bluuebunny/crossref_metadata_2025 huggingface dataset:
0621 A machine learning model to predict the risk of perinatal depression from sleep data in healthy pregnant women
Authors: Garbazza Corrado , Mangili Francesca , D'Onofrio Tatiana Adele , Malpetti Daniele , D’Agostino Armando , Cicolin Alessandro , Cirignotta Fabio , Manconi Mauro
Published: May 2023

Introduction

Perinatal depression (PND) is a complication of pregnancy associated with serious health consequences for both mothers and their babies. Identifying predisposing factors for PND during early pregnancy is key to early detection of women who may be at greater risk of developing this condition. Machine Learning (ML) techniques have recently been applied in a few studies, mostly to predict postpartum depression. None of them, however, considered sleep data in model building, neither focused on PND.

Methods

By analyzing data from a multicenter, prospective cohort study on sleep and mood changes during the perinatal period (the “Life-ON” study), we constructed a ML model for PND risk prediction and tested it in a cross-validation setting. PND was assessed using an EPDS score >12 during 9 visits from early pregnancy until 6 months postpartum. In a bivariate analysis, 47 sociodemographic, psychological, blood-based, medical/gynecological, and subjective sleep variables, collected from 439 pregnant women (33.7±4.2 yrs.) during the first trimester of gestation, as well as 33 polysomnographic (PSG) parameters, recorded from 353 women (33.6±4.2 yrs.) during the second trimester, were correlated with PND. A support vector machine (SVM) model was then trained using the 10-features with the highest permutation importance to predict the individual risk of PND for each woman.

Results

Among all variables considered, sleep quality (PSQI) and insomnia symptoms (ISI) (p< 0.001), daytime sleepiness (ESS) and RLS severity (IRLS) (p< 0.05), as well as the PSG parameters Apnea Index (p=0.001), number of central hypopneas and percentage of sleep stage N2 (p< 0.05), were all positively correlated to PND. The PSQI and ISI scores were also selected by the SVM classifier, which achieved a mean AUROC of 0.777 and an AUPRC of 0.393, corresponding to a sensitivity of 54.3% and a specificity of 82.6% in identifying women at risk for PND.

Conclusion

In our data-driven ML model to predict the risk of PND during early pregnancy, subjective poor sleep quality and insomnia symptoms identified women at greater risk of developing PND, while none of the PSG variables improved model performance.

Support (if any)

Swiss National Science Foundation (grant: 320030_160250/1). The Italian Ministry of Health and Emilia-Romagna Region (grant: PE-2011-02348727).
0625 Sleep when the baby sleeps? The effect of daytime nap behaviors on postpartum depression severity: a stress buffering hypothesis
Authors: Dhaliwal Sammy , Gehrman Philip , Le Huynh-Nhu (Mimi) , Keller Jennifer , Sharkey Katherine
Published: May 2023

Introduction

The early postpartum is a time of expected maternal sleep loss, normalized as part of infant care. While short duration and disrupted nocturnal sleep are posited risk factors for postpartum depression (PPD), the role of daytime sleep remains less understood, despite the widespread recommendation that mothers sleep when their baby is sleeping. This study examined associations between napping, stress, and longitudinal PPD in a sample of in a sample of healthy first-time mothers, using a prospective ambulatory field study design.

Methods

Fifty primiparous women (62% non-White; mean age=32 years) without a history of sleep disorders or psychopathology completed 10-days (9-nights) of actigraphy and sleep diaries at postpartum week 6. Sleep variables included nighttime duration and efficiency, and daytime nap frequency, timing and duration. Participants completed 3-days of superimposed ecological momentary assessment (EMA) rating naturalistic infant-related stressors (task demand; effort-reward-imbalance) at four daily intervals. Hierarchical mixed models tested whether daytime sleep characteristics predicted lower depression levels (via Edinburgh Postnatal-Depression Scale - EPDS) at 6-weeks, 8-weeks, and 3-months postpartum. Time-varying within-person covariates included time-of-day, baseline depression and anxiety (via Generalized-Anxiety-Disorder-7 scores), and previous night sleep. To test the putative stress-protective role of napping, we examined pre-post nap differences in EMA ratings.

Results

Sixty percent (n = 30/47) of women napped regularly (>3x/1 week, between 1-5 PM, < 90 min by both diary and actigraphy), rating 80% of these naps “intentional.” Women with greater nap regularity at 6-weeks had lower depression levels at all timepoints (Betas = -2.4(1.6); -1.4(.5), -.5(.01) ps<.001, respectively), and less of an increase in depression symptoms at 3-months postpartum, compared to non-nappers [Beta(SE)=-1.2 (.5); R^2=.21; p<.001]. At 6-weeks, regular nappers reported lower stress post-nap (effort-reward-imbalance; demand) [Beta(SE)=-6.3(1.4); 1.2(.12,), R^2=.27, .32, respectively; ps<.01].

Conclusion

This study demonstrates a contemporaneous mood-protective role of daytime sleep in a perinatal sample, using 24-hr objective sleep assessment coupled with daily assessments of naturalistic stressors. Moreover, these results provide support for the protective role of regular daytime sleep on development of PPD over time. Among new mothers who regularly nap, lowered post-nap stress may be one pathway through which daytime sleep buffers against PPD severity.

