bluuebunny/crossref_metadata_2025 huggingface dataset:
0653 The effects of light exposure on retinal responsivity in seasonal affective disorder
Authors: Taylor Maddison , Wescott Delainey , Klevens Alison , Roecklein Kathryn
Published: May 2023

Introduction

Seasonal affective disorder (SAD) is characterized as patterned depressed mood that emerges during the fall/winter and enters remission during the spring/summer. Retinal responsivity is lower in SAD in the winter and may contribute to the seasonal pattern of mood disruption (Roecklein et al., 2021). Light exposure in the month prior has been shown to influence retinal responsivity (Kawasaki et al., 2018). No work to date has investigated how more proximal prior light history may influence retinal responsivity differently in individuals with SAD versus controls. This study sought to examine group differences in how environmental blue light exposure impacts retinal responsivity in the 2 hours prior.

Methods

Participants included 19 never depressed controls (Mean Age = 33, SD = 11), and 17 individuals diagnosed with SAD (Mean Age = 36, SD = 10). SAD episode criteria were assessed using the SCID-5 and SIGH-SAD. Retinal responsivity was measured using the Post-Illumination Pupil Response (PIPR) in the winter months. The PIPR was calculated as percent of baseline difference between the blue and red stimuli from 10-30 secs. Light exposure was measured using the Phillips Actiwatch blue light levels in photon flux in 30-second epochs for 2 hours before the PIPR. Means were calculated and cube transformed to account for right skew. Covariates included circadian time of PIPR testing, calculated from DLMO, and Pupil Light Reflex as a measure of retinal irradiance.

Results

Multiple regressions were performed for the SAD and control groups, separately. Results indicated that the mean blue-light exposure 2-hours before the PIPR did not significantly predict PIPR in either group (Control group: b = -13e-7, p = 0.31/ SAD group: b = -12e-7, p = 0.13).

Conclusion

This is the first study to find that light exposure within the prior 2 hours does not influence retinal responsivity in SAD or control participants. Future studies should evaluate different light exposure parameters, such as a longer duration of light exposure before the PIPR, variation in light exposure across different timeframes, and circadian time of light exposure.

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0665 Ibogaine treatment in combat Veterans significantly improves sleep, beyond alleviating Posttraumatic Stress Disorder symptoms
Authors: Faerman Afik , Anker Lauren , Cherian Kirsten , Brown Randi , Williams Nolan
Published: May 2023

Introduction

Ibogaine is an indole alkaloid traditionally used in spiritual and healing rites in some African cultures. Ibogaine is primarily studied in the context of substance dependence, but indications suggest it may enhance recovery from trauma. Here, we investigated the effects of ibogaine treatment for multisystem effects of exposure to repeated blasts and combat on self-reported sleep disturbance, insomnia severity, and trauma-related symptoms.

Methods

Participants were Special Operations Veterans who independently and voluntarily underwent ibogaine treatment at a specialized clinic outside the USA. After meeting rigorous screening requirements, 30 participants were enrolled, all endorsing histories of repeated combat and blast exposure and traumatic brain injury. Participants were seen in person for baseline, immediate post-treatment, and 1-month post-treatment assessments, including the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for DSM-5 (CAPS-5), the Pittsburgh Sleep Quality Index (PSQI), and the Pittsburgh Insomnia Rating Scale (PIRS). Twenty-six participants completed sleep measures at baseline and 1-month post-treatment.

Results

Two-tailed paired samples t-tests revealed significant effects of time, with post-treatment improvements in CAPS (ΔM = -26.8±11.1, t(25) = 12.283, p < .001), PSQI (ΔM = -6.5±5.6, t(25) = 5.920, p < .001), and PIRS (ΔM = -23.8±15.5, t(24) = 7.690, p < .001). However, pre-post changes in PTSD symptom severity were not a significant predictor of improvements in PSQI (R² = .229, b = .354, p = .074) or PIRS (R² = .232, b = .339, p = .090) after controlling for age (p = .206 and p = .165, respectively).

Conclusion

To our knowledge, this is the first study examining the effects of ibogaine use on sleep in humans. Results indicated that while sleep and PTSD symptom severity improve 1-month post-treatment, they might be impacted by different mechanisms targeted by ibogaine. Even though a small sample size may have hindered the ability to reach desired probability values, the variance explained by the improvement in PTSD symptoms was still relatively modest (up to 23%). These promising findings demonstrate ibogaine’s therapeutic potential for disturbed sleep in the context of traumatic brain injury and trauma. Potential explanations are discussed.

Support (if any)

This study was supported by a private fund.
0677 Blunted daily light rhythm amplitude in adults with opioid use disorder (OUD)
Authors: Cox Rebecca , Haller Sophie , Martinez-Lisowska Zofia , Kuppa Abhignya , Sprecher Kate , Withrow Dana , Barry Declan , Scheinost Dustin , Redeker Nancy , Yaggi H , Wright Kenneth
Published: May 2023

Introduction

Accumulating evidence implicates sleep and circadian rhythm disruption in substance use disorders, including opioid use disorder (OUD). Blunted amplitude in daily rhythms of circadian-relevant variables (e.g., activity, light) may be a marker of psychopathology, as depressed adults demonstrate a smaller activity amplitude compared with healthy controls. The present study compared the light and activity amplitudes of adults with OUD with healthy controls.

