bluuebunny/crossref_metadata_2025 huggingface dataset:
0572 Sleep Quality Prior to Admission May Be Linked to Length of Stay in Older Intensive Care Unit Survivors
Authors: Elias Maya
Published: May 2022

Introduction

Older adults who are admitted to an intensive care unit (ICU) often experience daytime sleepiness and inactivity during hospitalization, yet it remains unclear how pre-hospital sleep may influence hospital outcomes. The aim of this study was to explore trends between pre-hospital self-reported nighttime sleep duration, post-ICU daytime sleep duration, and hospital length of stay (LOS) among older ICU survivors.

Methods

Thirty older ICU survivors who were functionally independent prior to hospitalization and were mechanically ventilated while in ICU were enrolled in the present pilot study. Actigraphy was used to estimate post-ICU daytime total sleep time (TST) for a daytime period (06:00-22:00) within 24-48 hours post-ICU discharge. The Pittsburgh Sleep Quality Index was used to estimate self-reported nighttime sleep duration prior to hospital admission, and participants were grouped into three categories: short sleep (5.5-7.5 hours), moderate sleep (7.5-9 hours), and long sleep (9-10.5 hours). Total hospital LOS in days was obtained via chart review. Descriptive statistics were used to explore trends between pre-hospital sleep duration, post-ICU daytime sleep duration, and hospital LOS.

Results

Of the 30 enrolled participants, 29 completed the post-ICU actigraphy observation period; one participant was transferred back to ICU for surgical complications. The mean post-ICU daytime TST among participants who reported short pre-hospital sleep was 6.54 hours, while the means for those who reported moderate and long pre-hospital sleep durations were 7.83 and 8.39 hours, respectively. Participants who reported short pre-hospital sleep had a mean hospital LOS of 14.1 days, while participants who reported moderate and long pre-hospital sleep durations had a mean LOS of 29.1 days and 29.2 days, respectively.

Conclusion

Older ICU survivors who reported shorter sleep at home prior to hospital admission tended to also sleep less during the daytime hours immediately following transition out of ICU, compared to those who reported longer sleep at home. In addition, older ICU survivors who reported shorter sleep at home tended to have shorter LOS, compared to those who reported longer sleep at home. Potential interventions may focus on increasing daytime activity in older ICU survivors who endorse frequent daytime sleepiness and long nighttime sleep at home.

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0574 Sleep Duration and Sleep Quality in Association with Risk of Prostate Cancer in the UK Biobank
Authors: Freeman Joshua , Saint-Maurice Pedro , Watts Eleanor , Patel Shreya , Moore Steven , Matthews Charles
Published: May 2022

Introduction

Studies of shift work suggest extreme sleep disruption may increase prostate cancer risk. However, studies evaluating sleep duration and quality are inconsistent due to low ascertainment of cases and whether subdomains of sleep quality were queried. Our objective was to evaluate sleep duration, multiple sleep quality domains, and prostate cancer incidence among a large, prospective cohort.

Methods

We conducted a secondary analysis among 219399 men aged 40-69 years without prevalent cancer enrolled in the UK Biobank (2006-2010). At baseline participants self-reported their usual sleep duration, difficulties falling or staying asleep, snoring, and falling asleep during the day. We used Cox-proportional hazards models to calculate hazards ratios and 95% confidence intervals for associations with prostate cancer risk. Models were adjusted for confounders. Given potential concerns of reverse causality due to nocturia from undiagnosed prostate cancers increasing sleep disturbances, we restricted the cohort to men with ≥4 years of follow-up in a sensitivity analysis.

Results

Over 6.7 years of follow-up, there were 5829 prostate cancer cases. Sleep duration (vs. 7-8 hours; <5 hours HR: 1.08, 95% CI: 0.95, 1.22; 5-6 hours HR: 0.92, 95% CI: 0.85, 1.00; 6-7 hours HR: 0.97, 95% CI: 0.91, 1.03; 8-9 hours HR: 0.93, 95% CI: 0.84, 1.04; ≥9 hours HR: 1.09, 95% CI: 0.91, 1.31) was not associated with prostate cancer. Participants who reported “sometimes” (HR: 1.09, 95% CI: 1.02, 1.16) or “usual” (HR: 1.17, 95% CI: 1.09, 1.26) difficulties falling or staying asleep had greater prostate cancer risk compared to those who reported “never/rarely.” Snoring and falling asleep during the day were not associated with prostate cancer. Results were unchanged when restricting to men who had ≥4 years of follow-up.

Conclusion

In this large, prospective study, sleep duration, snoring, and falling asleep during the day were not associated with prostate cancer. However, men who had greater difficulties falling or staying asleep had greater prostate cancer risk. These results suggest that poor sleep quality rather than sleep duration may be an important consideration for prostate cancer.

Support (If Any)

This work was supported by the NIH Intramural Research Program Cancer Research Training Award, NCI.
0576 Impact of Obstructive Sleep Apnea on In-Hospital Mortality Due to Acute Myocardial Infarction - A Large Retrospective National Study of Veterans
Authors: Valenzuela Andrew , Razjouyan Javad Javad , Sharafkhaneh Amir , Agrawal Ritwick
Published: May 2022

Introduction

Ischemic preconditioning (IPC) is a phenomenon that refers to multiple, brief periods of myocardial ischemia followed by reperfusion. This counterintuitive preconditioning is thought to provide cardioprotection from subsequent prolonged ischemic events. Obstructive sleep apnea (OSA) may lead to IPC by frequent, recurrent short episodes of hypoxia and sympathetic stimulation. We hypothesized in patients who were admitted with acute myocardial infarction (MI), the presence of OSA was associated with improved survival during the hospitalization, likely due to IPC.

