bluuebunny/crossref_metadata_2025 huggingface dataset:
0342 Eating Habits, Depression, and Poor Sleep: Assessing the Associations in First-Year College Students
Authors: Hirsch Sophie , Peach Hannah , Gaultney Jane
Published: April 2024

Introduction

Transitioning from high school to college often poses significant challenges to students. In many cases, freshmen are now required for the first time to take care of their health habits, including making choices surrounding food and sleep. Diets higher in fats and lower in fruits and vegetables have frequently been associated with an increase in inflammatory biomarkers, which may lead to increased symptoms of depression and poorer sleep (Firth et al., 2019; Hagedorn et al., 2021).

Methods

Given the increased rate of depression (Liu et al., 2022) and sleep disturbance (Luo & Hu, 2022), we conducted a simple mediation analysis using PROCESS macro, Model 4, on first-year college students (N = 73), to assess whether eating habits predicted sleep quality directly, and indirectly via depressive symptoms. We hypothesized that eating habits would directly and indirectly predict sleep quality.

Results

Results indicated that there was no direct relationship between eating habits on sleep quality. However, we found that there was an indirect relationship between eating habits on sleep quality via depression.

Conclusion

Thus, our findings highlight the importance of having a well-balanced diet for different health outcomes. Given that depression and poor sleep are associated with poor school performance due to memory and concentration issues (Dillon & Pizzagalli, 2018; Hershner & Chervin, 2014), promoting healthy food choices for students is necessary to allow for success in college.

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0346 Insomnia in the Initial Months of Emergency Work Is Associated with Future PTSD Symptoms in New Recruit Paramedics
Authors: Wolkow Alexander , Harris Rachael , Nguyen Elle , Meadley Ben , Rajaratnam Shantha M W , Williams Brett , Smith Karen , Bowles Kelly-Ann , Dobbie Megan L , Drummond Sean P A
Published: April 2024

Introduction

New paramedics commencing emergency work and adjusting to shift work can experience an increase in sleep problems. Sleep disturbances have been closely associated with poor mental health in emergency personnel. It is unknown, however, whether poor sleep experienced in the initial months of emergency work represents an early risk factor for future mental health problems in paramedics. The present study examined whether sleep disturbances in paramedics after 6-months of shift and emergency work were associated with mental health symptoms later in their career.

Methods

Sleep disorder and mental health symptoms were examined in new recruit paramedics (n=105) after their first 6- and 12-months of shift and emergency work. At each timepoint, participants completed validated self-report measures of insomnia (Insomnia Severity Index), shift work disorder (SWD; SWD Screening Questionnaire), obstructive sleep apnoea (OSA; Berlin Questionnaire), depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), post-traumatic stress disorder (PTSD; PTSD Checklist-5) and trauma exposure (Life Events Checklist-5). Linear regressions examined whether sleep at 6-months (i.e., insomnia, SWD, and OSA) predicted mental health symptoms (i.e., depression, anxiety, and PTSD) at the 12-month follow-up, while controlling for demographics (i.e., age and sex) and mental health symptoms at the 6-month timepoint. Additionally, the regression models examining sleep and PTSD also controlled for trauma exposure at 6-months via the Life Events Checklist-5.

Results

Increased insomnia symptoms at 6-months of emergency work and shift work significantly predicted higher PTSD symptoms at the 12-month timepoint (b=0.09 [0.03,0.15], p=0.01) while controlling for trauma exposure, PTSD symptoms and demographics at 6-months. Insomnia at 6-months was not, however, related to depression (p=0.36) or anxiety (p=0.42) at follow-up, and OSA and SWD risk at 6-months were not related to any of the mental health outcomes at follow-up (all p>0.05).

Conclusion

Our findings highlight insomnia symptoms in the initial months of emergency work as an early risk factor for the development of PTSD later in new paramedics’ careers. Given sleep is a largely modifiable factor, this finding highlights the need to investigate interventions that target insomnia early in paramedics’ careers to reduce the risk of future mental health problems in this high-risk occupation.

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0351 Protective Factors Buffer the Impact of High Shift Work Disorder Risk on Health Outcomes
Authors: Harris Rachael , Drummond Sean P A , Sletten Tracey L , Wolkow Alexander P
Published: April 2024

Introduction

Shift work disorder (SWD) is a circadian rhythm sleep disorder associated with increased chance of experiencing poor mental health symptoms and physical health complaints. Traditional protective factors, such as resilience, as well as the ability to sleep at different times of the day, known as sleep flexibility, are known to reduce the risk of SWD, and to protect against poor mental health. However, more research is needed to understand how protective factors and SWD risk interact to predict health and wellbeing outcomes. The current study aimed to explore the role of traditional and sleep-specific protective factors in buffering the impact of high SWD risk on mental health and physical health complaints.

Methods

One hundred and twenty-six permanent nightshift workers or those working rotating shift schedules including nightshifts participated in an online cross-sectional study. The SWD-screening questionnaire determined participants’ SWD risk (low vs high). Participants completed validated measures to assess depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder Questionnaire), insomnia (Insomnia Severity Index), excessive sleepiness (Excessive Sleepiness Scale), sleep quality (Pittsburgh Sleep Quality Index), and physical health complaints (Subjective Health Complaints inventory). Participants also completed measures assessing protective factors, including resilience (Resilience Scale), social support (Social Provisions Scale), organisational support (Survey of Perceived Organizational Support), perseverance (Short Impulsive Behaviour Scale), morningness-eveningness (reduced Morningness-Eveningness Questionnaire), and sleep flexibility and languidity (Circadian Type Inventory).