Methods

Light and activity data were collected from adults with OUD who were recently stabilized on medication-assisted treatment (N=27; Mage=44.25±13.21). Participants wore an Actiwatch for an average of 14.5 (SD=4.14) days. Light and activity data collected from healthy adults (N=15; Mage=22.88±2.76) who wore an Actiwatch an average of 11.59 (SD=1.07) days in a separate study were included as a comparison group. Light and activity amplitudes for each day and a composite amplitude for the sampling period were calculated using non-orthogonal spectral analysis.

Results

Results of mixed model ANOVA with subject as a random factor and group and day as fixed factors revealed a significant main effect of group on daily light amplitude (p<.01), such that the OUD group exhibited lower daily light amplitudes compared to healthy controls, and a trend-level main effect of group on daily activity amplitude (p=.09), such that the OUD group exhibited lower daily activity amplitudes compared to healthy controls. With age included as a covariate in the model, the main effect of group on light remained significant, whereas the trend-level effect on activity became non-significant. Results of between-subjects t-tests indicated significantly lower composite light and activity amplitudes during the entire sampling period in the OUD group compared to healthy controls (p’s<.05).

Conclusion

These findings indicate that OUD is characterized by blunted light amplitude, which could both reflect and contribute to disruptions in circadian physiology in OUD. Light amplitude may be a novel target for behavioral OUD interventions. Future research is needed to determine whether blunted light amplitude is associated with OUD treatment outcomes and to further examine activity amplitude in OUD with larger sample sizes.

Support (if any)

U01 HL150596; T32 HL149646; CTSA Grant UL1 TR002535; Office of Naval Research MURI N00014-15-1-2809
0682 Adapting a Transdiagnostic Sleep Intervention for Young Adults with Autism Spectrum Disorder: Preliminary Data
Authors: Lenker Kristina , Cozzi Anna , Murray Michael , Harvey Allison , Calhoun Susan , Fernandez-Mendoza Julio
Published: May 2023

Introduction

Young adults with Autism Spectrum Disorder (ASD) frequently report a multitude of pervasive sleep and circadian problems, including difficulties initiating and maintain sleep, excessive sleepiness, delayed phase, and irregular sleep–wake schedules. These sleep and circadian problems often occur in unison rather than as isolated problems and further impair social functioning, cognition, mood, and overall quality of life, during a particularly challenging developmental stage. Although sleep and circadian problems have been identified as a critical and unmet public health concern for young adults with ASD, and there is a robust evidence for transdiagnostic sleep interventions, there is a paucity of research on the efficacy of these interventions in young adults with ASD.

Methods

Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), a patient-centered sleep intervention which has demonstrated improvements in sleep and circadian problems and reduce symptomology in both mental and physical health domains across a variety of mental health disorders, will be adapted and iteratively pilot-tested, so that its contents and service delivery methods are appropriate for young adults with ASD. Qualitative methods (semi-structured interviews) will be used to conduct and analyze feedback from key stakeholders (n=20; 10 dyads of young adults with ASD and their caregivers), and used to directly guide adaptations of TranS-C.

Results

Preliminary data of 5 young adults (18-24y) with ASD show that these individuals are likely to receive multiple sleep disorder diagnoses at equally similar rates (60% circadian rhythm sleep disorder, 60% insomnia disorder), and concurrently present with comorbid mental health problems (60% anxiety disorder, 60% depression).

Conclusion

Our preliminary data along with existing studies suggest that (1) sleep and circadian problems experienced by individuals with ASD are multidimensional in nature, (2) negatively impact daytime functioning, both within several cognitive and mental health domains, and (3) require transdiagnostic approaches in individuals with ASD to address the broader range of sleep and circadian dysfunction experienced. Potential adaptations to TranS-C format and delivery may serve as a novel module for promoting intervention adherence and responding to unique features of ASD.

Support (if any)

Brad Hollinger Autism Research Endowment Award
0691 Quality of life and subjective sleep characteristics among a middle-aged population in Korea
Authors: Baek Younghwa , Jung Kyoungsik , Kim Jimi , Lee Siwoo
Published: May 2023

Introduction

Sleeping problems are associated with physical and mental conditions as well as quality of life (QoL). This study aimed to evaluate the association between sleep characteristics and QoL in a middle-aged population.

Methods

This cross-sectional study included 4051 adults (1751 males and 2300 females) aged 30-50 who were selected through a multi-stage stratified sampling based on sex, age, and region between 2017 and 2019. Sociodemographic, sleep characteristics, and QoL were evaluated and compared. Sleep characteristics were determined using the Pittsburgh Sleep Quality Index, and were defined as sleep duration (SD), sleep quality (SQ), sleep efficiency (SE), and sleep latency (SL). QoL was evaluated using the SF-12, which calculated physical and mental QoL. Degrees of insomnia symptoms were classified into 0-3 by summing up the number of cases of sleep duration (≤6.5 hours), sleep efficiency (< 85%), and sleep latency (> 30 min). We used linear regression models to estimate the relationship between sleep characteristics and degrees of insomnia symptoms with QoL, adjusting for sociodemographic covariates.

