bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambivalent (In)Securities: Comparing Urban Refugee Women’s Experiences of Informal and Formal Security Provision
Authors: Linn Sarah
Published: May 2022

Using feminist theories of geolegality, geopolitics, and intersectionality, this article presents Syrian refugee women’s experiences and perceptions of both formal and informal security providers in Amman and Beirut in 2016–2017. Based on qualitative data from refugee women based in these cities since the onset of the Syrian civil war, this article argues three related points regarding urban refugee women and their experiences with security providers. First, that although not gendered at the State level, refugee law is applied in gendered ways in the everyday by State and non-State security providers and that this has direct outcomes as to how refugee women perceive and access security services in their host cities. Secondly, that whilst women perceive both formal and informal security providers in ambivalent terms, they are deeply appreciative of State security presence in urban areas which seem vulnerable to tension and conflict. Lastly, in order to understand ambivalent experiences of (in)security of (in)formal security providers, we need closer examinations of the ways in which identity interacts with structures of policy, law and culture, using feminist theories of intersectionality and geolegality.
0012 Disordered sleep and emotional self-regulation in a prospective cohort of preschool-age children
Authors: Emond Jennifer , Ballarino Grace , Carlson Delaina , Lansigan Reina , Godzik Cassandra , Gilbert-Diamond Diane
Published: May 2022

Introduction

Disrupted sleep has been associated with poor emotional self-regulation among preschool-age children cross-sectionally, with few studies examining change over time. Our goal was to examine the prospective association between disrupted sleep and emotional self-regulation over six months among preschool-age children.

Methods

Analyses included 54 children, age 3-5 years old, who completed their participation in a currently ongoing, 6-month prospective study conducted in a rural area of New England to examine early-life predictors of obesity. Parents completed the 35-item Children’s Sleep Habits Questionnaire (CSHQ), a validated scale to measure problematic sleep, reflecting both reduced sleep quantity and quality. Total scores greater than 41 reflect a clinically-meaningful sleep disorder. Parents also completed the 5-item emotional self-regulation subscale of the validated Child Social Behavior questionnaire. A final score was computed as the average across the 5 items (range 1-7), with higher scores indicating poorer emotional self-regulation. A series of linear regression models were used to examine associations between sleep and emotional self-regulation at baseline, as well as change in self-regulation over six months. Each model was adjusted for child age, sex, and parental education level.

Results

The sample was largely white, non-Hispanic (87.0%), with 61.1% of male children, 90.7% of accompanying parents as mothers, and 79.6% of parents with a Bachelor’s degree or greater. One-fourth (n=14, 25.9%) of children met the criteria for disordered sleep at baseline. In an adjusted linear regression model, children with disordered sleep at baseline, on average, had worse self-regulation at baseline (beta coefficient=0.90, SE=0.33; p<0.01) and, separately, a greater decrease in self-regulation over six months (beta=0.78, SE=0.30; p=0.01). When further adjusting for disordered sleep at month 6, disordered sleep at baseline remained predictive of a greater decrease in self-regulation over time (beta=1.12; SE=0.41; p<0.01).

Conclusion

In this preliminary analysis, disordered sleep was associated with poor emotional self-regulation cross-sectionally and a decline in emotional self-regulation over six months. Generalizability is limited because of the high socioeconomic status of the sample. Yet findings suggest that the effects of disordered sleep on emotional self-regulation may manifest within in the preschool-years.

Support (If Any)

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, grant number K01DK117971.
0015 Effectiveness-Implementation Study of Two Novel Lighting Interventions for Shiftworkers on a Submarine Watchfloor
Authors: Bessman Sara , Harrison Elizabeth , Easterling Alexandra , Phares Ashley , Teisberg Madeline , Snider Michelle , Robertson Ian , Glickman Gena
Published: May 2022

Introduction

Shiftwork is common in the military, where around-the-clock readiness is necessary. Yet, non-standard schedules can negatively impact sleep, circadian health, and performance. Light is a leading countermeasure due to its phase shifting and alerting properties, with higher intensities and shorter wavelengths eliciting relatively greater effects. New technologies allow for deliberate spectral engineering that targets specific photobiological responses. This study examined the efficacy and implementation of two spectrally-distinct lights for improving sleep, alertness, and performance in active duty service members working nightshift schedules.

Methods

Participants were service members working 12-h shifts (0530-1730) on a high-security, submarine watchfloor (N=56, 9 females; mean+SE age=28.95 + 0.76). Lighting interventions included LED panels (3,721 cm2) that were either enhanced (SW+) or depleted (SW-) in short wavelength energy, while maintaining a comparable color temperature (~3000 K) and photopic illumination (~300 lux at 46 cm from eyes). For both SW+ and SW-, a bank of light panels were arranged across the front of the watchfloor and illuminated for the full duration of the nightshift. In addition, participants wore blueblocker glasses after nightshifts up until bedtime, when eye masks were worn during sleep. There were two data collection periods that coincided with existing 16-day schedule cycles: the first contained an 8-day baseline (BL1) and 8-day SW+ condition, and the second contained an 8-day baseline (BL2) and 8-day SW- condition (order within those 16-day periods was pseudo-randomized). Sleep and alertness were assessed via actigraphy, sleep diary, psychomotor vigilance test (PVT), and Karolinska Sleepiness Scale (KSS). Implementation metrics were obtained with questionnaires.

