bluuebunny/crossref_metadata_2025 huggingface dataset:
0292 Development and Validation of the Sleep Conflict Scale in Couple Relationships
Authors: Novak Joshua , Miller Kaleigh , Gunn Heather , Troxel Wendy
Published: May 2023

Introduction

Although there is considerable sleep concordance between partners in couple relationships, less is known about sleep practices between them and if there is conflict around sleep habits, preferences, and behaviors. Past empirical work suggests that couples who share the same sleep-wake preferences (i.e., morning vs. night people) report higher marital adjustment and less relational conflict. And yet the mechanism through which this occurs is yet unknown. One such mechanism is sleep-related conflict whereby partners disagree about their partners' sleep rituals causing sleep-related conflict.

Methods

The present study utilizes two samples to validate the Sleep Conflict Scale (SCS), one in individuals in relationships and the other sample of paired partners (dyadic data). The sleep conflict scale is a 5-item measure and includes items such as "My partner and I disagree about sleep routines and habits" and "Our relationship is negatively affected by our sleep differences". In order to identify the underlying factor structure of the SCS, several criteria was assessed to determine suitability for factor analysis, including bivariate correlations, the Kaiser-Meyer-Olkin Measure of Sampling Adequacy, and Bartlett’s test of Sphericity. Composite scores were computed and internal consistency was assessed by conducting Cronbach Alpha reliability estimates. We tested convergent validity by identifying associations between the SCS and relational and psychological health measures. Finally, using the dyadic sample, we also tested a structural equation model using the SCS on both partners' sleep hygiene and sleep quality.

Results

Results revealed that the SCS fit a one factor solution of five items and that a summed or mean score can be used. The SCS demonstrated excellent internal reliability and external validity when compared to other relational and psychological measures. Finally, higher sleep conflict was associated with worse sleep hygiene and poorer sleep quality for both partners.

Conclusion

The analyses provided support that the SCS scale is a psychometrically sound measure, in that it demonstrates a single factor structure, is highly reliability, and is qualitatively different than other couple or sleep-related measures. The SCS can be used in both primary and secondary care settings to identify couples who would benefit from relational intervention especially when sleep adherence is low.

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0293 Sleep Health in America: Update from the National Sleep Foundation’s 2022 Sleep Health Index®
Authors: Dzierzewski Joseph , Hendren Lindsey , Langer Gary
Published: May 2023

Introduction

Sleep is a crucial measure of health and wellbeing. Individuals with good sleep health tend to have better physical, emotional, cognitive, and social functioning than individuals with poor sleep health. The National Sleep Foundation developed the Sleep Health Index® (SHI) in 2016 as a means to monitor the sleep health of the general population. Since its inception, the National Sleep Foundation has administered the SHI annually to a representative sample of the US population. This study reports on the 2022 SHI and examines US population trends in sleep health from 2019 through 2022.

Methods

The SHI is a valid, reliable measure consisting of 16 questions related to the three discrete constructs of sleep duration, sleep quality, and disordered sleep. In 2022, the SHI was administered to a nationally representative, random sample of 1,042 Americans via the probability-based Ipsos KnowledgePanel®, in which panelists complete surveys online in English or Spanish. Results have a margin of sampling error of 3.2 points. We examined sleep health trends from 2019 through 2022 and examined whether sleep health in 2022 differed from previous years. Group differences in sleep health were also investigated.

Results

Americans’ average SHI score in 2022 was 75 (on a 0–100 scale), which is consistent with SHI scores observed in previous years. The SHI total score was statistically highest among college graduates, Hispanic adults, and people with household incomes of $100,000+ a year and statistically lowest among those with household incomes less than $50,000. Despite stable SHI total scores, there were statistically significant declines in both average weekday sleep scores (76 in 2021 to 71 in 2022) and in sleep deficit scores (86 in 2021 to 82 in 2022), which are based on the difference between weekday sleep and the amount of sleep respondents say they need to be well-rested and feel their best.

Conclusion

While overall sleep health remained stable, weekday sleep duration and sleep deficit worsened considerably as pandemic-related restrictions came to an end. The sociocultural and political contexts in which sleep health occurs, as well as associated features, like mental and physical health, deserve further consideration.

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0298 Romantic Relationships and Insomnia in Military Soldiers
Authors: Cruz Nayeli Nunez , So Christine , Miller Katherine , Gehrman Philip
Published: May 2023

Introduction

Intimate relationships may impact insomnia symptoms. In particular, marriage may serve as a protective factor against the development of insomnia, particularly for men. However, little research has studied how relationship quality may contribute to insomnia, particularly in military populations where social support may be particularly important. Therefore, this study will examine the associations between indices of relationship quality and insomnia in a sample of Army Soldiers.

Methods

Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; mean age= 28.6; 88.24% male). Participants completed a survey that included questions about insomnia symptoms and their social networks. Items assessed marital status, duration of marriage, frequency of disagreements, and relationship quality and happiness. Chi-squared analyses were used to examine the associations between probable insomnia from the past 30 days and relationship items.

Results

Approximately 38.2% of this sample experienced past month insomnia symptoms. Insomnia was more prevalent in divorced or separated individuals. Among partnered individuals, Soldiers who reported that they talked more about ending the relationship and had more disagreements with their partners were more likely to have insomnia symptoms. Conversely, those reporting that their relationships were going well or satisfied in their relationship were more likely to not have insomnia.