Results

Sleep characteristics of the participants include average sleep duration 6.8 hours (≤6 h short, 45%; ≥9 h long, 3%), sleep quality 4.6 points (poor SQ, 29%), sleep efficiency 94.5% (< 85% SE, 11%), and sleep latency 19.7 minutes (>30 min SL, 9%). About 26% had one insomnia symptom and 11% had two or more insomnia symptoms. All sleep characteristics showed significant associations with physical and mental QoL. Particularly, physical QoL was associated with long SD (coefficients [B]: -1.56, 95% confidence interval [CI]: -2.77, -0.35), low SE (B: -2.32, 95% CI: -2.94, -1.7), and long SL (B: -3.3, 95% CI: -3.97, -2.6), and mental QOL was associated with low SE (B: -3.3, 95% CI: -4.0, -2.5) and long SL (B: -5.1, 95% CI: -5.8, -2.5). Physical and mental QoL was significantly linearly decreased with number of insomnia symptoms (for physical QoL, B: -0.87, -2.87, and -4.24; for mental QoL, B: -1.1, -4.01, and -5.9, by number of insomnia symptoms 1, 2, and 3, respectively).

Conclusion

Poor sleep characteristics were negatively associated with QoL in Korean middle-aged adults.

Support (if any)

This was funded by the Korea Institution of Oriental Medicine, KSN2023120.
0694 Sleep Disorders and Serious Mental Illnesses: Comorbidity, Treatment, & Demographic Factors in VA Health Record Data
Authors: Bonfils Kelsey , Longenecker Julia , Seo Yeonjung , Soreca Isabella , Hammer Lillian , Tighe Caitlan , Haas Gretchen , Bramoweth Adam
Published: May 2023

Introduction

People diagnosed with serious mental illnesses (SMI), including schizophrenia-spectrum disorders, bipolar disorders, and major depression with psychosis, report high rates of clinically significant sleep disturbance. Yet, examination of how demographic- and health-related factors impact diagnosis and treatment in this group is scarce. We aimed to fill this gap by examining medical records of Veterans receiving treatment in VA VISN 4 healthcare facilities.

Methods

We used VA health record data to examine comorbidity between SMI and sleep diagnoses and receipt of sleep treatment from 2011-2019 (total N=573,974). A combination of descriptive and statistical techniques were used to investigate prevalence of sleep disorders, receipt of sleep treatment, and associations with demographic- and health-related factors.

Results

In 2019, 21.8% of Veterans with SMI were diagnosed with sleep disorder(s) in the medical record. White Veterans with SMI were more likely to have a sleep disorder than Veterans identifying as racial minorities. Veterans with SMI and sleep disorders were also younger, had higher BMIs, and had more medical comorbidities. Veterans with SMI were more likely to receive sleep treatment than Veterans without SMI, primarily driven by higher rates of sleep medication. Importantly, in contrast to findings regarding sleep disorder comorbidity, Veterans identifying as racial minorities received sleep treatment at a higher rate than White Veterans, and Veterans with higher BMIs received sleep treatment at a lower rate. Demographic factors including sex, age, and rurality were also associated in varying ways with rates of sleep treatment.

Conclusion

Our findings suggest that Veterans with SMI are being treated for sleep disorders at higher rates than Veterans without SMI. However, diagnosis and treatment are differentially impacted by demographic and health-related factors. Work is needed to better understand drivers of demographic differences and to examine any potential inequities in diagnosis or treatment of sleep disorders in Veterans with SMI.

Support (if any)

This work was funded by the Veterans Health Foundation (Co-PIs: Bonfils & Longenecker). Additional support was provided by pilot project funds (PI: Bramoweth) from the Department of Veterans Affairs VISN 4 Mental Illness Research, Education and Clinical Center and the Mississippi Center for Clinical & Translational Research (U54GM115428).
0705 Restless sleep disorder and periodic limb movement disorder in children with history of prematurity
Authors: DelRosso Lourdes , Mogavero Maria , Bruni Oliviero , Ferri Raffaele
Published: May 2023

Introduction

Children with history of prematurity are at higher risk of complications, comorbidities and iron deficiency, including restless legs syndrome and periodic limb movements of sleep (PLMS). In this study we assess the prevalence of restless sleep disorder and PLMS in children with history of prematurity.

Methods

Retrospective chart review of sleep studies in children aged 1-18 years, with history of prematurity, from July 2021 to July 2022 at Seattle Children's Hospital. Only diagnostic studies in children without diagnosis of a genetic syndrome or airway surgery were included.

Results

During the study, 2,577 sleep studies were conducted, 162 were in children with history of prematurity (6%): 25 were split or titration studies (14%), 29 children had syndromes (Down, Prader Willi, Wiedmann Beckmann, Achondroplasia), 4 tracheostomy studies, 6 in infants aged < 12 months and 6 were post airway intervention. Ninety-two diagnostic studies were included in analysis. Median birth age was 31 weeks, interquartile range (IQR) 27-34 weeks. Thirty-two (34.8%) children were referred for restless sleep and 55 (59.8%) for snoring; 18% had PLMS index >5/hour, 14% fit the criteria for restless sleep disorder (RSD). There were no statistically significant differences in PSG parameters between the children with RSD, PLMS and the remaining group, except for lower obstructive apnea/hypopnea index (Kruskal-Wallis ANOVA 8.621, p=0.0135) in the RSD group (median 0.7, IQR 0.3-0.9) than in the PLMS (median 1.7, IQR 0.7-3.5), or than in the nonRSD/nonPLMS group (median 2.0, IQR 0.8-4.5). Altogether, children with RSD and those with PLMS had restless sleep as an indication for the sleep study in 70% of cases while snoring was the indication in only 26.7% of them.

