bluuebunny/crossref_metadata_2025 huggingface dataset:
169 Qualitative Identification of Multilevel Influences on Sleep in Latinx Pre-Adolescents
Authors: Nguyen-Rodriguez Selena , Buxton Orfeu
Published: May 2021

Introduction

The prevalence of obesity among U.S. Latinx children is nearly 10% higher than in their white counterparts. Long-term success of diet and activity level-focused interventions has been limited. Poor sleep is associated with increased obesity risk in youth. Application of social ecological models of behavior change to identify influences of sleep in Latinx youth may reveal unique intervention targets to improve their sleep, which may reduce obesity risk. This qualitative study aimed to identify the multilevel factors that Latinx pre-adolescents believe affect their sleep duration, quality and timing.

Methods

Eleven focus groups were conducted with forty-six 10-to-12-year-old Latinx pre-adolescents (50% female). Focus groups continued until saturation was reached, and no new information was emerging. Iterative deductive thematic content analysis was conducted by two independent coders (IRR=.815).

Results

Three themes affecting children’s sleep resulted: 1) Individual-level (emotional/ physical feelings or behaviors); 2) Social (direct interactions with others); and 3) Environmental (characteristics, objects or perceptions of physical environment) influences. Individual-level influences were primarily psychological (e.g., stress, “Whenever I have a test the next day, I am stressed and I wake up I’m like so tired”) and behavioral (e.g., activity levels, “just sitting just the whole day… when it comes to nighttime, you’re not even tired”), and affected sleep quality and timing. Interactions with siblings (e.g., “She [sister] always gets mad at me and like in the night she like wakes me up” and friends (e.g., “arguments like with a really good friend… the whole night I think about it”) were social factors affecting sleep quality. Environmental influences came from within the sleep area and neighborhood, including temperature (e.g., “I like my pillows cold”) and noise (e.g., “My neighbor’s dog… they always take them out at night time to like play with them and then I could hear the dog barking and them screaming”).

Conclusion

While social influences exist, individual feelings and sleep environment seem to be more prevalent impacts on sleep of Latinx children. Findings support the notion that developing multi-level strategies may be effective in enhancing sleep duration, quality and timing for Latinx pre-adolescents.

Support (if any)

NIH-NHLBI 5K01HL140283
174 Discrimination moderates the association of sleep and cognitive function in older Black adults: The Einstein Aging Study
Authors: Ji Linying , Jiao June , Zhaoyang Ruixue , Derby Carol , Buxton Orfeu , Gamaldo Alyssa
Published: May 2021

Introduction

Experiences of discrimination attributed to a range of individual characteristics (race, skin color, age, sex, etc.) may influence the extent to which sleep impacts cognitive functioning in order adults, particularly within older minorities. Thus, we investigated the effect of discrimination on the relationship between actigraphic sleep quality and cognitive function in analyses stratified by race.

Methods

Participants (N=286, mean age=77.4 years, 32% males; 45% white, 41% Black, 14% Hispanic/others) enrolled in The Einstein Aging Study were included. Sleep disturbance, as measured by wake after sleep onset (WASO) (mean=63 min, sd=27 min), was calculated from wrist actigraphy over 15.4±1.4 days. Participants’ mean ambulatory cognitive function was assessed with a validated, memory binding, smartphone-based EMA task (Color Shapes) repeated 4 times daily. A modified version of the Williams’ Everyday Discrimination questionnaire, optimized for older adults, measured participants’ endorsement of discriminated characteristics. Linear regressions, stratified by race (white, Black separately), were conducted with interaction terms to investigate whether discrimination moderated associations between WASO and ambulatory cognitive function. Models controlled for age, education, income, and gender. Regions of significance were also evaluated.

Results

Race-stratified analysis indicated that the association between mean WASO and cognitive function was significantly moderated by the number of discriminated characteristics among Black adults (n=117), not whites (n=128). Specifically, among Black adults who identified few discriminated characteristics, WASO was not significantly associated with memory binding. However, Black adults who identified discriminated characteristics at +1 SD above the mean (5.5 traits) exhibited a 12% lower average memory binding test score (percent responses correct) with each half-hour greater mean WASO (p=.01). Analysis of the region of significance showed the association is significant when participants endorsed more than three discriminated characteristics.

Conclusion

These findings emphasize the importance of considering sociocultural factors, such as discrimination, to understand the association between sleep quality and cognitive functioning, particularly for older Blacks.

Support (if any)

R01AG062622
176 Linear and Nonlinear Associations Between Sleep and Academic Achievement in Middle Childhood: The Role of Early Life SES
Authors: Rea-Sandin Gianna , Breitenstein Reagan , Doane Leah , Vakulskas Emily , Valiente Carlos , Lemery-Chalfant Kathryn
Published: May 2021

Introduction

Elementary-aged children in low socioeconomic environments are more likely to experience poor sleep, which can negatively impact academic performance. However, it is unknown whether early-life socioeconomic status (SES) influences associations between sleep and academic achievement later in childhood. Using a demographically diverse sample of children followed longitudinally from 1 to 8 years, we tested linear and nonlinear associations between actigraphy-based sleep duration, midpoint time, sleep duration variability, and parent-reported sleep problems with academic achievement. In addition, we examined whether these associations varied by early SES.