Conclusion

In this sample of Soldiers, marriage only served as a protective factor when individuals had a positive outlook in their relationship. These results also suggest that healthier relationships are generally associated with better sleep. These findings underline the importance of relationship quality and its effects on insomnia.

Support (if any)

This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. CJS’s time was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Mental Illness Research and Treatment. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874).
0300 A prospective follow-up study of Covid’s effects on Sleep and Cognition in post-acute period in a primarily minority population
Authors: Ibrahim Malika , Nanduri Sumant , Singh Gagan , Batta Yashvardhan , Kim Rachel , Smith Tori , Kolawole Oluwapelumi , Ogwo Valarie , Shayegh Nader , Challa Suryanarayana , Ashktorab Hassan , Brim Hassan , Oskrochi Gholamreza , Martirosyan Zara
Published: May 2023

Introduction

Long Covid, the post-acute sequelae of COVID-19, has evolved in recent months into a recognized spectrum of manifestations that persist after acute Covid-19 illness. Despite over 2 years of information since the start of the pandemic, data remains limited on the effect Long Covid may have on sleep and cognition. This study aims to assess the association between COVID-19 infection and sleep impairment in the post-acute period.

Methods

A total of 747 patients were identified from hospitalized COVID-19 patient records at Howard University Hospital between Feb 2020 and May 2021. 285 of these patients were interviewed by the research team 6-12 months after their initial infection. Sleep symptoms were collected via a questionnaire from 125 patients (64% African American, 34% Hispanic) to include the following four data points: difficulty falling asleep, worsened sleep quality, daytime somnolence (since COVID-19 occurrence) and the number of hours of sleep in 24 hours. In addition, a cognitive assessment was also conducted via a Mini-MOCA questionnaire(n=103 patients, 59% African American, 35% Hispanic). Of note, all sleep questionnaire participants did not report pre-COVID-19 sleep issues concerns. We looked for any associations between multiple clinical variables, sleep disturbance, and abnormal MOCA scores using proper statistical methods such as t-tests, chi-square tests, univariate and multivariable logistic regression.

Results

Out of the 285 respondents to the interview, 28 of 125 completing sleep assessments declared sleep disturbance symptoms, and 79 of 103 completing Mini-Moca assessments had an abnormal Mini-MOCA score. Patients with sleep disturbance symptoms were further analyzed and a significant association was identified between sleep disturbance and the following variables: increase in age (p=0.046), Diabetes Miletus diagnosis (p=0.009), elevated troponin level on admission (p< 0.05), ARB use during hospitalization (p=0.006), ICU admission during hospitalization (p< 0.05), and exposure to ECMO (p=0.011). Not surprisingly, sleep disturbance had a significant association with reduced total sleeping hours in 24 hr period (p< 0.0001).

Conclusion

Preliminary findings indicate the presence of sleep disturbance on longitudinal follow-up of patients previously infected with SARS-CoV-2. Additionally, we found a significant association between sleep disturbance in COVID-19 patients with many variables. Larger studies are required to further analyze these associations.

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0302 Impact of the COVID-19 pandemic on the sleep pattern of a Brazilian population sample
Authors: Porcacchia Allan , Tufik Sergio , Pires Gabriel , Bezerra Andréia , Tufik Sergio , Andersen Monica
Published: May 2023

Introduction

As of late 2019, a new viral variant that causes respiratory infection has concerned humanity: SARS-CoV-2. The following year, the COVID-19 pandemic was declared by the World Health Organization. The spread of the virus across country borders led to the implementation of security measures to contain new infections. The confinement during the pandemic helped to minimize new infections, but it affected people's mental health, including sleep parameters. This study evaluated the impact of the pandemic and social isolation on sleep parameters, including sleep quality and hygiene, in a sample of the Brazilian population.

Methods

An online questionnaire on the Google Docs platform was sent to all participants who agreed to contribute to the study, constituting a convenience sample. The questionnaire consisted of 8 parts: written consent; socio-demographic characteristics; assessment of quarantine status, COVID-19 infection, and other health complaints; general sleep evaluation; Pittsburgh Sleep Quality Index (PSQI); Insomnia Severity Index (ISI); Sleep Hygiene Index (SHI); closing remarks. All questions were presented in Portuguese and participants had to answer them considering 2 different contexts: before and during the pandemic. PSQI and ISI categorical data from the two periods were evaluated using the McNemar-Bowker test. To evaluate the effects of the pandemic on questionnaire scores, sleep efficiency and total sleep duration (TSD), generalized estimating equations models were used. Age and quarantine time were covariates in the model.

Results

The final sample comprised 1,109 individuals. During the pandemic, it was observed an increase in sleep efficiency (β=3.537; p=0.002) and in the TSD (β=29.212; p=0.002). Yet, during the pandemic there was an elevation in the PSQI score (β=4.196; p< 0.001) and in the ISI score (β=–6.952; p< 0.001). For this last, there was a statistical significance when considering the interaction between life context and gender, in which women during the pandemic had higher ISI scores than men before the pandemic (β=–1.877; p< 0.001). A decrease in the SHI score was reported during the pandemic (β=–6.768; p< 0.001).

