bluuebunny/crossref_metadata_2025 huggingface dataset:
0060 Morning Locus Coeruleus Activation During the PVT Predicts Later-Day Sleepiness
Authors: Lei H , Quan P , Liu W , Zhang X , Chai Y , Yang F , Dinges D , Rao H
Published: May 2020

Introduction

The locus coeruleus (LC) plays a key role in the regulation of arousal and autonomic function. Homeostatic sleep pressure refers to the drive for sleep that increases as a saturating exponential when we stay awake and decreases exponentially when we sleep. The current study used arterial spin labeling (ASL) functional magnetic resonance imaging (fMRI) to investigate the relationship between homeostatic sleep pressure (sleepiness) and LC activity during the psychomotor vigilance test (PVT).

Methods

We analyzed sleepiness and ASL imaging data from N=70 health adults (40 males, age range 21–50 years) who participated in a controlled in-laboratory sleep study. All participants were scanned at rest and during the PVT on the morning between 0700h-1000h after 9 hour time-in-bed (TIB) baseline sleep. LC regions-of-interest (ROI) were defined by standard templates from Keren et al. (2009). Sleepiness was assessed by the Karolinska Sleepiness Scale (KSS) every two hours from 10:30 am to 10:30 pm.

Results

Sleepiness scores gradually increased over wakefulness time and reached its peak in the evening at about 10:20pm. PVT-induced CBF changes did not correlate with sleepiness scores on the morning (p > 0.05), but showed significant negative correlations with sleepiness scores on later day when sleep pressure became higher, especially during the night-time (r = -0.41, p < 0.001). Specifically, LC CBF showed significant increases during the PVT scan as compared to the resting scan (p = 0.04) in individuals with less nigh-time sleepiness (KSS < 4), but no differences (p > 0.1) in individuals with greater nigh-time sleepiness (KSS ≥ 5). After controlling for age, gender, and total sleep time, PVT-induced regional CBF difference in the LC still negatively predicted sleepiness (β = -0.325, p = 0.005).

Conclusion

Our findings showed that individuals with greater LC CBF increases during the PVT were less sleepy during the night, supporting the key role of LC activity in promoting wakefulness and maintaining sleep homeostasis. PVT-induced LC activation may provide a non-invasive bio-marker of homeostatic sleep pressure in healthy adults.

Support

Supported in part by NIH grants R01-HL102119, R01-MH107571, R21-AG051981. CTRC UL1RR024134, and P30-NS045839.
0068 Circadian Alignment Predicts Neural Response to Monetary Reward in Late Adolescent Drinkers
Authors: Hasler B P , Soehner A M , Ngari W , Clark D B
Published: May 2020

Introduction

Abundant evidence from animal models implicates the circadian system in modulating the brain’s reward circuitry, but evidence in humans has been more limited. In particular, published evidence has relied on self-report and/or behavioral proxies of circadian misalignment and cross-sectional designs. Here, we employed objective measures and a prospective design to assess whether circadian alignment predicts the neural response to reward in a sample of late adolescent drinkers.

Methods

Participants included 23 late adolescents (18–22 y/o; 14 females) reporting weekly alcohol use. Participants completed pre-weekend (Thursday) circadian phase assessments via the dim light melatonin onset (DLMO). Sleep-wake timing was assessed via wrist actigraphy (midpoint of sleep on Tuesday and Wednesday prior to DLMO assessment). Circadian alignment was operationalized as the DLMO-midsleep interval. Neural response to reward was assessed via a card-guessing monetary reward fMRI task; analyzed on reward anticipation and reward win relative to neutral conditions. Mean BOLD signal was extracted from two regions-of-interest (striatum and medial prefrontal cortex, mPFC) for analyses in regression models, accounting for sex and scan order (participants also completed scans on Monday in counterbalanced order, not reported here).

Results

Shorter DLMO-midsleep intervals (i.e., greater misalignment) predicted lower striatal response to anticipated reward (beta=0.48,p=0.02) and showed a trend towards predicting lower mPFC response to anticipated reward (beta=0.39,p=0.06). No statistically-significant effects were found for reward win. Notably, a lower striatal response to anticipated reward correlated with more binge-drinking episodes in the past 30 days, but was not associated with alcohol use in the weekend immediately following the scan.

Conclusion

Our findings provide preliminary evidence of proximal associations between objectively-determined circadian alignment and the neural response to anticipated monetary reward. Ongoing work in a larger sample of adolescents aims to replicate this finding and more definitively determine its relevance to adolescent drinking.

Support

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R21 AA023209; R01 AA025626).
0069 Sleep in Drosophila is Regulated by the Chromatin Remodeling Factor ISWI
Authors: Gong N N , Dilley L C , Moscato E H , Williams C E , Kayser M S
Published: May 2020

Introduction

Sleep is commonly disrupted in patients with neurodevelopmental disorders (NDDs). Despite strong clinical associations between disrupted sleep and other NDD symptoms, we lack an understanding of how these are pathophysiologically related. Drosophila melanogaster exhibit essential characteristics of human sleep and have well-defined neural circuits underlying learning and social behaviors. This represents an ideal system to investigate the mechanistic interaction between disrupted sleep and other behavioral dysfunctions in NDDs.

Methods

We performed a reverse genetic RNAi-based screen targeting Drosophila homologs of human genes within NDD-associated risk loci. Pan-neuronal knockdown of risk genes was achieved using the Gal4-UAS system.

