bluuebunny/crossref_metadata_2025 huggingface dataset:
707 Association of Self-Reported Anxiety, Informational Support, and Sleep in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Arentson-Lantz Emily , Debian Ahmad , Kokanda Manasa , Shaib Fidaa , Nowakowski Sara
Published: May 2021

Introduction

Stressful events, such as the COVID-19 pandemic, can have a detrimental effect on sleep. It is important for practitioners to understand how their patients are affected by events to optimize their care. In this study we evaluated associations of anxiety and daily habits with self-reported sleep disturbance among sleep medicine clinic patients.

Methods

Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were asked about changes in their daily habits (sunlight exposure, caffeine consumption). During the 5-month survey completion time window, the weekly average of positive COVID-19 cases in the Houston area was 2,914. Stepwise linear regression was performed using SAS to determine if self-reported anxiety and informational support predicted PROMIS Sleep Disturbance, PROMIS Sleep-Related Impairments and ISI.

Results

Anxiety had a significant effect on Sleep Disturbance (0.43 ± 0.11, p=0.0001), Sleep-Related Impairments (0.53 ± 0.12, p=0.0001) and ISI (0.28 ± 0.08, p=0.0004). Informational support had a significant inverse effect on Sleep Disturbance (-0.29 ± 0.10, p=0.0063), Sleep-Related Impairments (-0.26 ± 0.11, p=0.01) and ISI (-0.31 ± 0.08, p<0.0001) measures. Decreased sunlight exposure during the pandemic contributed to a significant increase in Sleep Disturbance scores (0.06 ± 0.03, p=0.045). Increased caffeine consumption during the pandemic had significant increase in ISI scores (16.3 ± 7.59, p=0.035).

Conclusion

Higher levels of anxiety and lower levels of informational support predicted greater insomnia severity, sleep disturbance, and sleep-related impairments in sleep medicine clinic patients during the COVID-19 pandemic. Decreased sunlight exposure and increased caffeine consumption also predicted greater sleep disturbance and insomnia severity, respectively. Addressing anxiety symptoms and access to accurate information during the pandemic is advised when treating sleep medicine clinic patients.

Support (if any)

This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).
713 Sleep of infants and toddlers during 12 months of the COVID-19 pandemic
Authors: Gupta Gita , O’ Brien Louise , Dang Louis , Shellhaas Renée
Published: May 2021

Introduction

SARS-CoV-2 changed the lives of children and their parents in 2020. To our knowledge, no studies have examined infant and toddler sleep during this pandemic. We sought to compare parent-reported sleep characteristics of infants and toddlers over successive quarters of the past year.

Methods

Parents of children aged 0–36 months were surveyed primarily in the Midwestern USA between 01/17/2020 and 12/07/2020. Each parent responded only once. Age was categorized as: <6 months, 6–12 months, 12–24 months, and 24–36 months. Income was categorized as: <$50,000, $50-100,000, $100-150,000, and >$150,000. The year was divided into quarters. Multivariable linear regression included Total Sleep Time (TST), Sleep Onset Latency (SOL) and parental frustration with sleep (any frustration, scale of 1–5) as dependent variables and year quarter, child’s age, prematurity, child’s comorbidities, maternal age (during their child’s birth), parenting experience, household income, and room sharing as independent variables. Logistic regression included nap consistency (napping at the same time daily) as the dependent variable, and year quarter, child’s age, prematurity, comorbidity, maternal age, parenting experience, household income, and room sharing as independent variables.

Results

Of 594 children, mean age was 18.5±9.7 months and 52% were female. Prematurity and comorbidities were reported for 8% and 15%, respectively. Mean maternal age was 31.8±4.5 years. Neither TST (β=-0.488; p= 0.16) nor SOL (β= 0.029; p=0.23) were associated with year quarter. SOL was 3 minutes less for each increase in income category (β =-0.051; p= 0.003). TST (β = -0.994; p<0.001) and SOL (β =0.092; p<0.0001) were most associated with child’s age. Parental frustration was associated with child’s age (β=0.12; p= 0.04), comorbidity (β=0.30; p=0.05) and room sharing (β= -0.38; p=0.006), but not year quarter. Nap consistency was associated with increased child age category (OR 1.47; 95% CI 1.13, 1.94) and lack of room sharing (OR=2.09; 1.10, 3.97), but not year quarter.

Conclusion

Parent-estimated TST, nap consistency and sleep-related frustration did not differ significantly over the first 12 months of the pandemic. Yet, our results underscore that special attention should be given to the sleep of infants and toddlers with comorbidities, who share a room, and who have a lower household income.