Methods

This is a retrospective cohort study utilizing national Veterans Health Administration (VHA) records. The cohort includes patients from 1999-2020 with a hospitalization for MI as the principal diagnosis. We confirm the OSA diagnosis using ICD9/10 codes. The primary outcome was in-hospital mortality during the index admission for acute MI. We reported the odds ratio (OR) of in-hospital mortality between with-OSA and without-OSA using logistic regression. We adjusted the OR (aOR) by age, gender, race, ethnicity, BMI, and Charlson Comorbidity index.

Results

Out of 4,237,444 veterans with any sleep diagnosis, 76,359 patients were hospitalized with a diagnosis of MI. We observed 30,116 with OSA (age, 64±10; BMI, 33±7) and 43,480 without OSA (age, 68±12; BMI, 29±6). The aOR of in-patient mortality was lower in with-OSA (n = 333[1.1%]; aOR, 1.86; 95% CI, 1.63 to 2.12) compared to without-OSA (n = 1,102[2.5%]; aOR, 2.02; 95% CI, 1.78 to 2.30). After stratifying the patients based on previous history of MI, the results remained the same.

Conclusion

We found that in patients admitted with acute MI, the OSA cohort was associated with lower mortality when compared to non-OSA cohort. We speculate that these differences may be attributed to IPC likely due to repetitive, chronic episodes of hypoxia in obstructive sleep apnea. Further research is warranted to elicit the clinical implications of ischemic preconditioning and OSA.

Support (If Any)

Culebras, A. Exploring the trail between cerebral ischemic aggravation and ischemic preconditioning. Obstructive sleep apnea leads the way. Sleep Medicine, Volume 67 ,2020, p 276-277Salman LA, Shulman R, Cohen JB. Obstructive sleep apnea, hypertension, and cardiovascular risk: epidemiology, pathophysiology, and management. Curr Cardiol Rep 2020;22(2):6
0579 The impact of intracranial EEG on sleep is independent of whether a craniotomy was performed
Authors: Tyner Kevin , Alsammani Abdallah , Hegeman Garnett , Stacey William , Gliske Stephen
Published: May 2022

Introduction

Patients with refractory epilepsy are often evaluated with intracranial electrodes prior to resection. While depth electrodes can be placed through small burr-holes, grids and strips generally require large craniotomies. We have observed many differences in patient experience between these two populations. As sleep is crucial for many aspects of health and healing, our objective was to quantify whether subjects with craniotomies had different sleep patterns.

Methods

We analyzed data from N=47 patients with refractory epilepsy who underwent intracranial EEG monitoring at the University of Michigan (N = 23 with craniotomies). Sleep stages were scored by a certified sleep technician using simultaneously recorded scalp EEG. To quantify sleep patterns, we computed the fraction and average bout-length of each state of vigilance.

Results

No statistical difference was found between subjects with or without craniotomies for any measure (p>0.4, Wilcoxon Rank Sum). The median fraction of time awake for all subjects was 0.70 (0.65-0.74, 95% confidence interval). However, sleep architecture appeared altered, with median fraction of sleep time in NREM 1 being 0.07(0.06-0.09), NREM 2 being 0.16 (0.13-0.17), NREM 3 being only 0.01 (0.0-0.2) and REM being 0.05 (0.04-0.06). The median bout lengths for all stages of sleep was less than 5 minutes.

Conclusion

Intracranial monitoring appears to alter sleep similarly for both subjects who received craniotomies and those who had smaller burr-holes. The impact on sleep is not a significant factor when deciding between grid or depth electrodes.

Support (If Any)

National Institutes of Health (K01-ES026839 and R01-NS094399), and the Doris Duke Foundation (grant number 2015096).
0585 Use of a Hybrid Closed Loop Insulin Delivery System Improves Sleep and Glycemic Control in Adults with Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness
Authors: Malone Susan , Matus Austin , Peleckis Amy , Flatt Anneliese , Grunin Laura , Yu Gary , Jang Sooyong , Weimer James , Lee Insup , Rickels Michael , Goel Namni
Published: May 2022

Introduction

Insulin delivery and continuous glucose monitoring systems (CGMs) have been reported to disrupt sleep in individuals with type 1 diabetes (T1D), potentially thwarting the adoption and continued use of diabetes therapeutic technologies. This study assessed changes in actigraphic sleep and glycemic outcomes in individuals at high risk for life threatening nocturnal hypoglycemia after initiating a hybrid closed loop (HCL) insulin delivery system with integrated CGM.

Methods

10 adults (median age=51y) with long-standing T1D (median duration=34y) and hypoglycemia unawareness participated in an 18-month ongoing clinical trial assessing the effectiveness of a HCL system. Wrist actigraphs and CGMs measured sleep and glycemic control, respectively, at baseline (1 week) and at months 3, 6, 9, 12, 15, and 18 (3 weeks) following HCL initiation. Body mass index and hemoglobin A1c (HbA1c) were also collected at these timepoints. Hypoglycemia awareness was assessed using the Clarke hypoglycemia questionnaire, HYPO score, and glycemic lability index. Paired sample t-tests and Cohen’s d effect sizes modeled changes in sleep, glycemic control, and hypoglycemic awareness and the magnitude of these changes from baseline to 18 months.