Results

Pan-neuronal knockdown of ISWI led to dramatic deficits in sleep and circadian arrhythmicity in the adult fly. Across species, ISWI and its homologs are ATP-dependent chromatin remodelers that regulate gene expression important for neural differentiation. We found that depleting ISWI also leads to memory and social deficits. ISWI functions during dissociable temporal windows of pre-adult development and in different circuits to establish different adult behaviors. The sleep phenotype associated with ISWI knockdown mapped to a specific population of cells. RNA-Seq of developing brains during the window important for sleep deficits revealed significant transcriptional changes in genes associated with nervous system development, suggesting ISWI acts in the development of sleep regulatory circuits. Finally, mutations in the human homologs of ISWI, SMARCA1/5, have been implicated in NDDs. Expressing either SMARCA1/5 in the setting of ISWI knockdown differentially rescued adult deficits.

Conclusion

Identification of ISWI provides a platform for unraveling pleiotropic behavioral effects from an NDD risk gene. Sleep, circadian rhythms, memory, and social behaviors are affected by ISWI knockdown, and map to different developmental periods and circuits. In addition, SMARCA1/5 differentially rescue adult behaviors, suggesting NDD-causing mutations in these genes may affect different behaviors. Current work aims to determine how human mutations in SMARCA1/5 affect behaviors.

Support

This work was supported by NIH K08 NS090461 (MSK) and T32 HL007953 (NNG), Hearst Foundation Fellowship 2018 (NNG), Burroughs Welcome Career Award for Medical Scientists, March of Dimes Basil O’Connor Scholar Award, and Sloan Research Fellowship (MSK).
0076 The Role of Preoptic Area GABAergic Axonal Projections to Tuberomammillary Nucleus in Sleep Homeostasis
Authors: Maurer J , Covarrubias I , Baik J , Weber F , Chung S
Published: May 2020

Introduction

Sleep deprivation has profound widespread physiological effects including cognitive impairment, compromised immune system function and increased risk of cardiovascular disease. The preoptic area (POA) of the hypothalamus contains sleep-active GABAergic neurons that respond to sleep homeostasis. We have shown that activation of POA GABAergic axons innervating the tuberomammillary nucleus (TMN, GABAergicPOA ->TMN) are critical for sleep regulation but it is unknown if these projections modulate sleep homeostasis.

Methods

To monitor in vivo neural activity of GABAergicPOA ->TMN projection neurons during sleep deprivation and rebound, fiber photometry was used. GAD2-Cre mice (n=6) were injected with AAV-DIO-GCaMP6S into the POA and an optic fiber was implanted into the TMN. An electroencephalogram (EEG) and electromyography (EMG) implant was mounted upon the skull to identify brain states. Calcium activity was measured for six hours starting at ZT4. Each mouse was recorded for three days to establish baseline sleep calcium activity with at least two days between sessions. During sleep deprivation sessions, an experimenter sleep deprived each mouse starting at ZT0 for six hours by gently brushing the animal with a small paintbrush to maintain wakefulness and minimize the stress to the animal.

Results

During baseline sleep recordings, GABAergicPOA ->TMN projection neurons are most active during sleep (NREM and REM) which is maintained until wake onset. As sleep pressure increases, GABAergicPOA ->TMN projection neurons display gradual increase in neural activity compared to time-matched points during baseline sleep recordings. Once mice were permitted to enter sleep rebound, GABAergicPOA ->TMN projection neurons gradually displayed decreased activity as sleep pressure eased.

Conclusion

GABAergicPOA ->TMN projection neurons show a strong increase in activity to drive homeostatic sleep need during periods of increased sleep pressure but subside once this pressure is reduced.

Support

This work is supported by NIH grant R01-NS-110865.
0077 Objective Sleep and Neural Response to Thermal Pain Testing Following Cognitive Behavioral Treatment in Patients with Comorbid Insomnia and Fibromyalgia: A Pilot Study
Authors: McCrae C , Craggs J , Curtis A , Staud R , Berry R , Robinson M
Published: May 2020

Introduction

Fibromyalgia (FM) is characterized by high rates of insomnia and abnormal central pain processing/heightened response to stimuli (i.e., central sensitization). This study examines whether cognitive behavioral treatments (CBTs) that target insomnia and pain improve central pain processing [indicated by decreased response to quantitative sensory testing (QST) using thermal stimuli] in patients with fibromyalgia and insomnia.

Methods

Before and after CBT-I, CBT-P or waitlist, adults (N=32, Mage=55.9, SD=12.2) with FM and insomnia completed QST during fMRI (Phillips Achieva 3T scanner), 14-daily pain ratings [least(0)-most(100) intense pain imaginable] and 1-night in-home polysomnography (AURA/Grass Technologies). Imaging data were processed using Brain Voyager (Brain Innovation/Netherlands). Random effects ANCOVA identified regions with significant group (3-CBT-I, CBT-P, waitlist) by time (baseline, post-treatment) interactions in brain hemodynamic response to QST. Linear regressions (using residualized change scores) were conducted for each significant region to examine how pain and sleep changes (%Stages 1–3 NREM, %REM) were related to brain response changes.