Results

All analyses are still ongoing. Preliminary examinations show higher satisfaction with the SW+ than BL1, and greater comfort and fewer symptoms under both SW+ and SW- as compared to BL1. Most felt the SW+ and SW- improved alertness on shift and expressed an interest in keeping the lights on the watchfloor.

Conclusion

Findings thus far indicate the interventions were well-received by participants. Subsequent analyses will further examine barriers to intervention use and the efficacy of the lights for improving sleep, alertness, and performance in service members working nightshifts.

Support (If Any)

ONR TS-788
0016 Changes in Alertness Over Consecutive Workdays for Internal Medicine Interns: A Secondary Analysis of the iCOMPARE Trial
Authors: Cordoza Makayla , Dinges David , Asch David , Shea Judy , Bellini Lisa , Malone Susan , Desai Sanjay , Volpp Kevin , Mott Christopher , Coats Sara , Mollicone Daniel , Basner Mathias
Published: May 2022

Introduction

Little is known about the impact of cumulative workdays on medical residents' alertness. The purpose of this study was to examine changes in alertness over consecutive workdays following a day off for internal medicine interns.

Methods

This is a secondary report of a randomized non-inferiority trial of 12 internal-medicine residency programs assigned to either standard duty-hour (80h workweek/16h shifts) or flexible (80h workweek/no shift-length limit) policies. Interns were followed for 2 weeks during inpatient rotations. Each morning, alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses) was assessed, and interns selected the type of shift worked (day-off, days, nights, beginning/ending extended overnights, or other). Sleep duration (actigraphy) was averaged each 24h day. For this analysis, interns were included if they had ≥1 day-off followed by at least 3 workdays, and had no flagged PVT-B results for non-adherence. To examine the longitudinal effect of consecutive workdays on alertness, a generalized linear mixed model with random intercept and slope, and Poisson distribution was used to determine the rate of PVT-B lapses for up to 4 work days following a day off, controlling work shift type, sleep duration, and policy, with sleep and shift type interaction, and linear spline to account for the change in slope after the 2nd workday.

Results

N=328 interns were included (mean age 27.8±2.2y, 49% males). Mean±SD number of PVT-B lapses were 3.4±4.5, 4.2±5.6, 5.3±6.6, 4.8±5.8, and 4.7±6.0, and mean±SD sleep duration was 9.0±1.9, 6.9±1.3, 6.5±2.1, 6.6±1.8, and 6.9±1.7 hours for a day off and workdays 1-4 respectively. Rate of lapses increased by 1.1 lapse/day from a day off to the 2nd workday (p=0.004; 95%CI: 1.03-1.18), and then significantly decreased from days 2-4 at a rate of 0.89 lapses/day (p<0.0001; 95%CI: 0.85-0.92). Patterns of change in the rate of lapses were similar to changes in sleep duration, where, from baseline, every 1h longer sleep duration was associated with 0.91 fewer PVT-B lapses (p<0.0001; 95%CI: 0.93-0.97).

Conclusion

Both sleep and subsequent alertness were negatively impacted when returning to work following a day off for interns in this study. After two workdays, sleep duration appeared to increase again, with observed improvements in alertness.

Support (If Any)

Funded by the NHLBI and American Council for Graduate Medical Education. M.C. is supported by NIH/NINR (K99 NR019862).
0023 Screen Time and Insomnia Symptoms in University Students
Authors: Hodges Nicholas , Zhou Eric , Trevorrow Tracy , Dietch Jessica
Published: May 2022

Introduction

Prior research has demonstrated a relationship between screen time and sleep health, but more work is needed to understand the potential impact of reason for screen time and timing (i.e., weekend vs. weekday). This study aimed to determine whether screen time, and reason for use, was associated with insomnia symptoms in a sample of university students during the school term. Further, we sought to determine whether effects differed by weekend/weekday.

Methods

Participants were 767 enrolled students from two universities (age x̄=20.94 [SD=5.25]; 74% women). Insomnia symptoms were assessed with the Insomnia Severity Index (ISI); screen time was a self-report of average daily screen time for a variety of purposes (productivity, social media, streaming media, browsing the internet, or video games) on weekdays/workdays and weekends/off days.

Results

A total of 16.4% of the sample had insomnia symptoms in the clinical range (ISI x̄=9.1 [SD=5.3]). Participants reported 10.0 hours (SD=4.5) of screen time per day on weekdays and 10.8 hours (SD=5.2) per day on weekends. During the week, the most screen time (44%; x̄=4.4 [SD=2.6] hours/day) was spent on productivity (work or school). On weekends, the most screen time (30%; x̄=3.3 [SD=2.1] hours/day) was spent on streaming media. More screen time on the weekends was associated with greater insomnia symptoms (r=.10, p=.004), but not during the week (r=.05, p=.185). Regression analyses indicated weekend screen time accounted for 2% of the variance in insomnia symptoms, and this relationship was driven by screen time for productivity (beta=.09, p=.017) and video games (beta=.09, p=.019).

