bluuebunny/crossref_metadata_2025 huggingface dataset:
212 An Election During a Pandemic: Relationship Between Political Affiliation and Pandemic-Related Sleep and Dreams
Authors: Grandner Michael , Ruby Perrine , Killgore William , Kennedy Kathryn , Wills Chloe
Published: May 2021

Introduction

In 2020, a global pandemic impacted sleep for many people in the US, which was also experiencing an extremely contentious election season. These overlapped somewhat, as the liberal/left side of the political spectrum was more vocal about the dangers of COVID-19 and the pandemic, while the conservative/right frequently expressed less concern about COVID-related risks. Perhaps this confluence was borne out in sleep quality and dreams.

Methods

A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants rated their political affiliation on a scale of 0 (Very Conservative/Right) to 6 (Very Liberal/Left). Participants were also asked whether, since the pandemic, their sleep improved or worsened, whether their dream content has become more positive (more or less positive content, versus same) or negative (more or less negative content, versus same), the number of nightmares they recall, and whether their dreams included themes of politics and/or COVID. Regression analyses examined political affiliation as independent variable with ordinal logistic analyses for sleep improvement/worsening, multinomial logistic analyses for positive/negative content, linear regression analyses for nightmare frequency, and binary logistic analyses for presence of political/COVID themes in dreams. All analyses were adjusted for age, sex, and race/ethnicity.

Results

Greater liberal/left affiliation was associated with a greater likelihood of worsened sleep (oOR=1.20, p=0.002), but no difference in likelihood of sleep improvement. Greater liberal/left affiliation was associated with a greater likelihood of decreased positive dream content (RRR=1.29, p=0.001) but no different in likelihood of increased positive content. In addition, greater liberal/left affiliation was associated with an increased likelihood of more negative dream content (RRR=1.33, p<0.0005) but no difference in the experience of less negative content. Liberal/left affiliation was also associated with more frequent nightmares during the pandemic (B=1.55, p=0.019), and more political dreams (OR=1.29, p=0.010) but no difference in COVID-related dreams.

Conclusion

During the COVID-19 pandemic, more liberal/left individuals reported a greater degree of worsening sleep and dream content that was less positive and more negative in nature. Though there was no difference in COVID-related dream content, there was a difference in political content in dreams.

Support (if any)

None
227 Poor sleep as a predictor of COVID-19 related stress, fear and sadness in young adolescents: a longitudinal study
Authors: Kiss Orsolya , Alzueta Elisabet , Yuksel Dilara , Durley Ingrid , Volpe Laila , Dulai Teji , Arra Nicole , Obilor Todd , Pohl Kilian , de Zambotti Massimiliano , Baker Fiona
Published: May 2021

Introduction

Adolescence is a transitional life-stage accompanied by large biopsychosocial changes and greater psychophysiological vulnerability. Global events like the COVID-19 pandemic may increase vulnerability to depression and anxiety in this population. Poor sleep is often associated with depression, and both sleep and mood have been shown to be strongly impacted by the COVID-19 pandemic, with most studies focusing on adults. The current study investigates psychological distress in young adolescents during the pandemic, and specifically, whether poor sleep before the pandemic predicts psychological distress.

Methods

Self-report data were analyzed from 3099 adolescents (9-10 years at baseline) in the population-based, demographically diverse, Adolescent Brain Cognitive Development (ABCD) study across three pre-pandemic annual visits and 3 monthly time points during the COVID-19 pandemic (ages 11-13 years). At each assessment, children and their guardians completed questionnaires including those about sleep, environment, and psychological wellbeing. Gradient Boosted Tree machine learning algorithms were used to identify the strongest predictors of pandemic-related psychological distress in individuals. We trained models using pre-pandemic sleep measures along with demographics, economic, and social measures during the pandemic. We evaluated the performance of the models using area under curve (AUC) metrics and interpreted the models by using the recently proposed SHapley Additive exPlanations methodology.

Results

Pandemic-related perceived stress, fear and sadness were accurately detected with our classifiers (AUC = 0.83 for perceived stress, AUC = 0.73 for fear, AUC = 0.79 for sadness). Across all models, shorter sleep duration, prolonged sleep onset latency, and longer time between waking and getting out of bed predicted greater distress. Moreover, female sex, and pandemic-related factors, including greater family conflict, fewer economic resources, and more screen time contributed to prediction performance in all three models.

Conclusion

Findings highlight the importance of addressing sleep problems and ensuring sufficient sleep duration in children to protect against the psychological impact of major life events, including the COVID-19 pandemic. Considering the long-lasting effects of sleep, it would be crucial to improve sleep health by targeted prevention, intervention and increased awareness among adolescents.

Support (if any)

NIH U01DA041022
241 Remotely Delivered Yoga Nidra for Insomnia and Anxiety during COVID-19
Authors: Sharpe Erica , Butler Matthew , Hanes Doug , Bradley Ryan
Published: May 2021

Introduction

Insomnia and related anxiety affect 30 - 50% of the US adult population. These conditions often coexist, and contribute to increased mortality from depression, heart disease, and stroke. The current COVID-19 pandemic has heightened anxiety and sleeplessness, and 53% of US adults report the pandemic has affected their mental health. There is a need for research into therapies for anxiety and insomnia that can be delivered remotely for increased accessibility to reach more individuals in need.

Methods

To contribute to this need, we examined the effects of remotely delivered Yoga Nidra (translated to mean “yogic sleep”), a guided meditation practice, on anxiety and sleep. The practice was delivered in real-time before bed, or asynchronously via an online REDCap-based platform, once per week for 16-weeks from April to July (during the early months of the COVID-19 pandemic).