Support (if any)

NIMH-1R36MH118000-01, CTSI89431, T32-HL007713
0627 Postpartum Insomnia and Poor Sleep Quality are Uniquely Predictive of Postpartum Mood Disorders
Authors: Okun Michele , Lac Andrew
Published: May 2023

Introduction

Many postpartum women experience symptoms of depression (PPD) and anxiety (PPA). Insomnia and poor sleep quality are frequently reported by postpartum women and are risk factors for postpartum mood disorders. This longitudinal study sought to assess whether perinatal insomnia or sleep quality predicted depression and anxiety across each month of the first 6 months postpartum in women with a history of depression.

Methods

Pregnant women (N = 178) aged 18-45 years with a self-reported prior history of depression were recruited from social media in late pregnancy. None of the women were depressed at enrollment. In late pregnancy and for up to six months postpartum, women completed monthly online questionnaires including the ISQ, PSQI, EPDS, and GAD-7. Repeated-measures multilevel models were performed using the generalized linear mixed model command in the software IBM SPSS 28 to determine predictive associations across the postpartum. Demographics (age, education, race, and sex of baby) were statistically controlled for in these models.

Results

The rate of depression averaged (15.7%) and anxiety averaged (17.0%) across the postpartum. The prevalence of insomnia was 20.4%, and the prevalence of poor sleep quality was 67.8% across the first 6 months postpartum. Insomnia in the postpartum predicted greater depressive and anxiety symptoms, even after controlling for prenatal insomnia. Likewise, poor sleep quality in the postpartum predicted greater depressive and anxiety symptoms after controlling for prenatal poor sleep quality scores. When considering clinical cutoffs of the EPDS ≥ 12 and GAD ≥ 10, postpartum insomnia and sleep quality uniquely predicted postpartum depression (OR = 5.69, 95% CI 3.33-9.74 and OR = 3.13, 95% CI 1.70 -5.77). Insomnia predicted postpartum anxiety (OR = 11.15, 95% CI 5.99-20.78), with sleep quality trending (OR = 1.76, 95% CI 0.99 -3.12). None of the demographic variables significantly contributed (P’s > 05).

Conclusion

Both postpartum insomnia and poor sleep quality contributed to clinical postpartum mood. The chronic sleep deprivation of insomnia and the subjective experience of poor sleep quality are uniquely relevant to risk for postpartum mood. The consideration and treatment of both is important as they are uniquely associated with adverse outcomes for mother and child.

Support (if any)

Happiest Baby, Inc
0630 For Whom the Bell Tolls: Empirical Clustering of Insomnia and Suicidal Ideation
Authors: Tubbs Andrew , Karp Jordan , Perlis Michael , Grandner Michael , Fernandez Fabian-Xosé , Killgore William
Published: May 2023

Introduction

Insomnia is associated with risk for suicidal thoughts and behaviors. It is unclear if insomnia drives risk equivalently across all individuals, or whether there are subgroups of high-risk individuals for whom insomnia is more relevant. This exploratory archival analysis examined the relationship between insomnia and current suicidal ideation among subgroups of individuals with lifetime suicidal ideation.

Methods

Data were acquired from the Military Suicide Research Consortium on 2,617 individuals without missingness on measures of suicidal thoughts and behaviors, anxiety, insomnia, thwarted belongingness, traumatic brain injury, risky alcohol use, and symptoms of post-traumatic stress. Medoid (k-means) clustering algorithms identified subgroups. Robust Poisson models tested interactions between insomnia and cluster identity in association with current suicidal ideation. Models were unadjusted, adjusted for demographic factors, and adjusted for clinical characteristics.

Results

Clustering identified two subgroups: Cluster 1 (N=1,141) and Cluster 2 (N=1,494). Cluster 1 had fewer individuals with current suicidal ideation (29.2% vs. 66.6%) and in general had less severe symptoms of anxiety, PTSD, insomnia, traumatic brain injury, and suicidal thoughts and behaviors. Across clusters, insomnia severity was associated with risk for current suicidal ideation (PRR: 1.09 [1.03-1.14]). Although individuals in Cluster 1 were less likely to have current suicidal ideation (PRR 0.51 [0.44-0.58]), greater severity of insomnia was associated with greater risk (PRR: 1.11 [1.04-1.18]). By contrast, individuals in Cluster 2 had a greater risk of current suicidal ideation (PRR: 1.68 [1.51-1.88]) and greater severity of insomnia was associated with a diminished risk of current ideation (PRR 0.92 [0.88-0.97]).

Conclusion

In this exploratory study, individuals with less severe psychopathology were more likely to report current suicidal ideation with worsening insomnia, while those with severe psychopathology were less likely to report suicidal ideation with worsening insomnia. Insomnia may disproportionately increase suicide risk among lower risk individuals.

Support (if any)

This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-16-2-0003). Opinions, interpretations, conclusions, and recommendations are those of the author and are not endorsed by the MSRC or the Department of Defense.
0632 The relationship of shift work disorder with depression, anxiety, and stress
Authors: Chang Melinda , Mendieta Miguel , Vidafar Parisa , Birk Jeffrey , Shechter Ari
Published: May 2023

Introduction

Shift work-related circadian misalignment can adversely impact health and well-being. Shift workers often experience disturbances in mood and impairments in waking vigilance and cognitive performance. Shift workers also commonly experience disturbed sleep. Shift work disorder (SWD) is a circadian rhythm sleep disorder characterized by insomnia symptoms during the sleep episode and sleepiness during the wake episode, temporally associated with shift schedules. Here, we examined the association between SWD and mental health.

