bluuebunny/crossref_metadata_2025 huggingface dataset:
660 Chronotype Associations with Insomnia, Depressive Symptoms, and Changes in Sleep and Health Behaviors during the COVID-19 Pandemic
Authors: Petrov Megan , Buman Matthew , Epstein Dana , Youngstedt Shawn , Hoffmann Nicole , Mattingly Jennifer , Hasanaj Kristina , Jiao Nana , Kasraeian Kimiya , Sominsky Anthony , Stievater Elena
Published: May 2021

Introduction

Evening chronotype (i.e., night owl preference) is associated with worse insomnia and depressive symptoms, and poorer health behaviors. The aim of this study was to examine the association between chronotype and these symptoms and health behaviors during COVID-19 pandemic quarantine.

Methods

An online survey, distributed internationally via social media from 5/21/2020–7/1/2020, asked adults to report sociodemographic/economic information, changes in sleep (midpoint, total sleep time, sleep efficiency, time-in-bed), and health behaviors (i.e., physical activity, sedentary screen time, and outdoor light exposure patterns) from prior to during the pandemic, chronotype preference (definitely morning [DM], rather more morning [RM], rather more evening [RE], or definitely evening [DE]), and complete the Insomnia Severity Index (ISI) and the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10). Multinomial logistic regression and ANCOVA models, adjusting for age and sex, examined associations of chronotype with COVID-19 pandemic related impacts on sleep, depressive symptoms, and health behaviors.

Results

A subsample of 579 participants (M age: 39y, range: 18–80; 73.6% female), currently under quarantine and neither pregnant nor performing shift work, represented each chronotype evenly (~25%). Participants delayed their sleep midpoint by 72.0min (SD=111.5) during the pandemic. DE chronotypes had a greater delay than morning types (M±SD DE: 91.0±9.0 vs. RM: 55.9±9.2 & DM: 66.1±9.3; p=0.046) with no significant change in other sleep patterns relative to other chronotypes. However, DE and RE chronotypes had greater odds of reporting that their new sleep/wake schedule was still not consistent with their “body clock” preference relative to morning types (Χ2[15]=54.8, p<0.001), reported greater ISI (F[3,503]=5.3, p=.001) and CES-D-10 scores (F[3,492]=7.9, p<.001), and had greater odds for increased or consistently moderate-to-high sedentary screen time (Χ2[12]=22.7, p=0.03) and decreased physical activity (Χ2[12]=22.5, p=0.03) than DM chronotype. There was no significant difference in change in outdoor light exposure by chronotype (Χ2[12]=12.1, p=0.43).

Conclusion

In an international online sample of adults under COVID-19 pandemic quarantine, evening chronotypes, despite taking the opportunity to delay sleep to match biological clock preference, reported their sleep/wake schedules were still inconsistent with personal preference, and reported greater insomnia and depressive symptoms, and odds of engaging in poorer health behaviors than morning chronotypes.

Support (if any):
664 Characteristics of respondents to a virtual trial of a digital behavioral treatment for insomnia during the COVID-19 pandemic
Authors: Thorndike Frances , Saver Keith , Braun Stephen , Williams Karren , Xiong Xiaorui
Published: May 2021

Introduction

Rates of sleep disturbance and sleep medication use have increased during the COVID-19 pandemic, at a time when face-to-face delivery of behavioral insomnia treatments is severely limited. To support research during the pandemic, the FDA released guidelines promoting the use of “alternative methods” to conduct trials in a virtual or decentralized manner. Currently, few data exist regarding the impact of virtual trial enrollment during a pandemic. This abstract presents data from a decentralized, open-label, single-arm real-world clinical trial of the Somryst prescription digital therapeutic for insomnia, which provides insight on who seeks care for insomnia using virtual research methods.

Methods

In alignment with FDA guidance, the DREAM trial began enrolling patients in March, 2020 with an expected final sample size of 350 adults (Clinical Trial # NCT04325464). This abstract presents data from participants seeking enrollment into the trial via an online screening. Demographic and sleep variables were collected to confirm eligibility.

Results

Of 1,063 respondents, the majority were female (62%) and the most common age brackets were ages 30–39 (22%); 40–49 (20%); and 50–59 (20%). Most respondents (63.8%) did not report being under the care of a healthcare provider for their insomnia. Respondents reported sleep problems for an average of 12.9 years; sleep problems 5 nights/week; and sleeping an average of 5.4 hours/night. Geographic diversity was high with respondents from 45 states and Washington DC. Of those passing initial screening (N=270), 5.5% reported having another diagnosed sleep disorder, 14.4% reported a comorbid psychological condition, 58.9% reported taking a medication for insomnia, and 30.7% reported taking a medication for depression. Using the Insomnia Severity Index, 16.7% had subthreshold/mild insomnia (score 8–14), 60.0% had moderate insomnia (score 15–21), and 23.7% had severe insomnia (score > 21).

Conclusion

Respondents to this decentralized trial reported moderate-severe, long-lasting insomnia with high rates of medication use for sleep and depression. Results demonstrate that virtual trials can quickly draw a highly geographically diverse research population, overcoming logistical challenges inherent in a pandemic and resulting in recruiting appropriate, but more geographically diverse, samples than those typically observed in randomized trials of cognitive behavioral therapy for insomnia (CBT-I).