Results

Seventy-four individuals joined the study, of whom 71% reported subthreshold insomnia (Insomnia Severity Index score of 14 ± 4), and 74% reported anxiety (Generalized Anxiety Disorder Index score of 10 ± 5). Seventy-one (96%) participants accessed the asynchronous recordings. Remote delivery of this practice proved very feasible, with no adverse events reported, and although we provided no monetary compensation, 50% of our sample still completed a post-intervention survey. Further, 52% of n=25 respondents who completed both pre- and post-intervention sleep surveys reported decreased sleep onset latency (SOL) the following day, with a mean decrease of 10 minutes (95% CI = −19.0, −0.5) for all respondents, and strongest change (−34 min; p=.017) measured for those who reported SOL between 30-120 min at baseline. Overall state anxiety was decreased by 41% for n=32 respondents who completed pre-post State Trait Anxiety Index (STAI) surveys surrounding a single practice (average score of 47 ± 11 before practice vs. 27 ± 8 after practice, p<.0001).

Conclusion

Remotely delivered Yoga Nidra is feasible to deliver, and demonstrates potential benefits for anxiety and insomnia, warranting additional research.

Support (if any)

This work was supported by the R90 BRIDG grant at the Helfgott Research Institute at the National University of Natural Medicine.
243 Adverse relationships between sleep apnea, white matter integrity and perfusion is attenuated in more physically fit older adults
Authors: Driscoll Ira , Hagen Erika , Barnet Jodi , Lose Sarah , Edmunds Kyle , Gaitán Julian , Motovylyak Alice , Okonkwo Ozioma , Peppard Paul
Published: May 2021

Introduction

White matter (WM) integrity declines with age and is sensitive to vascular risk modifiers, such as exercise. Sleep apnea is believed to contribute to cerebral white matter change via intermittent hypoxia-induced alterations to cerebral blood flow resulting in cerebrovascular shearing. Existing literature highlights the relationships between poor sleep and numerous adverse health outcomes, including risk for cardiovascular disease and dementia. Conversely, exercise seems to have a positive effect on both brain structure and function. Here we examine a potential interaction between sleep apnea severity and cardiorespiratory fitness (characterized by a gender-specific Non-Exercise CardioRespiratory Fitness Measure, NECRFM) as predictors of MRI measures of brain WM integrity and cerebral blood flow (CBF) in a sample of non-demented older adult participants of the Wisconsin Sleep Cohort (WSC).

Methods

Cross-sectional linear models using data from a subset of 124 WSC participants (50% female; mean age[range]=67.6 [49.6, 85.3]) examined the relationship between sleep apnea severity (apnea-hypopnea index, AHI) and cardiorespiratory fitness in predicting MRI-assessed total WM and lesion volumes, WM hyperintensities (WMHs; a marker of small vessel disease in the brain) and Arterial Spin Labeling (ASL) CBF, controlling for age, sex, BMI, education, and hypertension.

Results

Greater sleep apnea severity was associated more strongly with both total lesion and WMH loads in less fit compared to more fit persons (p’s<0.05) in the absence of significant differences in total WM volume. Regional perfusion revealed higher CBF in the angular gyrus, middle frontal cortex, and superior frontal gyrus and lower CBF in the anterior cingulate gyrus and the hippocampus of more fit compared to less fit persons (p’s< 0.05), in the absence of differences in mean global perfusion.

Conclusion

Overall, our results suggest that better general fitness may attenuate negative brain health outcomes related to poor sleep. We highlight an important relationship between brain health and modifiable behavioral factors, namely sleep and fitness, that have the potential to help maintain or improve brain integrity with age.

Support (if any)

This work was supported by United States National Institutes of Health grants R01AG062167, R01AG058680, R01HL62252, 1R01AG036838 and 1UL1RR025011.
250 AI-Supported Sleep Staging from Activity and Heart Rate
Authors: Chowdhury Samadrita , Song TzuAn , Saxena Richa , Purcell Shaun , Dutta Joyita
Published: May 2021

Introduction

Polysomnography (PSG) is considered the gold standard for sleep staging but is labor-intensive and expensive. Wrist wearables are an alternative to PSG because of their small form factor and continuous monitoring capability. In this work, we present a scheme to perform such automated sleep staging via deep learning in the MESA cohort validated against PSG. This scheme makes use of actigraphic activity counts and two coarse heart rate measures (only mean and standard deviation for 30-s sleep epochs) to perform multi-class sleep staging. Our method outperforms existing techniques in three-stage classification (i.e., wake, NREM, and REM) and is feasible for four-stage classification (i.e., wake, light, deep, and REM).

Methods

Our technique uses a combined convolutional neural network coupled and sequence-to-sequence network architecture to appropriate the temporal correlations in sleep toward classification. Supervised training with PSG stage labels for each sleep epoch as the target was performed. We used data from MESA participants randomly assigned to non-overlapping training (N=608) and validation (N=200) cohorts. The under-representation of deep sleep in the data leads to class imbalance which diminishes deep sleep prediction accuracy. To specifically address the class imbalance, we use a novel loss function that is minimized in the network training phase.

Results

Our network leads to accuracies of 78.66% and 72.46% for three-class and four-class sleep staging respectively. Our three-stage classifier is especially accurate at measuring NREM sleep time (predicted: 4.98 ± 1.26 hrs. vs. actual: 5.08 ± 0.98 hrs. from PSG). Similarly, our four-stage classifier leads to highly accurate estimates of light sleep time (predicted: 4.33 ± 1.20 hrs. vs. actual: 4.46 ± 1.04 hrs. from PSG) and deep sleep time (predicted: 0.62 ± 0.65 hrs. vs. actual: 0.63 ± 0.59 hrs. from PSG). Lastly, we demonstrate the feasibility of our method for sleep staging from Apple Watch-derived measurements.

