bluuebunny/crossref_metadata_2025 huggingface dataset:
1185 Developing A Care Pathway For Insomnia In Older Adults And Adults With Dementia: Results Of A Consensus Meeting
Authors: Benca R , Ferziger R , Wickwire E M , Bertisch S , Biddle J , Boustani M , Culpepper L , Gooneratne N , Lett J , Manderscheid R , Mehra R , Reynolds C , Grandner M
Published: May 2020

Introduction

Insomnia among older adults and dementia patients carries a high public health burden. Yet, treatment is inconsistent or absent. Standardized, programmatic carepaths can be implemented in clinics/systems/communities to address this after tailoring to local environments. To determine what elements should be included, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building among diverse stakeholders.

Methods

Participants represented a wide range of stakeholders and specialties, including academic research, clinical care, industry, government, payors, sleep medicine, primary care, geriatrics, psychiatry, neurology, nursing, pharmacy, quality, and implementation science. 27 statements regarding key components of carepaths for insomnia in elderly and dementia populations were presented and discussed. These represented items addressing identification of patients, screening and assessment, deciding treatment modality and delivery, providing behavioral treatment, providing pharmacotherapy, addressing combined therapy, addressing comorbidities, and incorporating outcome evaluation. All N=20 participants voted individually whether they agreed or disagreed with each statement. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree.

Results

Despite diversity among attendees, median rate of agreement was 95% (IQR=85-95%). Mean score was 0.69 (SD=0.31). 95%CIs were computed for each proportion and compared to the mean. The following elements were significantly different from the mean (p<0.05): medication decision trees (M=0.25), accounting for comorbidities (M=0.26), include outcome evaluation (M=0.30), utilization of EMR (M=0.40), incorporate caregiver (M=0.42), and differ across parts of the system (M=1.79).

Conclusion

Insomnia carepaths for older adults should address identification, screening and assessment, treatment decisions, treatment type and delivery, and evaluation. Organizations should consider these elements when designing carepaths for insomnia among older adults and dementia patients. Consensus-building should begin during the process of prioritizing care path components.

Support

Merck Research Labs provided support
1197 Utility of Fitbit Charge 2 for Sleep Monitoring in Patients With Obstructive Sleep Apnea
Authors: Kim D , Shin W , Byun J
Published: May 2020

Introduction

The wearable device may be useful in monitoring sleep. Many studies reported reliable data in detecting sleep-wake states and sleep stage proportion in healthy adults, However, only a few validation studies were performed evaluating sleep using the wearable devices in patients with obstructive sleep apnea(OSA), which showed insufficient accuracy. We aimed to evaluate the reliability of multi-sensory wristband (Fitbit Charge 2) in patients with OSA.

Methods

This was a preliminary analysis of a prospective single-center observational study. Consecutive patients underwent standard Polysomnography (PSG) for evaluation of OSA with Fitbit Charge 2. Sleep data from PSG and Fitbit charge 2 were compared using paired t-tests and Bland-Altman plots.

Results

A total of eighty-six patients were analyzed. Four of them had poor data quality, 18 of them did not show sleep stages. Compared with the PSG, Fitbit Charge 2 showed higher total sleep time (419.1±194.0 vs 269.8±22.6, p<0.001) and sleep efficiency (95.8±2.5 vs 84.6±7.1, p<0.001). Those with sleep stage data showed higher sleep efficacy (87.7±5.5 vs 82.37.5, p=0.024) and a lower proportion of N1 sleep (33.7±19.9 vs 65.3±38.8, p=0.01).

Conclusion

Fitbit Charge 2 showed limited utility in monitoring sleep in patients with obstructive sleep apnea.

Support

none
1216 Markedly decreased ictal discharges with positive airway pressure (PAP) treatment in a patient with refractory epilepsy and severe obstructive sleep apnea
Authors: Massoud Mona , Schütz Sonja G
Published: May 2020

Introduction

Individuals with epilepsy are at increased risk for obstructive sleep apnea (OSA). Treatment of OSA with positive airway pressure (PAP) can result in decreased seizure frequency in patients with epilepsy, possibly due to decreased sleep disruption and normalization of oxygenation saturation levels when using PAP. The following case report demonstrates an example in which treatment of OSA with PAP resulted in a dramatic improvement of electroencephalographic seizures.

Report of Case

A 32 year-old man with refractory epilepsy presented to our office complaining of loud snoring, witnessed apneas, and excessive daytime sleepiness. Despite prior left frontal and left anterior temporal lobectomy, vagus nerve stimulator treatment, and excellent treatment adherence to four different antiepileptic medications, the patient continued to have 1-3 clinical seizures per day. Physical examination was notable for obesity (BMI=39.4 kg/m2), high arched palate and Mallampati class 4 airway. Long-term eletroencephalogram (EEG) monitoring was significant for frequent interictal discharges during wakefulness and sleep, as well as frequent subclinical seizures during sleep characterized by C3/P3 polyspike bursts followed by brief rhythmic fast activity. A diagnostic polysomnogram revealed severe OSA (AHI=69/hour). The patient subsequently underwent a PAP titration study with extended EEG montage, which was notable for a marked decrease in polyspike discharges on effective PAP pressures, from an average of 24 polyspike discharges per hour on PAP pressures < 15 cm of water to an average of 3 polyspike discharges per hour on PAP pressures ≥ 15 cm of water. PAP treatment was initiated following the titration study.