Results

Sleep improved from baseline to 18 months [shorter sleep latency (p<0.01), later sleep offset (p<0.05), and less wake after sleep onset (WASO) (<0.01)]. Medium effect sizes were found for later sleep onset (d=0.74) and later sleep midpoints (d=0.77). HCL also improved hypoglycemia awareness from baseline to 18 months [Clarke score (p<0.01), HYPO score (p<0.01), lability index (p<0.05)]. Medium to large effect sizes were found for reduced nocturnal hypoglycemia (percent time glucose was <54mg/dL,<60mg/dL,<70mg/dL; d=0.66 – 0.81), daytime and nocturnal hypoglycemia (percent time glucose was<54mg/dL,<60mg/dL,<70mg/dL; d=0.61 – 0.69), and glucose variability (coefficient of variability; d=0.62).

Conclusion

HCL insulin delivery with CGM improved sleep over time as indicated by shorter sleep onset latency, later sleep offset, and less WASO. HCL insulin delivery also improved hypoglycemia awareness and led to clinically significant reductions in hypoglycemia and glucose variability.

Support (If Any)

NIH (R01DK117488 (NG), R01DK091331 (MRR), K99NR017416 (SKM), and UL1TR001878 (University of Pennsylvania Center for Human Phenomic Science)). National Aeronautics and Space Administration (NASA) (NNX14AN49G and 80NSSC20K0243 (NG)) and from the Pennsylvania Department of Health (SAP 4100079750 (IL)).
0586 Extending Sleep in Short Sleeping Middle-aged Adults at Risk for the Metabolic Syndrome
Authors: Malone Susan , Patterson Freda , Hoopes Elissa , Wong Agnes , Grunin Laura , Yu Gary , Dickson Victoria , Melkus Gail
Published: May 2022

Introduction

Short sleep predicts the metabolic syndrome (MetS). Extending sleep improves certain MetS factors, specifically insulin sensitivity and blood pressure in adults without MetS. The absence of sleep intervention studies in community-dwelling adults with MetS limits progress in advancing sleep extension interventions to this subgroup. This study evaluated the feasibility, acceptability, and impact on End-of-Treatment (EOT) sleep outcomes of a 12-week sleep intervention.

Methods

Middle aged adults who were short sleepers and at risk for METs participated in a single-arm 12-week, 12-session sleep intervention based on cognitive behavioral therapy for insomnia delivered via videoconferencing platform. Feasibility and acceptability were assessed using retention and attendance rates as well as mean sleep diary completions (≥4 diaries/week). Anticipated (baseline) and experienced (EOT) acceptability were assessed using a 16-item survey that estimated self-reported acceptability, feasibility, perceived benefit, satisfaction, and overall satisfaction. Sleep was estimated from baseline and EOT 2-week wrist actigraphy data. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in acceptability, feasibility, perceived benefit, satisfaction, overall satisfaction, sleep and daytime sleepiness from baseline to EOT.

Results

The intent-to-treat sample included 44 adults (mean age 52y, 59% female, 41% Black, 48% White, 11% Other, 82% non-Hispanic). Three participants withdrew leaving N=41 (retention rate=93%). Eighty-six percent attended >80% of sessions and mean sleep diary completion was 6.7 diaries/week. There were statistically significant changes in self-reported anticipated (baseline) and experienced (EOT) acceptability surveys indicating greater EOT acceptability (p<0.001), perceived benefit (p<0.001), satisfaction (p<0.001), and overall evaluation (p<0.001). Statistically significant improvements in sleep from baseline to EOT included increased time-in-bed (Mbaseline=6.00h SD= 0.68h – MEOT=7.48, SD= 1.21; p<0.001), increased total sleep times (Mbaseline=5.16, SD= 0.63 – MEOT=6.26, SD= 1.23 p<0.001), earlier sleep onsets (Mbaseline=12.26am, SD= 0.05 – MEOT=11.53pm, SD= 0.06 p<0.05), more regular sleep onsets (Mbaseline=0.06, SD= 0.04 – MEOT=0.04, SD= 0.02 p<0.01), a higher sleep regularity index (Mbaseline=44.02, SD= 17.25 – MEOT=55.88, SD= 12.82 p<0.01), and reduced daytime sleepiness (Mbaseline=7.26, SD= 4.30 – MEOT=3.15, SD= 2.46, p<0.001).

Conclusion

Extending sleep, as well as improving sleep timing and regularity in racially/ethnically diverse middle-aged short sleepers using a videoconferencing platform is acceptable and feasible.

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0589 REM Sleep Behavior Disorder is Associated with Poor Outcomes in Pulmonary Embolism Hospitlizations
Authors: Al Khateeb Mohannad , Laswi Hisham , Al Jabiri Yazan , Aldiabat Mohammad , Yusuf Mubarak , Horoub Ali
Published: May 2022

Introduction

REM Sleep Behavior Disorder (RBD), is a rare sleep behavior disorder, characterized by loss of skeletal muscle atonia during REM sleep, resulting in prominent motor activity with exhibited behavior mirroring the image of the dreams during sleep. Other sleep disorders were studied before in patients with Pulmonary Embolism (PE). Although, REM sleep behavior disorder association with pulmonary embolism has never been described. In this study we aim to study the prevalence of RBD in patients admitted with PE, and to assess the association between RBD and PE.