Results

Eleven regions exhibited significant interactions (ps<.00; large effects; right hemisphere: inferior frontal, superior temporal, mid-occipital, and cingulate gyri, lentiform nucleus; left hemisphere: angular, superior temporal, mid-frontal, inferior occipital, mid-temporal, and inferior frontal gyri). CBT-I decreased brain response to QST in 8 regions and CBT-P in 3 regions (CBT-I effects>CBT-P). Waitlist increased response in 6 regions. Pain ratings, %Stage 2 and %REM sleep were not significant for any region and were dropped from the models. Increased %Stage 1 and/or %Stage 3 predicted decreased brain response to QST in 8 of the 11 regions (ps<.01), accounting for 19–45% of the variance.

Conclusion

Compared to CBT-P, CBT-I prompted greater improvement in abnormal pain processing in patients with fibromyalgia and insomnia. Increased NREM sleep may underlie these pain processing improvements following treatment. Future research examining the potential role of NREM sleep in central sensitization and pain processing is warranted.

Support

National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055160 and R01AR005160-S1; McCrae, PI). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (McCrae, PI).
0089 Sleep and Hippocampal Development in Early Childhood
Authors: Allard T L , Lokhandwala S , Spencer R M , Riggins T
Published: May 2020

Introduction

With sleep, memories are consolidated, leaving them less susceptible to interference. This process is believed to reflect transfer of memories from the hippocampus to the cortex. Research has established that naps benefit memory in typically napping children. This nap-benefit has been associated with sleep spindles during nREM2 sleep. Although research has separately related memory development to the hippocampus and to sleep, the association between hippocampal development and sleep physiology is not understood. The purpose of this investigation is to assess relations between sleep physiology and the hippocampus in early childhood.

Methods

Subjects are part of an ongoing longitudinal investigation. Preliminary analyses included 24 participants (Mage= 3.96 years, 14 females). Children participated in three consecutive visits, one week apart. During the first two visits, they completed a visuospatial memory task before and after a wake or nap period (order counterbalanced). Sleep physiology was assessed via polysomnography and hippocampal volumes were obtained via Freesurfer v5.1 using T1-weighted scans (.9 mm3).

Results

Preliminary results showed that total hippocampal volume was positively related to minutes spent in nREM2 sleep when controlling for age and gender (B=14.7, p=0.03). Further analysis showed that this relation held for left but not right hippocampus (B=10.1, p=0.01). Results also indicate a positive relation between sleep spindle count and left but not right hippocampal volume when controlling for age and gender (B=16.1, p=0.02).

Conclusion

Results show that greater time spent in nREM2 and greater sleep spindles across nREM2 are both related to a larger hippocampus in early childhood. These findings demonstrate an association between sleep physiology and the hippocampus during an important period of memory development, early childhood. Future analyses will assess differences in hippocampal volume between typical nappers and non-nappers at the second wave of data collection.

Support

Support was provided by NIH (HD094758) and NSF (BCS 1749280).
0102 The Relationship Between Overnight Consolidation and Next-Day Learning
Authors: Guttesen A V , Appleby G , Madden E , Gaskell M , Cairney S A
Published: May 2020

Introduction

Contemporary models of sleep-associated consolidation posit that overnight memory processing paves the way for next-day learning in hippocampus. However, the extent to which new hippocampal learning is dependent on overnight consolidation has yet to be investigated. In this study, we compared the impacts of sleep and sleep deprivation on the consolidation and encoding of hippocampus-dependent memories and, importantly, examined whether individual differences in consolidation were associated with individual differences in encoding.

Methods

Thirty healthy adults (17 females, mean age 20.1±1.65) were trained on a spatial memory task in the evening before a night of sleep or total sleep deprivation (repeated measures). Participants completed a spatial memory test the following morning, and then encoded a novel set of word-image pairs. Two days later (after recovery sleep), memory for the word-image pairs was tested. We predicted that participants’ spatial memory recall would predict performance on the word-image test, suggesting that overnight consolidation lays the groundwork for new encoding in hippocampus.

Results

Sleep (vs. sleep deprivation) improved spatial memory accuracy the following morning (t(29)=3.93, p<.001, d=0.72) and word-image recall two days later (t(29)=12.19, p<.001, d=2.23), suggesting that sleep facilitated the consolidation and encoding of hippocampus-dependent memories, respectively. However, the benefit of sleep for spatial memory recall was not significantly correlated with the benefit of sleep for word-image encoding (r(28)= 0.01, p=0.971), suggesting that hippocampal encoding was not contingent on foregoing overnight consolidation processes.

Conclusion

In support of previous findings, overnight sleep improved consolidation and next-day encoding, as compared to an equivalent period of sleep deprivation. However, the present results did not reveal any relationship between an individual’s sleep-associated consolidation and their next-day learning.

Support

Department of Psychology, University of York scholarship to A.áV.G. Medical Research Council Career Development Award (MR/P020208/1) to S.A.C.
1010 Individuals with Metabolic Syndrome and Unrecognized Sleep Apnea Can Be Identified by an Employer-Sponsored Healthcare Program and At-Home Sleep Study
Authors: Iakoubova O A , Tong C H , Arellano A R , Bare L A , Fragala M S , Devlin J J , Birse C E
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is common in individuals with metabolic syndrome (MetS) and increases risk of cardiovascular (CVD) events. Once recognized, therapeutic interventions can reduce OSA severity and associated CVD risk. Of the 25 million Americans with OSA, 80% are unaware of their disease. To facilitate and improve diagnosis of OSA, diagnostic devices for at-home OSA testing have been developed in clinical studies and approved by FDA. We evaluated an employer-sponsored healthcare outreach program and at-home OSA testing as a means of identifying individuals likely to have OSA and referring them into care.