Support (if any)

2T32HL110952-06
719 Insomnia in Those Diagnosed with COVID-19
Authors: Taylor Emily , Cloonan Sara , Grandner Michael , Killgore William
Published: May 2021

Introduction

Recent meta-analyses suggest that as many as 75% of COVID-19 patients report sleep problems. Here, we sought to characterize this in terms of self-reported insomnia. We hypothesized that those endorsing a positive COVID-19 diagnosis would also report greater levels of insomnia than those with a negative diagnosis.

Methods

Between April and September 2020 we administered the Insomnia Severity Index (ISI), each month to a total of 6162 English speaking adults in the United States ranging in age from 18–84 (M=36.2 years, SD=12.1; 53.9% female), recruited from all 50 states and the District of Columbia using Amazon Mechanical Turk (MTurk) crowdsourcing platform. Data collections occurred cross-sectionally, approximately one month apart. Data were analyzed using Kruskal-Wallis H tests.

Results

In total, 247 (4.01%) participants responded “Yes” to the question “Have you been formally diagnosed with COVID-19?” (male=128, female=119). Those reporting “yes” had a higher mean score on the ISI (M=14.52, SD=5.56) compared to reporting “no” (M=9.98, SD=6.55). Total ISI scores were higher for those who reported that they were diagnosed with COVID-19 than those that did not, χ2(1)=121.818, p=0.0001. Among those that reported that they were diagnosed with COVID-19, 57.11% had ISI scores indicating moderate to severe clinical insomnia compared to 25.42% of those who were not diagnosed with COVID-19.

Conclusion

Those who reported that they had been diagnosed with COVID 19 had greater insomnia compared to those without such a diagnosis. This could be due to greater stress and anxiety in those who had a positive COVID-19 diagnosis due to the many uncertainties surrounding the short and long-term prognosis as well as potential impacts on the individual’s family and workplace. However, it is important to consider the broader health picture of those diagnosed with COVID-19. This study is limited by the nature of the self-reported data, where we cannot verify a positive COVID-19 test. Causality cannot be inferred due to the cross-sectional nature of this study. Future work will need to determine the extent to which sleep-related factors are due to biological versus psychological factors associated with the diagnosis of COVID-19.

Support (if any):
740 Insomnia, cognitive arousal, and perinatal-focused rumination fuel perinatal depression
Authors: Castelan Andrea Cuamatzi , Kalmbach David , Cheng Philip , Drake Christopher
Published: May 2021

Introduction

Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in non-perinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship.

Methods

Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25–30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, perinatal-focused rumination). Mixed effects models were conducted to test hypotheses.

Results

Women were at elevated risk of screening positive for depression when experiencing high levels of insomnia (OR=2.36, 95%CI=1.28, 4.35), nocturnal cognitive arousal (OR=3.05, 95%CI=1.60, 5.79), perinatal-focused rumination (OR=2.05, 95%CI=1.11, 3.79), and perseverative thinking (OR=7.48, 95%CI=3.90, 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia.

Conclusion

Perseverating at night, particularly on perinatal concerns, fuels insomnia. In turn, lying awake at night provides ample opportunity for perseverating. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.

Support (if any):
743 Differences in the prevalence of sleep disturbance and associated risk factors in alcohol use disorders and major depression
Authors: Kolla Bhanu Prakash , Coombes Brandon , Mansukhani Meghna , Biernacka Joanna
Published: May 2021

Introduction

Sleep disruption is common in patients with alcohol use disorders (AUD) and major depressive disorders (MDD). Our understanding of the differences in the rates of sleep disturbance and overall sleep duration in patients with AUD, MDD, and comorbid AUD and MDD is limited. Furthermore, it is unknown whether there is variation in demographic and clinical characteristics associated with sleep disturbance and duration in these diagnostic groups.

Methods

This study utilized data from the UK Biobank (UKB). Depression status was determined based on review of International Classification of Diseases (ICD) codes and health records. AUD status was based on AUDIT scores (score ≥8 was defined as AUD) and sleep disturbance was evaluated utilizing a self-reported questionnaire. The sample was categorized into those with MDD alone (MDD+/AUD-)(n=18,154), AUD alone (MDD-/AUD+)(n=6123), both (MDD+/AUD+)(n=9027), and controls with neither (MDD-/AUD-)(n=27,573). We used generalized linear models (GLMs) to compare rates of sleep disruption and duration among the groups and determine the clinical predictors of sleep disturbance/duration in the four groups as well as test whether these factors differed among the groups.

