bluuebunny/crossref_metadata_2025 huggingface dataset:
651 Longitudinal, unobtrusive, and ecologically valid sleep metric estimation from a smart bed to predict the pathology of COVID-19
Authors: Guzenko Dmytro , Garcia Gary , Siyahjani Farzad , Monette Kevin , DeFranco Susan , Sikri Deepika , Chung Johnny , Van Cauter Eve , Somers Virend , Mushtaq Faisal
Published: May 2021

Introduction

Pathophysiologic responses to viral respiratory challenges such as SARS-CoV-2 may affect sleep duration, quality and concomitant cardiorespiratory function. Unobtrusive and ecologically valid methods to monitor longitudinal sleep metrics may therefore have practical value for surveillance and monitoring of infectious illnesses. We leveraged sleep metrics from Sleep Number 360 smart bed users to build a COVID-19 predictive model.

Methods

An IRB approved survey was presented to opting-in users from August to November 2020. COVID-19 test results were reported by 2003/6878 respondents (116 positive; 1887 negative). From the positive group, data from 82 responders (44.7±11.3 yrs.) who reported the date of symptom onset were used. From the negative group, data from 1519 responders (48.4±12.9 yrs.) who reported testing dates were used. Sleep duration, sleep quality, restful sleep duration, time to fall asleep, respiration rate, heart rate, and motion level were obtained from ballistocardiography signals stored in the cloud. Data from January to October 2020 were considered. The predictive model consists of two levels: 1) the daily probability of staying healthy calculated by logistic regression and 2) a continuous density Hidden Markov Model to refine the daily prediction considering the past decision history.

Results

With respect to their baseline, significant increases in sleep duration, average breathing rate, average heart rate and decrease in sleep quality were associated with symptom exacerbation in COVID-19 positive respondents. In COVID-19 negative respondents, no significant sleep or cardiorespiratory metrics were observed. Evaluation of the predictive model resulted in cross-validated area under the receiving-operator curve (AUC) estimate of 0.84±0.09 which is similar to values reported for wearable-sensors. Considering additional days to confirm prediction improved the AUC estimate to 0.93±0.05.

Conclusion

The results obtained on the smart bed user population suggest that unobtrusive sleep metrics may offer rich information to predict and track the development of symptoms in individuals infected with COVID-19.

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654 Potential Longitudinal Association Between COVID-19 Infection Outcomes and Insomnia Symptoms
Authors: Vargas Ivan , Muench Alexandria , Grandner Michael , Perlis Michael
Published: May 2021

Introduction

The COVID-19 pandemic has had an unequivocal negative impact worldwide, including increases in stress related to social isolation, unemployment, grief, and fear of contracting the virus. This increased stress has likely led to a greater prevalence of sleep continuity disturbance (i.e., insomnia) in the general population. The goal of the present study was to assess the prevalence of sleep continuity disturbance (i.e., insomnia) in the United States during the initial months of the pandemic. In addition, longitudinal assessment is currently ongoing in order to further assess participant experiences with COVID-19. Specifically, these follow-up data will be used to assess whether, among those that contracted COVID-19, insomnia at baseline (Time 1) predicts worse outcomes (e.g., symptoms of greater frequency, duration, or severity) upon follow-up (Time 2).

Methods

A national survey was conducted from April-June 2020. Participants answered questions regarding social distancing practices, mood, sleep, physical activity, and COVID-19 symptoms. Insomnia symptom prevalence and severity were estimated with a retrospective sleep diary and the Insomnia Severity Index (ISI). A follow-up assessment is currently ongoing and will be completed in March 2021. The follow-up survey consists of similar questions and additional items regarding COVID-19 testing, symptoms [frequency, duration, and severity], and outcomes [outpatient treatment, incidence and duration of hospitalization, and incidence and type of respiratory assistance].

Results

4,133 adults (Mage = 45.8 years; range = 18 - 86 years; 78.7% female) completed the baseline survey. The prevalence of clinically significant sleep continuity disturbance (≥ 30 minutes) was 44.6% for sleep latency problems and 36.2% for wake after sleep onset problems. Nearly 34% of subjects reported average total sleep times of less than 7 hours. Over 17% of subjects (n = 719) reported total ISI scores in the clinical range (ISI total score ≥ 15).

Conclusion

The present study suggests the prevalence of clinically significant insomnia symptoms during COVID-19 remain high in the general population (17–45% depending on definition of insomnia). Similarly, the prevalence of short sleep is elevated. Whether these incident data are associated with COVID-19 outcomes remains to be determined and will be the subject of follow-up analyses in January/February 2021.