Conclusion

We have previously reported that in the Seattle Children's Hospital Sleep Center the prevalence of RSD is 7.7% and that of PLMS is 9.3%; in this new analysis we found a higher frequency of RSD and elevated PLMS in children with history of prematurity. Premature children are higher risk of iron deficiency, among other complications and comorbidities. These new results confirm the previous reports of increased PLMS and add new knowledge on the prevalence of RSD in these children

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0715 Machine Learning Model to Predict Isolated REM Sleep Behavior Disorder Phenoconversion Time and Subtype using EEG
Authors: Jeong El , Shin Yong Woo , Byun Jung-Ick , Sunwoo Jun-Sang , Kim Han-Joon , Han Sun Jung , Jung Ki-Young
Published: May 2023

Introduction

More than 80% of patients of isolated rapid eye movement (REM) sleep behavior disorder (iRBD), a prodromal disease of α-synucleinopathies, progress to neurological disease like Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Resting-state EEG measurements taken at baseline have been related to the phenoconversion. The timing of the conversion and the disease to which it will convert are crucial issues in iRBD. This work used baseline EEG in iRBD to create a prediction model for the phenoconversion time and subtype of α-synucleinopathy.

Methods

Resting-state EEG and neurological assessments were performed at baseline on patients with iRBD. EEG spectral power, Shannon entropy and weighted phase lag index were employed as features. Four models were used to predict subtypes for the PD-MSA and DLB groups, and three models were used to predict survival. External validation was also performed.

Results

29 patients out of 143 who were followed up to nine years (mean 3.4 years) later developed α-synucleinopathies (14 PD, 9 DLB, 6 MSA). With a concordance index of 0.8130 and an integrated Brier score of 0.0921, the random survival forest was the best model for predicting survival. For the subtype prediction analysis, the model with the highest accuracy, extreme gradient boosting, had an accuracy of 86.52%. Both models indicated a high importance on EEG slowing related features.

Conclusion

It is possible to predict the timing and subtype of phenoconversion in iRBD using machine learning models of using EEG biomarkers. To confirm our findings, further study is required, including large sample data from various countries.

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0718 Sleep-Related Neck Myoclonus Clinical Characteristics: a Case Series
Authors: Dandawate Nupur , Grayson Kammi , Rodriguez Alcibiades
Published: May 2023

Introduction

Sleep-related neck myoclonus is an involuntary, brief muscular contraction of the neck that occurs during Rapid Eye Movement (REM) stage sleep. Neck myoclonus has been suggested to be a normal physiological phenomenon with unclear clinical significance; however, at times, these movements may cause symptoms, especially at high rates. We describe a series of 6 cases of patients with neck myoclonus in REM sleep and studied metrics of their polysomnograms (PSGs) to assess for any possible associations.

Methods

We assessed each patient's age, sex, sleep related complaints, as well as PSG findings such as Neck Myoclonus Index (NMI), Neck Myoclonus Arousal index (NMAI), Arousal Index, Periodic Limb Movements of sleep Index (PLMS Index), total Apnea Hypopnea Index (AHI), and REM AHI.

Results

There were 6 patients ranging in ages from 6 to 45 years, 4 out of 6 of which were men. Four out of six patients complained of sleep maintenance insomnia, 1 out of 6 complained of daytime headache, and none complained of abnormal movements in sleep. The NMI for the patients ranged from 9 to 51.6 and their NMAI ranged from 3 to 45. Their PLMS index ranged from 0 to 40.7, out of which 2 patients had abnormal elevations in PLMI as defined by AASM criteria. Overall arousal indices ranged from 6.3 to 18.3. Five out of 6 patients had clinically significant obstructive sleep apnea per the AASM criteria, with AHI ranging from 0.2 to 8.7 and REM AHI 0.8 to 11.2.

Conclusion

Though historically sleep-related neck myoclonus has been considered a normal physiological process, suggestions have been made to find a pathological cut off to better define the relationship between the frequency of neck myoclonus and other REM sleep disorders. Despite our 6 patients having frequent sleep-related neck myoclonus, this remains of unclear clinical significance as 5 out of 6 were also found to have clinically significant obstructive sleep apnea and 2 out of 6 had abnormally elevated PLMS Index. Co-morbidities need to be taken into account as well. Hence, this supports the necessity of defining a pathological cut off for a neck myoclonus index to better understand its significance.