Conclusion

An increase in sleep efficiency, total sleep time and SHI score was reported in the sample during the pandemic, although insomnia symptoms and sleep quality worsened.

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0306 Circadian Disrupting Light Exposure within Pediatric Hospital Rooms
Authors: Fidler Andrea , Waitt Julie , Lehmann Leslie , Solet Jo , Duffy Jeanne , Gonzalez Brian , Beebe Dean , Fedele David , Zhou Eric
Published: May 2023

Introduction

Pediatric patients undergoing stem cell transplant (SCT) often experience extended hospitalizations. Inappropriate lighting during admissions is known to disrupt sleep and circadian health, which can result in worse health outcomes. This study aimed to describe patterns of light across 24-hour periods in two inpatient rooms of children undergoing SCT.

Methods

Wall-mounted light meters (Extech SDL400) continuously tracked noise and light levels at one-minute intervals in two patient rooms over six months. We determined the percent of time that patients were exposed to non-optimal light levels (< 448 lux during the daytime, >18 lux in the evening, >2 lux at night); thresholds were based on converting recent consensus-based melanopic equivalent daylight illuminance guidelines to vertically measured illuminance thresholds. We assessed the frequency that light exceeded thresholds associated with night wakings (>150 lux). Wilcoxon rank-sum tests compared light levels between the two rooms. Room A had a single northwest-facing window overlooking a narrow courtyard. Room B had an unobstructed window facing north.

Results

On average, hospitalized pediatric SCT patients spent 50% of their time in inappropriate light conditions. They were exposed to light spikes >150 lux on 2% of nights, with overnight light peaking at 513 lux. When comparing average daytime and nighttime light levels between the two rooms, Room A was significantly dimmer than Room B, p <.001. In the dimmer room, light levels never reached the recommended threshold during the daytime, and the light was too bright for 19% of the evening and 17% of the nighttime. In the brighter room, light levels were too dim during 97% of the daytime and too bright during 59% of the evening and 30% of the nighttime.

Conclusion

During the day, pediatric SCT patients are rarely exposed to light bright enough to preserve a healthy circadian rhythm. Hospitals have an opportunity to significantly improve the sleep and circadian health for children already at elevated risk for health morbidities during transplant.

Support (if any)

This research was generously supported by grant funding from Pedals for Pediatrics (PI: Zhou) and an institutional research training grant (T32DK063929).
0307 Day and night light exposure are associated with psychiatric disorders: An objective light study in >80,000 people
Authors: Burns Angus , Windred Daniel , Rutter Martin , Olivier Patrick , Vetter Celine , Saxena Richa , Lane Jacqueline , Phillips Andrew , Cain Sean
Published: May 2023

Introduction

Circadian rhythm disturbance is a common feature of many psychiatric disorders. Light is the primary input to the circadian clock, with daytime light strengthening rhythms and night light disrupting them. Therefore, habitual light exposure may represent an environmental risk factor for susceptibility to psychiatric disorders.

Methods

We performed the largest to-date cross-sectional analysis of light, sleep, physical activity, and mental health in participants from the UK Biobank actigraphy cohort (n = 86,772 adults; aged 62.4 ± 7.4 years; 57% women). We examined the independent association of day and night light exposure intensity with covariate-adjusted risk for psychiatric disorders and self-harm.

Results

Greater night light exposure was associated with increased risk for major depressive disorder, generalized anxiety disorder, PTSD, psychosis, bipolar disorder, and self-harm. Independent of night light, greater day light exposure was associated with reduced risk for major depressive disorder, PTSD, psychosis, and self-harm. These findings were robust to adjustment for sociodemographics, photoperiod, physical activity, and sleep quality.

Conclusion

Our findings demonstrate that low day light and bright night light exposure are associated with a wide range of psychiatric outcomes. Avoiding light at night and seeking light during the day may be a simple and effective, non-pharmacological means of broadly improving mental health.

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0308 Impact of Customized Lighting on Sleep in Hospitalized Patients
Authors: Adawi Ayham , Parekh Ankit , Weinberg Alan , Khan Rabia , Perez Octavio , Rabin Barbara , Condrat Lindsay , Fraser Allison , Loor Marjorie Zambrao , Rajda Geetanjali , Varga Andrew , Vincent Richard , Dunn Andrew
Published: May 2023

Introduction

Inpatient sleep may be disrupted for myriad reasons, including lighting exposure that is typically fixed at constant intensity and spectra. In this study we employed customized lighting that promotes circadian entrainment by exposing patients to blue-augmented lighting during the morning and blue-suppressed lighting evening to improve sleep timing and duration.

Methods

Two Mount Sinai hospital rooms (with 2 beds each) were outfitted with Eight Mattress sensors that use a combination of movement, breathing, heart rate, and temperature variables to estimate wake and sleep vigilance states in 30-second epochs. One room contained customized lighting between 7 am and 11 pm, while the other room contained standard hospital lighting. The current analysis includes 60 participants (30 in the control room and 30 in the custom lighting room), who were matched for time-of-year hospital admission date. We first analyzed the probability of sleep during any given 30-second epoch across each subject’s admission and compared the distributions of sleep probability across the 24-hour cycle for all subjects in the lighting vs control conditions. We additionally evaluated total nocturnal sleep duration(11 PM – 7 AM) by 1) summating all sleep epochs on nights containing at least 50% valid data and 2) normalizing all measured sleep epochs to all valid sleep/wake outputs (excluding indeterminate epochs).