Results

Multiple regression analyses revealed that in individuals with high SWD risk, having high social support was associated with reduced depression symptoms (p=.004). In those at risk of SWD, higher levels of morningness protected against insomnia severity (p=.01) and poor sleep quality (p=.01). Lastly, high perceived organisational support buffered the impact of SWD risk on gastrointestinal (p=.006) and allergy complaints (p=.005).

Conclusion

Improving support systems for shift workers presents an opportunity to prevent poor outcomes when workers are experiencing SWD symptomology. For instance, organisations can implement strategies that support workers to reduce symptoms of depression and physical health complaints. Furthermore, organisations that rely on shift work should consider strategies to support those with low morningness, especially when they are at risk of SWD.

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0353 Shining Light on Photic Measurement for Sleep and Circadian Field Studies
Authors: Bessman Sara , Harrison Elizabeth , Easterling Alexandra , Preilipper Sebastian , Glickman Gena
Published: April 2024

Introduction

Light is the most potent signal for the circadian regulation of sleep. To quantify light’s biological impact via melanopic Equivalent Daylight Illuminance (EDI), photic intensity is weighted based on the spectral sensitivity of melanopsin. This metric for light and time-of-day specific threshold recommendations support development, standardization, and replication of studies of the physiological effects of light. Light measurement outside the lab poses many unique challenges (e.g. greater variability in timing, intensity, spectrum; individual factors; technology limitations). Thus, consistent methods for measurement and reporting are important for maximizing the utility of emerging tools.

Methods

A framework for assessing and reporting light in field studies was developed, incorporating: 1) factors that influence light exposure, 2) methods for capturing the most significant factors, 3) strategies for addressing unique tradeoffs and challenges, and 4) an initial step-by-step protocol for measuring and reporting lighting characteristics in field studies of the physiological effects of light. This framework was applied in multiple study protocols to inform development and refinement.

Results

All studies used both static and continuous measures, along with subjective assessments. In one study, lighting was not homogenous and therefore position and location in the space mattered (melanopic EDI seated vs standing, 133.84 vs 221.91 lux; between workstations (seated), 133.84 vs 62.29 lux). In a second study, lighting was more homogenous but varied by time-on-shift; thus, continuous measures with a stationary meter were used. In a third study, subjective assessment of behaviors that influence photic exposure patterns over the past month indicated individuals likely did not meet nighttime light recommendations (melanopic EDI < 1 lux): 73% used their phone in bed often or always before sleep; and 20% often or always checked their phone if awakened from sleep.

Conclusion

When measuring and reporting light in the field, a one-size-fits-all approach is impossible, but some level of standardization is necessary. The proposed multi-level framework expands on recent lab-based guidelines by making adaptations for field studies, facilitating the evidence-based translation of our fundamental understanding of the effects of light on sleep and circadian health.

Support (if any)

CDMRP JPC-5 Fatigue Countermeasures Working Group (#66619).
0355 Donning Sunglasses at Night: Advancing Fashion and Circadian Phase of Adolescents
Authors: Crowley Stephanie , Misiunaite Ieva , Adams John , Eastman Charmane
Published: April 2024

Introduction

Previously, we reported that evening room light and sleep restriction due to late bedtimes can reduce the expected circadian phase advances in response to morning bright light in adolescents or can shift rhythms later (delay). Here, we examine whether reducing evening light with sunglasses can rescue this effect and help rhythms shift earlier (advance).

Methods

So far, 57 adolescents (29 females; 14.1-18.0 years) completed a 14-day protocol. On days 1-7, they kept individualized 10-h sleep/dark schedules at home. On days 8-14, they lived in the laboratory. On day 8, we measured their Dim Light Melatonin Onset (DLMO). On days 9-10, they went to bed 1.5h, 3.0h, or 4.5h later. Wake time was unchanged; thus, sleep opportunity was 8.5h, 7h, and 5.5h, respectively. In each sleep restriction group, participants remained awake in room light (104±11 photopic lux; 8.5h n=9; 7h n=12; 5.5h n=8) or wore amber-lensed sunglasses (transmitted 14% of light and 10% of short wavelength light; 8.5h n=5; 7h n=4; 5.5h n=9). A control group (n=10) kept their baseline bedtime, so was not exposed to additional evening light or sleep restriction. On days 11-13, sleep/dark was gradually shifted earlier, and adolescents received three 30-min exposures of bright light (8599±885 photopic lux) upon waking. Final DLMO was measured on day 14. Multiple linear regression examined sleep restriction dose, sunglasses, and the dose-by-sunglasses interaction effects on phase shift.

Results

The control group advanced +2.1±1.0h. Greater sleep restriction reduced phase advances (dose: β=-1.31, p<.001), but evening sunglasses attenuated this effect (dose-by-sunglasses: β=1.01, p<.05). When sleep/dark was 8.5h, sunglasses produced larger advances (+1.3±0.6h) compared to no sunglasses (+0.5±0.6h) [t(12)=-2.4, p=.04]. Compared to no sunglasses, evening sunglasses prevented delays when sleep/dark was 7.0h (-0.8±1.1h vs +0.5±0.9; t(14)=-2.2, p=.04) and 5.5h (-2.6±1.2h vs +0.0±1.1h; t(15)=4.8, p<.001). With evening sunglasses and 7.0h or 5.5h sleep/dark, advances were still smaller than control (p’s≤.01).

Conclusion

Reducing evening light with amber-lensed glasses during a phase-advancing protocol with morning bright light facilitates larger advances or prevents delays in adolescents. However, ≤7h sleep/dark reduces phase advances in response to morning bright light even when evening light is reduced.