Support (if any):
690 An Analysis of Objective and Subjective Sleep and Infection Symptoms of Medical Personnel Working through the COVID-19 Pandemic
Authors: Eldringhoff Hannah , Mickelson Carolyn , Moore Lonique , Pirner Maddison , Doyle Scott , Mantua Janna , Mckeon Ashlee
Published: May 2021

Introduction

There is a well-established connection between sleep and the immune system, and in the midst of a global pandemic, it is vital to understand the relationship between COVID-19 symptomatology and sleep. While our communities practice safety protocols, medical personnel working on the COVID-19 response effort are at high risk for exposure and contraction. This creates an urgent need to better understand whether sleep may contribute to COVID-19 symptom onset, severity, and recovery. This study examined the relationship between subjective and objective sleep during infection.

Methods

Fifty volunteers (age 35.15±9.97) considered high risk for COVID-19 participated in the study. The sample consisted mostly of medical personnel (93.27%) working through the pandemic. Over six months, participants completed monthly surveys and daily logs via Qualtrics. These surveys included questions about sleep, infection symptoms, COVID-19 tests and diagnoses, and mood. Wrist-worn actigraphy was collected continuously throughout the study. Sleep duration, latency, wake after sleep onset, and efficiency were processed using Philips Actiware 6.0. Actigraphy and survey data were analyzed using SPSS v. 25.

Results

Sixty-two percent of participants experienced infection symptoms. Those experiencing symptoms were significantly more likely to report having poorer sleep quality t(255.59)=5.78, p=<.001, poorer mood upon waking t(258.03)=6.53, p=<.001, feeling less alert upon waking t(255.61)=4.56, p=<.001, and spending more time awake at night t(2.66.98)=-7.29, p=<.001. Results showed that compared to those asymptomatic, participants with cough t(2164)=2.07, p=.039, diarrhea t(2161)=2.51, p=.012, and headache t(106.18)=7.05, p=<.001 all had significantly less total sleep time, while those with body aches spent significantly more time awake at night t(2164)=2.10, p=.036.

Conclusion

This preliminary examination of the data broadly suggests that medical personnel experiencing infection symptoms may have difficulty obtaining adequate sleep. Further, specific infection symptoms may share a stronger relationship with key sleep parameters than others. These findings support further testing of the bi-direction relationship between infection symptoms and sleep. Results from this research will contribute to enhancing prevention, detection, and treatment guidance related to future domestic and globally-experienced infections.

Support (if any)

Support for this study comes from there Military Operational Medicine Research Program of the United States Army Medical Research and Development Command.
692 Longitudinal Stability of Sleep and Health Correlates in Adults with Autism Spectrum Disorder
Authors: Puzino Kristina , Pearl Amanda , Calhoun Susan , Essayli Jamal , Alexander Danielle , Murray Michael , Fernandez-Mendoza Julio
Published: May 2021

Introduction

Individuals with Autism Spectrum Disorder (ASD) experience sleep disturbances to a greater degree than the general population. The majority of research investigating sleep disturbances in ASD has focused on children and adolescents. The aim of the current study was to determine the stability and health correlates of self-reported sleep disturbances in adults with ASD.

Methods

Participants included 55 adults with ASD recruited from state-funded Pennsylvania programs (31.2±7.6 years old, 80% male, 10.9% minority). Patient-Reported Outcomes Measurement Information System (PROMIS) measures assessing Sleep Disturbances, Sleep-Related Impairment, Fatigue, Anxiety, Depression, Anger, and Physical Health, were completed at baseline and every 90 ± 14 days over a 2-year period. Intraclass correlation coefficients (ICC) were calculated for each sleep outcome, and interpreted as 0.00–0.20=“poor stability,” 0.21–0.40=“slight stability,” 0.41–0.60=“moderate stability,” 0.61–0.80=“substantial stability,” and 0.81–1.00=“almost perfect stability” across the first three time-points. Linear mixed models examined the independent association of sleep disturbances, sleep-related impairment, and fatigue on anxiety, depression, anger, and physical health over the two-year period.

Results

Sleep-related impairment (ICC=0.73) and fatigue (ICC=0.64) were substantially stable, while sleep disturbances were moderately stable (ICC=0.58). All three sleep-related outcomes were independently associated with anxiety (sleep-related impairment p=0.012; sleep disturbance p<0.001; fatigue p=<0.001) and anger (sleep-related impairment p=<0.001; sleep disturbance p=0.001; fatigue p<0.001) across the two-year period. Sleep disturbance (p=<0.001) and fatigue (p<0.001), but not sleep-related impairment (p=0.267), were associated with depression across the two-year period. In contrast, none of the sleep-related outcomes (sleep-related impairment p=0.285; sleep disturbance p=0.250; fatigue p=0.709) were associated with physical health over time.

Conclusion

Measures of sleep-related impairment, fatigue, and sleep disturbance remained stable over time, suggesting that they can provide clinicians and researchers with a brief, accurate, and reliable way to assess patient-reported sleep outcomes in adults with ASD. Furthermore, given the stability of these sleep measures and their independent association with elevated mental health outcomes, there is a need for evidence-based treatments targeting sleep difficulties and associated symptomology in adults with ASD, a particularly underserved population.

