bluuebunny/crossref_metadata_2025 huggingface dataset:
615 Sleep Restriction Leads to Fewer Prosocial Responses to Ambiguous Social Vignettes among School-aged Children
Authors: Gonzalez Rogelio , Meir Priel , Palmer Cara , Alfano Candice
Published: May 2021

Introduction

Introduction. After sleep deprivation, adults demonstrate reduced ability to accurately discriminate socio-emotional cues, including increased perceptions of threat and decreased recognition of subtle emotional facial expressions. Experimental studies in youth are far more limited, but sleep loss may have more profound effects on detection of socio-emotional cues during development when these abilities are still developing. The current study therefore compared children’s responses to ambiguous social vignettes after a night of adequate sleep and two nights of sleep restriction (SR). We hypothesized that SR would result in fewer pro-social responses compared to when children were rested.

Methods

Methods. A total of 53 healthy children aged 7–11 years old (M = 9.08, SD = 1.34; 56.6% female) completed two counterbalanced emotional assessments; one after a night of 10 hours in bed (assessed via at-home polysomnography) and one a week later after two consecutive nights of SR (7 hours and 6 hours in bed, respectively). At each assessment, children listened to three brief stories depicting ambiguous social vignettes with peers or adults. After each story, children were asked what they would do next in the situation. Responses were recorded verbatim and later coded by blind raters as prosocial, avoidant, aggressive, or ambivalent.

Results

Results. A difference in response type was detected for one of the three types of vignettes after SR compared to when rested (χ2 (1) = 4.51, p = .02). Specifically, stories including ambiguous actions of another child at school resulted in 1.47 lower odds of a prosocial response compared to all other types when children were sleep restricted.

Conclusion

Conclusion. Our preliminary findings suggest that inadequate sleep may undermine children’s behavioral responses in ambiguous social situations with peers. These preliminary results require replication, but such investigations may provide greater insight into mechanism that explain documented relationships between sleep and social problems in childhood.

Support (if any):
617 Electrocardiogram Abnormalities in Children Undergoing Polysomnography
Authors: Amin Ankit , Paola Mogavero Maria , Ferri Raffaele , Delrosso Lourdes
Published: May 2021

Introduction

Monitoring electrocardiogram (EKG) is an integral component of pediatric polysomnography (PSG). There is limited data regarding arrhythmia and conduction disturbances in the pediatric population undergoing a PSG. In this work we will present abnormal EKG findings during PSG in our sleep center.

Methods

A retrospective chart review from children at Seattle Children’s Hospital who underwent PSG read by a single Sleep Medicine physician (LD) in the last year was carried out. Data included age, sex, type of EKG abnormality, sleep diagnosis from PSG. Data from children with 1st or 2nd degree atrioventricular block (AVB) were compared to those from children with premature ventricular contractions (PVC).

Results

A total of 1,235 PSG were included. Twenty-four children (9 girls and 15 boys) aged 2–17 years (median 9 years) were identified with arrhythmias or conduction disturbances (1.9%). Nineteen out of 24 of these children (79.2%) had oAHI >1/hour; this frequency was not significantly different from that found in the whole group of 1,235 children (Chi-square test p=0.16). When comparing PSG parameters from children with AVB with those with PVC, we found no statistically significant difference. Seven out of nine children with AVB and seven out of ten with PVC had oAHI >1/hour (Fisher exact test p=0.56) while eight children with AVB out of nine and four out of ten with PVC were males, and this difference was the only statistically significant difference found (Fisher exact test p=0.04). None of the children were found to have a structural or conduction abnormality when referred to cardiology.

Conclusion

Our study found ECG abnormalities in 1.9 % of children undergoing PSG. None of the children were found to have abnormal findings after cardiology referral. Our study supports that EKG abnormalities are rare in PSGs of children and not associated with cardiac disease or sleep disorders, but appear more commonly in males.

Support (if any):
627 Adolescent Delayed Sleep Phase and Circadian Irregularity Associated with Substance (Mis)Use in Young Adulthood
Authors: Calhoun Susan , Krishnamurthy Venkatesh , Bui Linda , Ciarletta Matt , Liao Jiangang , He Fan , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio
Published: May 2021

Introduction

Substance use disorders are reaching epidemic proportions among adolescents and young adults. While disturbed, insufficient sleep is known to be associated with substance use, little is known about the role of circadian misalignment in precipitating or perpetuating substance misuse.

Methods

The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). In adolescence, a delayed sleep phase was defined as a 7-night actigraphy-measured mean sleep midpoint later than 4:00 AM, while an irregular circadian phase as a within-subjects standard deviation in sleep midpoint greater than 1 hour. Alcohol, tobacco, and drug use was ascertained by parent- and/or self-reports in adolescence, while alcohol, tobacco and marijuana use was ascertained by self-reports in young adulthood. Logistic regression models tested the association between delayed and irregular circadian phase with substance use adjusted for age, sex, race/ethnicity, BMI, SES, mental health problems and psychoactive medications.