Results

The prevalence of sleep disturbance in the control sample (MDD-/AUD-) was 26.4% and the self-reported sleep duration in this sample was 7.209±0.919. Subjects with AUD and/or MDD had greater rates of sleep disturbance and shorter sleep duration. Among the different diagnostic categories, the prevalence of sleep disturbance was highest in subjects with MDD+/AUD+ (36.5%) followed by those with MDD+/AUD- (35.6%) and MDD-/AUD+ (27.9%)(all p<0.0001). Similarly, the sleep duration was shortest in subjects with MDD+/AUD+ (7.143±1.016), followed by MDD+/AUD- (7.158±1.050) and by MDD-/AUD+ (7.202±0.891)(all p<0.0001). Subjects with sleep disturbance were more likely to be older, female, and with higher body mass index, Townsend deprivation index, and neuroticism scores across all four groups (all p<0.05).

Conclusion

In a large population-based cohort, MDD with and without comorbid AUD was associated with greater rates of sleep disturbance and shorter sleep duration than AUD alone. The clinical and demographic factors associated with sleep disturbance did not differ in these diagnostic categories, indicating possible similar underlying risk factors.

Support (if any)

NA
744 Correlates to improvement in sleep in acute mania
Authors: Golebiowski Raphael , Mansukhani Meghna , Kolla Bhanu Prakash
Published: May 2021

Introduction

Sleep disruption and reduced sleep duration are potential triggers and also core symptoms of a manic episode. Our understanding of how sleep duration changes during the course of a manic episode and its potential association with symptom improvement is limited. We examined the natural course of sleep duration and its association with time to discharge and other clinical and demographic factors in patients with mania.

Methods

This was a retrospective study conducted in patients admitted to an acute care psychiatric unit with a manic episode. Sleep duration was determined based on observer report as logged by nursing staff. Sleep duration at admission and discharge were determined by averaging the total sleep time on day 2/3 of hospitalization and day 3/2 preceding discharge date. We obtained data on possible confounders including antipsychotic (chlorpromazine equivalents), benzodiazepine (diazepam equivalents) and other hypnotic medication doses administered at admission and discharge. We examined the associations between the change in sleep duration from admission to discharge with length of hospitalization and other clinical and demographic characteristics.

Results

The sample consisted of 35 patients (54.3% male) aged 32 ± 9.96 years with an average length of hospitalization of 20.63 ± 18.62 days. The mean sleep duration on admission was 6.23 ± 1.77 hours and was 7.45 ± 1.49 hours on discharge, with a mean change of 1.23 ± 1.93 hours. The change in sleep duration was positively correlated with length of hospitalization (r=0.42; p=0.01). Other clinical factors including benzodiazepine or antipsychotic dose on admission, age, sex, and use of mood stabilizers were not correlated with the change in sleep duration.

Conclusion

There was a substantial improvement in the total sleep duration in patients with mania over the course of hospitalization. Overall, the change in sleep duration was only correlated to the length of stay and did not appear to be impacted by other clinical and demographic characteristics.

Support (if any):
760 Does Obstructive Sleep Apnea Increase Suicidality in Patients with Bipolar Disorder?
Authors: Reddy Abhishek , Mansuri Zeeshan , Trivedi Chintan , Vadukapuram Ramu
Published: May 2021

Introduction

Bipolar disorder (BPD) is associated with suicidality in adult population. There are several risk factors for suicide, however the relationship between Obstructive Sleep Apnea (OSA) and suicidality in patients with BPD has not been explored. Hence, we decided to perform this study with primary objective of comparison of suicidality by OSA diagnosis in patients with BPD.

Methods

We used inpatient hospitalization data from National Inpatient sample dataset year 2016–2018. Our primary population (BPD + OSA) was composed of adult patients admitted to the hospital with the primary diagnosis of Bipolar Disorder and secondary diagnosis of Obstructive sleep apnea. Age-gender matched (1:4 matching) control population was selected with primary diagnosis of BPD having no OSA (BPD-OSA). Data on suicidality (suicidal ideation/attempt) were collected and compared between the groups using logistic regression analysis methods by including OSA, age, gender, race, substance use disorder and personality disorder as predictors.

Results

From the dataset, 17895 patients were obtained for the BPD + OSA group (average age: 50.5 years, male 45.5%). After 1:4 age-gender matching, 71575 patients were included in the BPD-OSA group. In the unadjusted analysis, suicidal ideation was significantly high BPD+OSA group compared the BPD-OSA group (38.4% vs. 31.9%, p < 0.001). Rate of suicide attempt and self-inflicted injuries were similar in two groups (3.5% vs. 3.3%, p: 0.27). In the adjusted logistic regression analysis odds of suicidality were 36% more in BPD+OSA group compared to BPD-OSA (Odds Ratio: 1.36, 95% Confidence interval: 1.25–1.48, p < 0.001).

Conclusion

In adult patients with BPD, diagnosis of OSA significantly increases the odds of suicidality. Addressing OSA in patients with BPD, can improve management, and potentially reduce the incidence of suicide. We believe our study will be helpful in guiding future research and development on this issue.