Conclusion

Among university students, self-reported screen time during the week was not associated with elevated insomnia symptoms. Weekend screen time, particularly for the purpose of productivity and video games, was associated with elevated insomnia symptoms though the effect was small. Although screen time is often highlighted as a key contributor to poor sleep health, this impact was minimal in the current study. Future work should continue to examine whether different motivations for screen time is associated with various facets of sleep health, and delineate these associations by weekend vs. weekday.

Support (If Any)

None
0026 Targeted genome sequencing identifies multiple rare variants in Caveolin-1 associated with obstructive sleep apnea
Authors: Wang Heming , Liang Jingjing , Cade Brian , Kurniansyah Nuzulul , Sofer Tamar , Redline Susan , Zhu Xiaofeng
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. There is strong clinical and epidemiologic evidence supporting the importance of genetic factors influencing OSA, but limited data implicating specific genes.

Methods

Leveraging high depth genomic sequencing data from the NHLBI Trans-Omics for Precision Medicine (TOPMed) program and imputed genotype data from multiple population-based studies, we performed linkage analysis in the Cleveland Family Study followed by multi-stage gene-based association analyses in independent cohorts to search for rare variants contributing to OSA severity as assessed by the apnea-hypopnea index (AHI) in a total of 7,708 European-Americans.

Results

We identified 21 non-coding rare variants in Caveolin-1 (CAV1) associated with lower AHI after accounting for multiple comparisons (P = 7.4×10-8). These non-coding variants together significantly contributed to the linkage evidence. Follow-up analysis revealed significant associations between increased CAV1 expression with lower AHI (P=0.024) and higher minimum overnight oxygen saturation (P=0.007).

Conclusion

Caveolin-1 is a membrane scaffolding protein that is essential in the formation of plasma membrane lipid rafts and mediates cholesterol trafficking; regulates several signaling molecules including transforming growth factor β (TGF-beta), Toll Like Receptor 4 (TLR4) and endothelial nitric oxide synthase (eNOS); with mutations implicated in disorders associated with OSA: pulmonary hypertension, diabetes, atherosclerosis, endothelial and cardiac dysfunction, and inflammation. Our results indicate that caveolin-1 also plays a significant role in OSA, with rare variants and higher CAV1 expression associated with lower AHI.

Support (If Any)

R35HL135818, R01HG011052, R01HL153814
0033 Dysregulated sleep and NREM sleep electroencephalogram delta power induced by intermittent hypoxia exposure are attenuated in NLRP3 knockout mice
Authors: Zielinski Mark , Strecker Robert , McKenna James , McNally James , Cade Brian , Redline Susan
Published: May 2022

Introduction

The nucleotide-binding domain leucine rich family pyrin containing 3 (NLRP3) inflammasome protein complex activates caspase-1 to convert the pro-forms of IL-18 and IL-1 beta (IL-1β) into their active forms and is involved in homeostatic sleep and sleep responses to pathogenic stimuli. Intermittent hypoxia (IH) is a hallmark of sleep disordered breathing (SDB) and both IL-18 receptors are associated with SDB in humans. Thus, we hypothesized that NLRP3 inflammasomes are involved in SDB-related sleep disturbances.

Methods

Sleep architecture was assessed by polysomnography in NLRP3 knockout (KO) and wild-type (WT) mice (N = 8 per group). A gas exchange mixer delivered house air serving as a control or chronic IH that involved 90 second episodic oxygen reductions that consisted of ambient oxygen (21%) with brief hypoxic conditions (~10%) that lasted for 3 seconds for the first 10 h of the light period for 5 consecutive days. Gene expression and protein levels in the brain and lungs were assayed using real-time polymerase chain reaction and enzyme-linked immunosorbent assays, respectively.

Results

In WT mice, significant increased non-rapid-eye movement (NREM) sleep amounts and NREM sleep electroencephalogram delta power (0.5-4 Hz) were found after 1 day of IH compared to control conditions (p < 0.001). After 5 days of IH, WT mice showed a significant attenuation in NREM sleep amounts and NREM sleep delta power (p < 0.001) and increased wake bout frequency (p = 0.006) when compared to control conditions. However, the IH-induced NREM sleep and NREM sleep delta power enhancements and reductions were attenuated (21-35%) in NLRP3 KO mice compared to WT mice. In WT mice, NLRP3, IL-1β, IL-18 and caspase-1 gene expression, IL-1β and IL-18 protein levels, and caspase-1 activity were significantly increased in the somatosensory cortices, NTS, and lungs after both 1 and 5 days of IH when compared to control conditions (p < 0.05 for all), although NLRP3 KO mice did not exhibit significant differences in molecules downstream of NLRP3 inflammasome activation.

Conclusion

Our findings indicate that altered NLRP3 inflammasome activation contributes to dysregulated sleep occurring from IH and likely is involved in sleep disturbances in SDB.