Methods

The sample comprised 707 twins (52% female; Mage=8.44 years; 28.7% Hispanic/Latinx; 29.7% at or below the poverty line). SES was ascertained at 1 and 8 years, and children wore actigraph watches to assess sleep for 7 nights (Mnights=6.79) and completed the Applied Math, Picture Vocabulary, and Passage Comprehension subtests of the Woodcock-Johnson IV Tests of Achievement. Primary caregivers also reported on their children’s sleep and academic performance (Children’s Sleep Habits Questionnaire and Health and Behavior Questionnaire, respectively).

Results

Sleep was not linearly related to academic achievement, but there was a significant quadratic association between sleep midpoint with Picture Vocabulary (b=0.28, p<.01) and Passage Comprehension (b=0.17, p<.05). More parent-reported sleep problems were negatively related to Applied Problems performance for lower (b=-1.16, p<.001) and positively associated for higher early SES (b = 1.00, p < .01). More parent-reported sleep problems predicted lower Passage Comprehension for lower (b = -0.59, p < .05), but not higher early SES. Longer sleep duration predicted higher parent-reported academic achievement for lower early SES (b=0.14, p<.01) and lower achievement for higher early SES (b=-0.23, p<.001).

Conclusion

Our findings illustrate the complex, sometimes nonlinear associations between children’s sleep and academic performance. Many associations varied by early-life SES, suggesting that early childhood environments have long-lasting implications for child functioning, over and above the effect of concurrent SES. Increasing the quantity and quality of children’s sleep could improve academic outcomes, particularly for children who have experienced socioeconomic disadvantage.

Support (if any)

This research was supported by grants from NICHD (R01HD079520 and R01HD086085) and ASU T. Denny Sanford School of Social and Family Dynamics.
178 Sleep Disparities in Adolescent Women: Role of Pubertal Development, Menstrual Cycle and Premenstrual Symptoms
Authors: Kaur Harsimar , Hasoglu Tuna , Gomaa Hassaan , Ricci Anna , Criley Carrie , Calhoun Susan , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio
Published: May 2021

Introduction

About 20-30% of children experience sleep difficulties and about 50-60% of those persist into adolescence. Sex differences in sleep become more apparent after the onset of puberty, suggesting a role for maturational changes in the sleep of males and females. In addition, adolescent females experience greater sleep difficulties with the advancement of pubertal stages and around the time of menstruation. Although adult studies have shown sex differences in sleep continuity and architecture, there is a large gap of knowledge in adolescents.

Methods

We analyzed data from the Penn State Child Cohort, a random, population-based sample of 421 adolescents (16.5±2.3y, 53.9% male) who underwent one-night in-lab polysomnography (PSG) and seven-night at-home actigraphy (ACT) as well as a thorough physical exam and clinical history, including self-reports of Tanner staging, menstrual cycle and use of oral contraceptives (OC).

Results

Upon PSG, females had a longer sleep latency (p<0.05), while males a greater number of awakenings (p<0.05), longer wake after sleep onset (p<0.01) and greater stage N1 (p<0.05). Per ACT, females had longer total sleep time and greater sleep efficiency (p<0.01). Sex differences in PSG and ACT parameters were more prominent among adolescents reporting Tanner stages 4-5, including females having greater stage N3 than males (p<0.01) and females reporting premenstrual symptoms (PMS) having a longer sleep latency than males or than those not reporting PMS (P<0.05). Among females, those who had their last period 8-14 days prior to the PSG had a shorter sleep latency than those who had their period within the previous 7 days (p<0.01) or 15-25 days before (p<0.05). Females using OC (n=38) did not show significantly different PSG or ACT parameters than those not using OC (n=156).

Conclusion

Our study provides evidence for sex-related health disparities in objective sleep arising in adolescence. Females sleep objectively better than males from a sleep continuity and sleep architecture perspective, particularly when examined at the same pubertal stage. Additionally, sleep onset is significantly impacted by the menstrual cycle and associated symptoms but females preserve greater levels of deep sleep, a sign of sleep resilience.

Support (if any)

NIH Awards Number R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127
183 Influence of Feelings of Neighborhood Safety on Anxiety and Sleep
Authors: Vane Ryan , Habhab Zouhour , Corona Frida , Mednick Sara
Published: May 2021

Introduction

Sleep is a significant factor in the regulation of mood and behavior in individuals, with loss of sleep potentially leading to negative effects such as behavioral or emotional difficulties (Dahl 1999; Baum, Desai, Field, Miller, Rausch, & Beebe, 2014). Neighborhood safety plays a critical role in the perception of stress, with the negative perception of safety predicting higher mental distress, thus leading to rumination and increasing the difficulty for the individual to fall asleep (Henderson, Child, Moore, Moore, & Kaczynski, 2016; Dahl 1996). The goal of this study is to analyze how feelings of neighborhood safety and neighborhood demographics influence anxiety and sleep.

