bluuebunny/crossref_metadata_2025 huggingface dataset:
0279 Sleep Hygiene for Sleep Health in the General Population: What Does Data From Consumer Sleep Technology Tell Us?
Authors: Gottlieb Elie , Gahan Luke , Wilson Samantha , Watson Nathaniel F , Raymann Roy
Published: May 2023

Introduction

Despite being used and widely recommended since the 1970s, few studies have examined whether adherence to sleep hygiene practices affect objectively measured sleep in non-clinical populations. While individual components of sleep hygiene such as limiting caffeine and alcohol consumption are clearly related to sleep by plausible physiological and psychosocial mechanisms, the real-world evidence of overall sleep hygiene practices on sleep is surprisingly inconsistent. Here, we examined the association between self-reported sleep hygiene practices and objectively measured sleep in a general population.

Methods

Responses to a survey on sleep hygiene were used and matched with objective sleep data, resulting in data from 720 users (mean age: 52.5 ± 15.9, 63.4% female). Objective sleep data across 92,808 nights were included in the analysis from the PSG-validated SleepScore Mobile Application, which uses a non-contact sonar-based method to capture sleep-related metrics and self-reported lifestyle. Self-reported sleep hygiene practices were assessed with 13-items on a 5-point scale ranging from “Never” to “Always”. Descriptive statistics and linear regressions were used for the analysis, controlling for age and gender.

Results

Overall, the top three most frequented poor sleep hygiene practices were going to bed at different times (29.7%), overthinking/worrying in bed (24.0%), and waking at different times (22.7%). Linear regressions revealed a significant negative association between composite sleep hygiene scores and objective sleep measures, whereby poorer sleep hygiene was associated with significant reductions in total sleep time (ß=-0.89, SE=0.33, p< 0.01), REM duration (ß=-0.24, SE=0.10, p< 0.05), and SleepScore (ß=-0.15, SE=0.05, p< 0.01), an objective sleep quality metric. No significant associations were observed between individual sleep hygiene factors and objectively measured sleep.

Conclusion

While we could not identify a relationship between individual hygiene factors and sleep, poorer aggregated sleep hygiene scores were associated with poorer objectively measured sleep. Thus, sleep health may not be defined by one single behavior, but rather by the sum of its parts. Future work should examine the efficacy of personalized sleep hygiene factors in sub-clinical populations, where targeted sleep hygiene education may be preferred given it is more intuitive and less burdensome than other behavioral interventions.

Support (if any)

SleepScore Labs
0284 Sleep Health in Latino Day Laborers: Occupational Health and Wellbeing
Authors: Ramirez Jahanett , Ebner Nina , Ramos Alberto
Published: May 2023

Introduction

Little is known about the sleep health of Latin(x) day laborers. Existing research demonstrates that they experience precarious employment, low wages, and hazardous working conditions. Recent studies also show that periods of unemployment and psychosocial stressors, such as financial insecurity, have been associated with worsened mental health outcomes and poor sleep health. Our investigation brings these insights together in order to understand how sleep health impacts well-being in the workplace and how precarious work, such as day labor, impacts sleep, contributing to health disparities.

Methods

This was a mixed-methods study in which twenty participants were recruited using purposive sampling from a worker center run by the Austin Public Health Department and an informal hiring site. Participants were male, over 18 years of age, of Latin(x) ethnicity, who reported problems with sleep. All completed a semi-structured interview with validated sleep questionnaires. Interviews were audio-recorded, transcribed, and thematically coded.

Results

Most workers were between 30 - 44 years of age, of Mexican ethnicity, and worked in construction. Workers reported poor sleep quality with an average of 5.6 hours of sleep at night. Eighty-five percent (n=17) had problems with either clinically significant insomnia (Insomnia Severity Index ≥ 15), daytime sleepiness (Epworth Sleepiness Scale ≥ 10), or both. In addition, 50% reported either moderate or severe anxiety or depression. Most agreed (80%) that poor sleep affected their quality of life. Regarding work performance, 50% found themselves not concentrating enough on their work two or more times a week. Common themes included: (1) lack of routine and unpredictability of work schedule (2) poor sleep habits and coping mechanisms (3) negative impact of fatigue on work routine and relationships (4) belief that sleep would improve unaided and (5) willingness to seek behavioral health interventions for sleep concerns.

Conclusion

Our results indicate that study participants experience short sleep duration and insomnia in conjunction with high levels of anxiety and/or depression. Participants linked these with unpredictable work schedules, stress, and financial difficulties. However, many were interested in receiving a clinical behavioral intervention to improve their sleep.

Support (if any)

This work was supported in part by BSM PRIDE Institute SRP funding from NHLBI (R25HL105444).
0286 Yours, Mine, or Ours? Exploring Sleep Hygiene Concordance in Mixed-Gender, Bed-Sharing Couple Relationships
Authors: Novak Joshua , Miller Kaleigh , Gunn Heather , Troxel Wendy
Published: May 2023

Introduction

Despite research exploring sleep concordance between partners in couple relationships, some variability exists between partners’ sleep quality because of the social and relational context. One such mechanism that may help to explain the variability is sleep hygiene and if couples are similar or different in their sleep hygiene and if or how these similarities or differences predict worse sleep, relational, and psychological health. The present study explored the similarities and differences in sleep hygiene and associations with sleep, psychological, and relational health outcomes in 143 mixed-gender, bedsharing couples.