Results

The distribution of sleep probability was significantly different in the lighting vs control condition (p < 0.001) with most apparent diversion of the distributions between 9 pm and 9 am. The average raw nocturnal sleep duration was significantly higher in lighting condition (270.0 ± 23 minutes vs 201 ± 23 min in control, p = 0.037), as was the average minutes of sleep per hour of valid recording (36.9 ± 15 minutes vs 28.4 ± 13 in control, p = 0.022). There were no significant differences in the number of nocturnal wake or indeterminate epochs between conditions.

Conclusion

Custom lighting appears to promote sleep in hospitalized patients, but the interpretation is tempered by absence of full validation of the mattress sensor against polysomnography. Future work will evaluate differences in sleep timing and continuity between conditions.

Support (if any)

McClung Foundation, R01 AG066870
0313 Implementation Outcomes from a Multi-Component Lighting Intervention in Shiftworkers on a High-Security Submarine Watchfloor
Authors: Bessman Sara , Harrison Elizabeth , Easterling Alexandra , Preilipper Sebastian , Glickman Gena
Published: May 2023

Introduction

Shiftwork is prevalent in the military and causes circadian health and performance impairments. Negative consequences may be mitigated through evidence-based lighting solutions that optimize timing, spectrum and intensity of exposure; however, the practical utility of these solutions hinges on their implementation and adoption. Therefore, we examined the implementation effectiveness of a multi-component lighting intervention that had demonstrated efficacy for improving alertness and performance in active duty service members working nightshift schedules on a high-security watchfloor.

Methods

Participants worked 12-h shifts (0530-1730) (N=56, 9 females; mean+SE age=28.95 + 0.76). Lighting interventions included two types of LED panels (3,721 cm2) that were either enhanced (SW+) or depleted (SW-) in short wavelength energy (both ~3000 K, ~300 lux at 46 cm from eyes). For both SW+ and SW- conditions, a bank of panels were arranged across the front of the watchfloor and illuminated the entire nightshift. In addition, blue-blocker glasses were worn after nightshifts up until bedtime, and eye masks were worn during sleep for both intervention conditions. Data collection coincided with existing watchfloor schedules: there was an 8-day baseline (BL1) and 8-day SW+ condition, and an 8-day baseline (BL2) and 8-day SW- condition (order within those 16-day periods was pseudo-randomized). Implementation was measured via weekly questionnaires.

Results

Participants who completed BL1, SW+, and SW- conditions (n =24) reported more positive feelings (happy, alert, relaxed) and fewer negative feelings (sad, sleepy, anxious) with both interventions compared to standard lights (BL1) (p< 0.05 for both SW+ and SW-). More negative symptoms (e.g. glare, headache, fatigue) were reported in BL1 versus the intervention conditions (p< 0.01). Most participants reported that alertness was the same or better under intervention conditions (96% SW+, 95% SW-); 75% found both the blue-blocker glasses and eye masks somewhat or very easy to use; and 100% reported sleep as either the same or better with each intervention tool. Finally, most participants reported they would want to keep the intervention lights at the end of the study.

Conclusion

The intervention was generally well-received by participants, thus providing evidence for the feasibility of implementing multi-component lighting strategies to mitigate the negative consequences of shiftwork.

Support (if any)

ONR TS-788
0317 A single-arm proof-of-concept clinical trial of a mindfulness-based intervention for prenatal insomnia
Authors: Seymour Grace , Kalmbach David , Cheng Philip , Ong Jason , Reffi Anthony , Walch Olivia , Fellman-Couture Cynthia , Bayoneto Alec , Roth Thomas , Drake Christopher
Published: May 2023

Introduction

Cognitive behavioral therapy for insomnia (CBTI) improves sleep in pregnancy, but its therapeutic benefits may be diminished in pregnancy due to undertreatment of cognitive arousal (i.e., heightened cognitive activity, especially at night). Growing evidence indicates that mindfulness-based interventions produce large reductions in cognitive arousal, which may enhance insomnia therapy outcomes. The present study was a proof-of-concept, single-arm trial of Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness intervention framework and tailors sleep and mindfulness components to pregnancy. We evaluated patient engagement, treatment outcomes, and patient feedback from 12 pregnant women with insomnia who received PUMAS treatment.

Methods

Twelve pregnant women with DSM-5 insomnia disorder were treated with six weekly telemedicine sessions of PUMAS. Patient engagement was operationalized as session attendance. Treatment outcomes were assessed before and after PUMAS, which included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale’s cognitive factor (PSASC), and Glasgow sleep effort scale (GSES). Patients completed the Consumer’s report treatment satisfaction scale and provided treatment feedback.

