bluuebunny/crossref_metadata_2025 huggingface dataset:
0917 Excessive Daytime Sleepiness and Health-related Quality of Life in Adolescent Patients with PCOS
Authors: Chase Margaret , Kamboj Manmohan , Bonny Andrea , Kalra Maninder
Published: April 2024

Introduction

Patients with polycystic ovary syndrome (PCOS) have been reported to have an impaired quality of life (QoL). A high prevalence of sleep disorders has also been reported in this group. This study seeks to evaluate the degree of excessive daytime sleepiness and sleep related QoL in adolescent patients with PCOS.

Methods

Patients seeking treatment at our multidisciplinary PCOS clinic who were evaluated by Sleep Medicine from July 2023 to December 2023 and completed the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) and OSA-18 questionnaire were included in this study. The ESS-CHAD is an 8 question, validated measure of daytime sleepiness in children 12-18. Scores >10 suggest excessive sleepiness. The OSA-18 is an 18-item questionnaire that uses a Likert-type scoring system to collect information about 5 subscales that are elements in QoL: sleep disturbance, physical symptoms, emotional symptoms, daytime function, and caregiver concerns. A summary score is calculated that ranges from 18 (no impact on QoL) to 126 (major negative impact). Scores lower than 60 suggest a mild impact on QoL, scores between 60 and 80 suggest a moderate impact, and scores greater than 80 suggest a large impact. Descriptive statistics include means (SD) and n (%).

Results

Sixteen subjects, mean age 16.68 years (SD 1.65), mean BMI 41.8 (SD 11.02) met inclusion criteria. Ten (62%) reported excessive daytime sleepiness as assessed by the ESS-CHAD. OSA-18 scores ranged from 23 to 84 with 2/16 (12.5 %) of subjects having a moderate or severe impairment and 14/16 (87.5%) subjects having a mild impairment.

Conclusion

Among adolescent patients seeking treatment at a multidisciplinary PCOS clinic, the majority reported excessive sleepiness with mild impact on their QoL as assessed by disease specific questionnaires. Future studies will further investigate the contribution of sleep disordered breathing and evaluate the impact of obesity and insulin resistance on excessive sleepiness and health related QOL as measured by ESS-CHAD and OSA-18 scores.

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0919 Shaking up the Night: PCD & Sleep-Related Movement Disorders
Authors: Quinones Roberto Cardona , Ramírez-Rivera Edicer , Alvarez-Torres Edwin , Hernandez Saidy Salem , Reyes Fabiola Guasp , Criado Maria Rivera , Vargas-Perez Noel , De Jesus-Rojas Wilfredo
Published: April 2024

Introduction

Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The literature on sleep movement disorders in PCD is limited, especially for Hispanics. This pilot study aims to assess the presence of sleep movement disorders and other comorbidities in patients with the RSPH4A PCD founder mutation [c.921 + 3_921 + 6delAAGT] in Puerto Rico. Our specific aim is to identify sleep-related movement disorders in PCD patients with the Puerto Rican founder mutation. Recognizing the importance of early diagnosis and prevention of PCD-related sleep disorders in pediatric and adult patients with PCD will help increase the knowledge of this condition and its comorbid manifestations.

Methods

We performed a prospective case series of fourteen PCD patients (n=15; seven pediatric and eight adults) at the Puerto Rico PCD Center and Neurosleep Sleep Laboratory in San Juan, Puerto Rico. Both pediatric and adult patients were interviewed for sleep disturbances and sleep-related movement during the night. Sleep questionnaires such as the Epworth Sleepiness Scale, and STOP-Bang (including the Pediatric Modified) were administered. Finally, polysomnography (PSG) was performed on every PCD patient to evaluate for sleep-related disorders.

Results

Our preliminary data showed that most patients with RSPH4A [c.921 + 3_921 + 6delAAGT] PCD founder mutation presented a high risk for sleep-related movement disorders or manifestations, including Sleep-Related Bruxism, Periodic Limb Movement of Sleep, Hypnagogic Foot Tremor, Rhythmic Movement Disorder. However, there were additional manifestations presented in both history-taking and PSG results such as Alpha-Delta Sleep, NREM Parasomnias, and others presented with Obstructive Sleep Apnea.

Conclusion

PCD is a rare genetic condition characterized by oto-sino-pulmonary pathologic manifestations with multiple comorbidities, including sleep-related disorders. The mechanism for the development of sleep-related movement disorders due to this ciliopathy is not well understood. Further research involving Multiple Sleep Latency Tests, Actigraphy, and additional comprehensive neurophysiologic testing and evaluation is needed to make an early diagnosis and prevent further clinical deterioration. Additional studies are needed in multicentric clinical trials to answer whether these sleep manifestations are related to a neurodevelopmental or neurodegenerative process due to this rare ciliopathy like PCD.

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0921 Pilot Cognitive Behavioral Sleep Health Randomized Controlled Trial for Young Adults with Type 1 Diabetes
Authors: Griggs Stephanie , Howard Quiana , Pignatiello Grant , Strohl Kingman , Li Chiang-Shan R , Grey Margaret , Crawford Sybil , Hickman Ronald
Published: April 2024

Introduction

Short sleep duration and inconsistent timing have been linked to poor glycemic target achievement and greater comorbidities in individuals with type 1 diabetes (T1D), particularly adults aged 18-26 years who achieve glycemic targets at the lowest rates (only 14%). Preliminary evidence supports cognitive behavioral sleep interventions (sleep extension + timing consistency) in improving the achievement of sleep and glycemic targets. The purpose of this pilot randomized controlled trial (RCT) was to determine the preliminary effects of a cognitive behavioral sleep health self-management intervention (CB-Sleep Health - sleep extension + timing consistency) on self-report and objectively derived sleep health dimensions (satisfaction, alertness, timing, efficiency, and duration) in young adults with T1D.