Conclusion

This case demonstrates that effective treatment of OSA can lead to a reduction of abnormal EEG discharges in a patient with intractable epilepsy. Additional clinical follow up is needed to assess whether PAP treatment also resulted in decreased frequency of clinical seizures.
1269 Off-Label Use of Solriamfetol In Idiopathic Hypersomnia
Authors: Wong Tammy , Memon Talha
Published: May 2020

Introduction

Solriamfetol is a new daily dopamine and norepinephrine reuptake inhibitor indicated for improving daytime wakefulness in adults with obstructive sleep apnea (OSA) and narcolepsy. It was FDA-approved on 3/20/2019. In this report, we present a patient with refractory idiopathic hypersomnia (IHS) who benefitted from off-label use of solriamfetol at a private sleep center.

Report of Case

A 37-year-old non-obese female previously diagnosed with IHS vs narcolepsy, presented in 2015 with excessive daytime sleepiness since her mid-teens. She also had a history of periodic limb movement (PLM) and anxiety and trialed clonazepam, which caused daytime hangover effects. At her previous office, she began sodium oxybate but had psychiatric side effects, and was thus started on methylphenidate. Modafinil was added due to build-up of tolerance. Three separate polysomnographies (PSG) over 9 years revealed similar findings of mild snoring without OSA, PLM with variable arousals. Multiple sleep latency testing (MSLT) showed very rapid sleep onset <4 min and no sleep-onset REM periods. The patient never had cataplexy but occasional hypnogogic hallucinations and sleep paralysis. All studies to-date suggested IHS, less likely narcolepsy without cataplexy, and at her initial visit, the patient trialed armodafinil instead of modafinil, and methylphenidate was weaned down. When seen again in 2017, the patient reported persistent daytime sleepiness on methylphenidate and modafinil (PSG-MSLT showed sleep latencies ~3.5 min on 5/5 nap opportunities), without cataplexy. When seen 9/2019, patient continued to have daytime sleepiness and fatigue. She was then weaned off methylphenidate and modafinil, and started on solriamfetol. Since then, she has been doing well solely on solriamfetol 75mg BID.

Conclusion

Off-label use of solriamfetol for IHS has been demonstrated to be effective in a treatment-resistant patient at a private sleep center. More data and further discussion in support of its off-label use are warranted for this patient population.
0158 Loss of Connexin 36 Elicits Abnormalities in Thalamocortical Network Activity Relevant to Neuropsychiatric Disorders
Authors: McNally J M , Thankachan S , Uygun D S , Basheer R
Published: May 2020

Introduction

Neuronal gap-junctions are extensively expressed in mammalian forebrain and suggested to contribute to state-regulation and thalamocortical network activity. However, the physiological role of gap-junctions on these processes remains poorly understood. Connexin-36 (Cxn36) is highly expressed in the brain, representing a mechanism for electrical coupling of inhibitory neurons. We examined the effects of global Cnx36 deletion on sleep/wake and spontaneous and evoked EEG activity.

Methods

We recorded in vivo EEG/EMG in Cxn36KO mice and littermate controls. Electrodes were stereotaxically implanted above frontal cortices. We analyzed sleep/wake states and algorithmically detected sleep spindles over 24 hours. Mice underwent auditory stimulation paradigms including the auditory steady state response (ASSR; 1 second train 20-50Hz clicks, 100 reps., 85dB) and mismatch negativity (MMN; 2.5kHz standard 90%, 10kHz deviant 10%, 300ms ISI, 90dB). Social behavior and investigation-evoked EEG activity were also assessed via the social habituation task (repeated 5 min exposures to novel mouse).

Results

Cnx36KO mice exhibited limited sleep/wake abnormalities (n=7/group). Power spectra of EEG revealed significant impairments in spontaneous gamma-band activity (30-80Hz; All States, Light & Dark Phases), and beta activity (15-25Hz; All States, Light Phase). Sigma activity (10-15Hz) was significantly decreased (NREM and REM, Light phase). This was particularly pronounced during NREM-REM transitions. Despite no changes in spindle density, both spindle amplitude and duration were significantly decreased in Cnx36KOs. Cxn36KOs exhibited a blunted gamma-band response to acute ketamine (15mg/kg; IP), impaired 30 & 40Hz ASSR, and an abnormal response in the MMN task (decrease ERP peak amplitude & gamma). Finally, Cxn36KO mice exhibit impaired social habituation and significantly decreased investigation evoked slow gamma-band activity (30 - 55Hz).

Conclusion

Our data suggest Cxn36 plays a critical role in regulating thalamocortical network activity. Further, impairments in Cnx36KO mice reflect abnormalities in neuropsychiatric disorders, including schizophrenia, implicating Cnx36 containing gap junctions as a novel therapeutic target.

Support

Research supported by VA CDA Award BX002130 (JMM), VA Merit Awards BX004500 (JMM), BX001404 (RB), and NIMH RO1 MH39683 (Ritchie E. Brown).
0159 Reduced REM Sleep Percent in Frequent Cannabis Versus Non-Cannabis Users
Authors: Carr M , Borcsok R , Taylor M , Segust S , Pigeon W , Bradshaw C
Published: May 2020

Introduction

THC (the main psychoactive component of cannabis) has been shown to suppress REM sleep and decrease sleep latency, although this is not consistently replicated. Increased dream vividness is reported to occur in abstinent cannabis users, although dream quality in active users is unstudied. The current study aimed to assess the effects of cannabis use compared to non-use on objective sleep measures, dream reports, and self-reported anxiety, memory, and sleep quality. To collect objective sleep data we piloted the use of a portable PSG headband that allows EEG and EOG recording at home.