Results

Eleven of 12 patients completed all six sessions (91.7%). Intent-to-treat analyses revealed very large reductions in ISI (ISI: 14.50±2.50 to 3.67±3.11; p<.001, Cohen’s dz=3.05), resulting in an 83.3% insomnia remission rate (n=10/12). Among the five patients with comorbid depression (EPDS≥10), PUMAS produced large antidepressant effects (EPDS: 14.00±3.32 to 5.00±2.55; p=.004, Cohen’s dz=2.76), and all five patients remitted from depression at posttreatment. PUMAS yielded very large reductions in cognitive arousal (PSASC: 20.75±4.58 to 12.50±4.23, p<.001, Cohen’s dz=2.08) and sleep effort (GSES: 5.92±2.64 to 2.08±1.62; p<.001, Cohen’s dz=2.06). Patients reported the highest rates of treatment satisfaction for improvement in insomnia (100%), energy (90.9%), pregnancy stress (90.9%), mood (90.9%), and coping with stress (83.3%). Patients identified sleep restriction and meditations as the most helpful PUMAS components.

Conclusion

Pregnant women with DSM-5 insomnia disorder are engaged in PUMAS, which produced large reductions in insomnia, depression, cognitive arousal, and sleep effort. Patients reported high satisfaction across several domains of functioning. This trial supports testing PUMAS in a randomized controlled trial.

Support (if any)
0319 Evaluating Illness Severity from Acute to Chronic Insomnia: Is the First the Worst?
Authors: Boyle Julia , Muench Alexandria , Morales Knashawn , Ellis Jason , Vargas Ivan , Grandner Michael , Posner Donn , Perlis Michael
Published: May 2023

Introduction

The Spielman 3P and Perlis 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst when subjects experience acute illness (as compared to the subchronic and chronic phases of the disorder). The 4P model suggests that illness severity crescendos with chronicity. The present analysis uses an archival data set to assess illness severity with new onset illness (i.e.,from Good Sleep [GS] to Acute Insomnia [AI] and from AI to Chronic Insomnia [CI]). Illness severity is quantified in terms of Total Wake Time (TWT). Number of affected days/week is a tabulation of nights/week with clinical insomnia symptoms.

Methods

Subjects were recruited as GSs(N=911), followed up to 1-year with digital sleep diaries, and were classified as GS, AI, or CI based on standardized criteria. Data for CI subjects were anchored to the 1st of 14 days with insomnia so that day-to-day TWT, SL, WASO, and EMA were represented for ~100 days prior-to-and-following AI onset. A similar graphic (+/-Acute onset) was constructed for number of days per week with insomnia. GS data were matched to CI subjects dates (i.e., the data were temporally tethered). Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS and AI period.

Results

883 subjects remained as GSs (Mage=53.1±10.8years;35.1%female;83.0%white), while 28 indi-viduals transitioned to AI and then CI (Mage=53.6±12.6years;39.3%female;89.3%white). Average TWT rose over the course of the first 2 weeks from the AI onset(b=1.6,SE=0.52minutes,p=0.002) and then was stable for 3 months(b=-0.004,SE=0.03,p=0.91). This worsening of sleep continuity was almost entirely related to increased WASO. Average number of affected days was found to be stable from AI to CI (b=0.002,SE=0.002,p=0.20). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident.

Conclusion

These data suggest that, in our sample of CIs with primarily middle insomnia, the average severity and number of affected days was worst with the onset of AI (worst is first) and stable thereafter. Whether this temporal trend applies equally to new onset Initial and Late insomnia remains to be determined. Analyses ongoing.

Support (if any)

R01AG041783
0322 Measuring sleep-wake state discrepancy in a heterogeneous sample of cancer survivors with insomnia symptoms
Authors: Kwon Misol , Zhu Jingtao , Wilding Gregory , Dickerson Suzanne , Dean Grace
Published: May 2023

Introduction

Sleep-wake state discrepancy is a common phenomenon identified among people with insomnia where greater sleep difficulties are self-reported in comparison with estimates obtained from objective assessment. This study provides the investigation into the sleep-wake state discrepancy and correlation between sleep diary (subjective) and actigraphy-derived (objective) sleep measures.

Methods

Participants included 136 cancer survivors with insomnia symptoms (M age = 63.8 ± 10.0; 55.9% female; 87.5% White) from baseline data in an ongoing clinical trial. Demographics, Insomnia Severity Index (ISI), 7-consecutive days of sleep diary and actigraphy data were obtained. Sleep measures included time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%). Mean bias was defined as the discrepancy between sleep diary and actigraphy-derived sleep measures. The agreement between sleep diary and actigraphy-derived sleep measures were graphically assessed using the Bland-Altman plot. Using the mixed linear model approach, the estimated bias and 95% limits of agreement (LOA) were computed. Further, the Pearson correlation coefficient and concordance correlation coefficient (CCC), computed via maximum likelihood methods, were obtained.