Conclusion

This work demonstrates the viability of high-accuracy, automated multi-class sleep staging from actigraphy and coarse heart rate measures that are device-agnostic and therefore well suited for extraction from smartwatches and other consumer wrist wearables.

Support (if any)

This work was supported in part by the NIH grant 1R21AG068890-01 and the American Association for University Women.
251 Agreement and reliability of a new polysomnography sleep staging algorithm against multiple human scorers
Authors: Magalang Ulysses , Keenan Brendan , Staley Bethany , Anderer Peter , Ross Marco , Cerny Andreas , Vasko Raymond , Kuna Samuel , Bakker Jessie
Published: May 2021

Introduction

Scoring algorithms have the potential to increase polysomnography (PSG) scoring efficiency while also ensuring consistency and reproducibility. We sought to validate an updated sleep staging algorithm (Somnolyzer; Philips, Monroeville PA USA) against manual sleep staging, by analyzing a dataset we have previously used to report sleep staging variability across nine center-members of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC).

Methods

Fifteen PSGs collected at a single sleep clinic were scored independently by technologists at nine SAGIC centers located in six countries, and auto-scored with the algorithm. Each 30-second epoch was staged manually according to American Academy of Sleep Medicine criteria. We calculated the intraclass correlation coefficient (ICC) and performed a Bland-Altman analysis comparing the average manual- and auto-scored total sleep time (TST) and time in each sleep stage (N1, N2, N3, rapid eye movement [REM]). We hypothesized that the values from auto-scoring would show good agreement and reliability when compared to the average across manual scorers.

Results

The participants contributing to the original dataset had a mean (SD) age of 47 (12) years and 80% were male. Auto-scoring showed substantial (ICC=0.60-0.80) or almost perfect (ICC=0.80-1.00) reliability compared to manual-scoring average, with ICCs (95% confidence interval) of 0.976 (0.931, 0.992) for TST, 0.681 (0.291, 0.879) for time in N1, 0.685 (0.299, 0.881) for time in N2, 0.922 (0.791, 0.973) for time in N3, and 0.930 (0.811, 0.976) for time in REM. Similarly, Bland-Altman analyses showed good agreement between methods, with a mean difference (limits of agreement) of only 1.2 (-19.7, 22.0) minutes for TST, 13.0 (-18.2, 44.1) minutes for N1, -13.8 (-65.7, 38.1) minutes for N2, -0.33 (-26.1, 25.5) minutes for N3, and -1.2 (-25.9, 23.5) minutes for REM.

Conclusion

Results support high reliability and good agreement between the auto-scoring algorithm and average human scoring for measurements of sleep durations. Auto-scoring slightly overestimated N1 and underestimated N2, but results for TST, N3 and REM were nearly identical on average. Thus, the auto-scoring algorithm is acceptable for sleep staging when compared against human scorers.

Support (if any)

Philips.
255 Spectrophotometric Properties of Commercial Blue-Blocking Lenses in Sunlight
Authors: Mason Brooke , Tubbs Andrew , Fernandez Fabian-Xosé , Grandner Michael
Published: May 2021

Introduction

Blue-blocking glasses are increasingly used as an intervention for jet-lag and other situations where an individual wishes to promote a “dark” signal despite the presence of ambient light. However, most studies on blue-blockers are done under controlled laboratory settings using emissions generated from electric light sources. The present study evaluated the performance of commercially available blue-blockers under daytime sunlight conditions.

Methods

A calibrated spectroradiometer (Ocean Insight), cosine corrector, optic fiber, and software package were used to measure the absolute irradiance (uW/cm^2/nm) available midday in a standardized location that received direct sunlight. Thirty-one commercially available blue-blockers were individually placed in front of the cosine corrector and intensity was measured and analyzed. Each lens was tested for its ability to block visible light, as well as light within the 440-530nm range. Lenses were evaluated individually and grouped by lens type: red-tinted lenses (RTL), orange-tinted lenses (ORL), orange-tinted lenses with blue reflectivity (OBL), brown-tinted lenses (BTL), yellow-tinted lenses (YTL), and clear lenses with blue reflectivity (RBL).

Results

Across the full spectrum, RTL blocked 66% of the light, OTL blocked 60%, OBL blocked 43%, BTL blocked 56%, YTL blocked 28%, and RBL blocked 20%. When the range was restricted to 440-530nm, RTL blocked 99%, OTL blocked 96%, OBL blocked 90%, BTL blocked 66%, YTL blocked 38%, and RBL blocked 17% of the light. Variation across lens types was significant for the full spectrum (one-way ANOVA, p < 0.0001) as well as the 440-530nm range (one-way ANOVA, p < 0.0001). Individual lenses showed variability in performance, though this variability was smaller than the between-group differences.

Conclusion

Under daylight conditions, red and orange lenses (RTL, OTL, and OBL) blocked at least 90% of the light in the 440-530nm range. Notably, RBL lenses restricted the most short-wavelength light as a proportion of the total light blocked. These data suggest that RTL, OTL, and OBL are effective at blocking the most circadian photosensitive components of daylight at the cost of reducing total illumination.