Support (if any)

Pennsylvania State Bureau of Autism Services through the Autism Services, Education, Resources, and Training (ASERT) grant
696 Quality of sleep is the only predictor of suicide during Covid-19 lockdown in University students?
Authors: Castelnuovo Alessandra , Mombelli Samantha , Bottoni Daniela , Somma Antonella , Fossati Andrea , Ferini-Strambi Luigi , Marelli Sara
Published: May 2021

Introduction

COVID-19 epidemic led to great psychological and social stress, related to anxiety, depression, sleep disorders, suicidal risk and behavior, and changes in daily routine. The aim of this study was to assess the psychological impact of COVID-19 lockdown in Italian students. We focused on perceived sleep quality, anxiety and depression symptoms, and mostly on risk of suicide.

Methods

A total of 307 students (mean age 22.84±2.68) completed Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). In our study, we focused on item 9 of BDI-II, that is related to suicide. We divided our sample on presence or absence of suicidal ideation based on this item.

Results

We found that 30.1% showed depressive, while 38.2% anxious symptoms. Concerning item 9 of BDI-II (suicidal thoughts or wishes), 84.7% answered that they do not have any thoughts of killing themselves, while 15.3% answered that they have some suicidal ideation. Concerning sleep variables, we found that 58% of our sample showed a PSQI total score higher than 5 (poor quality of sleep), and a global worsening in sleep quality and increase of insomnia both in student with and without suicidal ideation.

Conclusion

Our results on risk of suicide are in line with literature. Recent reviews focused on suicidal ideation in medical students found that depressive symptoms and suicidal ideation are common among medical students, finding a prevalence of suicidal ideation of 11%. Several studies suggest that sleep disorders are a risk factor for suicidal thoughts and behaviours. Our findings show that sleep cannot considered a predictive factor of risk of suicide during health emergency, because the risk is polyfactorial.

Support (if any)

None
699 Sleep Health Traits and COVID-19: Mortality Risk from the UK Biobank
Authors: Zheng Xi , Ulsa Ma Cherrysse , Li Peng , Gao Lei , Hu Kun
Published: May 2021

Introduction

While there is emerging evidence for acute sleep disruption in the aftermath of coronavirus disease 2019 (COVID-19), it is unknown whether sleep traits contribute to mortality risk. In this study, we tested whether earlier-life sleep duration, chronotype, insomnia, napping or sleep apnea were associated with increased 30-day COVID-19 mortality.

Methods

We included 34,711 participants from the UK Biobank, who presented for COVID-19 testing between March and October 2020 (mean age at diagnosis: 69.4±8.3; range 50.2–84.6). Self-reported sleep duration (less than 6h/6-9h/more than 9h), chronotype (“morning”/”intermediate”/”evening”), daytime dozing (often/rarely), insomnia (often/rarely), napping (often/rarely) and presence of sleep apnea (ICD-10 or self-report) were obtained between 2006 and 2010. Multivariate logistic regression models were used to adjust for age, sex, education, socioeconomic status, and relevant risk factors (BMI, hypertension, diabetes, respiratory diseases, smoking, and alcohol).

Results

The mean time between sleep measures and COVID-19 testing was 11.6±0.9 years. Overall, 5,066 (14.6%) were positive. In those who were positive, 355 (7.0%) died within 30 days (median = 8) after diagnosis. Long sleepers (>9h vs. 6-9h) [20/103 (19.4%) vs. 300/4,573 (6.6%); OR 2.09, 95% 1.19–3.64, p=0.009), often daytime dozers (OR 1.68, 95% 1.04–2.72, p=0.03), and nappers (OR 1.52, 95% 1.04–2.23, p=0.03) were at greater odds of mortality. Prior diagnosis of sleep apnea also saw a two-fold increased odds (OR 2.07, 95% CI: 1.25–3.44 p=0.005). No associations were seen for short sleepers, chronotype or insomnia with COVID-19 mortality.

Conclusion

Data across all current waves of infection show that prior sleep traits/disturbances, in particular long sleep duration, daytime dozing, napping and sleep apnea, are associated with increased 30-day mortality after COVID-19, independent of health-related risk factors. While sleep health traits may reflect unmeasured poor health, further work is warranted to examine the exact underlying mechanisms, and to test whether sleep health optimization offers resilience to severe illness from COVID-19.

Support (if any)

NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.
700 Young African American Adults Endorse Greater Distress from Racism than COVID though COVID may have Greater Impact on Sleep
Authors: Ndubuizu Nkemdilim , Hurst Travan , Wilson Amanda , Mellman Thomas
Published: May 2021

Introduction

Much attention has been given to stress-related symptoms including insomnia related to the COVID-19 pandemic. Exposure to racially targeted police violence and the disproportionate impact of COVID on their communities have been particularly salient stressors for African Americans. Aims for this presentation are to illuminate the emotional impact of COVID and racism on young adult African Americans and their relationship to sleep problems.

Methods

An online survey was sent to participants in an ongoing study focusing on sleep and health along with new participants recruited through a snowball method. The survey included the Insomnia Severity Index (ISI), Impact of Event scale (IES), as well as items to assess experiences with COVID, exposure to racially targeted violence, and disparate community impact.