Results

Adolescents with a delayed sleep phase (n=164) showed later bed and wakeup times, lower morningness scores and greater circadian phase irregularity. Cross-sectionally, a delayed sleep phase in adolescence was associated with 1.9-fold odds (95%CI=1.1–3.2) of alcohol, tobacco and/or drug use; specifically, the odds of alcohol and tobacco use associated with a delayed sleep phase were 1.9-fold (95%CI=1.1–3.4) and 2.4-fold (95%CI=1.1–5.3), respectively, while non-significant for drug use (n=28) for which mental health problems were among the strongest risk factors (OR=3.0, 95%CI=1.3–6.8). Longitudinally, an irregular circadian phase in adolescence was associated with 2.2-fold odds (95%CI=1.1–4.5) of alcohol, tobacco and/or marijuana use in young adulthood; specifically, the odds of alcohol use in young adulthood associated with an irregular circadian phase in adolescence were 1.9-fold (95%CI=1.1–3.5), while non-significant for tobacco (n=58) or marijuana use (n=76) for which mental health problems were the strongest risk factor (OR=2.2, 95%CI=1.3–3.7).

Conclusion

A delayed or irregular circadian phase in adolescence is associated with substance use, particularly alcohol use in the transition to adulthood. Beyond disturbed and insufficient sleep, circadian misalignment should become a target of early interventions to prevent substance use disorders.

Support (if any)

R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127
631 Sleep SMART in Adolescents with Neurodevelopmental Disorders
Authors: Hanish Alyson , Jo Klein Abbey , Mathews Therese , Berger Ann , Kupzyk Kevin , Ellis Cindy , Kuhn Brett
Published: May 2021

Introduction: Introduction

Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs.

Methods: Methods

Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary & urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination.

Results: Results

At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO & urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions.

Conclusion: Conclusion

Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST.

Support (if any)

Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).
633 Dysregulated REM Sleep in Children with Moebius syndrome
Authors: Edlund Wendy , Kotagal Suresh
Published: May 2021

Introduction

Moebius syndrome (MBS) is a rare disorder characterized by failure of development of the 6th and 7th cranial nerve nuclei located in the pons. Though the congenital lesion abuts the pontine tegmentum, sleep architecture has not been evaluated in MBS.

Methods

We report the clinical features of three children with MBS, and discuss implications for “developmental” RBD.

Results

Three clinically and MRI brain scan-confirmed MBS children, age 0.5 to 16 years, mean 8.5 ± 6.3 years, were evaluated for disrupted sleep, with repetitive crying (1/3), yelling (2/3), agitation in sleep (2/3), and injuring a co-sleeping sibling (1/3); 3/3 had REM sleep without atonia while 2/3 had RBD. REM sleep was reduced in all three: 21.7% in the infant (reference REM percentage value in infancy is about 40%), 11.4% in subject 2 and 3% in subject 3. Treatment with clonazepam (patients 2 and 3) or melatonin (patient 1) had variable results.

Conclusion

Children with Moebius syndrome have both quantitative (reduced percentage) and qualitative abnormalities of REM sleep (RSWA/RBD). The association of MBS with RSWA/RBD suggests more extensive involvement than published in literature, with extension into the sub-laterodorsal pontine tegmentum and “REM-off” neurons. Moebius syndrome might serve as a model for study of “developmental” REM sleep behavior disorder.

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635 Evening Sunglasses Plus Stable Wake Times: Can This Intervention Help Adolescents with Delayed Sleep-wake Phase Disorder?
Authors: Crowley Stephanie , Killen Logan , Robert Auger R
Published: May 2021

Introduction

Evening light can increase alertness and shift the circadian clock later (delay) and, in turn, delay sleep onset timing. We are examining whether reducing evening light exposure (by wearing sunglasses) paired with stable wake times can shift circadian and sleep onset times earlier in adolescents with Delayed Sleep-Wake Phase Disorder (DSWPD).

Methods

Fifteen adolescents (14.7–18.1 years; 4 male) diagnosed with DSWPD are included in this interim analysis. Participants sleep without restriction at home for a baseline week, and then complete a 2-week intervention. One group (Amber; n=7) wears glasses with amber lenses (Cocoons®, Live Eyewear) beginning 7 hours before their baseline mid-sleep time until self-selected bedtime or for 7 hours (corresponds to the phase delay region of the adolescent phase response curve to light). The amber lens transmits 14% of light to the eye and absorbs most short wavelength light. The frame blocks light from all angles. Amber participants are also instructed to wake at their average baseline school-morning wake-up time (±30 mins). Another group (Clear; n=8) wears identical glasses with clear lenses at the same time and wake time is unrestricted. Glasses wear time is monitored with an iButton placed at the temple tip. Dim Light Melatonin Onset (DLMO) is measured after the baseline week and after the 2-week intervention; 2 participants (one from each group) do not have melatonin data due to technical error. Sleep is measured with wrist actigraphy and sleep diaries throughout the study. DLMO and sleep onset changes (baseline-intervention) are compared between groups with t-tests.