Support (if any)

R01MD011600, R01DA051321
269 Sleep Enhancement Technology: A Survey of Apps
Authors: Stekl Emily , Klosterman Grace , Simonelli Guido , Collen Jacob , Doty Tracy Jill
Published: May 2021

Introduction

The ever-evolving market for sleep technologies far outpaces the ability of providers to understand and counsel patients about developments in this area. Although significant literature has validated the performance of sleep tracking technologies, there is little evidence regarding sleep enhancement technologies. Our study systematically surveys currently available commercial sleep enhancement smartphone applications to empower both providers and patients alike.

Methods

We systematically searched the App Store (Apple) and Google Play Store (Android) in the US on 26 MAY 2020 using the keyword “sleep.” This survey is inclusive of all smartphone applications found.

Results

We identified 342 apps: 70.2% were found on Android (N=240) and 29.8% on Apple (N=102). Ninety-five percent of apps offer a free version. The majority of sleep apps are intended for use during wake (65.8% exclusively during wake; 28.7% during both wake and sleep), with only 5.6% intended to be used during sleep alone. Most apps purport to enhance rather than measure sleep (78.7% versus 1.8%). The vast majority of apps claim to enhance sleep via reductions in sleep latency (65.8%). Reduced sleep latency is primarily achieved using a combination of non-verbal auditory stimuli such as nature sounds (84.4%), artificial stimuli (64.5%), and instrumental music (77.1%).

Conclusion

Interestingly, most sleep apps are designed to be used while awake, prior to sleep, and focus on the enhancement of sleep, rather than measurement, by targeting sleep latency. Given the multitude of available sleep enhancement apps, many of which are free to try, these should be considered a reasonable strategy for providers and consumers to consider for empowering patients to improve sleep!

Support (if any)

Department of Defense Military Operational Medicine Research Program (MOMRP)
287 East? I Thought You Said Weast! The Influence of Travel on College Football Team Performance
Authors: Kealaiki-Sales Micah , Pradhan Sean
Published: May 2021

Introduction

Previous research in professional basketball and baseball has shown that traveling up to three hours westward can hamper performance due to circadian disadvantages. However, findings in the context of collegiate football are conflicting, as some prior studies have reported negative effects on scoring during either eastward or westward travel. The current study extends the literature by investigating the impact of travel on both offensive and defensive team performance within National Collegiate Athletic Association (NCAA) Division I college football.

Methods

Following the NCAA’s introduction of the College Football Playoff in 2014, data from 1,909 away games from 64 “Power Five” conference teams played during the 2014 to 2019 regular seasons were collected from the publicly available sports database, Sports-Reference. For the purposes of our analyses, we excluded all games played at neutral sites. We examined the effects of the direction of travel away from the college’s home city and time of game day on visiting team performance, specifically game outcomes, points scored, points allowed, completion percentages, penalties, fumbles, interceptions, and total turnovers forced and committed, controlling for both visiting and home team conference, day of game, and team rankings.

Results

Teams playing in the afternoon allowed significantly more points (OR = 1.05, p < .001) and forced more opponent turnovers than those playing in the evening (OR = 1.14, p = .05). Teams traveling eastward threw significantly more interceptions than those traveling in the same time zone (OR = 1.48, p = .004). A significant interaction between direction of travel and time of day was detected for points allowed (χ2 = 12.30, p = .02), and a marginal interaction was present for points scored (χ2 = 8.42, p = .08). Several other marginal differences were also identified for points scored, interceptions, and team turnovers (OR > 1.03, p < .10).

Conclusion

Findings from our study offer evidence for the influence of circadian factors on team points allowed, interceptions, and opponent turnovers forced. Specifically, travel in varying directions and the time of day when a game is played can impact team performance during away games within college football.

Support (if any)

None
294 Impacts of travel and time zone differences in the National Hockey League (NHL)
Authors: Charest Jonathan , Samuels Charles , Bastien Célyne , Lawson Doug , Grandner Michael
Published: May 2021

Introduction

Elite athletes are at risk of poor sleep which can be exacerbated by frequent travel. The present exploratory study investigated the impact of travel on the winning percentage, number of goals scored in the 3rd period and the number of penalties in the 3rd period over the 2013–2020 seasons in the National Hockey League (NHL).

Methods

Data from away and home games from the 2013–2020 seasons in the NHL were included in this study. The outcomes were based on winning percentage with additional covariates including home and away games; timing of the game (afternoon/17:30 or earlier; evening/18:00 or later; number of time zones travelled (one, two or three); direction of the travel (eastward or westward); length of the game (regular, overtime or shootout). Additionally, data exclusively from the 3rd period were assessed for the number of penalties received and the number of goals scored for and against. Data were analyzed with logistic regressions to evaluate the effects of the aforementioned variables on winning percentage for both eastern and western conference teams.

Results

Regardless of the length of the game, results indicated no difference between eastern and western teams on winning percentage. However, there was a significant impact of home-ice on winning percentage for both conferences (p<0.001). In addition, there was no difference on the winning percentage based on the travel direction and the number of time zones crossed (p = 0.747) or the time of the day (p=0.991). Moreover, visiting teams received significantly more 3rd period penalties than home teams (p<0.001), regardless of travel and while travelling within the same time zone compared to eastward travel (p<0.001) but not westward travel (p=0.078). Finally, there was an increased risk of being scored against when team travelled three time zones (p=0.03), regardless of the direction.

Conclusion

This 7-year investigation of data from the NHL demonstrates an unexplored aspect of the impact that travel and circadian factors may have on emotion regulation and performance. Translational application of this knowledge to enhance general public health and performance would be warranted.