Support (if any)

None
762 Bedtime Procrastination but Not Total Sleep Time Mediates the Association Between Anxiety and Sleep Problems
Authors: Campbell Rebecca , Ledesma Roselee , Guzman Linda , Bridges Ana
Published: May 2021

Introduction

There is a high rate of sleep disorders and anxiety in primary care settings and patients are most likely to report such issues to their primary care provider. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems when covarying for age and attitudes about sleep.

Methods

308 adult primary care patients seen at either a university integrated primary care clinic (n = 147; 47.7%) or federally qualified health center (n = 161; 52.3%) from August 2019 to March 2020 completed intake paperwork including questions assessing psychiatric symptoms and sleep.

Results

A structural equation model was used. To test for statistical mediation, we performed 500 bootstraps and examined bias-corrected estimates. The model evidenced good fit, X2 (16) = 22.53, p = .127, CFI = .98, TLI = .95, SRMR = .03, RMSEA = .04 [90% CI: .00, .07]. All manifest variables loaded significantly onto their latent factors (standardized loadings > .40, p values < .05). The model explained 14.7% of the variance in total sleep time (TST), 14.8% in sleep procrastination, and 54.0% in sleep problems. Anxiety was negatively associated with TST (β = -.36, p < .001) and positively associated with bedtime procrastination (β = .35, p < .001) and greater sleep problems (β = .63, p = .006). The association between anxiety and sleep problems was not statistically mediated by TST. There was a significant indirect effect of anxiety on sleep problems through bedtime procrastination. The total effect of anxiety on sleep problems was significant (β = .70, p = .003). We found a significant direct association between age and TST, and age and bedtime procrastination. However, there was no significant direct association between age and sleep problems (β = .00, p = .984). Sleep attitudes were unrelated to any of the primary study variables. None of the exogenous variable covariances were significant. The covariance between TST and bedtime procrastination was significant.

Conclusion

Sleep problems are pervasive and complex. This study highlights factors related to sleep problems and support anxiety and pre-bedtime behaviors as treatment targets.

Support (if any)

D40HP29826 (PI: Ana J. Bridges).
772 Examining sleep difficulties and suicide ideation among those reporting abuse and dependence on illicit drugs and alcohol
Authors: Robbins Rebecca , DiClimente Ralph J , Weaver Matthew , Gangi Catherine Di , Chalem Isabel , Quan Stuart , Klerman Elizabeth
Published: May 2021

Introduction

Sleep disturbance is associated with poor mental health and may contribute to initiating or continuing use/abuse of alcohol and drugs. Using data from a nationwide survey, we examined the relationship between sleep disturbance and suicide behaviors among youth and adults, including those who report drug/alcohol use and abuse.

Methods

We analyzed data from the 2018 National Survey on Drug Use and Health (NSDUH), an annual survey collecting information about the use of illicit drugs and alcohol among non-institutionalized U.S. youth (age 12–17) and adults (age>17). The 2018 survey included 9,398 youth and 43,026 adult respondents. Depression was assessed in adults with the Kessler-6 and in youth with several questions assessing psychological distress. Those who scored at risk for psychological distress were also asked about sleep disturbance and suicidal behaviors (i.e., ideation, planning, attempt). All were asked to report their drug/alcohol use and/or abuse. Our study population included those who reported psychological distress. We conducted binary logistic regression to examine the relationship between suicidal behavior and sleep disturbance in this population. We also conducted sub-analyses to explore the relationship between suicidal behavior and sleep disturbance among those reporting drug/alcohol use and abuse.

Results

Youth were 29% male and 71% female, adults were 36% male and 64% female. Adult participants, 39% were 18 to 25, 22% were 26 to 34, and 39% were age 35 and older. Among those with psychological distress, suicidal behavior was more likely among those who reported sleep disturbance (youth: OR=2.7, 95%CI:1.8–4.0; adults: OR=1.3, 95%CI:1.2–1.5). Also, among those with psychological distress, suicidal behavior was more likely among those who reported concomitant sleep disturbance and either alcohol abuse/alcoholism (youth: OR:3.3, 95%CI:1.6–7.0; adults: OR=1.4, 95%CI:1.1–1.7); illicit drug abuse (youth: OR=3.5, 95%CI:1.6–7.4; adults: OR=1.3, 95%CI:1.0–1.6); or alcohol and illicit drug abuse (youth: OR=3.2, 95%CI:1.5–6.9; adults: OR=1.4, 95%CI:1.1–1.7).

Conclusion

Youth and adults with psychological distress and sleep disturbance are more likely to also report suicidal behaviors. Alcohol and drug use or abuse increase their risk for suicidal behavior compared to those who do not report sleep disturbance. Future work should include examination of causality and of interventions.