Methods

12 regular cannabis users (> 3 days per week) & 9 non-users (aged 19 - 27; 43% female) participated; participants used no other drugs or alcohol on study nights. The most common form of cannabis use was smoking in joints with tobacco (range = 1 - 15 per day). Participants wore the PSG headband (the Hypnodyne ZMax) over 2 nights at home (2nd night used for analysis), and were instructed to awaken 4 times across the night to fill out brief dream reports. Objective sleep measures included TST, Sleep latency, REM latency, and REM percent. Self-report measures included the Pittsburgh Sleep Quality Index, Everyday Memory Questionnaire, and State-Trait Anxiety Index. Dream measures included recall frequency, word length, and three attributes rated on a 1–7 Likert scale - sensory vividness, emotional intensity, and bizarreness.

Results

There were no group differences on self-report measures. Cannabis users showed longer REM latency (t=2.23, p=.04) and lower REM% (U=22, p=.02); there were no other objective group differences. Cannabis users reported higher bizarreness in their dreams (t=2.07, p=.05); there were no other dream differences.

Conclusion

The study presents a novel approach to assess sleep at home and cannabis use. Significant differences emerged between users and non-users on REM latency, REM%, and dream bizarreness.

Support

N/A
0164 Evidence Suggesting Early Airway Collapse as Cause of Spontaneous Arousals
Authors: Rechul D , Rechul K
Published: May 2020

Introduction

Spontaneous arousals can occur in response to a number of stimuli like noise, movement, hypoxia, or airway obstruction. Some arousals occur “spontaneously” and in individuals donning a hyper-arousable phenotype, spontaneous arousals can dominate the sleep architecture. While arousal mechanisms for some stimuli have been well described, there is a profound lack of knowledge to explain spontaneous arousals. During clinical testing of a device that was designed by SleepMethods, Inc. to anticipate obstructive sleep apnea events by the ability to sense minute airway caliber changes, it was noted, incidentally that the device would signal impeding airway collapse but a spontaneous arousal followed the signal before an obstructive airway event ever developed. This phenomenon was observed many times within and between subjects, suggesting the possibility that very early airway changes are causing “spontaneous arousals”

Methods

Ten adults (7M;3F) aged 18-80y/o (avg. 54.7y/o) with a known AHI ≥ 15/hr (avg. AHI = 42.6/hr) underwent 1 overnight PSG recording while wearing the device. Patients were required to forego their usual CPAP therapy on the night of study in efforts to expose the device to an adequate number of total obstructive events (defined as apneas and hypopneas; RERAs and snores were excluded). Standard PSG analysis was performed. Scoring rules were applied to determine whether signals were true/false positives and/or true/false negatives based on pre-clinical data showing anticipation accuracy for up to 45 seconds prior to an obstructive airway event. Signals designed to herald obstructive events were noted, incidentally, appearing prior to spontaneous arousals.

Results

Preliminary results suggest that early phases of airway collapse, as the airway progresses from patency to clinically significant obstruction, are causing EEG arousals which, by current standards, are considered “spontaneous”. Because these findings were incidental to another primary purpose of the clinical study, data analysis is in early stages but currently suggesting at least an associative relationship.

Conclusion

If final data analysis shows statistically significant correlation between early airway collapse and “spontaneous arousals”, it may have tremendous implications for patients with hyper-arousability, insomnia, and/or pathologically elevated spontaneous arousal indices by proposing therapies aimed at airway patency maintenance.

Support

N/A
0173 Spring Forward, Fall Back: Increased Patient Safety-Related Adverse Events Following the Spring Time Change
Authors: Kolla B , Coombes B J , Morgenthaler T I , Mansukhani M P
Published: May 2020

Introduction

“Spring forward,” the start of daylight savings time (DST) reduces sleep opportunity by an hour. The resulting sleep deprivation in healthcare workers can increase the potential for medical errors. We examined the change in patient safety-related adverse events (AEs) following the time change in both spring and fall.

Methods

Self-reported AEs that occurred 7 days prior to and following the spring and fall time changes for years 2010–2017 in a large healthcare organization were ascertained. AEs likely resulting from human errors were identified. The change in the number of AEs (all AEs or restricted to those resulting from human error) following the spring and fall time change were modeled using negative binomial mixed models using a random effect to correct for non-independent observations in consecutive.

Results

Over the 8 year period, there were more AEs (all and human) in the 7 days following the change in time both in spring (All: 2812 V. 2699; Human: 1902 V. 1625) and fall (All: 3207 V. 3007; Human: 2189 V. 2087). However, the only statistically significant increase was for the estimated 18% increase in human errors following time change in spring (95% CI: 6% to 34%; p = 0.004). The 18% AE increase in spring was also significantly greater than the 5% increase in AE in fall (p = 0.018).

Conclusion

There is a significant increase in human error related AEs following the “spring forward” clock change which can jeopardize patient safety. Based on safety considerations, DST might best be eliminated; alternatively, policy makers and healthcare organizations should evaluate measures to mitigate the increased risk during this period.

Support

NA
0177 Measuring Sleep Health Across Survey, Actigraphy, and Diary Methods in Young Adults
Authors: Jakubowski K P , Wright A G , Matthews K A
Published: May 2020

Introduction

Sleep health is a relatively new construct including multiple dimensions of nighttime and daytime sleep across the 24-hour day. To date, few studies have investigated sleep health across various types of sleep measures. We collected sleep health data using survey, actigraphy, and daily diary, affording the unique ability to compare the latent factor structure of the sleep health construct across methods in a single sample of healthy young adults.