Support (If Any)

VA Career Development Aware IBX002823, VA Merit BX004500, NIH/NIMH 1R21MH125242, NIH/NHLBI R03 HL154284, and NIH/NHLBI R35 HL135818. JTM received partial salary compensation and funding from Merck Investigator Sponsored Programs but has no conflict of interest with this work.
0038 Acute Blue Light Exposure Increases Activation in the Pulvinar Nucleus
Authors: Reign Deva , Dailey Natalie , King Rylee , Grandner Michael , Alkozei Anna , Killgore William
Published: May 2022

Introduction

Blue-wavelength light can produce phase-shifts in the circadian rhythm. We have previously shown that morning blue light exposure was associated with advanced onset of sleep time and diminished daytime sleepiness. These changes were associated with increased gray matter volume in the left pulvinar nucleus of the thalamus, a key hub of the visual attention network. However, very little is known about the underlying mechanisms of these light activations. We hypothesized that the pulvinar may be affected more by the acute activating effects of light rather than its effects on melatonin. Therefore, we exposed individuals to blue or amber light while undergoing functional neuroimaging at a time of day when melatonin levels are almost non-existent.

Methods

Twenty-six healthy individuals (15 male; 11 female; age=24.27, SD=6.27) completed a counterbalanced cross-over study involving two 3T functional MRI sessions separated by one week. During scanning, participants were acutely exposed to either continuous blue light (470 nm; active condition) or amber light (580 nm; placebo) while completing an N-Back working memory task. We contrasted the 2-back versus the 0-back condition and compared the blue and amber sessions using a paired t-test in SPM12.

Results

Acute blue light (versus amber placebo) during a working memory task was associated with significantly greater activation (p<.05) within the left pulvinar nucleus (k=47 voxels; MNI: x=-14, y=-34, z=8), a region nearly identical to that found in our previous work where we found increased volume with six-weeks of daily blue light exposure. Salivary melatonin levels were unchanged by either light condition.

Conclusion

Acute exposure to blue-wavelength light (versus amber placebo light) activated a key region of the visual attention network that was previously demonstrated to be enlarged by 6-weeks of daily morning blue light exposure. As melatonin levels remained unchanged by the light in this study, the findings point to an underlying neural mechanism that may lead specifically to activation of the pulvinar, which over time may enhance gray matter volume of that structure. These findings suggest a concordance of functional and structural changes induced by blue light exposure, which have been associated with shifts in sleep and circadian rhythms.

Support (If Any)
0042 COVID-19 related distress and sleep among trauma-exposed South Asians: Does generational status matter?
Authors: Almeida Isamar , Slavish Danica , Rafiuddin Hanan , Contractor Ateka
Published: May 2022

Introduction

The COVID-19 pandemic has resulted in substantial changes in social interactions, work schedules, and socioeconomic factors that may negatively impact sleep onset, maintenance, and quality. The ongoing stress of the pandemic also may exacerbate existing racial/ethnic disparities in sleep health. In this study, we examined the effects of COVID-19 related distress on sleep-related impairment and sleep disturbances among trauma-exposed South Asian adults. Since a health advantage among foreign-born individuals has been previously noted in the literature (the “immigrant paradox”), we also assessed whether generational status (i.e., being born in the U.S. or not) moderated associations between COVID-19 related distress and sleep outcomes.

Methods

Participants were recruited through Amazon’s Mechanical Turk and completed online surveys on demographic information, the COVID-19 Stress Scale, The Life Events Checklist for DSM-5 (LEC-5), and PROMIS™ Sleep-Related Impairment and Sleep Disturbances Scale. The final sample included 316 South Asian adults residing in the U.S, who had been exposed to a traumatic event at some point in their lifetime. Most participants were male (55%) and U.S.-born citizens (64%), with an average age of 35.32 (SD = 9.52) years.

Results

Examination of t-scores for PROMIS™ sleep-related and sleep disturbances revealed that our sample endorsed slightly higher values than the general U.S. population. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.09, p < .001, sr2 = .04) and sleep-related impairment (b = 0.20, p < .001, sr2 = .12). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep.

Conclusion

In our sample, we found that psychological distress triggered by the pandemic (e.g., fear of contamination, fear of the dangerousness of the virus, socioeconomic worries) was associated with greater sleep difficulties. Our findings highlight the importance of developing targeted interventions to cope with stress and sleep disturbances during the pandemic, particularly among vulnerable populations, such as those exposed to trauma. Our results did not support the immigration paradox: stress and sleep associations were similar regardless of generational status. Future studies are needed to better understand the role of generational status on sleep across different immigrant subgroups.

Support (If Any)
0043 Job Loss, Financial Hardship, and Sleep during the COVID-19 Pandemic: Differences by Sex/Gender and Race/Ethnicity
Authors: Gaston Symielle , Alhasan Dana , Strassle Paula , Stewart Anita , Pérez-Stable Eliseo Eliseo J , Nápoles Anna , Jackson Chandra
Published: May 2022

Introduction

In the United States (US), health and financial consequences of COVID-19 have disproportionately impacted minoritized groups. Yet, few US studies have investigated COVID-related financial loss/consequences and sleep health disparities.

