bluuebunny/crossref_metadata_2025 huggingface dataset:
1033 Sleep and Patient-Reported Outcomes in Persons With Heart Failure With Preserved Ejection Fraction
Authors: Baniak L M , Atwood C W , Strollo P J , Forman D E , Chasens E R
Published: May 2020

Introduction

Sleep quality has a significant bearing on disease. A better understanding of sleep quality may help identify opportunities to improve patient-reported outcomes (PROs) in persons with heart failure with preserved ejection fraction (HFpEF). We aimed to explore the association between sleep and PROs in patients clinically diagnosed with HFpEF.

Methods

Cross-sectional study of 22 participants (71.2±7.2 years, 95% male, 86.4% white) with HFpEF, recruited from a heart failure (n=14) and sleep clinic (n=8). Sleep disordered breathing was measured objectively using one-night in-home obstructive sleep apnea (OSA) testing (ApneaLink). Actigraphy (7 days) was used to assess sleep duration, efficiency, and wake after sleep onset (WASO). Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). PROs included functional status (Functional Outcomes Sleep Questionnaire [FOSQ]), depression (PROMIS Depression), fatigue (PROMIS Fatigue), and heart failure specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]; overall summary score [KCCQ-os] and clinical summary score [KCCQ-cs]). The KCCQ-cs includes physical function and symptom scores to corresponds with NYHA Classification.

Results

Fifty percent of the participants had poor sleep quality (PSQI >5) and 2 (9.1%) had ISI scores >14. The majority (64%; n=14) had OSA; 10 currently on OSA therapy. Mean oxygen desaturation index (ODI) was 20.8±17.8. Mean actigraphy data indicated poor sleep (sleep duration 302±116 minutes, sleep efficiency 70.0±18.6%, and WASO 52±28 minutes) despite only 5 (22.7%) participants reporting excessive daytime sleepiness (ESS>10). Greater insomnia symptom severity was associated with lower heart failure specific quality of life (KCCQ-os) and functional status, and, greater fatigue and depression (all p-values <.05). FOSQ was negatively associated with PSQI (r= -.710, p= <.001) and positively with sleep efficiency (r=.496, p=.026). The KCCQ-cs was positively associated with sleep duration (r=.496, p=.026) and negatively but not significantly associated with ODI (r= -.453, p=.07).

Conclusion

Impaired sleep and OSA are highly prevalent in patients with HFpEF and both are adversely associated with PROs. Goals to improve sleep is important for effective symptom management and for potential improvements in PROs.

Support

American Nurses Foundation, Preventative Cardiovascular Nurses Association
1038 Sleep Architecture In Individuals Receiving Methadone For Medication-Assisted Treatment Of Opioid Use Disorder
Authors: Erwin J A , Wilson M , Finlay M , Hansen D A , Little-Gott A , Reynolds D , Quock R M , Layton M E , Van Dongen H
Published: May 2020

Introduction

It has been established that the use of opioids suppresses stage N3 sleep. For individuals with opioid use disorder (OUD), medication-assisted treatment (MAT) is a widely employed opioid replacement therapy used to mitigate withdrawal effects and drug cravings. We investigated sleep architecture in individuals receiving methadone-based MAT.

Methods

N=6 individuals (aged 43.8±12.8y; 5 females), who were within 90 days of methadone initiation, underwent in-laboratory overnight polysomnography (8h TIB; 22:00-06:00). Prior to bedtime, pain intensity and opioid withdrawal symptoms were assessed using the Numeric Pain Rating Scale (0-10) and the Clinical Opiate Withdrawal Scale (0-48). Sleep recordings were scored visually according to AASM guidelines.

Results

In this sample, subjects exhibited 87.4-93.0% (M: 92.2%) sleep efficiency (SE), 8.0-16.2min (M: 12.1min) sleep latency (SL), 5.5-7.5% (M: 6.5%) N1, 46.4-52.7% (M: 49.6%) N2, 20.7-30.6% (M: 25.6%) N3, 17.5-19.1% (M: 18.3%) REM, 28.0-38.5min (M: 33.3min) N3 latency, and 84.1-125.9min (M: 105.0min) REM latency. Subjects reported moderate pain intensity scores of 5-6 (M: 5.3) and mild to moderate withdrawal symptoms of 1-15 (M: 7.8).

Conclusion

Relative to published healthy sleeper norms, subjects showed more N1 and N3 and less REM sleep. The increased N3 was unexpected given that opioids (such as methadone) typically suppress N3; it may reflect subjects carrying a substantial sleep debt. Pain and withdrawal symptoms may be a factor increasing N1 and reducing REM sleep. Such potential sleep deficiencies may interfere with subjects achieving OUD recovery goals and are worthy of further investigation.

Support

Supported in part by a seed grant from the Washington State University Office of Research Advancement and Partnerships.
1046 Assessing Sleep-Related Hypertension Risks Using JNC 8 Guidelines: Analysis Of The National Health And Nutrition Examination Survey Data
Authors: Lough L , Seixas A , Avirappattu G , Robbins R , Rogers A , Williams S , Jean-Louis G
Published: May 2020

Introduction

Associations between self-reported sleep duration and risk of hypertension (HTN) are well established. The level of sleep-related HTN risk based on the new JNC 8 classification guidelines requires further research. In this study, we modeled the associations of insufficient sleep with HTN using the National Health and Nutrition Examination Survey (NHANES).