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0720 Depression and pain are barriers to benzodiazepine and z-drug deprescribing
Authors: Fung Constance , Ghadimi Sara , Mitchell Michael , Martin Jennifer , Dzierzewski Joseph , Moore Alison , Zeidler Michelle , Badr Safwan , Guzman Andrew , Der-Mcleod Erin , Naeem Saadi , Perdomo Claudia , Smith Jason , Alessi Cathy
Published: May 2023

Introduction

Clinical guidelines recommend avoiding benzodiazepines and z-drugs (BZRAs) in older adults due to an increased risk of adverse outcomes (e.g., falls) in this population. Efforts to reduce BZRA use among older adults are growing, yet long-term BZRA deprescribing among patients with insomnia is challenging. We examined whether clinical conditions commonly comorbid with insomnia (i.e., depression, pain, nightmares, and anxiety) are barriers to BZRA deprescribing.

Methods

In an ongoing multi-site trial comparing two BZRA deprescribing programs (both include cognitive behavioral treatments for insomnia), participants aged >=55 years with chronic BZRA use for insomnia (N=165, mean age 68.7, sd 7.9) completed baseline Patient Health Questionnaire-9 (PHQ9), Brief Pain Inventory (BPI), Disturbing Dreams and Nightmare Severity Index (DDNSI), and Generalized Anxiety Disorder-7 (GAD-7). Deprescribing outcomes (discontinuation, dose, and frequency of use over 7-days) were assessed 1 week and 6 months after completing the deprescribing program. Using logistic and linear regression models, we assessed whether depression, pain severity, nightmare severity, and anxiety were predictors of BZRA deprescribing outcomes, controlling for site, gender, and age.

Results

Among participants assessed 1 week (n=133) and 6 months (n=106) after intervention, 77% and 66% discontinued their BZRA use, respectively. Worse PHQ-9 was associated with reduced odds of discontinuation (OR 0.88, 95% CI 0.79-0.99, p=.027) at 6 months, but not frequency of use or dose at follow up. Pain severity predicted more frequent use (b=0.26, p=.02) and higher dose (b=0.94, p=.016) but not discontinuation at 6 months. DDNSI (p values >=.068) and GAD-7 (p values >= 0.15) were not significant predictors of discontinuation, frequency, or dose at follow-up.

Conclusion

More severe depression at baseline is a predictor of BZRA deprescribing failure long-term. Pain is also a barrier to BZRA reduction efforts. Programs aimed at reducing and discontinuing BZRAs used for insomnia should consider interventions that not only address underlying insomnia, but also depression and pain.

Support (if any)

NIA R01AG057929; VA IIR 17-234
0733 The Association of Nocturia and Napping with Obstructive Sleep Apnea Among Older Adults with Insomnia and/or Daytime Sleepiness
Authors: Polisetty Lakshmi , Pan Yulu , Iannone Lynne , Knauert Melissa , Yaggi Klar , Gill Thomas , Miner Brienne
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is underdiagnosed in older adults (OAs) due to the poor performance of screening questionnaires. Symptoms of nocturia and napping may improve the identification of OSA in this population. We examined the association of these symptoms with OSA in OAs, and whether the association differed by gender.

Methods

In a prospective, observational study among 39 community-living adults ≥ 65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we evaluated the association of nocturia and napping with OSA. Nocturia was assessed by the self-reported average number of times getting up to urinate at night. Napping was evaluated by self-reported number of naps/week, average nap duration (in minutes), and napping minutes/week (naps/week x minutes/nap). OSA was assessed by the Apnea Hypopnea Index (AHI) from home-based polysomnography. We used Pearson correlation coefficients to examine the strength of the association of nocturia and napping with AHI among all subjects, and separately in men and women.

Results

In all participants, the mean age was 74+/- 6.8 years, 72% were women, and the mean AHI was 19+/- 15.9 events/hr. When compared to women, men reported more nocturia (1.6 vs.1.3 episodes/night), more napping (including naps/week [3 vs. 2], nap duration [31 vs.17 minutes], and napping minutes/week [150vs. 55 minutes]). In addition, they had higher AHIs (25 vs.16 events/hr). Among all participants, nocturia was not significantly correlated with AHI, while nap duration and napping minutes/week were significantly correlated with AHI (p values < 0.02). Among 11 men, nap duration and minutes per week were correlated with AHI (correlations 0.74 [p=0.009] and 0.56 [p=0.07], respectively). Among women, no napping characteristics were significantly correlated with AHI.

Conclusion

Among community-dwelling OAs with insomnia and daytime sleepiness, napping, and not nocturia, was associated with OSA. This association was driven by the strong correlation among men, particularly for nap duration. Napping may be a good screening question for OSA in older men, but examination of other symptoms is warranted in older women.

Support (if any)

Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342), the Robert E. Leet and Clara Guthrie Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).
0738 Association of socio-demographic determinants, smoking, and obesity with sleep trouble among women of reproductive age
Authors: Park Ariel , Thakur Bhaskar , Khan Safia
Published: May 2023

Introduction

While sleep quality in women is well known to be affected by hormonal factors such as menstrual cycle, pregnancy, and postpartum period, the connections between their sleep and socio-demographic characteristics are not widely studied. Our study objective was to examine the self-reported sleep problems among women of reproductive age in the US and their association with socio-demographic determinants of health as well as other health-related factors using the National Health and Nutrition Examination Survey (NHANES).