Results

Self-reported TST and SE were shorter than derived by actigraphy (TST: 6.8 min. [95%CI: -18.7, 5.13]; and SE%: 0.7% [95%CI: -3.0, 2.0], respectively). Self-reported TIB, SOL, and WASO were longer than derived by actigraphy (TIB: 8.6 min. [95%CI: 3.7, 13.5]; SOL: 14.8 min. [95%CI: 9.4, 20.2]; and WASO: 20.7 min. [95%CI: 9.4, 20.2], respectively). Moderate to high agreement and correlation were found between the sleep diary and actigraphy-derived TIB (CCC=0.78; r=0.73) and TST (CCC=0.58; r=0.51). In contrast, SOL (CCC=0.48; r=0.35), WASO (CCC=0.36; r=0.18), and SE% (CCC=0.39; r=0.22) showed only fair or poor agreement and correlation. Calculated Bland-Altman LOA between sleep diary and actigraphy derived measures were as follows: TIB (95%LOA: -121.5, 138.7), TST (95%LOA: -197.9, 184.3), SOL (95%LOA: -82.5, 112.1), WASO (95%LOA: -123.5, 164.8), and SE% (95%LOA: -0.37, 0.36).

Conclusion

Among a heterogeneous sample of cancer survivors with insomnia symptoms, average self-reported sleep duration and efficiency were shorter and self-reported TIB, SOL, and WASO were longer than objectively measured sleep measures. Agreement between two methods varied across different measures.

Support (if any)

NIH/NINR R01NR018215 (Dean), ClinicalTrials-NCT03810365
0323 Natural Evolution of Insomnia in Major Depressive Disorders
Authors: Ohayon Maurice , Cote Marie-Lise
Published: May 2023

Introduction

Insomnia is a fairly common sleep disturbance affecting nearly one third of the general population. Although its predictive value for major depressive disorder (MDD) has been well documented, little is known about its role in the appearance of a first episode or in the recurrence. In this study, we examine the predictive value of insomnia symptoms in the incidence and recurrence of MDD.

Methods

In this longitudinal study, 2 interview waves were conducted between 2002 and 2015. The initial interviews (wave 1 [W1]) were carried out with 12,218 individuals aged ≥18 years from the general population in 8 US states. At follow-up 3 years later (wave 2 [W2]), 10,931 of the initial participants agreed to be interviewed again. Data were analyzed for the individuals who participated in both interviews (N=10,931). A diagnosis of MDD was made according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Insomnia symptoms were defined according to DSM-5 criteria A, C, and D for insomnia disorder.

Results

The 12-month prevalence of MDD was 9.5% (95% CI, 9.0%-10.0%) and 12.1% (95% CI, 11.5%-12.7%) in W1 and W2, respectively. Over the course of the study, 2.6% of participants experienced recurrence of depression (95% CI, 2.3%-2.9%). After adjusting for age, gender, race, and body mass index, participant characteristics in W1 that predicted recurrent MDD in W2 included early morning awakenings (EMA) (relative risk [RR], 3.2; 95% CI, 2.3-4.4), being dissatisfied with one’s sleep (RR, 2.8; 95% CI, 2.1-3.7), nocturnal awakenings (RR, 2.4; 95% CI, 1.8-3.2), and difficulty initiating sleep (DIS) (RR, 2.0; 95% CI, 1.5-2.9). MDD incidence was predicted by DIS (RR, 3.8; 95% CI, 2.5-5.9), being dissatisfied with one’s sleep (RR, 2.1; 95% CI, 1,4-3.2), and EMA (RR, 2.0; 95% CI, 1.2-3,2) at W1.

Conclusion

Insomnia symptoms appear to play an important part in predicting both the development of a first depressive episode as well as the recurrence of depression.

Support (if any)

Data analysis study were funded by Takeda Pharmaceutical Company.
0332 Improving Sleep with Continuous Theta Burst Transcranial Magnetic Stimulation (TMS) of the Default Mode Network
Authors: Killgore William , Jankowski Samantha , Henderson-Arredondo Kymberly , Hildebrand Lindsey , Trapani Christopher , Lucas Daniel , Suckow Emmett , Desai Shivani , Reich-Fuhrer Melissa , Franca Gabriela , Reign Deva , Huskey Alisa , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie
Published: May 2023

Introduction

Chronic insomnia is a disorder associated with increased cognitive arousal. Insomnia is also associated with activation/connectivity within the default mode network (DMN) of the brain, consistent with the hyperarousal theory. We hypothesized that suppression of the DMN with a type of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS) would lead to improved overnight sleep.

Methods

Twenty participants (12 female; age=26.9, SD=6.6 years) meeting criteria for insomnia/sleep disorder completed a counterbalanced sham-controlled crossover study in which they served as their own controls on two separate nights of in-laboratory polysomnography (PSG) monitored sleep. In-lab visits occurred on separate weeks at least 5 days apart. Sessions included two resting state functional magnetic resonance imaging (fMRI) sessions separated by a brief 40 second cTBS rTMS session applied over an easily accessible cortical surface node of the DMN located at the left inferior parietal lobe. After scanning/stimulation, participants were allowed an 8-hour sleep opportunity from 2300 to 0700 monitored with PSG.

Results

One session of active cTBS significantly altered functional connectivity (p<.05, FDR corrected) within the DMN, while the sham condition produced no changes in functional connectivity from pre- to post-treatment. After controlling for age and IQ, active treatment was associated with significant (p<.05) improvements in PSG measured Total Sleep Time (TST; ηp2=.28), latency to Slow Wave Sleep (SWS; ηp2=.23), Sleep Efficiency (SE; ηp2=.28), and a lower Arousal Index (ηp2=.22). Overall, individuals obtained 16 minutes more sleep after active cTBS compared to sham. Moreover, changes in brain connectivity following cTBS significantly (p<.05) predicted sleep outcomes, including TST, sleep latency, SE, minutes of wake, SWS, number of awakenings, arousals, and arousal index, and a trend toward increased REM (p=.06).