Methods

Participants were adults (18 y+) who engaged in non-standard work shifts (morning, evening, night, rotating, other). Data were collected via online survey, and included questions about demographics, job details, sleep, and mental health. Participants completed the validated SWD Questionnaire, assessing the presence and severity of symptoms, categorizing individuals as high or low risk for SWD based on International Classification of Sleep Disorders criteria. Participants completed the Depression, Anxiety, and Stress Scale-21 (DASS-21). Higher scores on each DASS-21 subscale indicate higher symptom severity. Linear regression was used to determine the relationship between the presence of SWD and depression, anxiety, and stress symptom scores, adjusting for age, gender, shift work type, self-reported work-day sleep duration, and alcohol use frequency.

Results

Sixty participants were included (60% female, mean age: 37 [SD: 12.2] y). High risk for SWD was seen in 55% of participants. Sleep duration was on average ~40 minutes shorter in those with vs. without SWD (5.61 [1.24] h vs. 6.31 [1.31] h, p=.037). Participants with SWD reported significantly higher depressive symptoms than those without (B=3.59, SE=1.52, 95% CI [0.54, 6.65], p=.022). SWD was not associated with anxiety, and was marginally associated with stress (B=2.48, SE=1.26, 95% CI [-0.06, 5.02], p=.055). Age was significantly associated with lower stress symptoms (B=-0.11, SE=0.05, 95% CI [-0.22, -0.01], p=.029). No other covariates were significantly associated with depression, anxiety, or stress (all other ps ≥.10).

Conclusion

SWD was common. Its presence was associated with higher severity of depression symptoms. Intervention approaches targeting underlying causes of SWD (e.g., strategic light-dark exposure and cognitive behavioral therapy for insomnia that is adapted for shift work) should be tested as methods to protect shift workers’ mental health.

Support (if any)
0633 Age matters: Association between age and depression severity at the time of OSA diagnosis, and PAP adherence in adult patients
Authors: Niraula Rijesh , Singh Amitoj , DelRosso Lourdes , Meghpara Sanket , Keenan Lynn , Van Gundy Karl
Published: May 2023

Introduction

Numerous studies have shown association and symptom overlaps between Obstructive Sleep Apnea (OSA) and depression. However, data is limited on association between age, severity of depression at time of OSA diagnosis, and its impact on PAP adherence. Patient Health Questionnaire-9 (PHQ-9) is a validated depression screening and severity scoring tool recommended by DSM-V. In this retrospective observational study, we will evaluate the interrelationship between age at OSA diagnosis, depression severity and positive airway pressure (PAP) adherence.

Methods

Patients were seen at the University of California, San Francisco Fresno sleep center. PHQ-9 scores for depression severity uses a 1-5 scale (1 = none, 2 = mild, 3 = moderate, 4 moderately severe, 5 = severe). PHQ-9 was administered at diagnosis of OSA and follow up, and average daily PAP usage was obtained from PAP devices after 1 month of therapy initiation. IBM SPSS version 29.0.0 was used to calculate descriptive statistics, Pearson correlation and Mann Whitney test.

Results

Twenty-six participants were included with mean age 53.04 years and standard deviation (SD) 17.97. PHQ-9 scores ranged 4-27 with mean 10.6, SD 5.9, 40% with mild and 66.3% with moderate to severe scores. 53.8% were 50 years or older (“older”) while 46.2% were 49 years or younger (“younger”). Pearson correlation between average CPAP use and PHQ-9 scores was 0.181. Age did not affect PAP adherence (Pearson correlation -0.046). Moderate correlation was noted between age and PHQ-9 scores (-0.4390) with younger patients showing more severe depression scores. Comparison between “older” and “younger” patients showed significant difference in PHQ-9 scores (p=0.020).

Conclusion

This study showed that PHQ-9 scores at the time of OSA diagnosis are moderately correlated with younger age, with those patients younger than 50 years old having more moderate to severe PHQ-9 scores than patients 50 years or older. We did not find correlation between age and PAP adherence or between PHQ-9 scores and PAP adherence. Our findings can help identify depression early on in the diagnosis of obstructive sleep apnea and bring awareness that the young adult population can be particularly vulnerable.

Support (if any)
0635 Associations Between Ambient Light Exposure and Development of Depressive Symptoms in Women at Risk for Postpartum Depression
Authors: Sharkey Katherine , St. Hilaire Melissa
Published: May 2023

Introduction

There is increasing recognition that ambient light exposure plays a critical role in daytime functioning, including mood regulation. In this analysis, we examined associations between 24-hour light exposure patterns and mood in women at risk of developing postpartum depression.

Methods

Perinatal women ages 18-40 with a history of major depressive disorder or bipolar disorder who did not meet criteria for depression at study enrollment during 3rd trimester wore wrist actigraphs that recorded ambient light levels for one week at 3rd trimester (~33 weeks’ gestation) and again during postpartum weeks 2, 6, and 16. Depressive symptoms were assessed with the Hamilton Depression Rating Scale (HAM-D-17) at the end of each recording week. To summarize the light data, we calculated the arithmetic mean of the log-light levels in twenty-four 60-minute bins across each day and then aggregated each hour across each recording week. We used nonlinear model fitting (cosinor) to calculate area under the curve (AUC) and compared 24-hour and morning (8:00 am to 12:00 pm) light exposure patterns between women with elevated depression symptoms at week 16 (HAM-D-17 > 7) and women with low depression symptoms at study entry and week 16 (HAM-D-17 <=7) using Mann-Whitney U-tests.