Methods

A subset of 200 participants from a larger data collection were recruited to participate in a questionnaire administered through Amazon Mechanical Turk, university SONA credit system, and social media. Measures include the Pittsburgh Sleep Quality Index, Neighborhood Questionnaire Safety Subscale, and the Spielberger State-Trait Anxiety Inventory.

Results

Poorer sleep quality is predicted by higher feelings of anxiety and lower feelings of safety in ones neighborhood.

Conclusion

The specific factors contributing to the anxiety resulting from feelings of lower neighborhood safety are an area that require further investigation with a broader sample.

Support (if any):
196 Sleeping Through a Pandemic: Sleep Health in Adults Around the World During the COVID-19 Lockdown
Authors: Yuksel Dilara , McKee Grace , Perrin Paul , Alzueta Elisabet , Caffarra Sendy , Ramos-Usuga Daniela , Arango-Lasprilla Juan-Carlos , Baker Fiona
Published: May 2021

Introduction

The novel COVID-19 disease rapidly escalated into a global pandemic affecting people around the world. While communities imposed mitigation measures to stop the spread of the disease, the mass (home) confinement in addition to the uncertainty of the pandemic led to drastic changes in all aspects of life, including sleep. Sleep health is strongly linked with mental and overall health and could play a protective role against the development of mental distress during the pandemic. Here, we investigated sleep health in a global multicultural sample of adults during the COVID-19 pandemic.

Methods

We surveyed 6,882 adults (18-94 years) across 59 countries about their sleep health (RU-SATED scale), sleep behaviors, demographics, pandemic-related factors, and mood between late April and early May 2020. A hierarchical stepwise multiple linear regression was performed to investigate correlates of sleep health.

Results

Compared with pre-pandemic times, more than one third of the sample reported an increase in sleep disturbances, and more than half of the sample shifted their sleep schedule towards later bed- and wake-up times. Better sleep health was associated with being partnered, older age and living in a higher-income country (p<.001). Poorer sleep health was associated with a stricter level of quarantine, and other pandemic-related factors including being laid off from job, financial strain, or difficulties with transitioning to working from home (R2=.116, p<.001). Domestic conflict emerged as the strongest correlate of poorer sleep health in the regression model. Greater depression and anxiety symptoms were associated with a poorer sleep health (p<.001). In a global comparison, Latin Americans reported the lowest sleep health scores.

Conclusion

Our findings highlight how sleep behavior has changed during the international quarantine- and isolation measurements and show the association between pandemic-related factors and poor sleep health, which, in turn, is closely linked with poorer mental health. These results emphasize the importance of maintaining good sleep health during the pandemic, since poorer sleep health may trigger or exacerbate mental disorders. Maintenance of good sleep health should be incorporated into public health messages aimed at helping people maintain optimal mental and physical health during major stressful life events like the COVID-19 pandemic.

Support (if any):
199 COVID-19 Pandemic Sleep and Dreams at the US-Mexico Border
Authors: Isalva Luz , Valencia Dora , Ghani Sadia , Delgadillo Marcos , Bastien Célyne , Madhivanan Purnima , Krupp Karl , Ruiz John , Killgore William , Wills Chloe , Grandner Michael
Published: May 2021

Introduction

The impact of the COVID-19 pandemic in the border region is not well-described, including the impact of pandemic-related sleep disturbances on dream experiences, despite frequent reports of meaningful changes to dreams in the population.

Methods

Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and a COVID sub-study (95% Hispanic/Latino). Participants were asked whether, as a result of the pandemic, they have experienced more schedule regularity, improved/worsened sleep, more initial or middle-of-the-night insomnia, more sleepiness, and more napping. They were also asked whether they experienced more, fewer, or the same amount of dreams in general, positive dreams, and negative dreams. Multinomial logistic regressions were used to examine overall, positive, and negative dream recall (more or less vs same) as outcome and perceived change in sleep as independent variable, adjusted for age, sex, socioeconomics, and mental health symptoms (assessed with PHQ4).

Results

Those who reported more schedule regularity were less likely to report more negative dreams (Relative Risk Ratio [RRR]=0.40, p=0.010). Those who reported improved sleep were also more likely to report more positive dreams (RRR=3.97, p=0.004). Those with worsened sleep were more likely to report fewer dreams overall (RRR=2.23, p=0.037), fewer positive dreams (RRR=2.24, p=0.003) and more negative dreams (RRR=3.69, p<0.0005). Those with more initial insomnia were more likely to report fewer positive dreams (RRR=2.43, p=0.002) and more negative dreams (RRR=4.12, p<0.0005). Those with more middle-of-the-night insomnia reported fewer dreams overall (RRR=2.35, p=0.018), fewer positive dreams (RRR=2.55, p=0.001), and more negative dreams (RRR=5.01, p<0.0005). Those with more daytime sleepiness were more likely to report fewer dreams overall (RRR=4.75, p<0.0005), fewer positive dreams (RRR=1.92, p=0.019), and more negative dreams (RRR=3.91, p<0.0005), and were less likely to report more positive dreams (RRR=0.26, p=0.018). Those who reported napping more were more likely to report fewer dreams overall (RRR=2.78, p=0.008), fewer positive dreams (RRR=2.10, P=0.008), and more negative dreams (RRR=2.83, p=0.003), and were less likely to report more positive dreams (RRR=0.16, p=0.004).

