bluuebunny/crossref_metadata_2025 huggingface dataset:
0230 Sleep Duration Associated with Hospital Utilization in the US: Revisiting Andersen's Behavioral Model of Health Service Use
Authors: Moise Rhoda , Narcisse Marie-Rachelle , Locklear Clarence , Turner Arlener D , Seixas Azizi , Rogers April , Jean-Louis Girardin
Published: May 2023

Introduction

One in three Americans is sleep deprived, sleep disturbances are associated with greater health service utilization and costs. This study examined factors associated with Emergency Department visits (ED) and overnight admission hospitalization (OA) in a large representative sample of adults aged ≥18 in the US.

Methods

Guided by Andersen's Behavioral Model of Health Service Use, zero-inflated negative binomial and multivariable logistic regressions were used to examine associations between predisposing, enabling, and health needs factors and health service utilization (α=0.05).

Results

ED visits significantly increased with age, female sex, Black race, and less than high school education (15%, 36%, and 85%, respectively). Enabling factors analysis found that those who were unemployed, had problems paying medical bills, lived under the federal poverty line, and did not have private insurance were more likely to have ED visits. ED visits also increased by health needs including adults reporting poor/fair health, increased number of chronic conditions, and very short or long sleep. Regarding OA, significant risk predisposing factors included female sex and foreign-born nativity. Factors for OA found adults who were unemployed and had with problems paying bills were more likely to be hospitalized. Adults with Medicaid, Medicare, and other insurance were more likely (70%, 34%, 44%, respectively) to be hospitalized. Of the health needs factors examined, OA odds increased for those with less than excellent health status, without a usual source of care, and an increased number of chronic conditions. Adults with very short or short sleep were also more likely to be hospitalized (48% and 22%, respectively).

Conclusion

This is the first-time sleep duration is examined as a health needs component of Andersen's Behavioral Model of Health Service Use. When determining predictors associated with hospital utilization, sleep duration should be considered a key factor as it significantly increases the odds of ED visits and overnight hospital admissions. Future studies should investigate the influence of other dimensions of sleep health and sleep disorders.

Support (if any)

Programs to Increase Diversity among individuals engaged in Health-Related Research (PRIDE) training grant from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI): R25HL-10-5444 (PIs: G Jean-Louis, OG Ogedegbe).
0231 Slow Wave Activity During Restricted Sleep Buffers Against Negative Effects on Daytime Positive Emotion in Pre-pubertal Children
Authors: Rech Megan , Baran Bengi , Myers Annika , Palmer Cara , Alfano Candice
Published: May 2023

Introduction

Increased slow-wave activity (SWA) following sleep loss is a well-established physiological marker of increased sleep pressure. Recent research found SWA changes in response to sleep loss partially accounted for next-day decrements in positive affect (Finan et al., 2015; 2017). To our knowledge, however, this line of inquiry has been limited to adults. Recently, we found greater SWA during a night of healthy sleep predicted greater next-day positive emotion among pre-pubertal children (Rech et al., 2022). Here, we explored whether SWA during the second of two nights of partial sleep restriction predicted next-day emotional responses in the same cohort.

Methods

N=24 healthy, unmedicated children (7 to 11 years) completed a baseline assessment and one night of at-home PSG monitoring (10 hours in bed). Ten days later, children completed one night of at-home sleep restriction (7-hour sleep opportunity) followed by one night of in-lab sleep restriction with PSG monitoring (6-hour sleep opportunity). The next day, children completed an in-lab emotional assessment where they provided arousal and valence ratings in response to positive affective images from the International Affective Picture System (IAPS).

Results

Controlling for age and total sleep time during the first sleep restriction night, hierarchical multiple regression analyses examined if N3 SWA in frontal, central, and occipital regions during the second sleep restriction night predicted IAPS ratings. In separate models, both frontal, F(1,20)=8.535, p=.008, and occipital SWA density, F(1,20)=12.313, p=.002, predicted valence ratings in response to positive images (where lower scores indicated more positive valence).

Conclusion

While preliminary, findings indicate relationships between “rebound” SWA after sleep restriction and next-day emotional functioning in pre-pubertal children. Findings suggest that, prior to the pubertal transition, trait-based differences in homeostatic sleep pressure and recovery from sleep loss might alter emotional responding, potentially influencing risk for later mood disturbances.

Support (if any)

This research was supported by NIMH grant #R21MH099351 awarded to C.A.A.
0232 A mindfulness intervention to improve sleep in a diverse sample: results from a pilot feasibility study
Authors: Johnson Dayna , Ward Laura , Jagtiani Ashna , Johnson Leslie , Barber Lauren , Gujral Unjali
Published: May 2023

Introduction

Emerging data suggests that stress is a contributor to sleep health disparities. Mindfulness techniques are effective at reducing stress, yet limited studies have examined its effect on sleep among a diverse sample. We examined stress, sleep, and cardiovascular risk factors before and after participation in a pilot 30-day mindfulness intervention study.

Methods

Among a sample of Asian, Black, Hispanic, and White young adults (n=18), participants underwent 35-days of wrist actigraphy, completed questionnaires on stress (Perceived Stress Scale) and sleep patterns (Pittsburgh Sleep Quality Index) and provided blood pressure and weight measurements at baseline, midpoint, and endpoint. Following approximately 5-days of actigraphy, participants received 1-hour of sleep hygiene education and started a 30-day mindfulness meditation via a mobile application (Headspace™). We calculated means and standard deviations (SD) or frequencies for stress levels, sleep quality, and sleep duration, body mass index, and blood pressure before and after the intervention.

