bluuebunny/crossref_metadata_2025 huggingface dataset:
1273 Does a more personalized approach to desensitization and daytime titrations improve PAP compliance, PAP therapy satisfaction/efficacy, and perhaps even save resources?
Authors: Yeager K K , Kern J D , Cutrufello N J , Begay M N , Glasser J
Published: May 2020

Introduction

Seventy three patients at the Raymond G Sleep Center within the New Mexico VA Healthcare System were identified as patients who were at high risk for PAP therapy non-compliance, were invited to participate in a new patient service program.

Report of Case

This program included an individualized daytime desensitization process coupled with a potential daytime titration. The final analysis of these data revealed co-morbid conditions that may serve as barriers to PAP usage as well as medical conditions which are known to benefit from compliance on PAP therapy. Special attention was paid to co-morbid psychiatric conditions.

Conclusion

This process resulted in a roughly 25% increase in PAP compliance, a 30 % change in PAP modality and improved access to in-lab titrations. This study elucidated factors that may help predict success or failure regarding PAP therapy.
0151 The Dual Orexin Receptor Antagonist Almorexant Blocks the Sleep-Disrupting Effects of Methamphetamine in Male Rhesus Monkeys
Authors: Berro L F , Rowlett J K
Published: May 2020

Introduction

Individuals with stimulant use disorder show a high prevalence of sleep problems. In the laboratory, stimulant drugs have been shown to affect sleep parameters in human and nonhuman primates, even when administered many hours before bedtime. Although the mechanisms underlying the relationship between stimulant use/abuse and sleep impairment remain unclear, recent research has implicated the orexin (also called “hypocretin”) system as a critical regulator of sleep-wake states. The aim of the present study was to investigate the effects of the dual orexin receptor antagonist (DORA) almorexant on the sleep-disrupting effects of methamphetamine in rhesus monkeys.

Methods

Male adult rhesus monkeys (Macaca mulatta, n=4) were fitted with primate collars to which Actiwatch monitors were attached. Actigraphy recording was conducted during baseline conditions and on the night after acute morning (9h) administration of vehicle or methamphetamine (0.03, 0.1 or 0.3 mg/kg, i.m.). During a second set of treatments, vehicle or almorexant (1, 3 or 10 mg/kg, i.m.) were administered in the evening (16:30h, 1.5h before “lights off”) following morning (9h) administration of methamphetamine (0.3 mg/kg, i.m.).

Results

Morning methamphetamine administration dose-dependently impaired sleep in rhesus monkeys, with the dose of 0.3 mg/kg significantly increasing sleep latency and decreasing sleep efficiency. Evening administration of almorexant improved both actigraphy-based sleep measures after morning administration of methamphetamine in a dose dependent manner.

Conclusion

Our findings indicate that orexin receptor systems are involved in methamphetamine-induced sleep disruption. The exact role of the two orexin receptors in this effect, alone or together, remains to be determined. This study suggests that DORAs can be effective in treating sleep impairment in individuals with methamphetamine use disorder or under stimulant prescription for other sleep and psychiatric disorders.

Support

Supported by UMMC Research Enhancement Funds.
0160 Chemogenetic Activation of Hypothalamic Tachykinin 1-Expressing Neurons Reduces Sleep and Increases Resistance to Isoflurane
Authors: Reitz S , Wasilczuk A Z , Beh G , Kelz M B
Published: May 2020

Introduction

The hypothalamic preoptic area (POA) is a heterogeneous region of the brain, containing intermingled populations of excitatory and inhibitory neurons expressing a wide variety of molecular markers. Of its many important homeostatic roles, the POA modulates arousal including natural states (sleep and wakefulness) as well as drug-induced (anesthetic-induced unconsciousness) states. Although sleep and anesthetic-induced unconsciousness are undoubtedly distinct, multiple lines of evidence demonstrate that shared neuronal circuits regulate both states. Previous work identified a population of sleep-promoting, tachykinin 1-expressing (Tac1) neurons within the POA. Given evidence in the VLPO and SON, we hypothesized that Tac1 POA neurons would be another site of convergence for facilitating entry into both NREM sleep and anesthetic-induced unconsciousness.

Methods

Sleep and isoflurane sensitivity were assessed in Tac1-Cre mice expressing either a Cre-dependent excitatory hM3Dq DREADD or a control fluorophore in the POA. Sleep was assessed using beam break actigraphy, while isoflurane sensitivity was assessed using video tracking as well as a loss of righting reflex assay to construct dose-response curves.

Results

Unexpectedly, activation of Tac1 POA neurons with 3mg/kg CNO reduced cumulative sleep time by 55% compared to controls (p<0.0001). Decreased sleep time was due to a 59% reduction in sleep bout duration (p<0.01), as the number of sleep bouts remained unchanged. Activity, measured as distance traveled, also increased by 167% compared to vehicle (p<0.0001). Activation of these neurons also increased resistance to isoflurane on both induction (p<0.0001) and emergence (p<0.0001). Additionally, activation during a continuous steady-state exposure to isoflurane destabilized the unconscious state.

Conclusion

Our results support the concept that POA Tac1 neurons function as a point of convergence for neural circuits regulating arousal from endogenous and drug-induced states of unconsciousness, while also illustrating the complexity of sleep and wake regulation within the hypothalamus.