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R01HL146772 (Crowley)
0359 Comorbid Insomnia and Sleep Apnea: Mortality Trends in a Large National Cohort of US Veterans
Authors: Razjouyan Javad , Crew Earl , Sweetman Alexander , Wallace Douglas , Melaku Yohannes , Azarian Mehrnaz , Sharafkhaneh Amir
Published: April 2024

Introduction

Comorbid insomnia and sleep apnea (COMISA) is a prevalent condition among veterans. Insomnia and sleep apnea (SA) may be diagnosed concurrently or on separate occasions (e.g., concurrent diagnoses, insomnia first, or OSA first). No study has investigated temporal sequences, time intervals, or health-associations of diagnostic intervals in people with COMISA. We examined these patterns of COMISA diagnoses in a large longitudinal clinical database.

Methods

We used ICD 9/10 codes to identify veterans with confirmed diagnosis of insomnia or SA. We used previously validated confirmed diagnosis algorithm. For insomnia, we further required evidence of treatment (medications or CBT-I). Time interval between the two diagnoses was defined in months (30 days), delta-month. We calculated the odds ratio of all-cause mortality followed for 36 months adjusting (aOR) for age, sex, race, ethnicity, Charlson Comorbidity Index (CCI) and exposure time (time from index insomnia or SA diagnosis) using patient with concurrent diagnosis as the reference (delta-month=0).

Results

We identified 303,803 people with COMISA with prevalence of 14.1% (Age 52.5, male 89.2, BMI 32.4±6.1, White 68.3%, CCI≥2 18.5%). 11,396 (3.8%) had both conditions diagnosed concurrently, 153,386 (50.5%) had insomnia followed by later SA diagnoses, and 139,021 (45.7%) had SA followed by later insomnia diagnoses. All-cause mortality rates were lowest among the concurrent diagnosis group (13%) and increased with larger time intervals between diagnoses (either insomnia-first, or OSA-first). Mortality rates increased to 16% from 5 to 14 months and reached 17% in ≥15 months. The aOR for mortality increased with greater delta-month up to 5 months, then plateaued from 5-14 months (1.19±0.03) and further rose and plateaued thereafter (1.24±0.05).

Conclusion

In COMISA, the timing of each diagnosis is heterogenous and may be associated with health outcomes. Mortality rates increase with wider time intervals between the two diagnoses, regardless of which condition is diagnosed first. Further exploration of mechanisms underlying this association of increased diagnostic delta and higher mortality risk in people with COMISA is warranted.

Support (if any)

Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0361 A Novel Longitudinal Approach to Evaluating Comorbid Insomnia and Sleep Apnea in Individuals Tested for Sleep Apnea
Authors: Speer Thomas , Rohrscheib Chelsie , Germain Anne
Published: April 2024

Introduction

Comorbid insomnia and sleep apnea (COMISA) is a debilitating disorder marked by a bi-directional relationship between obstructive sleep apnea (OSA) and insomnia. To explore this relationship, we employed a novel approach to evaluate metrics associated with comorbid-insomnia (sleep maintenance) in individuals who tested for OSA with a longitudinal (multi-night) home sleep test.

Methods

3,370 tests were evaluated (1,358 participants; mean age 49.73 years, SD 15.0; mean tests/participant 3.1, SD 4.5). OSA was measured by apnea/hypopnea index (AHI) and hypoxic burden (HB). ANOVA and PCC (99% CI) were used to evaluate the relationship between SA severity and measures of comorbid-insomnia (total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), #awakenings (#W), %light sleep (%L), %REM sleep (%REM)).

Results

TST (F[3,3357]=5.21; p< 0.001), SE (F[3,3357]=16,12; p< 0.001), and %REM (F[3,3357]=2.84; p=0.014) decreased, and #W (F[3, 3357]=3.20; p< 0.001), WASO (F[3, 3357]=15.22; p< 0.0001) and %Light (F[3,3357]=3.40; p< 0.0001) increased with AHI severity. Between normal (AHI 0-4.99) and mild (AHI 5-14.99) tests, SE (-2%; p=0.005) decreased, and #W (+1.05; p=0.01) and WASO (+10.3 min; p< 0.0001) increased. The largest change occurred between normal and severe (AHI >30) tests (TST -28.65 min; WASO +27.15 min). AHI and HB were positively correlated (r=0.67; p< 0.0001). AHI was weakly, but significantly, correlated with TST (p< 0.0001), SE (p< 0.0001), #W (p< 0.0001), and WASO (p< 0.0001). HB was correlated with SE (p< 0.0001), #W (p< 0.0001), and WASO (p< 0.0001).

Conclusion

Comorbid-insomnia measures increased with SA severity at all levels, suggesting that the presence of OSA at any severity is a risk factor for COMISA. Further analysis is required to determine if the presence of SA and the impact of HB are the primary factors driving COMISA. Contextual issues surrounding the sleep period need to be addressed.

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0362 Obstructive Sleep Apnea, Insomnia and a Novel Approach to Separating Dangerous Bedfellows – Just “ASHQ”
Authors: Epstein Matthew , Chiu Stephanie , Cerrone Federico
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) can lead to numerous adverse health sequelae, increased medical costs and impaired quality of life, and insomnia may have similar consequences. The frequent co-occurrence of OSA and insomnia (comorbid insomnia and sleep apnea, COMISA) results in a bi-directional, synergistic relationship with greater symptomatology and refractory treatment outcomes. Poor sleep hygiene may directly contribute to insomnia, and identifying and correcting maladaptive sleep habits could improve sleep and management of COMISA. Numerous questionnaires are available to measure subjective sleepiness, fatigue and sleep quality, but there are no sleep hygiene surveys to identify the plethora of contemporary, maladaptive lifestyle behaviors that may contribute to insomnia. An instrument to detect detrimental sleep habits could help COMISA patients to optimize sleep hygiene, improve insomnia, and enhance treatment.