Results

Participants on average were 30 years of age (SD=10.2), 88.9% female, and identified as Asian (11.1%), Black/African American (44.4%), Hispanic (22.2%-not mutually exclusive), and White (33.3%). Most participants had a bachelor’s degree or higher (88.9%). After completing the intervention, participants decreased in stress levels [15.7 (SD=7.7) vs. 13.4 (SD=7.5)] and poor sleep quality [8.3 (SD=2.1) vs 5 (SD=2.2)]. The distribution of short sleepers decreased, 27.8% to 11%. There were no changes in actigraphy-measured sleep duration. The prevalence of obesity and elevated blood pressure decreased from 53% to 47% and 16.7% to 11.1%, respectively.

Conclusion

We found it feasible to conduct a 30-day app-based intervention among a predominately racial/ethnic minority population. There were modest decreases in stress, short sleep, obesity, and hypertension after the completion of the intervention. Our results suggest stress reduction may be an avenue to improve sleep and cardiovascular health among racial minorities. These results should be replicated in a larger sample to confirm.

Support (if any)

National Institutes of Health, National Institute for Heart Lung and Blood 1R01HL157954 and K01HL138211; Georgia Center for Diabetes Translation Research (GCDTR) Pilot & Feasibility Pilot Award Program
0234 Sleep health disparity and frailty in middle aged people living with HIV in an African setting
Authors: Zheng Xi , Mosepele Mosepele , Cai Ruixue , Gao Chenlu , Ponatshego Ponego , Gao Lei , Montano Monty , Hu Kun , Li Peng
Published: May 2023

Introduction

The aim of this proof-of-concept study is to explore sleep health disparity and associations with frailty in middle-aged (i.e., age< 65 years) people living with HIV (PLWH) in an African setting.

Methods

Data were from 98 participants (age: 56.8±4.3 [mean±SD] years; female: 49 [50%]) enrolled in Botswana, Africa, between March-December 2021. Forty-eight participants were HIV seropositive (i.e., PLWH) and on suppressive antiretroviral therapy regimens; 50 participants were confirmed uninfected (i.e., controls). PLWH and controls were matched for age and sex. Sleep health was assessed subjectively based on answers to two questions related to sleep quality, and was scored 1 (i.e., better sleep quality) if the participant answered “very much” to question “I am sleeping well” and “not at all” to question “I need to sleep during the day” or 0 (i.e., worse sleep quality) if otherwise. To assess frailty, 29 health deficits related to weight loss, obesity, physical activity, emotion, and fatigue were examined to construct a composite frailty index ranged between 0 and 1 (i.e., 0=no deficit present and 1=all deficits present). Logistic regression and linear regression models were conducted respectively to compare sleep quality (dichotomous) and the frailty index (continuous) between PLWH and controls. In addition, linear regression models were used to examine the association between frailty index and sleep quality stratified by HIV serostatus. All models were adjusted for age and sex. Statistical significance was rendered at p< 0.05.

Results

PLWH displayed 2.5-fold higher odds of having worse sleep quality compared to controls (PLWH: 61.4%, controls: 38.6%; p=0.02). The frailty index did not differ significantly between PLWH (0.15±0.08 [mean±SD]; range: [0.02, 0.36]) and controls (0.14±0.10; range: [0.03, 0.56]; p=0.6). Within PLWH, having worse sleep quality was significantly associated with an increase in the frailty index (0.76 SD of the group) (p< 0.001). No significant association was observed in HIV-seronegative controls (p=0.4).

Conclusion

Treated PLWH had worse self-reported sleep than controls, and worse sleep quality in PLWH is linked to an increased burden of physical frailty in Africa. Future studies are warranted to elucidate the causal direction and underlying mechanisms.

Support (if any)

Developmental Award (CFAR; P30AI060354); Pilot Grant (HIV&Aging; R33AG067069-02).
0235 Social Jetlag and Diet Quality Among US Young Adults
Authors: Lyu Xiru , Dunietz Galit , Leung Cindy , Jansen Erica
Published: May 2023

Introduction

Young adults are among the populations with the lowest quality diets in the US, and poor sleep could be a contributing factor. Social jetlag, the lack of consistent sleep timing from weekdays to weekends, is also more common among young adults. Our objective was to examine associations between social jetlag and diet quality among US young adults, and to evaluate effect modification by sex or race/ethnicity.

Methods

The study population included 1,308 adults aged 20-39 who participated in the 2017-2018 National Health and Nutrition Examination Survey. Social jetlag was considered as ≥2-hour difference in sleep midpoint (median of bedtime and wake time) between weekends and weekdays. Diet quality was assessed with the Healthy Eating Index (HEI)-2015, which is comprised of 13 dietary components and ranges from 0 to 100 (higher scores=better diet quality). Scores were binned into three groups based on tertile cutoffs. Ordinal logistic regression analyses were utilized to evaluate the relationship between social jetlag and HEI-2015 scores as well as the individual HEI components, adjusting for age, sex, race/ethnicity, educational attainment, recent tobacco use and physical activity. Effect modification by sex and race/ethnicity were also considered.