Support

R01-GM088156-06, T32-HL007953
0165 The Relationship Between Anxiety Symptoms and Sleep Quality: Mediating and Moderating Factors of Pre-Sleep Arousal and Anxiety Sensitivity
Authors: Nagy S , Pickett S M , Hedge M , Mesa J , Mechal R
Published: May 2020

Introduction

The relationship between anxiety and sleep has been well-established, with many studies demonstrating the relationship between anxiety and reduced REM time, increased sleep latency, and reduced sleep efficiency. Anxiety sensitivity, or the fear of experiencing anxiety-related sensations, has also been associated with increased sleep latency and sleep dysfunction. This delay in sleep onset may be explained by increased arousal, both physical and cognitive, immediately before sleep related to worry or anxiety. The current study examined the relationship between anxiety and subjective sleep quality through pre-sleep arousal and investigated the moderating effect of anxiety sensitivity.

Methods

Participants (n=322) were recruited from Amazon’s MTurk site, with most identifying as female (58.5%) and White/Caucasian (84.4%) and with an average age of 37.51 (SD = 12.12). Participants completed the Daily Assessment of Symptoms - Anxiety Scale (DAS-A), the Anxiety Sensitivity Index (ASI), the Pre-Sleep Arousal Scale (PSAS) and the Pittsburg Sleep Quality Index (PSQI). A moderated mediation analysis was conducted using Model 58 in PROCESS for SPSS.

Results

Results indicated that pre-sleep arousal partially mediated the relationship between anxiety and the dichotomous sleep quality variable while controlling for the covariates of age, and therapy participation, (a1= .186, p<.001, b1= .113, p<.001, c’= .038, p<.001). Additionally, the conditional effects and interactions of the moderating anxiety sensitivity variable were significant in both pathways (a1: F=24.702, p<.001; b1: χ 2 = 5.255, p=0.22).

Conclusion

These results help to identify potential mechanisms and conditions of the relationship between anxiety and sleep quality and contribute to the development of evidence-based interventions for sleep disturbance or other sleep complaints in individuals experiencing anxiety and anxiety symptoms.

Support

N/A
0166 Sleep Inconsistency Related Changes in Brain Function During Task and Rest
Authors: Zhang R , Tomasi D , Shokri-Kojori E , Wiers C E , Wang G , Volkow N D
Published: May 2020

Introduction

Sleep deprivation and circadian disruptions impair brain function and cognitive performance, but few studies have examined the effect of sleep inconsistency. Here we investigated how inconsistent sleep duration and sleep timing between weekend (WE) and weekdays (WD) affected behavior and brain function during task and at rest in 56 (30 female) healthy human subjects.

Methods

WE-WD differences in sleep duration and sleep midpoint were calculated using one-week actigraphy data. All subjects underwent 3Tesla BOLD-fMRI to measure brain activity during a visual attention task (VAT) and in resting-state condition.

Results

We found that WE-WD inconsistency of sleep duration and sleep midpoint were uncorrelated with each other (r=.08, p=.58) and influenced behavior and brain function differently. Our healthy subjects showed relatively small WE-WD differences (WE-WD: 0.59 hours) and benefited from longer WE catch-up sleep, which was associated with better attentional performance (3-ball: β=.30, t=2.35, p = .023; 4-ball: β=.30, t=2.21, p =.032) and greater deactivation of the default mode network (DMN) during VAT (p < .05, cluster-corrected) and greater resting-state functional connectivity (RSFC) between anterior DMN and occipital cortex (p < .01, cluster-corrected). In contrast, inconsistent WE-WD sleep midpoint (WE-WD: 1.11 hours) was associated with worse performance (4-ball: β=-.33, t=-2.42, p = .020) and with lower occipital activation during VAT and lower RSFC within the DMN.

Conclusion

Our results document the importance of consistent sleep timing for brain function in particular of the DMN, and provide evidence of the benefits of WE catch-up sleep in healthy adults.

Support

This work was supported by NIAAA IRP (Y01AA3009). R.Z. received research fellowship from German research foundation (DFG).
0170 Association of HIF-1 Alpha and Beta Subunits with Clock and BMAL1 Proteins in Obstructive Sleep Apnea Patients
Authors: Gabryelska A , Sochal M , Turkiewicz S , Bialasiewicz P
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a chronic condition that is characterized by intermittent hypoxia. Key regulator of oxygen metabolism is hypoxia inducible factor (HIF), which consists of oxygen sensitive subunit and continuously produced subunit. Circadian clock is composed of set of genes, which function as activators - CLOCK and BMAL 1, who similarly to HIF are basic helix-loop-helix-PER-ARNT-SIM transcription factors. Therefore, the aim of the study was to assess the relationship between HIF-1alpha, HIF-1beta, CLOCK, BMAL1 and polysomnography (PSG) variables in healthy individuals and severe OSA patients.

Methods

The study included 20 individuals, who underwent PSG and based on apnea-hypopnea index (AHI) were divided into severe OSA group (n=10; AHI30; 90% male) and healthy control (n=10; AHI<5; 70% male). All participants had their peripheral blood collected in the evening (9:00-10:00 pm) before and in the morning (6:00-7:00 am) after the PSG. HIF-1alpha, HIF-1beta, CLOCK and BMAL1 protein concertation measurements were performed using ELISA.