Methods

To investigate differences by sex/gender and race/ethnicity in cross-sectional associations between both job/business loss and substantial financial hardship (SFH) with sleep health, we used data collected from 12/2020 to 2/2021 among 4,726 men and women in the nationally representative COVID-19 Unequal Racial Burden (CURB) Study (N=5,500 American Indian/Alaska Native (AI/AN), Asian, Black, Hispanic/Latino, Multiracial, Native Hawaiian/Pacific Islander (NH/PI), and non-Hispanic (NH)-White adults). Participants reported job/business loss since the start of the pandemic (yes, no) and SFH (e.g., unable to pay for housing costs). Poor sleep health was defined as concurrence of self-reported fair/poor sleep quality, non-restorative sleep, sleep problems, and difficulty falling asleep in the past week. Adjusting for sociodemographic and health characteristics and receipt of financial assistance, weighted Poisson regression with robust variance estimated prevalence ratios (PRs) for poor sleep overall, by sex/gender, and by race/ethnicity.

Results

Men and women equally reported both job/business loss (20%) and SFH (11% men and 12% women). Minoritized racial/ethnic groups except Asians most frequently reported job/business loss (20%-25% vs. 16% Asian, 13% NH-White) and SFH (11%-15% vs. 9% NH-White, 5% Asian). Poor sleep health was more prevalent among women (21%) than men (14%) and among AI/AN, NH/PI, and Multiracial adults (each 22% vs. 11%-19% remaining racial/ethnic groups). Both job/business loss and SFH were associated with a higher prevalence of poor sleep health, overall. Compared to women, men had stronger associations for both job/business loss (PRmen=1.80 [95% CI:1.39,2.33], PRwomen=1.23 [1.01,1.50]; pinteraction=0.01) and SFH (PRmen=4.46 [3.18,6.26]), PRwomen= 1.82 [1.45,2.30]; pinteraction=0.01). For job/business loss, associations were strongest among Asians (PR=2.07 [1.32,3.23] vs. PR range=0.88-1.89; pinteraction=0.09).

Conclusion

COVID-19 related job/business loss and financial hardship were both associated with poorer sleep health, and associations for job/business loss were strongest among men and Asian adults.

Support (If Any)

Divisions of Intramural Research: National Institute of Environmental Health Sciences (Z1AES103325[CLJ]) and National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH); National Institute on Aging, NIH (P30 AG015272[ALS])
0048 The Association Between Sleep Health and Work- and Health-Related Quality of Life in Desk Workers and Differences in Associations Pre- and Post-COVID-19 Emergence
Authors: Sanders Rachel , Vogan Olivia , Gibbs Bethany Barone , Egeler Mara , Kubala Andrew , Cheruka Caitlin , Paley Joshua , Patel Sanjay , Hall Martica , Perera Subashan , Jakicic John , Kline Christopher
Published: May 2022

Introduction

COVID-19 resulted in many office workers switching to remote work. Emerging studies report working from home has negatively affected sleep health (SH) and psychological well-being. Our aim was to evaluate the relationship between SH and health- and work-related quality of life and explore whether these associations differed pre- and post-COVID-19 emergence.

Methods

Baseline data from 125 adults enrolled pre- (n=59) and post-COVID-19 emergence (n=66) in a clinical trial with desk jobs were included in this analysis (86.4% White; 49.6% female; 43.9±10.7 y). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, which addresses eight health concepts (physical, social, and role functioning; mental health; health perceptions; energy or fatigue; pain; general health) and yields 2 summary scales (mental component summary, physical component summary). Workplace productivity and worker health was measured using the Health and Work Questionnaire (HWQ). Six SH dimensions were assessed using questionnaires (satisfaction, alertness) and 7 nights of actigraphy (regularity, timing, efficiency, duration). Each dimension was categorized as “good” or “poor”; a composite score was created based on the sum of good SH dimensions. Multiple linear regression models were adjusted for gender and age and stratified by enrollment pre- or post-COVID-19 emergence. Data are presented as standardized coefficients (β) and p-values (p).

Results

Compared to participants enrolled prior to COVID-19, those enrolled post-COVID-19 had worse SF-36 emotional, social, and general health and greater HWQ-assessed impatience (all p<0.05); however, SH did not differ between those enrolled pre- and post-COVID. Prior to COVID-19, greater SH was associated with higher SF-36 physical component scores (β=.389, p=.003); however, no association was observed post-COVID (β=.137, p=.271). In contrast, no association was observed pre-COVID between SH and SF-36 mental component scores (β=.181, p=.160), but greater SH was associated with greater mental component scores post-COVID (β =.308, p=.004). Furthermore, better SH was associated with lower stress post-COVID (β =-.423, p<.001).

Conclusion

SH was associated with HRQoL and workplace and worker health, though these associations sometimes differed between pre- and post-COVID emergence. Research should explore whether promoting SH in employees impacts their personal and workplace-related quality of life.

Support (If Any)

This study was funded by National Institutes of Health (NIH) grants R01HL134809 and R01HL147610.
0070 A Mexican Spanish Version of the Brief Index of Sleep Control
Authors: Begay Tommy , Valencia Dora , Granados Karla , Delgadillo Marcos , Ghani Sadia , Molina Patricia , Alfonso-Miller Pamela , Wills Chloe , Grandner Michael
Published: May 2022

Introduction

The Brief Index of Sleep Control (BRISC) is a 4-item assessment of the degree to which an individual perceives that they are in control of their sleep. Previous work shows that this measure may be useful for sleep health promotion efforts. The present study describes an attempt to develop a version of this measure in Spanish, particularly for individuals of Mexican descent.

