bluuebunny/crossref_metadata_2025 huggingface dataset:
709 Healthy Sleep as an important resource and buffer for intersectional discrimination: Results from Covid 19 study
Authors: Pandey Abhishek , Littlewood Kerry , Spadola Christine , Rosenthal Michelle , Cooper Larry , Carter Shima , Bennett Russell , Hash Jonika , Kirtman Nissa , Ward Teresa
Published: May 2021

Introduction

Our previous studies have highlighted sleep disparities for this underserved population, including how Grandparents Raising Grandchildren (GRG) experience troubled and disruptive sleep. Intersectional types of discrimination facing these families during COVID 19, include: race/ethnicity of self and children, income, age, essential workforce status, and impairments (mobility, vision, and hearing). This current study intends to explore how healthy sleep is an important resource (potential buffer) for GRG experiencing intersectional discrimination during COVID 19.

Methods

We used community partnerships to recruit 600 GRG from all fifty states in USA and several tribes to complete an online survey on their experiences with caregiving and intersectional discrimination during COVID 19. We developed an index on intersectional discrimination based on GRG lived experiences to inform the survey and used descriptive and bivariate statistics to profile this group. Chi-square Automatic Interaction Detector (CHAID) analysis was used to build a predictive model to help determine how variables in our study best merge to explain intersectional discrimination.

Results

Of the GRGs’, 37% were between 54–65 years and 33% cared for children 6 to 10 years for at least 5 years. The types of discrimination that were more likely to be included in intersectional discrimination include: Black or African American [83.8% (31)], my child’s race [59.5% (22)], my lower economic status [56.8% (21)], and my status as a caregiver [56.8% (21)]. The resource needs that showed the most disparity (higher rate showed higher priority/extreme concern) between those with ID and those without included: Information on how COVID impacts race and ethnicity differently (6.0 vs. 3.61), ability to pay utilities (3.7 vs. 1.99), and information on how to achieve healthy sleep (4.19 vs. 2.64).

Conclusion

This study suggests that GRG facing intersectional discrimination identify the importance of attaining information on how to achieve healthy sleep as an important resource to them during COVID 19. These results can be used to help mobilize resources and disseminate information for this underserved group to improve healthy sleep and also model for their extended families and communities.

Support (if any)

This study was conducted by the Grandfamilies Outcome Workgroup, (GrOW), with support from Generations United and Collaborative Solutions.
720 Actigraphy to Evaluate Sleep in the Inpatient Setting: A Systematic Review
Authors: Sussman Sarah , Fares Elie , Ananth Ashwin , Boon Maurits , Fast Zhanna , Huntley Colin
Published: May 2021

Introduction

Sleep disruption is common among hospitalized patients due to psychological, physiological, and environmental reasons including illness, pain, anxiety, invasive interventions, frequent monitoring, and stimuli, especially noise and light. The AASM has published guidelines for the use of actigraphy in the outpatient setting, but there is a paucity of literature evaluating the validity of actigraphy in inpatients. We sought to summarize the evidence surrounding the use of actigraphy for inpatient sleep evaluation.

Methods

Systematic review was conducted according to the Preferred Reporting of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases were queried by two independent reviewers for English-language studies published between 1990 and 2020. The initial search screened for all occurrences of “actigraphy AND sleep AND hospital” then was further refined to include studies of actigraphy used for monitoring in the inpatient hospital setting and exclude studies evaluating actigraphy in outpatient, rehabilitation, immediate postoperative, or intensive care unit settings.

Results

1221 were screened from initial search results. 48 articles were identified through screening of abstracts. Full-text review of the articles was then completed. Of the 48 articles, a total of 12 studies examined general medical inpatients, 12 studies examined inpatients with neurologic disorders, 5 studies examined inpatients with cancer, 6 studies examined patients with mental illness, 9 studies examined elderly patients, and 4 studies examined other defined populations (pregnancy, trauma, liver transplantation, and hip arthroplasty). We summarize the qualitative findings of inpatient actigraphy as it relates to each of these populations. Commonly reported outcome measures were total sleep time (TST), number of nighttime awakenings, and concordance with polysomnography (PSG).