Support (if any)

NIH K24-HL105664, P01-AG009975, T32-HL007901, K01HL150339, 1R56HL151637
775 The Relationship Between Sleep and Suicidal Ideation in College Students
Authors: Taneja Krishna , Tubbs Andrew , Fernandez Fabian-Xosé , Perlis Michael , Grandner Michael
Published: May 2021

Introduction

Suicide is the second-leading cause of death for young adults and insomnia increases suicide risk. However, the data on disrupted sleep and suicidal ideation in college students is mixed, including whether disrupted sleep fits into the framework of the Interpersonal Theory of Suicide. Therefore, the present study explored how four different sleep variables influenced recent suicidal ideation in a collegiate sample.

Methods

Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcome, active suicidal ideation in the last 3 months, was assessed using several self-report questions derived from the Columbia Suicide Severity Rating Scale. The predictors were weekday short sleep (≤6h; assessed by retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models estimated the associations between suicidal ideation and sleep variables in models that were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness (constructs from the Interpersonal Theory of Suicide).

Results

A total of N=121 (23.9%) respondents endorsed suicidal ideation in the last 3 months. Individuals with suicidal ideation were in poorer health (p<0.001) and had more severe depression (p<0.001) and anxiety (p<0.001). In unadjusted models, individuals were more likely to report suicidal ideation if they had short sleep (OR 1.93 [1.23–3.05]), ISI scores of 8 or more (OR 3.01 [1.94–4.74]), and DDNSI scores of 10 or more (OR 2.66 [1.69–4.19]). Higher BRISC scores were associated with lower odds of suicidal ideation (OR 0.53 [0.41–0.68]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate any of these relationships.

Conclusion

Insomnia, short sleep, nightmares, and less perceived sleep control were all associated with recent suicidal ideation in college students. Moreover, these findings were generally independent of the Interpersonal Theory of Suicide. Further research is needed to understand how sleep affects suicide risk in this population, and whether sleep interventions can reduce this risk.

Support (if any):
778 Poor Sleep Quality is Associated with Reduced Myelination in Patients with Psychotic Disorders
Authors: Yuksel Cagri , Chen Xi , Watford Lauren , Gardner Margaret , Lewandowski Kathryn , Du Fei , Ongur Dost
Published: May 2021

Introduction

Recent studies show that sleep favors oligodendrocyte proliferation and myelination, and sleep loss is associated with alterations in white matter structure and decreased myelination. Psychotic disorders are characterized by disrupted white matter integrity, and abnormal axon and myelin structure. Despite common sleep disturbances in these disorders, little is known about the relationship between sleep quality and white matter findings. A novel in vivo neuroimaging technique that combines diffusion tensor spectroscopy (DTS) and magnetization transfer ratio (MTR) allows separately examining the axon structure and glial function, and myelin content, respectively. Using this method, we examined the association of sleep quality with white matter biology in a sample of patients with psychotic disorders and matched healthy controls.

Methods

Participants included patients diagnosed with bipolar disorder with psychotic features (euthymic or depressed, n=12) and schizophrenia spectrum disorders (n=9), and age and sex matched healthy controls (n=20). DTS and MTR data was collected from the right prefrontal white matter at 4T. DTS measures included apparent diffusion coefficients of water, NAA, creatine and choline. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI).

Results

PSQI total score was significantly higher in patients. and patient sample included a higher percentage of poor sleepers (PSQI total score>5). In patients, total PSQI score and sleep onset latency were significantly and negatively associated with MTR (F=6.9, p=0.02 and F=9.7, p=0.007, respectively). There was no difference in any DTS measures between groups.

Conclusion

Our preliminary results show that poor sleep quality is associated with decreased myelin content in the frontal lobe, in patients with psychotic disorders. This finding suggests that sleep loss may be a mediator of white matter alterations in psychosis.

Support (if any)

This work is supported by National Institute of Mental Health K23MH119322 to Cagri Yuksel
782 Sleep restriction reduces feelings of interpersonal connectedness and social motivation
Authors: Palmer Cara , Powell Suzanna , John-Henderson Neha , Deutchman Dagny , Boylan Rebecca
Published: May 2021

Introduction

Feeling socially connected with others is essential for promoting and maintaining psychological health. Emerging research suggests that insufficient sleep may result in deleterious social outcomes such as greater reactivity to stressful social situations. However, little is known regarding how sleep may impact motivation to feel connected with others, and experiences of connectedness after positive social interactions.

Methods

Healthy participants (N = 56; 83.9% female, ages 18–30) were randomly assigned to one night of sleep restriction (SR, 4 h) or a night of typical sleep (TS, 8 h) in a controlled laboratory setting and verified with actigraphy. All participants did not have any known or suspected sleep or psychiatric disorders, were free of medical conditions and current medication use known to impact sleep and/or psychological functioning, and wore an actigraph for one week prior to the experimental night to ensure adequate sleep duration. Following the experimental night, participants reported on their motivation for social connectedness (e.g., “Right now, I would like to be close with friends, family, and significant others.”), and completed a task where they spent 5 minutes writing about a positive interpersonal event. After the task, participants reported on their feelings of interpersonal connectedness. Qualitative text analysis was conducted to extract emotional tone and number of social words used during the task.