Methods

Young adults with T1D for at least 6 months with a hemoglobin A1C ≥ 7% or ≤ 80% time in glucose range were randomly assigned 1:1 stratified by sex at birth to a 12-week CB-Sleep Health (n = 21) or time balanced attention control (AC) condition (n = 18). Participants completed the Pittsburgh Sleep Quality Index (sleep satisfaction) and trail making test (daytime alertness) while concurrently wearing continuous glucose monitors and research grade actigraphy (timing, efficiency, and duration) for 14 days at baseline, post-intervention, and a 3-month follow up.

Results

Thirty-nine young adults (mean age 21, BMI 25.9 kg/m2, A1C 8.5% and 44% time in glucose range, 59% male, 26% Non-White - 18% Black/8% other race) participated. Baseline sleep health dimension values (mean + sd) were 5.4 + 0.7 vs. 5.3 + 0.5 score (satisfaction), 18.4 + 1.4 vs. 20.3 + 1.3 seconds (daytime alertness), 16:07 + 0.4 vs. 15:95 + 0.4 hours (timing), 85.6 + 4.1% vs. 84.7 + 4.5% (efficiency), and 6.4 + 1.0, vs. 6.9 + 1.0 hours (duration) for CB-Sleep Health vs. AC respectively. Sleep duration and alertness improved for CB-Sleep Health compared to AC post intervention (+18 minute vs. -25.8 minutes, p = .01 and -3.92 seconds vs. +0.71, p = .005) and were sustained at the 3-month follow up.

Conclusion

Preliminary effects of a CB-Sleep Health intervention on sleep duration and alertness without impairing efficiency for young adults with T1D are encouraging.

Support (if any)

National Institute of Nursing Research (R00NR018886)
0924 A 4-Week Morning Light Treatment Reduces Amygdala Reactivity and Clinical Symptoms in People with Traumatic Stress
Authors: Burgess Helen , Rizvydeen Muneer , Duval Elizabeth , Kim Hyungjin Myra , Phan K Luan , Liberzon Israel , Klumpp Heide , Abelson James , Horwitz Adam , Raglan Greta , Zalta Alyson
Published: April 2024

Introduction

Trauma exposure can result in anxiety, depression, and posttraumatic stress disorder. Although psychotherapies and pharmacotherapies exist for traumatic stress, many individuals remain symptomatic. New interventions for traumatic stress that target underlying mechanisms (e.g. amygdala reactivity) and are safe and acceptable are needed. Here we report on a randomized clinical trial in which we tested 3 doses of a 4-week morning light treatment in people with traumatic stress.

Methods

Forty-two adults (32 females, 19-57 years) with traumatic stress (experienced a DSM-5 Criterion A trauma, DASS score >22, and ≥ 2 moderate hyperarousal symptoms) completed a 5-week protocol. In the first week each participant slept at home, ad lib, on their usual sleep schedule. Thereafter, they followed a fixed sleep schedule and a 4-week morning light treatment (randomized to 15 mins, 30 mins or 60 mins of light each morning). Amygdala reactivity (emotional faces task - fMRI), clinician rated symptoms (PSSI, HAM-A, HAM-D) and self-reported symptoms (PCL-5, DASS) were assessed at baseline, and after 4 weeks of morning light treatment.

Results

Amygdala reactivity (left and right, negative faces vs shapes) in all 3 morning light groups significantly reduced during treatment (ps< 0.04). The 30 and 60 min groups had larger effect sizes in the reduction in amygdala reactivity than the 15 min group (ds=0.33-0.67 vs ds=0.11-0.16). All clinical symptoms significantly reduced during the treatment (ps< 0.001). There was a trend for self-reported depression, anxiety and stress symptoms to decline the most in the 60 min group (DASS d=1.35, p=0.06). Similarly, clinician rated depressive symptoms declined the most in the 60 min group (HAM-D d=2.25, p=0.03). No significant side effects were reported. Treatment satisfaction (average 7/10) and adherence (average 91%) were similar between groups (ps>0.05).

Conclusion

Results suggest that a 4-week morning light treatment can reduce amygdala reactivity and improve clinical symptoms in people with traumatic stress. The longest duration of morning light treatment, 60 minutes, produced some of the largest reductions in self-reported depression, anxiety and stress symptoms, and in clinician rated depressive symptoms. Morning light treatment should be further explored as a feasible, acceptable and effective adjunctive non-pharmacological treatment for traumatic stress.

Support (if any)

R61 MH117157
0929 The Role of Insomnia, Sleep Apnea, and Psychological Distress on Quality-of-Life in Veterans with and Without PTSD
Authors: Krueger Mason , Tsai Thomas , Romaker Emma , Wallace Douglas , Wohlgemuth William
Published: April 2024

Introduction

Obstructive sleep apnea (OSA), insomnia, and psychological distress have been independently linked to various negative outcomes, including poorer quality-of-life (QOL). However, prior literature has not investigated differences in QOL outcomes between veterans with and without PTSD that may be influenced by sleep apnea severity, insomnia, and psychological distress. This study aimed to investigate the relationships of sleep apnea severity, insomnia, and psychological distress with QOL (i.e. physical and social functioning) between veterans with and without PTSD.