Support (if any)

Vargas: K23HL141581; Perlis: K24AG055602
657 Patient Perspectives on Telesleep Care in COVID Times: An Urban Teaching Hospital Survey
Authors: Munoz Tomas , Patel Palakkumar , Viswanath Shilpa , Prasad Bharati
Published: May 2021

Introduction

Telehealth is a relatively new tool for patient care, and to reach underserved areas where certain specialties are available. With the advent of the COVID19 pandemic, Telehealth has become a universal way to provide safe and quality patient care. However, Telehealth is a new experience for many providers and patients. We surveyed patients who received telehealth visits in sleep medicine between March and June 2020 to determine patient satisfaction and common technology-related barriers. The goal was to formulate actionable steps for improving patient’s experiences and determine the feasibility of long-term telehealth services for sleep medicine.

Methods

We interviewed 63 patients by phone, utilizing IRB approved surveys for telehealth satisfaction and technology. Responses were de-identified, tabulated, and analyzed in aggregate using Excel®.

Results

85% of respondents had a high-school diploma or a higher level of education (9.6% students, 39.7% employed, 15.9% unemployed, and 19% retirees). 62% of participants participated in Telehealth for the first time. 89% preferred Telehealth, and 76% rated telehealth experience as good or better than in-person visits. 92% did not require technical assistance during the visit. Long-term telehealth care was acceptable to 63% of participants. Approximately 33% had technology-related barriers (no computer or webcam), and 12% did not have email. However, 89% had smartphones (70% connected to personal internet). Other barriers cited were lack of private space (13%) and taking time off work (9%). No clear preference for phone versus video Telehealth was noted (approximately 40% each), but 7% expressed concern about bi-directional video communication. This may be related to the privacy and security concerns expressed by 20% of respondents. However, only 5% reported using the electronic health record (EHR) based secure communication portal.

Conclusion

Sleep care via Telehealth is preferred by most patients during the COVID pandemic and is acceptable to two-thirds of patients for the long-term. In addition to access to personal devices or the internet, privacy concerns were a barrier to Telehealth. We plan to increase patient enrollment in the EHR-based portal to deliver telehealth services and communication securely to mitigate these barriers.

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662 PAP Therapy: A Review of Resources for the Uninsured during COVID-19
Authors: Malinky Melissa , Oberla Abigail , Khan Meena , Melanie Lyons M
Published: May 2021

Introduction

In 2019, the United States Census estimated 8% (26.1 million) people were without health insurance. Further, an estimated 3.5 million people became/remained uninsured from COVID-19-related job losses. Patients with OSA that belong to a lower socioeconomic status (SES) are less likely to have access to healthcare and may be under or uninsured. Untreated OSA can lead to increased risk of symptoms and associated co-morbidities. Resources to help the uninsured to obtain PAP therapy were available pre-COVID, including two main sources, American Sleep Apnea Association (ASAA) and our local branch serving central Ohio, The Breathing Association. However, the COVID pandemic limited access or closed these programs. Our Sleep Medicine clinics saw 148 uninsured OSA patients between March-December, 2020. Given these difficulties, we re-evaluated available resources for the uninsured.

Methods

We conducted a search for current low cost ($100 or less) PAP therapy options for the uninsured, March 15, 2020-December 3, 2020, by: (1) contacting pre-COVID-19 resources, including Durable Medical Equipment (DME) providers, (2) consulting social work, and (3) completing a librarian assisted web-search not limited to PubMed, Embase, CINAHL for academic related articles and electronic searches using a combination of English complete word and common keywords: OSA, PAP, uninsured, no insurance, cheap, medically uninsured, resources, self-pay, low-income, financial assistance, US. Resources such as private sellers were not investigated.

Results

During COVID-19, assistance for PAP machines/supplies have closed or required a protracted wait-time. Options including refurbished items range from low, one-time fixed cost or income-based discounts from: one local charity (Joint Organization for Inner-City Needs) and DME (Dasco), and four national entities (ASAA, Second Wind CPAP, Reggie White Foundation, CPAP Liquidators). An Electronic Health Record-based tool was developed and distributed to increase provider awareness of pandemic available resources.

Conclusion

Untreated OSA is associated with increased risk of cardiovascular co-morbidities. Access and cost may limit treatment in OSA patients from a lower SES. The COVID-19 pandemic has shuttered programs providing discount PAP and supplies, leaving fewer resources for these patients, thus further widening this health care disparity. Alternatives are needed and current resources are not easily accessible for providers and patients.

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Social media for students sleep health promotion: A health intervention report during COVID-19
Authors: Lopes Maria-Cecilia , Gutierres Gabriela , Salmazo Henrique
Published: May 2021

Introduction

The COVID-19 pandemic affected sleep health. Students’ sleep health requires cognitive processes, mental and physical balance. We assume that the pandemic COVID-19 has modified some sleep habits by eliciting environmental and social interaction changes. According to the perspective that the students need health education interventions on sleep hygiene, we aimed to promote sleep health education based on social media in students using Instagram.