Results

Significant difference was observed in the following protein measurements between study groups: evening and morning HIF-1 (p=0.020 and p=0.043, respectively), evening HIF-1alpha (p=0.047), evening and morning CLOCK (p=0.037 and p=0.019, respectively) and morning BMAL1 (p=0.016). No differences were observed between morning and evening protein levels in both groups. Evening HIF-1beta corraleted with evening CLOCK and morning BMAL1 (R=0.511, p=0.21 and R=0.594, p=0.006, respectively), while morning HIF-1 with evening BMAL1 (R=474, p=0.35). Furthermore, evening and morning HIF-1 correlated with evening BMAL1 (R=564, p=0.010 and R=0.689, p=0.001, respectively). Additionally, morning CLOCK and BMAL1 correlated with AHI (R=0.510, p=0.022 and R=0.560, p=0.010, respectively) and desaturation index (R=0.487, p=0.209 and R=0.570, p=0.009, respectively).

Conclusion

There is significant correlation between both subunits of HIF-1 protein and circadian clock proteins: CLOCK and BMAL1, which further correlate with increased disease severity. This suggests OSA patients are in risk of circadian clock disruption due to present hypoxia.

Support

The study was financed by Polish National Centre Grant no. 2018/31/N/NZ5/03931.
0178 The Cycle of Daily Stress and Sleep: Sleep Measurement Matters
Authors: Slavish D C , Asbee J , Veeramachaneni K , Messman B , Scott B , Walker J , Sin N L , Taylor D J , Dietch J
Published: May 2020

Introduction

Disturbed sleep can be both a cause and a consequence of increased stress. Yet intensive longitudinal studies have demonstrated that sleep assessed via sleep diaries and actigraphy is inconsistently associated with daily stress. We expanded this research by examining daily associations between sleep and stress using a three-fold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography [EEG].

Methods

Participants were 80 adults (M age = 32.65 years, 63% female) who completed 7 days of sleep and perceived stress assessments in a naturalistic setting (resulting in 560 possible measurement occasions). Multilevel models were used to examine bidirectional associations between daily stressor occurrence (0 = stressor did not occur, 1 = stressor occurred) and stressor severity (0 = not at all severe to 3 = very severe) and sleep parameters assessed via diary, actigraphy, and EEG (e.g. total sleep time [TST], sleep efficiency [SE], and sleep onset latency [SOL], wake after sleep onset [WASO]).

Results

Participants reported at least one stressor on 37% of days. Compared to days without a stressor experienced, days with a stressor were associated with a 14.4-minute reduction in actigraphy-determined TST the subsequent night (β = -0.24, p = 0.030). Nights with greater sleep-diary determined WASO were associated with greater next-day stressor severity (β = 0.01, p = .026). No EEG-determined sleep parameters were associated with next-day stressor occurrence or severity, or vice versa.

Conclusion

Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary — not redundant — sleep measurement approaches.

Support

Funding for this study included NIH/NIAID R01AI128359-01; DoD-VA 1I01CU000144-01; the Foundation for Rehabilitation Psychology; and General Sleep Corporation.
0185 Sleep Behaviors and Thoughts as Links Between Social Rhythmicity and Depressive Symptoms
Authors: Sabet S M , Dautovich N D , Dzierzewski J M
Published: May 2020

Introduction

Disturbances in social circadian rhythms (e.g. regularity of meals and social interactions) and poor sleep are two potential factors that may contribute to the development of mood disorders. To date, no studies have investigated sleep behaviors (e.g. sleep health) and sleep thoughts (e.g. sleep self-efficacy) as potential links between social rhythmicity and mental health outcomes. The current study explored whether (1) higher social rhythmicity predicted fewer symptoms of depression and whether (2) sleep health and sleep self-efficacy act as mechanisms underlying this association.

Methods

An archival analysis was performed using data from an online study, Investigating Sleep Across Normal Development (ISLAND Study). The sample consisted of 4,261 adults aged 18+. Measures of social rhythmicity (SRM-10), sleep self-efficacy (SES), sleep health (RU SATED), and depressive symptoms (PHQ-2) were utilized. Age and gender were included as covariates in mediation analyses.

Results

The overall model was significant, p < .0001 and 26.4% of the total variance was accounted for by social rhythmicity. Controlling for covariates, higher social rhythmicity was directly associated with fewer depressive symptoms (95% CI [.0326, .0420]). Additionally, both sleep health 95% CI [.0034, .0078] and sleep self-efficacy [.0119, .0169] significantly mediated the association between social rhythmicity and depressive symptoms.

Conclusion

Individuals who have higher levels of daily routine regularity experienced less depressive symptoms than those who are more irregular in their daily routines. Furthermore, individuals who had more regular lifestyle habits were more likely to engage in healthy sleep behaviors and thoughts. Thoughts and behaviors are common factors that may have an impact on mental health given their daily reoccurrence. Also, as these factors are modifiable they could be targeted to potentially reduce depressive symptoms. Future research should continue to examine the link between social rhythmicity and sleep behaviors and thoughts on various health outcomes.