Results

Compared with women who did not become depressed (n=15), those who ultimately developed depression (n=8) had significantly lower morning light exposure at 3rd trimester and at postpartum week 6, but not at postpartum week 16. Effect sizes were moderate at 3rd trimester (eta-squared=0.30) and small at Week 6 (eta squared=0.24). There were no significant differences in the overall 24-hour AUC of light exposure between participants who developed significant depressive symptoms at postpartum week 16 and non-depressed women at any time point [3rd trimester: p=0.35; postpartum week 6: p=0.92; postpartum week 16: p=0.35].

Conclusion

In this sample of perinatal women at risk for postpartum depression, new mothers who developed clinically-significant depressive symptoms at postpartum week 16 had lower levels of morning light exposure during 3rd trimester and at 6 weeks postpartum. Lower peripartum morning light exposure may predict the development of postpartum depression.

Support (if any)

MH086689 to KMS
0637 Associations Between Sleep Quality and Child Behavioral Problems, a Longitudinal Analysis
Authors: Tussey Emma , Wong Maria
Published: May 2023

Introduction

Internalizing and externalizing behaviors are important mental health outcomes in children. Internalizing symptoms are characterized by a disturbance in mood or emotion. Symptoms include loneliness, sadness, anxiety, rumination, and depression. Externalizing symptoms are behaviors that are aversive to others and experienced by other people. Symptoms include aggression, hyperactivity, property destruction, and losing one’s temper. This longitudinal analysis examined how children’s sleep quality related to their internalizing and externalizing behaviors.

Methods

246 Children (n = 246 at T1, n = 196 at T2, n = 151 at T3), with a mean age of 9.9 (SD = 1.4) at time one, participated in a longitudinal study on sleep and substance use. Sleep quality was measured with the Adolescent Sleep Wake Scale (range 1-6); higher scores represent better sleep quality. Child internalizing and externalizing behavior problems were measured using the Childhood Behavior Checklist; higher scores indicate higher levels of behavioral problems. The associations between sleep quality, and internalizing and externalizing behavior at T1, T2, and T3 were examined. One year separated each time-point. Data were analyzed by structural equation modeling. Latent variables of sleep quality, internalizing, and externalizing were created from the observed measurements at the three time-points. Latent variables of internalizing and externalizing were regressed on sleep quality.

Results

The model indicated an excellent fit with the data (χ2 = 21.94, p = 0.46; CFI = 1.00; TLI = 1.00; RMSEA = 0.00). All observed variables loaded significantly onto their respective latent variables, internalizing, externalizing, and sleep quality (p < 0.001). Results indicated that the latent variable of sleep quality predicted both the latent variables of internalizing (b = -0.34, se = 0.09, p < 0.001) and latent externalizing behaviors (b = -0.31, se = 0.08, p < 0.001).

Conclusion

These results indicate children with better sleep quality have fewer internalizing and externalizing behavioral problems. This suggests that improving sleep quality could improve behavioral problems in children. Alternatively, improving behavioral problems may improve sleep quality. Future research should examine the directionality of this relationship. Future research should also test if sleep or behavioral interventions improve sleep quality and child behavioral problems.

Support (if any)

NIH Grant R01 AA020364
0642 Effect of Iloperidone on Sleep Symptoms in Bipolar Patients with Manic and Mixed Episodes: A Randomized, Placebo Controlled Study
Authors: Torres Rosarelis , Smieszek Sandra , Xiao Changfu , Czeisler Emily , Polymeropoulos Christos , Birznieks Gunther , Polymeropoulos Mihael
Published: May 2023

Introduction

Iloperidone, a dopamine D2 receptor and serotonin 5HT2A receptor antagonist, was evaluated for the treatment of acute manic and mixed episodes associated with bipolar I disorder in adults in a phase 3 clinical trial. A core symptom of bipolar I disorder is disturbance in sleep. During manic episodes this commonly presents as reduced need for sleep with studies finding that 69%–99% of bipolar individuals report a lessened need for sleep or difficulties in falling and/or staying asleep. Here we present a post hoc analysis evaluating iloperidone effects on the sleep component of the Young Mania Rating Scale (YMRS) in patients with bipolar I disorder which addresses both sleep and the reduced need for sleep in that component.

Methods

This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group study of iloperidone in patients with acute manic or mixed episodes associated with bipolar I disorder. Patients received four weeks of double-blind treatment. The primary analysis demonstrating an overall improvement from baseline YMRS score in iloperidone assigned patients versus placebo assigned patients (p = 0.000008) at the end of the study (week 4). A YMRS item level analysis evaluated changes on YMRS single items including the sleep component in the intent-to-treat population (N = 392) using a mixed-effects model for repeated measures approach.

Results

The least squares mean difference (LSMD) in change from baseline to day 28 was statistically significant on the YMRS sleep component in favor of iloperidone versus placebo (iloperidone = -1.26, placebo = -0.95; p = 0.008).

Conclusion

In addition to improving overall mania symptoms as reported by the YMRS, improvements were also seen in iloperidone treated patients in the sleep component which at baseline included assessments of both decreased sleep and decreased need or denial of the need for sleep.

Support (if any)

This work was supported by Vanda Pharmaceuticals Inc.
0643 Machine Learning Model to Predict Depressive Mood Using Graph Theory Analysis of Polysomnography
Authors: Kim Seung Soo , Yang Kwang Ik
Published: May 2023

Introduction

The authors conducted this preliminary study to discover the brain signal features for subjective depressive mood by the method that combines a machine learning approach and a graph theory analysis.