Methods

Veterans presenting to the Miami VA Sleep Center who were at risk for OSA (n=645, M age=52 years, 84.5% male) completed the Insomnia Severity Index and the PROMIS-29. The social and physical functioning subscales from the PROMIS-29 were used. Questionnaires were completed the night prior to undergoing a home sleep apnea test. Multigroup structural equation modelling was used to compare the PTSD (n=210) and non-PTSD (n=435) groups, controlling for age, gender, race, education, and BMI.

Results

The final model met statistical criteria for good fit (CFI=0.951, RMSEA=.051). For those with PTSD, higher psychological distress was associated with both reduced social (β=-.54, p<.001) and physical functioning (β=-.35, p<.001). Neither insomnia nor sleep apnea was associated with QOL outcomes in those with PTSD. In those without PTSD, higher psychological distress and higher insomnia were associated with lower social (β=-.38, p<.001; β=-.42, p<.001) and physical functioning (β=-.30, p< 001; β=-.29, p< 001). Sleep apnea was not associated with QOL outcomes in those without PTSD.

Conclusion

The present findings suggest that for those without PTSD both insomnia and psychological distress, but not sleep apnea, are associated with QOL. However, for those with PTSD, only psychological distress was related to QOL. Neither insomnia nor sleep apnea was associated with QOL in those with PTSD. These results indicate that, in those without PTSD, QOL is influenced by both a sleep disorder (insomnia) and psychological distress. However, in those with PTSD, QOL appears to be primarily influenced, not by a sleep disorder, but by psychological distress. The current findings highlight importance of and the need to prioritize treatment for psychological distress in veterans with PTSD to improve their QOL.

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0932 Comparison of Language and Somatic Experiences Between Reports of Trauma & Trauma-Related Dreams
Authors: Hickey Kimberly , Mendelsohn Augustus Kram , Pace-Schott Edward
Published: April 2024

Introduction

Trauma-related nightmares (TRNs) are common sequela of psychological trauma. We explored linguistic and somatic-experience differences between self-reports of a trauma and those of nightmares related to the trauma.

Methods

Seventeen participants with varying severity of PTSD symptoms reporting recurring TRNs (mean age 27, 14 females) recalled traumatic experiences and nightmares related to that trauma. Trauma reports were written by participants, while nightmare reports were transcribed from audio recordings made as soon as the nightmares were recalled. Following reports, participants indicated co-occurring somatic experiences by choosing from a predetermined list. Choices were later grouped into cardiovascular, respiratory, interoceptive, and tension categories. Linguistic content was measured using the Linguistic Inquiry and Word Count (LIWC) program and words were grouped into positive emotion (positive tone, prosocial, power, affiliation), negative emotion (negative tone, anxiety, anger, sadness, conflict), and somatosensory (visual, auditory, feeling) categories. Shapiro-Wilk tests showed non-normally distributed data therefore nonparametric tests (Wilcoxon Signed-Rank Test, Spearman Correlation) were used. Because trauma reports had significantly higher word counts than TRNs (p=0.0495), LIWC data were normalized for word count. Total and symptom-cluster severities were assessed using the PTSD check list for DSM-5 (PCL-5).

Results

We found significantly more somatic experiences of interoception (p=0.0084) and tension (p=0.024) in trauma versus nightmare reports but no differences in cardiovascular or respiratory experiences. No differences between report type were found for LIWC categories. The PCL-5 Intrusion (cluster B) PTSD symptoms were associated with cardiovascular (rho=0.592, p=0.0156) and respiratory (rho=0.619, p=0.0109) experiences in trauma reports and interoception (rho=0.718, p=0.0033) and tension (rho=0.556, p=0.0224) experiences in nightmare reports. No other symptom clusters, nor PCL-5 total score, were correlated with other somatic-experience categories. No LIWC categories in either report type were correlated with symptom clusters or total PCL-5 score.

Conclusion

More somatic experiences of interoception and tension were recalled from traumas than TRNs. Because the brain is relatively deafferented from sensory input during dreaming, we expected, but did not find, state differences in other somatic experiences. Word categories in narratives also did not show state differences. Only the intrusion symptoms of PTSD predicted bodily sensations in trauma as well as TRN reports.

Support (if any)

R21MH128619
0933 Dreaming Under Anesthesia Occurs During Pre-emergence State
Authors: Ishii Toru , Kawai Makoto , Heifets Boris , Chow Harrison
Published: April 2024

Introduction

Dreaming during anesthesia is defined as any recalled experience that occurs between induction and the first moment of consciousness upon awakening. It is a commonly reported phenomenon in the perioperative period, just like dreaming during natural sleep. It has also been reported that general anesthesia with propofol often results in dreams with positive content, which influences emotions after awakening. However, the details of when and under what conditions the brain undergoes dreaming experiences during anesthesia remain poorly understood. In addition, the homology between dreaming under anesthesia and spontaneous sleep is yet to be uncovered. Herein, we aimed to investigate the relationship between EEG and dreaming experiences under general anesthesia.