Methods

We recently developed a sleep hygiene questionnaire (Atlantic Sleep Hygiene Questionnaire, ASHQ) consisting of 20 detrimental sleep habits based on a critical analysis of the current sleep hygiene literature. In a prior validation study, ASHQ score strongly correlated with sleepiness, fatigue and subjective sleep quality in 700 adult patients with various sleep-related diagnoses. We now administered the ASHQ to a new cohort of 80 patients with only OSA. Patients also completed a single item sleep quality assessment (Sleep Quality Score, SQS) and a screening tool for insomnia (Insomnia Severity Index, ISI). ASHQ scores were summarized and compared to SQS and ISI survey results, and correlations were analyzed for each assessment.

Results

ASHQ and ISI scores were elevated in a majority of OSA patients, consistent with COMISA. ASHQ scores were significantly associated with SQS and ISI scores. There was a direct correlation between detrimental sleep habits, sleep quality and insomnia, confirming the validity of the ASHQ to assess sleep hygiene and its potential risk in patients with OSA and COMISA.

Conclusion

The ASHQ is a novel instrument to assess sleep hygiene, and ASHQ scoring strongly correlates with both sleep quality and insomnia in patients with OSA. ASHQ may be a useful tool to identify COMISA, improve sleep hygiene and concomitant insomnia, and facilitate treatment of underlying OSA.

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0363 Insomnia with Short Sleep Duration Is Associated with Increased Catecholamine Secretion in Young Adults
Authors: Fernandez-Mendoza Julio , Atha Raegan , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward
Published: April 2024

Introduction

Prior studies have shown insomnia to be associated with increased sympatho-adrenal-medullary (SAM) axis activity, as indexed by higher 24-hour urinary catecholamine secretion. These studies also showed that the activity of both axis of the stress system in those with insomnia is positively related to the degree of polysomnography (PSG)-measured sleep disturbance, ascertained by four consecutive nights. However, these pathophysiologic findings have not been replicated in population-based samples.

Methods

We studied 270 young adults (median 25y, 53% female, 24% racial/ethnic minority) from the Penn State Child Cohort who underwent a 9-hour PSG recording, clinical history, self-report scales and provided a urine sample upon awakening from the PSG to assay for 8-hour release of catecholamines (i.e., epinephrine, norepinephrine, and dopamine). Insomnia symptoms were defined as difficulties initiating or maintaining sleep, insomnia diagnosis or complaint, and/or sleep medication use. PSG-measured short sleep duration was defined by the median total sleep time of the sample (i.e., < 7-h), and identified normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and insomnia with short sleep duration (ISSD). A multivariate general linear model tested mean differences in catecholamine levels across the four groups while adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, medication and substance use.

Results

Compared to NSD (18.8±1.5) and INSD (20.9±1.1), ISSD showed significantly higher total epinephrine/norepinephrine levels (24.0±1.1; p=0.007 and p=0.046, respectively). This association was primarily driven by higher norepinephrine levels in ISSD (3.1±0.3) compared to NSD (2.2±0.5; p=0.018). Neither INSD (p=0.260) nor SSD (21.4±1.7; p=0.255) showed significantly elevated levels compared to NSD. There were no significant differences in dopamine levels across groups [e.g., NSD (238.1±10.8) vs. ISSD (241.6±7.6); p =0.809].

Conclusion

ISSD, but not INSD, is associated with higher morning norepinephrine levels, suggesting hyperactivity of the SAM axis of the stress system and increased risk for cardiovascular and psychiatric disorders.

Support (if any)

NIH (R01HL136587, R01MH118308, UL1TR00127)
0370 Short Sleep Duration Modifies the Association of Obstructive Sleep Apnea and Insomnia Symptoms with Biomarkers
Authors: Pejovic Slobodanka , Vgontzas Alexandros , He Fan , Fernandez-Mendoza Julio , Karataraki Maria , Elmslie Gwendolynne , Bixler Edward
Published: April 2024

Introduction

Co-morbid insomnia and obstructive sleep apnea (COMISA) have been shown to be associated with higher risk of cardiovascular disease than its individual components. Insomnia with objective short sleep duration (ISSD) has been associated with adverse cardiometabolic impact i.e., hypertension or diabetes. The aim of this study is to examine whether objective short sleep duration modifies the effect on clinical (hypertension) and preclinical inflammatory and metabolic biomarkers in patients with mild-to moderate OSA (mmOSA) and insomnia symptoms.

Methods

A clinical sample of 164 adults (52.76±13.08 years old) with mmOSA (5 ≤ AHI < 30) underwent polysomnography or home sleep testing, measures of blood pressure (BP), body mass index (BMI), fasting blood glucose, insulin, CRP and IL-6 plasma levels, and completed Epworth Sleepiness Scale (ESS) and Pittsburg Sleep Quality Index (PSQI). Presence of EDS was defined as ESS score ≥ 11. Insomnia symptoms were defined as a self-report of more than 3 nights/week over the past 4 weeks of at least one of the following symptoms in the PSQI: “Cannot get to sleep within 30 minutes” or “Wake up in the middle of the night or early morning”. Objective short sleep duration was defined as < 6.8-hours sleep based on the median total sleep time. Participants were classified into 4 clinically meaningful groups: asymptomatic mmOSA (control group), mmOSA with EDS, mmOSA with insomnia symptoms and objective short sleep duration (COMISA-SSD) and mmOSA with insomnia symptoms and objective normal sleep duration (COMISA-NSD). Univariate general linear models were conducted controlling for age, gender and BMI.