Methods

Students participated by answering an online questionnaire in Instagram platform. The sample was 300 students with internet access between two weeks of March/2020. This period refers to the second and third week of the social isolation policy enacted due COVID-19. The Snowball strategy was the dissemination method, a non-probabilistic sampling technique in which the participants invited new participants from their network of acquaintances.

Results

The valid responses were from students among 18–24 y.o. The sample was mostly female (61,7%), between 18 and 22 y.o., and they sleeped less than 8 hours. Also, 76,3% of the surveyed reported somnolence during the day, 70,2% anxiety and 87,8% worse sleep associated to stress and/or anxiety, which indicated the variables for an educational health intervention design in this context. Most of the sample did stipulate a schedule to wake up on the weekdays (96,6%), and 24,4% of the sample didn’t stipulate a fixed schedule for bedtime during the weekdays. More than 150 people (53,2%) didn’t make any effort to avoid screens before sleeping. The responses’ distribution showed that an average number of people (73,9%) try to avoid using the bed for work or watch television, and 83,1% seek to avoid heavy foods before sleeping.

Conclusion

The Instagram profile focused on the main sleep issues seen in the survey. The posts were created using subjects about sleep process, sleep hygiene practices for students; sleep stages, function and regulation; sleep-wake circadian rhythms. The creation of the @comodormimos profile on Instagram was based on the need for a subject understanding by the researched public. Coronavirus’ pandemic increased the harmful sleep behavior of students. Further studies should be done to understand the impact of COVID-19 pandemic in the student’s sleep health.

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673 Did the COVID-19 pandemic increase insomnia?
Authors: Stanley Neil , Gardiner Alison , Sunter Nicola
Published: May 2021

Introduction

COVID-19 has been an unprecedented health event with far-reaching health and economic consequences. There have been numerous surveys published that have suggested that insomnia has increased during the pandemic. However, there have been no comparisons of data from the pandemic with that from other years. Here we present baseline data from people signing up to an online CBTi course to investigate the impact of COVID-19 on sleep.

Methods

We investigated the difference in age; diary-reported Sleep Efficiency (SE%) and Total Sleep Time (TST); sleep quality and disturbances as measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale (ESS); between the first wave of COVID-19 in the UK (1st March -31st July 2020) as compared to the same period in 2019.

Results

In 2019 n=2231 patients were assessed as compared to n=6173 in 2020. There were no significant differences in the age of the two cohorts (47.1 years v 46.3 years, NS). SE% was significantly lower in the 2019 cohort (66% v 67.6, p <0.001) as was their total sleep time (5.71 hrs v 6.05 hrs, p<0.0001). PSQI scores were also higher in 2019 (13.13 v 12.72. p<0.0001). The level of daytime sleepiness was lower in the 2019 cohort (5.4 v 5.6 p <0.001)

Conclusion

Our results show that there was no evidence of an increase in the severity of sleep disturbance during the 1st wave of the COVID-19 pandemic in the UK in contrast to what numerous surveys have suggested. Indeed, we found that people signing up to Sleepstation’s online dCBTi course during the 1st wave of the pandemic had statistically significant better subjective sleep, although they had a higher level of daytime sleepiness than those in the same period a year previously. Although statistically significant, our results do not demonstrate a clinically relevant difference between the two cohorts. It is also interesting that despite the age-related impact of COVID-19, there was no significant difference in the age of the patients. Thus, in contrast to the survey data, we found no evidence for a worsening of sleep during the 1st wave of the pandemic.

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680 Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes
Authors: Hwang Dennis , Chen Aiyu , Arguelles Jessica , Kim Joseph , Becker Kendra , Woodrum Rosa , Benjafield Adam , Cole Kate , Shi Jiaxiao
Published: May 2021

Introduction

We explore the impact of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on novel coronavirus (COVID-19) infection rate and severity.

Methods

Retrospective analysis was performed utilizing a database of patients evaluated by Kaiser Permanente Southern California sleep medicine between 2015–2020 (includes sleep study, daily PAP, and electronic health record data.) Adult patients were analyzed if: on March 1, 2020 patient was alive, had ≥1 month health-plan enrollment, and had sleep diagnostic or PAP data. PAP adherence was calculated between March 1, 2020 to COVID-19 confirmation, death, disenrollment or study end date (July 31, 2020), whichever came earlier. COVID-19 outcomes were evaluated based on OSA status and PAP adherence: patients with PAP <2 hours/night were considered “untreated”; ≥2 hours/night were “treated”; 2–3.9 hours/night were “moderately-treated”; ≥4 hours/night were “well-treated”. Apnea hypopnea index (AHI) defined OSA severity. Multiple logistic regression evaluated the association of various demographic/clinical factors.