Methods

Nine-hundred individuals with MetS, positive OSA Berlin questionnaire score and no prior diagnosis of OSA, as determined by annual workplace screening and health claims, were invited to participate in the sleep program. Those who agreed to participate (9.9%) received a diagnostic device for at-home OSA testing. Apnea-hypoapnea index (AHI) results recorded on returned diagnostic devices were evaluated by a sleep specialist. A telephone consultation with a program physician then provided each participant with an explanation of test results and referral into care. Based on AHI we identified individuals with moderate (AHI 16-30) to severe (AHI >30) OSA and referred them to care.

Results

Of the 89 participating individuals, 21% had 3 MetS components, 53% had 4 components, and 20% had 5 components; 30% were diabetic; 83% had hypertension; and >50% were obese. Moderate to severe OSA was diagnosed in 52 (58%) of participants. Of those, 50% had moderate OSA and 50%, had severe OSA. Among individuals with moderate to severe OSA, 29 (56%) had a physician consultation and were referred to treatment.

Conclusion

A personalized employer-sponsored healthcare outreach program identified individuals with unrecognized OSA and referred them into care.

Support
1018 Sleep and Fatigue: Examining the Impact on Cognitive Function in Older Adults Living with HIV
Authors: Frain J A , Chen L
Published: May 2020

Introduction

Poor sleep affects 75% of older adults living with HIV, negatively impacting health. The purpose of this study was to examine the associations between sleep, fatigue and cognitive function in older adults living with HIV with well-controlled HIV virus.

Methods

Forty-three adults aged 50 years and older living with HIV were recruited for this study. Participants provided demographic and health information. Participants wore actigraph watches continuously for one week, while completing a daily sleep diary, fatigue instrument, and Epworth Sleepiness Scale. After one week participants returned and completed the Pittsburgh Sleep Quality Index (PSQI) and performed cognitive testing including the NIH Toolbox Cognition Battery and the Montreal Cognitive Assessment (MoCA).

Results

Fluid cognition (measured with the Cognition Battery) positively correlated with hours of sleep measured via actigraph the night immediately prior to testing (p = .008), but not by average hours slept over the week. Average daily fatigue and daytime sleepiness were also correlated with fluid cognition (p = .012, p = .032 respectively). Similar results were found when cognition was measured using the MoCA, with sleep (p = .001), average fatigue (p = .017), and daytime sleepiness (p = .028) all correlated with cognition. When sleep was measured subjectively, Pearson correlation indicated that there was a statistically significant negative relationship of moderate strength between global sleep and cognitive function (r = -.47, p = .015).

Conclusion

The study provides evidence that poor sleep, measured objectively or subjectively, is associated with cognitive impairment. Despite we-controlled HIV virus, 86% of study participants had global sleep scores indicating poor sleep. Sleep measured objectively resulted in less nightly sleep than by subjective measure, 4.5 vs 6.07 average hours per night. Studying effective interventions to improve sleep should be a next step as a way of improving cognitive function for this population.

Support

This study was supported through a grant funded by Sigma Theta Tau International and the National Gerontological Nurses Association.
1027 Differences in Polysomnography-Based Sleep Disorders Between HIV-Infected Persons and Matched Controls
Authors: Chen Y , Chen C , Strollo P J , Li C , Ko W , Lin C , Ko N
Published: May 2020

Introduction

Sleep disturbance is a prevalent problem among HIV-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls.

Methods

The study included 170 men with a Pittsburgh sleep quality index (PSQI) greater than 5, composed of 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (-/+ 3.0 years) and BMI (-/+ 3.0 kg/m2). For all participants an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or Chi-square tests.

Results

HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p<0.001) and suspected rapid eye movement (REM) behavior disorder (RBD) (25.0% vs. 4.8%, p<0.01) than that of controls. The sleep-disordered breathing (SDB) in HIV-infected persons was less common than that in controls (56.8% vs. 87.3%, p<0.001). The mean percentage of REM sleep among HIV-infected patients was higher than that among the controls (20.6% vs. 16.6%, p<0.001). Enuresis was more common in HIV-infected persons than controls (40.9% vs. 22.2%, p=0.02).

Conclusion

Psychological disturbances and SDB can be the possible explanations of sleep disturbances in HIV-infected persons, in which suspected RBD is notable. Further studies are warranted to examine underlying factors of suspected RBD among HIV-infected persons with sleep disturbances.

Support

This work was supported by the Ministry of Science and Technology, Executive Yuan of Taiwan [MOST 105-3011-E-006-002], and National Cheng Kung University Hospital [NCKUH-10702022]
1028 Sleep and Enteric Disease: Sleep Now for Less Diarrhea Later
Authors: Mantua J , Gutierrez R L , Isidean S D , Alaca A N , Testa K J , Talaat K , Doty T J , Capaldi V F , Porter C
Published: May 2020

Introduction

The bi-directional relationship between sleep and immune function is well-established. Sufficient sleep supports immune health and can increase vaccine efficacy. Conversely, sickness can disturb sleep quality, which can delay recovery and waking functioning. However, the bidirectional relationship between sleep and infectious diarrhea, the leading infectious disease threat to deployed military populations, has not been studied. We assessed the bi-directional relationship between sleep and enteric disease utilizing data from a recently-completed controlled human infection model (CHIM) with enterotoxigenic Escherichia coli (ETEC).