Methods

Data were collected from a sample of N=100 individuals of Mexican Descent in Nogales, Arizona, located at the US-Mexico border. The BRISC is a 4-item scale that quantifies the degree to which an individual perceives that their sleep is under their control, assessing perceived control over time to bed, time out of bed, total sleep time, and sleep quality. To translate the measure into Spanish, the following procedure was followed: (1) a bilingual study team member performed an initial translation; (2) a bilingual community member edited the translation; (3) a certified medical translator edited the revision; (4) a focus group of N=5 bilingual community members made contextual edits; (5) a back-translation was performed; (6) an additional bilingual focus group examined the final version for compatibility; and (7) the medical translator certified the accuracy of the final version. T-tests examined differences between those who completed the measure in Mexican Spanish vs English.

Results

Of the N=100 survey respondents, N=42 completed the BRISC in Spanish. No significant differences were seen in overall scores between those who completed the measure in English or Spanish (p=0.69). In addition, no differences were seen for individual items regarding time to bed (p=0.30), wake time (p=0.77), total sleep time (p=0.58), or sleep quality (p=0.98).

Conclusion

Data collection instruments be linguistically and culturally appropriate to the study population. This version of the BRISC was adapted to Mexican Spanish for use in future studies.

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0074 Neighborhood-Level Sleep Health and Childhood Opportunity Index at the Census Tract Level: Comparison to Other Health Indicators
Authors: Gorovoy Suzanne , Phan Sydney , Begay Tommy , Valencia Dora , Hale Lauren , Killgore William , Wills Chloe , Grandner Michael
Published: May 2022

Introduction

Promoting sleep health at the neighborhood level may be an efficient way to promote overall health and well-being. This study examined the relative contribution of sleep health, versus other regional health metrics.

Methods

Neighborhood sleep health values were obtained from the “500 Cities” data collected by the CDC, which includes census tract and proportion that report values associated with health. Data include the population of each census tract as well as census-estimated proportion of the population in each census tract that report obtaining at least 7 hours of sleep. Other health indicators evaluated included access to health insurance, past-year routine medical or dental checkup, older adult preventive care, leisure-time activity, mammography, pap testing, and prevalence of arthritis, binge drinking, hypertension, antihypertensive use, cancer, asthma, coronary disease, cholesterol screening, colon screening, COPD, smoking, diabetes, hypercholesterolemia, kidney disease, poor mental and physical health, obesity, stroke, and teeth lost. The Child Opportunity Index (COI) is a publicly-available index (DiversityDataKids.org) reported at the census tract level. It provides indices for “Education,” “Health and Environment,” and “Social and Economic” domains, as well as a global score. The present analysis merged the 500 Cities data with the COI data, using census tract as the matching variable. When data were merged, 27,130 census tracts were included.

Results

In stepwise analyses adjusted for population size, with global COI as the dependent variable, sleep health emerged as the strongest predictor, accounting for 57.2% of the variance of global COI (p<0.0001). When all other health predictors were included in the model, the next largest contributors were teeth lost (additional 15.5%), health insurance (additional 3.0%), and asthma (additional 1.4%). Similarly, when stepwise analyses examined each component of COI as dependent variable, sleep health consistently emerged as the most substantial predictor, accounting for 41.2%, 24.3%, and 56.4% of the variance of “Education,” “Health and Environment,” and “Social and Economic” scores, respectively (all p<0.0001).

Conclusion

Sleep health is more strongly associated with overall COI (and all its components) than any other regional health metric. Public health efforts targeting sleep health may have disproportionately beneficial impact on factors that support family health and well-being.

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0078 Assessing Sleep Health in Children Recently Adopted from Foster Care
Authors: Cifre Anthony , Kim Jinu , Alfano Candice
Published: May 2022

Introduction

An estimated 450,000 children were in the U.S. foster care system in 2019. Early adversity including maltreatment and/or neglect renders this vulnerable population at high risk for negative outcomes, both physical and psychological. Burgeoning evidence suggests that children in foster care develop high rates of sleep disruption. Sleep disruption is associated with negative life outcomes including heart disease, diabetes, and psychiatric disorders. However, there is still a lack of knowledge examining sleep health in children adopted from foster care.

Methods

Sleep quality and problems were examined among a sample of children adopted from foster care (n = 234) within the past two years, ages 4 to 11 years (M = 5.94, SD = 1.97). Caregivers across the US were invited to complete an anonymous Qualtrics survey via private Facebook groups for foster families. The Child Sleep Habits Questionnaire (CSHQ) was completed by foster parents to assess child sleep problems (e.g., nightmares, bedwetting, snoring, etc.) and overall sleep quality. Caregivers endorsed sleep problems and frequency using responses “Never,” “Sometimes,” and “Usually; sleep quality was rated using a Likert scale from 1 = Very Poor to 10 = Excellent.

Results

Paired-samples t-test compared first month (i.e., when first arrived in the home) and current child sleep quality based on caregiver-report. Sleep quality showed significant improvement since arrival in the foster home; t(233) = 12.98, p < .001, d = 0.85. However, on the CSHQ, 99% of the sample scored above the clinical cutoff for this measure indicating elevated sleep problems.