Results

Compared to TS, participants undergoing SR were less motivated to feel connected with others [t(54) = -2.62, p = .01], and reported feeling less social connectedness after the task [t(53) = -2.06, p = .04]. Text analysis revealed no differences in positive or negative emotional tone, but participants in the SR group used less social words when describing their positive interpersonal event [F(1, 53) = 6.65, p = .01], even after adjusting for differences in total number of words used.

Conclusion

One night of sleep restriction reduces motivation to engage in social interactions, and also results in feeling less connected with others after reflecting on a positive social event. These findings add to a limited body of research on sleep and social experiences and provide further support for the negative psychological effects of sleep loss.

Support (if any):
785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?
Authors: Moore Jesse , Williams Ellita , Popp Collin , Briggs Anthony , Blanc Judite , Jean-Louis Giardin , Seixas Azizi
Published: May 2021

Introduction

Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep.

Methods

Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score >13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models.

Results

On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= <.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=<.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not.

Conclusion

We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED.

Support (if any)

NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)
788 Is Dysphagia a Marker for Obstructive Sleep Apnea (OSA) in Traumatic Brain Injury (TBI) Patients: A VA TBI Model System Study
Authors: Matarese Christine , Nakase-Richardson Risa , Almeida Emily , Whyte John , Nallu Sagarika , Anderson William , Schwartz Daniel , Kieffer Kathryn
Published: May 2021

Introduction

Recent work has highlighted prevalent obstructive not central sleep apnea following traumatic brain injury (TBI). Treatment of comorbid OSA may facilitate neurologic recovery but widespread screening is limited. Mixed support exists for the presence of dysphagia as a biomarker of OSA in the general population and stroke patients. Dysphagia is common following TBI; however, no study has examined the relation between OSA and dysphagia in this cohort. Leveraging data from a recent six-center clinical trial of OSA and TBI during inpatient rehabilitation, this secondary analysis examined the association between OSA severity indices and proxy measures of dysphagia.

Methods

Level 1 polysomnography (PSG) was used to assess OSA (AHI ≥ 5 and ≥ 15) during inpatient rehabilitation for the overall sample (N=248; 203 male; 60.6% severe injury) evaluated at a median of 120.6 days post-TBI and subset ≤ 60 days post-injury. Dysphagia was approximated as the presence of a PEG tube and/or a modified texture diet (MTD) on the day of PSG. Chi square and Fisher’s Exact tests were utilized for group comparisons.

Results

As previously reported, OSA in this cohort was prevalent (68.2% (n=169) at AHI ≥ 5 and 33.5% (n=83) AHI ≥ 15) with predominantly obstructive events. 27.4% (n=68) met criteria for dysphagia combining proxy measures (34 peg; 49 MTD). No significant difference was found for presence of dysphagia across OSA severity cutoffs (AHI ≥ 5 & 15; p=0.1029 & 0.5959). When examining OSA across the individual proxy measures, persons without a peg tube were significantly more likely to have OSA at AHI ≥ 5 (62.5% vs 5.65%; p=0.0003) and AHI ≥ 15 (31.05% vs 2.42%; p=0.0353). When examining participants less than 60 days post-TBI, the group differences remained.

Conclusion

The incidence of dysphagia in TBI patients, as indexed by a modified diet or presence of a feeding tube, was not elevated in those with OSA. Sample bias (for undergoing Level 1 PSG and improvement facilitating inpatient rehabilitation admission) may have contributed to findings. Finally, future work with more sensitive indices of dysphagia is needed to accurately evaluate this association.

Support (if any)

PCORI (CER-1511–33005), NIIDLRR (90DPTB0004)
791 Association of Obstructive Sleep Apnea Severity and Novel Plasma Biomarkers of Alzheimer’s Disease Pathology
Authors: Bubu Omonigho , Turner Arlener , Umasabor-Bubu Ogie , Kam Korey , Mullins Anna , Parekh Ankit , Williams Ellita , Blanc Judite , Williams Natasha , Rapoport David , Varga Andrew , Ayappa Indu , Jean-Louis Giardin , Osorio Ricardo
Published: May 2021

Introduction

Recent evidence suggests novel plasma Alzheimer’s Disease (AD) pathology biomarkers have high potential for AD risk prediction. We determined whether obstructive sleep apnea (OSA) severity is associated with plasma levels of Aβ40, Aβ42, Aβ42/Aβ40, Tau, tau/Aβ42 and NfL and whether this relationship is dependent of amyloid burden.