Results

Respondents were African Americans age 18–35. 45% endorsed worsening sleep during the pandemic. 25% had ISI scores of probable insomnia and 61% had IES scores above the symptom threshold for clinical concern. Racism-related distress was endorsed at higher levels than worries related to COVID. There was a significant relationship of insomnia severity with the number of COVID related stressors and a trend level relationship with COVID worries. Sleep outcomes were not correlated with racism-related distress.

Conclusion

While distress related to racism was endorsed more than COVID worries, our preliminary findings suggest COVID worries but not racism exposure negatively impact sleep health. This may be a consequence of habituation to the chronic stress of racism in contrast with the novel stress of COVID.

Support (if any)

5R01HL136626 from the National Heart Lung and Blood Institute
705 PAP Use Pattern Change During the COVID-19 Lockdown
Authors: Esmero Veronica , Herdegen James
Published: May 2021

Introduction

The COVID-19 pandemic has greatly impacted not only the physical health of society, but also its social, mental, and economic health. The Illinois shelter in place orders enacted in March and April limited work and activities outside the home. Our aim for this study was to compare the effects of the COVID-19 shelter in place orders on PAP use patterns in patients with OSA.

Methods

We selected 30 patients seen between May and October 2020. Patients had been diagnosed with OSA for at least one year, prescribed PAP therapy and had been compliant with therapy as defined by 70% use greater 4-hour for 30 days prior to their clinic visit. Using data collected from chart review as well as online ResMed AirView cloud data, we evaluated PAP on/off and average use time during shelter in place order for a 90 day period (March through May 2020). We compared this data to a similar period in the year prior.

Results

Average age of our study group was 58.6 years old with 19 men and 11 women. Mean AHI was 51.7. Reported average bedtime was 10:00pm with average wake time 7:30am during the shutdown compared with a bedtime of 9pm and wake up time 6:30am. Patients reported having more time to sleep and required less naps during the day. Average PAP use during shut down was 7 hours 20 minutes and average PAP use prior to shutdown was 6 hours and 50 minutes. An average of 30 additional PAP minutes was observed among patients during the shelter in place order. Only one of our patients was diagnosed with COVID during this time period.

Conclusion

For patients with OSA on PAP therapy we observed an increase in PAP use. Among patients suddenly required to shelter in place, we observed a delayed sleep onset and wake time of more than 1 hour, resulting in a slightly longer overall PAP use time. This circadian phase shift was greater among working patients compared to retired patients. The health effects of longer PAP use and circadian phase shifting remain to be determined.

Support (if any):
717 Sleeping Well During a Pandemic: The Role of Various Forms of Social Support in Protecting Against Insomnia
Authors: Jankowski Samantha , Cloonan Sara , Grandner Michael , Killgore William
Published: May 2021

Introduction

Social support from friends, family, and significant loved ones is critical to sustaining mental health during crises. During the course of the COVID-19 pandemic, the populace has had to restrict many aspects of normal social contact. Consequently, social isolation and accompanying feelings of loneliness have spiked. There has also been a contemporaneous increase in the rates of insomnia. Considering this correlation, we investigated the potential role of various types of social/emotional support on the severity of insomnia. We hypothesized that greater social support from family, friends, and significant loved ones would all contribute to lower insomnia during the pandemic.

Methods

During October 2020, 1020 participants (58.2% female) completed an online survey that included the Multidimensional Scale of Perceived Social Support (MSPSS), a measure of social support, and the Insomnia Severity Index (ISI), a measure of insomnia. The severity of insomnia was predicted using multiple linear regression, with the three sources of support from the MSPSS (family, friend, and significant other) entered stepwise.

Results

All three sources of support were significantly correlated with lower ISI scores (family, r=-.163, p= p = 1.6x10-7; friend, r=-.125, p=6.5x10-5; significant other, r=-.095, p=.002). However, when all three variables were entered into stepwise regression, only increased familial support was significantly associated with lower insomnia levels (R2 = 0.027, β =-.163, p = 1.6x10-7). In contrast, neither the support of friends nor support from significant others added any additional predictive power once family support was in the model.

Conclusion

While perceived social support from friends and significant others was correlated with lower insomnia, we found that ISI scores were most significantly associated with perceived family support. In fact, once family support was accounted for, other sources of support did not account for additional variance. Ongoing family support plays a critical role in mental health and wellbeing, which is clearly demonstrated in the quality of sleep. During the social distancing imposed by the pandemic, it is vital that we find creative ways to maintain familial social support. Future work may benefit by examining the association between the use of electronic technologies to sustain social support and sleep outcomes.

Support (if any):
727 Impact of Washington State COVID-19 Lockdown on Sleep
Authors: Peterson Mary , Lundholm Kirsie , Skeiky Lillian , Van Dongen Hans , Hansen Devon
Published: May 2021

Introduction

The COVID-19 pandemic caused a global disruption to daily routines. Studies using surveys and sleep-related applications on mobile devices suggest that the pandemic has contributed to increases in sleep disruption or onset of new sleep disturbances. We present results from a naturalistic at-home study in which objective sleep measurements were made using both a wrist actigraph (Actiwatch-2, Philips Respironics) and a non-contact monitoring device (SleepScore Max, SleepScore Labs), comparing sleep measurements obtained immediately before and after the start of the first mandatory COVID-19 stay-at-home order in Washington State.

