. Overall, our study may provide neurobiological evidence for the 24-hour hyperarousal theory of insomnia.

Support (if any)

The Korea Institute for Advancement of Technology funded by the Ministry of Trade, Industry and Energy (study no.: P0014279, 20009210).
0386 Brief cognitive-behavioral therapy for insomnia among Japanese university students with sleep disturbances
Authors: Kawakatsu Yuki , Takahata Miki , Satake Shinji , Sato Toshiaki , Eakman Aaron
Published: May 2023

Introduction

Sleep disturbances among Japanese university students negatively affect their academic performance and mental health. Student habits, such as naps and using smartphones in bed, may lead to sleep problems. We hypothesized the Sleep Health through University Student Habits (SHUSH) program, a four-week cognitive-behavioral therapy for insomnia intervention, would improve sleep disturbances in university students.

Methods

We used a pretest-posttest, single arm pilot study design and evaluated the feasibility and preliminary efficacy of SHUSH. Occupational therapy and physical therapy students (N = 18) in a university with self-reported sleep disturbances (Insomnia Severity Index; ISI score ≥ 9) were offered 90-minutes of sleep education (e.g., two-process model of sleep regulation, stimulus control, and sleep hygiene) then prescribed personalized sleep restriction therapy (SRT) and stimulus control therapy (SCT) goals based upon 10-days of sleep diary data. This was followed by weekly 15-minute individualized meetings for three consecutive weeks; SRT and SCT goals were titrated based upon sleep diaries, and occupational therapists supported treatment adherence. Assessments included validated Japanese versions of sleep-related (e.g., sleep disturbance), mental health-related (e.g., depression) and sleep diary (e.g., sleep efficiency) variables. Dependent t-tests (d) and Wilcoxon rank sum tests (r) were used to test differences between baseline and posttest assessments.

Results

There were 15 students who completed SHUSH with a mean age of 19.7 years; 9 were women. Improvements were found in sleep disturbance (r = 0.843), sleep quality (r = 0.851), daytime sleepiness (d = 0.762), sleep hygiene practice (d = 1.216) and change from an eveningness towards a morningness circadian preference (d = 0.990). Anxiety (d = 0.604) and depression (d = 0.729) improved. Sleep onset latency (r = 0.851), nighttime awakening (r = 0.514), and sleep efficiency (r = 0.880) also improved. Participants were satisfied with the SHUSH group-based education, one-on-one therapist meetings, and program brevity; there were no adverse events.

Conclusion

SHUSH is a feasible and preliminarily effective sleep improvement program for reducing sleep disturbances among Japanese university students. Improved sleep was associated with improved mental health and sleep-promoting behaviors. A randomized controlled trial of SHUSH is recommended.

Support (if any)

Fulbright U.S. Scholar Award to Japan
0388 Comparison of objective and subjective sleep evaluations based on with or without insomnia symptoms among Japanese city employees
Authors: Omichi Chie , Kadotani Hiroshi , Sumi Yukiyoshi , Ubara Ayaka , Nishikawa Kohei , Matsuda Arichika , Tsovoosed Uyanga , Ozeki Yuji
Published: May 2023

Introduction

Discrepancies between subjective and objective assessments of sleep duration and onset latency have been reported among insomnia patients. However, such discrepancies have not been well studied in the general population or working populations with sleep EEG measurements. The aim of this study was to compare subjective and objective assessments of sleep at home in a working population.

Methods

Between 2017 and 2019, a questionnaire survey including the Athens Insomnia Scale (AIS) and home 1-Ch electroencephalograph (EEG) measurements were conducted among municipal employees in Koka, Shiga Prefecture, Japan (NinJaSleep study). Sleep duration and sleep onset latency (SL) on weekdays answered in the questionnaire were used as the subjective evaluation. Sleep duration and SL determined with 1-Ch EEG were used as the objective evaluation. AIS≥6 was defined as having insomnia. The study protocol was approved by the Ethics Committee of the Shiga University of Medical Science.