Methods

During a CHIM to assess the efficacy of an immunoprophylactic targeting ETEC (NCT03040687), we measured sleep via actigraphy over an 8-day inpatient period. Participants ingested prophylaxis 3 times/day during days -2 and -1 and ingested ETEC on day 0. The primary outcome was moderate-severe diarrhea following the ETEC challenge. We hypothesized better sleep pre-challenge would reduce risk of disease after the challenge (assessed using linear regression). We also hypothesized total sleep time (TST) and sleep efficiency (SE) after the challenge would be lower/poorer than baseline (assessed using paired t-test).

Results

Among 59 participants (aged 34.4±8.1yrs, 64% female), longer TST the night preceding ETEC challenge was associated with lower total diarrhea volume (B=-3.13,p=.001). SE was slightly but significantly poorer after the challenge (78 vs. 76%; t(55)=2.2,p=.03), but there was no significant change in TST, potentially due to low TST pre-challenge (316 vs. 329 minutes; p=0.12).

Conclusion

These results - in aggregation with previous work on sleep and vaccines - suggest military sleep regulations should be put in place to increase sleep prior to traveling to an area of responsibility with high risk for enteric disease. These minor behavioral changes could provide lasting benefits to readiness of military servicemembers.

Support

This work was supported by Joint Warfighter Medical Research Program (JWMRP) and the Military Operational Medicine Research Program (MOMRP). 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 Department of Defense. This abstract has been approved for public release with unlimited distribution.
1040 Post-ICU Daytime Sleep And Activity Impact Hospital Discharge Outcomes For Older ICU Survivors
Authors: Elias M N , Liang Z , Munro C L
Published: May 2020

Introduction

The aims of this study were to: describe post-ICU daytime sleep and activity among older ICU survivors within 24-48 hours post-ICU discharge, and to examine differences in post-ICU daytime sleep and activity by prospective acuity of discharge disposition at time of hospital discharge.

Methods

Within 24-48 hours of ICU discharge, we enrolled 30 ICU survivors who were at least 65 years old, functionally independent prior to hospitalization, and mechanically ventilated while in ICU. Actigraphy was used to estimate daytime total sleep time (TST, hours) and daytime activity (mean activity counts/minute) for one daytime period (06:00 AM to 22:00 PM) within 24-48 hours post-ICU discharge. Independent samples t-tests examined differences in mean daytime TST and daytime activity counts, between subjects who were discharged home versus those who were discharged to a facility (inpatient rehabilitation facility, skilled nursing facility, or long-term acute care hospital).

Results

The mean age was 71.37 ± 5.35 years; 63.3% were male and 76.7% were White non-Hispanic/Latino. The mean daytime TST was 7.61 ± 4.31 hours; the mean daytime activity count was 41.2 ± 28.24 counts/minute. Subjects who were discharged to a facility (8.88 ± 3.69 hours) slept significantly longer than those discharged to home (5.54 ± 4.21 hours; t(26) = 2.083, p = .047). Additionally, subjects who were discharged to a facility (32.96 ± 24.26 counts/minute) were significantly less active during the daytime than those discharged to home (54.42 ± 29.30 counts/minute; t(25) = -2.157, p = .041).

Conclusion

Older ICU survivors who were ultimately discharged to a facility slept significantly longer and were less active during the daytime hours immediately following transition out of ICU, compared to subjects who were discharged home. Intervention studies should investigate whether increasing daytime activity while promoting nighttime sleep consolidation following transfer out of ICU improves discharge outcomes.

Support

N/A
1042 Sleep Characteristics In Ehlers Danlos Patients With Hypermobile Type: A Polysomnographic Study
Authors: Metlaine A , Leger D , Sauvet F , Gomez-Merino D , Chennaoui M , Hamonet C
Published: May 2020

Introduction

Ehlers-Danlos syndrome (EDS) is an heritable collagen disorder with various multisystemic clinical manifestations affecting primarily skin, ligaments and joints, blood vessels and internal organs. The clinical spectrum is very large from mild skin and joint hypermobility to severe physical disability. Patients with Ehlers-Danlos syndrome often complain of poor sleep quality and fatigue with impaired quality of life. The purpose of this study was to assess any objective sleep disturbances in EDS by polysomnography.

Methods

In this case-control study, we included 47 patients EDS type III (hypermobile type) (29 F et 18 M) which were one to one strictly matched to 47(29 F et 18 M) controls according to sex, age, and BMI. Participants underwent level-1 polysomnography for a complete sleep study.

Results

The two group were strictly similar for age and BMI (mean age 29.3 ± 9.2 years, BMI 23.3 ± 4.4 kg/m²). Total Sleep time (TST) was significantly reduced in EDS (343.7 ± 69.3 min versus 395 ± 74.8 min; F= 11.9; p< 0.01). Sleep quality was significantly impaired, with a decreased Sleep efficiency (SE): 74.4 ± 10.5 versus 90.2 ± 7.8 F= 68.5; p< 0.001), an increased wake after sleep onset (WASO) time (116.5 ± 45.7 min versus 43.3 ± 36.8 min; F= 73.2; p <0.01) and micro arousal index (14.8 ±7.8 versus 6.5 ±4.3; F= 41.2; p<0.01). We also found a significant reduction of slow wave sleep length, but REM sleep was not affected. The apnea-hyponea index (IAH) and periodic leg movement index (PLMI) were higher in EDS patients (IAH: 10.8±4.8 versus 5.8±3.9; F= 30.4; p<0.01 et PLMI: 4.5 ±4.6 versus 2.6± 2.5; F= 6; p<0.01). In patients with EDS type III, the prevalence of OSA (AHI>10/hour) was 75% versus 7.1 % in the control group (OR 5.1 (95% CI 2.3 to 14.7); p<0.001).