Methods

The authors retrospectively investigated the records of 13 subjects who had undertaken polysomnography (PSG) and patient health questionnaire-9 (PHQ-9). We divided the data to a training set (10 subjects) and a test set (2 subjects). The predictive modeling was conducted by 3 steps: 1) estimation of the small world coefficient (sigma, omega) of each frequency bands (delta: 0.5-4.0 Hz, theta: 4.0-8.0 Hz, alpha: 8.0-12.0 Hz, sigma: 12.0-16.0 Hz, beta: 16.0-30.0 Hz, gamma: 30.0-100.0 Hz) of electroencephalography (EEG) channel for N1 and N2 sleep, 2) training predictive models, and 3) evaluation of final performance of model by using test set. The authors used mean absolute error (MAE) and mean squared error (MSE) as evaluation metrics. The training was conducted using Python 3.8, and its libraries (MNE-Python, MNE-connectivity, NetworkX, xgboost scikit-learn).

Results

Median value of PHQ-9 score was 6.0 (interquartile range: 5, 8). Lasso regression model showed good performance (MAE 0.6, MSE 0.4). XGBoost model also showed good performance (MAE 0.8, MSE 1.3).

Conclusion

Lasso regression model using small world coefficient of EEG in overnight PSG showed good predictive value for PHQ-9. The further research using a sufficient sample is needed.

Support (if any)
0644 Poor Sleep Quality Predicts Worse Mood Symptoms in Adolescents with Bipolar Disorder: A Longitudinal Randomized Controlled Trial
Authors: Stepan Michelle , Teresi Giana , Franzen Peter , Rode Noelle , Goldstein Tina
Published: May 2023

Introduction

Adolescents with bipolar disorder are at ultra-high risk of suicide and poor psychosocial functioning. Sleep is impaired during periods of depression, mania, and euthymia in adults with bipolar disorder and may be a transdiagnostic risk factor for new onset of mood symptoms. Sleep worsens during adolescence, but less is known about the interrelationships between poor sleep and mood symptoms in adolescents with bipolar disorder.

Methods

Participants included adolescents with bipolar disorder (n=75, 12-18 years, 65 females) who consented to a randomized controlled trial of Dialectical Behavior Therapy (DBT) vs. Standard of Care (SOC; other evidence-based psychotherapy approaches) at a specialty psychiatric clinic. Participants completed seven assessment visits, five during the year-long treatment period (baseline, 3-months, 6-months, 9-months, 12-months) and two during the post-treatment follow-up (18-months, 24-months). During each visit, participants completed the Pittsburgh Sleep Quality Index (PSQI) and a semi-structured interview to obtain weekly clinician-rated mood symptom ratings for depression, hypomania, and suicidal ideation.

Results

Most participants (75.9%) had a PSQI score >5 at baseline, reflecting poor sleep quality (M=8.86, SD=4.30). Sleep quality improved between baseline and 3-months (Mdiff=-2.01, p=.006) and remained stable thereafter but did not differ between treatment groups. Lag analyses examined whether sleep quality predicted the next month’s average mood symptom ratings. Across treatment group, sleep quality at 6-months predicted next month depression, hypomania, and suicidal ideation severity (ps<.032). For DBT, sleep quality at baseline predicted next month suicidal ideation severity (p=.047), and sleep quality at 9-months predicted next month hypomania severity (p=.003). For SOC, sleep quality at 6-months predicted next month depression severity (p=.027), and sleep quality at 9-months predicted next month suicidal ideation severity (p=.005). Worse sleep quality predicted worse future mood symptoms for all significant lagged effects.

Conclusion

Sleep quality is poor among adolescents with bipolar disorder. Sleep quality predicted future mood symptoms, suggesting that poor sleep may causally contribute to worse mood symptoms, particularly mid to late treatment. Thus, poor sleep could be a critical therapeutic target in future treatments to further improve mood symptoms in this population.

Support (if any)

R01 MH100056.
0646 Psychological distress as predictors of disturbed sleep among college students
Authors: Watson Kennedi , Ji Xiaopeng , Covington Lauren , Brownlow Janeese
Published: May 2023

Introduction

Poor sleep quality is prevalent among college students and has a significant impact on their daily activities. Further, college students are under extreme pressure to excel in an academic, occupational and social context, and psychological distress often exacerbate sleep quality. This study aimed to examine relationships between psychological stress and sleep quality among undergraduate students.

Methods

Baseline data were obtained from students who completed self-report measures as part of a larger study (n=56; mean age 20.23 (1.5); 83.9% females). Poor sleepers were categorized when participants had at least 2 of the following indicators: excessive daytime sleepiness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), and poor sleep quality (Pittsburgh Sleep Quality Index). The Beck Depression Inventory-II assessed depressive symptoms, the PCL-5 determined posttraumatic stress disorder (PTSD) symptomatology, and the Generalized Anxiety Disorder-7 (GAD) scale assessed for anxiety symptoms. Binary logistic regression analyses identified the association between poor sleepers, PTSD, GAD, and depressive symptoms, while adjusting for sex and body mass index (BMI).

Results

Approximately 33.9% of students experienced excessive daytime sleepiness, 30.4% suffered from insomnia, 89.3% had poor sleep quality, and 62.5% of the sample experienced one or more psychological stressors. Forty-eight percent of the students were categorized as poor sleepers. Using binary logistic regression, after adjusting for sex and BMI, students who experienced PTSD (OR= 1.075, 95%CI [1.023, 1.130]), GAD (OR=1.227, 95%CI [1.072, 1.406]), and depressive (OR=1.105, 95%Cl [1.023, 1.192]) symptoms had an increased risk for being poor sleepers.