Conclusion

Those whose sleep worsened due to the pandemic reported less dream recall, and dream content that was more negative and less positive overall.

Support (if any)

R01MD011600, R01DA051321
201 COVID-19 Pandemic Sleep Disturbances Related to Stress Experiences at the US-Mexico Border
Authors: Begay Tommy , Valencia Dora , Ghani Sadia , Delgadillo Marcos , Madhivanan Purnima , Krupp Karl , Ruiz John , Seixas Azizi , Jean-Louis Giardin , Killgore William , Wills Chloe , Grandner Michael
Published: May 2021

Introduction

The COVID-19 pandemic has impacted many individuals at the vulnerable US-Mexico border region in a variety of ways. Fear, worry, and stress have increased for many, as has poor sleep. The present study evaluated the degree to which worsened sleep due to the pandemic impacted stress experiences.

Methods

Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). They were asked the degree to which their sleep worsened due to the pandemic. They also reported the degree to which they agreed with statements regarding various pandemic-related stress experiences. These included infection-related stresses, stresses about community impact, personal psychosocial stresses, stresses about consequences of potential infection, media and society-related stresses, feelings of safety, and how the pandemic has impacted home life. Ordinal logistic regressions were used to determine whether changes in sleep were associated with agreement with statements about pandemic-related stress experiences, adjusted for age, sex, financial status, education, and mental health (PHQ4).

Results

Those who perceived that their sleep worsened were more likely to report greater endorsement of beliefs that they were infected (ordinal Odds Ratio [oOR]=2.82,p<0.0005), they could possibly be infected (oOR=1.98,p=0.003), they feared testing (oOR=1.94,p=0.006), COVID-19 would impact their community (oOR=1.75,p=0.017) and would do so for a long time (oOR=1.90,p=0.006), they experience more general (oOR=4.10,p<0.0005), financial (oOR=3.15,p<0.0005), food-related (oOR=2.97,p<0.0005), housing-related (oOR=2.14,p=0.002), family-related (oOR=2.53,p<0.0005) and relationship (oOR=3.37,p<0.0005) stress, their shopping was impacted by scarcity (oOR=1.76,p=0.014), and they are at high risk for COVID (oOR=1.87,p=0.008). Furthermore, media coverage of COVID-19 had increased their stress (oOR=2.46,p<0.0005), there is too much panic about COVID-19 (oOR=1.67,p=0.032), and they themselves are scared of getting COVID-19 (oOR=1.95,p=0.005), worried about the future (oOR=1.71,p=0.022), feel less secure (oOR=0.59,p=0.028), are thriving less (oOR=0.40,p<0.0005), and their mental health is not improving (oOR=0.46,p=0.002).

Conclusion

Worse sleep due to the COVID-19 pandemic was associated with increased reports of stresses across a wide range of domains. Perhaps sleep health interventions could improve social and emotional health in these domains and reduce stress experiences and better cope with the pandemic. Alternatively, mental health interventions should perhaps be targeted to this population.

Support (if any)

R01MD011600, R01DA051321
204 Changes in Physical Activity During the COVID-19 Pandemic Associated with Changes in Sleep
Authors: Abdi Harun , Killgore William , Wills Chloe , Kennedy Kathryn , Charest Jonathan , Knowlden Adam , Grandner Michael
Published: May 2021

Introduction

The COVID-19 global pandemic has likely led to changes in physical activity as behavioral patterns were disrupted. This is important because sleep and physical activity are interrelated and promote health, and well-being. This study examined whether changes to physical activity were related to changes to sleep health as a result of the COVID-19 pandemic.

Methods

A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked to estimate the number of minutes per day they engaged in physical activity during the pandemic, as well as before. These were subtracted from each other, and a difference score was computed. Then, responses were categorized as no change (<=15 mins difference), 16-45 minutes more or less activity, or 46+ minutes more or less activity (5 categories total). Outcome variables included the degree to which participants believed that due to the pandemic, they experienced (1) more schedule regularity, (2) better sleep, (3) worse sleep, (4) more difficulty falling asleep, (5) more difficulty maintaining sleep, (6) more sleepiness, and (7) more napping. Ordinal regressions were adjusted for age, and sex.