Results

646 employees (44.7 ± 11.5 years, AIS: 5.4 ± 3.6 points) participated in the study. In the with-insomnia group (AIS≥6, n=274), no significant difference was found between subjective and objective sleep duration (347.1±75.8 min vs. 355.1±78.9 min, p=0.153), and subjective SL was longer than objective SL (24.5±20.2 min vs. 19.5±18.8 min, p=0.002). In the without-insomnia group (AIS< 6, n=372), no significant differences were found between subjective and objective evaluations in both sleep duration (372.3±64.6 min vs. 369.9±78.6 min, p=0.597) and SL (18.9±15.8 min vs. 16.9±12.3 min, p=0.259).

Conclusion

In the with-insomnia group, subjective SL was perceived longer than the objective SL. No differences were found between subjective and objective sleep duration both in with and without insomnia groups, which may come from the study performed in a working population.

Support (if any)

Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. / MSD K.K. The funders had no role in the study design, data collection, analyses, interpretation, writing of the manuscript, or in the decision to publish the results.
0389 Co-sleeping with pets does not worsen insomnia symptoms among US veterans with sleep disorders
Authors: Gohari Ellaheh , Wohlgemuth William , Wallace Douglas
Published: May 2023

Introduction

Little is known about the association of pets and insomnia symptoms among US veterans. The aim of this study was to examine the association between pets sleeping in the bedroom environment and insomnia symptoms in a sleep clinic cohort of US veterans.

Methods

The sample consisted of US veterans at risk for sleep apnea (SA) evaluated at the Miami VA Sleep Center between 9/2019 and 10/2020. Veterans completed home polysomnography and questionnaires which queried demographics, pet characteristics, insomnia (insomnia severity index [ISI]), and mental health symptoms (PROMIS-29 anxiety and depression). Three linear regression models were constructed evaluating the associations between pet ownership (pet sleeping in bedroom or bed vs no pet) and a) total ISI score, b) nocturnal symptoms only (first 3 ISI items), c) daytime impairment symptoms (last 4 ISI items). Models were adjusted for relevant covariates (age, gender, race, apnea-hypopnea index, depression, anxiety, during or before COVID).

Results

The sample consisted of 411 veterans (age 51 ±14, BMI 32 ± 6 Kg/m2, 41% black, 87% male). Sixty-seven veterans (16%) reported sleeping with a pet in the bedroom (57% co-sleeping with their pet). Of these, 19% sleep with a cat, 76% sleep with a dog, 6% sleep with both, and 31% sleep with multiple pets. The mean ISI was 18 ± 7 while the mean AHI 21 ±19 events / hour, and 81% of the sample had SA. In adjusted analyses, relative to veterans without pets, sleeping with a pet in the bedroom (outside of the bed) was not associated with any insomnia symptoms. However, co-sleeping with a pet in bed was associated with a lower total ISI (β = -2.1, p = 0.032) and less daytime impairments (β = -1.5, p = 0.016), but co-sleeping with a pet was not associated with nocturnal insomnia symptoms.

Conclusion

Among veterans with a high prevalence of SA, co-sleeping with pets in bed mitigated daytime impairments and did not worsen nocturnal insomnia symptoms. Further studies are needed to clarify the mechanisms of why co-sleeping with pets may lessen daytime impairments among veterans with SA and insomnia complaints.

Support (if any)

None
0390 Cracking the EEG Code on Insomnia: How Odds Ratio Product Architecture Relates to Number of Insomnia Symptoms
Authors: Lambing Kari , Guadagni Veronica , Bender Amy
Published: May 2023

Introduction

Objective markers of insomnia have remained largely elusive. Odds ratio product (ORP; a marker of objective sleep quality), is currently being investigated for a potential role in assisting in insomnia diagnosis. Recent research has shown how patients with insomnia may present with hyperarousal and may be identified by looking at ORP architecture. In the current study, we aimed to investigate how ORP architecture, and specifically time spent in the lowest two (deep sleep) and last decile (full wakefulness) of ORP, relate to the number of insomnia symptoms.