Conclusion

PSG may help in better understanding the diagnosis and treatments of EDS patients.

Support
1043 The Relationship Between Nighttime Eating And Body Mass Index
Authors: Low D , Leroux A , Urbanek J , Crainiceanu C
Published: May 2020

Introduction

Late night eating has been associated with higher odds of being overweight or obese. This study aims to evaluate the relationship between late night eating and body mass index in a nationally representative sample.

Methods

Actigraphy was used to estimate the average bedtime, waketime, duration and midpoint of sleep in the National Health and Nutrition Examination Survey 2003-04 and 2005-06 cohorts. Given the circular nature of clock time, the average was calculated to be the point that minimized the sum of squares of differences between time points. Dietary data was collected through two detailed interviews of the participants. Nighttime calories were defined as the average amount of calories consumed between the average bedtime and the average midpoint of time-in-bed, based on the data recorded during the dietary interviews.

Results

Higher average nighttime caloric consumption (in units of 100 kcal) was associated with higher BMI [B(95% CI): 0.062 (0.003, 0.121)]; this remained significant after adjustment for age, gender, and race [B(95% CI): 0.084 (0.026, 0.142)]. Higher nighttime caloric consumption (as a percentage of total average daily calories consumption) was associated with higher BMI [B(95% CI): 1.522 (0.312, 2.733)]. This remained significant after adjustment for age, gender, and race [B(95% CI): 1.718 (0.505, 2.931)].

Conclusion

Higher nighttime caloric consumption, both in average amount (in units of 100 kcal) and as a percentage of average daily calories consumption, was associated with higher BMI. Additional study is needed to further elucidate the relationship between nighttime eating habits and body mass index.

Support

NHLBI T32HL110952
1045 Impact Of Pre-treatment Sleep And Menopausal Status On Sleep Quality In The 12 Months Following A Breast Cancer Diagnosis
Authors: Squires L , Mahon K , Rash J , Powell E , Seal M , Garland S N
Published: May 2020

Introduction

Sleep disturbances are a prevalent and enduring problem in women who have completed treatment for breast cancer. Less is known about whether sleep during and after cancer treatment is influenced by pre-treatment sleep quality and menopausal status. The present study aims to examine the trajectory of sleep quality in the 12 months following a cancer diagnosis and assess whether trajectory is influenced by pre-treatment sleep quality and menopausal status.

Methods

Newly-diagnosed women (N=88) with non-metastatic BCa were recruited before beginning treatment. They completed the Pittsburgh Sleep Quality Index (PSQI) before treatment and 4, 8, and 12 months later. Women with a score ≥5 on the Pittsburgh Sleep Quality Index at treatment onset were classified as poor sleepers. Menopausal status (pre- or post-menopausal) was chart abstracted. A mixed ANOVA assessed the impact of pre-treatment sleep quality and menopausal status on sleep quality trajectory.

Results

The mean age of the sample was 60 years, 70% were classified as poor sleepers, and 72% were post-menopausal. There was a significant linear time by sleep quality interaction, F(1, 83)= 5.79, p =.02. Good sleepers experienced a greater initial worsening of sleep quality than poor sleepers. At 12 months, poor sleepers had returned to baseline levels whereas scores in good sleepers remained higher than baseline. The 3-way time x sleep quality x menopausal status and the 2-way time by menopausal status interactions were not significant.

Conclusion

Baseline sleep quality is a more powerful determinant of sleep trajectory during treatment than menopausal status. Early intervention is necessary to treat existing sleep problems and prevent the development of sleep problems in women with a history of good sleep.

Support

Dr. Garland is supported by a New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).
1051 Level Of Agreement Between Objective And Subjective Sleep Measures In Lung Cancer Survivors With Insomnia
Authors: Weiss C , Kwon M , Dickerson S , Dean G
Published: May 2020

Introduction

Lung cancer survivors (LCS) have the second-highest incidence of impaired sleep among cancer population. Clinical studies use self-reported and objective measures to assess insomnia in LCS. However, negative beliefs of sleep patterns may impair sleep perception, impact psychological state, and influence insomnia treatment and survivorship outcomes. This study aims to assess the level of agreement between subjective and objective sleep measures in LCS.

Methods

Forty-four non-small cell lung cancer survivors, stage I-III, at least 6 weeks after treatment completion, with Insomnia Severity Index >7, were recruited from two sites from 2014-2016. Individuals with sleep apnea, menopause, rotating shift work, uncontrolled substance abuse, or unstable medical/psychiatric illnesses were excluded from the study. Agreement between total sleep time (TST), sleep latency (SL) and sleep efficiency (SE) from Sleep Diary and wrist-actigraphy (i.e. CamNtech) were assessed with Intraclass Correlation (ICC) and Bland-Altman plots. Analysis of ICC, mean difference, standard deviation (SD) and 95% confidence interval (CI) were conducted using SPSS 24.

Results

LCS were male (63.6%), 60-69 years old (52.3%), married or living with a partner (50%). Self-reported measurements underestimated TST (-68.2 minutes, ICC 0.45, CI 95%, SD 108.1) and SL (-25.9 minutes, ICC 95%, ICC -0.54, DS 17.5). Objective and self-reported measurements largely overlapped for SE, with a small actigraphy-based overestimation (9.2, ICC 0.2, CI95%, SD 7.3). Bland-Altman plots revealed that the agreement increased with lower SE values.