Methods

Paired samples t tests between partners were conducted using the total Sleep Hygiene Index scores (aim 1a), and at the individual-item level (aim 1b). Intraclass Correlation Coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner’s sleep hygiene (aim 1c). Finally, a dyadic score model was examined using Structural Equation Modeling to identify associations between both a between-partner difference in sleep hygiene score and within-couple sleep hygiene average score on individual sleep quality, couple conflict frequency, and individual emotional distress.

Results

Results revealed a significant difference between men (M = 14.45, S.D. = 7.41) and women’s total score self-report sleep hygiene ((M = 17.67, S.D. = 8.27); t (142) = -5.06, p <.001). Further, partners only had similar sleep hygiene for 5 out of the 13 items. Partners’ had moderate agreement on sleep hygiene (.69-.856), suggesting that partners largely know each others' sleep hygiene habits. Finally, lower within-couple sleep hygiene was linked with both partners’ worse sleep outcomes, more relational conflict, and higher emotional distress.

Conclusion

Findings from this study suggest that couples are less concordant in sleep hygiene practices than sleep quality. Moreover, partners are relatively aware of each other's sleep hygiene which may in part be associated with their psychological and relational functioning. Differences between partners seemed to be less impactful than the couples' average sleep hygiene on sleep, relational and psychological well-being outcomes. These results suggest that couple-level intervention on sleep hygiene may benefit both partners and carry over into relational and psychological benefits.

Support (if any)
0290 Ambulatory blood pressure monitoring does not reduce the sleep of off-duty firefighters
Authors: Ayeni Aanuoluwakiitan , Haswarey Ayeisha , Ordaz-Johnson Omar , Robinson LaTroy , Abdelmoaty Walaa , Herzig Maya , Hurtado David , McHill Andrew , Gonzalez Joshua , Bodner Todd , Shea Steven , Bowles Nicole
Published: May 2023

Introduction

Ambulatory blood pressure monitoring (ABPM) across 24 hours is recommended to confirm hypertension and, outside of a laboratory setting, is the only means to measure the extent of any nocturnal decrease in blood pressure (BP) i.e., nocturnal BP dipping. The ambulatory device is traditionally programmed to inflate every 20-30 minutes during awake and sleep. Despite diagnostic benefits, ABPM may disturb sleep and lead to reduced compliance in some individuals. Firefighters, an occupational group with a greater risk of developing cardiovascular disease, often note continued vigilance during sleep, possibly reflecting light sleep and/or frequent awakenings. This potential sleep disturbance may contribute to firefighters’ cardiovascular disease risk and may also impact ABPM data.

Methods

To assess the effect of ABPM on total sleep time (TST) and wake after sleep onset (WASO) in firefighters, we measured sleep using wrist actigraphy in 120 firefighters (91.3% male) from two different departments in Oregon. As part of a larger longitudinal study, participants’ sleep off-shift (as noted from daily survey) was recorded for up to 14 days at two different time points, two months apart. During two consecutive days off, participants completed 24-48 hours of ABPM with simultaneous actigraphy. Overall, there were 1273 measures of sleep, 206 with the cuff and 1067 without the cuff. Separate mixed models with cuff (on/off) as a fixed effect and participant as a random effect, were run for TST and WASO. Models were adjusted for total time in bed, department, and collection interval.

Results

Surprisingly, TST with the cuff on was significantly greater than nights without the cuff (marginal mean ± SE: 432.0±3.1 vs. 415.9±1.7 minutes respectively, p< 0.001). Increased TST was attributable to a lower WASO with the cuff than without the cuff (43.8±2.9 vs 59.8±1.7 minutes, respectively, p< 0.001).

Conclusion

Contrary to our expectations, ABPM was not associated with actigraphy measured disturbed sleep among firefighters. In fact, in these data, sleep appeared to be improved while wearing the cuff. Perhaps concerns around poor sleep when wearing the device may have led to improved sleep behaviors on those nights, but this hypothesis needs further investigation.

Support (if any)

U19OH010154, K01HL151745
0297 Pathways: A Pilot Study Examining the Impact of Nightshift Work on Obesity and Type 2 Diabetes Risk in Free-Living Shift Workers
Authors: Clark Kevin , Cleveland Joseph , Holzhausen Elizabeth , Stieneker Zachary , Lim Joseph , Patterson William , Kraemer Gabby , Broussard Josiane , Vetter Celine , Melanson Edward , Creasy Seth , Wright Kenneth , Alderete Tanya
Published: May 2023

Introduction

Traditional risk factors for obesity and type 2 diabetes, such as poor diet and low physical activity, cannot fully explain the increased incidence of these diseases. Insufficient sleep and circadian misalignment due to shift work may contribute, in part, to this epidemic through their growing prevalence and associated impaired glucose regulation and eating out of phase.