Methods

403 participants (age 46.3±12.3, range 18-79, 172 females) recorded their sleep with in-home PSG using the Cerebra Sleep System and completed sleep questionnaires. Sleep quality was measured using the odds ratio product (ORP) derived from micro-analyzing frontal EEG channels. On the questionnaires, participants reported whether they experienced any of the following insomnia symptoms at least three times a week: trouble falling asleep, trouble staying asleep, and waking up too early. Statistical analyses included number of insomnia symptoms as a dependent variable in a multiple linear regression, time spent in the lowest two deciles of ORP and the highest decile of ORP as independent variables, and age as a covariate in a separate model.

Results

60 participants reported 1 symptom of insomnia, 82 reported 2 symptoms, and 68 reported 3 symptoms. The full model was significant (F2,399=4.675, p=0.010, R=0.228, R2 adj=0.052) and indicated that time spent in the highest decile of ORP was the only significant predictor of number of insomnia symptoms (t399=2.321, p=0.021, β=0.131) after controlling for age. Time spent in the lowest two deciles of ORP (deep sleep) was not a significant predictor (p >0.05).

Conclusion

Time in the highest ORP decile, indicative of full wakefulness, is positively associated with insomnia symptoms after controlling for age. Individuals reporting more insomnia symptoms spent more time in full wakefulness. Time spent in deep sleep was not associated with insomnia symptoms. This may indicate hyperarousal and low sleep drive in participants with subjective insomnia complaints, which is consistent with insomnia etiology.

Support (if any)
0393 Durability of treatment effects for a stepped-care model integrating digital therapy for insomnia
Authors: Bayoneto Alec , Cheng Philip , Iqal Justin , Kalmbach David , Drake Christopher
Published: May 2023

Introduction

A stepped-care model going from digital cognitive behavioral therapy for insomnia (dCBT-I) to clinician-led CBT-I (fCBT-I) has been shown to be acutely effective. However, the sustainability of the effects over longer periods of time has not yet been examined. This study tested the durability of treatment effects of this stepped-care approach two years following the end of treatment.

Methods

1018 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions at step 1: dCBT-I (N=613), or an online sleep education control (N=624). Participants in the dCBT-I condition who did not remit (ISI>9) were further randomized to either face-to-face CBT-I (N=103) or sleep education (N=104). Insomnia remission and treatment gains at 2-year follow-up were compared across treatment conditions.

Results

Among step-1 non-remitters, odds of insomnia remission for those who stepped-up to fCBT-I was almost three times higher (60% in remission) than those who received the step-2 control (33% in remission), OR = 2.95, 95% CI [1.3, 6.7]. Odds of remission was not significantly different between those who remitted at step-1 (64% in remission at year 2) and those who received fCBT-I, OR = 3.53, 95% CI [1.7, 7.5]. The treatment gains were higher in the fCBT-I group (9.6 point improvement from baseline) compared to those who remitted at step-1 (7.7 point improvement from baseline) (Cohen’s d = 0.44).

Conclusion

Preliminary evidence indicate that the treatment effects of this stepped-care model are durable two years after treatment.

Support (if any)

Support for this study was provided from the National Institute of Mental Health R56MH115150 and R01MH122636 awarded to Dr. Christopher Drake.
0395 Effects of Insomnia and Rest-Activity on Hospitalizations and Emergency Department Visits in People with Stable Heart Failure
Authors: Jeon Sangchoon , Conley Samantha , Hollenbeak Christopher , O’Connell Meghan , Yaggi H , Jacoby Daniel , Wang Zequan , Tocchi Christine , Redeker Nancy
Published: May 2023

Introduction

People with heart failure (HF) have frequent hospitalizations, and emergency department (ED) visits. We examined the effects of insomnia and rest-activity rhythms (RARs) on time to hospitalizations and ED visits after controlling for other known risk factors among participants in a randomized controlled trial of cognitive behavioral therapy for insomnia compared to heart failure self-management education (attention control).