Methods

Data were extracted from the 2006-2016 NHANES (n=38,540), a nationally representative study of the US civilian population. Self-reported demographic and sleep duration were determined from household interview questions. Insufficient sleep was categorized as sleeping <7hrs. Using 2017 ACC/AHA guidelines, HTN was classified as elevated (SBP:120-129mmHg and DBP <80mmHg, Stage I (SBP:130-139mmHg and DBP:80-89mmHg), or Stage II (SBP ≥140mmHg and DBP ≥90mmHg). Logistic regression modeling was performed using R.

Results

Participants’ ages ranged from 18-85 years. Of the sample, 51% were female, 41% white, 22% black, 26% Hispanic, 8% others; 46% were married, and 25% completed <high school. The model showed strong age and BMI-adjusted associations of insufficient sleep with HTN at all levels: (elevated: OR=1.079, CI=1.03-1.13; Stage I: OR=1.127, CI=1.07-1.18, and Stage II: OR=1.334, CI=1.17-1.52). Important sex and race/ethnicity differences in sleep-related HTN risks were observed: males (elevated: OR=1.024, CI=0.95-1.10; Stage I: OR=1.077, CI=1.01-1.15, and Stage II: OR=1.254, CI=1.06-1.48); females (elevated: OR=1.125, CI=1.05-1.21; Stage I: OR=1.170, CI=1.08-1.26, and Stage II: OR=1.445, CI=1.17-1.79); whites (elevated: OR=1.007, CI=0.93-1.08; Stage I: OR=1.030, CI=0.95-1.12, and Stage II: OR=1.131, CI=0.90-1.43); blacks (elevated: OR=1.047, CI=0.94-1.16; Stage I: OR=1.080, CI=0.97-1.20, and Stage II: OR=1.179, CI=0.95-1.46); and Hispanics (elevated: OR=1.066, CI=0.94-1.21; State I: OR=1.089, CI=0.96-1.24, and Stage II: OR=1.337, CI=0.92-1.92).

Conclusion

Our analyses showed that sleep-related HTN risks vary as a function of individual’s sex and race/ethnicity. Increasing sleep duration at all HTN severity level is important and males and Hispanics at Stage II HTN might benefit the most.

Support

This study was supported by funding from the NIH: R01MD007716,R01HL142066, R01AG056531, T32HL129953, K01HL135452 and K07AG052685
1047 Social Rhythm Instability Is Associated With Abdominal Adiposity After Involuntary Job Loss
Authors: Haynes P L , Apolinar G , Thomson C A , Quan S , Silva G E , Kobayashi U , Glickenstein D A
Published: May 2020

Introduction

Involuntary job loss is an acute stressor that disrupts daily time structure and activity and exacerbates economic hardship and psychological distress. Studies show that unemployment is associated with negative obesity-related health outcomes, such as metabolic syndrome. However, very little is known about daily routine, depression, and obesity in individuals who have recently experienced involuntary job loss. We hypothesized that individuals with less consistent daily routines, or unstable social rhythms, after job-loss would have more abdominal adiposity than individuals with more consistent social rhythms. We also hypothesized that this relationship would vary as a function of depressive symptoms.

Methods

Cross-sectional baseline data (n = 186) from the ongoing ADAPT study (Assessing Daily Activity Patterns through occupational Transitions) were analyzed using linear regression techniques. Participants were predominantly female (62%) with a mean age of 41.12 years (SD = 10.16 years); 31% were Hispanic or Latino. Over two weeks, participants completed the daily Social Rhythm Metric-17 (SRM), Beck Depression Inventory II (BDI), and waist circumference (adiposity) measurements (cm).

Results

A significant BDI x SRM interaction was detected in the prediction of waist circumference, B = .36, SE = .18,  p  < .05, 95% CI [.002, .709], R2 = .07). The SRM was inversely associated with waist circumference, B = -5.57, SE = 2.25,  p  < .05, 95% CI [-9.98, -1.13], only at lower levels of BDI (-1 SD below the mean). Results from the Johnson-Neyman technique identified that the conditional effect of SRM on waist circumference was statistically significant at a BDI raw score of 8.33 (0-13 points is minimal depression) with ~45% of cases within this region.

Conclusion

A less consistent daily routine was associated with a larger waist circumference among individuals with minimal depressive symptoms. These findings are the first to demonstrate a relationship between social rhythm stability and abdominal adiposity in adults at high risk for central obesity. Results highlight the moderating role of depression in obesity prevention. Future prospective analysis is necessary to examine causal pathways.

Support

#1R01HL117995-01A1
1050 Sleep, The Missing Domain For Cardiovascular Health?
Authors: Foster B E , Collen J F , Eliasson A H
Published: May 2020

Introduction

In developed countries, cardiovascular disease (CVD) is the leading cause of death. Identification and mitigation of CVD risk factors has been the chief strategy for prevention of CVD. To this end, the American Heart Association (AHA) and American College of Cardiology (ACC) suggest metrics of ideal cardiovascular (CV) health in seven domains and have published guidelines encouraging use of the “Simple Seven” to improve CV health. Sleep is notably absent from the Simple Seven despite substantial epidemiological evidence of its importance for CV health. We sought to measure the correlation of sleep parameters with CVD risk estimate by Framingham risk score (FRS).