Methods

Female nightshift healthcare workers (n=5) worked ≥2 shifts (~7pm-7am) during the 7-day study. Actigraphy was measured and participants wore continuous glucose monitors and completed three 24-hour dietary recalls. Dim light melatonin onset was predicted (pDLMO) for each worker from an actigraphy derived algorithm validated for shift workers. The timepoints two hours after (pDLMO+2) and 10 hours after (pDLMO+10) predicted DLMO are presented as a range in which sleep typically occurs, on average, relative to DLMO.

Results

Mean participant age was 30.7 years and body mass index 22.8 kg/m2. Dietary recalls report the average total energy consumed on workdays to be 1,653 kcal ± 444 (mean ± SD) compared to 1,517 kcal ± 421 on free days (p=0.64). Average eating windows were 13.88 ± 2.69 hours on nightshifts compared to 9.88 ± 1.82 hours on workfree days (p=0.051, n=4 one individual did not report eating while on shift). Further, eating occasions between 10pm–7:30am were only reported on worknights. Average pDLMO was 23.26 ± 1.27 hours, corresponding to the middle of shift. The average interstitial glucose level between pDLMO+2 and pDLMO+10 on shift was 88.4 mg/dL ± 9.0 and the average during the same interval on workfree nights was 81.1 mg/dL ± 7.0 (p = 0.024). Additionally, an increase in 24-hour average glucose was observed on shift 90.9 ± 4.9 compared to free days 86.1 ± 6.2 (p=0.021).

Conclusion

Early results from this ongoing study show that an extended eating window, eating overnight, and/or working overnight contribute to increased glucose levels while night workers are on shift compared to their days off. Increased overnight glucose levels, especially at a time the body may be accustomed to sleeping, represent a time of impaired glucose tolerance and potentially reduced insulin sensitivity.

Support (if any)

Anschutz CCTSI Pilot Grant Award, CTSA Grant UL1 TR002535
0311 Partial blue light blocking glasses advanced sleep phase but did not alter salivary melatonin secretion in Japanese schoolchildren
Authors: Maeda-Nishino Naoya , Yoshimoto Ryohei , Ono Taisuke , Chiba Shintaro , Nishino Seiji
Published: May 2023

Introduction

A late bedtime is one of the most common characteristics of sleep habits in modern society. This is also the case for schoolchildren, with negative consequences for their academic performance. Light exposure at night, particularly blue wavelength light, was thought to delay bedtime, and melatonin suppression via blue light was considered to be one of the mechanisms responsible for the delayed sleep phase.

Methods

In the current study, we evaluated the effects of partial blue light blocking glasses (JINS Screen Lens Heavy [40%cut]) on salivary melatonin levels, sleep and circadian phase and daytime behavior (via actigraphs and questionnaires), with and without blue light blocking (JINS Standard Clean Lens) glasses in 39 male school children (ages between 10-12). The study design was a cross over design, with respective glasses worn for 3 hours before the habitual bedtime for two weeks, with a one-week washout period (with their own regular glasses) in between sessions. Saliva collections and questionnaires were performed during the first and second weeks of each session, with saliva collected -3, -2, -1, and 0 hours before the habitual bedtime. Actigraph data were collected throughout the evaluation periods.

Results

We found that while partial blue light blocking glasses had no effect on salivary melatonin levels, they did significantly advance the sleep phase compared to the non-filter session (bedtime: 22.03±0.08h vs. 22.1±0.1h, sleep onset: 22.26±0.08h vs. 22.36±0.10h, p= 0.04). The filter effects were most noticeable in the second week, where significant advances in bedtime (-0.12h, p=0.03), sleep onset (-0.14h, p=0.03), wake up time (-0.13h, p=0.02), and leaving-bed time (-0.14h, p=0.02) from the 1st week were observed, whereas no changes were seen during the control session (without filter). Along with the sleep phase advancement observed, daytime irritability and acting out towards siblings and friends were significantly reduced in the second week of the filter session.

Conclusion

Our results suggest that partial blue light blocking glasses advanced the sleep phase and improved behavior in schoolchildren, but that the effects were not mediated by changes in melatonin secretion. Further research into the mechanisms involved is warranted.

Support (if any)

This study was supported by Jins Holdings Inc (SPO236998).
0314 Late Evening Room Light and Sleep Restriction Reverses the Phase Advancing Effect of Bright Morning Light in Adolescents
Authors: Crowley Stephanie , Misiunaite Ieva , Eastman Charmane
Published: May 2023

Introduction

Late bedtimes and sleep restriction are common during adolescence, particularly on school nights. We examined circadian phase advancing effects of bright morning light (ML) with increasing doses of evening room light exposure and sleep restriction due to late bedtimes.

Methods

Adolescents (n=38, 21 girls) aged 14.1 to 18.0 years completed a 14-day protocol during summer vacation. On days 1-7, they slept at home on individualized 10-h sleep/dark schedules. On days 8-14, they lived in the laboratory. On day 8, we measured their Dim Light Melatonin Onset (DLMO). On days 9 and 10, they were put to bed 1.5h (n=9), 3.0h (n=12), or 4.5h (n=8) later and kept awake in room light (104±11 lux at the angle of gaze). Wake time was unchanged; thus, sleep opportunity was shortened to 8.5h, 7h, and 5.5h, respectively. The fourth group (n=9) kept their baseline bedtime, were not exposed to any additional evening light (EL) and were not sleep restricted. On day 11, all groups were put to bed and awakened 1.5 h earlier and were exposed to intermittent bright ML (three 30-min exposures; 8599±885 lux). On each subsequent day (12 and 13), sleep and ML were advanced 1h. Thus, there were 3 days of a gradually advancing sleep schedule and bright ML. Final DLMO was measured on day 14.