Results

Amber DLMOs shifted 1.0±2.0h earlier (min-max: 0.4-h delay-5.0-h advance) and Clear DLMOs shifted 0.4±1.1h later (min-max: 2.0-h delay-0.6-h advance) [t(11)=1.60,p=0.14]. Average school-night sleep onset shifted earlier in both groups (Amber:0.4±1.3h; Clear:0.6±1.0h; t(13)=0.2,p=0.8]. Average non-school-night sleep onset shifted 1.1±1.0h earlier in Amber (min-max:0.6-h delay-2.2-h advance) and remained stable (0.03±1.0h) in Clear (min-max: 1.8-h delay-1.7-h advance) [t(13)=1.92,p=.08].

Conclusion

Trends from this ongoing study suggest that amber-lensed glasses to block evening light plus stable wake-up times may shift circadian rhythms earlier. This strategy appears to help adolescents with DSWPD fall asleep earlier predominantly on non-school nights.

Support (if any)

AASMF Strategic Research Award (184-SR-17) to RRA
636 Associations among sleep, physical activity and high body mass index in youth: Age differences
Authors: Ji Xiaopeng , Covington Lauren , Brownlow Janeese
Published: May 2021

Introduction

Short sleep duration is associated with overweight and obesity. Less clear is how sleep regularity and physical activity interact with sleep duration in predicting overweight across adolescent stages. This study examined interactions between (1) sleep duration and regularity, and (2) sleep duration and physical activity on overweight in preadolescents (10–11 years), early (12–14), and middle (15–17 years) adolescents.

Methods

Using the National Survey of Children’s Health 2017–2018 dataset, we included youth with sleep, physical activity and overweight data available (n=25,875) in the analyses. Parents reported their children’s sleep duration, sleep regularity and physical activity (>60 min/day) frequency per week. High Body Mass Index (BMI, ≥85th percentile) for age and sex indicated overweight/obesity. Accounting for complex survey design and covariates (age, sex, race, poverty, and resilience), separate logistic regression models (STATA 16.0) estimated the associations in preadolescents, early and middle adolescents.

Results

Preadolescents had the highest odds of high BMI compared to other age groups (OR= 0.64 and 0.78, p<0.001). Every hour increase in sleep duration was associated with 4–18% decrease in the odds of having high BMI, with the highest magnitude shown in preadolescents (OR=0.82, p<0.001), followed by adolescents aged 12–14 (OR=0.89, p<0.001) and 15–17 years old (OR=0.96, p=0.04). For preadolescents, irregular sleep (OR=1.41, p<0.001) and physical activity (OR=0.83, p=0.03) modified the association between sleep duration and BMI. Specifically, the association was attenuated or even reversed among irregular sleepers (OR=1.09, p=0.27) compared with regular sleepers (OR=0.77, p<0.001). Preadolescents with regular physical activity (≥4 days/week) showed stronger associations (OR=0.74, p<0.001) between sleep duration and BMI than their counterparts (OR=0.89, p=0.01). Sleep regularity was not associated with BMI nor a modifier in other age groups. Although there was no interaction with sleep duration, regular physical activity was independently associated with decreased odds of having high BMI (OR=0.62, p<0.001) in early and middle adolescents.

Conclusion

The relationship between lifestyle factors (i.e., sleep duration and physical activity) and BMI varies by age groups. Sufficient sleep duration, regular bedtimes and physical activity represent resilience factors against overweight/obesity, especially in preadolescents who are at greater risk for high BMI.

Support (if any)

N/A
639 An exploratory study of parents-child co-sleeping in Korea
Authors: Kang Solbi , Chung Seockhoon , Suh Sooyeon
Published: May 2021

Introduction

Asian cultures, including Korea, are known to have a higher proportion of parent-child co-sleeping than Western cultures. While recent studies have shown that bed-sharing increases the mother’s depression and causes sleep problems for children, there has never been a study in Asia on the sleep problems of parents and children caused by co-sleeping. Therefore, we aim to investigate the types of sleep problems in children and their mothers’ insomnia severity due to co-sleeping.

Methods

This study was conducted in 79 mothers (mean age 33.65 ±3.98 years) who reported having insomnia due to their children. All participants had children between 6 to 36 months old. Participants were asked to answer the survey includes demographics, sleep environment, child’s sleep problems, child’s health status items and the mother’s insomnia (measured by the Insomnia Severity Index; ISI). Children’s age was divided into 5 age groups (6 – 11, 12 - 17, 18 - 23, 24 - 29, and 30 to 36 months). Frequency analysis and independent t-test were conducted.