Conclusion

LCS tended to underestimate TST and SL. An apparent agreement between objective and self-reported measures for SE may indicate sleep state misperception. Differences in various sleep parameters and potential covariates should be investigated for contribution to the unexplained considerable individual variability in behavioral treatment response among cancer survivors in larger sample sizes.

Support

1R01NR018215-01 (GED); T32GM099607(CW).
1052 Continuous Blood Pressure Monitoring In Sleep
Authors: Roth R H , Bonner H , Logan J , Baruch M , Calhoun D , Berry R , Cho Y , Kwon Y
Published: May 2020

Introduction

Abnormal nocturnal blood pressure(BP) such as non-dipping or nocturnal hypertension(reverse-dipping) represents a potent marker for cardiovascular risks. Standard cuff-based ambulatory nocturnal BP measurement yields limited data points potentially resulting in imprecise results, especially compared to continuously recorded BP. We hypothesized nocturnal BP based on periodic measurement would be different from true average beat-to-beat based BP.

Methods

We prospectively enrolled patients undergoing clinically indicated in-lab polysomnography, both CPAP and non-CPAP studies, for sleep apnea evaluation. Nocturnal BP was continuously monitored beat-to-beat by a noninvasive Caretaker™ device, which uses the Pulse Decomposition Analysis(PDA) algorithm. We compared BP recorded at 30-minute intervals with average BP continuously recorded over 30 minutes, both recorded by Caretaker™. We also looked at the differences between recording spot and continuous BP from an awake or sleeping state and BP variability(SD) based on continuously recorded BP. Using first 30 min as a reference, we determined dipping status (dipping: 10-20% reduction, level: 0-10% reduction, riser: any increase) by the two methods.

Results

A total of 18 patients were recruited(male:11, mean age:52.2). Among a total of 261 periodic BP measurements, 60 (30.0%) were obtained while awake. Mean nocturnal SBP by periodic BP measurement was higher compared with beat-to-beat-derived average BP(135.6mmHg[24.2] vs. 131.5[20.3], p<0.0001). The difference between the two methods remained similar when continuous BP was derived from sleep vs. awake period(4.5mmHg[3.1] vs. 7.7[9.9], p=0.202). BP variability was more pronounced during awake compared with sleep period(6.7mmHg[8.1] versus 3.95[7.5], p=0.047). 8 patients were dippers by spot check measurement, but 11 were dippers by continuous BP.

Conclusion

Standard ambulatory periodic nocturnal BP recording may not yield true sleep BP patterns due to its spot-check nature and lack of sleep-awake information, which leads to inaccurate dipping measurements. Incorporation of beat-to-beat continuous BP measurement can provide more accurate and meaningful nocturnal BP information.

Support

N/A
1053 Sleep Duration And Timing Associated With History Of Breast Prostate And Skin Cancer: Data From A Nationally-representative Sample
Authors: Piro B , Garland S , Jean-Pierre P , Gonzalez B , Seixas A , Muench A , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Sleep disturbances are a common problem among cancer survivors. Also, cancer patients can have altered circadian rhythms and these changes can continue to affect the patient long after the conclusion of their treatment. This analysis aims to investigate how the sleep and wake times of cancer survivors differ from the rest of the population, depending on the type of cancer.

Methods

Data from the 2015-2016 National Health and Nutrition Examination Survey were used. Population-weighted data on N=5,581 individuals provided complete data. History of breast, prostate, and skin cancer (melanoma or other) was self-reported. Sleep duration was self-reported in half-hour increments, and typical bedtime and waketime was self-reported. Covariates included age, sex, and race/ethnicity. Weighted linear regressions with sleep duration, bedtime and waketime were examined, with each cancer type as predictor.

Results

Prevalence was 1.7% for prostate cancer, 1.5% for breast cancer, 2.3% for non-melanoma skin cancer, and 0.8% for melanoma. In adjusted analyses, prostate cancer was associated with an additional 26.5 minutes of average total sleep (95%CI 2.2,50.9, p=0.03), a 23.1 bedtime minutes earlier (95%CI -40.4,-5.8, p=0.009), and no difference in waketime. Breast cancer was associated with a bedtime that was 41.1 minutes later (95%CI 10.3,72.0, p=0.009) and a waketime that was 48.7 minutes later (95%CI 12.5,84.9, p=0.008), but no difference in sleep duration. No statistically significant effects were seen for either type of skin cancer, melanoma or non-melanoma.

Conclusion

Prostate cancer was associated with an earlier bedtime and associated increased sleep time. Breast cancer, on the other hand, was associated with a phase delay of the sleep period but no change in sleep duration. Skin cancer was not associated with differences in sleep duration or timing. These findings may have implications for not only treatment of sleep problems in different types of cancer, but also possible circadian mechanisms.

Support

Dr. Grandner is supported by R01MD011600
1054 Improving Sleep By Reducing Allergy Symptoms
Authors: Rus H , Danoff-Burg S , Cruz Martir L , Raymann R J
Published: May 2020

Introduction

Allergies can impact sleep quality and, in turn, quality of life. Sleep is affected because allergens irritate nasal passages, which can make breathing more difficult, start an immune response, and directly interfere with sleep. Nasal congestion often is worse at night, and during the night some anti-allergic control processes of the body dip, which can lead to increased symptoms. We tested if an air purifier in the bedroom would improve sleep and reduce allergy symptoms.