Results

In the analytic sample, 31% of young adults had social jetlag. Overall, there were no associations between social jetlag and diet quality. However, interaction analysis revealed several associations were race-specific (P, interaction< 0.05). Among Black adults, social jetlag was associated with lower overall diet quality (OR = 0.4, 95% CI 0.2, 0.8; i.e., less likely to be in higher diet quality tertiles) and more unfavorable scores on total vegetables (OR = 0.6, 95% CI 0.3, 1.0) and added sugar (i.e., OR = 0.6, 95% CI 0.4, 0.9). For Hispanic adults, social jetlag was associated with higher intakes of sodium (OR=0.6, 95% CI 0.4, 0.9) However, White adults with social jetlag had higher intake of greens and beans (OR = 1.9, 95% CI 1.1, 3.2).

Conclusion

Within a nationally-representative sample of US young adults, social jetlag was related to certain indicators of lower diet quality among Black and Hispanic Americans.

Support (if any)

Dr. Jansen was supported by K01HL151673.
0236 Assessing the Impact of Race and Income on Children's Sleep Habits
Authors: Hansen Devon , Sherick Courtney , Skeiky Lillian
Published: May 2023

Introduction

Ample research supports the need for adequate sleep to develop normal physical and mental health throughout childhood. While objective sleep monitoring is ideal, it is not always practical in real-world settings. Therefore, subjective reports provide a more realistic alternative. The validated Children’s Sleep Habits Questionnaire (CSHQ) requires parents/caregivers to retrospectively report sleep quality in school-aged children. In a nation-wide study, we compared CSHQ ratings to determine any relationship with sleep quality and demographic variables.

Methods

CSHQ and demographic questionnaires were completed for n=152 children (ages 3-12y, 63% Male, 37% female), 45% African American and 55% Caucasian. Means of CSHQ scores and demographic variables were compared using independent t-tests and chi-square test of independence.

Results

Overall, African American children had lower reported sleep quality compared to Caucasian children (t150= -3.77, p< 0.001). Additionally, reported sleep quality was lower in households earning less than 100K compared to those earning more than 100K (t146= 2.69, p< 0.01), with more African American families earning less than 100K compared to Caucasian families (Χ2(1) = 11.99, p < 0.001).

Conclusion

Our results are consistent with previous research indicating that African American children have lower reported sleep quality than their Caucasian counterparts. While families with lower income report higher rates of sleep disturbance, this appears to be more prevalent in African American households. Although significantly different, both groups reported high levels of sleep disturbance, highlighting the need for general sleep education as well as the development of interventions tailored to different ethnic groups and demographic levels.

Support (if any)

Elson S. Floyd College of Medicine Dean’s Excellence Award Scholarship
0241 Sleep Across the Lifespan in Hispanic/Latinx Adults
Authors: Soto Pablo , Ramos Mayra , Dautovich Natalie , Corona Rosalie , Dzierzewski Joseph
Published: May 2023

Introduction

Studies examining racial/ethnic sleep disparities have observed that minoritized individuals are more likely to experience poor sleep compared to non-Hispanic whites. Existing research on Hispanic/Latinx (H/L) individuals further reinforces this assertion. However, to date, little attention has been paid to lifespan examinations of sleep within minoritized groups. The present study assessed sleep characteristics differences across the lifespan within a large sample of H/L adults. We hypothesized that older adults would report more concerns and symptoms associated with impaired sleep.

Methods

Participants included 1,072 (63.3% female; µ=36.43) adults who self-identified as H/L and completed an online survey assessing insomnia symptoms (Insomnia Severity Index), sleep-related daytime impairment (PROMIS Sleep-Related Impairment), sleep regularity (Sleep Regularity Questionnaire), subjective sleep quality (Pittsburgh Sleep Quality Index), and self-reported sleep duration. A One-Way ANOVA was utilized to detect mean differences in sleep markers across age groups [Young (18-25), Middle (30-50), and Late adulthood (55+)]. Significant mean differences were further analyzed with Duncan’s post hoc analysis.

Results

The One-Way ANOVA revealed significant mean differences across all sleep markers analyzed: insomnia symptoms, F(2, 1069)=67.459, p<.001; sleep-related daytime impairment, F(2, 1069)=77.465, p<.001; sleep regularity, F(2, 1069)=74.091, p<.001; sleep quality, F(2, 1069)=29.300, p<.001; and total sleep duration, F(2, 1069)=5.898, p=.003. Post hoc analyses revealed significantly more insomnia symptoms (µ=14.325) and poorer sleep quality (µ=1.623) in late adulthood compared to younger (µ=8.270; 1.092) and middle-aged (µ=10.186; 1.345). As well as significant elevations in sleep-related daytime impairment (µMiddle=22.314; µLate=23.508) and poorer sleep regularity (µMiddle=16.556; µLate=16.704) in middle and late adulthood compared to younger adults (µ=16.056; 13.054). Lasty, young adults slept (µ=6.756) significantly less than middle and late adulthood (µMiddle=7.025; µLate=7.162).

Conclusion

Results suggest that age is important factor in the consideration of sleep among H/L adults. These findings generally point to an increase in poor sleep as age increases. It’s important to consider this trend when working with minoritized individuals due to the disproportionate burden of sleep factors being potentially compounded by age.