Methods

Undergraduates (N=540; 50% female; 71% white; mean age=18) self-reported sleep health via the 6-item RUSATED survey (Buysse, 2014), which queries “typical” sleep patterns including: daytime alertness and nocturnal sleep regularity, satisfaction, timing, efficiency, and duration (0=rarely/never to 2=usually/always); total score=0–12 (higher=better sleep health). A subsample (N=114) provided 7-day actigraphy and daily diaries, which were used to derive weeklong averages of the aforementioned sleep dimensions. Confirmatory factor analysis was conducted to assess model fit of three factors (survey, actigraphy, diary), each including within-method indicators of the six sleep dimensions; note the actigraphy model included diary satisfaction. Acceptable model fit was assessed using established criteria (e.g., Bentler, 1990): RMSEA < .08, CFI > .90, and TLI > .90. Maximum likelihood estimation was used.

Results

Average RUSATED total score was 7.1 (SD=2.5). Average actigraphy [diary] sleep dimensions were: Alertness (i.e., proportion of days napped)=21% [25%]; Duration=6.2hr [7.1hr]; Timing (i.e., midpoint)=5:00am [3:30am]; Regularity (i.e., SD of midpoint)=56 min [40 min]; Efficiency= 82% [95%]; Satisfaction=“average” to “good”. The survey model demonstrated acceptable fit (RMSEA [90%CI] = .06 [.03, .09], CFI=.96, TLI=.92) after correlating regularity and timing, as suggested by modification indices; factor loadings [λ(SE)] ranged from .27(.05) for efficiency to .71(.04) for satisfaction. Fit was poor for the diary model, whereas the actigraphy model failed to converge.

Conclusion

Sleep health models demonstrated adequate fit using survey but not actigraphy or diary data. The lack of acceptable fit for the latter may reflect differences in the measurement timeframe (e.g., “typical” sleep vs. 7-day averages) or the smaller sample size for the actigraphy/diary measures. Determining how to best measure sleep health and ultimately apply it to health-relevant outcomes is a valuable research agenda.

Support

T32HL07560; T32MH018269
0184 Predicting Strategic Napping in Surgical Residents by Individual and Rotation Characteristics
Authors: Devine J K , Schwartz L P , Hursh S R , Mosher E , Schumacher S , Boyle L , Davis J E , Smith M , Fitzgibbons S
Published: May 2020

Introduction

Strategic napping, or napping on-shift, is recommended to reduce fatigue in medical residents. The actual prevalence of strategic napping in relation to residents’ workload, schedule, or demographics is largely unquantified. This study objectively measured sleep patterns and work schedules in surgical residents working a variety of service lines over a two-month period in order to identify which resident and service line attributes predict on-shift napping.

Methods

Surgical residents from an academic surgery program in the Washington, DC area provided schedule information, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu Watch) continuously for 8 weeks. Multiple linear regression was performed to predict percent days with on-shift napping from resident demographics (age, gender, post graduate year (PGY), sleep characteristics (ESS, total sleep time (TST), sleep efficiency (SE)), schedule characteristics (shift start time, shift length, rotation length, percent days on-shift, percent night shifts), and service line characteristics (service line category, number of service lines worked).

Results

Twenty-two (n=22) residents completed the study, rotating through at least 1 of 5 different service line categories (Acute Non-Elective Surgery, Elective Surgery, Night Float, Surgical Intensive Care Unit, and Other). Residents slept an average of 6 hours within a 24-hour period (370±129 minutes) with normal SE (87.13%±7.55%). ESS scores indicated excessive daytime sleepiness (11.64±4.03). Ninety-five percent (n=21) of residents napped at least once while on shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 2300-0500 hours. Earlier shift start times predicted less on-shift napping (B=-0.08,SE=0.04,β=-2.40,t=-2.09,p=0.05) while working more night shifts (B=1.55,SE=0.44,β=4.12,t=3.52,p=0.003) and shifts over 24 hours.

Conclusion

Residents take advantage of opportunities to nap on-shift, particularly when working at night. Despite naps, however, residents exhibit insufficient sleep with excessive daytime sleepiness, representing a safety risk to themselves and their patients.

Support

NA
0221 Late Meals, Sleep Duration, and Sleep Fragmentation: Findings From the American Time Use Survey
Authors: Iao S , Shedden K , Jansen E C , O’Brien L M , Chervin R D , Knutson K L , Dunietz G L
Published: May 2020

Introduction

Sleep hygiene recommendations discourage eating close to bedtime, though published data on the impact are not consistent. Associations between eating or drinking, within 1-hour prior to bedtime, sleep duration and sleep fragmentation were examined in a nationally-representative sample.

Methods

Data from the American Time Use Survey (ATUS), administered to a nationally representative sample of n=201,151 US residents aged ≥15 years were utilized. In an annual phone interview, ATUS participants were asked to record their activities during a 24-hour period (04:00am to 04:00am on the interview day) and were randomly selected to report weekdays or weekend activities. The present analysis included data from 2003–2018 and restricted to weekday respondents (n=124,242). Reporting of eating/drinking activities within 1-hour prior to bedtime was considered as a dichotomous variable (yes/no). Sleep fragmentation was defined as any awakening during the primary sleep episode (yes/no). Linear and logistic regression models, adjusted for age, sex, cohabitation, education and employment, were used to examine associations between eating/drinking and sleep duration or sleep fragmentation.