Methods

All participants underwent surgery under general anesthesia with propofol at Stanford University Hospital between 2021 and 2022. Standard ASA monitors and Sedline EEG electrodes at the frontal area were recorded during surgery, and the presence and content of dreaming experiences were interviewed immediately after awakening from anesthesia. The data from thirty-four patients (52.5±15.9 yrs.) who reported dreaming and twenty-eight patients (48.8±13.4 yrs.) who did not report dreaming after emergence from anesthesia were analyzed. Time-frequency analysis was performed on EEGs, and parameters between dreamers and non-dreamers were compared.

Results

The pre-emergence state from the steady state of anesthesia to extubation was significantly longer in the Dreamer group (17.1±9.3 min vs. 9.1±8.6 min, d=0.8, p=0.01). During the pre-emergence state, a sharp decrease in frontal alpha-power and a sharp increase in Beta/Gamma power were observed.

Conclusion

The results suggest that dreaming occurs in the pre-emergence state between deep anesthesia and awakening. The finding that this state is characterized by a reduction in frontal alpha oscillation, which is considered to reflect the activity of the thalamocortical loop, provides insight into the neural basis of dreaming, nightmares, and consciousness.

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0940 Frontal Attentional Processes Correlate with Sleep Problems in Veterans with Post Traumatic Stress Disorder
Authors: Lanthier Malika , Tavakoli Paniz , Higginson Caitlin , Richard-Malenfant Claude , Leveille Chloe , Porteous Meggan , Kaminsky Zachary , Shlik Javok , Robillard Rebecca
Published: April 2024

Introduction

Post-traumatic stress disorder (PTSD) instigates a series of neurocognitive dysfunctions, with sleep irregularities and attentional difficulties being key interacting features. Despite the known impact of sleep problems on cognitive performance, there is limited understanding about how poor sleep may be associated with basic attentional processes in individuals with PTSD. This study investigated associations between sleep macroachitecture and brain responses to attention processing involving the frontal cortex in veterans living with PTSD.

Methods

Event-related potentials were recorded before bedtime under two conditions: 1) presentation of an auditory stimulus at a rapid pace (every 2 seconds) and 2) the same auditory stimulus presented at a slower pace (every 16 seconds). Event-related potentials elicited in the slow condition are recognized for activating attentional networks in the frontal lobe, while event-related potentials elicited in the fast condition would activate the auditory cortex. Polysomnography was recorded throughout the night for sleep architecture. Associations between sleep architecture parameters and the N1 and P2 event-related potential components were assessed using Pearson correlations.

Results

Thirteen veterans (1 female, Mean+SD = 49 + 8.9 y.o.) with a PTSD diagnosis based on DSM-V criteria participated in this study. Most participants were using serotonergic medications. The P2 elicited in the slow condition was significantly negatively correlated with REM latency (r=-0.69, p=.008) and positively correlated with minutes spent in REM (r=0.59, p=.033). No other significant correlations were found.

Conclusion

Veterans living with PTSD often experience increased REM pressure, as reflected by shorter REM latency and higher amounts of REM sleep. This study highlights an association between REM abnormalities with increased brain resources mobilized by frontal attentional processing. Investigating how sleep interventions may influence attentional processes may help improve our understanding of how good sleep could counteract the adverse effects of PTSD on brain functions.

Support (if any)

This project was funded by a competitive grant from the Canadian National Defence (Innovation for Defence Excellence and Security (IDEaS)).
0941 Limb Movements in Sleep [LMS] and PTSD-related Physical Symptoms: Preliminary Observations
Authors: Gupta Madhulika
Published: April 2024

Introduction

Periodic Limb Movements in Sleep [PLMS] can be present in over 60% of Posttraumatic Stress Disorder [PTSD] patients versus about 10% in the general population. PTSD is often associated with physical complaints. In the general population PLMS can be associated with physical symptoms . To my knowledge the association of PLMS and physical complaints in PTSD has not been reported.

Methods

106 PTSD patients [all from MAG’s practice] completed a battery of instruments. 44/106 patients (mean age+/-SD = 47.04+/-13.27 years; 89.6% female) met the inclusion criteria (no current use of benzodiazepines or narcotics; ability to have LMS ratings completed by bed partner). All participants met the DSM-5 criteria for moderate-to-severe PTSD during their initial consultation, with a Clinician Administered PTSD Scale for DSM-5 (CAPS-5) score of at least 55. The PTSD Checklist for DSM-5 (PCL-5) was used to obtain an index of the current PTSD severity (mean = 37.41, SD = 19.84; PCL-5 > 30 cut-off for PTSD). Limb Movements in Sleep [LMS] were considered a proxy for PLMS [ICSD3, 2014] and were measured using Item 10c of the Pittsburgh Sleep Quality Index [PSQI] [Buysse DJ,1989] where the patients’ bed partner rated the patients’ severity of “Legs twitching or jerking while they slept”; Low-LMS frequency included "< one time per week" or "not during the past month" and High-LMS frequency included " once or twice a week " and " three or more times a week".Physical symptoms were rated using the Pennebaker Inventory of Limbic Languidness [PILL][Pennebaker JW,1982] which rates 54 physical symptoms using the following scale: 1=Have never or almost never experienced the symptom; 2=Less than 3 or 4 times per year; 3=Every month or so; 4=Every week or so; and 5=More than once every week.

Results

The mean scores of 20/54 PILL items were significantly [ p< 0.05] lower between the Low- versus High-LMS groups. The total 54 item mean PILL score was significantly [p=0.002] greater in the PTSD group with High-LMS [PILL score of 105 ] versus the Low-LMS scores [PILL score of 73].