Methods

As part of a larger study, nine Washington State residents (ages 22–48, 5 female, 4 male; 6 insomniacs, 3 normal sleeper) were enrolled in a 10-week at-home sleep monitoring study, which involved 1 week of actigraphy, 8 weeks of non-contact monitoring (data available for 6 subjects), and 1 week of actigraphy. During the study, the Washington State governor issued a stay-at-home order, effective March 15, 2020. We compared sleep measurements obtained before this date (mean ± SD: 25.0 ± 15.0 nights) and after this date (25.2 ± 13.9 nights) using mixed-effects ANOVA.

Results

Non-contact monitoring measurements indicated that after the start of the lockdown, participants woke up later by 63.2 ± 12.1 min (mean ± SE; F[1,299]=27.40, p<0.001) without significant change in bedtime (F[1,299]=0.29, p=0.59). Sleep latency lengthened by 4.0 ± 2.3 min (F[1,295]=4.92, p=0.027), and there were increases in number of awakenings (F[1,295]=6.22, p=0.013) and wake after sleep onset (F[1,295]=12.58, p<0.001). Actigraphy data complemented these results, showing delayed sleep onset by 53.4 ± 15.1 min (F[1,101]=12.46, p<0.001) and delayed final awakening by 104.3 ± 19.6 min (F[1,101]=28.43, p<0.001), with longer sleep duration (F[1,101]=6.06, p=0.016), increased number of awakenings (F[1,101]=13.00, p<0.001), and a trend for increased intermittent wakefulness (F[1,101]=3.88, p=0.052) post-lockdown.

Conclusion

In this sample, we found evidence of increased sleep disruption following the first Washington State stay-at-home order related to COVID-19. Our findings are consistent with previous studies based on self-report data, which observed later wake times and decreases in sleep quality post-lockdown.

Support (if any)

NIH grant KL2TR002317. Non-contact monitoring devices provided by SleepScore Labs.
737 Prediction of drop out in an adjunctive light treatment trial in patients with non-seasonal depression and evening chronotype
Authors: Chan Joey W , Wing Y K , Lam S P , Li Shirley Xin , Zhang J
Published: May 2021

Introduction

Drop out during treatment hampers therapeutic effect of interventions. The current study examines the possible predictors of drop out during the five-week light treatment in patients with unipolar non-seasonal depression and evening-chronotype.

Methods

Baseline characteristics including demographics, sleep diary parameters, light treatment prescribed, and early clinical outcomes changes were compared between the Drop out and Non drop out group. Logistic regression analysis was used to examine predictors for drop out. All data were analyzed in a modified intention to treat analysis with last observation carried forward approach.

Results

A total of 91 subjects (Female 79%, 46.3 ± 11.8 years old) were included in the analysis. There was no significant difference in the baseline demographic and clinical characteristics between the Drop out and Non drop out group. There was also no significant difference in the improvement of clinical parameters over the first week among the two groups. However, treatment non-adherence (in terms of compliance of less than 80% of prescribed duration) over the first treatment week predicts a five-fold increase in risk of drop out during light therapy. (OR: 5.85, CI: 1.414–24.205, p=0.015) after controlling for potential confounders including age, gender, treatment group, patient expectation, and treatment-emergent adverse events.

Conclusion

This study found that baseline clinical characteristics including depression severity and improvement of depressive symptoms in the initial week did not differ between the Drop out and Non drop out group. The drop out was also not affected by the type of light (dim red versus bright red light), indirectly supporting dim red light as a valid placebo in bright light therapy trial. Treatment adherence is the early phase of light treatment is an important predictor of drop out.

Support (if any):
742 Linkages between sleep quality and mental health among couples coping with type 1 diabetes across survey and daily diary methods
Authors: Tracy Eunjin , Berg Cynthia , Butner Jonathan , de Grey Robert Kent , Allen Nancy , Porter Margot , Helgeson Vicki
Published: May 2021

Introduction

Sleep serves an important role in maintaining and promoting metabolic and mental health. The interdependent nature of couple relationships makes examining sleep quality from a dyadic perspective critical. This study examined the effect of sleep quality on mental health among couples coping with type 1 diabetes across survey and daily diary methods and investigated whether relationship satisfaction moderated these relations.

Methods

199 persons with type 1 diabetes (Mage = 46.82) and their spouses (Mage = 46.41) completed one survey questionnaire reporting their own sleep quality (PSQI), depressive symptoms (CESD), and relationship satisfaction (CSI). They also completed 14-day diaries reporting on their own sleep quality and negative affect. The actor-partner interdependence model and multi-level model were used to examine the effect of sleep quality on mental health across the cross-sectional and daily diary surveys. Multi-level modeling examined effects of within-person and between-person effects of sleep quality on next-day daily negative affect (controlling for prior day affect).

Results

Cross-sectional survey data revealed an association between poorer global sleep quality and higher depressive symptoms for both partners (actor effects). Spouses’ poorer sleep quality was associated with higher depressive symptoms for persons with T1D (partner effects). Daily diary data demonstrated an association between within-person and between-person effects of own poor sleep quality and higher negative affect for both partners. Poorer daily sleep quality for persons with T1D was associated with higher negative affect for spouses (partner effects). When examining the moderating role of relationship satisfaction, spouses’ poorer overall sleep quality was associated with greater depressive symptoms and overall negative affect respectively for those with lower relationship satisfaction but not for those with higher relationship satisfaction across both methods.