Results

In this ATUS sample, 56% of respondents were female and the mean age was 45 years. Mean sleep duration was 8.02 (0.007) hours, and 6% of survey participants ate/drank within 1-hour prior to bedtime. Overall, eating/drinking within 1-hour prior to bedtime was associated with longer sleep duration (p<0.01). Women and men who ate/drank within 1-hour prior to bedtime, in comparison to those who did not, had 35 minutes and 26 minutes longer sleep duration (p- value<0.0001) Eating/drinking activities within 1-hour prior to bedtime were associated with 1.8 higher odds of fragmented sleep (p<0.001).

Conclusion

In this large population-based survey, weekday eating or drinking within 1-hour prior to bedtime was associated with sleep fragmentation and longer sleep duration. Causal pathways would be difficult to discern, though sleep fragmentation could lead to compensatory increases in sleep duration.

Support

None
0228 The Impact of Westward Travel Across 9 Time Zones on Sleep Behaviors of Female Collegiate Athletes
Authors: Frisco D J , Goodrich J A , Byrnes W C , Holliday M , Wright K P
Published: May 2020

Introduction

Jet lag can significantly impact an athlete’s health and performance. However, the effect of ultra long-haul travel (> 12h flying time) westward across nine time zones on the sleep of female collegiate athletes is limited. We therefore studied the sleep behavior of NCAA Division I female volleyball players on an exhibition tour to China.

Methods

For this observational study, eleven females were recruited from a NCAA Division I Volleyball team. During the Tour, sleep behavior was monitored using wrist actigraphy (Actiwatch Spectrum, Phillips) before (5 days) outbound travel (PRE-FLIGHT), during air travel to (1) & from (2) China (FLIGHT-DAY 1 & 2) and during the athletes’ tour while in China (TOUR-DAY 1–8). Athletes were instructed to wear the actigraphs at all times, except during competition. Standard parameters were collected from the actigraph including sleep durations and sleep efficiency and expressed as mean ± sd.

Results

Sleep duration and sleep efficiency were similar for PRE-FLIGHT days (~8.3 hrs ± 1.5, 90.6 ± 3.2%). Sleep duration and efficiency were significantly lower on FLIGHT-DAY 1 & 2 compared to TOUR-DAY and PRE-FLIGHT, but were not significantly different from each other (~5.2 ± 2.4h, 80.5 ± 8.8%). Sleep duration during TOUR-DAY 1–7 followed a quadratic relationship, peaking on TOUR-DAY 1 and reaching a nadir on TOUR-DAY 5, before increasing again through TOUR-DAY 7 (p<0.05). Sleep duration on TOUR-DAY 8 (~5.9 ± 0.9 h) was significantly lower than PRE-FLIGHT and TOUR-DAY 1,2,6 & 7.

Conclusion

During travel female collegiate volleyball players showed sleep disturbance. Implementation of sleep interventions for jet lag are warranted for athletes traveling across multiple time zones.

Support

PAC-12 Student-Athlete Health and Wellbeing Initiative, Grant #1554240
0235 Sleep Duration and Timing Associated with Eating Behaviors: Data from NHANES 2015–2016
Authors: Bombarda A , St-Onge M , Seixas A , Williams N , Jean-Louis G , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

Previous studies have shown that, in the laboratory, sleep deprivation leads to unhealthy eating patterns. In real-world samples, lack of sleep is associated with obesity. Few real-world studies of sleep and food intake patterns exist, especially from nationally-representative samples.

Methods

Data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) were used. NHANES is a national-representative survey collected by the CDC. N=6,291 participants provided data about dietary behaviors and sleep timing. Dietary behaviors included the number of meals not made at home in the past 7 days (NOTHOME), number of fast food/pizza meals in the past 7 days (FASTFOOD), number of pre-made meals in the past 30 days (PREMADE), and number of frozen meals in the past 30 days (FROZEN). Linear regression models examined these as outcomes and predictors including bedtime (minutes), waketime (minutes), sleep duration (hours), and daytime tiredness/fatigue (never, rarely, sometimes, often). Covariates included age, sex, education, income/poverty ratio, race/ethnicity, and body mass index.

Results

Number of meals not made at home (NOTHOME) was associated with a later bedtime (B=2.25, p=0.01) and shorter sleep duration (B=-0.12, p=0.01). FASTFOOD was associated with shorter sleep (B=-0.13,p=0.003) and tiredness/sleepiness sometimes (B=0.77, p=0.007) and often (B=0.55, p=0.03). FROZEN meals were associated with a later waketime (B=3.31, p=0.003) and tiredness/sleepiness sometime (B=1.20, p=0.025) and often (B=1.60, p=0.04). A sleep duration by bedtime interaction was not significant for any outcomes. In models that included overall levels of anxiety, these relationships were maintained.

Conclusion

This is one of the largest studies to show that habitual sleep patterns are associated with real-world food choices. In particular, shorter sleep duration and tiredness/sleepiness are associated with more ready-made and fast food meals. It is possible that lack of sleep leads to worse food choices, or that stress leads to both lack of sleep and easier food options. Given the often poor nutritive value of foods consumed outside the home and pre-prepared foods, these associations may in part explain the influence of sleep on cardiometabolic risk factors.

Support

Dr. Grandner is supported by R01MD011600
0247 Executive Function and Social-Cognitive Predictors of Behavioral Sleep Restriction
Authors: Irish L A , Mead M P , Veronda A C , van Lamsweerde A E , Gunstad J
Published: May 2020

Introduction

Although insufficient sleep is a global public health concern, the causes of insufficient sleep in the general population are variable and complex. A substantial number of individuals engage in behavioral sleep restriction (BSR), defined as limiting nocturnal time in bed to less than the recommended total sleep time, but little is known about the factors that influence BSR. Notably, the impact of cognitive processes on BSR has not been empirically tested, though processes such as executive function (EF) and social-cognitive beliefs are clearly relevant to other health-related behaviors. This study sought to investigate the extent to which EF and social-cognitive factors predict BSR.