Results

The 0h EL group showed a large DLMO advance (2.2±1.0 h), but the advance was reduced in the 1.5h EL group (0.5±0.6 h). DLMO delayed in the 3h EL group (-0.9±1.1 h). There was a large phase delay in the 4.5h EL group (-2.6±1.2 h). Phase shifts differed among all groups [F(3,34)=36.7, p<.001].

Conclusion

Circadian rhythms of adolescents were advanced when they were exposed to bright ML and a gradually advancing sleep schedule, as shown in many studies of adults. However, when kept up later in ordinary room light, the same advancing sleep schedule and bright ML did not produce as much of an advance. Phase delay shifts occurred when bedtimes were 3h or 4.5h later. EL and sleep restriction can reverse the advancing effect of bright ML.

Support (if any)

R01 HL146772 (Crowley)
0318 Early Sleep Intervention Mitigates Poor Sleep and Improves Mood in the COVID-19 Pandemic
Authors: Osorno Raquel , Solomon Natalie , Ahmadi Maryam , O'hora Kathleen , Lopez Mateo , Morehouse Allison , Kim Jane , Manber Rachel , Goldstein-Piekarski Andrea
Published: May 2023

Introduction

Rates of sleep disturbance and depressed mood increased during the COVID-19 pandemic. Acute symptoms of sleep disturbance may develop into chronic insomnia if left untreated and constitute a risk for depression. However, the impact of early treatment of insomnia symptoms on the development of chronic insomnia and depressive symptoms remains unknown. Here we present the primary outcome results from a pre-registered, 2-arm randomized controlled feasibility trial launched early in the pandemic, investigating whether a brief telehealth insomnia intervention targeting acute insomnia symptoms prevents the subsequent deterioration of insomnia and depression.

Methods

Forty-nine participants with pandemic-onset insomnia symptoms were randomized to receive four telehealth sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Primary outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 excluding the sleep item collected at weeks 0, 6, 12, and 28. Linear mixed-effects models tested the hypotheses that early insomnia intervention improves the 28-week trajectory of insomnia and depressive symptoms relative to the control group. The MacArthur framework tested if improvement of insomnia mediates subsequent improvement in depression.

Results

The two linear mixed-effects models revealed significant time-by-intervention interactions, indicating improved trajectories of insomnia and depressive symptoms across the 28-weeks in the CBT-I group compared to the control group (Insomnia: B=-1.03, p<.001; Depression: B=-0.52, p=0.009). The rate of improvement in insomnia during treatment (0-5 weeks) mediated the subsequent improvement in depressive symptoms following treatment (6-weeks; B=2.31, p=0.005), but not at 12- or 28-weeks (all B’s <=1.44, all p’s>0.203). In contrast, depression symptom improvement during treatment was not associated with insomnia symptoms (all timepoint p's>=0.132). The percentage of participants with insomnia diagnosis was lower in the CBT-I vs control group at both timepoints (short-term: 21.7% vs. 50%; long-term: 22.7% vs. 50%).

Conclusion

These are the first findings establishing that brief telehealth CBT-I significantly improved both acute pandemic-onset insomnia symptoms and subsequent trajectory of insomnia and depression. Although the sample size was small and pandemic conditions may never fully be replicated, these results support treatment of acute sleep disturbance in the context of stressors for improved long-term sleep and mood symptoms.

Support (if any)
0320 Improvements in Sleep & Drinking Outcomes Among Heavy Drinkers Following a Digital CBT-I Program
Authors: Verlinden Justin , Moloney Mairead , Vsevolozhskaya Olga , Ritterband Lee , Winkle Fiona , Weafer Jessica
Published: May 2023

Introduction

Insomnia and Alcohol Use Disorder (AUD) and are highly comorbid, due in part to the use of alcohol as a sleep aid among individuals with insomnia. Initial studies have shown that cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia, is moderately successful at improving both sleep and drinking outcomes in heavy drinkers with insomnia. However, CBT-I is not widely available. Digital CBT-I could be a more accessible alternative. One digital CBT-I program, Sleep Healthy Using the Internet (SHUTi), is especially promising due to its high efficacy in treating insomnia and its individualized and interactive platform. Here we conducted a pilot study to examine the efficacy of SHUTi on improving sleep and drinking outcomes in a sample of heavy drinkers with insomnia.

Methods

Heavy drinking men and women with insomnia (n=53) were randomly assigned to complete the SHUTi program (n=26) or a nine-week patient education control program (n=27). Questionnaires examining sleep (Insomnia Severity Index and Pittsburgh Sleep Quality Index) and alcohol use (30-day Timeline Follow-Back) were completed pre-intervention, post-intervention, and 3-months post-intervention. Linear mixed effect models were used to examine the effects of SHUTi on sleep and alcohol consumption and whether any effects of SHUTi on drinking were mediated by the effects of SHUTi on sleep.