Methods

Subjects prospectively enrolled in a CV Health Registry provided data for FRS, the seven domains of the “Simple Seven” including blood pressure, physical activity, total cholesterol, diet, weight, smoking, and glucose level, and completed validated questionnaires: Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) for sleep apnea. Pearson correlations were analyzed between FRS and the “Simple Seven” as well as for the sleep questionnaires for comparison.

Results

Among the 646 subjects (mean age 55.4 ±9.9y, 43% men, 399W, 190B, 26H, 12A, 19other), FRS correlated substantially with blood glucose (R=0.398, p<0.00001), moderately with blood pressure (R=0.220, p<0.00001), and mildly with weight (r=0.145, p-0.0002) and physical activity (R=0.110, p=0.01). A negative (paradoxical) correlation was identified between total cholesterol and diet when compared to FRS. In comparison, FRS did correlate mildly with BQ (R=0.114, p=0.0002) and PSQI (r=-0.103, p=0.009).

Conclusion

This study suggests that sleep parameters, specifically BQ and PSQI, may contribute to risk assessment of CVD while also offering actionable information for improving CV health.

Support
1058 Modeling Self-reported Sleep Duration And Hypertension Using Deep Learning Network: Analysis Of The National Health And Nutrition Examination Survey Data
Authors: Williams S , Seixas A , Avirappattu G , Robbins R , Lough L , Rogers A , Beaugris L , Bernard M , Jean-Louis G
Published: May 2020

Introduction

Epidemiologic data show strong associations between self-reported sleep duration and hypertension (HTN). Modeling these associations is suboptimal when utilizing traditional logistic regressions. In this study, we modeled the associations of sleep duration and HTN using Deep Learning Network.

Methods

Data were extracted from participants (n=38,540) in the National Health and Nutrition Examination Survey (2006-2016), a nationally representative study of the US civilian non-institutionalized population. Self-reported demographic, medical history and sleep duration were determined from household interview questions. HTN was determined as SBP ≥ 130 mmHg and DBP ≥ 80 mmHg. We used a deep neural network architecture with three hidden layers with two input features and one binary output to model associations of sleep duration with HTN. The input features are the hours of sleep (limited to between 4 and 10 hours) and its square; and the output variable HTN. Probability predictions were generated 100 times from resampled (with replacement) data and averaged.

Results

Participants ranged from 18 to 85 years old; 51% Female, 41% white, 22% black, 26% Hispanic, 46% married, and 25% < high school. The model showed that sleeping 7 hours habitually was associated with the least observed HTN probabilities (P=0.023%). HTN probabilities increased as sleep duration decreased (6hrs=0.05%; 5hrs=0.110%; 4hrs=0.16%); HTN probabilities for long sleepers were: (8hrs=0.027; 9hrs=0.024; 10hrs=0.022). Whites showed sleeping 7hrs or 9hrs was associated with lowest HTN probabilities (0.008 vs. 0.005); blacks showed the lowest HTN probabilities associated with sleeping 8hrs (0.07), and Hispanics showed the lowest HTN probabilities sleeping 7hrs (0.04).

Conclusion

We found that sleeping 7 hours habitually confers the least amount of risk for HTN. Probability of HTN varies as a function of individual’s sex and race/ethnicity. Likewise, the finding that blacks experience the lowest HTN probability when they sleep habitually 8 hours is of great public health importance.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, T32HL129953, K01HL135452, and K07AG052685.
1062 The Role of Sleep in Sex and Racial/Ethnic Differences in 10-Year CVD Risk in the Sleep Heart Health Study: The Use of Machine-Learnt and Precision Insights to Understand Racial/Ethnic and Sex Differences in Sleep-CVD Disparity
Authors: Seixas A , Jin P , Liu M , Nunes J , Grandner M , Rogers A , McFarlane S , Jean-Louis G
Published: May 2020

Introduction

The current study investigated whether insufficient sleep (<7 hrs.) explains differences in 10-year CVD risk, using Framingham risk (FRS) and Reynolds risk (RRS) scores, between blacks and whites and characterized risk and protective CVD risk profiles.

Methods

Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (<5%), low-medium (5% to <10%), medium-high (10% to <20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles.

Results

Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups.

Conclusion

These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts.

Support

K01HL135452, R01MD007716, R01HL142066, K07AG052685
1073 Sleep Disorders Contribute To Anger In Service Members With Posttraumatic Stress Disorder
Authors: Miles S R , Pruiksma K , Slavish D , Nakase-Richardson R , Nicholson K , Wardle S , Young-McCaughan S , Resick P , Williamson D , Dondanville K , Litz B , Mintz J , Keane T , Peterson A , Taylor D
Published: May 2020

Introduction

The emotion of anger and behavioral acts of aggression can lead to severe negative consequences, including family violence, legal charges, and death. Anger can be a symptom of posttraumatic stress disorder (PTSD), particularly in service members. Service members report difficulties managing their anger and trouble with the subsequent results. Factors that differentiate service members with PTSD who have anger related problems from those who do not are still unknown. Impaired sleep is associated with negative mood states in the general population and may be a risk factor for anger in those with PTSD. This project examines how sleep disorders commonly diagnosed in service members (i.e., obstructive sleep apnea and insomnia) relate to PTSD and anger.