Methods

We analyzed a secondary data with 5,610 female participants aged 15 to 49 years who participated in the NHANES conducted during 2013 – 2018 to examine for the prevalence of self-reported sleep trouble as well as socio-demographic determinants (age, ethnicity, marital status, education, and income) and the presence of smoking and obesity. A design-based F-test and survey-based generalized linear model with Poisson family and log link function were performed to estimate the adjusted and unadjusted prevalence ratio (PR) with statistical significance of associated factors.

Results

The likelihood of trouble sleeping for those in the age group of 41 to 49 were significantly higher than those in the age group of 15 to 20 (PR 1.77 [95% CI 1.14-2.77]). Significantly more minority women including non-Hispanic Asian (PR 0.46 [95% CI 0.32-0.67]), Hispanic (PR 0.63 [95% CI 0.46-0.86]), and non-Hispanic black (PR 0.73 [95% CI 0.54-0.99]) reported less likely to have trouble sleeping than non-Hispanic multiracial group. When looking at marital status, married individuals reported less trouble sleeping (PR 0.83 [95% CI 0.80-0.99]) as compared to those who never married. Smoking was also associated with more trouble sleeping (PR 1.43 [95% CI 1.27-1.61]). Prevalence of reporting trouble sleeping was significantly higher for obese women compared to those with normal weight (PR 1.25 [95% CI 1.07-1.46]). There were no statistically significant differences in reported sleep trouble based on education status and income.

Conclusion

Using the large-scale population-based cross-sectional survey analysis, we identified that the problem of sleep disturbance was independently and positively associated with the higher age, unmarried, smokers and obese women in the reproductive age group.

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0751 Early Childhood Sleep Associated with Adolescent Sleep Physiology among Youth with ADHD
Authors: Lunsford-Avery Jessica , Kollins Scott , Krystal Andrew
Published: May 2023

Introduction

Sleep complaints are prevalent and impairing symptoms among adolescents with ADHD. Our recent work has shown that key aspects of sleep physiology differentiate adolescents with ADHD from healthy controls (HC), including reduced slow-wave sleep percentage (SWS%) and relative delta power (rDelta) and increased stage 2 percentage (N2%) and relative sigma power (rSigma) after accounting for sleep duration. ADHD-related sleep problems may emerge as early as toddlerhood, yet little is known about the trajectory of sleep disturbances over time in ADHD. The current study examines relationships between early childhood sleep problems and adolescent sleep physiology in ADHD and HC.

Methods

Sixty-two medication-free adolescents (31 with ADHD, mean age=15.3, 50% female) completed a diagnostic interview (Mini International Neuropsychiatric Interview) and 3 nights of at-home polysomnography. Spectral analysis was conducted on a single O1-C3 channel. Caregivers reported on participants’ sleep problems during toddlerhood and preschool (Child Behavior Questionnaire; CBQ). Linear regressions controlling for age, sex, and pubertal status examined relationships between early childhood sleep problems and aspects of sleep physiology implicated in adolescent ADHD (SWS%, rDelta, N2%, rSigma) and whether associations differed between groups.

Results

Adolescents with ADHD had greater caregiver-reported early childhood sleep problems compared to HC (t(60)=3.71, p<.001). In the full sample, greater caregiver-reported sleep problems in early childhood were associated with reduced SWS% (β=-.28, p=.04) and rDelta (β=-.27, p=.04), and increased rSigma (β=.33, p=.02), in adolescence. An early childhood sleep by group interaction was observed for rDelta (β=1.09, p=.04), such that the association was significantly stronger for adolescents with ADHD than HC.

Conclusion

The current study found that sleep problems in early development were associated with disruptions in sleep physiology in adolescents, including relatively less time spent in SWS, reduced delta power, and increased sigma power. Results suggest that ADHD-related sleep problems may begin early in life and persist into adolescence. Screening for and treating sleep problems during early development may be important for supporting sleep health among adolescents with ADHD, and future studies should assess this possibility. Future studies employing longitudinal designs may clarify the contribution of sleep disturbances to the onset and persistence of ADHD symptoms across development.

Support (if any)

K23MH108704; R34MH128440
0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood Pressure During Late Adolescence
Authors: Phillips Shameka , Li Peng , Ward Teresa , Chandler-Laney Paula , Bowen Pamela , Affuso Olivia , Rice Marti
Published: May 2023

Introduction

Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence.

Methods

This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions.

Results

This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p < 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model.

Conclusion

This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group.

Support (if any)

1st author - NHLBI T32HL105349 & NICHD 5T32HD101397-03
0758 Initial Efficacy of a Brief, Trauma-Informed Sleep Intervention for Children in Foster Care
Authors: Alfano Candice , Rech Megan , Harmouch Sirine
Published: May 2023

Introduction

Children in foster care experience impairing sleep problems that contribute to greater attachment, emotional and behavioral problems concurrently and over time. Sleep nonetheless remains a critically neglected aspect of health among this vulnerable group. To address the unique sleep needed of this population, we developed a brief, telehealth-delivered behavioral sleep intervention for caregivers of young children currently or formerly in foster care, called Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T). The current study examined the initial efficacy of SAFE-T.