Support (if any):
307 Sleep and occupational wellbeing in active duty U.S Army Soldiers
Authors: Pirner Maddison , Doyle Scott , Mantua Janna , Bessey Alexxa , Naylor Jacob , Ritland Bradley , Sowden Walter , Burke Tina , Mckeon Ashlee
Published: May 2021

Introduction

Insufficient sleep is ubiquitous among active duty service members in operational settings. Although insufficient sleep has been linked to poor cognitive, psychological, and physiological outcomes in military populations, little research has investigated the impact of insufficient sleep on Soldier occupational wellbeing. This study examined the longitudinal association between sleep quality and occupational functioning in a population of active duty U.S. Army Soldiers.

Methods

Sixty male Soldiers (age 25.41±3.74 years) participated. Sleep quality and occupational outcomes were assessed four weeks apart (before and after an annual training mission). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Occupational outcome measures included the Emotional Exhaustion Scale, Walter Reed Functional Impairment Short Scale, Role Overload Scale, and Perceived Stress Scale. Linear regressions assessed the prediction of PSQI Global Score on occupational outcome scores. Student’s t-tests compared occupational outcomes between “good” and “poor” sleepers (PSQI Global Score > 5 = poor sleeper).

Results

Poorer sleep quality at baseline broadly predicted poor occupational outcomes post-training. Specifically, higher PSQI Global Scores predicted higher emotional exhaustion (B = 1.6, p < 0.001, R2 = 0.25), functional impairment (B = 0.29, p < 0.03, R2 = 0.14), role overload (B = 28, p < 0.008, R2 = 0.12), and perceived stress (B = 0.34, p < 0.004, R2 = 0.2). Furthermore, occupational outcome scores were significantly higher in poor sleepers than good sleepers: emotional exhaustion: (t(58) = -4.18, p < .001); functional impairment: (t(59) = -3.68, p = .001); role overload (t(58) = -3.20, p = .002); and perceived stress (t(58) = -2.43, p = .02).

Conclusion

This study identified a longitudinal relationship between sleep quality and occupational outcomes, suggesting that service members with poor sleep may be at risk for experiencing poor workplace wellbeing. Given the association between service member wellbeing and likelihood to re-enlist, insufficient sleep may negatively impact Soldier attrition. Future studies should aim to augment sleep quality and track occupational outcomes in this population.

Support (if any)

This work was funded by the Military Operational Medicine Research Program of the United States Army Medical Research and Development Command.
308 Sleep Quality Predicts Discrepancy between Objective and Self-Ratings of Performance in Cadets during U.S Army ROTC Advanced Camp
Authors: Klosterman Grace , Mickelson Carolyn , Choynowski Jake , Sowden Walter , Mantua Janna , Mckeon Ashlee
Published: May 2021

Introduction

U.S. Army Reserve Officer Training Corps (ROTC) Advanced Camp (AC) is a month-long capstone course that evaluates Cadet leadership. Although the relationship between sleep and objective performance is well established, less is known about how sleep may impact self-perception of performance, especially in the military context. This study examined the impact of habitual sleep on self-expected and objective AC performance.

Methods

577 Cadets (age 22.22 ± 2.74; 74.36% male) completed the Pittsburgh Sleep Quality Index (PSQI) at baseline to measure subjective sleep quality (Global; higher scores indicate poorer sleep quality) and total sleep time (TST) in the month before training. Self-expected AC performance was captured by asking Cadets to estimate what their final performance score would be and objective performance was determined from summary scores from Instructors. Performance discrepancy was calculated as the difference between Cadet’s expected and objective scores. Regression models assessed the predictive utility of habitual TST and Global on performance.

Results

Ordinal regressions showed that as Global increased, expected AC score also decreased with an OR of .684 (95% CI, -.694 to -.064), Wald χ2(1) = 5.56, p = .018. Further, Global independently predicted performance discrepancies, where the odds of a difference existing between a Cadet’s self-expected and their objective performance was .895 less likely for those with increasing Global (p = .028). Together TST and Global predicted discrepancy magnitude between Cadet self-expected and objective performance, F(2, 349) = 2.99, p = .05, with Global as a independent predictor p < .05. Independent findings related to TST were varied and warrant further testing.

Conclusion

Cadets with poorer sleep quality prior to AC self-expected to perform worse and had discrepancies between their self-expected and objective performance when compared to those with higher sleep quality. TST enhanced the predictive power of Global when predicting magnitude of performance discrepancy. Therefore future research examining Global, while accounting for TST, is warranted to better understand how sleep may influence self-expectations of military performance.

Support (if any)

Support for this study came from the Military Operational Medicine Research Program of the United States Army Medical search and Development Command.
332 Non-REM EEG Spectral Power at Baseline and After Total Sleep Deprivation in Individuals with Sleep-Onset Insomnia
Authors: Finlay Myles , Hansen Devon , Skeiky Lillian , Van Dongen Hans
Published: May 2021

Introduction

The baseline non-REM sleep EEG of individuals with insomnia has been found to display increased spectral power at frequencies >14Hz, which may reflect hyperarousal. There is some evidence in this population of reduced slow wave activity after total sleep deprivation (TSD), potentially indicating altered sleep homeostasis. We investigated non-REM sleep EEG spectra at baseline and after TSD in individuals with sleep-onset insomnia.