Results

Of the total respondents, 72.2% (n=57) reported co-sleeping with their children. The most reported sleep problem in children was waking up in the middle of the night 51.9% (n=41), followed by difficulty in sleep initiation 12.7% (n=10), looking for mother or an attachment object 12.7% (n=10), sleep-limiting problems 7.5% (n=6), multiple problems 12.7% (n=10), and none 2.5% (n=2). An independent t-test results for determining whether co-sleeping caused a difference in the severity of maternal insomnia was significant in the 6 to 11 months group only (t=-2.336, p<.05). The co-sleeping mother’s ISI average score (M=18.28) was significantly higher than mother who slept separate from her child (M=14.31).

Conclusion

Co-sleeping in Asian cultures is prevalent, and may require attention and intervention for mothers who report having insomnia due to their children’s sleep disturbance.

Support (if any):
640 Regular bedtime routines and biological obesity risk among 9-year old children from the Fragile Families Child and Wellbeing Study
Authors: Chung Alicia , Jin Peng , Moore Jesse , Nunes Joao , Seixas Azizi , Jean-Louis Giardin
Published: May 2021

Introduction

Obesity rates among Hispanic (26%) and Black (22%) children are considerably higher compared to their white counterparts (14%), which evidence suggests may be attributable to biological, behavioral, and psychosocial factors affecting the family unit. Bio-behavioral factors in the household may affect child health behaviors, including sleep, a known predictor for obesity. Hispanic and Black children report shorter sleep duration, later bedtimes, and are often lacking in bedtime routines, compared to white children. Evidence suggests that early childhood routines are highly predictive of overweight status in children. Herein, we investigate whether bedtime routines are associated with the genetic allele for obesity in a racially diverse sample of children.

Methods

Data for the present analysis emanated from wave 5 (Year 9--2007–2010) cohort of the Fragile Families Child and Wellbeing Study dataset. During home visits, interviews with children’s mother and father during home visits, around the target child’s ninth birthday collected data on home routines and other parent-child relationship and school connectedness topics. Saliva samples were also collected at Year 9 to assess telomere length and DNA methylation levels and changes. The independent variable was regular bedtime routine, and biological variable for fat mass and obesity (rs9939609) was the dependent variable. Adjusted covariates included child’s age and BMI, and parent household income.

Results

Analysis of the final sample of 466 children showed 52% of the children were male and were 9 years old, on average; 35% were White, 46% Black, 20% Hispanic, 4% Asian and 5% other. The median family income was $42,500. The child’s sleep measures captured was ‘children have a regular bedtime routine’ was associated with (β = -0.137, p = 0.01) decrease in the odds of having the genetic allele for obesity.

Conclusion

Regular bedtime routines among 9-year old Black and Hispanic children may be associated with genetic alleles related to fat mass and obesity. Regular bedtime routines could aid in promoting healthy weight in children.

Support (if any)

NIH (T32HL129953, K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453.
647 Adolescent and Young Adult Sleep and Sleep-Related Behaviour Change During the COVID-19 Pandemic
Authors: Carmona Nicole , Carney Colleen
Published: May 2021

Introduction

Sleep disturbance, poor sleep quality, and dissatisfaction with sleep are common among adolescents and young adults (AYAs; e.g., Becker et al., 2018; Hicks et al., 2002; Hysing et al., 2013). Environmental and behavioural factors (e.g., early school start times, evening technology use and social pressures) are barriers to healthy sleep among AYAs that contribute to a “perfect storm” of sleep disturbance during this period (Carskadon, 2011; Crowley et al., 2018). Notwithstanding, few AYAs have access to sleep treatments. The COVID-19 pandemic lockdowns decreased academic and scheduling demands, providing an opportunity to study unconstrained AYA sleep and potentially facilitating better access to sleep interventions (Simpson & Manber, 2020). This study evaluated differences in baseline sleep and sleep-related behaviour change (i.e., how AYAs use an evidence-based app for sleep disturbance) before vs. during the lockdown.

Methods

Participants between the ages of 15 and 24 (M=20.66, SD=2.38) completed a 4-week feasibility study evaluating a free, transdiagnostic sleep self-management app (DOZE) before the lockdown (“Pre-Lockdown”; n=51) or during the lockdown (“Lockdown”; n=29). After 2 weeks of completing baseline sleep diaries, participants could set goals based on feedback and access tips, followed by 2 more weeks of completing sleep diaries.

Results

Compared to Pre-Lockdown, Lockdown demonstrated less variability in their sleep schedules (ps≤.011), less napping (p=.002), but increased time in bed (TIB; p<.001) and total wake time (p=.007). Total sleep time, lingering in bed in the morning, and sleep efficiency did not differ between groups. Relative to Pre-Lockdown, Lockdown showed a greater tendency to set goals to reduce schedule variability (p=.010) and to restrict excessive TIB (p=.005). Rates of goal setting for lingering in bed in the morning, sleepiness, naps, and sleep-interfering substance use did not differ between groups. Rates of accessing tips did not differ between groups.