Support

This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).
0188 Mood Disorders Moderate the Relationship Between Sleep Quality and Leadership Development for U.S. Army Officer Candidates During ROTC Advanced Camp
Authors: Choynowski J , Pirner M , Mickelson C , Mantua J , Sowden W J , Burke T , Capaldi V F , McKeon A B
Published: May 2020

Introduction

U.S. Army Reserve Officer Training Corps (ROTC) Cadets are college students training to be Army Officers. During a month-long capstone course (Advanced Camp), Cadets are rated on their leadership ability. Little work has been done to determine predictors of leadership ability at Advanced Camp. This study examined the effect of poor sleep and mood disorders -- two prevalent factors among college students -- on leadership ability.

Methods

Metrics on leadership, sleep quality, anxiety, and depression, were assessed in 159 ROTC Cadets (22.06±2.49 years; 23.90%female) at Days 1 (Baseline), 14 (Mid), and 29 (Post) of Advanced Camp. Leadership ratings were determined by ROTC Instructors over the course of Advanced Camp (1–5 score; higher score indicates poorer leadership). Predictors were the Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9. The relationships between the predictors and leadership scores were tested using linear regression. The interaction between mood disorders and sleep quality on leadership was tested using SPSS Process (Model 1).

Results

Poorer sleep quality at the Post time point (reflecting the prior 2 weeks of sleep) predicted poorer leadership (B=.05,p=.03), while sleep quality from Baseline (B=.03,p=.14) and Mid (B=.01,p=.67) did not. Higher anxiety and depression scores from all time points predicted poorer leadership (p-values<.03). There was an interaction: higher anxiety and high depression predicted poorer leadership only in the context of poor sleep quality (not good or average sleep quality) [anxiety: R2=.04,F(1,159)=6.04,p=.02; interaction: R2=.03,F(1,155)=5.30,p=.02].

Conclusion

The current study identified a relationship between sleep quality and leadership ratings in ROTC cadets. This relationship was moderated by anxiety and depression. ROTC instructors should encourage ROTC Cadets to take advantage of sleep opportunities at Advanced Camp in order to maximize leadership potential.

Support

Support for this study came from the Military Operational Medicine Research Program (MOMRP) of the United States Army Medical Research and Development Command (USAMRDC).

Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US
0189 Sleep Duration and Subjective Resilience to Sleep Loss Predict Functional Impairment in Elite Infantrymen During Military Training
Authors: Mickelson C A , Mantua J R , Burke T M , Choynowski J , Bessey A F , Naylor J A , Krizan Z , Sowden W J , Capaldi V F , McKeon A B
Published: May 2020

Introduction

Insufficient sleep during military operations is detrimental to cognition, physical performance, and general health outcomes. However, there is evidence of inter-individual differences in resilience to sleep loss. Therefore, some Soldiers may be more resilient to the effects of sleep loss than others. This study examined the relationship between sleep duration, resilience, and Soldier well-being during a deployment-readiness training event.

Methods

Seventy-six male Soldiers (aged 25.7±4.0y) from the 75th Ranger Regiment participated while undergoing a two-week training exercise. Surveys were administered at the completion of training and queried subjective measures of sleep duration during training, functional impairment (Walter Reed Functional Impairment Scale), and resilience to sleep loss (Iowa Resilience to Sleepiness Test; iREST). The independent relationships between sleep duration, resilience to sleep loss, and functional impairment were assessed using linear regressions. The interaction between sleep duration and resilience to sleep loss was assessed using SPSS Process (Model 1).

Results

Shorter sleep duration during training predicted higher functional impairment at the end of training (B=-.71, p=.001). Less resilience to sleep loss also predicted higher functional impairment (B=.07,p=.004). An interaction between sleep duration and resilience predicted Soldier impairment (R2 change: .06; F(1,68)=.17,p=.03). Individuals with both shorter sleep duration during training and less resilience had the highest functional impairment. Those with more sleep, and those with high resilience and less sleep, both had lower functional impairment.

Conclusion

This study suggests the iREST can be used as a quick, subjective screening tool to indicate who may be most vulnerable to the effects of sleep loss. Identifying individual resilience to sleep loss may be useful in the military context for prescribing sleep strategies before and during missions in order to enhance Soldier readiness and performance.

Support

Support for this study came from the Military Operational Medicine Research Program (MOMRP) of the United States Army Medical Research and Development Command (USAMRDC).
0200 Trait Mindfulness Moderates the Within-Person Relationship Between Sleep and Pain in Nurses
Authors: Mu C , Lee S
Published: May 2020

Introduction

Sleep and pain have a bidirectional relationship in clinical populations; however, we know less about the daily association in non-clinical but potentially vulnerable populations. Nurses are prone to poor sleep and pain symptoms due to work schedules and occupational stress. Implications from mindfulness-based interventions suggest that mindfulness may play a role in improving sleep and subsequently, reducing pain. The current study examined the within-person relationship between sleep and pain in nurses, and whether trait mindfulness moderates the relationship.

Methods

Participants were 60 nurses employed at a cancer hospital (Mage=35.35±11.83, 32% reported pain). For 14 consecutive days, ecological momentary assessment collected participants’ sleep characteristics, pain symptoms (i.e., chest pain, headaches, upset stomach, and other pain), and pain interference with daily activities. Trait mindfulness was measured using the 15-item Mindful Attention Awareness Scale. Multilevel modeling decomposed variances at the between- and within-person levels.