Results

Those who increased their activity by over 45 minutes per day reported that they were less likely to experience more daytime sleepiness (oOR=0.28, p<0.02). Those who decreased their activity by over 45 minutes per day reported that they were more likely to experience worse sleep (oOR=2.38, p<0.01) and less likely to experience a more regular schedule (oOR=0.37, p<0.003) than prior to the pandemic.

Conclusion

Overall, those who increased their physical activity since the beginning of the pandemic reported less daytime sleepiness; and those who decreased their physical activity reported worse sleep experiences and a more irregular schedule. The relationship between physical activity and sleep during the pandemic may be bidirectional.

Support (if any)

R01MD011600, R01DA051321
208 Sleep Disturbances During the COVID-19 Pandemic Associated with Worries and Fears About Possible Infection
Authors: Lujan Matthew , Kennedy Kathryn , Killgore William , Wills Chloe , Grandner Michael
Published: May 2021

Introduction

The sudden COVID-19 pandemic and the uncertainty surrounding the virus has led to increased worry and fear. How this fear is associated with sleep remains unknown.

Methods

419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked about agreement with statements endorsing beliefs that they were currently infected, that they would someday be infected, that they fear testing, and that they are worried about a family member becoming infected. They were asked to rate agreement with statements regarding changes to sleep during the pandemic. Ordinal logistic regressions with degree of agreement with statements about sleep changes were outcomes, agreement with statements about COVID infection beliefs as predictor, and age, sex, and race/ethnicity as covariates were examined.

Results

Those who believed they were infected were 65% less likely to be keeping a regular schedule (p=0.001), 61% less likely to report improved sleep (p=0.009), 2.9 times as likely to report worse sleep (p=0.001), 2.7 times as likely to report difficulty falling asleep (p=0.002), 2.1 times as likely to report sleep maintenance problems (p=0.03), 2.9 times as likely to report sleepiness (p=0.001). Those who believed they would be infected in the future were 83% less likely to report improved sleep (p=0.005), 7.49 times as likely to report worse sleep (p=0.001), 5.3 times as likely to report difficulty falling asleep (p=0.003), 4.1 times as likely to report sleep maintenance problems (p=0.01), and 5.7 times as likely to report sleepiness (0.003). Those that feared testing were 5.7 times as likely to report more sleepiness (p=0.03). Those that worried about family were 80% less likely to be keeping a regular schedule (p=0.01), 75% less likely to report improved sleep (p=0.02), 4.5 times as likely to report worse sleep (p=0.02), 4.5 times as likely to report sleep maintenance problems (p=0.01), and 8.3 times as likely to report sleepiness (p=0.001).

Conclusion

Those who believed they were infected reported worsening sleep, though the degree was even greater among those who anticipated infection for themselves or a family member. Worries about COVID-19 may result in more adverse impact on sleep than potential infection itself.

Support (if any):
213 Eating Patterns Associated with Sleep Duration, Insomnia, Daytime Sleepiness and Overall Sleep Quality at the US-Mexico Border
Authors: Ghani Sadia , Delgadillo Marcos , Granados Karla , Okuagu Ashley , Wills Chloe , Alfonso-Miller Pamela , Buxton Orfeu , Patel Sanjay , Parthasarathy Sairam , Haynes Patricia , Molina Patricia , Seixas Azizi , Knowlden Adam , Jean-Louis Giardin , Grandner Michael
Published: May 2021

Introduction

Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep for health among this group.

Methods

Data were collected from N=100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for “cognitive restraint,” “uncontrolled eating, “and “emotional eating.” Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included: age, sex, Body Mass Index (BMI), education and immigrant status.

Results

When adjusted for age, sex and immigrant status (model-1), eating patterns were associated with greater insomnia (95%CI:[0.066,1.095];p=0.027), poorer sleep quality (95%CI:[0.170,1.456];p=0.014), sleepiness (95%CI[0.032,1.026];p=0.037), and weekend (but not weekday) sleep duration (95%CI:[-0.031,0.003];p=0.015). Further adjustment for education (model-2) revealed similar significant associations. Additional adjustment for BMI (model-3) revealed a change in daytime sleepiness, where no association was seen (95%CI:[-0.202,0.805];p=0.238). Regarding subscale scores, relationships were generally seen between sleep and both emotional eating and uncontrolled eating, but not cognitive restraint. However, after adjustment for BMI, there was a significant association between cognitive restraint and weekend sleep duration (95%CI:[-0.015,-0.001];p=0.030).

Conclusion

Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US Mexico border, particularly in terms of uncontrolled eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Support (if any)

Supported by T32HL007249, R01MD011600, R01DA051321
215 Sleep duration, quality and timing during confinement amid the COVID-19 Pandemic
Authors: Kaizi-Lutu Marc , Dinges David , Cordoza Makayla , Jones Christopher , Mange Ami
Published: May 2021

Introduction

As of March 2020, most U.S. states and territories issued statements advising people “stay at home” to avoid spreading the novel Coronavirus (COVID-19). This resulted in an unprecedented number of people practicing physical confinement and social distancing. This study examined self-reported changes in sleep duration, quality and timing in response to confinement and isolation.