Conclusion

Effects of COVID-19 lockdown on AYA sleep included less variability in their schedule and a decreased need for naps, but negative effects on TWT and TIB. As a result, AYAs set different goals during the COVID-19 lockdowns, focusing more on restricting excessive TIB than on schedule variability.

Support (if any)

Canadian Institutes of Health Research eHealth Innovation Partnership Program (#143551).
648 Associations between objective afternoon and evening physical activity and polysomnographic sleep in fibromyalgia
Authors: McGovney Kevin , Curtis Ashley , McCrae Christina S
Published: May 2021

Introduction

Patients with fibromyalgia (FM) suffer from pain which limits physical activity and disrupts sleep. Research examining the relationship between pre-bedtime physical activity, pain, and objective sleep is limited. This study examined whether objectively measured activity levels (via actigraphy), pain intensity, or their interaction are associated with polysomnographic sleep outcomes and sleep architecture.

Methods

Adults with FM (n=158, Mage=52, SD=12, 93% female) completed 14 daily pain ratings, 14 days of actigraphy, and a single night of polysomnography. Activity levels (i.e., magnitude of wrist motion captured per 30 second epoch) were recorded, and average afternoon/evening activity for intervals 12:00-15:00, 15:00-18:00, and 18:00-21:00 was computed, removing days in which participants slept during these periods. Sleep architecture was quantified as the percentage of sleep time in rapid eye movement (%rem) and non-rem (i.e. %stage 1, %stage 2, and %stage 3). Multiple regressions examined whether average afternoon/evening activity, average evening pain [0 (no pain)–100 (most intense pain imaginable)], or their interaction predicted polysomnographic sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), %stage 1, %stage 2, %stage 3, and %rem, controlling for age, body mass index, average individual bedtime, time in bed, and sleep or pain medication usage.

Results

Greater afternoon activity from 12:00-15:00 was independently associated with lower SE (B= -.08, p=.01), greater WASO (B=.45, p<.001), and greater %stage 1 (B=.04, p<.01). Pain intensity interacted with physical activity from 12:00-15:00 such that the association between physical activity and higher WASO (p=.05) and greater %stage 1 (p<.01) was stronger for individuals with higher pain. Pain intensity and activity from 15:00-18:00, and 18:00-21:00 were not associated with sleep outcomes.

Conclusion

Our results suggest greater afternoon activity is associated with greater polysomnographic sleep fragmentation and greater %stage 1 sleep in FM, and these relationships are stronger for individuals with higher pain. These relationships are consistent with activity pacing recommendations for chronic pain and suggest pacing in the afternoon may be important for good sleep in FM. However, future research examining causal pathways linking physical activity levels and timing, pain, and sleep is needed.

Support (if any)

Support: NIAMS (R01AR055160/R01AR005160- S1;PI McCrae). Data collected at University of Florida (Clinical Trial-NCT02001077;PI McCrae).
653 Are Daily Variations in Sleep Quality and Quantity Related to General Stress and COVID-19-Related Anxiety?
Authors: Hire Veronica , Thurmon Casey , Snyder Hope , Harra Ryan , Walker Jamie , Vargas Ivan
Published: May 2021

Introduction

Sleep modulates a number of psychological and cognitive processes, such as emotion regulation, executive control, and coping with stress. It is therefore not surprising that insufficient sleep quality or quantity are associated with greater self-reported stress levels. The COVID-19 pandemic has led to a particularly stressful and unprecedented time in history. While stress has been undoubtedly high during the past year, it’s less clear to what extent sleep has affected people’s perceived stress on a daily basis. The aim of this research was to estimate whether daily variations in sleep quality and duration were associated with general stress and/or stress related to COVID-19.

Methods

The study used a nationally representative sample to assess daily variations in sleep and stress for a period of two weeks during the COVID-19 pandemic. Morning assessments were conducted using online sleep diaries. These diaries were used to estimate sleep duration (in minutes) and sleep quality (subjective rating on a 5-point Likert scale). Evening assessments were also completed online and prompted participants to rate (0 to 100) their current “general” stress level, as well as their current anxiety in relation to COVID-19. Separate mixed effects models were conducted with days (Level 1) nested within participants (Level 2). Stress variables were lagged by a day to estimate the association between sleep (AM assessment) and stress (PM assessment). TST and SQ were entered as fixed effects and intercepts were allowed to vary randomly.

Results

4,048 participants (Mage = 46.3 years; 78% women) were included as part of the analyses. The results supported that lower self-reported sleep quality predicted greater general stress levels (b = -1.43, p < 0.001). Lower self-reported sleep quality also predicted greater COVID-19 related anxiety (b = -0.543, p < 0.001). In contrast, sleep duration was not significantly related to general stress or COVID-19 anxiety after controlling for sleep quality.