Conclusion

Findings support the conceptualized link between sleep quality and mental health as both an intraindividual and dyadic process among couples coping with T1D across survey and daily diary methods. Additionally, better relationship satisfaction may buffer the effect of overall poor sleep quality on mental health for spouses.

Support (if any)

This work was supported by NIH NIDDK program project grant (DP3DK103999). Individual support was provided by T32 MH019986 (ELT).
746 Delayed Rhythm Is Associated with Enhanced Discrimination for Negative Emotional Information
Authors: Chen Ivy , Neikrug Ariel , Adams Joren , McMillan Liv , Mander Bryce , Yassa Michael , Benca Ruth
Published: May 2021

Introduction

Mnemonic discrimination, the ability to differentiate novel and highly similar but not identical stimuli, is negatively associated with sleep deprivation and depression. Depression is additionally associated with increased discrimination specifically for negative emotional stimuli. While sleep and circadian activity rhythm (CAR) disturbances are common in depression and have been reported to have negative impact on hippocampal-dependent memories, their relationship with emotional discrimination has yet to be investigated.

Methods

As part of a larger study, 14 patients with DSM-5 major depressive disorder (22.9±4.1 years, 71.4% female) and 13 healthy controls (29.4±8.5 years, 61.5% female) were evaluated with wrist-actigraphy (7–14 days) and completed an emotional discrimination task. Lure discrimination index (LDI) for each emotion type (i.e., negative, neutral, and positive) was calculated to indicate how well participants discriminated among highly similar lures. Actigraphy-derived sleep parameters included total sleep time (TST), sleep efficiency (SE), and midsleep time. Minute-by-minute actigraphy-derived activity counts were used to characterize CAR and parametrized using cosinor analysis and Generalized Additive Models (GAM) deriving the rhythm Acrophase, Amplitude, UP time, and DOWN time. A repeated measures ANOVA (within-subjects: emotion, between-subjects: group) assessed whether mnemonic discrimination differed between patients with MDD and controls. Partial correlations examined the association between sleep and CAR parameters with mnemonic discrimination, while controlling for age, state anxiety, depression severity, TST, and groups.

Results

We found a significant effect of emotion [F(2,90)=3.25, p=0.043], where neutral information was remembered better than emotional information (p’s<0.005); no significant effect of group (MDD vs. control) was observed. Midsleep time and Acrophase were each positively associated with negative LDI (r=0.576, p=0.008; r=0.540, p=0.014, respectively). Exploratory GAM results suggested a significant positive correlation between UP time and negative LDI (r=0.497, p=0.022). TST, SE, Amplitude or DOWN time was not associated with LDIs.

Conclusion

Delayed CAR, characterized by latter midsleep time and delayed acrophase and peak time of the morning activity, is associated with increased discrimination for negative emotional information, independent of depressive symptom severity. Future studies are needed to replicate these findings and further explore the potential cognitive benefits of adjunctive interventions addressing sleep/CAR in mitigating symptoms of depression.

Support (if any)

National Institutes of Health R01 432MH102392.
748 Impact of Deep Transcranial Magnetic Stimulation on Insomnia Comorbid with Treatment Resistant Depression
Authors: Chopra Amit , Kodya Suzanne
Published: May 2021

Introduction

Deep Transcranial Magnetic Stimulation (dTMS) is an FDA-approved non-invasive brain stimulation treatment for management of treatment-resistant depression (TRD). However, the efficacy of dTMS on Insomnia, a commonly prevalent and one of the most refractory symptoms of depression, is not clearly established. Our study aims to assess the impact of dTMS on outcomes of insomnia comorbid with TRD.

Methods

Single center retrospective study examining mood and insomnia outcomes in TRD patients (n=25), with greater than 3 failed psychotropic medication trials, undergoing dTMS for unipolar major depression.. Questionnaires including Patient Health Questionnaire (PHQ-9), Insomnia Severity Index (ISS),Generalized Anxiety Disorder-7 (GAD-7) were compared at baseline and at the end of dTMS treatment course.

Results

TRD patients with ‘low insomnia’ (n=12; ISS=7.9) and ‘high insomnia’ (n=13; ISS=20) were examined in terms of mood and insomnia ouctomes. No significant differences at baseline were noted between two groups in terms of demographic, mood, and anxiety variables. Depression and anxiety symptoms for patients in ‘Low Insomnia’ group significantly improved from baseline to final dTMS session- PHQ-9 [t(11) = 6.021, p < .0001]], GAD-7 [t(11) = 2.389, p = .036]. TRD patients in ‘High Insomnia’ group also reported significant improvements in depression [t(12) = 5.596, p < .0001], anxiety [t(12) = 2.743, p = .018], and insomnia [t(12) = 6.057, p < .0001]] at final dTMS session as compared to baseline. Non-responders in ‘High Insomnia’ group did not achieve statistically significant improvements in either depression or insomnia outcomes.

Conclusion

Insomnia comorbid with TRD responds to treatment with dTMS irrespective of the insomnia severity at baseline. Prospective research with the use of objective assessment measures for insomnia is warranted to confirm these findings. Non-response to insomnia was associated with poor mood outcomes as well in TRD patients. The probable mechanistic action of insomnia improvement in patients with TRD undergoing dTMS is unclear and further systematic research to understand the clinical and neural correlates of insomnia response with dTMS is needed.