Methods

We developed the “Anonymous Survey on Confinement during the COVID-19 Pandemic” to collect information on the American population practicing social distancing and some level of confinement. The survey collected information on demographics, duration and degree of confinement, and sleep-wake dynamics. The online survey was available for completion by any individual ≥18 years of age through the Penn Medicine Clinical Research page from May 16th to November 11th 2020. Descriptive statistics characterized the nature of confinement and non-parametric correlations evaluated the relationships between confinement and sleep-wake dynamics.

Results

N=226 participants completed the survey (n=176 female [77.8%]; n=47 male [20.8%]). The average age was 44.9±17.4 years. N=215[95.1%] reported confinement since March 2020 for an average of 89.3±41.7 days in confinement. Surveyed participants in confinement reported sleeping more than before confinement [40.0%], taking the same amount of time to fall asleep [56.6%], and felt that they were getting enough sleep [66.3%]. However, 36.3% of participants reported going to bed earlier and waking up earlier. Participants that engaged in naps prior to confinement reported taking more naps in confinement [50.8%]. Participants reported more daytime sleepiness [42.9%] and more disturbed sleep quality during confinement relative to before confinement [42.5%]. There were no significant correlations between time in confinement and sleep outcomes.

Conclusion

During the confinement amid the COVID-19 pandemic, participants responded by sleeping more and at different times, which could reflect circadian disruption of sleep. Changes in sleep amount and sleeping timing were accompanied by increased daytime sleepiness and a reduction in sleep quality. These changes may have been due to age, stressors experienced during the pandemic, social isolation, and/or a change in behavioral routines in response to changing demands and schedules. Our findings suggest that attention to changes in sleep-wake dynamics due to prolonged confinement is likely important to maintain healthy behaviors.

Support (if any):
216 Resilience, sleep difficulties, and subjective sleep quality during COVID-19
Authors: Socarras Laura Ramos , Potvin Jérémie , Forest Geneviève
Published: May 2021

Introduction

We have shown in a previous study that despite significant improvements in sleep patterns and sleep duration during COVID-19 in teens and young adults, only teens reported better sleep quality and satisfaction. Moreover, sleep difficulties seem to be more prominent in the older group during the pandemic, suggesting that there could be additional risk factors involved. The current study aimed to investigate the role of resilience in the association between changes in sleep and the subjective sleep quality (SSQ) in teens and young adults during COVID-19.

Methods

289 teens (12-17 years old) and 294 young adults (18-25 years old) completed the Connor-Davidson Resilience Scale-10 and an adapted version of the Pittsburgh Sleep Quality Index online. Teens and young adults were each divided into a resilient and less resilient group. Hierarchical regression models were conducted to examine the unique contribution of weekdays sleep duration, sleep difficulties, and resilience to SSQ. Sleep duration, sleep difficulties and SSQ before COVID-19, and gender were entered as controls.

Results

Results show that in less resilient teens, changes in sleep onset difficulties (β=-.285, p=.003), nocturnal and early awakenings (β=-.218, p=.019), and weekdays sleep duration (β=.282, p=.001) significantly predicted SSQ and explained 36.5% of the variance. In less resilient young adults, changes in nightmares (β=-.309, p=.027) and sleep onset difficulties (β=-.263, p=.012) significantly predicted SSQ and explained 24.1% of the variance. In resilient teens, changes in weekdays sleep duration (β=.296, p=.007) significantly predicted SSQ and explained 20.1% of the variance. In resilient adults, changes in sleep onset difficulties (β=-.325, p=.001), nocturnal and early awakenings (β=-.374, p=.000), and weekdays sleep duration (β=.192, p=.009) significantly predicted SSQ and explained 46.0% of the variance.

Conclusion

Our results suggest that resilience appears to be a protecting factor in the impacts of sleep difficulties on sleep quality, but only in adolescents. Indeed, in young adults, sleep difficulties seem to be a more important factor modulating sleep quality than changes in sleep duration. These results underline the importance of focusing on the intrinsic characteristics of each population to better target interventions.

Support (if any):
231 COVID-19 Lockdown Policies Across 20 Countries Modulate Sleep and Resting Heart Rate Measures
Authors: Ong Ju Lynn , Lau Teyang , Karsikas Mari , Kinnunen Hannu , Chee Michael
Published: May 2021

Introduction

Lockdowns imposed to stem the spread of COVID-19 have disrupted the lifestyles of many worldwide, but studies to date are mostly confined to observations within a limited number of countries, based on subjective reports and survey from a narrow time window. In the present study, we investigate associations between the severity of lockdown policies and objective sleep and resting-heart rate measures.

Methods

Data from 113,000 users of a consumer sleep tracker across 20 countries were gathered between Jan–Jul 2020 and compared with an equivalent period in 2019 as a control for naturally occurring seasonal fluctuations. Lockdown stringency was derived using scores from the Oxford Government Response Tracker. Multilevel growth curve models were used to quantify the effect of lockdown stringency on changes to sleep patterns (midsleep time and midsleep variability) and resting heart rate changes, and to predict changes in resting heart rate from changes to sleep patterns.