Conclusion

The present data supports that daily variations in sleep quality are related to a person’s overall stress levels and COVID-19 anxiety. These findings may have implications for the role of good sleep in mitigating the increases in stress that have resulted from the COVID-19 pandemic.

Support (if any)

Vargas: K23HL141581
656 Self-isolation due to COVID-19 was not associated with changes in depression, sleepiness, and insomnia in Shiga prefecture, Japan
Authors: Kadotani Hiroshi , Ubara Ayaka , Sumi Yukiyoshi , Ito Kazuki , Matsuda Arichika , Miyamoto Towa , Omichi Chie
Published: May 2021

Introduction

We aimed to analyze the changes in depression, sleepiness, insomnia, and sleep habits in relation to the degree of self-isolation due to COVID-19 pandemic. A state of emergency was declared for the whole of Japan on 7 April 2020. People in Shiga prefecture were recommended to stay at home and refrain from moving to other prefectures from 8 April to 31 May 2020.

Methods

We enrolled 54 patients who regularly visited the sleep outpatient clinic in Shiga University of Medical Science Hospital, Japan. We compared the sleep habits, depression (Patient Health Questionnaire-9: PHQ-9), insomnia (Athens Insomnia Scale: AIS), and sleepiness (Epworth Sleepiness Scale: ESS) of patients, one year before (from April to July 2019), during (May 2020) and six months after (Nov 2020) the self-isolation period due to the COVID-19. We conducted repeated measures ANOVA to examine changes.

Results

PHQ-9 (3.89±0.64, 3.65±0.62 and 3.52±0.66: p=0.410), AIS (4.78±0.59, 4.65±0.57 and 4.63±0.57: p=0.843) and ESS (7.93±0.76, 7.07±0.68 and 7.00±0.73: p=0.088) were not significantly different among three visits. Sleep duration (6.06±0.23hr, 6.29±0.19hr and 6.16±0.22hr: p=0.248) and sleep onset latency (24.8±5.55min, 19.2±3.97min and 21.0±4.85min: p=0.445) were also not significantly different.

Conclusion

Self-isolation due to COVID-19 was not associated with changes in depression, sleepiness, and insomnia among patients for sleep outpatient units in in Shiga prefecture, Japan.

Support (if any)

The present study was supported by MEXT/JSPS (KAKENHI Grant Number: 17H00872).
669 Increased Nightmares During the COVID-19 Pandemic: Exploring the Role of Resilience and Emotions
Authors: Potvin Jérémie , Socarras Laura Ramos , Forest Geneviève
Published: May 2021

Introduction

COVID-19 had a tremendous impact on many aspects of our lives and has caused an increase in stress and mental health issues in many people. We have recently found that there was an increase in nightmares during the pandemic in young adults. Since emotions have been associated with both resilience and nightmares, the objective of this study was to investigate the role of resilience and emotional changes in the increase in nightmares observed during the pandemic, in a group of young adults.

Methods

Resilience, emotions and nightmares were assessed using the Connor-Davidson Resilience Scale-10, the Differential Emotions Scale-IV and an adapted version of the Pittsburgh Sleep Quality Index. Measures were administered to 209 young adults (18–25 years old, 76.1% females). Hierarchical multiple regression models were computed to examine the unique contribution of changes in positive and negative emotions during the pandemic to the increase in nightmares during the pandemic. Analyses were controlled for nightmares and emotions prior to COVID-19, and for gender. The sample was separated in two groups: resilient and less resilient young adults.

Results

Results show that in less resilient young adults, nightmares prior to COVID-19 (β=.79, p<.001) and increase in negative emotions (β=.21, p=.033) significantly predicted nightmares during the pandemic and explained 67.0% of their variance. In resilient young adults, nightmares prior to COVID-19 (β=.56, p<.001) and gender (β=-.15, p=.04) significantly predicted nightmares during the pandemic and explained 52.0% of the variance.

Conclusion

Our results show that increase in negative emotions during the pandemic is associated with an increase in nightmares in less resilient young adults, but not in resilient young adults. Furthermore, our results show that in resilient young adults, being a woman is associated with an increase in nightmares during the pandemic. These results suggest that resilience may be a protective factor in managing the impact of negative emotions on nightmares, but only in men.

Support (if any):
670 Changes in Childhood Sleep Patterns in an Intervention Study Prior to and During COVID19 Restrictions
Authors: Mitchell Jonathan , Morales Knashawn , Williamson Ariel , Jawahar Abigail , Juste Lionola , Zemel Babette , Dinges David , Fiks Alexander
Published: May 2021

Introduction

We conducted a childhood sleep promotion study between March 2019 and December 2020 in Philadelphia. COVID19 was first detected in Pennsylvania in March 2020 and non-essential services were strictly curtailed (including school closures), with easing of curtailments by the fall 2020 (including hybrid schooling in some districts). We determined if changes in sleep duration were consistent during pre-, earlier, and later COVID19 periods.