Conclusion

A brief targeted 40-second stimulation with cTBS altered DMN brain functioning, and improved PSG measured sleep outcomes during the night following stimulation. The effect sizes often exceeded those reported for other established treatments such as cognitive behavioral therapy for insomnia or hypnotic sleep medications. Further work involving multiple stimulations over several days or weeks will be necessary to demonstrate the potential utility of this approach as a treatment for insomnia.

Support (if any)

W81XWH2010173
0337 24-Month Patterns of Sleep Medication Use with a Prescription Digital Therapeutic for Chronic Insomnia – A Retrospective Analysis
Authors: Mahon Rowan , Velez Fulton , Thorndike Frances , Maricich Yuri
Published: May 2023

Introduction

Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, but sedative-hypnotic medications are often used first, despite contraindications and risk of misuse. This study assessed change in sedative/hypnotic use/dosage in patients with chronic insomnia treated with Somryst® (tested as SHUTi), a prescription digital therapeutic (PDT) delivering CBT-I.

Methods

A retrospective claims data analysis was conducted with chronic use of prescribed sedatives/hypnotics (days’ supply: 8-200; units dispensed: >12) in patients with self-identified sleep problems who initiated the PDT (index) between June 2016 and December 2018, and who had available closed claims data 24 months pre- and post-index. Eligible medications were used at least once in the year prior to initiation of the PDT, or 90 days after PDT initiation. Outcomes evaluated: dose change, stoppage/initiation, or medication switch, using nearest pre-index medication and furthest post-index medication. Dose change was evaluated using total strength per day: medication dose quantity dispensed/day's supply. Medication switch was evaluated as post-index cessation of a pre-index medication, accompanied by a post-index initiation of a different sedative/hypnotic.

Results

Of the 248 individuals observed, 131 (52.8%) utilized an eligible sedative/hypnotic medication. On average, individuals were on 1.5 (median of 2, range 1-6) sedative/hypnotic medications. In 59 individuals (45% of the cohort), there was either a decrease in dosage (13 patients, 9.9%), a full stopping of a medication (52 patients, 39.7%), or a stopping of all medications (41 patients, 31.3%). In 32 individuals (24% of the cohort), there was either an increase in dosage (8 patients, 6.1%) or an initiation of a new medication (28 patients, 21.3%). Twenty-two patients (16.7%) switched to a different medication in the post-index period. Forty-three patients (32%) experienced no changes in a specific medication and its dosage, including 25 (19%) patients who had another medication already counted in the groups described above, and 18 (13.7%) patients not counted elsewhere.

Conclusion

Real-world evidence from a PDT delivering digital CBT-I demonstrated dose reduction and/or stoppage of sedative/hypnotic medications in almost half of the population, with almost a third of patients stopping all such medications.

Support (if any)

This study was funded by Pear Therapeutics (US), Inc.
0340 AASM Insomnia Summit 2022
Authors: Schotland Helena , Leu Roberta , Khosla Seema , Ong Jason , Lewin Daniel , Dawson Spencer , McCrae Christina , Lee-Iannotti Joyce , Wickwire Emerson , Martin Jennifer
Published: May 2023

Introduction

Significant challenges exist in access to high-quality care for insomnia disorder. After the recent publication of clinical practice guidelines on behavioral/psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a virtual one-day summit in September 2022 to discuss improving care for patients with insomnia disorder.

Methods

Fifty attendees representing a variety of organizations (e.g., medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the Summit.  Videos highlighting patient perspectives and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions: (1) barriers to care, (2) facilitators of high-quality care, and (3) future directions and innovations. After 3-4 brief topical presentations by content experts, summit participants divided into seven breakout groups to brainstorm and prioritize issues. Each breakout highlighted 3-5 priorities and reported back to the broader group following each thematic session.

Results

The top barriers to care for insomnia disorder identified by summit participants included (1) limited access to care, (2) limited awareness of insomnia treatment options, (3) limited treatment formats, (4) low perceived value of insomnia treatment, and (5) insufficient number of trained clinicians to provide care.  The top facilitators of care included (1) increased education and awareness, (2) novel models to increase access to care, (3) developing and expanding the insomnia patient care workforce, (4) incorporating research into practice, and (5) increasing reimbursement. Top priorities for future directions included (1) increasing awareness among patients and healthcare providers, (2) increasing the number of skilled behavioral sleep medicine providers, (3) increasing advocacy efforts to address insurance issues (e.g., billing, reimbursement, and performance measures), and (4) working collaboratively with multidisciplinary organizations to achieve common goals for insomnia disorder care.

Conclusion

The AASM and participants from partnering organizations successfully engaged in a summit and identified prioritized strategies to improve access to high-quality care for insomnia disorder across diverse clinical settings (e.g., private practice, academic institutions, and rural areas).  The priorities are to improve access to care for insomnia disorder, which require advocacy efforts to increase awareness of treatment options, improve reimbursement, and grow the skilled workforce for treating insomnia disorder.