Methods

The analysis included 168 HF patients who had available medical records for dates of hospitalization, ED visit, transplant, and death from a randomized clinical trial for insomnia of people with HF and insomnia. The known risk factors included age, sex, New York Heart Association (NYHA) Class, ejection fraction, and comorbid conditions. We used the insomnia severity index (ISI) and evaluated the strength of RAR using the ratio of the amplitude to the MESOR estimated with cosinor analysis with activity counts from a wrist-actigraph worn for at least five consecutive days. Cox proportional hazard models were used to examine ­insomnia and the RAR metrics with the known risk factors on time to first hospitalization, ED visit, transplant, and death.

Results

Eighty-five (50.1%) had at least one hospitalization, and ninety-one (54.2%) participants had an ED visit. Approximately 42% of the participants were admitted to the hospital due to cardiac events. Older age, male sex, higher NYHA, and greater comorbidity were associated with earlier hospitalization or ED visits. After controlling for those risk factors, stronger RAR was associated with later time to hospitalization, and ED visit with hazard ratios (HRs) of 0.26 (95% CI=[0.07, 0.91]) and 0.25 (95% CI=[0.07, 0.89]); higher insomnia severity (ISI ≥22) was associated with shorter time to ED visits, with an HR of 2.28 (95% CI=[1.19, 4.38]).

Conclusion

In addition to known demographic and clinical risk factors, insomnia severity and RAR predict hospitalizations and ED visits in people with HF. Further research is necessary to assess the biological mechanism of the associations and examine whether the effects of the risk factors could be modified by improving insomnia severity and RAR in people with HF.

Support (if any)

This study was financially supported by grants R01NR016191 and P20NR014126 from NIH/NINR.
0399 Examining Insomnia Treatment Adherence and Outcomes in Black Women Veterans
Authors: May Kimiko , Erickson Alexander , Mitchell Michael , Washington Donna , Yano Elizabeth , Alessi Cathy , McGowan Sarah Kate , Carlson Gwendolyn , Kelly Monica , Fung Constance , Martin Jennifer , Song Yeonsu
Published: May 2023

Introduction

Black identified women and veterans consistently experience disproportionately higher rates of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) improves sleep outcomes, although higher rates of attrition and sub-optimal adherence in these groups can limit symptom improvement. Few studies have examined CBT-I treatment adherence and outcomes in women veterans, particularly among those who identify as black. . The current study examined differences in adherence and treatment outcomes in Black identified women veterans compared to white identified women veterans who engaged in CBT-I.

Methods

As part of a larger clinical trial (NCT02076165), 26 black and 25 white women veterans with insomnia disorder completed a 5-session CBT-I program. Insomnia Severity Index (ISI) and sleep diaries were completed at baseline, post-treatment, and 3-month follow-up. Multiple and fractional regression models were used to evaluate the association between race and change in ISI, change in sleep diary sleep efficiency (SE), and adherence to bedtime and rise time during CBT-I.

Results

Mean change from baseline to 3-month follow-up in ISI score for black and white women were -7.31 and -7.97 and mean change in diary SE was +14.9% and +10.8%, respectively. Race did not impact change-scores for ISI or SE (1.09 < F < 1.8, p>.05); however, in the fractional regression model, (Χ2=6.9, p=.008; pseudo R2=.058) race was a significant predictor (OR=.27, p=.009) of adherence to prescribed bedtime in the second week of CBT-I, with black women less likely to adhere to prescribed bedtime than women. Race was not a significant predictor of wake time adherence.

Conclusion

Both black and white women veterans benefitted from CBT-I; however, early adherence to the recommended sleep schedule was lower in black women. Future research could expand on these findings by examining potential barriers in early adherence to recommendations, and how to improve early adherence to ensure that therapy meets the needs of all patients.

Support (if any)

VA/HSR&D IIR-HX002300 (PI: Martin), NIH/NHLBI K24HL143055 and VA HSR&D RCS 20-191. Dr. May supported by the VA Office of Academic Affiliations.
0400 Examining the Effectiveness of Telehealth Delivered Cognitive Behavioral Treatment of Insomnia
Authors: Kautzmann Jeremie , Gehrman Philip , Findley James , Kayser Matthew , Weljie Aalim
Published: May 2023

Introduction

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be an effective tool in improving symptoms of insomnia, however access is limited. One option for increasing access is the use of telehealth. We conducted a randomized trial comparing CBT-I delivered in-person to over video telehealth and found that telehealth treatment was non-inferior on self-reported insomnia severity. The objective of this study was to extend this analysis to secondary outcomes of subjective and objective measures of sleep as further assessment of the efficacy of telehealth compared to in-person treatment.