Methods

Participants included 205 healthy adults aged 18–35. EFs (i.e., inhibitory control, working memory, cognitive flexibility) were assessed with a neurocognitive task battery and social-cognitive factors (i.e., attitudes, norms, perceived behavioral control) related to healthy sleep duration were self-reported, followed by 1 week of actigraphy. BSR was represented as the number of nights that actigraphy-estimated time in bed was fewer than 8 hours.

Results

On average, participants engaged in BSR 3 nights per week. Hierarchical linear regressions were tested separately for EFs and social-cognitive factors. Results revealed that, after controlling for general intelligence, EF did not predict BSR. In contrast, social-cognitive factors did predict BSR (F(202,3)=8.71, p<001), with both attitudes (β=.20, p=.005) and perceived behavioral control (β=.15, p<.001) emerging as significant predictors. Interactions between EFs and social-cognitive factors were also explored, suggesting interactions between inhibitory control and perceived behavioral control (p=.03) as well as cognitive flexibility and attitudes (p=.05).

Conclusion

Taken together, these results highlight the high frequency of BSR and the role that social-cognitive factors may play in facilitating BSR among adults who may otherwise obtain healthy sleep. Efforts to promote sleep health in the general population would benefit from greater understanding of modifiable factors that increase BSR.

Support

This research was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number 5P30GM114748.
0299 Total Sleep Deprivation and Time on Task: Not the Same for Sustained Attention and Executive Processes and Poor Benefit of Caffeine
Authors: Erblang M , Quiquempoix M , Vergez A , Van Beers P , Guillard M , Elbaz M , Drogou C , Léger D , Chennaoui M , Sauvet F , Rabat A
Published: May 2020

Introduction

Mental Fatigue is commonly questioned regarding time on task or sleep debt effect (Hockey, 2013; Pattyn et al., 2018) or sleep debt effect (Krause et al., 2017). No studies have neither investigated contributions of these two factors for different cognitive processes nor benefit of caffeine.

Methods

24 right-handed and healthy subjects (18–50 years old), with a median chronotype and sleep need participated in a 2-experimental counter-balanced (placebo: PBO and caffeine: COFFEE - 2.5 mg/kg) total sleep deprivation protocol (TSD = 27 hours of continuous wakefulness). Subjective sleepiness (KSS), sustained attention (PC-PVT), inhibition (Go-NoGo) and working memory (2N-Back) capabilities were tested each morning during BASE and TSD (10 min. test session from 9:15 am to 10:15 am). Caffeine was ingested with a decaffeinated drink at 8:30 am.

Results

KSS score (5.6±0.4 vs 3.2±0.3; p<0.001), number of Lapses (9.8±1.7 vs 0.4±0.2; p<0.001), mean response time (RT: 308±4.9 vs 260±9.4; p<0.001) in PVT, errors of commission (6.4±0.4 vs 3.1±0.3; p<0.01) and mean response time (RT: 336±24 vs 301±13; p<0.01) in Go-NoGo were significantly higher after TSD compared to BASE. Neither significant difference in the proportion of correct responses (CR: 0.92±0.015 vs 0.90±0.014; p>0.15) nor RT (592±49 vs 640±28 ms, p > 0,11), were observed in the 2N-Back task. Further analyses showed different TOT x TSD interaction for PVT (after 3 min of task engagement), Go-NoGo (after 6 min) and 2N-Back (after 8 min). Number of Lapses was significantly but partially reduced (5.8±0.4 vs 9.8±1.7; p<0.01) in COFFEE condition compared with PBO with more aversive effects for Go-NoGo errors and 2N-Back BR.

Conclusion

Our results are in accordance with previous studies showing differential kinetic of cognitive deficits under TSD, limited benefit of sleep banking and regular physical activity (Arnal et al., 2015; Rabat et al., 2019; Sauvet et al., 2019) and no benefit of caffeine on executive processes (Gottsellig et coll., 2006; Killgore et coll., 2007, 2012).

Keywords: TSD, TOT, Attention, Executive, Caffeine.

Support

Grants from the French General Directorate for Armament (Contract Number: SAN-1–509).
0309 Stress Induced Nitric Oxide Synthase Activation in the Basal Forebrain is a Result of Sleep Loss
Authors: Chiem E , Nichols I , Paul K
Published: May 2020

Introduction

The mechanisms underlying the reciprocal relationship between stress and sleep are unclear. Nitric oxide, a diffusible signaling molecule, plays an important role in physiological stress responses and sleep. The medial septum (MS) and vertical diagonal band (VDB) are sleep regulatory regions of the basal forebrain whose cells express nitric oxide synthase (NOS). In this study, we examined the effects of sleep loss and restraint stress on NOS activation in the MS and VDB.

Methods

Adult male and female C57BL/J6 mice were randomly assigned to a control, total sleep deprivation (TSD), or restraint stress group. TSD was performed for 6h using gentle handling, and restraint was performed for 6h by immobilizing the mice in a plastic restraint device. Both procedures began at light onset in a 12:12 light:dark cycle. Immediately following the procedures, mice were sacrificed, and NADPH-diaphorase (NADPH-d) was measured in the MS and VDB to determine NOS activity.