Methods

29 adults with self-reported allergy complaints participated in an 8-week field study, using a non-counterbalanced pre-post intervention design. Intervention consisted of the use of an Alen BreatheSmart 45i air purifier at home for 24 hours a day during the duration of the test period. Sleep was measured with self-report and objectively with ResMed S+ every night. Allergy symptoms were measured using self-report. Paired t-tests and multilevel regression were used to test for statistical significance.

Results

28 individuals reported a reduction in allergy symptoms and 27 reported better sleep during the intervention. Overall, participants reported a 38% improvement in allergy symptoms and a 59% improvement in sleep continuity. Moreover, participants felt they fell asleep faster (20% faster), experienced better sleep quality (14% better), and felt more rested in the morning (14% more rested). Objective data showed an 11% improvement of Wake After Sleep Onset and a 1.1% increase in sleep efficiency during intervention (all ps < 0.05), but only in the subgroup (n = 11) of participants with the poorest sleep at baseline.

Conclusion

Using an air purifier in the bedroom can reduce allergy symptoms and improve sleep. Objectively measured sleep improvements supported the self-reported improvements, but only in the subset of participants who showed compromised sleep at baseline.

Support

Alen Corporation
1066 Rapid Eye Movement (REM) Sleep Duration in Posttraumatic Stress Disorder (PTSD) Varies Dynamically and Directly Within the Individual With Indices of Sleep Consolidation and Parasympathetic Tone
Authors: Gupta M A
Published: May 2020

Introduction

Autonomic arousal in posttraumatic stress disorder (PTSD) has been associated with functional hypoactivation of the medial prefrontal cortex and hyperactivity of the amygdala which can directly affect sleep physiology including REM sleep. REM sleep has been associated with reduced fear conditioning; and PTSD has been associated with REM sleep fragmentation. A case report of a drug-free PTSD patient (Gupta MA,2019) who underwent 10 home sleep apnea tests (HSATs) observed a dynamic and inverse relation between REM sleep duration and indices of sympathetic activation during sleep and sleep fragmentation. This study has examined the relationship between REM sleep duration and sleep parameters related to sleep consolidation and parasympathetic tone in 17 PTSD patients who had completed at least 10 HSATs each.

Methods

17 civilian PTSD patients (all female; mean±SD age: 47.59±10.52 years; 16 white) each completed 10 HSATs (WatchPAT200, Itamar)(over 1 to 45 months). The mean±SD initial PTSD Checklist for DSM-5 score was 49.24±13.08 (n=17), and Clinician Administered PTSD Scale for DSM-5 (CAPS-5) score was ≥55. Patients using benzodiazepines and/or narcotics were excluded.

Results

The overall mean±SD REM duration for all 10 visits (for 17x10 HSATs) was 84.40±8.65 minutes (range 69.13-96.97 min); the mean REM duration over the 10 HSATs correlated with other sleep indices as follows: sleep onset latency (Pearson r= -0.667, p=0.035); sleep efficiency (r=0.636, p=0.048); light sleep (NI+N2) percentage (r= -0.754, p=0.012); light sleep duration (r=0.692, p=0.027);deep sleep (N3) duration (r=0.635, p=0.048).

Conclusion

Over the 10 HSATs the average (n=17) REM sleep duration was directly related to indices of sleep consolidation (decreased sleep latency, increased sleep efficiency, increase in both light and deep sleep duration). The direct relation of REM sleep duration to duration of deep sleep, and inverse relation with light sleep percentage suggests REM sleep- related promotion of increased parasympathetic tone within the individual.

Support

None
1067 Replicative and Non-Replicative Nightmares in the Development of Posttraumatic Stress Disorder
Authors: Maeder T , Daffre C , Oliver K I , Lasko N B , Seo J , Ulsa C , Kleim B , Pace-Schott E F
Published: May 2020

Introduction

Nightmares are a frequent and disturbing symptom of posttraumatic stress disorder (PTSD). They are associated with sleep disruption and increased psychopathology. There is growing evidence that different types of nightmares may differ in their effects on psychopathology. Previous findings suggest that nightmares that are close replications of the experienced traumatic event might be especially important in the development of PTSD. This study investigated trauma-related (replicative) and non-trauma-related (non-replicative) nightmares as predictors of PTSD in a civilian sample.

Methods

Participants were recruited from the general public of the greater Boston area. The sample consisted of 108 participants who had experienced a psychological trauma in the past 2 years (e.g. sexual or physical assaults and accidents). The criteria for PTSD were met by 49% of participants. PTSD diagnosis was assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Non-Patient Edition. Participants received an Actiwatch 2 (Philips Respironics, Bend, OR) and a sleep diary for sleep measurements over an average of 14 consecutive nights. The diary included a prospective nightmare assessment and an item assessing the relatedness of each nightmare to traumatic events. Logistic regression analyses were performed with PTSD as the categorical outcome variable.

Results

Our analyses showed that replicative nightmares were the only statistically significant predictor of PTSD (OR = 1.2, p = .027), while controlling for age, sex, time since the traumatic event, and actigraphy total sleep time and minutes awake after sleep onset. All of these variables, including non-replicative nightmares, did not significantly predict PTSD in our analyses.

Conclusion

This study confirms and adds to the existing knowledge of nightmares and the importance of the degree to which they replicate the trauma in the development of PTSD. These findings underline the potential role of specific nightmare treatments after traumatic events, with a special focus on replicative nightmares.

Support

R01MH109638