Methods

N = 25 foster or adoptive foster parents with a 2- to 5-year-old child (M = 3.9; SD = 1.7) were recruited from the state of Texas. After a baseline assessment including the Children’s Sleep Habits Questionnaire (CSHQ) and Parenting Stress Index (PSI), families were randomized to SAFE-T or an active control group. SAFE-T families (n = 14) received 3 telehealth-delivered sessions with a therapist who provided information about healthy sleep and trauma-informed suggestions for reducing child sleep problems. Control families (n = 11) were sent an informational booklet about sleep to keep. A post-treatment assessment was completed approximately one month after he initial assessment.

Results

Compared to the control group, the SAFE-T group evidenced greater reductions in total CSHQ sleep problem scores (η2 = .14), including Sleep Anxiety (partial eta squatted = .16), Sleep Onset Delay (η2 = .08), Bedtime Resistance (η2 = .09) and Daytime Sleepiness (η2 = .07) scores at post treatment. Based on the PSI, caregivers in the SAFE-T group reported greater reductions in Difficult Child scores (η2 = .35), Parent-Child Dysfunctional Interactions (η2 = .31) and Parenting Stress (η2 = .16) compared to the control group.

Conclusion

Medium to very large effects were found for reductions in caregiver-reported child sleep problems as well as parenting stress following intervention with SAFE-T. These promising results suggest that a brief, trauma-informed sleep intervention may be effective in improving child sleep health and caregiver well-being in foster families.

Support (if any)

This study was funded by the Grant to Enhance and Advance Research (GEAR) from the University of Houston.
0760 Applying machine learning to examine settling down period for children with and without sensory hypersensitivities
Authors: Hartman Amy , Kocanaogullari Deniz , Soehner Adriane , Bendixen Roxanna , Akcakaya Murat
Published: May 2023

Introduction

Children with sensory hypersensitivities have poorer subjective sleep health than their peers. However, traditional actigraphy variables (e.g., sleep efficiency, sleep duration) do not adequately capture these sleep deficits. In qualitative interviews, caregivers of children with sensory hypersensitivities identified the settling down period prior to sleep as a major family stressor, potentially indicating a novel target for intervention. We applied machine learning techniques to thoroughly characterize and discriminate differences in the settling down period for children with and without sensory hypersensitivities.

Methods

Children (ages 6-10) with sensory hypersensitivities (n=20) and children without sensory hypersensitivities (n=29) wore the GT9X Actigraph continuously for 2 weeks and caregivers completed daily sleep diaries. Settling down period (caregiver reported start of settling down until actigraphy indicated sleep onset) was isolated for each night and 7 features were extracted from the activity data (mean magnitude, maximum magnitude, kurtosis, skewness, Shannon entropy, standard deviation, interquantile range). Ten-fold cross-validation with random forests were used to determine the accuracy, sensitivity, and specificity of differentiating groups.

Results

We achieved an 83% accuracy in classifying children with sensory hypersensitivities versus those without hypersensitivities (sensitivity = 84%; specificity = 82%). Feature importance maps showed that the most important feature for differentiating groups was maximum activity count magnitude during the settling down period; children with sensory hypersensitivity had higher maximum bouts of activity during settling down. The hypersensitive group also showed a higher variance in activity during settling down, as demonstrated by greater interquartile range (variance within the time window), standard deviation of activity, and Shannon entropy (the amount of uncertainty in the time window).

Conclusion

Our novel machine learning analysis successfully uncovered objective features within the settling down period that differentiate children with sensory hypersensitivity from their peers. Our data highlights exciting new potential targets for intervention: children with sensory hypersensitivities have larger and sporadic bouts of activity during their settling down period that clearly set them apart from their peers without hypersensitivities.

Support (if any)

T32 HL082610, University of Pittsburgh School of Rehabilitation Science Doctoral Award (PI Hartman), Sensory Integration Education PhD Student Grant (PI Hartman).
0764 End of daylight saving and sleep children 4-24 months
Authors: Lucchini Maristella , Thakur Shambhavi , Barnett Natalie , Anders Thomas
Published: May 2023

Introduction

Daylight saving time (DST) imposes a twice yearly 1h change in local clock time. Although it may seem a small adjustment, there is increasing awareness of the potential acute and long term effects at the individual and population level. Several studies have shown detrimental effects on sleep patterns, but mostly focusing on adults. Only one study has looked at the effect in infants’ sleep of change from standard time (ST) to DST, reporting negative effects. One study limitation was the reliance on parental reports of infant sleep. In addition, effects of the change from DST to ST are unknown. We hypothesize that the change from DST to ST would lead to earlier rise times, leading to sleep loss in the week following the change.

Methods

Caregivers of 510 children ages 3-24 mos (M=9.8 mos) tracked their child’s sleep using Nanit baby-monitor. Sleep metrics analyzed were: Nighttime sleep duration (NSD) and midpoint, number of night-wakings and sleep efficiency. Wilcoxon rank sum tests compared the average of each sleep metric for the week preceding the time change (Oct 31st-Nov 4th 2022, Baseline) with sleep metrics for each night of the following week (Nov 7-11 2022, post-DST week). Analyses were repeated stratifying by age group (4-6,7-12 and 13-24 months).