Support (if any)

This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).
0243 SLEEP REGULARITY AND MENTAL HEALTH DURING EXTENDED ANTARCTIC RESIDENCE
Authors: Cifre Anthony , Mi Qi , Ahamed Nizam , Bower Joanne , Connaboy Christopher , Simpson Richard , Alfano Candice
Published: May 2023

Introduction

As humans’ advance towards a Mars mission, ensuring astronaut safety, well-being, and performance becomes increasingly critical. Long-duration space exploration presents several challenges for human sleep, including altered photoperiods, prolonged confinement, and monotony. Antarctica provides an ideal analog for understanding how these and other stressors impact sleep over time. Prior studies among Antarctic cohorts have found reduced total sleep, increased sleep onset, and circadian phase delay. However, day-to-day regularity of sleep-wake patterns in the Antarctic over prolonged periods has not been studied.

Methods

Crew members (N= 110) at a coastal (McMurdo: MM, n = 88) and an inland Antarctic station (South Pole: SP, n = 22) were studied longitudinally for up to 9-months. Sleep was monitored continuously with actigraphy (Actiwatch Spectrum, Philips Respironics) and examined in relation to cumulative time on station and calendar month (photoperiod). Self-reported mental health symptoms were also examined monthly using The Mental Health Checklist (MHCL). The Sleep Regularity Index (SRI; Phillips et al., 2017) which calculates the percentage probability of an individual being in the same state (sleep vs. wake) at any two time-points 24 hours apart was calculated to examine sleep regularity over time.

Results

Controlling for time on station prior to participation, we observed no significant changes in monthly SRI over a 6-month period at MM where photoperiod alterations are less extreme. At SP, SRI remained very stable during months of total daylight but declined during winter months in the absence of sunlight. SRI scores were significantly different between month-8 and month-9 and with large effect sizes across month-7, month-8, and month-9. Participants with lower month-7 SRI scores had significantly higher MHCL poor self-regulation scores at the end of the mission.

Conclusion

Day-to-day variability in sleep–wake patterns is an important predictor of health and safety. Our findings show reductions in sleep regularity during prolonged Antarctic residence particularly at the SP station, where sunlight is absent for 6 months of the year. Less sleep regularity predicted worse mental health functioning. These findings suggest that mitigation the impact of altered light-dark cycles on sleep is critical for a Mars mission.

Support (if any)

NASA award #NNX15AC13G S014 to the last author.
0246 Current shift work and frailty: findings from the UK Biobank
Authors: Cai Ruixue , Zheng Xi , Gao Lei , Hu Kun , Li Peng
Published: May 2023

Introduction

Shift work may disrupt sleep and circadian rhythms, leading to adverse health outcomes. The objective of this study is to examine whether performing shift work is associated with frailty in middle- to older-aged adults.

Methods

We examined current shift work exposure and frailty risk in 242,126 UK Biobank participants (38-71 years old; 128,595 females). Using the baseline self-reported employment information, participants were categorized as shift workers (with ‘work schedule that falls outside of the normal daytime working hours of 9am-5pm’) or day workers if no shift work schedule. Based on a previously validated approach, frailty phenotype was identified when three or more of the following five criteria were fulfilled: self-reported weight loss, exhaustion, low physical activity, slow walking pace, and measured low grip strength. Multivariate logistic regression models were used to assess the association between shift work and frailty.

Results

Among 242,126 participants, 201,489 (83.2%) were day workers and 40,637 (16.8%) shift workers. Frailty was identified in 4,308 participants (1.8%), including 3,312 day workers (1.6%) and 996 shift workers (2.5%). Compared with day workers, shift workers were at higher risk for frailty after adjusting age, sex, and ethnicity, i.e., odds ratio (OR) =1.58 [95% CI, 1.47-1.70] (p < 0.0001). The effect of shift work appeared to be more pronounced in 5,659 permanent night shift workers (OR = 1.98 [95% CI, 1.68-2.32], p < 0.0001). The differences between day workers and shift workers persisted even after further adjusting for social economic status, sleep duration, and chronotype (OR = 1.38 [95% CI, 1.28-1.48] for all shift workers; OR = 1.53 [95% CI, 1.30-1.80] for permanent night shift workers, both p values < 0.0001).

Conclusion

Middle- to older-aged adults who were currently performing shift work, especially those permanent night shift workers, were more likely to be frail. Longitudinal and interventional studies are warranted to elucidate the causal relationship between shift work and the risk of frailty.

Support (if any)

BrightFocus Foundation (A2020886S), NIH (RF1AG059867, RF1AG064312)
0247 Developing and Implementing Sleep Health Education for Foster Care Personnel: A Qualitative Analysis
Authors: Hope Peter , Nogales Josephina Munoz , Endlein Morgan , Wolfson Amy , McGlinchey Eleanor , Alfano Candice , Ripple Carol
Published: May 2023

Introduction

Sleep during childhood has a major impact on physiological, psychological, and cognitive development, yet sleep health is a neglected part of training/education for foster parents and agency staff. This study examined foster care agency staff perceptions of child sleep problems encountered by foster caregivers in order to inform the development of a sleep health training program for foster care agency staff and caregivers.

Methods

N=36 staff members from public and private foster care agencies in Texas, New York, New Jersey, and Maryland were interviewed remotely. Questions included knowledge of sleep policies, concerns surrounding sleep, methods for addressing sleep concerns, and sleep training recommendations. Two members of the research team coded the interviews using the Atlas.ti program. Coders first independently reviewed and coded transcriptions for thematic key words without formal concepts before reviewing and refining themes/codes with the full research team for consensus.