Conclusion

Children adopted from foster care show some improvement in sleep quality after achieving permanency. However, these data suggest this population continues to experience clinical levels of sleep problems even after being adopted. Our results suggest a need for specialized intervention services targeting sleep health among children recently adopted from foster care.

Support (If Any)

None
0087 Feasibility of examining component-specific effects of yogic breathing on self-report sleep metrics: A three-arm pilot RCT
Authors: Vazquez Michael , Buraks Olivia , Haack Monika , Mullington Janet , Yang Huan , Goldstein Michael
Published: May 2022

Introduction

Mind-body interventions (MBIs) continue to receive widespread interest for improving sleep disturbances. This study investigated the feasibility of using an automated electronic survey system in REDCap in the context of a fully remote clinical trial study to produce detailed measures of participant adherence, daily sleep quality, and associations with physiological outcomes captured by wearable devices.

Methods

Eighteen healthy participants (age 18-30 yrs, 12 female) were randomized to one of three 8-week long interventions: slow-paced breathing (SPB, N=5, 24.6 ± 2.1 years, 4 female), mindfulness (M, N=6, 23.7 ± 3.7 years, 4 female), or yogic breathing (SPB+M, N=7, 24.3 ± 3.1 years). Participants completed two weeks of daily sleep logs along with the Pittsburgh Sleep Quality Index (PSQI) prior to a virtual laboratory visit, which consisted of a 60-min intervention-specific training, including a 20-min guided practice, and subsequent tasks including experimental stress induction. Participants were then instructed to repeat their assigned intervention practice daily, selecting either the same or a similar guided audio as their initial training. After an initial video check-in appointment, participants received regular visual feedback of their data and completed weekly check-ins with the study team to improve adherence. At the end of the intervention period, participants again completed daily sleep logs and the PSQI, in addition to other outcome measures and a virtual laboratory visit. Data were analyzed using linear mixed models.

Results

Sleep log adherence was over 90% in all three groups. The groups were successfully distinguishable based on HRV-derived breathing and mindfulness ratings. For the SBP+M group only, there was a trend of reduced sleep onset latency (SOL, p=.093) and a significant increase in sleep efficiency (SE, p=.025). There were no significant changes in PSQI or other sleep log measures. More detailed analysis of timecourse across these measures is ongoing.

Conclusion

These findings support feasibility for a fully remote, semi-automated clinical trial study assessing component-specific effects of these MBIs on sleep in generally healthy young adults. Research evaluating MBIs for sleep in both clinical and nonclinical populations would benefit from similar study designs to examine intervention-specific components while increasing both scalability and quality control.

Support (If Any)

Pilot Research Grant, Osher Center for Integrative Medicine of Harvard Medical School and Brigham & Women’s Hospital; National Institutes of Health (5T32HL007901-22)
0093 Efficacy of a Chatbot-Based Sleep Intervention on Sleep Quality Improvement among Young Adults
Authors: Oh Yoo Jung , Zhang Jingwen , Ji Xiaopeng , Liao Wang , Feng Bo
Published: May 2022

Introduction

Insufficient sleep duration and poor sleep quality are prevalent in adolescents and young adults. Artificial-intelligent agents such as chatbots have been integrated into digital health interventions to support symptom management and promote health behaviors. This pilot study tested the efficacy of a sleep advice chatbot in young adults with self-reported sleep disturbances.

Methods

Young adults aged 18 to 28, who scored 55 and above (t-score) on the PROMIS Sleep Disturbance (Short Form) were enrolled into the study. Using a 2 x 2 research design, participants were randomly assigned into four groups: chatbot 1 (sleep advice), chatbot 2 (sleep advice & emotional support), human 1(sleep advice), human 2 (sleep advice & emotional support). Sleep advice chatbots were developed using Google’s Dialogflow. After the conversation, participants rated the effectiveness of the sleep advice on a 5-point Likert scale. Participants completed the PROMIS Sleep Disturbance seven days after the study.

Results

Of 293 participants who were enrolled, mean age was 19.75 (SD = 1.57) and 85.1% were females. Average sleep disturbance scores measured before and after the study was 25.47 (SD = 4.91) and 20.97 (SD = 5.55), showing a significant decrease in sleep disturbance (p < .001). Mean advice effectiveness was 3.96 (SD = 1.10), with human advice provider receiving better scores (p < 0.05). Controlling for age and sex, two-way ANOVA analysis showed a significant interaction between advice giver type (chatbot vs. human) and advice type (sleep advice vs. sleep & emotional support) on alleviating sleep disturbances [F(1, 262) = 4.07, p = .045, partial η2 = .015]. Specifically, participants who received sleep advice from a chatbot had greater decreases in sleep disturbances (Mdiff = -4.69, SD = 3.65) than from a human (Mdiff = -3.78, SD = 5.92). On the other hand, with emotional support, advice given by humans was more effective (Mdiff = -5.56, SD = 5.86) than chatbots (Meandiff = -3.44, SD = 6.31).

Conclusion

The results of this study suggest the potential efficacy of a chatbot-based sleep advice intervention among young adults. Future research can consider using a combination of chatbot and human expert-based sleep interventions.