Results

After the time change, there was no change in NSD or sleep efficiency. There was a significant decrease in the number of night-wakings for infants 3-6 months, with an average of 0.5 fewer wakings per night compared to Baseline (Baseline mean=5 wakings). Midpoint was significantly earlier for all ages by an average of 10min, every day of the post-DST week.

Conclusion

The return to ST affected infants’ sleep midpoint. Observed effects were minor compared to those reported in previous literature for the ST to DST change, in line with other fields like cardiovascular health. This easier adjustment could be attributed to the fact that during DST there is an increased mismatch between body clock and social clock time, thus infants more readily adjust to a return to ST which minimizes this mismatch.

Support (if any)

This research was supported by Nanit
0787 Sleep Problems and Sleep Disorders in Children with Rubinstein-Taybi Syndrome
Authors: Srisinghasongkram Pornchada , Simakajornboon Narong
Published: May 2023

Introduction

Rubinstein-Taybi syndrome (RSTS) is a genetic condition which characterized by distinctive facial features, broad and angulated thumbs and halluces, short stature, and moderate-to-severe intellectual disability. Sleep problems have been reported in children with RSTS. However, most studies were case reports in adult population. There is limited information on details about sleep problems in children with RSTS. The purpose of this study was to: (1.) Describe the demographics, clinical presentation of children with RSTS; (2.) Describe polysomnographic findings, sleep diagnoses and treatments of children with RSTS.

Methods

A retrospective study was performed in patients with RSTS (ages 0-20 years) who underwent polysomnography at Cincinnati Children’s Hospital Medical Center from January 1, 2000 to October 31, 2022. Demographics, clinical presentation, polysomnographic findings, diagnoses and treatments were reviewed. Descriptive statistics were utilized.

Results

Thirteen children with RSTS were included, 69% were male (N=9). The median age was 6.3 years (range 13 days to 12.6 years). The most common presenting symptoms included snoring (N=9, 69.2%), pauses of breathing (N=6, 46.2%) and nighttime awakenings (N=5, 38.5%). The age of onset of sleep symptoms ranged from birth to 5 years. From polysomnographic findings, the most common diagnosis was obstructive sleep apnea (OSA) (N=11, 84.6%) with obstructive apnea-hypopnea index ranging from 2.8 to 72.7/h, (mild, N=3; moderate, N=3; severe; N=5). All children with mild OSA (N=3) were treated with medications, while children with moderate-to-severe OSA were managed with PAP therapies (N=4), supplemental oxygen (N=3), and surgeries (N=3). Other diagnoses included central sleep apnea (N=2) and periodic limb movement disorder (N=2), which were treated with supplemental oxygen and iron supplements, respectively.

Conclusion

The most common presenting sleep symptoms in children with RSTS were snoring, pauses of breathing and nighttime awakening. The age of onset of symptoms was variable, but usually occurred during infancy through childhood. OSA was the most common diagnosis in these populations. Physicians should recognize the early signs and symptoms of sleep problems in children with RSTS to allow early diagnosis and appropriate treatment.

Support (if any)

Cincinnati Children's Hospital Research Fund
0788 Sleep Profile of Adolescents Following Posterior Spinal Fusion
Authors: Cucchiaro Giovanni , Ortiz Luis , Fierstein Jamie , Gray Geoffrey , Ahumada Luis , Householder Kym , Tudor Brant , Rehman Mohamed
Published: May 2023

Introduction

Major musculoskeletal operations can have a prolonged impact on patients’ quality of life during the postoperative period. Sleep patterns can be affected by general anesthesia, complex and prolonged operations, and post-surgical care. Sleep disturbance can be considered a determinant of poor postsurgical outcomes. In this study, we examined the sleep profile of adolescents who underwent Posterior Spine Fusion (PSF) utilizing the FitBit Charge 4TM wearable device.

Methods

Patients were approached at the time of their evaluation in the orthopedic office once they had been scheduled for PSF. Patients received a Fitbit Charge 4TM at the time of enrollment. Total sleep time (TST), the duration of REM and Deep Sleep phases, and sleep efficiency were obtained from patients’ FitBit4 data and were calculated by averaging data recorded over a 2-4-day period during the week prior to surgery, during the hospital stay, one-two-three weeks, and 3 months after patients were discharged home. Patients were given a PROMIS sleep questionnaire delivered to their cellular phone using Qualtrics the week before the hospitalization, during hospitalization, and 3 months after surgery. Pain scores were obtained every 4-6 hours during the patient’s hospital stay using the self-reporting numeric scale.

Results

16 patients (10 female (62%)) completed the 3 months study period. Mean age was 16±1.9 years. The average length of hospitalization was 3 days. The average TST, REM, and DEEP sleep at baseline was 387±111, 74±28, 75±25 minutes respectively. TST, REM, and DEEP sleep decreased during the acute post-operative period and gradually increased during the follow-up period going to baseline values by the 3rd post-surgery week in 72% of the cases. Perception of sleep showed mild disturbance at baseline and worsened during the hospital stay based on PROMIS scores with improvement or return to baseline by the 3rd month post-operatively in 86% of patients.

Conclusion

Sleep phases of adolescents are affected after a major surgery. Similar to patients of other major surgeries, these changes are short-lived and returned to baseline by the 3rd post-operative week. There was a broad range of changes among subjects during the study period.

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