Conclusion

PTSD patients with more frequent limb movements during sleep had greater daytime physical complaints.

Support (if any)

None
0942 The Mediating Role of Emotional and Behavioral Problems Between Nightmares and Suicidality in Adolescents
Authors: Li You , Sit Hao Fong , Cheung Forrest Tin Wai , Li Shirley Xin
Published: April 2024

Introduction

Adolescence is a transitional period that is susceptible to sleep and mental health problem. Previous research has shown that sleep problems, including both insomnia and nightmares, as well as emotional and behavioral problems, are respectively associated with the suicidal risk. However, it remained unclear whether nightmares play an independent role in this link. The present study aimed to examine the association between nightmares and suicidality, and the potential mediating role of emotional and behavioral problems in this relationship in a community-based sample of Hong Kong Chinese adolescents.

Methods

A total of 2475 adolescents (12–20 years; mean age 14.8 ± 1.8 years; female: 63.80%) were recruited from the local secondary schools in Hong Kong. Participants completed a battery of self-report questionnaires: nightmares were measured using a single item in the Pittsburgh Sleep Quality Index (PSQI); suicidality was measured by the suicidality item in the Patient Health Questionnaire (PHQ-9); emotional and behavioral problems were measured by the Strengths and Difficulties Questionnaire (SDQ); and insomnia severity was measured by Insomnia Severity Index (ISI). Frequent nightmares were defined as having nightmares at least once per week. Suicidality was defined by the presence of suicidal ideation over the past two weeks.

Results

45.4% of the participants reported having frequent nightmares, and 29.4% of the participants reported suicidal ideation over the past two weeks. Frequent nightmares (OR =1.53, 95% CI: 1.36 - 1.71), insomnia (OR = 1.13, 95% CI: 1.10 - 1.15) and emotional and behavioral problems (OR = 1.04, 95% CI: 1.03 - 1.05), age (OR = 0.93, 95% CI: 0.88- 0.98) were all found to be significantly associated with suicidality. Path analyses revealed that emotional and behavioral problems partially mediated the relationship between frequent nightmares and suicidality among adolescents (b = .03, 95% CI = .016, .051). The meditation effect remained significant after controlling age, gender, and insomnia severity.

Conclusion

Psychopathology mediates the relationship between nightmares and suicidality independent of the severity of insomnia. Nightmare disturbance and psychopathology should be taken into account in suicide prevention among adolescents. Future exploration on the mechanism underlying the link between nightmares and suicidality is needed.

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0947 Suvorexant Improves Symptoms of Opioid Withdrawal and Depressive Symptoms Through Changes in Oscillatory Band-power
Authors: Reid Matthew , Abraham Liza , Gamaldo Charlene , Mun Chung-Jung , Coon-Dekuiper William , Smith Michael T , Finan Patrick , Huhn Andrew
Published: April 2024

Introduction

Opioid withdrawal exacerbates depressive symptoms and poor sleep. Previous findings demonstrate suvorexant’s ameliorative effect on sleep disturbances during this period, but is unknown whether these changes also confer benefit for depressive or withdrawal symptoms. therefore, we aimed to examine the effects suvorexant oscillatory sleep-EEG power during inpatient opioid withdrawal, and to examine their association with withdrawal severity and depressive symptoms.

Methods

Participants with Opioid Use Disorder (N=38: age-range = 21-63years, 87% male, 45% white) underwent an 11-night withdrawal (3-night stabilization, 4-night buprenorphine taper, 3-night buprenorphine post-taper) and were randomly assigned to suvorexant (20mg [n=14] or 40mg [n=12]), or placebo [n=12], while ambulatory sleep-EEG data was collected. Linear mixed-effect models were used to test associations between sleep-EEG band power change, depressive symptoms, and withdrawal severity.

Results

Across the 11 night withdrawal period, reductions in oscillatory delta power were observed in all study groups, and increases in beta power (20mg: β = 2.579, pval = 0.009 | 40mg (β = 5.265, pval < 0.001) alpha power (20mg: β = 158.304, pval = 0.009 | 40mg: β = 250.212, pval = 0.001) and sigma power (20mg: β = 48.97, pval < 0.001 | 40mg: β = 71.54, pval < 0.001) were observed in the two suvorexant groups. During the four-night taper, decreases in delta power was associated with decreases in depression (20mg: β= -190.90, p = 0.99 | 40mg: β= -433.33, p = < 0.001 [*Bonferroni corrected]), and withdrawal severity (20mg: β= -215.55, p = 0.006* | 40mg: β= -192.64, p = < 0.001*), in both suvorexant groups and increases in sigma power were associated with decreases in withdrawal severity (20mg: β= -357.84, p = 0.004* | 40mg: β= -906.35, p = < 0.001*). Post-taper decreases in delta (20mg: β= -740.58, p = < 0.001* | 40mg: β= -662.23, p = < 0.001*) and sigma power (20mg only: β= -335.54, p = 0.023*) were associated with reduced depressive symptoms in the placebo group.

Conclusion

Results highlight a complex and nuanced relationship between sleep EEG power and symptoms of depression and withdrawal. Changes in oscillatory delta power may represent a mechanism influencing depressive symptoms and withdrawal.