Results

At the between-person level, after controlling for sociodemographic covariates, more frequent insomnia symptoms (β=0.35) or lower sleep sufficiency (β=-0.19) were associated with more pain symptoms (ps<.05). Inversely, individuals with more pain symptoms reported lower sleep sufficiency (β=-0.41, p<.05). At the within-person level, after nights with poorer sleep quality (β=-0.08, p<.01), lower sleep sufficiency (β=-0.08, p<.01), or shorter sleep duration (β =-0.03, p<.05), participants reported more pain symptoms the following day. There were significant interactions of mindfulness with (a) sleep sufficiency predicting pain interference and (b) sleep duration predicting number of pain symptoms, such that the adverse associations of less sufficient and shorter sleep with more pain were more apparent in those with lower mindfulness than those with higher mindfulness.

Conclusion

Although there was a bidirectional association between sleep and pain at the between-person level, sleep was more likely to be the predictor of pain at the within-person level in oncology nurses. The significant moderation by mindfulness suggest that promoting mindfulness among nurses, prone to having poor sleep and pain, may reduce the adverse impact of poor sleep on daily pain.

Support

This work was supported, in part, by the University of South Florida College of Behavioral & Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).
0218 Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents
Authors: Schwartz L P , Devine J K , Hursh S R , Mosher E , Schumacher S , Boyle L , Davis J E , Smith M , Fitzgibbons S
Published: May 2020

Introduction

Fatigue and its effects on performance have long been a concern in medicine. Evidence exists that current duty-hour restrictions for resident trainees have a limited impact on physician wellbeing and patient safety, prompting renewed efforts to address this threat. In this study, sleep patterns of general-surgery residents were used to optimize a biomathematical model of performance for use as a tool for fatigue risk management with residents.

Methods

General surgery residents based at a multi-hospital, general surgery residency program were approached for participation in this study. Enrolled residents wore actigraph devices for 8 weeks and completed subjective sleep assessments. Sleep data and shift schedules were then input into the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model to assess predicted cognitive performance. Performance was compared to an “effectiveness” level of 77 (equivalent to a blood-alcohol content of 0.05g/dL). Eight hours of sleep debt was considered “below reservoir criteria”.

Results

Sleep actigraphy data was collected from 22 general surgery residents. Modeling results showed that as shift lengths increased, effectiveness scores generally decreased, and the time spent below criterion (77) increased. Additionally, 11.13% of time on shift was below the effectiveness criterion and 42.7% of shifts included time spent below the reservoir criterion. Adjustments to the sleep prediction were made based on actual sleep, and performance predictions from actual sleep and the adjusted model were significantly correlated (p<.0001).

Conclusion

Despite adherence to national standards limiting work hours, current surgical resident sleep patterns and shift schedules create concerning levels of fatigue. This study illustrates how biomathematical fatigue models can predict resident physician sleep patterns and performance. Modeling represents a novel and important tool for medical educators seeking to create shift schedules that maintain physician preparedness and minimize fatigue risk.

Support

N/A
0232 Impact of Mental Health on 10-Year Trends in Habitual Sleep Duration
Authors: Khader W S , Tubbs A , Fernandez F , Jean-Louis G , Seixas A A , Williams N J , Chakravorty S , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Public health efforts aimed at reducing the decline in habitual sleep duration have not been successful. It is possible that this decline is differentially experienced relative to individuals’ mental health status. This would further support the need to focus on mental health as a strategy for improving sleep in the general population.

Methods

We examined 10 years of the National Health Interview Survey data (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height and weight (used to compute body mass index) were recorded in the same way. In addition, depressed mood in the past 30 days was evaluated (coded as none, mild, moderate, or severe). Weighted regression analyses examined sleep duration as an outcome, year and depressed mood as predictors, and sociodemographics as covariates. A year-by-depressed mood interaction was computed, and analyses were stratified by group.

Results

There was a significant year-by-depression interaction on linear change in sleep duration over the 10 year period (p=0.0001). Analyses were then stratified by depressed mood. In adjusted analyses, individuals with no depressed mood lost an average of 0.68 minutes of sleep per year (95%CI -0.82,-0.55; p<0.0001). Among those with mild depression, this was 7% higher, at 0.73 minutes (95%CI -1.13,-0.33; p<0.0001). Among those with moderate depressed mood, this was 154% higher, at 1.73 minutes lost per year (95%CI -2.31,-1.16; p<0.0001). Among those with severe depressed mood, this was 351% higher, at 3.07 minutes per year (95%CI -4.22,-1.92; p<0.0001).

Conclusion

The 10-year linear decline in habitual sleep duration seems to depend on mental health status. Individuals with better mental health lose less sleep over time, relative to those with worse mental health. This highlights the importance of mental health as a possible avenue for improving sleep health in the population.

Support

Dr. Grandner is supported by R01MD011600
0236 Team-Based Athletes Sleep Less Than Individual Athletes, But Do Not Report More Insomnia or Fatigue
Authors: Clay M A , Athey A , Charest J , Auerbach A , Turner R W , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Collegiate student-athletes face challenges balancing academics and athletics, and getting an adequate amount of sleep is one factor that can assist in sustaining an elite level of play. Team-based sports may present with systematically different sets of demands.