Results

Mean average systolic and diastolic BP were elevated in COMISA-SSD group compared to COMISA-NSD group (p=.042, p=.055, respectively). Plasma lnCRP and lnIL-6 concentrations were significantly elevated in COMISA-SSD group compared to control group (p=.010, p=0.014 respectively). Also, lnHOMA and insulin resistance (lnGlucose/insulin ratio) were significantly increased in COMISA-SSD group compared to COMISA-NSD group (p=.031, p=.046, respectively).

Conclusion

These findings show that the additive adverse cardiometabolic effects of COMISA phenotype are primarily driven by the insomnia short sleep duration phenotype, which appears to respond better to medication than psychological interventions.

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0371 The Odds Ratio Product: A Novel Tool to Identify Features of Comorbid Insomnia and Sleep Apnea
Authors: Hanif Umaer , Cairns Alyssa , Guadagni Veronica , Lambing Kari , Duke Guy , Mysliwiec Vincent
Published: April 2024

Introduction

Many patients presenting with either OSA or insomnia symptoms exhibit signs of the other condition. This overlap, known as COMISA, is often undetected due to differing diagnostic

methods

PSG for OSA and clinical symptoms for insomnia. The lack of objective diagnostic criteria for COMISA contributes to its low diagnosis rate. We sought to address this gap by investigating whether the Odds Ratio Product (ORP) algorithm can accurately distinguish between individuals with COMISA, OSA patients, and controls.

Methods

2000 patients (50% male/female) were selected from a large clinical cohort, equally grouped into 5 categories of 400 patients: clinic controls (AHI < 5, no insomnia), mild OSA (AHI 5-15), mild OSA and insomnia (defined by presence of self-reported complaints of difficulty initiating sleep, maintaining sleep, experiencing restless sleep, and daytime fatigue), moderate-severe OSA (AHI ≥ 15, ODI ≥ 15), and moderate-severe OSA and insomnia. The OSA and COMISA subgroups were matched by AHI. The ORP was computed using a 3-second sliding window, averaged across each 30-second epoch of PSG total recording time (TRT). Extracted ORP features included mean, minimum, and percent TRT spent in ORP deciles 1-10 (1=deepest sleep; 10=fully awake). Univariate ordinal regression was utilized to classify disease subgroups using each ORP feature as input.

Results

Each disease subgroup was compared to clinic controls (reference group) and statistically presented in the following rank-ordered format (mild OSA, mild COMISA, moderate-severe OSA, moderate-severe COMISA). Significant discriminatory ORP features for disease subtype were mean ORP in NREM (ORs: 3.51, 9.35, 17.3, 43.8, p < 0.001), minimum ORP (ORs: 5.67, 6.33, 5.62, 12.3, p < 0.001), and percent TRT spent in decile 2 “deep sleep” (ORs: 0.982, 0.969, 0.963, 0.947, p < 0.01) and 7 “transitional sleep” (ORs: 1.05, 1.08, 1.09, 1.11, p < 0.01).

Conclusion

This study demonstrates the potential utility of the ORP algorithm to identify and discriminate between OSA and COMISA subgroups, the latter being underdiagnosed and inadequately treated in the routine sleep clinic paradigm. These findings suggest that ORP may be a valuable tool in the polysomnographic assessment of comorbid sleep disorders, offering a pathway towards an objective assessment and targeted treatment strategies.

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0374 Dimensions of Sleep Health and Mood Disorders in Middle Eastern/North African Women
Authors: Sukhon Ahmad , Ismail Hadi , Irfan Bilal , Sankari Abdulghani , Attarian Hrayr , Herreshoff Emily , Duval Kim , Sankari Safa , Chervin Ronald , Dunietz Galit Levi
Published: April 2024

Introduction

Insomnia symptoms are a common sleep disturbance during midlife. However, emerging evidence suggests that midlife women also experience increased risk of obstructive sleep apnea and short sleep duration. Cohorts of women in midlife have mostly included white women, despite suspected sleep health disparities among women from underrepresented racial and ethnic backgrounds. To address this gap, we conducted a pilot study that examined sleep health among women from Middle Eastern/North African (MENA) ancestry.

Methods

This pilot study enrolled 77 women aged 40-60y from MENA ancestry, recruited mostly from Michigan. Women provided demographic, lifestyle, sleep and health information through interviews with structured and validated questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire (PHQ-9). Risk for obstructive sleep apnea (OSA) was evaluated using the STOP questionnaire+BMI and a subset of the women was tested with Watch-PAT, a one-night home sleep apnea testing device (OSA diagnosis, apnea-hypopnea index pAHI3%>5/h). The menopause rating scale was used to collect data on psychological and physiological symptoms.

Results

Mean age of women was 48y±5 years and mean BMI was 27.6±5 kg/cm2. Anxiety, irritability, and depression symptoms were identified in 33%, 25% and 31% of women. Half reported trouble falling asleep within 30 minutes, and 73% experienced nocturnal and early morning awakenings three or more times per week. Most women (75%) were aware of adequate sleep recommendations, but 54% reported short sleep duration, < 6 hours, and 30% reported < 5 hours of sleep per night. A STOP+BMI score ≥3 was observed in 20% of women. Twenty women were tested for OSA and 75% had it (mean pAHI3%=12.6/h). Moderate and severe OSA was apparent among 20% and 10% of the 20 women. Concurrent OSA and insomnia symptoms were observed among 40% of women. The odds ratio of insomnia were 9-fold and 3-fold for women with depression and anxiety, respectively.

Conclusion

We found a high burden of poor sleep and sleep disorders among midlife women from MENA ancestry. Moreover, poor sleep was associated with symptoms of depression and anxiety, raising the possibility that efforts to improve sleep health could benefit the mental health of these women as well.