Methods

Ninety-three service members with comorbid PTSD, insomnia, and nightmares (mean age = 35.86 years, SD = 8.38, 27% female, 45% white) completed polysomnography and other measures as part of a clinical trial. A multiple regression model examined how total Apnea Hypopnea Index (AHI), AHI during REM sleep, insomnia (Insomnia Severity Index), age, and race related to PTSD symptoms (Clinical Administered PTSD Scale-5: CAPS-5). A second multiple regression model examined the same variables’ associations with anger (Dimensions of Anger Reactions-5; DAR-5).

Results

More than a third of the sample (37%) met criteria for OSA (AHI scores>5) and 99% met criteria for insomnia (ISI>10). Total AHI and REM AHI were not associated with CAPS-5 scores or ISI. Across OSA and PSG indices, only greater REM AHI (b=.07, p<.05) and Insomnia (b=.43, p<.05) were positively associated with DAR-5 anger scores. Total AHI was unrelated to anger.

Conclusion

Elevated REM AHI and insomnia were associated with greater anger in service members with PTSD. Current treatments for anger are only moderately effective. Assessing and treating comorbid sleep disorders may reduce anger and enhance successful PTSD treatment.

Support

Consortium to Alleviate PTSD (W81XWH-13-2-0065), DVA (I01CX001136-01), GDHS (W91YTZ-13-C-0015) for DVBIC.
1079 Is PTSD In Young Women Associated With Rem Sleep Abnormalities?
Authors: Martinez D , Yeh M , Oliveira L , Coimbra B , Mello A F , Poyares D , Tufik S , Mello M F
Published: May 2020

Introduction

The increase in violence against young women has a high impact on the prevalence of Posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is twice as high in women. However, most studies assessing sleep disturbances in PTSD were conducted predominantly in male samples and combat veterans. Objective: To analyze the sleep of young women with and without PTSD. Hypothesis: Women with PTSD have worse sleep quality, higher arousability, and higher muscle activity during REM sleep.

Methods

Case-controlled study with young women. Seventy-four women who suffered sexual assault and developed PTSD (DSM-5); and 64 women from the community without PTSD. Women were recruited from the PTSD outpatient clinic (Universidade Federal de São Paulo, Brazil).Clinician-Administered Posttraumatic Stress Scale (CAPS 5), Beck Depression and Anxiety Inventories (BDI) (BAI), full in-lab Polysomnography (PSG), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Índex (PSQI), Fatigue Impact Scale (FIS), and Insomnia Severity Índex (ISI) were applied to all participants. Analysis of variance, regression models, and general linear modeling were used.

Results

Patients mean age was 28 vs 24 for the control group (p=0.004). CAPS mean score in PTSD-group was 42.5±9.1. BDI, BAI, FIS, PSQI, ISI scores were worse in PTSD-group (p<0.05, all). Pittsburgh Sleep Quality Index (PSQI) score was significantly associated with CAPS 5 independently of depression, fatigue, and sleep fragmentation.

The PTSD women had lower total sleep time (p= 0.01) and lower REM sleep percentage (p=0.04). However, the control group had higher arousal index (p=.0.01) and had higher muscle activity during REM sleep (p=0.03) than PTSD.

Conclusion

Women with PTSD had significantly worse score in PSQI, FIS, and ISI. PSQI score was associated with PTSD severity. However, when PSG results are concerned, we found higher sleep fragmentation in the control group. We speculate that women with PTSD may have felt safer and taken care of in the lab, which might explain the difference between objective and subjective measures of sleep quality in PTSD.

Support

Acknowledgments: FAPESP: Fundação de Apoio à pesquisa de São Paulo, AFIP: Associação Incentivo a Pesquisa
1088 Heart Rate Variability During Sleep in Adults With and Without a History of Depression and the Influence of Antidepressant Use
Authors: Egeler M E , Bowman M , Thayer J F , Brindle R C , Hall M , Kline C E
Published: May 2020

Introduction

Individuals with depression have an increased risk for cardiovascular disease. While lower daytime HRV may be one mechanism of this association, it is less clear whether HRV during sleep (sHRV) differs between adults with and without depression. Examining sHRV is an important measure to test given evidence that nocturnal differences in physiology are strong predictors of cardiovascular disease.

Methods

118 adults who completed psychiatric interviews between the ages of 21-60 y (T1) returned 18.7 ± 4.5 years later for a re-evaluation of their mental health and assessment of sleep (T2). 71 participants were diagnosed with Major Depressive Disorder (MDD) at either T1 or T2, while 47 participants were free from depression at both time points. At T2, participants underwent an overnight polysomnogram with concurrent assessment of electrocardiography. The primary measures of sHRV were root mean square of successive differences (RMSSD) values during rapid eye movement (REM) sleep and non-REM (NREM) sleep stages N2 and N3. Lower values of RMSSD suggest lower parasympathetic activity. RMSSD values were natural log-transformed prior to analysis. Differences in RMSSD between depressive groups were examined using analysis of covariance (ANCOVA), adjusting for age, body mass index, gender, race, and antihypertensive medication use. Additional ANCOVA models adjusted for antidepressant use.