Support (if any)

AASM
0354 Effect of Lemborexant on Sleep Architecture in Subjects with Comorbid Insomnia and Mild Obstructive Sleep Apnea from a Ph 3 Trial
Authors: Kushida Clete , Zammit Gary , Cheng Jocelyn , Kumar Dinesh , Moline Margaret
Published: May 2023

Introduction

Many patients with insomnia have co-morbid obstructive sleep apnea (COMISA). Patients with obstructive sleep apnea (OSA) may also have decreased REM-sleep. Lemborexant (LEM) is a dual-orexin-receptor-antagonist approved to treat adults with insomnia. LEM has been demonstrated to increase total sleep, with prominent increases in rapid eye movement (REM). Thus, sleep architecture was analyzed in subjects with insomnia/mild OSA receiving LEM in a phase 3 trial.

Methods

Study 304 (E2006-G000-304; NCT02783729) was a 1-month, randomized, double-blind, placebo (PBO)-controlled and active-comparator study in adults ≥55y with insomnia disorder. Subjects received PBO, LEM 5mg (LEM5), LEM 10mg (LEM10) or zolpidem tartrate extended-release 6.25mg (ZOL). Least-squares-mean (LSM) duration of each sleep stage (minutes) was compared across treatment groups from pooled data on Nights (NT)1/2 and NT29/30 for ­subjects with mild OSA (apnea hypopnea index ≥5 to < 15). Treatment-emergent adverse events (TEAEs) were recorded.

Results

The analysis set comprised 409 subjects (LEM5=114/LEM10=105/ZOL=112/PBO=78) with mild OSA. Mean (SD) change from baseline (CFB) in total sleep time was significantly larger (more sleep) in both LEM groups than ZOL or PBO at the post-randomization assessments. CFB for REM sleep was also significantly larger (P< 0.0001) for both LEM vs ZOL/PBO at both assessments, NT1/2: LEM5 21.08 (21.79), LEM10 32.57 (24.34), ZOL 3.06 (23.51), PBO 2.42 (17.51); NT29/20: LEM5 14.49 (18.12), LEM10 24.26 (24.50), ZOL 0.75 (22.32), PBO 2.14 (22.62). Compared with PBO, CFB for total nonREM sleep significantly increased (P< 0.0001) in the LEM groups at both assessments, NT1/2: LEM5 39.64 (34.30), LEM10 44.63 (37.85), ZOL 45.80 (37.43); PBO 7.80 (37.88); NT29/30: LEM5 44.66 (37.77), LEM10 44.08 (39.68), ZOL 36.22 (41.95), PBO 15.33 (36.52). Compared to ZOL, total nonREM sleep in either LEM group was not significantly different on NT1/2, and only LEM5 was significantly different vs ZOL at NT29/30 (P< 0.05). LEM was well-tolerated; most TEAEs were mild/moderate.

Conclusion

LEM significantly increased total sleep time in subjects with insomnia and mild OSA. The additional sleep was comprised importantly with REM sleep, a sleep stage that may be decreased in patients with OSA. These data support the use of LEM in a population with COMISA.

Support (if any)

Eisai Inc.
0356 Is There an Association Between Insomnia and Temperament in Adults?
Authors: Lundy Bethany , Noall Carissa , Kay Daniel
Published: May 2023

Introduction

Insomnia is an increasingly prevalent health concern influenced by environmental, biological, and dispositional factors. Adult temperament is the collection of fundamental characteristics that some have hypothesized may predispose individuals to insomnia. Despite this, there is little research on the relationship between insomnia and specific temperament factors in adults. A few investigations have shown negative affect as the most consistent association with poor sleep. This study investigated relationships between insomnia and adult temperament and tested whether the association between negative affect and insomnia is better explained by depression.

Methods

Participants were 66 adults, (Mdn = 23, 18-49 years old), 50% female, 86% white, ranging from good (no insomnia) to poor sleepers (mild to moderate insomnia). Data were pooled from two protocols designed to investigate associations between sleep and transdiagnostic features of mental illness. As part of a broader array of questionnaires and assessments, participants completed the insomnia severity index (ISI), adult temperament questionnaire (ATQ), and the patient health questionnaire-9 (PHQ-9). The ATQ subscales were calculated according to previously identified factors: negative affect, effortful control, orienting sensitivity, and extraversion/surgency. Spearman’s coefficient was used to explore associations between each temperament factor and insomnia severity. Multiple regression was used to determine whether the associations between insomnia severity and negative affect remained when adjusting for PHQ-9 total score, not including the sleep items.

Results

Insomnia severity was significantly correlated with negative affect (ρ = 0.345, p = .005), but no other temperament factors (p> .05, for all). Regression analysis of all four ATQ factors and the PHQ-9 in predicting ISI outcomes resulted in an R2 of .45, PHQ-9 being the only significant regressor (p< .05).

Conclusion

We failed to find support for the hypothesis that individual differences in temperament confer risk for insomnia. Although insomnia was associated with negative affect in bivariate correlation analysis, this association may be better explained by their shared association with depression. We recommend investigating how temperament interacts with various psychological conditions such as depression and anxiety to better understand the individual differences that may impact risks for developing insomnia.

Support (if any)

n/a