Methods

Adults with principal diagnosis of Pulmonary Embolism (PE) on discharge were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis. We queried the 2019 National Inpatient Sample for secondary diagnosis of RBD, Obstructive Sleep Apnea (OSA) and other secondary diagnoses (hyperlipidemia,history of old myocardial infarction, atrial fibrillation, Chronic obstructive pulmonary disease, hypertension, heart failure, smoking, chronic kidney disease , electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses.

Results

In a total of 188,355 hospitalizations with PE primary diagnosis on discharge were included from the 2019 national inpatient sample, 25 hospitalizations had concomitant secondary diagnosis with RBD. The overall in-hospital mortality for PE was 3.2%. On weighted analysis, Patients with RBD had statistically significant higher odds for mortality compared to patients without [adjusted odds ratio (OR): 17.15; 95% confidence interval (CI): 2.75-106.8, p= 0.002], 20% mortality rate in patients with RBD compared to 0.03% in patients without RBD (p= 0.03). OSA did not show significant result for mortality when compared to without OSA [adjusted odds ratio (OR): 0.83; 95% confidence interval (CI): 0.67-1.04, p= 0.114].

Conclusion

Our analysis showed a low number of patients with secondary diagnosis of RBD in hospitalizations with primary diagnosis of PE on discharge. However significant association between RBD and mortality in patients with PE primary diagnosis on discharge. The identification of patients with RBD in patients admitted with PE may help decrease mortality rate. Furthermore, our analysis showed that OSA is an independant variable for mortality in PE hospitalization.

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0604 Depression, Anxiety and Coping-avoidance Behaviors Associated with Long-Term Insomnia Symptoms During the COVID-19 Pandemic
Authors: Arentson-Lantz Emily , Kokonda Manasa , Debian Ahmad , Shaib Fidaa , Nowakowski Sara
Published: May 2022

Introduction

Stressful events, such as the COVID-19 pandemic, can have long-lasting, detrimental effect on sleep. It is important for practitioners to understand how their patients may be stil experiencing residual negative effects of the pandemic to optimize their care. In this study we evaluated how measures of self-reported measures of anxiety and depression during the COVID-19 pandemic predicted measures of sleep disturbnce 6 months later among sleep medicine clinic patients.

Methods

Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were recontacted 6 months later to complete the same surveys. 54 patients (55.2±18.4 y, 39% male, 70% Caucasian) completed the follow-up survey and were included in this present analysis. We conducted multivariate regression analyses to determine how the change in self-reported PROMIS measures from baseline during the pandemic were predictive of post-pandemc 6 month follow-up PROMIS measures and ISI.

Results

PROMIS depression score at baseline was predictive of both sleep disturbance (0.63 ± 0.15; p<.0001) and sleep impairment (0.49 ± 0.18; p=0.01) 6 months later. Baseline brief coping avoidance also predicted 6 month sleep disturbance (0.85 ± 0.33; p<0.009) and sleep impairment (0.85 ± 0.33; p=0.014) as well as ISI (0.52 ± 0.18 units; p=0.006). Baseline anxiety predicted ISI at 6 months (0.25 ± 0.09 units, p=0.009).

Conclusion

Higher levels of self-reported depression, anxiety and coping-avoidance behaviors during the COVID-19 pandemic lead to long-lasting increase in sleep disturbance and impairment as well as insomnia. Addressing depression, anxiety and coping behaviors that occur as result as a stressful event is advised to avoid long-term detrimental effects on sleep.

Support (If Any)

This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0605 Longitudinal assessment of CPAP use in Sleep Medicine Clinic Patients during the COVID-19 Pandemic
Authors: Nowakowaki Sara , Teague Taylor , Kokonda Manasa , Debian Ahmad , Arentson-Lanz Emily , Malhotra Sonal , Shaib Fidaa
Published: May 2022

Introduction

Due to the COVID-19 pandemic, there may be changes in continuous positive airway pressure (CPAP) adherence. This study aimed to examine the longitudinal effect of using CPAP as advised and self-reported sleep quality improvements in sleep medicine clinic patients using CPAP early in the pandemic and six months later.

Methods

Between June-November 2020, 81 sleep medicine clinic patients completed an online survey that included questions about CPAP use, using CPAP as advised, and changes in sleep quality associated with CPAP use. Patients were recontacted 6 months later to complete the same survey. Among survey respondents completing both surveys, 27 (50%; aged 58±18.2 y, 48% female, 67% Caucasian) reported using CPAP and were included in the present analysis. We conducted multivariate regression analyses Chi-square Association tests to determine whether self-reported CPAP use, CPAP use as advised, and sleep quality changed from baseline to 6-month follow up during the pandemic.

Results

Among CPAP users, 89% reported no change, 7% reported they use CPAP more, and 4% reported they use CPAP less at 6-month follow up. There was a significant increase in using CPAP as advised at 6-month follow up compared to the baseline survey, p=0.003. Additionally, there was a significant improvement self-reported sleep quality while using CPAP at 6-month follow up compared to the baseline survey, p=0.012.

Conclusion

Patients reported an increase in using CPAP advised and improvements in sleep quality as a result of CPAP use at 6-month follow up compared to a baseline survey administered early in the pandemic. Understanding why patients are more adherent to using CPAP as advised during the pandemic may help in developing interventions to increase CPAP adherence.