Methods

Cross-sectional analysis of baseline data from 120 community-dwelling, cognitively normal older-adults, selected from ongoing NYU prospective longitudinal studies on memory, sleep and aging. Of the 120 participants, 70 had baseline CSF-Aβ42 (measured using ELISA). OSA-severity was defined using AHI4% criteria. Levels of plasma Aβ40, Aβ42, Tau and NfL were determined using single molecule array technology ultra-sensitive assays. Associations of OSA-severity and plasma AD-biomarker levels (n=120) were assessed using Pearson correlation analysis. The association of OSA-severity and AD plasma biomarkers dependent on CSF-Aβ42 levels (n=70) was assessed using generalized linear models. Analyses were adjusted for age, sex, BMI, race, education and APOE4.

Results

Of the 120 participants, 80 (67%) were women. Mean (SD) age was 69.1 (7.2) years. Mean (SD) AHI was 14.3/hr. (16.3) {48 (40%) had AHI <5, 30 (25%) had AHI: 5 to ≤ 15, 18 (15%) had AHI: 15 to ≤30, and 22 (18%) had AHI >30}. Independent of amyloid-burden, OSA-severity was associated with higher levels of plasma Aβ40 (r=.21, p-value=.02), plasma Aβ42 (r=.26, p-value=.01), plasma Aβ42/Aβ40 (r=.20, p-value=.05), but not plasma Tau, plasma tau/Aβ42 or plasma NfL. The association of OSA-severity and plasma levels of Tau, Tau/Aβ42 or NfL dependent on CSF-Aβ42 levels revealed significant interactions between CSF-Aβ42 levels and AHI (p-value <.05 for all), with β-estimates suggesting that with combined increases in AHI and decreases in CSF-Aβ42 levels, there were corresponding increases in plasma levels of Tau, plasma Tau/Aβ42 or plasma NfL. The analysis was not powered for generating dichotomized strata specific (i.e. OSA+/Aβ+, OSA+/Aβ-, OSA-/Aβ+ and OSA-/Aβ-) estimates.

Conclusion

In this sample of cognitively-normal older- adults, OSA-severity was associated with levels of plasma Aβ40, Aβ42, Aβ42/Aβ40 and showed a synergistic effect with CSF Aβ42 on plasma levels of tau and NfL. Larger cohorts are necessary to delineate mechanisms and examine for OSA/Aβ strata-specific estimates.

Support (if any)

NIH/NIA/NHLBI (L30-AG064670, CIRAD-P30AG059303-Pilot, NYU-ADRC-P30AG066512-Developmental-Grant, AASM#231-BS-20)
806 Barriers to screening and diagnosis of obstructive sleep apnea during inpatient traumatic brain injury rehabilitation
Authors: Cotner Bridget , Nakase-Richardson Risa , Gius Becky , Fournier Lauren , Watach Alexa , Hoffman Jeanne
Published: May 2021

Introduction

Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders.

Methods

Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation.

Results

Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures.

Conclusion

Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes.

Support (if any)

PCORI-NCT03033901
812 Competency Based Goals for Sleep Medicine Curriculum in Undergraduate Medical Education in India: A Survey
Authors: Nagendra Puneet , Thanasekaran Lingadevi
Published: May 2021

Introduction

Sleep is recognized the world over as very important in health and disease. But there is no articulated curriculum in undergraduate (UG) medical education in India. Whence incorporated, these learning objectives serve as an important bridge across multiple medical faculties like pulmonary medicine, neurology, ENT, psychiatry, and basic sciences.

Methods

After obtaining informed consent, a questionnaire-based electronic survey was circulated to clinical/non-clinical teaching medical faculties in December 2020. They were asked to prioritize the objectives of the sleep medicine curriculum for the UG medical education program. The objectives were listed under knowledge and skill-based competencies each having 9 and 10 questions respectively, scale rated 1–5. Objectives were enlisted from the previous studies, consensus statements and modified according to the local needs after face to face meetings with faculties involved in UG curriculum development.

Results

Out of 400 faculty members from different medical schools all over India, 127 had responded. None of the Indian institutions had sleep medicine in their UG curriculum. 112 (88%) members showed their interest to begin a UG program. The suggested sleep medicine curriculum proposes a vertical integration of competency-based goals into the core curriculum with a clinical angle which will require skill and knowledge-oriented modules. Amongst the knowledge-based competency, sleep loss and its health effects (77%) was more preferred than distinguishing sleep in newborns and adults (36%). Whereas in the skill-based competency providing advice on sleep hygiene (71%) was more preferred than sleep disturbances during pregnancy and menopause (33%). When our curriculum gets implemented, it is possible to provide exposure to sleep-related disorders early on for the UG’s. This will invoke their interest and thus serve to bridge the lacunae caused by the shortage of trained sleep specialists in India.