Conclusion

We summarize the existing evidence for the use of actigraphy in the inpatient setting. Actigraphy may provide a simple and effective method for screening of sleep disorders in the inpatient setting. With regard to the published literature, there is support for the use of actigraphy in the inpatient setting in certain patient populations, especially traumatic brain injury. Variation in data output of actigraphy devices and outcome measures presents a barrier to meta-anaylsis of pooled data. Standardization of outcome measures will allow for effective synthesis of future studies.

Support (if any):
723 Sleep Apnea Care During the COVID-19 Pandemic: Perspectives on the Transition to Telemedicine from Clinicians and Patients
Authors: Bertisch Suzanne , Bakker Jessie , Hanes Sherry , Dos Santos Carolina , Bergrestresser Sloan , Siengsukon Catherine , Barwick Melanie , Redline Susan , Revette Anna
Published: May 2021

Introduction

Covid-19-related public health control measures have necessitated a rapid transition in healthcare delivery. We qualitatively explored clinicians’ and patients’ experiences of the pandemic’s impact on the delivery and receipt of obstructive sleep apnea (OSA) care.

Methods

Between September and December 2020, we conducted ten 90-minute virtual focus groups with sleep clinicians (n=19) and English and Spanish-speaking patients with OSA (n= 30) recruited through an urban academic sleep clinic, national organizations, social media, and snowball sampling. An interdisciplinary team conducted a rapid qualitative analysis that included prefigured and emergent domains. The team developed a comprehensive analytic matrix, identifying key themes within and between groups and triangulating them across participant types.

Results

Clinicians and patients across all groups confirmed a rapid shift to the adoption of telemedicine. Clinicians reported telemedicine enhanced evaluations by enabling direct observation of the home environment, providing opportunities to guide patients on medical equipment used in the home, and cultivating meaningful social connections for patients. Perceived benefits varied across patient subgroups (age, language, technological self-efficacy). The majority of clinicians reported that telemedicine’s initial uptake resulted in delays in care and revenue loss, but sustained use was thought to be feasible over time. Patients reported delays in care related to the pandemic’s disruption on healthcare and their personal safety concerns. Additionally, telemedicine’s adoption directly altered other elements of care, including the delivery of patient education materials and loss of tacit information gained during the in-person visit. All groups reported adequate mask fitting as a central challenge for patients using positive airway pressure therapy. Spanish-speaking patients noted concerns of increased difficulty accessing care and navigating the OSA care system due to limited English proficiency, in addition to the limited availability of OSA resources in Spanish.

Conclusion

During the Covid-19 pandemic, the rapid adoption of telemedicine largely facilitated OSA care but altered patient-clinician interactions, delivery of patient education materials, and mask fitting success. Given that telemedicine will likely be sustained post-pandemic, there are needs for targeted efforts aimed at addressing disparities in telemedicine, enhancing practitioner telepresence and education, and new approaches for mask fitting to ensure successful OSA care.

Support (if any)

Patient-Centered Outcomes Research Institute EADI-16493
736 Evaluation of suvorexant for trauma-related insomnia
Authors: Mellman Thomas , Birku Kiya , Sandhu Ishaan , Kobayashi Ihori
Published: May 2021

Introduction

Finding medication treatment that improves sleep disturbances with posttraumatic stress disorder (PTSD) has challenged the field of psychopharmacology with debate regarding the desirable profile of effects on sleep physiology. Evidence for fragmentation of REM sleep during the earlier stages of PTSD drew our interest to the first marketed dual orexin antagonist, suvorexant, which has been suggested in some studies to enhance REM sleep. This property has also raised concerns regarding potential exacerbation of nightmares and REM sleep related parasomnias. Insomnia is a common sequela of trauma exposure and can occur with and without other PTSD symptoms. The objective of our study was to evaluate the tolerability and preliminary efficacy of suvorexant for trauma related insomnia in a double blind, placebo controlled trial.