Support (If Any)

This work is supported by National Institutes of Health Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
0608 Characterization of Sleep in Emerging Adults with Cystic Fibrosis on CFTR Modulator Therapy
Authors: Meltzer Lisa , Jump Stephanie , Gross Jane
Published: May 2022

Introduction

Sleep disturbances are common among youth and adults with cystic fibrosis (CF). However, few CF programs regularly screen for sleep disorders beyond sleep disordered breathing. Emerging adults (18 to 25 years) with CF are a unique population, experiencing changes in sleep and life transitions (e.g., education, work, relationships), while also managing a complex chronic illness. CF transmembrane regulator (CFTR) modulator therapies have significantly improved medical and quality of life outcomes, yet the impact on sleep remains to be determined.

Methods

Emerging adults with CF (EA-CF; n=22, 59.1% female) and without CF (EA-Control; n=17, 76.5% female) completed an online survey that queried (1) symptoms of restless legs syndrome, parasomnias, and daytime sleepiness, and (2) frequency of exogenous sleep aid use (i.e., prescription medications, melatonin, over-the-counter [OTC] sleep aids, and marijuana/CBD). EA-CF were also asked about perceived changes in falling asleep, night waking frequency and duration, and daytime sleepiness since starting CFTR modulator therapy.

Results

Sleep disorder symptoms were more frequently reported by EA-CF compared to EA-Control, including restless legs syndrome (31.8% vs. 23.5%, small effect size), parasomnias (40.9% vs. 29.4%, small effect size), and excessive daytime sleepiness/fatigue (50.0% vs. 23.5%, medium effect size). OTC sleep aid use did not differ by group (EA-CF 31.8% vs. EA-Control 35.3%), but the frequency was significantly greater in EA-CF (>once/month: EA-CF 27.3% vs. EA-Control 0%, <once/month: EA-CF 4.5% vs. EA-Control 35.3%, large effect size). More EA-CF reported CBD/marijuana use compared to EA-Control (36.4% vs. 17.6%, small effect size), with 31.8% of EA-CF reporting use of CBD/marijuana at least several nights a week (vs. 5.9% of EA-Control, small effect size). Since starting CFTR modulatory therapy, 27.3% of EA-CF reported falling asleep faster, 31.8% reported fewer night wakings, 36.4% reported shorter night wakings, and 36.4% reported reduced daytime sleepiness.

Conclusion

This study is one of the first to examine sleep in emerging adults with CF on CFTR modulator therapy, with results highlighting the importance of screening for sleep disorders other than sleep disordered breathing, use of exogenous sleep aids to facilitate sleep, and the benefits of CFTR modulator therapy on sleep. Data collection is ongoing.

Support (If Any)

Natalie V. Zucker Award
0616 Retrospective Pain Reports in Obstructive Sleep Apnea Patients Relate to Age, Sex, BMI, Insomnia and Depression Scales, Not to Polysomnographic Measures of Sleep and Respiration
Authors: Dubrovsky Boris , Weingarten Jeremy , Cunningham John , Chen Steven
Published: May 2022

Introduction

OSA was found to alter pain experience, presumably due to apnea-related hypoxia and sleep disturbance. However, types of pain measures, demographic and subjective variables, such as mood, may influence pain experience in OSA. Presently, retrospective pain reports of patients referred for OSA evaluation were analyzed as a function of PSG measures, demographic variables, and self-reported mood and insomnia symptoms.

Methods

On the evening of a diagnostic in-lab PSG, patients reported pain intensity in the preceding 6 months (PI, rage 0-10, Chronic Pain Grade Scale), symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised, CESDR) and insomnia (Insomnia Severity Index, ISI). PI was regressed on age, sex, BMI, total sleep time (TST), sleep stage percentages, sleep efficiency, WASO, awakenings, respiratory arousal index, AHI, SpO2% nadir, time below SpO2 90%, desaturation index, CESDR and ISI using a stepwise entry.

Results

A total of 1293 patients with ≥2 hours of PSG-defined sleep completed the questionnaires; 3% Asian, 42% black, 5% Hispanic, 32% white; 62% women; 66% had OSA (AHI≥5); Mage=58.7±13.8, MBMI=33.8±7.3, MPI=3.5±3.1; MISI=12.9±6.9; MCESDR=14.7±13.1, MAHI=17.6±22.9, MSpO2%nadir=84.9±9.0. Higher PI was associated with female sex (p<0.001, R2=2.6%), older age (p<0.001, R2=3.7%), higher BMI (p<0.001, R2=2.5%), higher ISI (p<0.001, R2=4.5%), higher CESDR (p<0.001, R2=2.3%) and longer TST (p=0.028, R2=0.4%). No other sleep or respiratory variables related to PI. No significant interactions with AHI≥5 were present. No differences between OSA (AHI≥5) and no-OSA groups were present on PI, ISI or CESDR after controlling for age, sex and BMI.

Conclusion

Retrospective reports of pain intensity were unrelated to PSG measures of sleep and respiratory disturbance. Female sex, older age and higher BMI related to higher PI regardless of the OSA diagnosis and collectively accounted for 8.8% of the PI variance. Symptoms of insomnia and depression related to higher PI independently of OSA, accounting for 4.5% and 2.3% of the PI variance, respectively. As in prior research OSA was associated with insomnia and depression, these variables may mediate the relationship between OSA and pain.

Support (If Any)

None
0653 Poor sleep quality is associated with burnout in emergency medicine healthcare workers
Authors: Norful Allison , Belloir Joseph , Firew Tsion , Miranda Maody , Shaw Kaitlin , Schwartz Joseph , Macron Kathryn , Schultebraucks Katharina , Sullivan Alexandra , Chang Bernard , Shechter Ari
Published: May 2022

Introduction

Prolonged exposure to stressful environments is associated with adverse psychological outcomes, including sleep disturbance and burnout. Burnout rates have increased substantially during the unprecedented challenges faced by healthcare workers (HCWs) during the COVID-19 pandemic. Since burnout has been associated with significant health risk and adverse organizational outcomes, it is important to identify factors that inform preventive or therapeutic approaches to mitigate adverse outcomes in HCWs.