Results

SHUTi significantly improved sleep (ISI & PSQI; ps ≤ .021) and drinking outcomes (past 30-day total drinks, drinking days, and binge episodes; ps ≤ .032) over time relative to the control condition. Additionally, the effects of SHUTi on drinking quantity, but not frequency, were mediated by SHUTi’s effects on sleep.

Conclusion

These results show that SHUTi is an effective intervention for improving sleep among heavy drinkers with insomnia. Further, they suggest that sleep may be an effective treatment target to slow the progression of AUD in at-risk individuals. Together, these findings provide preliminary support for the implementation of an inexpensive, easily accessible health behavior intervention with significant public health impact in a high-risk population.

Support (if any)
0324 Protective and Risk Factors for Insomnia Over 5 Years in a Population-Based Sample of Adults
Authors: Morin Charles , Vézina-Im Lydi-Anne , Ivers Hans , LeBlanc Mélanie , Savard Josée
Published: May 2023

Introduction

Insomnia is a major public health concern and one of the most prevalent health issues among adults. Identifying protective and risk factors for insomnia could help identify vulnerable populations and design public health interventions to prevent some adverse medical and mental health consequences. The study objective was to identify protective and risk factors for insomnia in a population-based sample of adults.

Methods

Data is from a large epidemiological cohort study on the natural course of insomnia conducted in Canada before the COVID-19 pandemic. Insomnia and potential protective and risk factors for insomnia were measured annually over 5 years with validated questionnaires (e.g., Insomnia Severity Index, Pittsburgh Sleep Quality Index, State-Trait Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, Coping Inventory for Stressful Situations, Ford Insomnia Response to Stress Test, Arousal Predisposition Scale, Life Experiences Survey). Risk factors for insomnia were divided as predisposing or precipitating factors.

Results

From a cohort of 3,413 participants 1,709 adults were identified as good sleepers at baseline and were included in the analyses. A total of 202 people developed an insomnia syndrome during the 5-year follow-up. Using survival analysis for discrete events, the following variables were significant predisposing factors for insomnia: anxiety (HR=1.037; p=0.018), depression (HR=1.082; p< 0.001), perceived stress (HR=1.073; p< 0.001), number of negative life events (HR=1.478; p=0.02), perceived worse general health (HR=1.606; p=0.006), pain (HR=1.475; p=0.002), vulnerability to stress (HR=1.089; p< 0.001), and maladaptive emotional coping (HR=1.044; p< 0.001). The following variables were identified as precipitating factors for insomnia: loss of income (HR=1.346; p=0.03), increased anxiety (HR=1.070, p< 0.001), depression (HR=1.119; p< 0.001) and perceived stress (HR=1.083; p=0.001), decline in perceived general health (HR=2.061; p=0.006), and increased pain (HR=1.353; p=0.013). Physical activity was not a significant protective factor for insomnia (p=0.54).

Conclusion

These results provide new information that could be helpful to prevent the onset and chronicity of insomnia by targeting specific precipitating factors, and people with predisposing factors for insomnia. This is important as insomnia tends to be a persistent condition and is known to increase adverse medical and mental health outcomes.

Support (if any)

This study was funded by the Canadian Institutes of Health Research.
0327 The Effects of Wearable Device Data on Sleep Diary-Derived Metrics of Sleep
Authors: Conklin Sarah , Dietch Jessica , Tenan Matthew , Banerjee Nilanjan , Brooks Justin
Published: May 2023

Introduction

Precision measurement of sleep metrics like sleep onset latency (SOL) and total sleep time (TST) has long been a challenge. Multiple studies have demonstrated significant discrepancies between sleep diaries and wearable device derived sleep metrics especially in patients with subjective-objective sleep discrepancy (SOSD; e.g., some patients with insomnia). Typically SOSD manifests as longer than expected self-reported SOL and shorter than expected TST. Without a method of reconciliation between sleep diaries and wearable devices, the current practice is to rely on sleep diary data which is suboptimal in the context of SOSD, and could contribute to blunted or nonsignificant effects in clinical trials. The current study investigated the effects of providing wearable device data feedback contemporaneously with the completion of the sleep diary, on a daily basis across 288 nights. We expected that by providing wearable device data feedback, participants with SOSD could be identified and potentially self-correct their SOSD.

Methods

A 3 phase, randomized, crossover design study was used in which 24 undergraduate college students without a diagnosed sleep disorder completed week-long periods of control condition (digital sleep diary without wearable device data feedback), washout, and then test phase (diary with device feedback). Participants were randomized to start with control or test conditions.

Results

Within and between subjects analyses were performed to understand the effect of the wearable device data feedback on sleep diary responses. Two participants (8.3%) with SOSD were identified and had marked differences in their estimated SOL (~47 min) that were corrected when provided with their wearable device data. Importantly no subjects copied their wearable device data into their sleep diary. Between subjects analyses revealed no differences in the average or variability of sleep metrics.