Results

Eight interviews were coded for this preliminary analysis, focused on response to the question, “What kinds of questions/concerns/requests have you received from foster caregivers regarding children’s sleep?” Across the 8 transcripts, the code Fear/trauma associated with bed/sleeping (n = 22 occurrences) and Difficulty Sleeping (initiating, maintaining sleep) (n = 18 occurrences) were the most frequently reported concerns. Other codes included: Behavioral issues affecting issues fall asleep (n=11), Placement adjustment impacting sleep (n = 10); Lack of bedtime routine (n = 9); Concerns surrounding medication (n = 7); and Insufficient sleep impacting daytime functioning (n = 5).

Conclusion

Preliminary findings suggest that sleep training approaches and programs should focus on addressing fear and trauma associated with bedtime and sleeping, as well as establishing a healthy, consistent bedtime routine. Additionally, difficulties with the use of medications, placement adjustment, and behavioral issues manifesting around bedtime should be addressed.

Support (if any)

This research was funded by the AASMF grant: 266-CS-22.
0248 Disparities in Bed and Wake Times in the US Population
Authors: Mendoza Javier , Valencia Dora , Jean-Louis Girardin , Armenta M Denisse , Killgore William D S , Grandner Michael
Published: May 2023

Introduction

Although quality sleep is crucial for good health, well-being, and cognitive function, racial and ethnic minority populations are at an increased risk of having shorter sleep duration and poorer sleep quality in comparison to other groups. This study, which is nationally representative, intends to show differences in population-level sleep time. Population-level differences in timing have significant public health ramifications because of the important contribution that circadian rhythms play to health.

Methods

Data were obtained from adults who participated in the National Health And Nutrition Examination Survey (NHANES), overseen by the CDC, for the 2017-2018 and 2019-2020 (March, pre-pandemic) waves. These data were combined and weighted using NHANES sample weights. Habitual sleep timing was assessed as self-reported typical bedtime and wake time, which was converted to minutes from midnight. Race/ethnicity was self-reported as non-Hispanic White, Black/African-American, Mexican-American, Other Latinx, Asian, or Multiracial/Other. Covariates included demographics (age, sex), socioeconomics (education, income-poverty ratio), health (body mass index, overall health rating), mental health (depressed mood), and sleep health (sleep disturbance, daytime tiredness).

Results

In the fully-adjusted model, compared to non-Hispanic Whites, Blacks/African-Americans went to bed 17.8 minutes later (95%CI [6.011, 29.497], P=0.003) but did not differ regarding wake time. Asians went to bed 17.8 minutes later (95%CI [6.255, 29.365], p=0.003) and woke up 18.9 minutes later (95%CI [5.222, 32.626], p=0.007). Mexican-Americans went to bed 18.0 minutes earlier (95%CI [-30.722, -5.233], p=0.006) and woke up 33.9 minutes earlier (95%CI [-47.737, -20.112], p< 0.0005). The other groups did not significantly differ from non-Hispanic Whites. As a post-hoc analysis, habitual sleep duration was entered as an additional covariate, and bedtime differences between non-Hispanic Whites and Blacks/African-Americans were no longer significant.

Conclusion

Even after accounting for other elements of sleep, Blacks/African-Americans, and Asians still exhibit delayed sleep. This timing difference may reflect underlying circadian factors, or social ones that may influence timing of sleep. Future work should explore the possibility that circadian disparities exist as well, and may be related to health disparities since circadian rhythms play so many roles in health.

Support (if any)
0250 In-laboratory and at-home sleep assessments using wrist actigraphy in healthy individuals
Authors: Ishihara Asuka , Brychta Robert , LaMunion Samuel , Walitt Brian , Nath Avindra , Chen Kong
Published: May 2023

Introduction

Whole-room indirect calorimetry is the gold standard to measure metabolism during sleep. However, it is unknown whether sleep in a room calorimeter is reflective of a person’s natural sleep pattern or whether it suffers from limitations common to other in-laboratory assessments, such as the “first night effect”. To address this knowledge gap, we compared actigraphy-assessed sleep parameters measured in a room calorimeter with those measured at home to examine how research environments may alter natural sleep quality and patterns.

Methods

Ten healthy individuals (4 females; 41.5 ± 14.5 years old; 25.4 ± 4.2kg/m2) participated in the study (NCT02669212). Participants had no major sleep disturbances (Pittsburgh Sleep Quality Index; PSQI < 5) with minimal anxiety (0-7), assessed using the Beck Anxiety Index. The in-laboratory portion of the study was conducted in a whole-room indirect calorimeter with controlled diets and ambient temperatures. The out-patient, at home study was conducted for seven consecutive nights, further divided into weekday and weekend sleep for analysis. Sleep was measured with an ActiGraph wGT3X-BT accelerometer on the non-dominant wrist throughout the study.