Methods

Data were obtained at the start of the academic semester from N=189 NCAA Division-1 athletes from a wide range of sports. The sample was 46% female. Individuals were classified as playing in a team sport (e.g., football, basketball, baseball, softball, volleyball) or an individual sport (e.g., swimming, track, golf). Sleep-related outcomes included self-reported sleep duration and sleep latency, frequency of sleeping pill use (Never, Rarely, Sometimes, Often), Insomnia Severity Index score, and Fatigue Severity Scale score. Regression analyses were adjusted for age and sex.

Results

In adjusted analyses, team-based athletes reported 22.4 minutes less sleep than individual athletes (95%CI -42.8,-1.9; p<0.05). They also reported 5.6 less minutes of sleep latency (95%CI -10.8,-0.3; p<0.05). More frequent sleeping pill use was also reported (oOR=0.96; 95%CI: 0.26,1.67; p=0.007). They did not report any differences in insomnia or daytime fatigue levels.

Conclusion

These results suggest that even though team-based athletes may not report more sleep complaints or daytime complaints, they may be at increased risk for less sleep and more sleep medication. Further work is needed to identify the sources of these differences to guide interventions.

Support

The REST study was funded by an NCAA Innovations grant.

Dr. Grandner is supported by R01MD011600
0239 Mindfulness Moderates the Relationship Between Lucid Dreaming, Nightmare Distress, and Sleep Quality
Authors: Zendels P , Barngrover S , Peach H
Published: May 2020

Introduction

Nightmares can cause poorer sleep quality. Various mechanisms have been explored as potential treatments for nightmares, including mindfulness practices and lucid dreaming. Presently, little literature has looked at the interaction effects between mindfulness and lucid dreaming to reduce nightmare distress.

Methods

A sample of 275 individuals was recruited from both the United States and Thailand via social media and a student pool of research subjects at UNC Charlotte. Data were recorded on participants’ demographic information, lucid dreaming from the Lucidity and Consciousness in Dreams Scale (Voss et al., 2013), Mindfulness using the Five Facet Mindfulness Questionaire (Baer et al., 2006), Nighmares via the Nightmare Distress Questionaire (Belicki, 1992), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989). Higher scores on each measure were associated with more lucid dreaming, more mindful behaviors, more severe nightmares, and poorer sleep quality. PROCESS model 8 was run to conduct a moderated mediation analysis (Hayes, 2018). Lucid dreaming was used as the predictor; sleep quality as the outcome variable, nightmare distress as the mediator and mindfulness acted as a moderator on both the direct and indirect pathway of lucid dreaming onto the mediator and outcome.

Results

Mindfulness was a significant predictor at both the mediator and outcome variables. Nightmare distress was a significant predictor of sleep quality. A statistical trend (p=.054) suggests lucid dreaming may have a positive effect on nightmare distress. In the indirect path, lucid dreaming had a positive effect on PSQI scores only for individuals with low mindfulness.

Conclusion

The moderated mediation suggests that individuals with low mindfulness may see a decrease in sleep quality from lucid dreaming. This could be due to lucid dreaming being associated with more severe nightmares. A zero-effect size could not be ruled out of the confidence intervals for individuals of average or high mindfulness, but the data suggest that lucid dreaming alone may not help treat nightmares, but the combination of lucid dreaming and mindfulness therapies could promote lower distress and better sleep quality.

Support

Psychological Sciences departmental funding
0243 Community-Level Daytime Sleepiness and Substance Use: Implications of Sleep Time and Mental Health
Authors: Khader W S , Tubbs A , Fernandez F , Chakravorty S , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Daytime sleepiness is associated with impaired functioning and well-being. Those with more sleepiness may turn to illicit substances to overcome these problems. The present study examined whether community-level daytime sleepiness is associated with the likelihood of drug use.

Methods

Data were pulled from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 community adults (age 22–60). Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Use of different substances was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). The present analyses examined use within the past month of alcohol, tobacco, cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens, and illicit opioids. A separate item assessed caffeine. Ordinal logistic regression analyzed ESS score as a predictor of frequency of substance use adjusted for age, sex, education, and race/ethnicity. Additional models included habitual sleep duration and score on the PHQ9 depression scale.

Results

In sociodemographically-adjusted analyses, ESS score was associated with an increased risk of using tobacco (OR=1.04, p=0.015), cannabis (OR=1.04, p=0.014), cocaine (OR=1.07, p=0.009), amphetamines (OR=1.06, p=0.025), inhalants (OR=1.13, p=0.002), sedatives (OR=1.07, p=0.003), hallucinogens (OR=1.12, p=0.001), and opioids (OR=1.12, p=0.0001). Controlling for sleep duration did not significantly affect these relationships, while controlling for depression made every association non-significant except hallucinogens (OR=1.09, p=0.040).

Conclusion

Daytime sleepiness was associated with increased use of nearly all drug categories, but not alcohol or caffeine. Public consumption of alcohol and caffeine might be sufficiently common that the presence of their use cannot be adequately associated with sleepiness. Moreover, the increased frequency of drug use with sleepiness is not linked to sleep deprivation but may reflect emotional distress.