Results

Of 81,932 patients (39.8% female, age 54.0±14.9 years) analyzed, 1493 (1.8%) had COVID-19 with 224 (0.3%) hospitalizations and 61 (0.07%) resulting in intensive care or death. Increased severity of “Untreated” OSA was associated with higher COVID-19 rate and lower when “treated” [No OSA 1.7%; Mild 2%; Moderate 2%; Severe 2.4%; OSA unknown severity 2%; Treated 1.4%; p<0.0001]. Better PAP adherence was associated with reduced infection rate [“untreated” 2.1%; “moderately-treated” 1.7%, “well-treated” 1.3%, No OSA 1.7%; p=<0.0001]. Multivariable analysis confirmed increased infection rate with OSA versus no OSA [OR 0.82(0.70,0.96)] and the benefit of good PAP adherence versus “untreated” [“moderately-treated” OR 0.82 (0.65, 1.03); “well-treated” OR (0.69 (0.59, 0.80)]. Increased infection rate was also associated with obesity, higher Charlson Comorbidity score, Black and Hispanic ethnicities, and Medicaid enrollment; increasing age was associated with reduced infection rate. Separate multivariable analysis showed dose-response association of OSA severity on infection rate [Mild OR 1.21 (1.01,1.44 95%CI); Moderate-Severe OR 1.27 (1.07,1.51) versus no OSA]. Neither OSA presence nor PAP adherence significantly impacted rate of hospitalization nor intensive care or death.

Conclusion

Significant associations emerged with OSA increasing and PAP therapy reducing COVID-19 infection rate. Findings support continued PAP use during the pandemic.

Support (if any)

AASM Foundation SRA: 205-SR-19
695 Cannabinoids and Sleep Health in Patients with Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis
Authors: McParland Aidan , Daniel Kapustin , Bhatia Anuj , Clarke Hance , Aditya Trivedi , Brull Richard , Singh Mandeep
Published: May 2021

Introduction

Neuropathic pain (NP) syndromes are debilitating conditions which can impact sleep health and overall quality of life significantly. Pharmacological treatment with cannabinoids has not been evaluated for its impact on sleep health. The objectives of this systematic review and meta-analysis were to determine the effect of cannabinoids on sleep quality, pain control, and patient impression of treatment efficacy.

Methods

We reviewed randomized controlled trials comparing synthetic and natural cannabinoids (CB) to placebo in patients with central and peripheral neuropathic pain syndromes. A systematic search of the standard literature databases was conducted, including randomized controlled trials evaluating the pharmacological treatment of NP syndromes using cannabinoids. Data on NRS pain scales, sleep quality, daytime somnolence, nausea, dizziness, and patient global impression of change (PGIC) scores were recorded. Meta-analysis using the random effects model was conducted where appropriate.

Results

Of the 3536 studies screened, a total of 8 randomized controlled trials including 1051 patients (placebo: 478 patients; CB: 573 patients) with neuropathic pain were included. Cannabinoids included in the studies were Sativex (GW-1000–02), Nabilone, and medical cannabis preparations with THC dose ranging from 1mg to 130mg per day. Pain scores were significantly reduced in the CB group (standardized difference in means (SDM) = -0.236, 95% CI=-0.375 to -0.100, p-value = 0.001) compared to placebo (Figure 1). Significant improvement in sleep quality (Figure 2) was also observed in the CB group (SMD 0.389, 95% CI, 0.233 to 0.546, p<0.013). Additionally, patients in the CB group were more likely to report improvement in PGIC scores (OR=2.3, 95% CI 1.37 to 3.9, p=0.002) compared to patients treated with placebo (Figure 3). Notably, CB-treated patients were more likely to experience daytime somnolence (OR=2.2, 95% CI 1.3 to 3.9, p=0.004), nausea (OR=1.7, 95% CI 1.1 to 2.5, p=0.02), and dizziness (OR=3.8, 95% CI 2.6 to 5.7, p<0.001).

Conclusion

Cannabinoids are useful agents for NP as evidenced by significant improvement in pain, sleep quality, and PGIC. With the advent of new agents and more refined cannabis derivatives, further research is needed to comprehensively explore treatment effectiveness. Future work should incorporate clinically validated measures of sleep health to better evaluate this outcome.

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714 Sleep Disordered Breathing Polysomnographic Measures and COVID-19 Risk of WHO-7 Clinical Outcomes in a Large Health Care System
Authors: Pena Orbea Cinthya , Wang Lu , Shah Vaishal , Jehi Lara , Milinovich Alex , Foldvary-Schaefer Nancy , Chung Mina , Mashaqi Saif , Mehra Reena
Published: May 2021

Introduction

There is lack of clarity of sleep disordered breathing (SDB)--including the role of nocturnal hypoxia and confounding influence of obesity--on the clinical course of human coronavirus disease 2019 (COVID-19). We postulate that SDB portends increased risk of adverse COVID-19 clinical outcomes even after accounting for confounding factors.