Methods

Participants were HCWs (physicians, nurses, advanced practice providers, technicians etc.) from 4 emergency departments in New York City who completed a cross-sectional electronic survey (completed at study enrollment between November 2020-October 2021). The Pittsburgh Sleep Quality Index (PSQI) assessed global sleep quality. The Maslach Burnout Inventory (MBI) assessed 3 burnout dimensions: emotional exhaustion (EE; feelings of being emotionally overextended and exhausted by one's work); Feelings of depersonalization (DP; unfeeling and impersonal response towards patients); and reduced personal accomplishment (PA; feelings of competence and successful achievement in one's work). Descriptive statistics were calculated and separate binary logistic regressions were used to predict poor global sleep quality (PSQI >5) from individual MBI subscales (dimensions of burnout), while controlling for age, race, ethnicity, and gender.

Results

Ninety-one participants, studied to date, were included in the analysis (51% non-Hispanic/Latino White, 63% female, mean age: 40 [SD: 9.6] y). Poor global sleep quality was reported by 68%. High EE (score >9), DP (score >6) and reduced PA (score <9) were reported by 44%, 27%, and 18% of participants, respectively. Poor global sleep quality was significantly associated with presence of elevated EE (OR: 3.04, 95% CI: 1.07-8.63, p=0.037), but not with elevated DP (OR: 1.35, 95% CI: 0.44-4.10, p=0.603) or reduced PA (OR: 3.29, 95% CI: 0.65-16.44, p=0.146).

Conclusion

During the COVID-19 pandemic, poor sleep quality was reported by the majority of participants and associated with increased burnout in HCWs. Poor global sleep appears to have the most influence on the burnout dimension EE, thus suggesting new evidence about associations between sleep and emotional regulation in HCW during the pandemic. Future trials should test whether existing (or novel) interventions can improve sleep and thereby support HCWs in high stress periods.

Support (If Any)

R01HL146911
0654 Sleep, Mental Health, and Stress in College Students: Impact of COVID-19
Authors: Okun Michele , Dupy Cameron , Sollenberger Alaric , Raval Foram , Blide Jordyn , Gooding C Calvin , Feliciano Leilani
Published: May 2022

Introduction

The COVID-19 pandemic has had an unparalleled impact on sleep, mental health, and stress globally. This has been particularly true among college students. While Universities recognize the surge in mental health visits and high stress, few have evaluated sleep, even though poor sleep is a known contributor to poor mental health and stress.

Methods

To address this gap, data from 116 college students were examined for sleep disturbance (Pittsburgh Sleep Quality Index (PSQI)), as well as stress, depression, and anxiety scores from the Depression, Anxiety and Stress Scale (DASS-21). Data were collected between May 2020-October 2021.

Results

Participants included N = 10 (8.7%) males and 106 (91.3%) females, Mage = 23.1 (6.5) years. MPSQI scores = 7.8 (2.0) and 7.0 (3.9), for males and females, respectively. As a comparison, pre-pandemic data from 866 undergraduates from Dietch et al (2016) found a MPSQI = 5.64 (SD = 2.79). Examination of individual components indicate that MTST = 7.06 (1.65) hours, with a range of 1-12. Average bedtime = 10:25PM (44.0 minutes) with a range between 9:00PM-5:00AM, and average waketime = 7:45AM (.09 minutes) with a range between 4:30AM – 2:00PM. SOL was high with 48 (41.0%) indicating an average of 16-30 minutes and 41.8% reporting 31+ minutes. Sixty-seven (57.3%) indicated that they had fairly bad or a very bad time initiating sleep in the past month, while 54 (46.2%) reported difficulty staying asleep at least 2x/week. Medication use at least 3x/week was noted in 20 (17.1%) of the sample and 50 (42.7%) stated that keeping up their enthusiasm was somewhat or a big problem. MDASS-21 scores indicate that this sample was in the moderate to severe range for Depression =14.9 (11.4), Anxiety = 12.9 (10.0), and Stress = 19.1 (9.8). As a comparison, Kia-Keating et al., (2018) assessed 1400+ undergraduates and reported depression (M = 4.1, SD = 4.3), anxiety (M = 3.9, SD = 3.6), and stress (M = 6.0, SD = 4.1).

Conclusion

Regrettably, undergraduates are experiencing “long-haul’ impacts on sleep, mental health, and stress. Recognition of the enduring struggles is critical if we intend to mitigate a major health crisis among college students.

Support (If Any)
0657 Evening chronotype moderates the relationship between maternal and offspring’s depressive symptoms in a clinical population of adolescents
Authors: Sun Wanqi , Jiang Yanrui , Wang Guanghai , Wei Wenjing , Wu Hongying , Yuan Chengmei , Fan Juan , Li Shirley , Jiang Fan
Published: May 2022

Introduction

Although depression has shown a strong familial aggregation tendency, there are some moderators between parental and offspring’s depression. Meanwhile, it is known that evening chronotype is a risk factor for depression. Therefore, this study aimed to evaluate the moderating role of chronotype in the relationship between maternal and adolescent depressive symptoms in a clinical sample.