Support

This work was supported by a grant from Jazz Pharmaceuticals

Dr. Grandner is supported by R01MD011600
0273 Residual Sleep Difficulties During Reset Operations Predict Greater Post-Deployment Mental Health Difficulties in U.S. Soldiers: A Cross-Lagged Analysis
Authors: So C J , Alfano C A , Riviere L A , Quartana P J
Published: May 2020

Introduction

Military service is associated with a number of occupational stressors, including non-conducive sleeping environments, shift schedules, and extended deployments overseas. Service members who undergo combat deployments are at increased risk for mental health and sleep difficulties. Bidirectional associations between sleep and mental health difficulties are routinely observed, but the directional association of these difficulties from one deployment to the next has not been addressed. The purpose of this study was to examine whether residual sleep problems or mental health difficulties after a 12-month period of reset operations following an initial deployment were associated with changes in sleep and mental health following a subsequent deployment.

Methods

Data from 74 U.S. Soldiers were case-matched across three time points. Participants were assessed 6 months (T1) and 12 months (T2) following an initial deployment. Participants were then assessed 3 months (T3) following a subsequent deployment. Symptoms of PTSD, anxiety, depression, and sleep difficulties were assessed at all three time points.

Results

Cross-lagged hierarchical regression models revealed that residual sleep difficulties across the time points uniquely predicted later changes in PTSD and anxiety symptoms, but not depressive symptoms, following a subsequent deployment. Conversely, residual mental health difficulties were not unique predictors of later changes in sleep difficulties.

Conclusion

These findings suggest that higher levels of residual sleep difficulties 12 months following a prior deployment are associated with larger increases in mental health problems following a subsequent deployment. Moreover, and importantly, the converse association was not supported. Residual mental health difficulties prior to deployment were not associated with changes in sleep difficulties. These data provide a viable target for intervention during reset operations to mitigate mental health difficulties associated with combat deployments. They might also help inform return-to-duty decisions.

Support

N/A.
0278 Changes in Sleep Architecture During Long-Duration Spaceflight
Authors: Piltch O , Flynn-Evans E , Stickgold R
Published: May 2020

Introduction

Previous projects have shown that astronauts sleep significantly worse in mission than on Earth. However, it is unclear how sleep architecture is influenced by microgravity. Such information could inform our understanding of the adaptive mechanisms NREM and REM sleep on Earth. We investigated how sleep architecture is affected during spaceflight relative to on Earth.

Methods

Sleep architecture was assessed using the Nightcap monitor before (pre-flight, n=113 nights), during (in-flight, n=68 night), and after (post-flight, n=61 nights) missions aboard the Mir space station for four cosmonauts and one astronaut. We compared hand-scored REM/NREM/wake staging in/post-flight to a pre-flight baseline using mixed-effects regression to account for subject variability. We also used mixed-effects modeling to assess changes over time in different phases of the mission.

Results

Participants averaged an hour less sleep in space (5.4 ± 0.66) compared to pre-flight (6.6 ± 0.70; p < .0001) and spent significantly more time awake in bed, leading to a 20.8% reduction in sleep efficiency. Sleep architecture was also affected by spaceflight: percentages of time in bed for NREM and REM decreased significantly by 9.9% and 26.6% respectively. REM latency nearly doubled during spaceflight to 88 ± 3 minutes. All metrics were stable across the in-flight phase, with the exception of an increase in sleep latency (β: 0.47; p = 0.0009) and a decrease in time in bed (β = 0.85; p < .0001).

Conclusion

These data substantiate previous findings focused on sleep continuity in microgravity. A variety of metrics demonstrate worse sleep in space. NREM and REM time significantly decreased alongside an increase in wakefulness, but the relative proportion of these stages also changed significantly: REM sleep suffered more than NREM in spaceflight conditions. These longitudinal data add value to our nebulous understanding of how sleep functions in microgravity.

Support

Mary Gordon Roberts Fellowship, NAS 9-19406, NIMH #MH-48,832, The MacArthur Foundation Mind-Body Network, and Healthdyne Technologies
0283 Differential Impact of Chronotype on Positive and Negative Affect Following Sleep Restriction
Authors: Cox R C , Olatunji B O
Published: May 2020

Introduction

Previous research indicates sleep deprivation significantly decreases positive affect, while negative affect is often unaffected (Reddy et al., 2017; Schwarz et al., 2019). However, it is unclear whether individual difference factors predict a differential emotional response to sleep loss. Though one study found chronotype predicts decreased positive affect following sleep loss in adolescents (Dagys et al., 2012), the effect of chronotype on emotional response to sleep loss in adults remains unknown.

Methods

The present study addressed this limitation by examining whether chronotype predicts changes in positive and negative affect following partial sleep restriction. Healthy sleeping adults (N=113; Insomnia Severity Index<8) completed the Morningness-Eveningness Questionnaire (Horne & Ostberg, 1976) on day 1, and were instructed to sleep normally on night 1. On the evening of day 2, participants completed the Positive and Negative Affect Schedule (PANAS; MacKinnon et al., 1999) to sample baseline daily emotions. On night 2, sleep was restricted to 4-8am. On day 3, participants completed the PANAS post-sleep restriction. Compliance was verified with actigraphy (n=22 excluded for noncompliance), and response to the sleep restriction procedure was checked with the Stanford Sleepiness Scale (Hoddes, Dement, & Zarcone, 1972; n=18 excluded for nonresponse).