Conclusion

Findings indicate that mental health is a core component of well-being and sleep health, and that early assessment and treatment of psychological distress may be an important strategy for intervention of poor sleep quality and disturbed sleep among college students.

Support (if any)

This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
0647 Rest-activity pattern in Major depressive disorder - a case control study
Authors: Chen Jie
Published: May 2023

Introduction

Disruption of rest-activity pattern are important behavioral manifestations in patients with major depressive disorder (MDD). Actigraphy provides accessible and objective measurement on physical activity, sleep, and circadian rhythm, but it was not widely used in studying patients with MDD, especially among Asian population.

Methods

Rest-activity pattern was recorded by Actiwatch Spectrum Plus/PRO for 7 continuous days. Physical activity and sleep estimation was processed by Philips Actiware software 6. Circadian rhythm characteristics were generated by using the “cosinor” and “nparACT” packages in R to perform the cosinor and nonparametric analysis respectively.

Results

A total of 70 MDD subjects, and 59 age- and sex-comparable controls were included in the actigraphy data analysis. The mean age of MDD subjects was 51.24 ± 10.39 years, and 71.4% of MDD subjects were female. Of these MDD subjects, 54.3% were unremitted for their depressive illness. For sleep and circadian features, MDD subjects had higher Insomnia Severity Index (ISI score, MDD: 10.29 ± 5.70; controls: 6.05 ± 5.20, P < 0.001) and lower reduced Morningness-Eveningness questionnaire (rMEQ score, MDD: 13.19 ± 4.62; controls: 16.07 ± 3.28, P < 0.001) than controls. The percentage of mobility measured by actigraphy was significantly lower in MDD patients than controls (MDD: 58.58%; controls: 62.27%, P < 0.001), albeit the difference only occurred during rest period. MDD subjects had later acrophase (P = 0.024), M10 midpoint (P = 0.040) and a trend of delayed sleep midpoint (P = 0.076) and longer sleep duration (P = 0.067) than controls. When the comparison was performed among three groups, unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint than remitted MDD group (P = 0.021) and higher intra-individual variability for sleep duration than controls (P = 0.016).

Conclusion

MDD subjects had increased insomnia and eveningness than controls, which was supported by the acitgraphy data at which MDD had a tendency of longer major rest interval and delayed circadian phase. Unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint and sleep duration. These actigraphy parameters may be useful markers for phenotyping and monitoring of MDD.

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0648 Retinal responsivity is associated with light and season-related cognitions in older adults with seasonal depression
Authors: Klevens Alison , Wescott Delainey , Taylor Maddison , Roecklein Kathryn
Published: May 2023

Introduction

Maladaptive cognitions associated with lower light availability in winter and the changing of the seasons are elevated in winter depression and are treatment targets in psychotherapy. Mechanisms underlying the development of SAD-specific cognitions may be related to seasonal variation in melanopsin-driven retinal responsivity to light. Prior work has shown reduced retinal responsivity to light during the winter in seasonal depression. We hypothesized maladaptive seasonal cognitions would be associated with reduced retinal responses to light. We also tested whether age moderated this relationship, hypothesizing that this learned association may only appear in older individuals who have experienced a greater number of seasonal depressive episodes.

Methods

Participants ages 19-65 (M=36.13, SD=12.81) with seasonal depression (n=37) and non-depressed controls (n=32) completed assessments in winter months (21st December to 21st March). Maladaptive seasonal cognitions were measured by the Seasonal Beliefs Questionnaire (SBQ). Melanopsin-driven retinal responsivity was assessed using the post illumination pupil response (PIPR). Net PIPR as a percent of baseline was averaged across the 10-30 seconds post-stimulus for use in analyses. Using multiple regression, we tested (1) if seasonal beliefs predict the PIPR and (2) if an interaction between seasonal beliefs and age predicts the PIPR, controlling for gender, the pupillary light reflex (PLR), and circadian time of testing from Dim Light Melatonin Onset.

Results

Seasonal beliefs were not associated with the PIPR (b= -0.86e-5, SE=0.27e-3, p=0.98). There was a significant interaction between seasonal beliefs and age on the PIPR (b= -0.56e-4, SE=0.23e-4, p=0.02), in which greater seasonal beliefs were associated with reduced PIPR in older individuals but not younger individuals. The Johnson-Neyman interval indicated that in participants above age 49, greater seasonal beliefs were significantly associated with lower retinal responsivity (PIPR; p< 0.05).

Conclusion

Greater seasonal beliefs were associated with reduced retinal responsivity, but only in older adults with seasonal depression. It is possible that reduced retinal responsivity creates learned maladaptive schemas regarding seasonal changes that are reinforced with annually recurring winter depressive episodes. However, longitudinal data focused on changes in seasonal beliefs resulting from reduced retinal sensitivity is necessary to test whether retinal responsivity is a mechanism in the formation of these seasonal-specific cognitions.

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0650 Sleep and Mental Health Symptoms at the Population Level: Differences by Race/Ethnicity
Authors: Ghani Sadia B , Valencia Dora , Jean-Louis Girardin , Killgore William D S , Grandner Michael
Published: May 2023

Introduction

There is a bidirectional relationship between sleep duration and mental health. This relationship may be impacted by race/ethnicity, indicating differential risk profiles across groups. Therefore, we aimed to determine whether race/ethnicity play a role in the relationship between sleep and mental health at the population level.