Methods

Seventy-five adolescents who visited a sleep or psychiatric clinic with a major complaint of sleep disturbance or emotional problems agreed to participate, 51 adolescents and at least one biological parent who completed questionnaires were included in the current analysis (17 male adolescents, aged 9-17 yrs). Adolescent’s chronotype were measured by the reduced Morningness-Eveningness Questionnaire (rMEQ). Depressive symptoms in adolescents and parents were assessed by the Depression Self-Rating Scale for Children (DSRSC) and the Patient Health Questionnaire (PHQ-9), respectively. General linear models were applied to examine the interaction between parental depression and adolescent’s chronotype on adolescent’s depression, in which age and gender were entered as covariates.

Results

Mothers of adolescents with clinical depression (DSRSC>15, n=38) also reported more depressive symptoms (PHQ-9: 4.81±4.37 vs. 2.69±2.46, t=-2.14, p=0.039). But father’s depressive symptoms were not related with adolescent’s depression. In the current clinical sample, the prevalence of evening chronotype in adolescents was up to 45.1% (n=23). Adolescents with either non-evening or evening chronotype reported comparable level of depressive symptoms (DSRSC: 20.37±6.26 vs. 19.00±8.42, t=0.66, p=0.513). There was a significant interaction between maternal depressive symptoms and chronotype on offspring’s depressive symptoms (F=4.05, p=0.044). Specifically, maternal depressive symptoms were associated with offspring’s depressive symptoms only in adolescents with evening chronotype.

Conclusion

Our study suggested that adolescents with evening chronotype might be at an elevated risk of the transgenerational transmission of depression. Hence, our findings supported the need to consider circadian factors and maternal depression in identifying at-risk adolescents.

Support (If Any)

This work was supported by the Shanghai Sailing Program awarded to Dr. Wanqi Sun (Shanghai Science and Technology Committee, 19YF1442200).
0671 Nightmare type and its association with suicide attempts among veterans
Authors: Bishop Todd , Youngren Westley , Ashrafioun Lisham , Carr Michelle , Pigeon Wilfred
Published: May 2022

Introduction

Research has begun to distinguish between idiopathic (no known origin), trauma-related (recurring after a trauma), and complex nightmares (trauma-related nightmares that recur comorbidly with sleep disordered breathing). Nightmare type may impact symptom severity as well as treatment outcomes among various patient groups. Thus, we sought to examine the individual effects of nightmare type on suicide re-attempts and, secondarily, on treatment utilization.

Methods

This is a secondary analysis of electronic medical record data. Data were extracted for all Veterans with a documented suicide attempt (using ICD-10 codes) during FY13-14. A 1:1 case control was then created using age, sex, and prior year behavioral health treatment utilization. The present sample is comprised of all Veterans from that parent dataset who carry an ICD-10 diagnosis of nightmare disorder (n = 3207). Groups were defined as follows: 1) Idiopathic (n = 589; nightmare disorder only); 2) Trauma (n = 3207; nightmare disorder plus ICD-10 diagnosis of PTSD); 3) Complex (n = 576; nightmare disorder + PTSD + ICD-10 diagnosis of a sleep-related breathing disorder).

Results

Multiple logistic regression revealed that only trauma-related nightmares were positively associated with suicide re-attempts (B = 0.16, SE = 0.06, p < 0.01), with an estimated odds ratio of 1.27 (95% CI of 1.02-1.57). Regarding treatment utilization, regression analyses revealed that both complex nightmares (B = 0.36, p < 0.05) and trauma-related nightmares (B = 0.31, p < 0.05) were significantly associated with mental healthcare utilization (total days).

Conclusion

Our results revealed that both complex and trauma-related nightmares are associated with mental health treatment utilization. Only trauma-related nightmares were significantly associated with suicide re-attempts. Trauma-related nightmares may be distressing because of their trauma-related content, therefore making them more likely to predict reattempts. Overall, results suggest that nightmares are positively associated with suicide re-attempts and increased treatment utilization.

Support (If Any)

This work was supported by the VA Center of Excellence for Suicide Prevention in teh Finger Lakes Healthcare System.
0672 Twenty-Four Hour Activity Patterns, Pain, and Mental Health Trajectories After a Traumatic Event
Authors: Straus Laura , An Xinming , Cakmak Ayse , Clifford Gari , Neylan Thomas , McLean Samuel
Published: May 2022

Introduction

Among those who experience trauma, some individuals develop Adverse Posttraumatic Neuropsychiatric Sequelae (APNS). Identifying biomarkers associated with APNS is critical for predicting trajectories of recovery and informing interventions to reduce the impact of trauma. In this study, we examined objective 24-hour activity patterns and APNS in the weeks following a traumatic event.

Methods

Participants (n = 2,021) were recruited from emergency departments after experiencing trauma. Over 8 weeks, they wore wrist accelerometry devices to measure 24-hour activity patterns, and completed surveys assessing 10 Research Domain Criteria (RDoC) constructs associated with APNS. We aimed to 1) examine the relationship between 24-hour activity patterns and APNS symptoms, and 2) examine how 24-hour activity patterns changed over time in relation to changes in APNS over the 8-week period. A bivariate linear mixed model approach was used to model the cross-sectional and longitudinal associations with each of the 10 RDoC constructs.