Results

The in-laboratory total sleep time (TST) was 399.7 ± 85.7min, comparable to weekend sleep at home, which was 399.8 ± 57.6min (p=0.998). In-laboratory TST was slightly longer than weekday sleep at home (359.7 ± 69.3min), but was not significantly different (p=0.34). Sleep efficiency in all three conditions was similar for baseline (90.6 ± 6.3%), weekday (91.4 ± 4.5%), and weekend sleep at home (91.1 ± 4.9%). These results suggest that despite being in the laboratory, sleep in healthy individuals was not significantly affected by sleeping in the calorimeter. As expected, seven consecutive nights of sleep at home revealed a tendency for shorter total sleep time during the week (359.7 ± 69.3min) compared to the weekend (399.8 ± 57.6min) (p=0.095), suggesting the presence of social jetlag and circadian misalignment throughout the week.

Conclusion

The present study showed that actigraphy-measured sleep was not affected by sleeping in the whole-room indirect calorimeter in healthy individuals. Further studies would be crucial to address whether this trend holds for other study populations.

Support (if any)
0252 Social jetlag, sleep variability, its effect on sleepiness and mediation by sleep debt: an EPISONO study
Authors: Fernandes Guilherme , Vallim Julia , D'Almeida Vânia , Tufik Sergio , Andersen Monica
Published: May 2023

Introduction

Studies indicate the relevance of the timing system as integrating the causes and antecedents of sleepiness. Recently, social jetlag and sleep variability have been highlighted in regard to their relevance to sleep health. While the circadian misalignment represented by those variables have a known effect on sleepiness, it is often confounded by sleep debt. Therefore, we sought to assess the association between social jetlag, sleep variability and sleepiness, with sleep debt as a mediator in a representative population-based study.

Methods

A representative population-based sample of 1037 participants was analyzed. Participants answered the UNIFESP Sleep Questionnaire and Epworth Sleepiness Scale to collect data regarding sleep timing and subjective sleepiness, respectively. Subsequently, mid-sleep time, total sleep time, social jetlag (absolute difference between mid-sleep time on workdays and mid-sleep time on free days), standard deviation of mid-sleep time and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalized linear models were conducted to assess if sleep variability and social jetlag had an effect on the Epworth Sleepiness Scale score, with BMI as a control variable. A mediation model was run to test if observed significant effects were mediated by sleep debt.

Results

Average sleep variability was 0.69±0.5 hours, and prevalence rates were 23% for >1h and 12% for >2h of social jetlag. There was a statistically significant association between social jetlag and Epworth Sleepiness Scale score, independently of BMI. Moreover, this effect was significantly mediated by sleep debt. No association between sleep variability and sleepiness was observed.

Conclusion

The significant association between social jetlag and sleepiness and its mediation by sleep debt are evidence of their role in sleep health and should be considered as relevant factors in future population-based studies analyzing sleep.

Support (if any)

Our studies are supported by grants from the Associacão Fundo de Incentivo à Pesquisa (AFIP). GLF is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brazil (CAPES) – Finance Code 001) and CNPq (#141445/2021-1 to GLF). MLA and ST are Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) fellowship recipients.
0257 Topological Data Analysis of Electroencephalogram Signals for Pediatric Obstructive Sleep Apnea
Authors: Manjunath Shashank , Perea Jose , Sathyanarayana Aarti
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is difficult to diagnose and leads to significant complications, including poor rest and heart disease. Identification of OSA in patients typically requires a polysomnogram, which includes acquisition of electroencephalogram (EEG) signals in order to assist with identification of sleep stages. Recent advancements in signal processing technology, including topological data analysis (TDA), provide a novel new way to analyze EEG signals to assist with identification of OSA before disordered breathing occurs.

Methods

We leverage EEG signals from polysomnogram studies included in the Nationwide Children’s Hospital Sleep DataBank (NCHSDB) dataset for this study. This dataset includes 3,984 pediatric patients, of which we leverage 2,881 containing usable data. We analyze each sleep state (awake before sleeping, awake in between sleep, awake after study, N1, N2, N3, and REM sleep) individually. We first break the data into 30-second chunks, then compute a distance matrix based on the multivariate time series obtained as part of the polysomnogram for the delta, theta, alpha, beta, and gamma bands individually. We then apply TDA to the distance matrices, leading to a set of persistence landscapes for the 0th homology group. We then group persistence landscapes for OSA positive patients and OSA negative patients, and perform a permutation test for each frequency band, leading to a p-value indicating significance.

Results

Based on our permutation test, we find significant (p < 0.05) results in all bands for the N1 (p=0.0 for all bands), N2 (p=0.0 for all bands), N3 (p=0.0 for all bands), and REM sleep (p=0.023 for delta band, p=0.0 for all other bands) cases. In the cases when the patient is awake, we find significant differences in the delta (p=0.022), theta (p=0.007), and beta (p=0.002) bands in the awake before study case, the delta (p=0.003), theta (p=0.003), and beta (p=0.0) bands for the inter-sleep awake case, and no significant differences in the awake after study case.

Conclusion

Our results indicate that a statistically significant difference between OSA positive and OSA negative patients can be identified when patients are awake through topological data analysis.

Support (if any)
0260 Establishment of a polysomnography databank for sleep disorders in Japan
Authors: Kawamura Aoi , Matsui Kentaro , Yoshiike Takuya , Inoue Yuichi , Takeshima Masahiro , Ozone Motohiro , Suzuki Masahiro , Kuriyama Kenichi
Published: May 2023

Introduction

Polysomnography (PSG) has been suggested to be useful as an objective indicator (biomarker) that contributes to the diagnosis and severity evaluation of various sleep disorders. However, its regular use is still limited to the specialized institutions for sleep disorders. Therefore, PSG is essential for clinical diagnosis of only some sleep disorders, and further application of PSG in conjunction with biomarker development of disorders including such as insomnia, and psychiatric disorders with comorbid sleep disorders is expected. The aim of this project is to establish a PSG databank for sleep disorders in collaboration with major PSG laboratories in Japan.