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0380 Fatigue, Anxiety and Heavy Menstrual Flow Interfere in Severe Insomnia Symptoms of Women at Reproductive Age
Authors: Ishikura Isabela , Porcacchia Allan , Hachul Helena , Tufik Sergio , Andersen Monica
Published: April 2024

Introduction

Insomnia is the most prevalent sleep disorder worldwide, and women have a greater risk of developing insomnia symptoms than men. The high prevalence of insomnia in women may be due to the hormonal oscillations that occur across the entire course of a woman’s life during the reproductive age. Our aim was to investigate the association between insomnia severity symptoms and menstrual health, fatigue and anxiety symptoms in women at reproductive age.

Methods

We used data from the EPISONO database (2007) with a sample of 282 women. Women completed the Insomnia Severity Index (ISI), the Chalder Fatigue Scale (CFS) and the Beck Anxiety Inventory (BAI) to obtain information about insomnia, fatigue and anxiety symptoms. For menstrual health, we collected information using our institutional women’s questionnaire about menstrual flow and duration, the presence of pain during menstruation and menstrual cycle regularity. The statistical analysis was performed using multinomial logistic regression, considering p< 0.05.

Results

Our results demonstrated that fatigue and anxiety symptoms were statistically correlated with mild, moderate and severe insomnia symptoms (OR=1.43; 95%CI=1.02-1.99; p=0.034; OR=1.10; 95%CI=1.02-1.20; p=0.014, respectively). Heavy menstrual flow was statistically associated with severe insomnia symptoms (OR=13.8; 95%CI=1.58-121.9; p=0.018). Menstrual cycle regularity, pain during menstruation and menstrual duration were not statistically related to insomnia symptoms.

Conclusion

Our data showed that heavy menstrual flow increased the likelihood of having severe insomnia symptoms, while fatigue and anxiety symptoms contributed to the odds of having mild, moderate or severe insomnia symptoms. Menstrual health is an important subject that needs to be further explored by the scientific community in order to provide practices and treatments that can improve women’s sleep and quality of life.

Support (if any)

Our studies are supported by the following funding agencies: AFIP (Associação Fundo de Incentivo à Pesquisa). A.S.P. is a recipient of a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2021/05920-7). M.L.A. is a recipient of a grant from the Conselho Nacional de Desenvolvimento Científico e Tecnológico and FAPESP (2020/13467-8).
0381 Construct Validation of the Perinatal Rumination Scale at Night in Pregnant Patients Seeking Insomnia Treatment
Authors: Kalmbach David , Hirata Mika , Iqal Justin , Bayoneto Alec , Cheng Philip , Reffi Anthony , Pitts D'Angela , Swanson Leslie , Ong Jason , Fresco David , O'Brien Louise , Drake Christopher
Published: April 2024

Introduction

Perseverating on perinatal concerns at night (nocturnal perinatal rumination) increases insomnia, depression, and suicidal ideation (SI) during pregnancy. Poorly sleeping pregnant women identify reducing nocturnal perinatal rumination as critical for alleviating insomnia during pregnancy. However, no validated measures of nocturnal perinatal rumination exist, thereby limiting research in this area. We sought to develop and validate a brief survey to assess nocturnal perinatal rumination.

Methods

This study was a cross-sectional analysis of 223 pregnant women seeking insomnia treatment. Our team developed 11 questions to create the Perinatal Rumination Scale-Night (PRS-Night). Participants rated how intensely they experienced intrusive thoughts related to pregnancy while trying to sleep at night. Responses ranged from 0=not at all to 5=extremely (item examples: worry about your pregnancy or baby; have thoughts or concerns about childbirth). We conducted an exploratory factor analysis (EFA) with varimax rotation to identify the number of latent variables in our measure. Finally, we evaluated the measure’s internal consistency, convergent validity, and discriminant validity.

Results

159 patients (71.3%) screened positive for clinical insomnia (insomnia severity index [ISI]≥11), 88 patients (39.5%) screened positive for PND (Edinburgh postnatal depression scale [EPDS]≥10), and 161 patients (72.2%) screened positive for high cognitive arousal (pre-sleep arousal scale’s cognitive factor [PSASC]≥18). Bartlett’s test of sphericity was significant (p<.001) and KMO was >.90, supporting EFA. The scree plot revealed one factor (Eigenvalue=6.10) consisting of all 11 items. Internal consistency was excellent (Cronbach’s α=.92). The PRS-Night yielded good convergent validity with the PSASC (r=.56, p<.001), ISI (r=.53, p<.001), EPDS (r=.58, p<.001), and perinatal anxiety questionnaire-revised (r=.54, p<.001). SI rates were elevated for pregnant patients with high rumination (PRS-Night median-split high vs low: 19.6% vs 9.5%). The PRS-Night yielded good discriminant validity with the Epworth sleepiness scale (r=.13, ns) and patient-rated chronotype (r=.10, ns).

Conclusion

This study supports the psychometric validity of the PRS-Night for assessing nocturnal perinatal rumination. Given patient stakeholder interest in perinatal rumination at night, the PRS-Night has immense potential to help researchers better understand disease processes related to perinatal rumination and evaluate this construct as an important target mechanism in prenatal insomnia care.

Support (if any)

R34MH130562, PI: Kalmbach.
0382 The Neural Activation Involved in the Emotional Interference of Cognitive Control in Insomnia Disorder
Authors: Kim Sun-Young , Lee Kyung Hwa , Jeon Jeong Eun , Lee Ha Young , Shin Jiyoon , Seo Won Woo , Lee Yu Jin
Published: April 2024

Introduction

This study investigated the altered neural activation underlying emotional interference and its role in linking sleep disturbance in insomnia disorder.