Methods

Individuals with DSM-5 insomnia disorder (n=60) were randomized to telehealth CBT-I, in person CBT-I, or 8-week waitlist control, although this analysis only compared the CBT-I groups. CBT-I was delivered over 6-8 weekly sessions by video telehealth or in-person in an outpatient clinic. Follow-up assessment was at 2 weeks post-treatment. Both objective and subjective outcomes of sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST) were collected via actigraphy and sleep diaries. Random effects mixed models were used to determine the effects of group, treatment, and their interaction.

Results

The mean change in SE, SOL, WASO, and TST for objective measures from baseline to follow-up was 0.43% and -17.7 minutes, -6.8 minutes, -31.0 minutes, respectively, for in person CBT-I and 0.01%, -15.1 minutes, -2.1 minutes, -9.5 minutes, respectively, for telehealth. For subjective measures, the mean change was 0.16% and -27.0 minutes, -22.7 minutes, 28.9 minutes, respectively, for in person CBT-I and 0.15%, -23.4 minutes, -23.4 minutes, 51.6 minutes respectively for telehealth. The differences between the CBT-I groups were not statistically significant, nor were there significant interaction effects.

Conclusion

In both objective and subjective measures of insomnia, there is no evidence that outcomes from telehealth delivery of CBT-I is worse than in person treatment. Subjective effects were much larger than objective effects for insomnia possibly indicating a discrepancy between how sleep and more particularly insomnia is perceived by oneself and measured in the lab.

Support (if any)

This research was supported by grant 167-SR-17XYZ from the American Sleep Medicine Foundation and a Doris Duke Charitable Foundation Clinical Scientist Development Award.
0404 Heart Failure Nurses’ Perceptions of Cognitive Behavioral Therapy for Insomnia and the Feasibility of Providing it to Patients
Authors: O'Connell Meghan , Feder Shelli , Nwanaji-Enwerem Uzoji , Redeker Nancy
Published: May 2023

Introduction

People with heart failure (HF) often report insomnia. Despite strong evidence to support treatment with Cognitive Behavioral Therapy for Insomnia (CBT-I), few with HF have access to CBT-I programs. Access may be improved if it is offered where HF patients receive their medical care, but little is known about the feasibility of doing so. The purpose of this focus group study was to explore HF Nurses’ perceptions of: the importance of insomnia and the value of CBT-I to their patients; the feasibility of making CBT-I available in clinic settings and its delivery by HF nurses; and preferences for alternative modes of delivery.

Methods

We used a descriptive qualitative study design. We recruited focus group participants via electronic invitation to members of the American Association of Heart Failure Nurses and through requests to local nurse collaborators to distribute within their networks. We conducted virtual focus groups. After providing a brief description of the components of CBT-I and its efficacy in the HF population, we elicited participant perceptions of the value of providing CBT-I for HF patients in the clinic setting, facilitators and barriers to implementation, and ways to increase access to CBT-I. We audio-recorded the focus group discussions and used a professional transcription service. Two researchers coded the data and performed thematic content analysis.

Results

We conducted four focus groups with registered nurses and advanced practice nurses employed in HF clinics (N=23). Nurses endorsed the importance of sleep to HF patients, their interest in addressing sleep, perceived benefits of CBT-I, and the need for increased resources to address sleep in the clinic setting. They favored multiple modes of CBT-I delivery extending beyond the clinic. All nurses believed they had a role to play in addressing sleep, but differed in their views about the possibility of becoming CBT-I interventionists and the training and support needed to do so.

Conclusion

HF nurses recognize the importance of insomnia and support the implementation of CBT-I. Implementation studies are needed to identify effective methods of increasing access to evidence based CBT-I in the HF clinic setting, including appropriate support and training for nurses with interest in CBT-I delivery.