Methods

Typically developing children (9-12y) with sleep duration <8.5 hours per weeknight were enrolled. Sleep was measured using Fitbit devices during a baseline week and a 7-week intervention period. A factorial design was used to test five candidate intervention components: 1) sleep goal; 2) electronic device reduction messaging; 3) daily routine messaging; 4) child-directed financial incentive; and 5) parent-directed financial incentive. Sleep data were transmitted to a mobile health platform that automated delivery of the intervention components. We categorized participants when they completed the study: 1) Spring-Fall 2019 semesters (pre-COVID19); 2) Spring 2020 semester (started pre-COVID19, with strict restrictions impacting intervention periods); or 3) Fall 2020 semester (easing of COVID19 restrictions). Mixed effect modelling determined sleep changes.

Results

Mean age of participants was 11.6y (51% female and 29% Black participants). Pre-COVID19 (N=59), average sleep duration increased from baseline by 21 (95% CI: 10, 30) minutes per weeknight during the intervention. In spring 2020 (N=18), the average sleep duration increase was two times larger in magnitude at 41 (95% CI: 25, 59) minutes per weeknight. For fall 2020 (N=20), the average sleep duration increase was 24 (95% CI: 7, 40) minutes per weeknight. Changes in sleep timing from baseline during the intervention were consistent pre-COVID19 and in the fall 2020 (e.g., ≈15 minutes earlier sleep onset throughout the intervention period), whereas sleep timing changes were dynamic in the spring 2020 (e.g., 41 minutes earlier for week 1, and 44 minutes later for week 7).

Conclusion

This sleep intervention demonstrated increases in sleep duration pre-COVID19, with marked duration increases and dynamic timing changes coinciding with COVID19 restrictions during earlier (Spring 2020), but not later (Fall 2020), weeks of the COVID19 pandemic in Pennsylvania.

Support (if any)

K0 1 HL1 2 3 6 1 2 and CHOP
675 COVID-19 Instruction Style (In-Person, Virtual, Hybrid), School Start Times, and Sleep in a Large Nationwide Sample of Adolescents
Authors: Meltzer Lisa , Wahlstrom Kyla , Owens Judith , Wolfson Amy , Honaker Sarah , Saletin Jared , Seixas Azizi , Wong Patricia , Carskadon Mary
Published: May 2021

Introduction

The COVID-19 pandemic significantly disrupted how and when adolescents attended school. This analysis used data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study to examine the association of instructional format (in-person, virtual, hybrid), school start times, and sleep in a large diverse sample of adolescents from across the U.S.

Methods

In October/November 2020, 5346 nationally representative students (grades 6–12, 49.8% female, 30.6% non-White) completed online surveys. For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported school start times for IP or O/S days, and bedtimes (BT) and wake times (WT) for each applicable school type and weekends/no school days (WE). Sleep opportunity (SlpOpp, total sleep time proxy) was calculated from BT and WT. Night-to-night sleep variability was calculated with mean square successive differences.

Results

Significant differences for teens’ sleep across instructional formats were found for all three sleep variables. With scheduled instructional formats (IP and O/S), students reported earlier BT (IP=10:54pm, O/S=11:24pm, O/A=11:36pm, WE=12:30am), earlier WT (IP=6:18am, O/S=7:36am, O/A=8:48am, WE=9:36am), and shorter SlpOpp (IP=7.4h, O/S=8.2h, O/A=9.2h, WE=9.2h). Small differences in BT, but large differences in WT were found, based on school start times, with significantly later wake times associated with later start times. Students also reported later WT on O/S days vs. IP days, even with the same start times. Overall, more students reported obtaining sufficient SlpOpp (>8h) for O/S vs. IP format (IP=40.0%, O/S=58.8%); when school started at/after 8:30am, sufficient SlpOpp was even more common (IP=52.7%, O/S=72.7%). Greater night-to-night variability was found for WT and SlpOpp for students with hybrid schedules with >1 day IP and >1 day online vs virtual schedules (O/S and O/A only), with no differences in BT variability reported between groups.

Conclusion

This large study of diverse adolescents from across the U.S. found scheduled school start times were associated with early wake times and shorter sleep opportunity, with greatest variability for hybrid instruction. Study results may be useful for educators and policy makers who are considering what education will look like post-pandemic.

Support (if any):
688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes
Authors: Shah Vaishal , Foldvary-Schaefer Nancy , Wang Lu , Jehi Lara , Obrea Cynthia Pena , Milinovich Alex , Mehra Reena
Published: May 2021

Introduction

The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children.

Methods

A retrospective review of 120 consecutive patients (<18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2<90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data.

Results

Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2<90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart.

Conclusion

In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions.

Support (if any):
691 Associations of Sleep Quality and Burnout in Clinicians during the COVID-19 Pandemic
Authors: Shechter Ari , Rosenfeld Adam , Chang Bernard , Norful Allison
Published: May 2021

Introduction

Clinicians have faced unprecedented challenges in care delivery during the COVID-19 pandemic due to increases in patient volume/acuity, alongside fears of COVID-19 exposure. Increased burnout rates are associated with chronic health condition risk and adverse organizational outcomes. It remains unclear whether sleep is associated to burnout in clinicians treating COVID-19 patients.