Conclusion

These preliminary results suggest that presenting wearable device data during sleep diary completion may impact self-reporting by individuals with SOSD but not by those without SOSD. In the setting of a clinical trial, participants who have significant SOSD may be contributing to non-disease/non-treatment related variability that may be ameliorated by providing wearable device data during sleep diary completion.

Support (if any)
0329 Wake Intrusions in the EEG: A Novel Application of the Odds Ratio Product in Identifying Subthreshold Arousals
Authors: Gratton Matt , Hamilton Nancy , Gerardy Bethany , Younes Magdy , Mazzotti Diego
Published: May 2023

Introduction

Arousal scoring is controversial, due to its lack of objectivity and dependency on other intrinsic characteristics of sleep. Conventional arousal measurements have not consistently predicted insomnia severity. The present study used a novel application of the Odds Ratio Product (ORP), a measure of sleep depth ranging from 0 (deep sleep) to 2.5 (fully awake), to identify subtle wake intrusions in sleep (i.e., subthreshold arousals). We assessed whether these intrusions are better predictors of frequent insomnia symptoms when compared to conventional arousal measurements.

Methods

Using cross-sectional data from the Sleep Heart Health Study with high-quality ORP data (SHHS1; n = 5,771), accessed through the National Sleep Research Resource, we defined ‘wake intrusions’ as the number of times the ORP spiked above a wake threshold of 2.0 (99% agreement in wake scoring among sleep scorers) during sleep. The wake intrusion index (WII) was derived by calculating the quotient of the number of intrusions by total sleep time. Insomnia was defined from self-reported frequency of >15x/month of insomnia symptoms: delayed sleep onset, difficulty maintaining sleep, and/or early morning awakenings (n = 617). Linear models were used to examine the associations between insomnia and WII, as well as arousal index. Analyses were adjusted for age, sex, body mass index (BMI), and apnea-hypopnea index (AHI).

Results

There was a weak, but significant correlation between conventional arousal index and WII (r=0.25, 95%CI [0.22, 0.27], p< 0.001). After adjusting for age, sex, BMI and AHI, frequent insomnia symptoms were associated with WII (β=9.47, 95%CI [2.07, 16.87], p=0.012), but not with arousal index (β=0.16, 95%CI [-0.59,0.91], p=0.217).

Conclusion

Results suggest that the ORP WII may be more sensitive than the arousal index. Moreover, frequent insomnia symptoms were independently associated with WII in adjusted analysis, while not with the arousal index. The role of the ORP WII as a potential physiological marker of insomnia deserves further investigation.

Support (if any)

NIH (U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL64360, U01HL53938, U01HL53940, U01HL53941, U01HL63463, R24HL114473, 75N92019R002).
0330 Blinded Verses Open-Label Hypnotic Tapering for Hypnotic Discontinuation: A Randomized Clinical Trial
Authors: Edinger Jack , Wamboldt Fredrick , Eldridge-Smith E Devon , Holm Kristen , Johnson Rachel , Simmons Bryan , Wang Eileen , Scherger Rubab
Published: May 2023

Introduction

Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study is testing a blinded tapering approach designed to reduce patients’ anxiety during the hypnotic tapering process.

Methods

Thus far, a sample of 44 (M age = 59.1±14.1 yrs.; 61.4% women) users of benzodiazepine (BZD) or newer generation benzodiazepine receptor agonists (BZRA) have enrolled in this trial and completed a 3-month post-tapering follow-up. Following baseline assessments that included completion of the insomnia severity index (ISI), these enrollees completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of two 10-week, tapering protocols wherein their medication dosage was reduced by 25% every two weeks either in a blinded or open-label manner. Medication usage was assessed and ISI scores were obtained at the end of the tapering phase and at a 3-month follow-up.

Results

A linear mixed model analysis showed only an effect for time in study on ISI scores with both tapering groups showing a significant (F = 36.89; p = .0001) decline in these scores from baseline through the 3-month follow-up. By the 3-month follow-up, a slightly, albeit non-significantly, higher proportion of the blinded tapering group (76.2%) were no longer using their BZD/BZRA hypnotics than in the open label group (60.9%). However, there was a significantly higher BZD/BZRA discontinuation rate by the 3-month follow-up among those who achieved ISI score-determined insomnia remission than among unremitted participants both for the sample as a whole (85% vs. 54.2%; p = .05) and for the open label group (88.9% vs. 42.9%; p = .0397) considered separately. This difference between remitted and unremitted participants was not seen in the blinded tapering group.

Conclusion

Early findings in this trial suggest a slight advantage to blinded over open label hypnotic tapering in achieving hypnotic discontinuation. Moreover, insomnia remission may not be essential for hypnotic discontinuation when blinded tapering is conducted.

Support (if any)

National Institute of Drug Abuse, Grant # 1R01DA047341-01A1
0335 Persistence of Sleep Duration Phenotypes Across Nights of Laboratory and Home Sleep Recording
Authors: Edinger Jack , Krystal Andrew , Lunsford-Avery Jessica
Published: May 2023

Introduction

Vgontzas and colleagues have proposed dividing the population of persons with insomnia disorder into short (< 6 hours/night) and normal (> 6 hours/night) sleep duration phenotypes based on their objective sleep duration as measured by one or more nights of polysomnography (PSG). However, first night effects, homeostatic recovery mechanisms and the site where PSG is conducted may all affect the sleep duration observed on individual PSG nights. The current study evaluated the stability of objective sleep duration phenotyping across multiple laboratory and home-based PSG recordings.