Results

Participants with current or a history of MDD had lower RMSSD values during REM sleep (P=.01) and a trend toward lower values during NREM (P=.06) compared to those without MDD. Antidepressant use was significantly associated with lower RMSSD during both REM (P=.002) and NREM sleep (P<.001). Depression history was no longer associated with RMSSD during NREM or REM sleep following adjustment for antidepressant use (P>.40).

Conclusion

These data indicate that adults with MDD exhibit lower parasympathetic activity during sleep compared to those without MDD. These associations were modified by antidepressant use, suggesting that antidepressants may partially explain the association between depression and sHRV. Future studies investigating the influence of specific antidepressants for modifying nocturnal physiology may help to better understand the link between depression and cardiovascular disease risk.

Support

This study was funded by National Institutes of Health (NIH) grants R01 HL104607 and K23 HL118318.
1092 Attention-deficit/hyperactivity Disorder Symptoms And Sleep Characteristics Within A Seasonal Affective Disorder Spectrum
Authors: Kim K N , Wescott D L , Franzen P L , Hasler B P , Roecklein K A
Published: May 2020

Introduction

Seasonal affective disorder (SAD) increases risk for attention-deficit/hyperactivity disorder (ADHD), although the mechanism linking SAD and ADHD is unknown. Prior research has identified insomnia and delayed sleep phase in both ADHD and SAD. We hypothesized that sleep duration and timing in SAD would be associated with the severity of ADHD symptoms.

Methods

Adults with SAD (n = 45) and subsyndromal SAD (S-SAD; n = 18) aged 19-66 years from Pittsburgh, PA., were assessed for ADHD symptoms, self-report sleep quality, depression severity, and daytime sleepiness in the Winter. Participants wore an Actiwatch for 4-14 days, from which we calculated sleep-onset latency, total sleep time, sleep midpoint, and sleep efficiency. We conducted a hierarchical multivariate linear regression to determine if sleep characteristics predict ADHD symptom severity in our sample while controlling for depressive symptoms. Age and gender were added in Step 1, seasonal depression severity in Step 2, actigraphy-based total sleep time, sleep onset latency, midpoint, and efficiency in Step 3, and self-reported sleep quality and daytime sleepiness in Step 4.

Results

Participants mostly scored in the “likely” or “highly likely” ADHD range (87.30%, n=55), higher than the national prevalence rate (4.4%). When controlling for age, gender, and depression severity, only shorter actigraphy-based total sleep time was associated with higher ADHD symptom severity (β=-0.30, p<0.05). However, when self-reported sleep quality and daytime sleepiness were added as predictors, total sleep time was no longer a statistically-significant predictor of ADHD symptom severity and only daytime sleepiness predicted ADHD symptom severity (β=0.31, p<0.05).

Conclusion

Our results suggest that individuals with SAD who experience daytime sleepiness and/or possibly shorter actigraphy-based sleep duration experience higher ADHD symptom severity. Treatments like Trans-C or CBT-I to improve daytime sleepiness and sleep duration may be indicated for SAD patients who present with comorbid ADHD symptoms.

Support

NIMH K.A.R. MH103303
0111 Emotional Memory-Associated Voxel-Extent Reactivation During Episodic Memory Retrieval Varies as a Function of Post-Learning Sleep
Authors: Bottary R M , Kark S M , Daley R T , Payne J D , Kensinger E A
Published: May 2020

Introduction

Slow wave sleep (SWS) and rapid eye-movement (REM) sleep enhance neutral and emotional memory consolidation, respectively. Emotional episodic memory retrieval is also enhanced when encoding-specific functional brain patterns are reactivated at retrieval, especially in ventral visual stream and frontal brain regions as well as amygdala. Here we investigate how sleep impacts the association between memory-dependent brain pattern reactivation and episodic memory retrieval.

Methods

Healthy adults (N = 22; 11F, 11M; age: 19–29 years) were scanned during an incidental encoding task and a surprise recognition memory task 24h later. Overnight sleep was monitored with polysomnography. During encoding, participants viewed line drawings of negative, neutral, and positive images, each followed by their full-colored photo. At recognition, participants distinguished new from encoded line drawings. Brain reactivation was measured at the single-subject level as the percentage of voxels activated at encoding that were also activated during successful recognition (reactivation%); this metric was calculated independently in whole-brain and 3 ROI-based maps (inferior temporal lobe (ITL), medial prefrontal cortex, and amygdala). Multiple linear regression was performed to predict memory performance from functional brain reactivation and sleep physiology.

Results

In whole-brain analyses, the association between negative memory performance and reactivation% decreased with greater REM sleep amount. This interaction approached significance for positive, but was not significant for neutral, memory performance. Additionally, the association between neutral, but not emotional, memory performance and reactivation% decreased with greater amounts of SWS sleep. In ROI-based analyses, positive, but not negative or neutral, memory performance was independently predicted by REM sleep amount and ITL reactivation%. No effects of SWS amount were observed in ROI-based analyses.

Conclusion

Greater amounts of sleep decreased the association between brain reactivation and memory performance. Sufficient sleep may change cortical representations of episodic memories, resulting in less reliance on encoding-related reactivation during memory retrieval.

Support

NSF Grant BCS 1539361
1095 Use Of Mobile Devices At Night Associated With Mental Health In Young Adults
Authors: Mason B , Tubbs A , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Mobile technology use in bed is becoming commonplace and associated with habitual short sleep duration. The present study examined whether device use at night was related to mental health.