Methods

A retrospective cohort analysis of COVID-19 and sleep laboratory observational registries March-November 2020 within the Cleveland Clinic health system was performed. Ordinal logistic regression assessed the association of SDB indices and World Health Organization (WHO)-7 COVID-19 clinical outcome (hospitalization, use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ECMO and death) in an unadjusted model and adjusted for age, sex, race, body mass index(BMI,kg/m2),diabetes mellitus, hypertension, coronary artery disease, heart failure, asthma, chronic obstructive pulmonary disease (COPD), cancer and smoking using SAS software.

Results

Of 19,449 (32%) patients positive for SARS-CoV-2,2,290 (6%) had an available sleep study. The analytic sample included 1788 of which 1,484(64%) had an apnea hypopnea index (AHI, 3–4% hypopnea oxygen desaturation)≥5. The median duration from sleep study to COVID test was 5.8 years (IQR:3.3–9.0). Age was 56.5±14.4 years,50.4% female,28% African American with BMI=35.9±8.9kg/m2. Nine percent of patients were hospitalized,10% with supplemental oxygen,6% used non-invasive ventilation,2% required ECMO or mechanical ventilation and 2% died. For every AHI increase of 5, the odds of a higher WHO-7 level increased 2% (OR=1.02,95%CI1.01-1.04,p=0.005),but the association was mitigated in the adjusted model (OR=1.00,95%CI:0.98,1.02,p=0.80). Per 5% increase in time spent with SaO2<90%, the odds of a higher WHO-7 level increased 10% (OR=1.10,95%CI1.06-1.13,p=<0.001) persisting in the adjusted model(OR=1.06,95%CI:1.02–1.10,p=0.002). For every decrease of 5% mean SaO2, the odds of a higher level WHO-7 increased 56% (OR=0.56,95%CI:0.46–0.67,p<0.001) persisting in the adjusted model(OR=0.72,95%CI:0.58–0.89,p=0.003).

Conclusion

Even after adjustment for obesity, underlying cardiopulmonary disease and smoking, sleep-related hypoxemia was a potential key pathophysiologic mechanism associated with increased morbidity and mortality in COVID-19. Elucidation of sleep-related hypoxemia as a risk stratification measure, particularly given the silent hypoxia inherent to early COVID-19, is critical for future investigation, as is the role of sleep-related hypoxia reversal as a target to improve COVID-19 outcomes.

Support (if any)

Cleveland Clinic Neurologic Institute Resource Development Award
724 Does colorectal cancer site influence sleep quality?
Authors: Ton Mimi , Watson Nathaniel , Labadie Julia , Malen Rachel , Sillah Arthur , Reedy Adriana , Cohen Stacey , Burnett-Hartman Andrea , Newcomb Polly , Phipps Amanda
Published: May 2021

Introduction

Understanding sleep quality among colorectal cancer (CRC) patients could contribute to improved survivorship care in terms of sleep recommendations.

Methods

We ascertained sleep quality within an ongoing population-based study of CRC patients identified through the Puget Sound SEER cancer registry. We assessed sleep quality using components of the standardized Pittsburg Sleep Quality Index. Differences in sleep quality by CRC site were analyzed using chi-square and ANOVA tests. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of tumor site (rectal vs. colon) with sleep quality concerns. ORs were adjusted for age at diagnosis, sex, BMI, education, cancer stage, and time since diagnosis.

Results

Of the 1,454 CRC patients included in analyses, 37% (N=543) had rectal cancer compared to 63% (N=911) with colon cancer, and the stage distribution was as follows: 37% localized, 43% regional, and 18% distant stage. Overall, participants with rectal (vs. colon) cancer were more likely to report problems related to trouble sleeping (OR [CI]: 1.63 [1.23, 2.16]), but were also less likely to report trouble sleeping specifically due to issues with breathing, coughing, or snoring (OR [CI]: 0.51 [0.27, 0.96]. However, rectal cancer patients were more likely than colon cancer patients to report changes in sleep patterns after cancer diagnosis (OR [CI]: 1.33 [1.02, 1.73]), and to report trouble sleeping specifically due to getting up to use the bathroom (OR [CI]: 1.49 [1.17, 1.90]) or pain (OR [CI]: 1.50 [1.10, 2.04]). There were no significant differences between rectal and colon cancer cases in terms of amount of sleep, problems staying awake, bad sleep quality, and use of sleep medication.

Conclusion

Overall, rectal cancer patients are more likely to have sleep complications due to potential physical consequences compared to colon cancer patients. This suggests that survivorship care may be adapted according to CRC site to ensure patients receive appropriate support in terms of sleep recommendation.

Support (if any):
729 Daily stress and nightmares are bidirectionally associated among nurses
Authors: Garcia Odalis , Slavish Danica , Dietch Jessica , Messman Brett , Contractor Ateka , Haynes Patricia , Pruiksma Kristi , Kelly Kimberly , Ruggero Camilo , Taylor Daniel
Published: May 2021

Introduction

Nurses may experience frequent nightmares due to stressful work environments. Some studies estimate that 35% of nurses experience nightmares related to experiences at work. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmare occurrence and severity, and whether posttraumatic stress disorder (PTSD) symptoms moderated those relationships.