Support (If Any)
0096 Sleep Apnea Diagnosis using Tracheal Signals and Oximetry
Authors: Ghahjaverestan Nasim Montazeri , Aguiar Cristiano , Hummel Richard , Fan Wei , Yu Jackson , Bradley T Douglas
Published: May 2022

Introduction

Diagnosing sleep apnea requires detection of apneas and hypopneas during sleep either via in-laboratory overnight polysomnography (PSG) or portable in-home sleep apnea testing (HSAT). While PSG is the optimal method, it is expensive, inconvenient and often inaccessible for patients. Although HSATs are more convenient and less expensive than PSG, they are not as accurate and have relatively high failure rates because of the nature of the sensors used to measure respiratory variables. We have developed a HSAT, the Patch, that is unique in that it is very simple and reliable because it measures respiratory variables using tracheal motion and sound combined with oximetry to detect respiratory events. In this study we tested the ability of the Patch to detect respiratory events versus simultaneous PSG.

Methods

Participants were adults with a suspected sleep disorder referred to the sleep laboratory at Toronto Rehabilitation Institute for PSG. Simultaneous to the PSG, the Patch, consisting of a module containing a microphone and a 3-D accelerometer that was affixed to participants’ suprasternal notch, and a finger oximeter. After filtering the tracheal signals, the envelope of the tracheal motions in the cranial and postero-anterior directions and tracheal sound envelope were extracted. Along with tracheal features, the amplitude and slopes of oxygen desaturations were also extracted and, were fed into a supervised deep neural network model to detect apneas and hypopneas. The total number of detected events was divided by total estimated sleep time to estimate the apnea-hypopnea index (AHI). The performance of the model in diagnosing sleep apnea was evaluated by sensitivity (AHI≥15) and specificity (AHI<15). The relationship between the estimated AHI and PSG-based AHI was quantified using Pearson correlation.

Results

Ninety-nine participants (42 females, age: 48±16 years, body mass index: 29.2±5.2 kg/m2, and AHI: 15.8±19.4 events/hour) completed the study. We found that the Patch had 88.6% sensitivity and 89.1% specificity for diagnosing sleep apnea. Strong agreement was observed between the estimated and reference AHI values (r = 0.92, p < 0.001).

Conclusion

The Patch is a novel, robust and convenient portable device that provides an accurate means of detecting and quantifying sleep apnea. It has the potential to provide reliable home-based sleep apnea monitoring.

Support (If Any)

Funded by Bresotec Inc.
0101 Performance of a Multisensor Ring to Evaluate Sleep At-Home Relative to PSG and Actigraphy: Importance of Generalized Versus Personalized Scoring
Authors: Hutchison Stephen , Grandner Michael , Bromberg Zohar , Morrell Zoe , Graf Arnulf , Freckleton Dustin
Published: May 2022

Introduction

Multisensor sleep wearable devices have demonstrated utility for research and relative accuracy for discerning sleep-wake patterns at home and in the laboratory. Additional sensors and more complex scoring algorithms may improve the ability of wearables to assess sleep health.

Methods

Thirty-six healthy adults completed assessment while wearing the experimental device (Happy Ring), as well as Philips Actiwatch, Fitbit, Oura, and Whoop devices. Evaluations at home were conducted using the Dreem headband as an at-home polysomnography reference. The experimental Happy Ring device includes accelerometry, photoplethysmography, electrodermal activity, and skin temperature. Epoch-by-epoch analyses compared the Happy Ring to home polysomnography, as well as other sleep-tracking wearable devices. Scoring was accomplished using two machine-learning-derived algorithms: a “generalized” algorithm, similar to that used in other devices, which was static and applied to all users, and a “personalized” algorithm where parameters are personalized, dynamic, and change based on data collected across different parts of the night of sleep.

Results

Compared to home polysomnography, the Happy generalized algorithm demonstrated good sensitivity (94%) and specificity (67%), and the Happy personalized algorithm also performed well (93% and 75%, respectively). Other devices demonstrated good sensitivity, ranging from 91% (Whoop) to 96% (Oura). However, specificity was more variable, ranging from 41% (Actiwatch) to 60% (Fitbit). Overall accuracy using the Happy Ring was 91% for generalized and 92% for personalized algorithms, compared to 92% for Oura, 89% for Whoop, 89% for Fitbit, and 89% for Actiwatch. Regarding sleep stages, accuracy for the Happy Ring was 66%, 83%, and 78% for light, deep, and REM sleep, respectively, for the generalized algorithm. For the personalized algorithm accuracy was 78%, 92%, and 95%, for light, deep and REM sleep, respectively. Post-hoc analyses showed that the Happy personalized algorithm demonstrated better specificity than all other modalities (p<0.001). Kappa scores were 0.42 for generalized and 0.60 for personalized, compared to 0.45 for Oura, 0.47 for Whoop, and 0.48 for Fitbit.

Conclusion

The multisensory Happy ring demonstrated good sensitivity and specificity for the detection of sleep at home. The personalized approach outperformed all others, representing a potential innovation for improving detection accuracy.

Support (If Any)

Dr. Grandner is supported by R01DA051321 and R01MD011600. This work was supported by Happy Health, Inc.