Methods

Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study comes from a community-based sample, which was restricted to N=473 between the ages of 22-29. Device use was assessed as presence in the room at night, any use at night, texting, emailing, browsing the internet, making or receiving calls, and using social media. Participants were also asked how often they are woken by a call/alert from their phone (unplanned), how often they are woken by their phone alarm (planned), and how often they check their phone at night. These were recorded as never, rarely, some nights, almost every night, and every night, and were assessed as an ordinal outcome. Predictors included score on the Patient Health Questionnaire depression scale (PHQ9), GAD7 anxiety scale, Perceived Stress Scale (PSS), and Multidimensional Scale of Perceived Social Support (MSPSS). Ordinal logistic regression analyses were adjusted for age, sex, race/ethnicity, education, and income.

Results

Depression was associated with texting (oOR=1.03, p=0.025), email (oOR=1.03, p=0.022), internet (oOR=1.05, p=0.003), unplanned awakenings (oOR=1.05, p=0.001), and checking the phone (oOR=1.09, p<0.0005). Anxiety was associated with texting (oOR=1.05, p=0.001), email (oOR=1.05, p=0.001), internet (oOR=1.05, p=0.002), social media (oOR=1.04, p=0.009), unplanned awakenings (oOR=1.06, p<0.0005), planned awakenings (oOR=1.04, p=0.025), and checking the phone (oOR=1.10, p<0.0005). Perceived stress was associated with internet (oOR=1.02, p=0.034), unplanned awakenings (oOR=1.02, p=0.045), and checking (oOR=1.04, p<0.0005). Social support was associated with decreased checking (oOR=0.98, p=0.018).

Conclusion

Mobile device use at night itself is not associated with mental health, but specific activities may be. Also, those who report more disruptions from the device and more checking of the device also report worse mental health. Relationships might be bidirectional.

Support

Dr. Grandner is supported by R01MD011600

The SHADES study was funded by R21ES022931
1097 Sleep Disturbances, Sleep Burden, And Depressive Symptoms In US Hispanics/Latinos: Results From The HCHS/SOL Sueño Study
Authors: Alcantara C , Wallace M , Sotres-Alvarez D , Vetter C , Phillips A J , Shafazand S , Johnson D A , Wallace D , Gallo L C , Ramos A R , Penedo F , Wohlgemuth W K , Zee P C , Redline S , Patel S R
Published: May 2020

Introduction

While sleep disturbances and depression often co-occur, these associations are understudied among Hispanics/Latinos. We examined the associations of sleep disturbances and sleep burden with depressive symptoms among Hispanic/Latino adults in the United States.

Methods

We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sueño Ancillary study (2010-2013). The study enrolled 2072 adults (ages 18-64; 51.5% females) who completed one-week wrist-actigraphy and sleep questionnaires. Sleep burden was operationalized as the total count of sleep disturbances across six domains (duration, efficiency, midpoint, variability, insomnia, sleepiness). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale (CESD-10). We used weighted survey linear regressions to evaluate the association of sleep disturbances and sleep burden with elevated depressive symptoms (CESD≥10) in individual models adjusted for age, gender, site, heritage, nativity, education, income, and employment. Sensitivity analyses further adjusted for behavioral health risk factors and apnea-hypopnea index.

Results

An estimated 28.3% had elevated depressive symptoms, 8.0% had short sleep duration (<6 hours of sleep), 10.9% had long sleep duration (>9 hours), 45.2% exhibited a later sleep midpoint (≥4:00AM), 38.4% had high sleep timing variability (upper third tertile for between day sleep midpoint), 15.3% had insomnia (ISI≥10), 17.3% had excessive daytime sleepiness (ESS ≥10), 21.5% had poor sleep efficiency (<85%), and 77.4% had a total sleep burden count of ≥0. Insomnia (ß=0.49,95%CI:.43,.56), later sleep timing (ß=0.10,95%CI:.04,.16), excessive daytime sleepiness (ß=0.19,95%CI:.11,.27), poor sleep efficiency (ß=0.09,95%CI:.02,.17), high variability (ß=0.07, 95%CI:.01,.12), and sleep burden (ß=0.11,95%CI:.09,.13), were each positively associated with elevated depressive symptoms in individual adjusted models and sensitivity analyses. Extreme sleep durations were not associated with elevated depressive symptoms.

Conclusion

Multiple inter-related sleep disturbances, particularly those pertaining to sleep quality and timing, are associated with depression and may be targets for future interventions aimed at improving mood among Hispanics/Latinos.

Support

HL127307, HL098927, HL125748
1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions
Authors: Krishnamurthy V B , Hussain N , Puzino K , Yadav S , Del Tredici S , Vgontzas A N , Bixler E O , Fernandez-Mendoza J
Published: May 2020

Introduction

Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID).

Methods

We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S.

Results

No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group.

Conclusion

OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population.