Methods

392 nurses (mean age = 39.54 years; SD = 11.15; 92% female; 78% White) were recruited for a larger study on sleep and vaccine response. For 14 days, upon awakening, nurses completed daily sleep diaries to assess previous-day stress severity (0 = not at all, 4 = extremely), as well as nightmare occurrence (0 = no nightmare, 1 = nightmare occurred) and nightmare severity (0 = not at all, 3 = very). PTSD symptoms were assessed at baseline using the PTSD Checklist of DSM-5 (PCL-5). Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms.

Results

Approximately 10.5% of nurses met criteria for PTSD based on PCL-5 scores. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress severity were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity that night (b = 0.09, p = 0.033). Nightmare occurrence (b = 0.15, p < 0.001) was associated with greater next-day stress severity. PTSD symptoms did not moderate daily stress and nightmare associations.

Conclusion

Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Our results indicated nightmares and stress may occur in a bidirectional fashion among nurses. Results were similar regardless of nurses’ PTSD status. Future studies should explore whether targeting nightmares and stress may improve nurses’ health and well-being. Given the essential role that nurses play in maintaining patient health and safety, it is critical to understand the causes and consequences of their sleep-related disturbances.

Support (if any):
731 Who is most at risk for nightmares? Demographic and psychosocial differences in nightmare prevalence among nurses
Authors: Martinez Jaylin , Santiago Bianca , Slavish Danica , Dietch Jessica , Messman Brett , Kelly Kimberly , Ruggero Camilo , Taylor Daniel
Published: May 2021

Introduction

Nurses are subject to stressful work environments, which may negatively impact their sleep and increase their risk for nightmares. Previous studies have shown that women, night shift workers, and individuals with comorbid psychological conditions are more likely to report nightmares. Yet no studies have comprehensively examined demographic and psychosocial factors of nightmares among nurses.

Methods

To address this gap, we examined demographic (age, gender, race, ethnicity, number of children, marital status, shift work status) and psychosocial (chronotype, PTSD, anxiety, depression, perceived stress) correlates of nightmares in a sample of 462 nurses (91% female; mean age = 39.03, SD = 11.07; 78% White; 10% Hispanic/Latinx). Nightmares were determined two ways: 1) using a newly validated retrospective survey measure, the Nightmare Disorder Index (NDI), and 2) using aggregated prospective reports of daily nightmare frequency across 2 weeks (nurses who reported any nightmares in the past 2 weeks were classified as having nightmares).

Results

Nurses experiencing nightmares as determined by the NDI (n = 236; 51%) were younger, more likely to be female, less likely to have children, more likely to be an intermediate chronotype, less likely to be a morning chronotype, and had higher mean levels of PTSD, anxiety, depression, and perceived stress than nurses without nightmares. Nurses experiencing nightmares as determined by daily surveys (n = 191; 41%) were not different in terms of any demographic characteristics, but had higher levels of PTSD, anxiety, depression, and perceived stress than those nurses without nightmares.

Conclusion

Demographic and psychosocial differences in nightmare prevalence may differ based on how nightmares are assessed (i.e., retrospective vs. prospective measures). Overall, nurses with higher stress, PTSD, depression, and anxiety may be at greatest risk of having nightmares. Future studies should examine if targeting these factors results in improvements in sleep and well-being among nurses.

Support (if any)

NIH/NIAID R01AI128359-01
738 Effects of exogenous melatonin on sleep, circadian rhythms, and mood in women with premenstrual dysphoric disorder
Authors: Moderie Christophe , Shechter Ari , Lespérance Paul , Boivin Diane
Published: May 2021

Introduction

Most women with premenstrual dysphoric disorder (PMDD) report sleep disturbances. Our group found normal polysomnographic (PSG) sleep efficiency and increased slow wave sleep (SWS) across the menstrual cycle in women with PMDD and insomnia compared to controls. Reduced melatonin levels were found in PMDD women compared to controls, with reduced secretion during their luteal phase (LP) compared to follicular phase (FP). Here, we investigated the effects of exogenous melatonin in the patients we previously studied.

Methods

Five patients (age, mean: 33.6, SD: 2.7) diagnosed prospectively with PMDD and insomnia participated in the study. Following a baseline assessment, patients took 2 mg of slow-release melatonin 1h before bedtime during their LP for three consecutive menstrual cycles. At baseline (treatment-free condition), patients spent every third night of their menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual symptoms (PRISM), subjective sleep and ovarian hormones (estrogen and progesterone). Participants also underwent two 24-hour intensive physiological monitoring (during the FP and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration.

Results

In the intervention condition compared to baseline, we found increased urinary aMt6 (p<0.001), reduced objective SOL (p=0.01), SWS (p<0.001) and increased Stage 2 sleep (p<0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p<0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p<0.001).