Support (if any)

UG3DA048734
0948 Sleep Problems and Mental Health in Bus Drivers: A Cross-sectional Study
Authors: Cheng Hanrong , Li Xiao , Tang Yuming , Li Shirley Xin
Published: April 2024

Introduction

Public transit bus drivers, crucial to urban mobility, face unique challenges such as irregular schedules and prolonged driving hours, making them vulnerable to sleep problems. Despite the acknowledged impact of sleep issues on mental health in the general population, there is limited research exploring the relationship between sleep problems and mental health outcomes within this special population. This cross-sectional study aims to investigate the prevalence of self-reported sleep problems among bus drivers, and to analyze the relationship between sleep problems and mental health.

Methods: Methods

A total of 551 bus drivers (99.8% male, mean age: 49.07 ± 5.23 years) participated in the study. They underwent assessments for risk of obstructive sleep apnea (OSA, using STOP-Bang), insomnia symptoms (Insomnia Severity Index, ISI), excessive daytime sleepiness (Epworth Sleepiness Scale, ESS), and mood symptoms (Hamilton Anxiety Rating Scale, HAM-A; Hamilton Depression Rating Scale, HAM-D). Linear regression models were used to examine the associations between sleep problems and mental health, while controlling for age, sex, and BMI.

Results: Results

Ninety-eight (18%) drivers were identified as at risk of OSA (defined as STOP-BANG score ≥ 3), 35 (6%) had insomnia (defined as ISI score ≥ 15) and 62 (11%) had excessive daytime sleepiness (defined as EDS score ≥ 10). After controlling for age, sex, and BMI, anxiety symptoms demonstrated positive associations with the risk of OSA (St. β = 0.26, p < 0.001), insomnia symptoms (St. β = 0.52, p < 0.001), and excessive daytime sleepiness (St. β = 0.40, p < 0.001). Furthermore, depressive symptoms were positively associated with insomnia symptoms (St. β = 0.27, p < 0.001) and excessive daytime sleepiness (St. β = 0.01, p = 0.032).

Conclusion: Conclusion

Among bus drivers, the prevalence of OSA, insomnia, and EDS is noteworthy. These symptoms are associated with exacerbated mood symptoms. Prompt treatment for sleep problems is crucial to alleviate these effects and enhance overall well-being.

Support (if any)

This work was funded by Shenzhen People's Hospital clinical research project SYLCYJ202001.
0950 Social Rhythm Regularity and Mood: Two Forms of Impulsivity with Differential Moderating Effects
Authors: Maddox Mackenzie , Walsh Rachel , Alloy Lauren
Published: April 2024

Introduction

Circadian rhythm dysregulation can elicit maladaptive consequences, including mental and emotional health problems. The social zeitgeber model theorizes that irregular social rhythms can disrupt biological rhythms, which negatively impacts mood. This relationship is particularly apparent among individuals diagnosed with bipolar spectrum disorders (BSD), such that social rhythm disrupting life events can trigger episode onset. Impulsivity, a core feature of BSD, has also been shown to differentially effect mood symptom pathophysiology (hypo/mania vs. depression). This study examined whether two forms of impulsivity moderated the association between social rhythm regularity (SRR) and mood symptoms (hypo/mania vs. depression) in individuals at low-risk, high-risk, and diagnosed with BSD.

Methods

Adolescents and young adults (n = 490) were recruited based on levels of trait reward sensitivity and diagnostic interviews. For this study, participants completed a self-report measure of attentional, motor, and non-planning impulsivity (Barratt Impulsiveness Scale [BIS]), and a behavioral task of reward-related impulsivity (the Balloon Analog Risk Task [BART]). Participants also completed measures of SRR, depressive, and hypo/manic symptoms. Models were estimated with SRR as the focal predictor and impulsivity as the moderator. Significant interactions were probed using simple slopes analyses.

Results

Both forms of impulsivity moderated SRR - mood symptoms relationship. BIS score moderated the association between SRR and hypo/manic symptoms, and simple slopes analyses revealed that only those low in impulsivity exhibited a positive association between SRR and hypo/manic symptoms. This finding was not obtained for the BART. BART score moderated the association between SRR and depressive symptoms, and simple slopes analyses found that only those who scored low in impulsivity exhibited a negative association between SRR and depression. This finding was not obtained with the BIS.

Conclusion

Individuals with low levels of impulsivity were most vulnerable to the effects of SRR on mood, although the polarity of the mood (hypo/mania versus depression) differed based on the impulsivity measure used (BIS versus BART). It is not clear whether the difference is due to self-report vs. behavioral measurement or to the differing forms of impulsivity assessed by the BIS vs. BART.

Support (if any)

NIMH R01 MH77908 to Lauren B. Alloy
0956 Diurnal Variation in Anxiety and Activity Is Influenced by Chronotype and Probable Anxiety-related Disorder Status
Authors: Cox Rebecca , Wright Kenneth , Axelsson John , Balter Leonie
Published: April 2024

Introduction

Anxiety symptoms can vary extensively within a given day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day and are more likely to suffer from anxiety-related disorders. We here wanted to determine how chronotype influences diurnal variation in anxiety symptoms and to what degree such effects are amplified in individuals with a probable anxiety-related disorder.