Support

Junior Faculty Development Program, Penn State College of Medicine
1119 Superior Test-Retest Reliability of a Computerized Cognitive Assessment vs SLUMS During an 18-Month Longitudinal Study
Authors: Andrefsky J C , Cahn-Hidalgo D , Benabou R
Published: May 2020

Introduction

Chronic sleep deprivation has been associated with cognitive impairment (CI) in multiple studies. Cognivue is an FDA-cleared computerized testing tool that provides adaptive psychophysic evaluation of cognitive functions (CF). A reliable objective method to evaluate CF in patients with sleep disorders could be helpful to optimize long-term treatment. In an FDA clearance study, Cognivue demonstrated good agreement with St. Louis University Mental Status (SLUMS) and other neuropsychological tests, and superior test re-test reliability compared to SLUMS across 2 sessions, 1 to 2 weeks apart (Cognivue regression fit: R2= 0.81, r= 0.90); SLUMS regression fit: R2 = 0.67, r= 0.82).

Methods

238 subjects from the FDA clearance study enrolled in the longitudinal study. They underwent Cognivue test and SLUMS at 3 sessions over 18 months (6, 12, 18 months post-FDA study). An analysis of rank linear regression test-retest reliability was performed for both tests.

Results

Among these 238 patients, Cognivue demonstrated similar linear regression scores across comparisons (test session 1&2: regression fit: R2= 0.76; r = 0.87; test session 1&3: regression fit: R2= 0.72; r = 0.85; test session 1&4: regression fit: R2= 0.73; r = 0.86). The SLUMS test demonstrated greater variability in regression scores across test sessions (test session 1&2: regression fit: R2= 0.63; r = 0.79; test session 1&3: regression fit: R2= 0.43 r = 0.65; test session 1&4: regression fit: R2= 0.64; r = 0.80).

Conclusion

Cognivue demonstrated maintained superior test re-test reliability compared to SLUMS over a period of 18 months after the FDA clearance study. With that, Cognivue could be beneficial in detecting early stages of multi-domain CI in patients with sleep disorders, providing an opportunity for early intervention strategies and follow-up over time to improve patient outcomes.

Support

Cognivue, Inc.
1120 Inverse U-Curve Association Between Sleep Duration and Cognitive Performance Among Patients with Dementia: Findings From the Cretan Aging Cohort
Authors: Basta M , Simos P , Koutentaki E , Zaganas I , Tziraki S , Belogianni C , Panagiotakis S , Vgontzas A
Published: May 2020

Introduction

Previous research reports an inverse U-curve association between subjective sleep duration and cognition in elderly, while findings on objective sleep duration are inconsistent. Only one study found weak association between objective short sleep duration and cognition, mainly driven by demented elders. Our aim was to examine the non-linear associations between objective sleep duration and cognitive performance among community-dwelling patients with dementia.

Methods

A sub-sample of 46 patients with mild-to-moderate dementia(AD) [mean age: 80.3 (SD=5.6) years, 40% males] and 85 cognitively intact controls(NI) [mean age: 73.0 (SD=7.4) years, 37% males], were recruited from a large, population-based cohort [Cretan Aging Cohort] in the island of Crete, Greece of 3,140 older adults (≥60yrs). All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, and 3-day 24-h actigraphy. Comparisons between AD and NI participants on sleep parameters and neuropsychological performance were made using ANOVA controlling for demographics. Associations between 24-TST, and age- and education-adjusted cognitive scores and Independent Activity of Daily Living Scale (IADL) scores were assessed using hierarchical, non-linear, regression models, controlling for confounders.

Results

Dementia patients had significantly longer 24-h total sleep time (24h-TST) (491.2±107.1 min vs. 444.6±88.5 min, respectively, p=0.027), as well as lower cognitive/IADL sores as compared to the NI group. Significant associations between objective sleep and various cognitive /IADL scores were found only among patients with dementia. Specifically, we found a negative curvilinear association between 24-h TST and IADL, episodic memory indices (AVLT Retention, autobiographic memory) and visuomotor coordination speed (Trail Making Test, Part A).

Conclusion

Our study showed an inverse U-curve association between objective sleep duration and daily function, memory, and executive function in patients with dementia. Possibly, sleep loss may lead to cognitive impairment, whereas, prolonged sleep may be an indicator of worse cognitive performance among patients with dementia.

Support

National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant: MIS 377299).
1122 Sleep Architecture and Leg Movement Activity During Sleep in Patients with Multiple Sclerosis
Authors: Castelnovo A , Ferri R , Tanioka K , Tachibana N , Carelli C , Riccitelli G , Zecca C , Gobbi C , Manconi M
Published: May 2020

Introduction

Although sleep in patients with Multiple Sclerosis (MS) has been investigated in several studies using subjective measures, objective sleep data collected using polysomnography (PSG) are still scanty and often divergent. We herein present the largest study to date evaluating sleep architecture and total leg movement activity during sleep (LMS) in patients with MS.

Methods

We collected PSG recordings from 80 patients affected by multiple sclerosis (MS, 48.1±10.61yo 67.5% females), and 60 age and gender matched healthy control subjects (HC, 48.5±17.20 yo, 56% females). Group differences were computed using non-parametric statistics for all traditional sleep architecture parameters, LMS, short-interval (SILMS), periodic (PLMS), isolated LMS (ISOLMS) indices and duration, inter-movement interval (IMI) graphs and time-of-night distribution of LMS.

Results

Patients with MS showed a significantly decreased total sleep period, an increased number of awakenings and stages shifts per hour of sleep, and an increased representation of stage 1 (min and %) compared to the HC group; 26 (32.5%) MS patients had PLMS ≥15/hour versus 8 (13.3%) HC subjects. On average, the comparison between MS and HC groups yielded significant results in terms of an increase in LMS, PLMS, SILMS and ISOLMS indices but not durations. Moreover, MS patients displayed a higher periodicity index, an increased PLMS activity at all inter-movement intervals considered and their PLMS time-of-night distribution revealed that the PLMS increase was stable over the course of the night.