Methods

This project is collaborated with medical and research institutions that conduct PSG on a large scale in Japan. The National Center of Neurology and Psychiatry (NCNP) serves as the core institution. The initial collaborating institution is the Tokyo Medical University, which is in cooperation with the Yoyogi Sleep Disorder Center, the largest PSG facility in the Kanto region. We also collaborate with three other core PSG facilities in the Kanto, Tohoku and Kyushu regions: the Nihon University, the Akita University (in cooperation with the Akita Sleep Clinic), and the Kurume University. This project has been approved by the Ethics Committee of the NCNP.

Results

We have stored about 3,000 PSG data evaluated by the standard of the American Academy of Sleep Medicine clinical practice guideline or the traditional Rechtschaffen & Kales standard with adjunct clinical metadata for the past 9 years at the NCNP, about 17,900 at the Tokyo Medical University, about 1,900 at the Nihon University, about 500 at the Akita University, and about 3,000 at the Kurume University. We are continuously collecting and banking data for enhancing research availability of the PSG databank for sleep disorders.

Conclusion

The collected data will be used for research on the development of objective indices for sleep disorders or neuropsychiatric disorders, for which objective indices are lacking in diagnosis and pathological evaluation.

Support (if any)

This work was supported by the Intramural Research Grant (#2-1) for Neurological and Psychiatric Disorders of NCNP.
0261 Sleep Disturbance Reliably Predicted by Pain Sensitivity in Sciatic Nerve Crush Injury Model
Authors: Ho Anh , Kim Tae , Lee Sungjun , Drew Victor , Kang Jiseung , Jung Jieun
Published: May 2023

Introduction

A bi-directional relationship between sleep and neuropathic pain is of interest because of its impact on human health. Numerous studies in humans and animals have examined the association between sleep and neuropathic pain. However, animal studies showed inconsistent results compared to human data. Therefore, validation of an animal model for sleep-pain association research is needed. We examined the animal models to identify a best-fit model predicting sleep disturbances with the level of neuropathic pain.

Methods

Adult male C57BL/6J mice (n=7 per group) were implanted with electrodes for electroencephalogram (EEG) and electromyogram. After two weeks of recovery, we obtained baseline EEG data for 24 hours and evaluated the paw withdrawal threshold, a measure of pain sensitivity, by the von Frey test. Afterward, sciatic nerve crush injury (SCI) and common peroneal nerve ligation (CPL) were conducted to make the two different neuropathic pain models. Post-surgery sleep was recorded continuously for 24 hours, followed by von Frey tests. EEG recording during the light period and von Frey tests were repeated on post-surgery days 5, 10, and 15.

Results

Both SCI and CPL models showed lower paw withdrawal thresholds after the peripheral nerve injury. NREM sleep duration on post-surgery day 1 was reduced significantly compared to baseline in both SCI and CPL, but only SCI showed decreased REM sleep. There was a significant positive correlation between paw withdrawal threshold and NREM sleep duration in SCI (P< 0.0001) but not CPL. Also, wake alpha and theta EEG powers were correlated with pain threshold.

Conclusion

We confirmed that both models of neuropathic pain disturbed sleep patterns. Nevertheless, sleep disturbances were reliably predicted by the pain sensitivity in the SCI model. Hence, we suggest SCI as a reliable pain model for studying the mechanism of sleep-pain association.

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0262 Comparing Wrist Actigraphy to a Novel Wearable (Actigpatch): Nonparametric Activity Estimation
Authors: Markowitz Alexandros , Barker David H , Saletin Jared , Gredvig-Ardito Caroline , McGeary John , Carskadon Mary
Published: May 2023

Introduction

Wrist actigraphy is a standard for monitoring sleep in the field; however, data quality is reduced if participants remove the device. The Actigpatch is a novel, adhesive water-resistant wearable that we have previously demonstrated as comparable to wrist actigraphy for traditional sleep-wake estimation. Here we compare assessment of nonparametric activity indexes.

Methods

While following fixed schedules, 39 participants simultaneously wore the Micro Motionlogger actigraph (Ambulatory Monitoring Inc., Ardley, NY) on their non-dominant wrist and the Actigpatch (Circadian Positioning Systems, Newport, RI) over the triceps of their dominant arm. Our analyses included 35 participants (21F; 32.9±13.2yrs) who contributed ≥four nights of data (range: 4-14 [mean: 10] nights). After matching devices’ tri-axial actimetry in one-minute epochs, we derived key non-parametric parameters of diurnal activity and calculated intraclass correlations to measure agreement. The non-parametric parameters include interdaily stability (IS), intradaily variability (IV), timing of the five hours of lowest activity (L5onset) and ten hours of highest activity (M10onset), and overall relative amplitude (RA).