Methods

Data were used from adults age 18+ from the combined 2015-2020 (pre-pandemic) National Health and Nutrition Examination Survey (NHANES) (N=16,399). Habitual sleep duration was self-reported in half-hour increments and categorized as < 5h, 5.5-6.5h, 7-8h, 8.5-9.5h, or 10+h. Mental health symptoms in the past 2 weeks were reported as “not at all,” “several days,” “>half of days” or “nearly every day” and included depressed mood, anhedonia, feelings of guilt, appetite dysregulation, and suicide ideation. Race/ethnicity was self-reported as Non-Hispanic White (N=5499), Black/African-American (N=3975), Mexican-American (N=2337), Other Latinx (N=1846), Asian/Pacific-Islander (N=1984), or Multiracial/Other (N=758). Additional covariates included age and sex. NHANES sample weights were used for all analyses. Ordinal logistic regressions examined mental health outcomes associated with sleep duration stratified by race/ethnicity.

Results

Sleep duration by race/ethnicity interactions were seen for depression (p=0.006), guilt (p=0.009), appetite dysregulation (0.049), and suicide ideation (p< 0.0005), with a trend for anhedonia (p=0.185). Non-Hispanic Whites demonstrated U-shaped relationships with all mental health variables. Blacks/African-Americans demonstrated U-shaped relationships for depressed mood and anhedonia and relationships with short sleep for guilt, appetite, and suicide ideation. Mexican Americans demonstrated a U-shaped association with guilt and an association between long sleep and depressed mood, anhedonia, and suicide ideation. Other Latinx showed a U-shaped association with guilt and appetite, and long sleep relationships with depressed mood, anhedonia, and suicide ideation. Asians/Pacific-Islanders showed short sleep associations with depressed mood and appetite. Multiracial/Others showed a short sleep relationship with guilt and a long sleep relationship with suicide ideation.

Conclusion

Both short and long sleep duration were associated with worse mental health. However, this pattern of relationships depends on race/ethnicity, as different groups show different patterns of vulnerability. Future work should explore mechanisms of differential vulnerability and develop targeted interventions based on risk profile.

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0651 Sleep Reactivity as a Vulnerability Factor for Depressive Symptoms
Authors: Egeler Mara , Dickens Harrison , Hire Veronica , Walker Jamie , Vargas Ivan
Published: May 2023

Introduction

Insomnia and depression are closely linked. While poor sleep is often classified as a symptom of depression, research now supports that insomnia often precedes and predicts the onset of depression. One factor that may explain this relationship is sleep reactivity, or the tendency to experience sleep disturbances in response to stressful life events. Sleep reactivity is considered a vulnerability factor for insomnia. This study aimed to replicate recent findings that suggest sleep reactivity is also independently related to depression.

Methods

Survey data was collected from 236 U.S. adults (69.1% White, 61.9.3% Female, 18-85 y) regarding demographic information, sleep patterns, and general health and well-being. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD). Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). Sleep reactivity was assessed using the Ford Insomnia Response to Stress Test (FIRST). A hierarchical multiple regression was conducted with total CESD scores as the dependent variable. Total ISI scores and gender were entered as covariates in model 1 and total FIRST scores as the predictor variable in model 2.

Results

The fitted regression for model 1 was statistically significant (R2 = 0.37, F(2,233) = 64.47, p < .001). It was found that both greater ISI and being female gender predicted depression scores (β = 1.04, p < .001, and β = 1.64, p = .05). For model 2, the regression was also significant (R2 = 0.38, F(3,232) = 47.60, p < .001). Greater FIRST scores were related to greater depressive symptoms (β = 0.23, p = .02), even after controlling for both insomnia symptoms and gender.

Conclusion

Sleep reactivity is independently related to depression symptoms, independent of insomnia. Future studies examining how multiple types of stress reactivity impact an individual’s risk for developing depression should be considered.

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K23 HL141581
0654 TRAUMA LEADS ASSOCIATION BETWEEN SLEEP AND SUICIDAL IDEATION IN YOUTH
Authors: Vera Miranda , Miranda Regina , Dennis-Tiwary Tracy , Baroni Argelinda
Published: May 2023

Introduction

Sleep disturbances are established risk factors for youth suicidal ideation. Trauma is known to exacerbate sleep disturbances and suicide ideation severity. Given these relationships, it is worth examining the impact of trauma on the association between sleep and suicidal ideation as little research to date has explored this relationship in youth. The current study addresses this knowledge gap by investigating how trauma impacts youth suicidal ideation via sleep in an acutely suicidal, clinical sample of adolescents.

Methods

113 adolescents between ages 12 and 17 years old (M = 14.6, SD = 2.2) were recruited after presenting to public New York City hospitals for suicidal ideation or a suicide attempt within the preceding 2 weeks. This clinical sample is diverse, with 76% identifying as a racial minority, 61% as a Hispanic/Latino, 87% as a gender minority, and 75% as a sexual minority. Participants completed self-report measures via an online questionnaire measuring their suicide ideation severity (Suicidal Ideation Questionnaire-Junior; SIQ-JR), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and trauma symptoms (Child Trauma Screen; CTS). Partial correlations were conducted to examine the relationship between sleep quality and suicide ideation severity controlling for trauma symptoms.

Results

As expected, poorer sleep quality was associated with greater suicide ideation severity (r[103] = .244, p = .012). However, this association disappeared when controlling for trauma symptoms (r[102] = .064, p = .516). Of the 7 PSQI subscores, sleep quality, sleep latency, and daytime dysfunction correlated significantly with suicide ideation severity (r[103-110] = .195-.298, p = .001-.039). Ninety-percent of participants reported trauma symptoms.