Methods

Thirty-four insomnia patients (female 73.53%, mean age 50.76±11.98 years) and 33 controls (female 63.64%, mean age 42.73±11.90) were included in this study. They completed self-reported questionnaires (Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Dysfunctional Beliefs and Attitudes about Sleep (DBAS)) to assess subjective sleep quality, sleepiness and faulty sleep-related cognition. The sleep diary was used as a tool for the evaluation of subjective sleep parameters, whereas actigraphy and polysomnography were employed to assess objective sleep parameters. Depressive/anxiety symptoms were assessed using Beck Depressive inventory and Beck Anxiety inventory, respectively. All participants performed the emotional Stroop task in two blocks (negative emotional and neutral words) during functional magnetic resonance imaging (fMRI) assessments. We compared brain activation during the emotional Stroop between two group. Also, we analyzed correlations between altered neural activation and sleep/ emotion-related variables which show a difference between two groups.

Results

When performing the emotional Stroop task with negative emotional words, insomnia patients showed lower neural activation in the right occipital (MNI coordinates = 30,-88,-10; cluster size= 275; p=0.001) and right superior temporal (MNI coordinates =42,-28, 8; cluster size=174; p=0.007) area compared to controls. These decrease neural activations during negative emotional words were negatively correlated with the levels of subjective sleep quality and faulty sleep-related cognition (right occipital area: PSQI CE= -0.38, FDR corrected p=0.002; ISI CE= -0.32, FDR corrected p=0.032; DBAS CE= -0.39, FDR corrected p=0.009, right superior temporal area: PSQI CE= -0.34, FDR corrected p=0.030; DBAS CE= -0.45, FDR corrected p=0.002, respectively)

Conclusion

In insomnia patients, there may be a diminished capacity to perceive negative emotional stimuli and cognitive control under emotional interference associated with decreased activity of the right occipital and right superior temporal areas. This tendency is associated with subjective sleep disturbance and faulty sleep-related cognition.

Support (if any)

This study was supported by National Research Foundation (NRF) of Korea (Study no. NRF-2018R1D1A1B07049704 and no. NRF-2022R1A2C1008209).
0385 Hypnosis Intervention for Sleep Disturbances in Individuals with Mild Cognitive Impairment
Authors: Elkins Gary , Padilla Victor , Otte Julie , Sanford Keith , Benge Jared , Stevens Alan , Scullin Michael , Corlett Christopher , Ekanayake Vindhya
Published: April 2024

Introduction

Poor sleep quality is highly prevalent among individuals with mild cognitive impairment (MCI). Further, poor sleep quality is associated with reduced quality of life, increased stress response, memory impairments, and progression to dementia among individuals with MCI. Pharmacological treatments for sleep have mixed efficacy and can lead to dependency. Therefore, alternatives to pharmacological treatments for improving sleep among individuals with MCI are needed. The present study reports on the feasibility of a non-pharmacological. It was hypothesized that the hypnosis intervention program would be feasible and have acceptable levels of adherence to daily hypnosis practice.

Methods

A two-armed randomized controlled pilot trial was conducted using a sample of 21 adults with MCI. Eligible participants were randomly assigned to listen to either hypnosis audio recordings or sham hypnosis recordings for five weeks. Program feasibility, program adherence, pain intensity, stress, and sleep quality were measured using a daily home practice log, questionnaires, and wrist actigraphy.

Results

The results found mid or higher levels of treatment satisfaction, ease of use, and perceived effectiveness at one-week follow-up, with participants in the hypnosis arm reporting greater perceived benefit. Adherence to assigned audio recordings and meetings were likewise within acceptable margins in both groups. No intervention-related adverse events were reported in either treatment condition. Significant improvements in sleep quality, sleep duration, and daytime sleepiness were found for the hypnosis intervention.

Conclusion

The results of this study can be used to inform future research on the effects of hypnosis on sleep quality in adults with MCI.

Support (if any)
0389 A Computerized Cognitive Behavioral Therapy Randomized, Controlled, Pilot Trial for Insomnia in Epilepsy
Authors: Mouchati Christian , Andrews Noah , Bena James , Morrison Shannon , Foldvary-Schaefer Nancy
Published: April 2024

Introduction

Insomnia is the most common sleep-wake complaint in adults with epilepsy (AWE), impacting quality of life and potentially seizure control. Cognitive behavioral therapy for insomnia (CBTI) is the first-line treatment, although often costly and inaccessible. We conducted a Pilot Trial using web-based CBTI for Insomnia in AWE.

Methods

This randomized controlled trial was conducted at Cleveland Clinic comparing the efficacy of web-based CBTI Go to Sleep (GTS) to controls who received an informational sheet on sleep hygiene. The primary outcome was a change in the Insomnia Severity Index (ISI). Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and self-reported total sleep time (TST) were also evaluated. GTS adherence was measured by % of modules (total of 6) completed. Change in survey scores was assessed using ANOVA tests with Pearson’s correlations between baseline and 8 weeks post-randomization.

Results

A total of 35 subjects (GTS: N=18; control: N=17) were included; mean age 40.9±10.9, 77.1% female, ISI 21.6±3.4, FSS 46.3±9.5, ESS 9.6±5.9, PHQ-9 12.8±5.2, TST 6.1±1.8 hr. At baseline, all patients had ISI of 15+. At follow-up, 33.3% of GTS and 47.1% of controls had scores of 15+(p=0.88). ISI change was greater in GTS than in controls (-9.0 (-11.3,-6.6) vs. -5.8 (-8.4,-3.3); p=0.079). Changes in other patient-reported outcomes (PROs) and TST between groups were not significant. However, decreases in ISI were associated with decreases in ESS, p=0.004 and PHQ-9, p< 0.001, but not FSS or TST. Eleven (61.1%) of GTS patients completed the 6-module program. 75% reported satisfaction with the audio components and content of the program and found GTS very easy to use. Completion of lessons was associated with a decrease in FSS, p=0.031.