Conclusion

We have shown normalization of SWS and reduction in self-reported mood and somatic symptoms after administrating exogenous melatonin in women with PMDD. These findings support a role for disturbed melatoninergic system in PMDD that can be partially corrected by exogenous melatonin.

Support (if any)

This study was supported by the Canadian Institutes of Health Research (CIHR)
739 Association of hospital-diagnosed sleep disorders with suicide: A nationwide cohort study
Authors: Høier Nikolaj , Spira Adam , Erlangsen Annette
Published: May 2021

Introduction

Sleep disorders and psychiatric disease are closely related, and psychiatric diseases are associated with elevated suicide risks. Yet, it is not clear if sleep disorders are associated with suicide as previous studies were limited by self-reported measures. The aim of this study was to examine whether people with a hospital-diagnosis of sleep disorders had higher suicide rates than people with no diagnosis.

Methods

Using a retrospective cohort design, national data on all persons aged 15 years and over who lived in Denmark during 1980–2016 (males: 3,674,563, females: 3,688,164) were obtained. People with sleep disorders were identified in somatic hospital registers. The main outcome was death by suicide as recorded in the Danish Cause of Death register. Incidence Rate Ratios were obtained using Poisson regressions while adjusting for relevant covariates.

Results

Out of 23,927 male and 11,556 female suicide deaths, 299 and 117 had been diagnosed with a sleep disorder, respectively. Males with sleep disorders had a suicide rate of 47.4 (95% CI, 42.0–52.7) per 100,000 person-years compared to 29.9 (95% CI, 29.5–30.3) among those with no sleep disorders. For females the respective rates were 42.3 (95% CI, 34.7–50.0) versus 13.9 (95% CI, 13.6–14.1). An adjusted IRR of 1.6 (95% CI, 1.4–1.7) and 2.2 (95% CI, 1.8–2.6) was noted among males and females with sleep disorders, respectively, when compared to those with no disorders. Excess rates were noted with respect to insomnia, narcolepsy and, in males, sleep apnea. A difference with respect to age and sex was observed (p<0.001). Furthermore,IRRs of 4.1(95% CI, 3.1–5.5) and 7.0 (95% CI, 4.8–10.1) were noted for males and females, respectively, during the first 6 months of diagnosis when compared to those not diagnosed. The association between sleep disorders and suicide remained significant when adjusting for psychiatric disorders, although those with psychiatric disorders also had elevated rates, particularly amongst females.

Conclusion

In this study, individuals with sleep disorders had an increased suicide rate when compared to those with no sleep disorders. Higher suicide rates were found for individuals suffering from narcolepsy, insomnia and sleep apnea. More attention towards risks of suicide among people with sleep disorders might be needed.

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745 Association of Longitudinal Sleep Profiles with Cognitive Functioning in Bipolar Disorder
Authors: Boland Elaine , Ramsey Christine , Goldschmied Jennifer , Gehrman Philip
Published: May 2021

Introduction

Emerging evidence suggests that some cognitive deficits in bipolar disorder may be attributed to sleep disturbance. However, current findings are limited by cross sectional analyses or longitudinal studies with sparse follow up on sleep quality. The current study examined longitudinal profiles of sleep as predictors of cognitive performance across a series of domains to better understand how sleep disturbance may impact in bipolar patients.

Methods

241 bipolar disorder and 103 control participants had their sleep measured at baseline, 6- and 12-months using the Pittsburgh Sleep Quality Index (PSQI). Individuals with a “poor” categorical PSQI sleep rating (PSQI total score >5) at all time points were categorized as “Poor Sleepers” (n = 134). Those rated “good” at each time point were “Healthy Sleepers” (n = 107), and those with at least one discrepant sleep rating at any time point were labeled “Unstable Sleepers” (n = 103). Cognitive performance was assessed at 12-months, testing domains of memory, processing speed, and executive function. ANOVAs controlling for demographics, mood symptom severity, and diagnostic group examined effects of sleep profiles on cognitive function.

Results

Main effects for sleep group were found for the California Verbal Learning Test across all short and long delay recall conditions (F’s 4.45 – 5.8, p <.02 for all). The poor sleep group performed the worst, while no main effects for diagnosis were observed. Main effects of sleep group were found for time conditions of the Trail making task (F = 4.18, p = .016), but not for errors.

Conclusion

Sleep quality was more strongly related to verbal and visual memory than bipolar diagnosis, with weaker effects for executive function. Some cognitive domains in bipolar disorder may be more closely related to sleep disturbance than endogenous factors. Future studies should explore how improvements in sleep functioning relate to neurocognitive outcomes, and whether cognitive performance varies as a function of sleep instability independent of mood instability.