Methods

Seventy-six adults (Mage = 51.8±16.5 yrs.; 50% women) with an insomnia disorder underwent a series of three PSG recordings in the sleep lab and three in their homes in a counterbalanced order. Participants chose their own bed and rising times each night to produce results representative of their usual sleep patterns. Participants were classified into short (ISS: TST < 6 hours) and normal (INS: TST > 6 hours) duration phenotypes using the mean sleep times across all nights.

Results

Twenty-eight participants were classified as the ISS phenotype and 48 were classified as the INS phenotype with equal numbers of men and women in each group. A linear mixed models analysis showed only significant main effects for phenotype classification (F = 119.72; p < .0001) and recording night (F = 4.29; p < .025). The ISS mean TST was 326.8 minutes whereas the INS mean TST was 396.8 minutes. Mean TST across both groups was significantly shorter on the first PSG night (Mean = 353.0 min.) across settings than on night 2 (Mean = 372.4 min.). The majority of the ISS group (78.6%) and INS group (77.1%) had TST < 6 hours and TST > 6 hours, respectively, on 4 or more nights of sleep recordings.

Conclusion

ISS and INS sleep duration phenotypes have relative stability in their objective sleep times across nights and recording sites. These findings support the growing literature suggesting the distinctiveness of these subtypes of insomnia disorder.

Support (if any)

Funding support from the Department of Veterans Affairs Merit Review Grant Program
0348 Cognitive Behavioral Therapy for Insomnia in African Americans: A Pilot Study
Authors: Thompson Michelle , Muench Alexandria , Boyle Julia , VanCliff Camya , Seewald Mark , Jemmott John , Grandner Michael , Jean-Louis Girardin , Posner Donn , Perlis Michael
Published: May 2023

Introduction

Co-morbid sleep continuity disturbance (SCD) and insufficient sleep duration (ISD) disproportionately affect the sleep health of Black Americans (BA). Simultaneously, treating SCD and ISD may improve health and reduce disparities experienced by this community. Although standard cognitive behavioral therapy for insomnia (CBT-I) ranges from six to eight sessions and directly addresses SCD, standard CBT-I does not appreciably increase total sleep time (TST) and therefore does not adequately address ISD during treatment. This report presents the overall study outcomes of CBT-I (without respect to dose of CBT-I) in BA.

Methods

Twelve BA adults (83% female, Mage 46.0±13.9yrs) were recruited from the Philadelphia area. CBT-I was provided by one of four master CBT-I therapists via telehealth for up to 16 sessions. Two follow-up assessments were conducted at 3 and 6 months. Participants completed daily measures of sleep continuity (sleep diaries) and weekly measures of insomnia severity (ISI).

Results

Overall, 75% of participants exhibited a treatment response corresponding to a reduction of 58% (effect size [ES]=-2.3) on the ISI. With respect to sleep continuity (measured in minutes), there was a 61% (ES=-1.4) reduction in sleep latency (30.1 to 11.8), 76% (ES=-1.7) reduction in wake-after-sleep onset (32.4 to 7.8), 81% (ES=-1.2) reduction in early morning awakenings (32.2 to 6.3), 7% (ES=0.3) increase in TST (381.3 to 408.0), a 9% (ES=-0.6) reduction in time in bed (476.0 to 433.7), and an overall 16% (ES=2.9) improvement in sleep efficiency.

Conclusion

Results from this pilot study indicate that standard CBT-I produces robust effects in BA with insomnia. Analyses are ongoing and will examine group interactions and treatment durability at follow-up.

Support (if any)

K24AG055602
0349 Contribution of Insomnia After Trauma to Depression and Posttraumatic Stress Disorder in Women Service Members
Authors: Carlson Gwendolyn , Sharifian Neika , Jacobson Isabel , LeardMann Cynthia , Rull Rudolph , Martin Jennifer
Published: May 2023

Introduction

Trauma can lead to mental health disorders, such as posttraumatic stress disorder (PTSD) and depression. Historically, insomnia was thought of as a secondary symptom of these mental health disorders, but current research suggests insomnia can be an independent clinical disorder and can contribute to the development and severity of PTSD and depression among civilians. However, previous studies examining insomnia and mental health symptoms among service members are limited by cross-sectional designs, reliance on retrospective data, or inclusion of predominately male ­samples. We prospectively examined associations among trauma exposure, insomnia, and mental health symptoms in an exclusive sample of women service members and veterans.

Methods

We analyzed 2 waves of survey data (2011-2013, Time 1 [T1], and 2014-2016, Time 2 [T2]) from 26,443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas (combat experience and sexual trauma) in the past 3 years, probable insomnia at T1, and probable PTSD and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia.