Conclusion

Comparable improvement in insomnia symptoms and other PROs were observed in AWE engaging in web-based CBTI and sleep hygiene education. Program adherence was good. Despite sample size limitations, these findings support the role of non-pharmacological insomnia treatment in AWE.

Support (if any)
0392 Insomnia with Short Sleep Duration Is Associated with Heart Disease and Stroke: Evidence from the UK Biobank Cohort
Authors: Vgontzas Alexandros , Shang Yimeng , He Fan , Fernandez-Mendoza Julio , Pejovic Slobodanka , Lenker Kristina , Kong Lan
Published: April 2024

Introduction

Evidence on the association of insomnia short sleep duration phenotype (ISSD) with heart disease and cerebrovascular disease (CBVD) is limited and based on cohorts using polysomnography. The aim of this study is to assess the risk of ISSD with incident heart disease and CBVD including stroke in the large UK biobank cohort based on self-reported insomnia and objectively measured habitual sleep duration by accelerometer.

Methods

We identified 96219 participants from the UK Biobank who underwent a 1-week objective sleep measure during 2013-2016. Short sleep duration was defined as ≤ 7.3 hours/night (i.e., median), after excluding participants who slept ≤ 3 hours/night or ≥11 hours/night. Self-reported insomnia symptoms obtained ± 1-year within the objective sleep measure, which was available from 4156 participants, was used to define insomnia status. Participants reported “Usually” having insomnia symptoms (vs. Never/Rarely/Sometimes) were categorized as having insomnia. Four sleep phenotypes based on the presence of short sleep duration (Yes/No) and/or insomnia symptoms (Yes/No) were created. Major confounding factors, including age, sex, BMI, smoking, and alcohol intake, were extracted from the study visit closest to the objective sleep measure. To evaluate the associations between the sleep phenotypes with incident heart and CBVD, multivariable-adjusted Cox proportional hazards models were used. The effective sample sizes for analysis on heart and cerebrovascular diseases were 3630 and 4064, respectively.

Results

Compared to normal sleepers with normal sleep duration, only ISSD phenotype was associated with significant risk for heart disease (HR=1.77, 95%CI=1.25-2.49, P=0.001) whereas neither the insomnia normal sleep duration group nor the normal sleepers short sleep duration group were associated with increased risk for heart disease. Similarly, compared to normal sleepers with normal sleep duration, only the ISSD group was associated with increased risk for CBVD including stroke (HR=2.18, 95%CI=1.21-3.92, P=0.009) whereas there was no association between the other two sleep groups and CBVD.

Conclusion

These data from the large UK biobank database using an ecologically friendly method to assess habitual objective sleep duration suggest that it is the combination of insomnia plus short sleep duration (ISSD), that increase significantly the risk for heart disease and stroke.

Support (if any)
0395 Effectiveness of a Digital Clinical Decision Support Platform to Augment CBTI Capability Gaps in the DHA/DoD
Authors: Germain Anne , Wolfson Megan , Star John Blue , Espejo Emmanuel , Mysliwiec Vincent
Published: April 2024

Introduction

Insomnia is the most prevalent sleep disorder among active duty service members (ADSMs) and compromises readiness. Cognitive-behavioral therapy for insomnia (CBTI) is the DoD/VA recommended treatment, but access and delivery of CBTI is impeded by gaps between high patient demand for care and clinical capabilities. We evaluated the effectiveness of a digital clinical decision support (CDS) platform to overcome current CBTI capability gaps.

Methods

Mental healthcare providers (MHCPs) at military clinics were offered access to a novel CDS platform (COAST, NOCTEM® Health, Inc) to treat patients they deemed appropriate for this CBTI delivery mode. The platform consists of (1) clinician portal to remotely monitor and manage patients’ symptoms, progress, and adherence to algorithm-based, MHCP-approved treatment recommendations; (2) patient app that prospectively collects sleep diaries and displays MHCP-approved treatment recommendations (e.g., stimulus control, sleep restriction). The primary outcomes were treatment response (50% reduction in sleep latency (SL) or wake after sleep onset (WASO); increase of > 10% in sleep efficiency (SE)) and insomnia remission (response & SL & WASO < 30 minutes with SE > 85%) at the end of treatment. The magnitude of changes in diary-based SL, WASO, and %SE were compared from baseline and at the final intervention was quantified using Cohen’s d effect sizes.

Results

Nineteen MHCPs at 7 Air Force Bases, 2 Naval hospitals, and 1 Army medical center utilized the platform with 245 ADSMs presenting with insomnia (M age =32.6 + 8.0 y.o.; 27.3% women, 78% Sailors/Marines, 19% Airmen, 3% Soldiers). Average treatment duration was 5 ±1 weeks. The mean completion rate of diaries was 77% + 20%. Post-treatment, 83.5% of ADSMs met treatment response criteria, and 70.3% met remission criteria. From baseline to the last intervention, clinically meaningful improvements in SL, WASO, and %SE were observed (all Cohen’s d > .5).

Conclusion

Augmentation of CBTI capabilities among MHCP using a digital CDS platform is feasible and yields rapid and clinically meaningful improvements in sleep among ADSMs with insomnia. CDS-enabled services may facilitate the scalability of DoD/VA insomnia management practices and reduce CBTI capability gaps.

Support (if any)

MTEC-2019-406, AFMRA (29700-0007), Leidos (P010268077).