Methods

We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) in a community sample of adults (N=407; n=318 female, n=87 male, n=2 non-binary; Mage=32.1 ±8.9). Participants reported symptoms and activities during six diurnal sessions between ~08:00-00:00. Chronotype was measured by the reduced Morningness-Eveningness Questionnaire. Diurnal patterns of individual anxiety symptoms and activities and influence of probable GAD or OCD status and chronotype were tested by fitting generalized additive mixed effects models. Models were built with increasing complexity, including time of day, chronotype, and probable GAD/OCD and their interactions.

Results

Anxiety symptoms were higher in the evening and engagement in daily activities were lower in the morning in evening chronotypes (p's<.05), and these findings were most pronounced in those with probable GAD or OCD (p's<.05). Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening and engaged less in daily activities in the morning and evening than their morning chronotype counterparts (p's<.05).

Conclusion

The highest levels of anxiety symptoms are experienced in the evening. The worst evening anxiety symptoms were reported in evening chronotypes, despite preferring this time of day. Personalized treatment approaches should consider that anxiety symptoms are typically highest in the evening and that this is particularly true in evening chronotypes with a high risk for having GAD or OCD.

Support (if any)

NIH T32HL149646 (RCC, KPW); SU-Region Stockholm (nr FoUI-980356, LB, JA); Rut and Arvid Wolff Memorial Foundation (nr FS-2021:0008, LB)
0959 Sleep and Pharmacotherapy in Treatment-Resistant Late-life Depression: Findings from the OPTIMUM Clinical Trial
Authors: Mak Michael , Gebara Marie Anne , Lenze Eric , Blumberger Daniel , Brown Patrick , Cristancho Pilar , Flint Alastair , Karp Jordan , Lavretsky Helen , Miller J Philip , III Charles Reynolds , Roose Steven , Mulsant Benoit , Stahl Sarah
Published: April 2024

Introduction

Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems. However, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD or how sleep affects treatment response. We investigated the bidirectional relationship between sleep and treatment outcomes in the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) study, the largest comparative effectiveness trial of pharmacotherapy for TRLLD to date.

Methods

This analysis examined: (1) occurrence of reduced sleep in 634 participants in the OPTIMUM randomized controlled trial; (2) how their sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with consistent insufficient sleep [n = 164], worsened sleep [n = 62], or with improved sleep [n = 158]). We used item #4 (scale 0 – 6) from the Montgomery-Asberg Depression Rating Scale (MADRS) to assess insufficient sleep, representing reduced sleep duration or depth compared to usual sleep pattern. Scores >2 indicate a meaningful reduction in duration or sleep depth. Patients who scored >2 on item #4 throughout the trial were classified as having consistent insufficient sleep; patients who reported an increased score (and >2 at trial end) were classified as having worsened sleep; and patients who reported a decreased scores (and ≤2 at trial end) were classified as having improved sleep. Treatment response was defined as a > 50% reduction in the total MADRS score (minus item #4 ) at trial end.

Results

About half (51%, n= 323) of participants with TRLLD reported reduced or insufficient sleep before treatment. At trial end, consistent insufficient sleep and worsened sleep were each associated with treatment non-response. Improve sleep was not a significant predictor of treatment response, however participants with consistent sufficient sleep or improved sleep were three times more likely to experience treatment response compared to patients with insufficient sleep and worsened sleep.

Conclusion

Insufficient or reduced sleep are modifiable factors that may improve treatment outcomes in TRLLD. Given that sleep complaints including insomnia are associated with greater risk of depressive relapse and treatment non-response, a tailored treatment plan for those at greatest risk of sleep disturbance with concomitant depression may facilitate better outcomes.

Support (if any)
0961 Association of Sleep Disturbance and Depression with Effort-based Decision Making and Delay Discounting in Veterans
Authors: Boland Elaine , Larson Olivia , Kelley Nicholas , Nusslock Robin , Thase Michael , Sayers Steven , Convery Jillian , Wolf Daniel , Gehrman Philip
Published: April 2024

Introduction

Insomnia symptoms are associated with negative depression treatment outcomes including longer time to recovery, greater risk of depression relapse, and treatment non-response. A theoretical model has hypothesized that insomnia influences depression by impacting reward processes central to depression (e.g., effort-based decision making and delay discounting). The present study examined the cross-sectional relationships of insomnia and depression symptoms with behavioral measures of these constructs.

Methods

Eighty-nine veterans (Mage = 47.3, 60.2% male) with a range of insomnia and depression symptoms were administered the Hamilton Rating Scale for Depression (HRSD), the Insomnia Severity Index (ISI), and one week of sleep diaries and wrist actigraphy. Participants then completed a delay discounting task (DDT) along with two measures of effort-based decision making: the Effort Expenditure for Rewards Task (EEfRT) and the Progressive Ratio Task (PRT). Nine models were analyzed: linear regressions examined associations of insomnia (ISI and sleep efficiency from diaries and actigraphy) and depression jointly, with PRT and DDT outcomes; generalized estimating equations were conducted for EEfRT outcomes.

Results

Higher insomnia scores predicted greater delay discounting (B = 0.065, p = .02) while depression scores did not. Diary and actigraphy-measured sleep efficiency did not significantly predict delay discounting, however greater depression symptoms predicted greater delay discounting in those models (p’s <.006). Higher insomnia scores predicted greater effort on the PRT (B = 0.027, p = .01) whereas lower depression scores predicted greater effort (B = -.039, p <.001). Sleep diary efficiency and depression were likewise significant (p = .047 and .011 respectively) but only depression was significant in actigraphy models. Neither depression nor insomnia significantly predicted EEfRT outcomes.