Results

A multivariate ANOVA revealed main effects of TSD and restraint stress on NADPH-d in the MS (F(2,13) = 7.0921, p = 0.011) and VDB (F(2,13)=6.416, p = 0.014) in females. A post hoc analysis showed a significant difference between control and TSD (p = 0.011 (MS), p = 0.014 (VDB)), and between control and restraint (p = 0.032 (MS), p = 0.048 (VDB)), but no significant difference between TSD and restraint. There is a sex difference in NADPH-d in these regions (p < 0.005) that reverses direction following TSD and restraint stress.

Conclusion

Our findings provide evidence that NOS activity in the basal forebrain may underlie sex differences in stress responses. Since there is no significant difference between the TSD and restraint stress, this suggests that the effect of restraint stress on NOS activation is a result of sleep loss, and not due to induction of a stress mechanism.

Support

This study was partly funded by R01-NS078410 and UCLA start-up funds.
0311 The Impairments in Emotional Perception Following Total Sleep Deprivation and the Restorative Effects of Napping and Time of Day
Authors: Cunningham T J , Bottary R M , Kensinger E A , Stickgold R
Published: May 2020

Introduction

The ability to perceive emotions is a socially-relevant skill critical for healthy interpersonal functioning, while deficits in this ability are associated with psychopathology. Total sleep deprivation (TSD) has been shown to have deleterious effects on emotion perception, yet the extent to which these impairments persist across the day with continued wakefulness, or if brief periods of recovery sleep can restore emotion perception abilities, remains unexplored.

Methods

Participants viewed slideshows of faces ranging in emotional expression and were asked to categorize (Happy, Sad, Angry, Neutral) and rate the emotional intensity (1-9) of each face at baseline (2100; Session 1), at 0900 (Session 2) following a night of sleep or TSD, and at 1400 (Session 3) following either continued wakefulness (wake group) or a 90-minute nap opportunity (nap group).

Results

Emotion categorization ability marginally improved from Session 1 to Session 2 following overnight sleep, however, no changes in emotion intensity ratings or vigilance were observed. TSD led to an increase in error rates during vigilance testing [t(46)=2.9, p=0.005] and impairment in emotion categorization ability [t(46)=5.5, p<0.001] from Session 1 to Session 2, although by Session 3 performance levels on both measures returned to baseline for all TSD participants. TSD also led to a decrease in emotional intensity ratings from Session 1 to Session 2, particularly for the highest tertile of emotional faces [6-9; t(46)=6.1, p<0.001]. These ratings remained suppressed at Session 3 in both the wake [t(25)=7.8, p<0.001] and nap [t(18)=3.1, p=0.006] groups.

Conclusion

These results indicate that time of day effects, with or without any additional benefit of a nap, can restore the impairments in vigilance and emotional categorization caused by TSD. The ability to discriminate levels of emotional intensity, however, is not restored by time of day or napping, suggesting that this ability is more sensitive to the impact of TSD.

Support
0312 Performance on a Cognitive Interference Task in Children After One-Night of Sleep Restriction
Authors: de Queiroz Campos G , Dickstein D P , Carskadon M A , Saletin J M
Published: May 2020

Introduction

Short sleep contributes to attention failure in conditions such as ADHD. Whether sleep loss affects attentional processes as a task varies in cognitive interference is unclear. We used a multi-source interference task (MSIT) in a sleep restriction paradigm in children with a range of ADHD symptoms to examine how short sleep disrupts attention in these youth.

Methods

Thirteen children (7F, 11.7±1.28 years) with a range of ADHD symptom severity completed a repeated-measures experiment on two consecutive nights in the laboratory: baseline (BSLN; 9.5h time-in-bed) and sleep restriction (SR; 4h time-in-bed). Each morning they took part in an fMRI session including the MSIT, in which participants respond to a series of 3-digit numbers by indicating which digit is different on no-interference (e.g., 003; correct=3) or interference (e.g., 311, correct=3) trials. Performance measures were inverse reaction time (1/RT) and accuracy. A two-way within-subject ANOVA assessed performance across interference and sleep conditions respectively.

Results

1/RT showed main-effects of sleep loss (BSLN vs. SR; F(1,148)=4.01;p<0.05;η 2=0.026) and trial type (no-interference vs. interference; F(1,148)=24.7;p<0.001;η 2=0.143). Responses were slower for interference (BSLN RT: 799.3ms, SR RT: 895.8ms) than no-interference (BSLN RT: 653.2ms, SR RT: 697.4ms) trials. No interaction between interference and sleep loss was found (F(1,148)=0.11;p>0.05;η 2=0.001). Likewise, accuracy was lower (F(1,148) = 31.1, p<.001;η 2=0.174) in interference trials (73.5%) than in no-interference trials (92.2%), however with no effect of sleep loss, nor an interaction of interference and sleep loss (all p’s > .05).

Conclusion

These data provide evidence that partial sleep loss disrupts attention processes in children, yet these differences do not appear to depend on cognitive interference in our sample. Future analyses will examine whether ADHD symptoms distinguish individual differences, as well as analyze fMRI data to probe neural processes underlying attention control.

Support

K01MH09854 (to JMS); Brown University UTRA (to GDQC).
0335 Frontal Expression of NREM Sleep Oscillations are Associated with Executive Function in Children and Adolescents
Authors: Lui K K , Mander B A , Radom-Aizik S , Chappel-Farley M G , Dave A , Chen I Y , Benca R M , Neikrug A B
Published: May 2020

Introduction

The prefrontal cortex, an area known for executive functioning (including inhibition and self-monitoring) develops during childhood and adolescents, with a pattern of posterior to anterior brain development. Slow-wave activity (SWA) in NREM sleep, tracks brain development with high SWA power migrating from occipital to frontal region as brain maturation occurs. This pilot study aimed to examine whether slow wave topography is correlated with executive function in youth.