Support (if any)

N/A
750 Sleep disturbances mediates the association between emotional labor and depressive symptoms among healthcare workers
Authors: Zhang Yuan , ElGhaziri Mazen , Siddique Sundus , Gore Rebecca , Kurowski Alicia , Nobrega Suzanne , Punnett Laura
Published: May 2021

Introduction

Depression is the second leading cause of disability worldwide. Healthcare workers report a higher prevalence of depressive symptoms than the general population. Emotional labor has contributed to poor health and work outcomes. However, the mechanism for the potential association between emotional labor and depressive symptoms has not been well studied.

Methods

In 2018, healthcare workers (n=1,060) from five public sector facilities in the northeast U.S. participated in this cross-sectional survey. The survey included questions on participants’ surface-acting emotional labor (masking one’s feelings at work), depressive symptoms, sleep duration and disturbances, and socio-demographics.

Results

Nearly a quarter (21.7%) of the participants reported depressive symptoms, over a half (53.6%) reported short sleep duration (≤6 hours per day), and nearly one third (32.2%) reported sleep disturbances. There was a significant association between emotional labor and depressive symptoms (β=0.82, p<0.001) among these workers. Sleep disturbances, not short sleep duration, partially mediated this association by 17%. Both sleep disturbances and short sleep duration did not modify this association.

Conclusion

Depressive symptoms were prevalent among healthcare workers and were associated with emotional masking. Sleep disturbances play an important intermediate role in translating emotional labor to depressive symptoms in these workers. Effective workplace programs are needed to reduce healthcare workers’ emotional labor in order to improve their mental health. Sleep promotion should be emphasized to mitigate the negative effect of emotional labor and promote healthcare workers’ mental wellbeing.

Support (if any)

The Center for the Promotion of Health in the New England Workplace is supported by Grant Number 1 U19 OH008857 from the National Institute for Occupational Safety and Health (CDC). This work is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH. We are grateful to the CPH-NEW Research Team working together to collect the questionnaire data.
769 Is Alcohol Craving associated with Insomnia in Patients with Comorbid Insomnia and Alcohol Use Disorder?
Authors: Krouse Ryan , Aguiar Taylor , Mazur Rena , Makar Karen , Kampman Kyle , Rivera Louis
Published: May 2021

Introduction

A preliminary study showed the existence of a relationship between alcohol craving and insomnia symptoms. The current investigation aimed to further assess the relationship between obsessive and compulsive qualities of alcohol craving and insomnia disorder in a larger sample of subjects with Alcohol Use Disorder (AUD) seeking treatment for their drinking.

Methods

We used baseline cross-sectional data from a clinical trial of treatment-seeking patients with AUD (N=123). We used the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Obsessive Compulsive Drinking Scale (OCDS) scale scores for alcohol craving; Time-Line follow Back interview for computing the number of drinks per drinking day within the past 90 days; Hamilton Anxiety Rating Scale total score for the anxiety symptoms; and Addiction Severity Index for demographic variables. We used bivariate analysis to evaluate whether alcohol craving outcome measures (OCDS subscale scores and total score) were independently associated with the ISI total score. A multivariable model adjusted for sociodemographic and clinical covariates further evaluated this relationship between OCDS and ISI total scores.

Results

The mean (SD) age was 44.02 (10.37) years with 13.29 (3.10) years of education, 83.74% were males, 41.80% identified themselves as White, 17.21% were married, and 56.09% were employed. In a bivariate analysis, ISI total score was associated with the obsessive subscale (β=0.25, p<0.0001), compulsive drinking subscale (β=0.24, p<0.002), and OCDS total score (β=0.50, p<0.0001). The OCDS total score showed a stronger association with the insomnia symptoms (ISI items 1a-1c) (β=0.99, p<0.0001) than the manifestations of insomnia symptoms (items 2–5; β=0.83, p<0.0001). In the multivariable model adjusted for covariates, the relationship between OCDS and ISI total scores continued to remain significant (β=0.37, R2=0.18, p=0.01).

Conclusion

This study not only confirmed that alcohol craving was associated with insomnia in a larger sample but also demonstrated that insomnia is linked to both obsessive thoughts about alcohol use and compulsive drinking behavior, especially its obsessive aspect. These findings add to the growing literature on the relationship between a pathologic drive for alcohol use and abnormal wakefulness.

Support (if any)

The study was supported by VA grant IK2CX000855 (S.C.) and NIH grants R01 AA016553 (K.M.K.).
776 Perceived sleep control and nightmares distinguish college students with suicidal ideation from past attempters
Authors: Bodicherla Krishna , Tubbs Andrew , Fernandez Fabian-Xosé , Perlis Michael , Grandner Michael
Published: May 2021

Introduction

Suicidal ideation is common in college-aged students, but this is limited as a risk factor because ideation rarely leads to suicide attempts. Disrupted sleep increases suicide risk, but it is unclear whether this relationship applies equally to both ideators and attempters. Therefore, the present study explored four different sleep variables as discriminators between past suicidal ideation and a past suicide attempt.

Methods

Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcomes, lifetime history of suicidal ideation or a suicide attempt, were assessed using self-report questions derived from the Columbia Suicide Severity Rating Scale. Predictors were weekday short sleep (≤ 6h; from a retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models tested whether these predictors distinguished ideators from attempters. Models were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness from the Interpersonal Theory of Suicide.