Results

Lockdown severity modulated the size of shifts in sleep midpoint and regularity during this period. Midsleep times were delayed in all countries during strict lockdowns, particularly on weekdays, while midsleep variability reduced. The largest shifts in midsleep time (+0.09 to +0.58 hours), midsleep variability (–0.12 to –0.26 hours) and resting heart rate (–0.35 to –2.08 bpm) occurred in April and May - when most countries imposed their strictest lockdown measures. In addition, multilevel modelling revealed that for each unit increase in stringency index, midsleep time was delayed by 0.96 min, midsleep variability decreased by 0.46 min and resting heart rate decreased by 0.06 bpm. Finally, in models predicting changes in resting heart rate from changes to sleep patterns, midsleep variability was shown to be the strongest predictor of resting heart rate, wherein an hour increase in the standard deviation of midsleep variability predicted a 5.12 increase in bpm, while an hour increase in midsleep time only predicted a 1.25 decrease in bpm.

Conclusion

Our findings demonstrate the utility of large-scale data from consumer wearables in providing population-level insights into how lockdown severity directly impacts sleep health during this pandemic period.

Support (if any)

Work conducted at NUS is supported by a grant awarded to Michael Chee (NMRC/STAR19may-0001).
232 COVID stress and sleep disturbance among a racially/ethnically diverse sample of adolescents: Analysis from the NESTED study
Authors: Seixas Azizi , Honaker Sarah , Wolfson Amy , Wahlstrom Kyla , Owens Judith , Wong Patricia , Saletin Jared , Tsvetovat Maksim , Carskadon Mary , Meltzer Lisa
Published: May 2021

Introduction

Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance.

Methods

Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors.

Results

Sleep disturbance was prevalent among adolescents (89% above average, T-score >50); about two-thirds (64.4%) reported greater stress due to the pandemic. Compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents. Chi-square analysis indicated that both race/ethnicity (□2 = 14.96, p<.05) and SVI (□2 = 8.34, p<.05) had an effect on sleep disturbance. HBLR analysis indicated that compared to pre-pandemic, adolescents reporting “little stress” (OR=.70, 95% CI= .49-.99, p=.04) or “the “same amount of stress” (OR=.64, 95% CI= .47-.89, p=.007) had lower odds of sleep disturbance. Higher depression (OR=1.06, 95% CI=1.04-1.07, p<.001) and anxiety (OR=1.05, 95% CI=1.04-1.07, p<.001) symptoms increased odds of sleep disturbance, while male gender lowered odds of sleep disturbance (OR=.11, 95% CI=.015-.86, p<.05). Overall, race/ethnicity (p=.44) and SVI (p=.45) did not independently predict sleep disturbance. Race/ethnicity stratified analyses indicated that for Black and Hispanic adolescents, being in grades 11/ 12 and depression predicted sleep disturbance; and for Asian adolescents SVI and anxiety predicted sleep disturbance.

Conclusion

COVID-related stress and symptoms of depression and anxiety are associated with sleep disturbance. We observed differences in sleep disturbance across racial/ethnic groups and neighborhood social vulnerability strata, for specific racial/ethnic groups.

Support (if any)

AS was supported by funding from the NIH (K01HL135452, R01HL152453)
254 Validation of a Non-Wearable Sleep Tracking Device in Healthy Adults Under Normal and Restricted Sleep Conditions
Authors: Hsiou David , Gao Chenlu , Pruett Natalya , Scullin Michael
Published: May 2021

Introduction

Polysomnography (PSG) is the gold standard for measuring sleep, but this method is cumbersome, costly, and sometimes does not reflect naturalistic sleep patterns. Leading technology companies have developed non-wearable sleep tracking devices that have attracted public interest. However, the accuracy of these devices has either been shown to be poor or the validation tests have not been conducted by independent laboratories without potential conflicts of interest. Relative to PSG and actigraphy, and under conditions of both normal and restricted sleep, we assessed the accuracy of early and newer versions of a non-wearable sleep tracking device (Beddit, Apple Inc.).

Methods

Participants were 35 healthy young adults (Mage=18.97, SD=0.95 years; 77.14% female; 42.86% Caucasian). We randomly assigned them to go to bed at 10:30pm (normal sleep) or 1:30am (restricted sleep) in a controlled sleep laboratory environment. Lights-on was 7:00am for all participants. Sleep was measured by the early version (3.0) or newer version (3.5) of a non-wearable device that uses a sensor strip to measure movement, heart rate, and breathing. We also measured PSG, wristband actigraphy, and self-report. For each device, we tested accuracy against PSG for total sleep time (TST), sleep efficiency (SE%), sleep onset latency (SOL), and wake after sleep onset (WASO).