Methods

Seventeen healthy children and adolescents (ages 11-17; 10 females) underwent overnight polysomnography (PSG) with high-density electroencephalography (hdEEG). Behavior Rating Inventory of Executive Function (BRIEF) was administered to assess executive function. SWA (SWA1: 0.5-1 Hz; SWA2: 1-4.5 Hz) and spindle (slow sigma: 11-13 Hz; fast sigma: 13-16 Hz) activity was analyzed with spectral analysis using Welch’s method. BRIEF subscales of inhibition and monitor were correlated with SWA and sigma power across all derivations, with Holm-Bonferroni correction (126 channels). Significant derivations were then controlled for sex and self-reported Tanner stage using multiple regression

Results

BRIEF-Inhibition scale (i.e., ability to repress impulsivity) and SWA1 in anterior frontal derivations were negatively correlated (R2=0.58, p=0.047 corrected). BRIEF-Monitor scale (i.e., self-perception of one’s own behavior and interpersonal awareness) was negatively correlated with fast sigma in anterior frontal derivations (R2=0.65, p=0.013 corrected). These associations were significant after controlling for sex and Tanner stage.

Conclusion

These results support the hypothesis that NREM sleep oscillations are associated with executive function and reflect changes in neuroplasticity related to “back-to-front” brain maturation. Future longitudinal studies should combine multi-modal neuroimaging of brain structure and local sleep with comprehensive assessments of executive function to evaluate the possible link between local sleep and development of higher-order cognition in frontal brain regions in youth.

Support

NCATS grant #UL1TR001414 & PERC Systems Biology Fund
0343 Associations of Endogenous Hormones and Phthalate Exposure with Subjective and Objective Sleep Measures in Midlife Women
Authors: Hatcher K M , Smith R L , Li Z , Flaws J A , Davies C R , Mahoney M M
Published: May 2020

Introduction

Impaired sleep during the menopausal transition reduces quality of life and increases risk of multiple diseases. The changing hormonal milieu during midlife is associated with impaired sleep. Endocrine disrupting chemicals, such as phthalates, may also contribute to the increased prevalence of sleep disturbances in midlife women. Phthalates are known to impact the endogenous hormones associated with sleep. However, the link between phthalate exposure and sleep quality remains unexplored.

Methods

We recruited 26 midlife women (median age 50 years) through the Carle Regional Sleep Disorders Center in Urbana, Illinois. Subjective sleep was assessed through the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and self-reported frequency of sleep disturbances, insomnia, and restless sleep. Objective sleep was measured using actigraphy and manual sleep logs (7-day average). Serum levels of follicle-stimulating hormone, estradiol, progesterone, testosterone, free estradiol, and free testosterone were quantified using ELISAs from a single sample from each participant. Phthalate metabolites were quantified from urine using high performance liquid chromatography-mass spectrometry (HPLC-MS). Covariates, including depression, hot flashes, quality of life, demographics, and lifestyle factors, were measured via surveys.

Results

Preliminary unadjusted logistic regression was used to determine the association between hormone values and subjective sleep quality binomial variables, including daytime sleepiness, sleep efficiency, sleep onset latency, sleep duration, number of sleep disturbances, and frequency of sleep disturbances. Each of these subjective sleep measures is significantly associated with one or more hormones.

Conclusion

Our results are consistent with literature identifying associations between hormones and subjective sleep in midlife women. Additional analyses will determine associations between hormones and objective sleep, and phthalates with both subjective and objective sleep measures. Excitingly, our study will be among the first to investigate the association between endocrine disruption and sleep quality in this population.

Support

Carle Illinois Seed Grant Program
0349 Circadian Patterns of Blood Pressure Differ Between Retired Night Shift Workers and Retired Day Workers
Authors: Lehrer M , Bowman M A , Buysse D J , Hall M H
Published: May 2020

Introduction

Approximately 15% of full-time employees in the U.S. work outside the traditional daytime schedule. These individuals exhibit circadian rhythm abnormalities and increased rates of cardiovascular disease compared to day shift workers. Altered circadian patterns of cardiovascular function may persist into retirement even after returning to a normal nocturnal sleep schedule, and may contribute to the elevated cardiovascular disease burden among retired night shift workers. The purpose of this study was to determine whether circadian rhythms of cardiovascular indicators differed between retired night shift workers and retired day workers.

Methods

Participants (N = 72, 53% females, 83% non-Hispanic White, mean age: 68.66 years) were 33 retired night shift workers and 39 retired day workers who completed a 60-hour sleep/circadian laboratory assessment. Blood pressure and heart rate were assessed hourly during a 24-hour constant routine protocol. Multilevel cosinor analysis estimated group differences in circadian rhythms of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR). Covariates included age, sex, race, education, and body mass index.

Results

The 24-hour pattern of DBP (bsine*shiftwork = 1.47, [95% CI: 0.58, 2.35], p = 0.002) and MAP (bsine*shiftwork = 1.38, [95% CI: 0.28, 2.50], p = 0.015) differed between retired night shift workers and retired day workers. Retired night shift workers displayed a later trough of DBP and MAP compared to retired day workers. No group differences were found for circadian rhythms of SBP or HR.

Conclusion

Retired night shift workers exhibited altered circadian rhythms of blood pressure, which may indicate a circadian “scarring” of night shift work that persists after a return to normal daytime schedule. Future research should investigate explanations for observed differences and the extent to which chronic alterations in cardiovascular circadian rhythms affect morbidity and mortality.

Support

R01AG047139, T32HL082610, T32HL07560, UL1TR001857