Results

Results suggest a significant decrease in positive affect from pre-sleep restriction (M=15.63, SD=4.09) to post-sleep restriction (M=11.08, SD=3.93), t(71)=10.33, p<.01, and a trend decrease in negative affect from pre-sleep restriction (M=7.68, SD=3.62) to post-sleep restriction (M=6.90, SD=2.41), t(71)=1.60, p=07. Chronotype was significantly associated with post-sleep restriction negative affect, controlling for baseline negative affect (β=-.42, p<.01), such that eveningness was associated with increased negative affect following sleep restriction. In contrast, chronotype was unrelated to post-sleep restriction positive affect.

Conclusion

These findings indicate that evening types may be more likely to experience emotions implicated in anxiety-related disorders following sleep loss, such as fear and nervousness.

Support

This work was supported by the National Institute of Mental Health of the National Institutes of Health [F31MH113271] and a Graduate Student Summer Research Award from Vanderbilt University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0292 Baseline Pro-Inflammatory Cytokine and Cortisol Levels Differentially Predict Mood Disturbance and Working Memory Deficits Induced by Chronic Sleep Restriction
Authors: Jones C W , Kaizi-Lutu M , Mange A , Basner M , Dinges D F
Published: May 2020

Introduction

Sleep restriction disturbs mood, impairs neurocognitive performance, and elevates proinflammatory cytokine levels. However, whether basal inflammation influences mood and neurocognitive performance across sleep restriction is unknown. This study examines whether baseline IL-6, cortisol, and TNF-α levels predict the deterioration of mood and working memory performance across sleep restriction.

Methods

N=124 healthy participants (52% female; n=64), 22–45 years of age, had valid protein, mood, and working memory data. The study included two baseline nights (8h time in bed [TIB]) followed by five nights of 4h TIB. Venous blood was collected on the second baseline day and IL-6, cortisol, and TNF-α levels were measured via commercially available ELISA assays. The profile of mood states (POMS) and the digit span test (DST) were completed every 2h during wakefulness and daily averages were computed. Mixed-effects multi-level models, adjusted for baseline, evaluated the main effect of IL-6, cortisol, and TNF-α levels on the POMS and DST independently and examined the trajectory of POMS and DST by the interaction of protein levels and day of sleep restriction.

Results

At baseline, IL-6, cortisol, and TNF-α levels were not associated with POMS or DST. There was a main effect of IL-6, but not cortisol or TNF-α, levels on mood disturbance (β=3.811; P=0.015); IL-6 levels did not predict the trajectory of mood across sleep restriction (β=0.187; P=0.57). Higher baseline cortisol levels predicted increasing mood disturbance across days (β=-1.329; P<0.0001). Higher baseline TNF-α levels predicted degrading DST performance across days (β=-0.313; P=0.020). Higher IL-6 (β=-0.246; P=0.010) and lower cortisol (β=0.185; P=0.037) levels also predicted degrading DST performance across days.

Conclusion

The study findings suggest that basal inflammatory cytokine and cortisol levels are implicated in the individual risk of mood disturbance and working memory deficits resulting from chronic sleep restriction and highlight the need to consider biological processes and phenotypes together.

Support

This work was supported by National Institute of Health NIH R01NR004281 and National Space and Biomedical Research Institute NSRBI NCC 5–98.
0300 The Circadian Timing of Sleep Affects the Rate of Accumulation of Neurobehavioral Impairment Across Days of Sleep Restriction
Authors: McCauley M E , Van Dongen H , Banks S , Dinges D F
Published: May 2020

Introduction

Chronic restriction of nighttime sleep to less than ~8h/day leads to build-up of neurobehavioral impairment across days. Although it is known that sleep loss effects depend on the circadian timing of sleep, it is not known how the timing of restricted sleep influences the accumulation of neurobehavioral impairment over days. Here we studied the accumulation of impairment across days of restricted sleep placed in the morning or afternoon.

Methods

N=71 healthy young adults (39% female; ages 21-45y, mean±SD: 27.9±6.6y) completed a 14-day laboratory study. After two baseline days with nighttime sleep (8h TIB: 23:30-07:30), subjects were randomized to 10 consecutive days of A) morning sleep at 4h, 6h, or 8h TIB ending at 11:30 each day (n=18, 8, 8, respectively), or B) afternoon sleep at 4h, 6h, or 8h TIB ending at 19:30 each day (n=13, 17, 7, respectively). Subjects were tested on the 10min psychomotor vigilance test (PVT) every ~2 hours during scheduled wakefulness. Daily averages for PVT lapses (RTs>500ms) observed between 2h and 14h after awakening were analyzed with non-linear mixed-effects regression to investigate differences in the neurobehavioral impairment build-up rate between sleep restriction conditions.

Results

Afternoon sleep conditions showed a significant sleep dose-response effect (p<0.001), with the fastest accrual of PVT performance deficits across days in the 4h condition, and slow-to-negligible accumulation (p=0.36) of PVT performance deficits in the 8h condition. However, morning sleep resulted in no significant sleep dose-response effect (p=0.96). All 3 morning sleep doses displayed negligible (p≥0.12) accumulation of impairment across days.

Conclusion

In this sample of young adults, sleep dosages ending in the morning (at 11:30) appear to provide considerable protection against cumulative performance deficits from sleep restricted to 4h-6h/day over 10 days, suggesting that the afternoon circadian promotion of wakefulness can sustain behavioral alertness even over multiple days of repeated sleep restriction.

Support

NIH grants R01-NR04281 and M01-RR00040