Results

Women who experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI, 1.24-2.10), sexual harassment (OR = 1.22; 95% CI, 1.05-1.41), or combat (OR = 1.34; 95% CI, 1.20-1.49) at T1 had greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI, 2.31-3.06) and PTSD (OR = 2.57; 95% CI, 2.27-2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes.

Conclusion

Insomnia contributes to subsequent mental health symptoms following trauma. The diagnosis and treatment of post-trauma insomnia during military service should be prioritized to mitigate the development of posttraumatic mental health symptoms. Sleep health in women service members remains an understudied area of research and should also be prioritized.

Support (if any)

Millennium Cohort Study: Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs. VA HSR&D (RCS-20-191, Martin); NHLBI (K24HL143055, Martin).
0355 Insomnia Identity’s Association with Insomnia Problem Chronicity and Treatment History
Authors: Boeve Angelica , Boyle Julia , Muench Alexandria , Emert Sarah , Vargas Ivan , Thompson Michelle , Grandner Michael , Perlis Michael
Published: May 2023

Introduction

Insomnia identity is defined as the “conviction that one has insomnia” or self-identifies as an “insomniac.” The present study sought to evaluate whether insomnia chronicity and past insomnia treatment predicts whether someone identifies as an “insomniac” in a large sample of adult participants with sleep complaints.

Methods

This study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area. The data were drawn from 2,950 adults between 18 and 90 years of age who specifically reported problems with total sleep time (TST). All participants answered questions regarding age of problem onset, insomnia treatment history, and insomnia identity (“Do you think of yourself as an ‘insomniac’?”).

Results

Of the 2,863 participants included in this analysis (Mage=53.5±10.7; 76.6% female; 91.2% White), 45.1% identified as an “insomniac.” Binary logistic regression was used to examine whether TST problem chronicity (Myears=12.3±10.0) and treatment history (36.6%) were associated with the likelihood of identifying as an “insomniac.” Outliers were removed and assumptions were met. The model was statistically significant X2=(2, N=2,863)=172.4, p< 0.001, suggesting that it could distinguish between those who did and did not identify as an “insomniac.” The model correctly classified 60.9% of cases. TST problem chronicity (OR=1.04, 95% CI [1.027, 1.043]) and treatment history (OR=0.51, 95% CI [0.435, 0.596]) significantly contributed to the model.

Conclusion

Participants were 4% more likely to identify as an “insomniac” with each year of TST problem chronicity and were 49% less likely to identify as an “insomniac” if they engaged in prior insomnia treatment. Findings align with a recent study that also found that individuals with insomnia identity reported longer insomnia chronicity and that individuals with and without insomnia identity seek insomnia treatment. Future analyses should consider additional variables including insomnia frequency (days per week), severity (e.g., total nocturnal wakefulness [TWT]), daytime symptomatology, perceived sleep need, and demographic factors including age, sex, and race.

Support (if any)

K24AG055602
0362 Sleep Medication Use in Hospitalized Geriatric Patients and Associated Outcomes
Authors: Vaught Malcolm , Petteruti Audrey , Anagnostopoulos Antonios , Hussain Laila , Fleishman Samuel
Published: May 2023

Introduction

Disturbances in the diurnal sleep-wake cycles are prevalent within the geriatric population, consequently increasing the development of insomnia. Although insomnia is commonly treated in the inpatient setting, many pharmacologic interventions are classified as potentially inappropriate medications for the geriatric population, as defined through the Beers Criteria; potentially increasing the risk for adverse events (AEs) in this population.

Methods

A retrospective review and comparative analysis of medications used for the treatment of insomnia (diphenhydramine [DPH], hydroxyzine [HDX], trazodone [TZD]) in 121 hospitalized geriatric patients (≥65 years old) in our facility during the month of October 2021 was conducted. Multiple regression analysis was used to identify associations between selected medication use and AEs including inpatient falls, new or worsening delirium, and new onset urinary retention. Comparative analysis using individual T-testing between groups, and Kruskal-Wallis Testing for total comparison was used to identify significance between group outcomes.

Results

Patients treated with DPH or HDX showed significantly higher rates of AEs compared to patients treated with TZD (p< 0.001); but showed no significant difference in frequency of AEs between themselves (p=0.816). 54.8% of patients treated with DPH and 57.7% of patients treated with HDX had at least one recorded AE during their hospital stay. The most common AE in all treatment groups was new or worsening delirium at 31.0%, 38.5%, and 15.6% in DPH, HDX, and TZD groups respectively. Both DPH and HDX groups showed AEs of falls (4.8% and 11.5%) and new onset urinary retention (14.3% and 7.7%) respectively, whereas the TZD group showed neither of these AEs. Analysis yielded secondary outcomes with AE of new onset constipation occurring only within the DPH group at 11.9%. Further, secondary analysis showed treatment with DPH had a significant increase in hospital length of stay (HLOS) compared to TZD use (p< 0.01), but not compared to HDX use (p=0.755).

Conclusion

Treatment of insomnia in hospitalized geriatric patients is complex. Use of anticholinergic medications (DPH/HDX) substantially increases the risk for AEs within this population. Further, the use of DPH showed significant increased HLOS, possibly as a direct result of AEs incurred with the use of these medications.

Support (if any)