Methods

10 individuals with sleep-onset insomnia and 5 healthy controls (ages 22-40y, 11 females) completed a 5-day laboratory study with an adaptation night, baseline night, assignment to 38h TSD (n=5 insomnia, n=5 control) or equivalent non-TSD control (n=5 insomnia), and recovery night. Sleep periods were 10h (22:00-08:00) with digital polysomnography (250Hz; Nihon Kohden). Following artifact rejection, 5s subepochs of the non-REM (stages N2, N3) sleep EEG (C3-M2 derivation) in baseline and recovery nights were subjected to spectral analysis. Spectra (0.2Hz bins) were averaged over subepochs in 30s epochs. Repeated-measures ANOVA compared baseline spectra between insomnia and controls, and baseline-recovery difference spectra between TSD insomnia, non-TSD insomnia, and TSD controls.

Results

Average non-REM sleep amount was 5.9 at baseline, increasing by 1.1h after TSD, with no differences between groups (p≥0.20). At baseline, the insomnia group showed increased power in theta/alpha (~4–12Hz), reaching significance in the lower spindle range, compared to controls (p<0.05). As anticipated, no differences emerged between baseline and recovery nights in the non-TSD insomnia group. However, the TSD insomnia group showed increased delta (~1–3Hz) and theta/alpha (~6–10Hz) power (p<0.05) during recovery. Healthy controls showed expected power increases in delta and lower spindle range, and decreases in upper spindle range (~14–15Hz), after TSD (p<0.05).

Conclusion

Compared to healthy controls, individuals with sleep-onset insomnia showed increased non-REM sleep EEG power in the theta/alpha bands and low spindle frequency range, with further significant increases in theta/alpha in addition to delta power following TSD, despite small sample size. The increase in delta power following TSD was equivalent to that in healthy controls, suggesting no sleep homeostasis abnormality. Whether the elevated theta/alpha power may be related to hyperarousal is unclear.

Support (if any)

ONR grant N00014-13-C-0063
335 Evaluation of Dose Transition From Zolpidem to Lemborexant Across 14 Weeks: Results From a Multicenter Open-label Pilot Study
Authors: Rosenberg Russell , Amchin Jess , Kumar Dinesh , Perdomo Carlos , Atkins Norman , Moline Margaret , Malhotra Manoj
Published: May 2021

Introduction

E2006-A001-312 (Study 312; NCT04009577) was an open-label pilot study that examined pre-specified dosing paradigms for transitioning patients from zolpidem (ZOL: immediate [IR] or extended-release [ER]) to the dual orexin receptor antagonist lemborexant (LEM; 5mg [LEM5] or 10mg [LEM10]).

Methods

Study 312 included a 3-week Screening Period (subjects continued ZOL), 2-week Titration Period (TITR), 12-week Extension Period (EXT), and 4-week Follow-up Period. Adults with insomnia who were intermittent (3–4 nights/week) or frequent (≥5 nights/week) ZOL-IR or ZOL-ER users participated. Intermittent ZOL users and subjects with one week each of intermittent and frequent ZOL usage were assigned to Cohort-1 and began TITR with LEM5. Frequent ZOL users were assigned to Cohort-2 and randomized 1:1 to LEM5 or LEM10. Subjects who successfully transitioned to LEM had the option to enter EXT. During TITR and EXT, subjects could change LEM dose (only once during TITR). The primary endpoint was the proportion of subjects who transitioned to LEM at the end of TITR. Treatment-emergent adverse events (TEAEs) were assessed based on dose at time of TEAE.

Results

Fifty-three subjects enrolled (Cohort-1, n=10; Cohort-2, n=43). Of these, 43/53 (81.1%) transitioned to LEM at the end of TITR; all 43 (100.0%) entered EXT wherein 41/43 subjects received treatment. Three of these subjects discontinued treatment during EXT, so that 38/41 (92.7%) subjects entered EXT, received treatment and completed EXT. At the end of EXT, 25/41 (61.0%) subjects were receiving LEM10 and 16/41 (39.0%) were receiving LEM5. Based on modal dose (most frequent dose taken during TITR and EXT combined) groups, median time to first dose change was 14.5 days and 36.0 days for LEM5 and LEM10, respectively. The majority of TEAEs were mild/moderate in severity. Across the study (TITR and EXT), more TEAEs occurred with LEM10 than LEM5; the most common TEAEs were somnolence (n=4) and abnormal dreams (n=4).

Conclusion

Study results support the view that patients can successfully transition directly from ZOL to LEM. LEM was generally well tolerated; the safety profile was consistent with that observed in Phase 3 clinical development.

Support (if any)

Eisai Inc.
339 Long-term Perception of Medication Effectiveness in Subjects Receiving Lemborexant for up to 12 Months
Authors: Drake Christopher , Yardley Jane , Pinner Kate , Perdomo Carlos , Moline Margaret
Published: May 2021

Introduction

The Patient Global Impression–Insomnia version (PGI-I) is a self-report instrument used to evaluate a patient’s perception of the effects of their insomnia medication on their sleep relative to starting treatment. The PGI-I includes 3 items related to medication effects (helped/worsened sleep; decreased/increased time to fall asleep; and increased/decreased total sleep; responses include: 1=positive, 2=neutral, 3=negative) and 1 item related to perceived appropriateness of study medication strength (responses include: 1=too strong, 2=just right, 3=too weak). In Study E2006-G000-303 (Study 303; SUNRISE-2; NCT02952820), significantly greater percentages of subjects reported a positive impact of the dual orexin receptor antagonist lemborexant (LEM) versus placebo (PBO) at 1, 3, and 6mo for each of the PGI-I items related to medication effects. PGI-I results at 9 and 12mo are presented here for subjects that received continuous treatment with LEM for up to 12mo.