Conclusion

These findings suggest that trauma affects the association between sleep and suicidal ideation. However, given the prevalence of trauma symptoms in this sample, future research should seek to differentiate sleep and trauma effects on suicidal thoughts and behaviors and how specifically targeted treatments may ameliorate outcomes.

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1RF1MH120846 from NIMH/NIH (Regina Miranda, PI)
0655 Whose Mind after Midnight? Demographic and Clinical Variation in Nocturnal Suicide Risk
Authors: Gorovoy Suzanne , Tubbs Andrew , Fernandez Fabian-Xosé , Klerman Elizabeth , Basner Mathias , Chakravorty Subhajit , Perlis Michael L , Grandner Michael
Published: May 2023

Introduction

Although suicides are more prevalent during the day, the risk of suicide is highest at night when adjusted for population wakefulness. It is unclear how nighttime patterns of suicide risk vary by demographic and clinical subgroups.

Methods

Population wakefulness data were combined with time of fatal injury data for 78,647 suicides from 2003-2017. The primary outcome was number of suicides per hour with wakefulness as an offset/exposure term. Subgroups included sex, race, ethnicity, military service, blood alcohol category and marijuana positive on autopsy, current depressed mood or partner conflict, and prior suicidal ideation or suicide attempts. Formal interaction tests identified significant subgroup variations adjusted for age, sex, race, and ethnicity where appropriate. Groups with significant interactions were subsequently examined using robust Poisson regression models to measure incident risk ratios (IRRs).

Results

There were subgroup interactions for age (p < 0.001), ethnicity (p = 0.014), blood alcohol level on autopsy (p < 0.001), and current partner conflict at time of fatal injury (p < 0.001). There was a sharp peak in risk around 4AM for individuals aged 15 to 24 (aIRR: 3.11 [2.39, 4.05]) and 25-34 (aIRR 2.15 [1.63, 2.86]), and at 6AM for individuals aged 65 to 74 (aIRR: 1.78 [1.40, 2.25]) and 75+ (aIRR: 2.25 [1.69, 3.00]). Hispanic individuals had an elevated risk between 10PM and 3AM with a maximal 232% increase at 2am (aIRR: 2.32 [1.67, 3.23]). Current partner conflict increased risk from 8PM to11PM and from 1AM to 3AM with a peak risk at 11PM (aIRR: 1.53 [1.24, 1.89]). Individuals with a BAL < 0.08 mg/dL showed a sustained increased risk for suicide between 8PM and 4AM; individuals with a BAL of 0.08 mg/dL or more showed greater risk (aIRR 2.33 [1.88, 2.89] at 1AM) than those with a BAL < 0.08 mg/dL (aIRR: 1.68 [1.40, 2.01] at 12AM).

Conclusion

Nighttime suicide risk varied significantly by age, ethnicity, blood alcohol level on autopsy, and current partner conflict. Military service was not associated with greater nighttime risk, which contrasts with prior findings.

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0657 Incidence and Features of Nightmares and Trauma Associated Sleep Disorder in U.S. Military Personnel with Sleep Disturbances
Authors: Tchopev Zahari , Jacobus Brent , Hansen Shana , Mysliwiec Vincent , Brock Matthew
Published: May 2023

Introduction

The incidence and clinical significance of nightmares is difficult to estimate due to varying criteria across studies. The Nightmare Disorder Index (NDI) is a validated measure to evaluate nightmare disorder. However, there is no measure to differentiate trauma-related nightmares compared to trauma associated sleep disorder (TSD), a unique REM parasomnia. The objectives of this study were to (1) determine the incidence of nightmare disorder and TSD in patients referred for a clinically indicated sleep evaluation, and (2) further characterize TSD.

Methods

All initial sleep referrals completed intake questionnaires including validated measures such as the NDI, Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI). Patients who endorsed at least weekly nightmares related to trauma, with vocalizations or disruptive nocturnal behaviors, and autonomic surges additionally received a structured clinical interview focusing on thematic content of dreams, dream enactment behavior, self-reported symptoms of autonomic hyperactivity, and, if previously treated, nightmare severity before and after therapy.

Results

102 new patients completed the NDI and 56.9% (58) met criteria for probable nightmare disorder (ND). Of the 58 patients with probable ND, 13.8% (8) had symptoms consistent with TSD (7.8% of new referrals). Compared to ND patients, TSD patients were more likely to have higher ISI (24.0 ± 3.0 vs. 18.6 ± 5.6) (p=0.023) and total NDI score (15.8 ± 3.5 vs. 10.0 ± 3.7) (p< 0.001), but not ESS (p=0.158). Structured interview revealed all TSD patients had significant daytime distress or impairment. The nature of trauma was combat for 3 individuals, physical assault for 1, and sexual assault for 4 (one occurring while deployed). All individuals reported tachycardia secondary to nightmares and tachypnea and diaphoresis were each reported in 75% of patients. Regarding dream content, 25% endorsed accurate replay of trauma, 25% related to trauma but non-replay, and 50% mixed. For DNB, 87.5% of patients endorsed vocalization (moaning, screaming, or yelling), 87.5% endorsed movements (tossing, turning, or thrashing), and 37.5% endorsed combative behaviors (striking of bed partner).

Conclusion

This study reports a surprisingly high incidence of probable ND among all new sleep medicine patients. TSD appears to be a clinically distinct, more severe parasomnia compared to ND.

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