Results

A total of N=182 (36%) respondents endorsed lifetime suicidal ideation, while N=61 (12%) reported a prior suicide attempt. Attempters tended to be slightly older (p=0.016), in worse health (p<0.001), and have more severe depression (p<0.001) and anxiety (p<0.001) than ideators. In unadjusted models, higher BRISC scores were associated with reduced odds of a suicide attempt (OR: 0.62 [0.42, 0.90]) while DDNSI scores of >=10 were associated with greater odds of a suicide attempt (OR: 4.24 [1.28, 4.24]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate these relationships. Short sleep and ISI scores did not distinguish ideators from attempters.

Conclusion

Perceived sleep control and severity of nightmares, but not insomnia or short sleep, distinguished individuals with a history of suicidal ideation from those with a history of a suicide attempt. However, longitudinal research is needed to determine if poor sleep control or nightmares are proximal predictors of a suicide attempt.

Support (if any):
783 Early Life Adversity and Central Symptoms of Sleep Disturbance: A Network Analysis
Authors: Marquez Francisco , Decker Andrea , Taber Jennifer , Xia Mengya , Cribbet Matthew
Published: May 2021

Introduction

Individuals with early life adversity (ELA) experience a greater likelihood of sleep disturbance. Sleep disturbance is a hypothesized mechanism underlying the association between ELA and adverse health outcomes. However, it is unclear whether sleep disturbance presents differently in individuals with ELA when compared to individuals without ELA. Network analysis provides an analytic framework to examine the relationships and magnitudes of association between symptoms of sleep disturbance. Using a network framework, we investigated the differences in sleep disturbance symptoms between individuals with ELA and individuals without ELA.

Methods

College students (N=507; age=18±1, Female=72%) completed demographic measures, the Childhood Trauma Questionnaire (CTQ), and the Pittsburgh Sleep Quality Index using an online data collection platform from March-December 2020. Using clinical cutoffs, individuals with ELA were separated from individuals without ELA. Using the Pittsburgh Sleep Quality Index (PSQI; alpha=0.79), sleep disturbance was assessed. Two 7-node ELA-specific networks were generated using raw values for the 7 components of the PSQI. To assess network accuracy, stability coefficients were estimated using the ‘bootnet’ and ‘qgraph’ packages in R. The strength of association between each component and all other components of sleep disturbance were estimated using expected influence (EI). Network structures and measures of EI were examined for differences between exposure groups.

Results

Overall, the average global PSQI score was 7.50±3.37. Individuals with ELA had larger global PSQI scores when compared to individuals without ELA (8.18 versus 6.97, t=3.8, p<0.001, d=0.37). For individuals with ELA, sleep quality, duration, and efficiency were most associated with other symptoms of sleep disturbance. For individuals without ELA, subjective sleep quality, sleep latency, and daytime dysfunction were most related to other symptoms of sleep disturbance. Individuals with ELA demonstrated a more interrelated network structure, with greater raw measures of EI in most components of the PSQI.

Conclusion

For individuals with ELA, duration and efficiency strongly underly sleep disturbance. Moreover, most symptoms had greater measures of EI in individuals with ELA when compared to individuals without ELA, suggesting that symptoms of sleep disturbance may be more likely to co-occur in individuals with ELA. Future research may explore the utility of these symptoms in predicting adverse health outcomes.

Support (if any):
795 Real World Challenges and Barriers for Positive Airway Pressure Therapy Use in Acute Ischemic Stroke Patients
Authors: Pascoe Maeve , Grigg-Damberger Madeleine , Walia Harneet , Andrews Noah , Bruton Monica , Wang Lu , Bena James , Katzan Irene , Uchino Ken , Foldvary-Schaefer Nancy
Published: May 2021

Introduction

Untreated obstructive sleep apnea (OSA) in patients with acute ischemic stroke (AIS) increases morbidity and mortality post-stroke. However, diagnosing and treating OSA in AIS is challenging. As such, we aimed to determine the feasibility of portable monitoring (PM) for diagnosis and positive airway pressure (PAP) therapy for treatment of OSA in an inpatient stroke population.

Methods

We recruited inpatients with AIS from the Cleveland Clinic. Those who consented underwent PM; participants with a respiratory event (REI) ≥10 were offered auto-titrating positive airway pressure therapy (APAP). Ease-of-use questionnaires were completed. We summarized categorical variables using n(%) and continuous variables using mean±SD or median [IQR].

Results

27 participants (age 59.8±11.8, 51.9% female, 51.9% African American, BMI 33.3±11.4) enrolled. The study ended early due to Medicare contracting that forced most patients to complete stroke rehabilitation outside the Cleveland Clinic health system. 69.6% had large vessel occlusions and 52% had moderate/severity disability (Modified Rankin score ≥2). PM was attempted in 23 participants and successful in 19. Nursing and patients rated the PM device as highly easy to use. 11 of 14 patients who had an REI ≥10 consented to APAP titration, but only 5 continued APAP after discharge. Four patients who initially said APAP was easy to use noted that their stroke interfered with their APAP use at home.

Conclusion

This study demonstrates the challenges in the assessment and treatment of OSA in an acute ischemic stroke population, highlighting the necessity for further research into timely and feasible screening and treatment.

Support (if any)

ResMed