Results

While the early version displayed poor reliability (ICCs<0.30), the newer version of the non-wearable device yielded excellent reliability with PSG under both normal and restricted sleep conditions. Not only was agreement excellent for TST (ICC=0.96) and SE% (ICC=0.98), but agreement was also excellent for the notoriously difficult metrics of SOL (ICC=0.92) and WASO (ICC=0.92). This newer version significantly outperformed clinical grade actigraphy (ICCs often in the 0.40 to 0.75 range), and self-reported sleep (ICCs often below 0.40).

Conclusion

Surprisingly, a non-wearable device demonstrated greater agreement with PSG than clinical grade actigraphy. Though the field has generally been skeptical of commercial non-wearable devices, this independent validation provides optimism that some such devices would be efficacious for research in healthy adults. Future work is needed to test the validity of this device in older adults and clinical populations.

Support (if any)

National Science Foundation (1920730 and 1943323)
264 Field Test of Sound Machine Shows Significant Improvement in Perceived Sleep but Not Objective Sleep
Authors: Danoff-Burg Sharon , Rus Holly , Rodriguez Rodolfo , Weaver Morgan , Raymann Roy
Published: May 2021

Introduction

Ambient sound can mask external environmental noise, reducing sleep disturbances. Recently there has been a call for research with objective sleep measures examining noise as a sleep aid. This study investigated whether using a sound machine (Sound+Sleep SE) would improve sleep in healthy adults whose objective sleep data indicated difficulty falling asleep or waking up frequently during the night. In-home field testing provides insight into the effectiveness of sleep products under real-life conditions, yielding more ecologically valid results.

Methods

A within-subjects, pre-post intervention design was implemented, comparing a 2-week baseline period to 2 weeks of nightly product use. Participants (n=30) measured their sleep nightly using SleepScore by ResMed technology. Sleep experience questionnaires were completed before and after product use. Participants were instructed to use their preferred settings and sound options for the duration of the product use period and to refrain from using other types of sounds for sleep. Multilevel regression and paired t-tests were used to test for statistical significance.

Results

Across participants (63% male; age 28-72, avg. 53), there were 725 nights of tracked sleep. Multilevel analyses revealed no significant differences in objectively-measured sleep outcomes. However, improvements were seen in many aspects of self-reported sleep while using the sound machine: 30% decrease in perceived minutes to fall asleep (p<.05); 76% increase in perceived ability to sleep through the night (p<.001); 37% increase in perceived sleep quality (p<.01); and 46% increase in feeling rested upon waking in the morning (p<.001). Additionally, at the beginning of the study, 60% of participants reported having racing thoughts or worrying when trying to fall asleep. While using the sound machine, only 30% of participants experienced this concern.

Conclusion

Participants perceived a variety of benefits from sound machine use, even though these improvements were not observed in their objective sleep data. Given that adjustment to any product used during sleep varies from person to person, it is possible that changes in the objective sleep data might have been observed if the product use period had been longer. This study adds to the ongoing discussion of using noise as a sleep aid.

Support (if any)

ASTI
266 Contact-free Snoring Solution Reduces Objectively-measured Snoring and Improves Bed Partners’ Objectively-measured Sleep
Authors: Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Rodriguez Rodolfo , Raymann Roy
Published: May 2021

Introduction

Snoring can disturb the sleep of snorers as well as their bed partners. Recent technological advances allow objective measurement of sleep and snoring in the comfort of the bedroom. This study examined effects of a non-medical contactless snoring solution on snoring and sleep in snorers and their partners.

Methods

Self-reported snorers (n=29; 72% male; age 25-59 years, avg. 43; BMI<30) with non-snoring bed partners tracked their snoring nightly with the Do I Snore or Grind app while using the snoring solution at home (527 total nights across participants). During this time, partners tracked their own sleep nightly using ResMed S+. In addition, self-report data were collected from both snorers and partners. A within-subjects, pre-post design was used, comparing a 2-week baseline period to 2 weeks of nightly product use. Multilevel regression and paired t-tests were used to test for statistical significance. The snoring solution (Smart Nora) included a pillow insert that gently inflates when early sounds of snoring are detected, enabling breathing to return to normal.

Results

Objectively-measured average snoring reduced from 10% of the night when not using the product to 9% during the first week of use and 7% during the second week of use (p<.05). Partners perceived the snoring as less loud and less severe when the product was used. At the end of the study, no partner described the snoring as severe. Objectively-measured sleep of partners revealed a 16% decrease in wake after sleep onset (p<.05). Prior to product use, they spent an average of 38 minutes awake after falling asleep (approximately 9% of their sleep period). This decreased to 34 minutes during the first week of product use and to 32 minutes during the second week. Product use also led to improvements in the perceived sleep of snorers and their partners, including ability to sleep through the night without waking up, overall sleep quality, and feeling rested upon waking in the morning (all ps<.05).

Conclusion

By reducing the amount of snoring, the contactless snoring solution improved objectively-measured sleep in snorers’ bed partners. Also, the perceived sleep of both snorers and their partners improved.

Support (if any)

Smart Nora