Results

Overall, participants reporting more pain in the weeks following trauma also showed objectively less 24-hour activity variance (Pearson correlation = -0.14, p = 0.001). An improving pain trajectory over the 8 weeks was associated with increases in daily activity (Pearson correlation = -0.14, p < 0.001) variability in activity (Pearson correlation = -0.12, p < 0.001), and increases in sleep consolidation (Pearson correlation = 0.013, p < 0.001). Within subjects, an increasing number of transitions between sleep and wake over the study period was also associated with worsening self-reported anxiety (Pearson correlation = 0.06, p = 0.003) and sleep problems (Pearson correlation = 0.10, p = 0.003)

Conclusion

After a traumatic event, several 24-hour activity biomarkers were associated with APNS. Results suggest pain, activity, and sleep highly influence each other in the weeks following a traumatic event, and 24-hour activity patterns should be considered when making predictions about who is likely to recover from trauma. Targeted interventions for sleep and pain may promote recovery in the other domains.

Support (If Any)

NIMH U01MH110925, US Army Medical Research and Material Command, the One Mind Foundation, The Mayday Fund, Verily Life Sciences. LDS is supported by a Department of Veterans Affairs Career Development Award (IK2CX002032).
0682 Cognitive-behavioral therapy for insomnia alleviates and prevents suicidal ideation
Authors: Kalmbach David , Cheng Philip , Reffi Anthony , Ahmedani Brian , Peterson Edward , Seymour Grace , Sagong Chaewon , Sultan Zain , Drak Christopher
Published: May 2022

Introduction

Patients with insomnia disorder are at increased risk for suicidal thoughts and behaviors. Early evidence suggests that insomnia therapeutics may reduce suicidal ideation (SI). However, the role of digital insomnia therapeutics in both the alleviation and prevention of SI remains unclear.

Methods

A total of 658 community adults with DSM-5 insomnia disorder enrolled into a single-site RCT evaluating the efficacy of digital cognitive behavioral therapy for insomnia (CBTI) relative to attention control. Before treatment, 126 patients endorsed SI, whereas 532 patients denied SI. First, we tested whether CBTI can reduce SI in patients with baseline SI. Second, we tested whether CBTI reduces risk for SI development in those without baseline SI.

Results

Among those with baseline SI, just 30.0% of CBTI patients reported SI after treatment, which was lower than the 54.5% of controls with posttreatment SI (OR=2.81, p=.006). Among those without baseline SI, CBTI did not reduce risk for developing SI after treatment (p=.681). However, a multivariate logit model regression odds for SI onto condition (p=.140) and posttreatment remission status (OR=5.68, p=.007) indicated that patients who remitted from insomnia exhibited a reduction in SI risk. Importantly, CBTI was associated with a 6.29 odds increase of insomnia remission relative to control. PRODCLIN estimation of the indirect effect indicated that CBTI prevents SI, but that the effect is fully mediated by the extent to which CBTI produces insomnia remission (αβ=-3.13=5, 95% CI=-5.28, -0.96).

Conclusion

Digital CBTI reduces risk for SI development in insomnia patients without pretreatment SI. These data support a role for digital insomnia therapeutics in SI prevention in this high-risk patient population. Moreover, digital CBTI reduces SI in insomnia patients with SI. These data indicate that digital CBTI can alleviate SI, but it possible that adjunct treatment directly targeting SI may enhance suicide risk reduction.

Support (If Any)

Robert Wood Johnson Foundation
0683 Smoking and Perceived Stress: Examining Associations with Subjective Symptoms of Obstructive Sleep Apnea through Parallel Mediation Analyses
Authors: Chana Sofia Mildrum , Thomas S , Gamble Karen , Cropsey Karen
Published: May 2022

Introduction

Cigarette smoking is known to have a negative effect on individuals’ sleep quality. Specifically, evidence shows that smoking can exacerbate sleep disorders such as obstructive sleep apnea (OSA) by increasing irritation and inflammation of the upper respiratory conducts. Furthermore, previous research highlights a complex bidirectional positive association between cigarette smoking and perceived stress. Sleep quality may be an important aspect intervening in the association between smoking and perceived stress, given that individuals who report high stress also report more sleeping issues and increased risk for OSA. Further research is needed to elucidate the impact of smoking and OSA on perceived stress.

Methods

The present cross-sectional survey of N=459 (75.8% female; 60.3% non-Hispanic White) current smokers and non-smokers investigated the associations between smoking status and perceived stress through the indirect effects of subjective OSA symptoms. A parallel mediation analysis using PROCESS Macro Model 4 was conducted with three mediators: risk for OSA based on subjective symptoms (assessed using the STOP portion of the STOP-BANG questionnaire), average sleep propensity (evaluated using the Epworth Sleepiness Scale), and overall subjective sleep quality (assessed with the Pittsburgh Sleep Quality Index). Race, sex, employment, and income were added to the model as covariates.

Results

Analyses supported a significant indirect effect of risk for OSA based on subjective symptoms (B = -0.55, 95% CI [-1.07, -0.09]) and overall subjective sleep quality (B = -1.39, 95% CI [-2.16, -0.74]) on the relationship between smoking status and perceived stress. However, average sleep propensity was not found to mediate this association (B = -0.09, 95% CI [-0.45, 0.21]). The direct effect of smoking status on perceived stress was also not statistically significant (B = 0.06, t = 0.09, p = 0.93).

Conclusion

Findings illustrate that smokers tend to be at greater risk for OSA and overall report worse sleep quality, which in turn increases their reported levels of perceived stress. Further research is necessary to understand possible demographics-based differences behind these findings as well as potential clinical implications.

Support (If Any)

This project was financially supported by the National Institute of Drug Abuse (R01DA046096-02S1).