Conclusion

From our study, the learning objectives of the sleep medicine curriculum have been prioritized and are ready for implementation. The survey has also created awareness and interest amongst the Indian medical teaching faculty.

Support (if any):
813 Patient and Provider Experiences with CBT-I Administered In-Person or via Telemedicine
Authors: Gunter Paul , Gehrman Philip , Findley James , Kayser Matthew , Kuna Samuel , Frasso Rosemary
Published: May 2021

Introduction

CBT-I is the gold standard treatment for insomnia, but access to in-person care is limited, which has worsened due to the recent COVID-19 pandemic. While providers across spheres of care have rapidly pivoted to telehealth there have been few systematic comparisons of in-person treatments to telemedicine approaches. The current study, launched pre-COVID, aimed to examine the perspectives of patients who were randomly assigned to receive CBT-I in-person or via telemedicine. Additionally, provider reflections were collected.

Methods

Individuals with DSM5 Insomnia Disorder (n=60) were randomized to in-person CBT-I, telemedicine CBT-I or a wait-list control group. CBT-I was delivered over 6–8 weekly sessions by video telemedicine or in-person. This nested qualitative study addressed patient and provider perspectives on treatment approaches. A sample of participants from each group (n=36) were interviewed 3 months post-treatment. Phone interviews were audio recorded, transcribed and analyzed using a directed content analysis approach. Results were organized into thematic categories including 1) participant experience with CBT-I, 2) access issues and 3) accountability issues related to delivery approach. Additionally, participating providers (n=7) were interviewed and shared their reflections on delivering CBT-I in-person vs. telemedicine.

Results

Patients reflected positively on CBT-I, and this did not vary across treatment groups. Patients and providers noted telemedicine benefits related to access that included, but were not limited to, reducing transportation barriers to treatment and improved continuity of care (e.g. not having to cancel an appointment if a patient was traveling). Patients and providers shared concerns they had anticipated pre-treatment about possible telemedicine related technological hurdles and barriers to establishing meaningful rapport on-line. However, they reported that these concerns did not prove to be barriers to effective telemedicine visits.

Conclusion

This qualitative study allowed patients and their providers to reflect on their experience delivering in-person vs telemedicine CBT-I. CBT-I was accepted well regardless of delivery approach. Telemedicine is currently being deployed widely and this study provides a systematic comparison between approaches.

Support (if any)

This study was supported by the American Sleep Medicine Foundation.
815 Australian Surgery Trainee Education for Contemporary Airway Management of OSA: A Pilot Randomised Controlled Study
Authors: Hayward Nathan , Sideris Anders , Marshall Nathaniel , Burri Michael , Mackay Stuart G
Published: May 2021

Introduction

In Australia, ASOHNS delivers no formal curriculum for training of OHNS, or levels of competency required, to assess and treat complex OSA patients. Australian OHNS trainee confidence, knowledge and exposure to complex multi-level OSA surgery is lacking. Lack of exposure to sufficient complex OSA surgery case load has been identified as a major weakness in training within a recently published international survey. This study was a randomized clinical trial evaluating the effect of Australian OHNS trainee exposure to education materials compared with no exposure, on Sleep Surgery specific examination performance (multiple choice and short written answer).

Methods

70 accredited and 45 unaccredited OHNS trainees were invited to participate in this trial. Participants were randomly assigned to Sleep Surgery educational material exposure or no exposure to those materials. Those randomized to the exposure group were provided educational material and were given 2 weeks exposure time prior to the exam. Each participant then complete an online examin, consisting of 40 multiple choice questions and 1 short answer question (marked by a field expert). Differences between exposure and control group means were tested using independent t-tests.

Results

24 trainees were allocated to exposure and 22 to control. 33 participants attempted the examination. The were no significant differences between groups in the multiple choice (mean difference 1.3 ± 1.6 [3.3%], p=0.41) or written exam test scores (mean difference 1.8 ± 1.2 [9.0%], p=0.14). Accredited trainees performed better in the written exam (mean difference 2.6 ± 1.1 [13.0%], p=0.03). The mean test score in a separate exploratory group of 2 sleep fellowship trained OHNS was considerably higher in both exams.

Conclusion

This study suggests that exposure to formal education material may improve understanding of sleep surgery. Accredited trainees performed better than unaccredited trainees but the difference was small. Poor test performance in both groups may indicate further formal sleep surgery teaching is required in the ASOHNS training curriculum. Further research is required to identify the best ways possible to educate OHNS trainees in the complex and nuanced decision making required for OSA patients.

Support (if any)

Illawarra Health and Medical Research Institute Grant 2019.