Conclusion

Although greater depression symptoms were associated with diminished effort on the PRT task and reduced willingness to wait for rewards, insomnia symptoms showed differential relationships to these processes. Insomnia symptoms may represent heightened arousal that, even in the context of depression symptoms, may contribute to difficulty with disengagement in certain reward-relevant tasks. Future research is needed to disentangle the relative contributions of insomnia and depression to reward-relevant behavior.

Support (if any)

This study was supported by the Department of Veterans Affairs, CSR&D (Boland, IK2 CX001501).
0963 An Investigation of Sleep Disturbance, Depression, and Anxiety Among Emerging Adults
Authors: Washington Jasmine , Milligan Nia , Brownlow Janeese
Published: April 2024

Introduction

Sleep disturbances are highly comorbid with psychiatric disorders. Data indicates high comorbidity rates between insomnia and depression and anxiety disorders. However, limited data exist regarding whether sleep disturbance is an independent risk factor for or outcome of psychiatric disorders among emerging adults. This study explored relationships between insomnia, depression, and generalized anxiety.

Methods

Data were obtained from emerging adults (N=105; Mean age=20.28 (SD=1.9); 81% Female) who completed self-report measures. The Beck depression inventory (BDI-II) assessed for the presence and intensity of overall depressive symptoms. A cutoff score of greater than 20 was derived to determine probable depression. The Generalized Anxiety Disorder (GAD-7) scale assessed for severity and diagnosis of GAD. A cutoff score of 10 or greater was used to determine probable GAD. The Insomnia Severity Index assessed for the nature, severity, and impact of insomnia symptoms, with higher scores indicating greater symptom severity. All statistical analyses were conducted using IBM SPSS version 29.

Results

Approximately 36.2% of the sample had probable depression and 37.1% of the sample had probable generalized anxiety disorder. Data showed significant correlations between insomnia severity and probable depression (rpb=.316 p<.001) and generalized anxiety disorder (rpb=.449, p<.001), respectively. Linear regressions indicated that depressive symptoms (R2=.266, p<.001) and generalized anxiety symptoms (R2=.301, p<.001) were significant predictors for insomnia severity, respectively. Data also showed that insomnia severity significantly predicted depressive and generalized anxiety symptoms (R2=.355, p<.001), with insomnia being a stronger predictor for generalized anxiety symptoms (β=.374, p<.001) than depressive symptoms (β=.291, p=.004). Logistic regressions indicated that insomnia severity increased the odds of having both probable depression (X2=9.54, OR=1.14, p=.002) and generalized anxiety disorder (X2=17.30, OR=1.23, p<.001).

Conclusion

Findings suggest that insomnia severity is a risk factor for both depressive and generalized anxiety symptom severity and probable diagnoses. Data also indicated that depressive and generalized anxiety symptoms were independent risk factors for insomnia severity. Given the results, longitudinal studies are needed to understand whether there is a bidirectional relationship between sleep disturbance, depression, and generalized anxiety among emerging adults.

Support (if any)

This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
0965 Investigating Cardiac Autonomic Activity During Sleep in Individuals with Major Depression and Bipolar Disorder
Authors: Leveille Chloe , Saad Mysa , Brabant Daniel , Birnie David , Lee Elliott , Douglass Alan , Northoff Georg , Nikolitch Katerina , Carrier Julie , Fogel Stuart , Higginson Caitlin , Kendzerska Tetyana , Robillard Rebecca
Published: April 2024

Introduction

Autonomic nervous system dysfunction and reduced heart rate variability (HRV) have been reported in individuals with mood disorders, a phenomenon likely to be influenced by sleep disturbances. Several studies have previously assessed HRV in individuals with major depression or bipolar disorder across the entire sleep period. This study investigated whether distinct heart rate (HR) and HRV profiles across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep are linked to unipolar versus bipolar mood disorders in individuals with sleep complaints.

Methods

Polysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms referred to a specialized sleep clinic for sleep assessment [60 diagnosed with bipolar disorder (70% female, mean age= 43.4±11.6 years) and 60 age-matched cases diagnosed with a unipolar depressive disorder (68.3% female, mean age= 43.2±11.6 years)], and 60 age-matched healthy controls (68.3% female, mean age= 43.4±12.6 years). HR and time-based HRV parameters were computed on 30-second segments and averaged across the night for wake and sleep stages.

Results

Significant group by sleep stage interactions showed that the unipolar and bipolar groups had lower standard deviation of normal-to-normal intervals (SDNN) and vagal tone root mean square of successive R-R interval differences (RMSSD) compared to controls during NREM sleep ( p≤.001) and REM sleep (p≤.003), but not during wake (p>.050). The unipolar group had significantly higher heart rate than controls regardless of sleep stages (all, p≤ .042), while the bipolar group had higher heart rate than controls only during NREM 2 (p=.012) and NREM 3 (p=.009) sleep. These interactions persisted after excluding individuals taking antipsychotic, lithium, anticonvulsant, and cardiovascular medications.

Conclusion

While additional research is required to account for manic and euthymic states, as well as the impact of psychotropic and cardiac medications, and potential confounders like variations in body mass index, the present findings suggest that the sleep-based autonomic signature of depressive states differs across different types of mood disorders and could potentially inform the development of biomarkers and therapeutic targets.

Support (if any)

This project was supported by the Ottawa Region for Advanced Cardiovascular Research Excellence (ORACLE) funding program.