Conclusion

Sleep continuity is significantly impaired in patients with MS. Moreover, MS patients also an increased total LMS activity, including PLMS, which may contribute to disrupt sleep continuity. A disinhibition of lower spinal network due to cervical or supraspinal MS lesions might be implicated in the mechanisms underlying this latter finding.

Support

The Employer Department of Neurology, Regional Hospital Lugano (EOC), Lugano, Switzerland receives financial support from Teva, Merck Serono, Biogen Idec, Bayer Schering, Genzyme, Roche and Novartis. The submitted work is not related to these agreements.
1126 Relationship Between Headache and Sleep: A Longitudinal Study from the Population of Sao Paulo City (Brazil)
Authors: Lucchesi L M , Tempaku P F , Smith A A , Togeiro S , Hachul H , Andersen M , Tufik S , Poyares D
Published: May 2020

Introduction

The complaint of nocturnal awakening with headache (NAH), was prevalent (8.4%) in the São Paulo population and was associated with sleep disturbances, as demonstrated in a study conducted in 2007 (EPISONO). Indeed, this relationship between sleep and headache is well documented in the literature. Objective: To assess the incidence and evolution of NAH and to associate sleep-related variables in an eight-year prospective study.

Methods

From 1042 volunteers enrolled in the baseline, 712 agreed to participate in the follow-up. Questionnaires and scales were applied and polysomnography and actigraphy performed. The complaint of NAH was analyzed according to a frequency questionnaire and separated into frequent or occasional.

Results

At follow-up, 110 volunteers reported NAH, of which 82 were the same as those from the baseline, but only 38 had frequent complaints. Comparing with volunteers whose headache has become occasional, we have as a difference the insomnia severity index which is significantly higher in the group with frequent NAH (8.40 ± 5.10 vs 11.20±6.40 p:0.03) and worse sleep quality as measured by the Pittsburgh questionnaire (7.25±3.60 vs 10.25±4.60 p:0.002). In addition, these volunteers had higher anxiety (10.40±9.30 vs 12.00± 10:00 p: 0.008) and depression (10.60±9.90 vs 12:00±9.90 p:0.005) from Beck’s questionnaires and greater fatigue (4.85±3.10 vs 9.75±5.55 p:0.001). The associations of NAH with insomnia, nightmares, and bruxism observed in the baseline continued, but no difference was observed between those who had frequent or occasional complaints at follow-up.

Conclusion

Our study showed that NAH was highly prevalent in the Sao Paulo population in both the baseline and follow-up studies, but this frequency had a reduction in follow-up. Volunteers who persisted with the frequent complaint showed greater severity of insomnia, higher anxiety and depression and greater fatigue.

Support

Associação Fundo de Incentivo à Pesquisa (AFIP) and São Paulo Research Foundation (FAPESP)
1131 Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults
Authors: Dunietz G L , Chervin R D , Burke J F , Conceicao A S , Braley T J
Published: May 2020

Introduction

Obstructive Sleep Apnea (OSA) has been linked to dementia and Alzheimer’s Disease (AD), as well as pre-dementia. The potential benefits of OSA treatment on cognitive performance are inconclusive. Further, the impact of OSA treatment on the development of neurodegenerative disorders has not been sufficiently studied. This study examined associations between Positive Airway Pressure (PAP) therapy and incident diagnosis of pre-dementia (MCI), dementia (DNOS), or AD in a population-level sample of older adults.

Methods

Using a random 5% sample from Medicare claims data (persons age 65 and older), individuals with an ICD-9 diagnosis code for OSA prior to 2011 (n=53,321) were selected for analyses. Over the survey period (2011-2013), we further identified persons newly diagnosed with MCI (n=443), DNOS (n=378), or AD (n=1,057). We also identified individual HCPCS claims for PAP equipment as evidence of prescription, and repeated HCPCS claims for supplies as evidence of adherence to PAP treatment. Logistic regression models were used to adjust for potential confounders including age, gender, hypertension, and Parkinson’s Disease that might increase risk for dementia.

Results

Seventy-eight percent of beneficiaries with OSA were prescribed PAP, and 74% showed evidence of adherent use. After adjustment for potential confounders, prescription of PAP was associated with significantly lower odds of incident AD and DNOS (OR=0.78, 95% CI: 0.69, 0.89; and OR=0.69, 95% CI: 0.55, 0.85). Lower odds of MCI, approaching statistical significance, were also observed among beneficiaries who were prescribed PAP (OR=0.82, (95% CI: 0.66, 1.02). Evidence of adherence to PAP was significantly associated with lower odds of incident AD (OR=0.65, 95% CI: 0.56, 0.76).

Conclusion

Among older individuals with OSA, PAP prescription and adherence are each associated with a significantly lower risk of incident AD or DNOS, though not MCI. Although a prospective cohort design cannot prove causality, results suggest that treatment of OSA could reduce risk of subsequent dementia.

Support

This study was supported by The American Academy of Sleep Medicine Foundation Strategic Research Award 115-SR-15 (PI Braley).