Support (if any)

R01NR01691
0405 How Well Does Sexual Activity Improve Sleep When Compared With Pharmacologic Sleep Aids?
Authors: Kirsch Douglas , Khosla Seema
Published: May 2023

Introduction

Insomnia is a common sleep disorder with negative impacts on psychological and physical health. Films and books for the general public have commonly suggested that sexual activity is followed by increased sleep drive. Our initial survey was done to assess the perceived impact of sex and orgasm on sleep in people with insomnia in comparison to the use of sleeping pills.

Methods

An 8-question survey was created with Qualtrics. The link to the survey was shared via social media, including Twitter. Explanation was given about the purpose of the survey. Ages under 18 were excluded from the study.

Results

53 individuals completed the survey, 53% were female. The survey skewed to younger adults, 89% between 25-49 years of age. 75% of respondents reported that they slept better after sex/orgasm close to bedtime and the majority reported a moderate improvement in sleep on those nights. Medication was utilized to improve sleep by 66% of the individuals. In comparison to sex/orgasm, the majority of those surveyed felt that medication had similar or worse effect on their sleep (64%).

Conclusion

This was a preliminary survey of a general audience about the impacts of sex/orgasm on sleep and the comparison to medications. It appears that sex/orgasm had a positive impact on sleep in both males and females in the surveyed population and was used not infrequently to improve sleep. Although this survey demonstrated largely positive impact of sex/orgasm on sleep, negative associations with sexual activity were not explored and people with these negative associations (such as those with sexual-related trauma) may not have been well represented. Limited research has been done about the relative impacts of sex and orgasm on the quality of sleep, however, this survey suggests that media depictions of falling asleep faster after sex may be accurate in the general population. Given the above findings, further thoughtful examination of the impact of sexual activity on sleep is warranted, recognizing that there are many in whom sexual activity prior to bedtime is a negative experience and may worsen sleep.

Support (if any)
0406 Impact of comorbid insomnia and nocturia on subjects' lives as assessed through a concept elicitation study
Authors: Phillips-Beyer Andrea , Olivieri Antonio , Marco Tobias Di , Kimel Miriam
Published: May 2023

Introduction

The lived experiences of individuals with insomnia and comorbid nocturia are not properly understood. This study explored the lived experiences of individuals with insomnia and comorbid nocturia to identify relevant concepts that could be reflected in patient-reported outcome (PRO) endpoints in clinical studies.

Methods

This was a cross-sectional, qualitative observational study. Data were collected from a sample of 10 adult subjects from the US suffering from insomnia disorder (DSM-5) and comorbid nocturia (≥2 nocturnal voids). Interviews were conducted using semi-structured guides, lasted 60–90 minutes, and assessed patient-relevant concepts of interest for their insomnia and nocturia. Institutional review board approval and web-based informed consent were obtained prior to the interviews.

Results

Overall, 10 participants were included, and the mean age was 61 years (SD=6). Most participants were female (8/10), White (9/10), and lived with a partner/spouse, family, or friends (8/10). Almost all participants experienced insomnia symptoms at least 5 nights per week (9/10), most often impacting their emotional (10/10), social (10/10), physical (9/10), cognitive (9/10), and work and productivity (6/10) functioning. Almost all participants reported that decreasing the impact of insomnia would be meaningful (8/10), most often mentioning improvements in physical impacts such as having more energy or feeling less exhausted (7/10). All participants experienced nocturia at least 6 nights per week (10/10), often impacting their emotional (7/10), social (6/10), physical (6/10), cognitive (4/10), and work and productivity (4/10) functioning. Participants reported that going to the bathroom less often (i.e., two times per night, once per night, or not at all; each 2/10) and being able to sleep through the night (2/10) would be meaningful improvements.

Conclusion

Individuals with insomnia and nocturia experience disrupted sleep patterns that impact their emotional, social, physical, cognitive, and work functioning. Feeling less tired, being able to sleep through the night, and getting up less often to use the bathroom would be meaningful to patients living with both conditions.

Support (if any)

Funded by Idorsia Pharmaceuticals Ltd.