Results

We observed agreement ranging from good for IS (ICC=0.77 [95%CI=0.59;0.88]; [all mean differences are patch-watch] mean difference=-0.21) to poor for IV (ICC=0.43 [0.12;0.67]; mean difference=0.29). ICC showed good agreement for M10onset (ICC=0.82 [0.67; 0.90]; mean difference=-37min) and excellent agreement for L5onset (ICC=0.91 [0.82;0.95]; mean difference=-2min). Finally, we identified good agreement when estimating the activity relative amplitude (RA ICC=0.86 [0.75; 0.93]; mean difference=0.03). An example of excellent agreement was manifested in the close estimation of L5onset (patch mean=1:04am, SD=70min; watch mean=1:06am, SD=68min).

Conclusion

Adding to our prior evidence that these two devices offer similar sleep-wake estimation using traditional algorithms, the present data indicate the Actigpatch offers good agreement to the Motionlogger for nonparametric analyses of IS, activity timing, and RA. Agreement was not as good for IV, with the Actigpatch showing more intradaily variability than the watch, perhaps due to the triceps placement. Because the Actigpatch is unobtrusive, water-resistant, and can be worn continuously for three weeks, it has potential benefits for studies of individuals who struggle with adherence to wearing wrist worn devices.

Support (if any)

R01AA025593, P20GM139743. Actigpatches provided by Circadian Positioning Systems.
0265 Validation Framework for Sleep Stage Scoring in Wearable Sleep Trackers and Monitors with Polysomnography Ground Truth
Authors: Le Trung
Published: May 2023

Introduction

The rapid growth of point-of-care polysomnographic alternatives has necessitated standardized evaluation and validation frameworks. The current average across participant validation methods may overestimate the agreement between wearable sleep tracker devices and polysomnography (PSG) systems because of the high base rate of sleep during the night and the interindividual difference across the sampling population.

Methods

This study proposes an evaluation framework to assess the aggregating differences of the sleep architecture features and the chronologically epoch-by-epoch mismatch of the wearable sleep tracker devices and the PSG ground truth. An AASM-based sleep stage categorizing method was proposed to standardize the sleep stages scored by different types of wearable trackers. Sleep features and sleep stage architecture were extracted from the PSG and the wearable device’s hypnograms. Therefrom, a localized quantifier index was developed to characterize the local mismatch of sleep scoring.

Results

We evaluated different commonly used wearable sleep tracking devices with the data collected from 22 different subjects over 30 nights of 8-h sleeping. The proposed localization quantifiers can characterize the chronologically localized mismatches over sleeping time. The proposed framework not only characterizes the difference in the sleep stage distribution but also quantifies the chronologically localized mismatches over the sleeping time. Three major components of the framework consist of AASM-based sleep stage classification, sleep staging distribution analysis, and localized comparison analysis. The outperformance of the proposed method over existing evaluation methods was reported.

Conclusion

The proposed research extends our earlier work on evaluating commercial sleep trackers compared to PSG. The proposed evaluation method can be utilized to improve the sensor design and scoring algorithm.

Support (if any)

Nguyen, Quyen NT, et al. "Validation Framework for Sleep Stage Scoring in Wearable Sleep Trackers and Monitors with Polysomnography Ground Truth." Clocks & sleep 3.2 (2021): 274-288
0269 No More Actiwatches: Can Apple Watches be a More Scalable Alternative?
Authors: Caputo Dominick , Cheng Philip , Walch Olivia , Bayoneto Alec , Hannay Kevin , Moreno Jennette , Iqal Justin , Drake Christopher
Published: May 2023

Introduction

The Philips Respironics Actiwatch has become a gold standard for actigraphy data collection. With the announcement of their discontinuation, there has been increased momentum to identify an alternative, particularly with consumer-based devices. One promising solution is the Apple Watch because it allows user access to raw accelerometer data, thus eliminating the long-standing problem of the “black box algorithm” with wearable technology. This study compared the activity counts derived from Apple Watch data with that from the Actiwatch.

Methods

Adults wore an Actiwatch and Apple Watch on the same non-dominant wrist for 7 to 14 days (mean = 9). Accelerometer data were recorded and activity counts were derived from accelerometer data (algorithm for Apple Watch from Lindert et al, 2013). Daily sleep diaries were also completed. Actigraphy activity counts were binned into 2, 5, 10, 30, and 60 minute bins to examine concordance by bin sizes. Agreement between Apple Watch and Actiwatch were quantified with Lin’s Concordance Correlation Coefficients (CCC) across bins. Usability was assessed utilizing an exit survey.

Results

In increasing order of bins, the CCCs were: .63 (2 mins.), .70 (5 mins.), .78 (10 mins.), .90 (30 mins.), and .92 (60 mins.). Agreement was substantial for bins of 5 minutes or greater with 30 and 60 minutes showing the strongest agreement. The y-intercepts for all bins were positive indicating that Apple Watches were more likely to detect activity counts compared to Actiwatches. In terms of usability, a large majority (88%-100%) of participants favored the Apple Watch for comfort, convenience, preference to wear in public, and preference to wear again. The only dimension where there was not a clear preference was ease of use, with 56% indicating a preference for the Apple Watch.

Conclusion

This is the first study supporting Apple Watch as a potentially feasible alternative to an Actiwatch. Given that the Apple Watch’s accelerometer appears to be more sensitive, use of a different algorithm for determining activity counts from raw accelerometer data may improve the concordance at smaller bins. Future research should explore the effectiveness of the Apple Watch for sleep/wake detection in clinical samples.

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