Methods

A cross-sectional electronic survey was distributed via email across 3 hospital listserves from September to November, 2020. Clinicians delivering direct care to COVID-19 patients were eligible. Clinician burnout was measured using a single item from AHRQ’s Mini-Z survey. We assessed sleep using the Pittsburgh Sleep Quality Index (PSQI). Binary logistic regressions were used to determine the relationship between PSQI global score (global sleep quality) and burnout, controlling for age, race/ethnicity, gender, length of time employed, whether clinical role changed during COVID-19, and anxiety. In a separate model, we investigated the association between burnout and independent PSQI subcomponents: 1) sleep duration (“Hours of sleep per night”), and 2) subjective sleep quality (“How would you rate your sleep quality overall”) entered together, with the above covariates.

Results

The final sample included 315 clinicians, predominantly nurses (57% White, 15% Hispanic/Latino, 89% female). Burnout symptoms were reported by 61.6%, and poor global sleep quality (PSQI global score >5) in 84.4% of participants. Poor global sleep quality (PSQI global score >5 vs. ≤5) was significantly associated with the presence of burnout symptoms (OR: 2.52, 95% CI: 1.20–5.28, p=0.015). In the secondary model, self-reported sleep quality (rating of fairly or very bad vs. rating of fairly or very good) was significantly associated with burnout (OR: 4.13, 95% CI: 2.33–7.32, p<0.05), whereas short sleep duration (<6 h vs. ≥6 h) was not (OR: 0.726, 95% CI: 0.41–1.30, p=0.28).

Conclusion

Poor sleep quality is common and associated with increased burnout in clinicians delivering care to COVID-19 patients. Interestingly, sleep quality appears to be more strongly related to burnout than sleep duration. Increased evidence about the negative implications of poor sleep and burnout are emerging. Interdisciplinary efforts aimed at promoting effective sleep quality in clinicians during this pandemic may lead to improvements in long-term clinician physical and psychological health.

Support (if any):
703 From in-lab to at-home: Measuring sleep and memory in the time of SARS-COVID-19
Authors: Mullins Anna , Parekh Ankit , Kam Korey , Schoenholz Reagan , Valencia Daphne , Roberts Zachary , Castillo Bresne , Rapoport David , Ayappa Indu , Osorio Ricardo , Varga Andrew
Published: May 2021

Introduction

The SARS-COVID-19 pandemic restricted in-lab research activities especially in older individuals who are considered at-risk for severe disease. To continue longitudinal sleep research in this population we sought to test the feasibility of remotely conducting at-home sleep and memory research and to compare two ambulatory polysomnography (PSG) devices for ongoing home sleep testing.

Methods

20 older (age=65.6±5.5 years) cognitively normal adults (65% female) who had previously undergone 2 nights in-lab sleep, memory and vigilance testing were delivered equipment for 2 nights at-home, technician-guided remote PSG set-up (1 night each for Somté [EEG: Fp1-M2, Cz-M1] and Sleep Profiler (SP) [EEG: Fp1-Fp2] devices- randomized presentation), and 6 timed trials on a 3D spatial maze navigation memory plus morning psychomotor vigilance testing (PVT). The night-to-night differences for devices and in-lab versus at-home testing environments were compared for sleep macro and EEG microarchitecture using paired Wilcoxon rank sum and t-tests where appropriate. First-night maze completion time (CT) and PVT reaction time and lapses were also compared.

Results

19 people completed 2 nights at-home PSG, 18 completed PVT and 9 completed all 6 maze trials. Quality frontal EEG signals were obtained for 16 SP and 11 Somté recordings. There was no significant night to night differences (night 1–night 2) between in-lab and at-home environments for total sleep time (mean difference: in-lab= -0.27 vs at-home = 0.35 hours), wake after sleep onset (WASO) (median difference: in-lab= 3.0 vs at-home = 0.7 %WASO), or slow wave sleep (SWS) (mean difference: in-lab= -0.70 vs at-home = 2.3 %SWS). Relative frontal slow wave activity and spindle density were not significantly different between devices or environments. K-complex density (SP= 1.0 vs Somté =2.7/minNREM2, p=0.004) was significantly reduced with the SP device compared to Somté devices. There were no significant differences for maze CT and PVT measures between in-lab and at-home environments.

Conclusion

The night-to-night differences in sleep macroarchitecture do not appear to be influenced by environment or device however measures of EEG microstructure such as K-complexes, which are amplitude-dependent, may be underestimated with the Sleep Profiler device due to smaller EEG amplitude from a derivation with short inter-electrode distances.

Support (if any)

NIH (R01AG056031, R01AG056531, K24)