Methods

Study 303 was a 12-mo, randomized, double-blind, PBO-controlled (first 6mo [Period 1]), phase 3 study. Subjects were aged ≥18y with insomnia disorder. During Period 1, subjects received PBO (n=318) or LEM (5mg, [LEM5], n=316; 10mg, [LEM10], n=315). During Period 2 (second 6mo), LEM subjects continued their assigned dose while PBO subjects were rerandomized to LEM5 or LEM10 (reported separately). Subjects were also administered the PGI-I at months 9 and 12.

Results

At 9 and 12mo, the majority of LEM5 (9mo, n=241; 12mo, n=205) and LEM10 (9mo, n=211; 12mo, n=192) subjects reported that their study medication “helped” sleep at night (9mo: LEM5=73.4%; LEM10=76.3%; 12mo: LEM5=74.6%; LEM10=77.6%), reduced time to fall asleep (9mo: LEM5=79.3%, LEM10=78.2%; 12mo: LEM5=76.6%, LEM10=80.2%), and increased total sleep time (9mo: LEM5=62.2%, LEM10=73.0%; 12mo: LEM5=62.4%; LEM10=65.1%). Also, at both 9 and 12mo, the majority of subjects in the LEM5 and LEM10 groups, responded that treatment strength was “just right” (9mo: LEM5=60.6%, LEM10=62.1%; 12mo: LEM5=63.4%; LEM10=60.4%). LEM was well tolerated. Most adverse events were mild or moderate.

Conclusion

The majority of subjects receiving LEM5 or LEM10 reported a positive medication effect at both 9 and 12mo, sustaining similar positive effects for LEM achieved earlier, during the first 6mo of treatment in Study 303.

Support (if any)

Eisai Inc.
351 Informal Caregivers with Insomnia May Benefit From an Insomnia Treatment Using an Acceptance and Commitment Therapy Approach
Authors: Song Yeonsu , McGowan Sarah Kate , Kelly Monica , Carlson Gwendolyn , Fung Constance , Josephson Karen , Zeidler Michelle , Alessi Cathy , Martin Jennifer
Published: May 2021

Introduction

Insomnia among informal caregivers (providing care to family/friends) is common and associated with worse mental and physical health outcomes. Traditional cognitive behavioral therapy for insomnia may be challenging for caregivers whose beliefs about sleep may relate to beliefs and behaviors that are intertwined with their unique situation of caregiving. We examined whether an insomnia treatment using an acceptance and commitment (ACT) approach (i.e. committing to values-based actions toward goals vs. experiential avoidance of distressing emotions/thoughts) plus sleep restriction, stimulus control and sleep hygiene improves sleep, mental health, and daytime symptoms among caregivers.

Methods

We analyzed data from women veterans with insomnia who were informal caregivers (mean age=44 years [range 25–57]; N=6) and were participating in a clinical trial of an ACT-focused treatment (termed ABC-I). We measured: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), 11 items assessing symptoms of daytime impairment due to poor sleep derived from the International Classification of Sleep Disorders-Third Edition, and the Acceptance and Action Questionnaire (AAQ). Student t-tests were used to compare outcomes between pre- and post-ABC-I.

Results

Caregivers showed significant improvements between pre- and post-ABC-I (all p-values<0.05) in the following outcomes: ISI (14.3±5.4 vs. 3.8±3.2), PHQ-9 (9.8±7.2 vs. 2.8±3.8), GAD-9 (9.0±6.6 vs. 2.0±1.8), and number of symptoms of sleep-related daytime impairment (6.8±4.0 vs. 3.8±3.5). Caregivers also showed improvement trends in PSQI (10.0±4.1 vs. 5.2±1.2, p=0.06) and AAQ score (24.0±12.7 vs. 16.2±8.0, p=0.05).

Conclusion

We found that caregivers with insomnia may benefit from ACT-based treatment in improving perceived sleep quality and insomnia, depression, anxiety, sleep-related daytime impairment and reduced experiential avoidance. This approach may increase motivation by linking the sleep program to core values, and acceptance and tolerance of emotions or thoughts may benefit caregivers with insomnia. Further studies using an ACT-based insomnia program are needed to test its effect in a larger sample of caregivers and evaluate benefits in terms of reduced stress and improved health.

Support (if any)

VA HSR&D (Martin IIR 13-058-2 and RCS-20–191), NIA (K23AG055668, Song), NHLBI (K23HL143055, Martin) of the NIH, VAGLAHS GRECC, and VA Office of Academic Affiliations (Kelly; Carlson).
352 Feasibility of Hypnosis as Adjunctive Treatment for Subjective Sleep Disturbance: A Pilot Study and Proof of Concept
Authors: Zhao Emma , Faerman Afik , Spiegel David
Published: May 2021

Introduction

Hypnosis-based interventions have been shown to have a positive impact on several dimensions of sleep health. However, current evidence is limited as only a paucity of studies included populations with sleep complaints. Here we present a pilot data set to demonstrate the feasibility of developing a hypnosis-based adjunctive treatment for subjective sleep complaints.

Methods

Eleven adults (42% female; mean age 45±16.87 years) who sought treatment at the Stanford Sleep Medicine Center or Center for Integrative Medicine for subjective sleep complaints received hypnosis as adjunctive treatment. Self-report questionnaires were used to assess the weekly frequency of subjective sleep disturbances experienced before and after treatment, as well as 5-point Likert scale ratings of perceived qualitative improvement in symptom severity and overall sleep quality.

Results

Five participants (45%) reported a reduction in symptom frequency and severity after hypnosis treatment. All five participants attributed at least some of the improvement to hypnosis treatment. Most participants (63%) observed post-treatment improvements in their overall sleep quality. No participants reported adverse effects of hypnosis.