Support (if any)

Support: Heinz C. Prechter Bipolar Research Fund at the University of Michigan Depression Center, the Department of Veterans Affairs (IK2-CX001501; PI: Boland), the VISN 4 MIRECC, and National Institute of Mental Health (K23MH118580; PI: Goldschmied).
757 Associations Between Sleep Complaints, Suicidal Ideation and Depression Among Adolescents and Young Adults in Greece
Authors: Basta Maria , Vgontzas Alexandros , Simos Panagiotis , Karakonstantis Stamatis , Micheli Katerina , Li Yun , Defaermos Vasilis , Papadakis Nikolaos
Published: May 2021

Introduction

Suicide risk begins to increase among adolescents and young adults representing the leading cause of death in this age group. The aim of this study was to assess associations between sleep complaints, suicidal ideation and depression in a large, representative sample of adolescents and young adults of the general population in Greece.

Methods

A structured telephone questionnaire was conducted in a representative sample of 2.741 young Greeks aged 15–24 years, including sociodemographic variables, life-style habits, and substance use. symptoms were assessed using the PhQ-9. Suicidal ideation and sleep complaints, i.e. insomnia/ hypersomnia symptoms, were assessed based on the relevant questions of the PhQ-9 questionnaire. We conducted a direct and indirect effect analysis between the modified PhQ-7 scale, sleep complaints and suicidality controlling for gender, family income, education and substance use.

Results

In our sample prevalence of suicidal ideation was 7.8%, while 47.9% reported sleep complaints. The mean PhQ-7 score was 6.15±4.11. The direct paths from depression to sleep, as well as from sleep to ideation were both statistically significant with p-values <0.001. Indirect mediation analysis revealed a significant indirect effect of depression on ideation mediated by sleep complaints as indicated by the sobel test (z=3.59, p=0.0003). This is a partial mediation given that the direct effect of depression on ideation controlling for sleep (the mediator) remains significant (p<.001). The percentage of the effect of depression on ideation accounted for by the indirect effect through sleep is estimated at 16.5%. The mediation remains significant (p<.001) after controlling for income, gender, education, and substance use.

Conclusion

Our study supports that among youth there is direct associations between depression, sleep complaints and suicidal ideation. Furthermore, we found an indirect effect of depression on suicidal ideation mediated by sleep complaints. Our findings highlight the presence of complex interactions between subjective psychiatric symptoms and perceived sleep problems to account for suicidal ideation Therefore, treatment of sleep among youth with depression may significantly independently further reduce suicidal risk.

Support (if any)

EEA/Norwegian Financial Mechanism 2009–2014, under Project Contract n° EEA Grants/ GR07- 3757
766 Anxiety is a potential mediating factor in the insomnia-aggression association
Authors: Nielson Spencer , Dzierzewski Joseph , Kay Daniel
Published: May 2021

Introduction

Several recent studies have found an association between insomnia and increased aggression. Aggression may increase arousal, thereby predisposing individuals to sleep difficulties. Conversely, insomnia may impair brain circuitry involved in aggression. Ultimately, the relationship between insomnia and aggression remains poorly understood and understudied. This study sought to explore this association in a sample of individuals with a wide range of insomnia symptom severity, stratified from minimal to moderately severe.

Methods

Participants’ (N=66) insomnia symptoms were assessed using the Insomnia Severity Index. Participants also completed daily sleep diaries for 7–21 days followed by an ambulatory polysomnography overnight sleep study to characterize participants’ sleep and to rule out organic sleep disorders. The evening of the overnight sleep study, participants completed the 34-item Buss-Perry Aggression Questionnaire (AQ). Pearson’s correlation coefficient was used to assess associations between insomnia, AQ total score, and the AQ subscale scores (i.e., physical aggression, verbal aggression, anger, hostility, indirect aggression). Multiple regression was utilized to determine whether aggression was associated with insomnia severity while adjusting for demographic features, depression symptoms (Patient Health Questionnaire-9) and trait anxiety (State-Trait Anxiety inventory).

Results

In bivariate analyses, insomnia severity was significantly correlated with the AQ total score and with the anger and hostility subscales of the AQ (r=0.297, p<0.05; r=0.266, p<0.05; r=0.321, p<0.05 respectively). When adjusting for the significant association between anxiety and insomnia in multiple regression analyses, anger and hostility were no longer significantly associated with insomnia severity(p>.05).

Conclusion

Our investigation suggests that the association between insomnia and aggression is most specific to anger and hostility but that these associations may be better explained by their shared associations with anxiety.

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767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis
Authors: Marten Finja , Keuppens Lena , Baeyens Dieter , Boyer Bianca , Danckaerts Marina , Van der Oord Saskia
Published: May 2021

Introduction

During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables.

Methods

Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies.

Results

10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p<.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p<.001) and wake after sleep onset (z=13.50, p<.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p<.001) and subjective sleep satisfaction (z=3.50, p<.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p<.001), daytime sleepiness (z=26.68, p<.001) and sleep disturbances (z=8.00, p<.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included.

Conclusion

In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD.

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