Conclusion

Results suggest hypnosis-based adjunctive treatment may be effective for alleviating subjective sleep disturbances. The findings serve as preliminary support for further randomly controlled trials in larger samples.

Support (if any):
359 Tailoring of Cognitive Behavior Therapy for Insomnia for Patients with Kidney Failure Undergoing Hemodialysis: The SLEEP-HD Study
Authors: McCurry Susan , Cukor Daniel , Clark Carlyn , Brady Nisha , Rue Tessa , Unruh Mark , Mehrotra Rajnish
Published: May 2021

Introduction

Patients with kidney failure treated with hemodialysis (HD) frequently report insomnia symptoms. Cognitive-behavior therapy for insomnia (CBT-I) is a first line treatment for insomnia but there are unique issues surrounding kidney failure and HD that impact patients’ ability to access CBT-I and follow standard treatment recommendations. This presentation describes CBT-I protocol modifications made to address these issues as part of an ongoing multi-center clinical trial testing the efficacy of telehealth CBT-I compared to trazodone or medication placebo control.

Methods

CBT-I protocol modifications were made prior to starting the SLEEP-HD randomized trial based upon unique clinical considerations for HD patients, e.g., irregular sleep-wake scheduling that HD treatment demands, and napping during HD sessions or afterwards due to post-HD treatment fatigue. Participants in the SLEEP-HD study are undergoing thrice-weekly maintenance hemodialysis for >3 months and have baseline Insomnia Severity Index scores >10 with sleep disturbances >3 nights/week for >3 months. Participants randomized into the modified CBT-I protocol receive six weekly sessions, delivered by trained CBT-I therapists (1 MSW, 1 PhD) face-to-face via a HIPPA-compliant video telehealth platform. Participants keep a daily sleep diary throughout the CBT-I treatment period.

Results

To date, 91 patients (mean age=56.5 years [SD=14.7], 48.4% female) recruited from community-based dialysis facilities in Seattle and Albuquerque have been randomized into the SLEEP-HD study (n=31 CBT-I). Forty-eight percent of CBT-I clients have chosen to conduct their telehealth sessions during dialysis with the remainder choosing a different location. CBT-I adaptations include therapists developing weekly bed restriction recommendations based on non-dialysis treatment days; allowing shifts in dialysis day “bed window” scheduling for patients with very early or very late dialysis schedules so long as a consistent total time in bed in maintained; and including napping during early/late dialysis sessions as part of the allowable bed window duration. Treatment modifications were also designed to accommodate the diverse socioeconomic circumstances of dialysis patients, including housing instability, which can impact adherence to some standard stimulus control and bed restriction CBT-I recommendations.

Conclusion

It is feasible to deliver CBT-I via telehealth to HD patients but modifications to standard protocols are required.

Support (if any)

This work was supported by PHS grant 5R01AG053221.
384 Sleep, Pain, and Cognition in Women with Chronic Widespread Pain and Insomnia
Authors: Stephens Riley , Curtis Ashley , McCrae Christina S , McGovney Kevin
Published: May 2021

Introduction

Our team has shown pain interacts with sleep in its association with cognition in cardiac patients and older adults, such that better sleep is associated with better cognitive performance in individuals reporting high pain. Whether these associations exist in the context of chronic pain is unknown. This study examines these associations in women with chronic widespread pain and insomnia (CWPI) and extends our prior findings by including objective/subjective pain measures.

Methods

43 adult women (Mage=47.30, SD=13.93) with CWPI completed 14 daily diaries measuring wake time after sleep onset-WASO and total sleep time-TST. Daily diaries and thermal application [thermode on foot plantar] assessed subjective pain [0–100(most intense)]. Tender point testing assessed objective pain threshold [force(kg) on 18 tender points until painful]. Participants completed cognition tasks: Stroop (attention/processing speed) and Sternberg (working memory). Multiple regressions evaluated whether sleep (average WASO/TST) interacted with average subjective (diary/thermal ratings) and objective (force) pain in its association with cognition (Stroop reaction time (RT) on congruent trials/Sternberg #correct), controlling for age/education.

Results

WASO interacted with subjective pain (daily-B=.0003, SE=.0001, p=.009; thermal-B=.0002, SE=.004, p=.01) in its association with attention/processing speed. Higher WASO was associated with longer Stroop RT in high pain (~70/100) participants (B=.005, SE=.003, p=.047) and faster RT in low pain (~30/100) participants (B=-.009, SE=.004, p=.03). Higher WASO was associated with longer Stroop RT in those with high (~74/100; B=.01, SE=.002, p=.01), but not average (~46/100) or low (~19/100) thermal pain ratings (ps>.05). TST interacted with daily pain in its association with attention/processing speed (B=.001, SE=.00, p=.005). In participants with high (B=-.003, SE=.001, p=.02), not average (~50/100) or low pain (~30/100, ps>.05), longer TST was associated with faster Stroop RT. In those with low (~1kg, B=.07, SE=.02, p<.001) and average (~2kg, B=.05, SE=.01, p=.002) pain thresholds, longer TST was associated with better Sternberg performance (trending interaction: B=-.03, SE=.02, p=.09).

Conclusion

In CWPI patients with high pain, better sleep was associated with better cognitive performance. These findings suggest sleep may hold potential to mitigate pain’s impact on cognition. Future studies should examine whether interventions that target sleep also improve cognition in chronic pain patients with high pain.

Support (if any)

NINR(R01NR017168)/ClinicalTrials.gov(NCT02001077), PI McCrae.