Methods

64 met initial inclusion criteria and 42 participants had evaluable results. 65% were female, and 66% African-American, mean age was 35yrs.All participants were screened by the Duke Sleep Disorders Interview to met criteria for insomnia that began or was exacerbated following a DSM5 Criterion A trauma. Approximately a third of the study group met criteria for either current PTSD, past (remitted PTSD), or no PTSD, and 56% reported histories of traumatic nightmares hat generally had diminished from their initial severity.

Results

Medication intolerance was infrequent with one participant in the med group reporting mild sedation that precluded a dose increase to 20mg, and another, moderate sedation with feelings of derealization that led to discontinuation. There was no evidence for emerging nightmare symptoms or REM-related parasomnias. Overall there was significant improvement in sleep and PTSD symptoms in both the placebo and med group and a modest rise in REM sleep in the med group that did not differentiate statistically from placebo.

Conclusion

Our findings suggest that distressing trauma related insomnia can occur with and without PTSD and that suvorexant is well tolerated in this population. A larger and more symptomatic group is required to more definitively evaluate efficacy.

Support (if any)

supported by a grant from Merck (MISP 53678)
753 The role of circadian activity rhythms in depressive symptoms among female nursing students
Authors: Zhang Xin , Lee Shih-Yu
Published: May 2021

Introduction

Depression is prevalent among nursing students. Rumination and sleep-wake rhythms are associated to mental illness; however, no clear path has been found. This exploratory study aimed to examine the associations among circadian activity rhythms (CAR), rumination, and depressive symptoms in female nursing students; further, to test a hypothesized CAR conceptual model.

Methods

A total of 148 female nursing junior students in China completed a battery of questionnaires, including Athens Insomnia Scale (AIS), Ruminative Responses Scale (RRS), and Self-rating Depression Scale (SDS). Wrist actigraphy was used to collect total sleep time, CAR, and acrophase (time of the peak of the fitted activity curve). The path analysis was explored by using SPSS and AMOS.

Results

The mean age of the students was 20.64 years (SD = 0.86). About 58.8% of the participants were either mild or moderate depressed. About 93.9% of the students reported significant insomnia symptoms (AIS scores >6). Rumination was measured by the RRS (M= 2.01, SD = 0.54), and students scored higher in brooding than that of reflective pondering (2.07 vs. 1.95). The average of TST was 394.59 minutes (SD = 51.92). The CAR ranged from 0.40 to 0.98, with a mean of 0.75 (SD = 0.11). The acrophase ranged from 12:46 to 20:14 (median 16:30), with a later acrophase indicates of a more delayed circadian phase. The final model shows satisfactory fit (χ2= 2.238, p= .327); a better CAR can indirectly reduce depressive symptoms by directly reducing brooding (B = -1.149) and improving insomnia symptoms (B = -6.6443).

Conclusion

In order to prevent psychological problems of nursing students, ruminating and CAR should be part of health screening. The novel conceptual model provides a basis for reforming nursing education to prevent psychological problems.

Support (if any)

Chinese National Natural Science Foundation [71603279]
756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample
Authors: Palermo Emma , Goldschmied Jennifer , Boland Elaine , Klingaman Elizabeth A , Gehrman Philip , Perlis Michael
Published: May 2021

Introduction

Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI.

Methods

Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI.

Results

Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882).

Conclusion

In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt.

Support (if any)

Perlis: K24AG055602 & R01AG041783. 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.
761 Associations between Depression and Guidelines Met for Physical Activity and Sufficient Sleep in an International Sample
Authors: Bender Amy , Babins-Wagner Robbie , Laughton Angela
Published: May 2021

Introduction

Physical activity (PA) and sleep both influence symptoms of depression. Here we explored relationships between guidelines met for physical activity and sleep and how this related to depression scores.

Methods

N=23,663 respondents (age range 18–98, mean age 40.1y, 51% female) completed the 10-item Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS) online during one week in October from 2018–2020. Higher total scores on the HANDS indicated a higher likelihood of major depressive episode. Additional questions were added to the survey including questions on sleep duration and moderate to strenuous PA. The cut-off guidelines for PA were 150 weekly minutes and 7-9h of sleep per night. We categorized the sample based on those who met PA guidelines or not and whether respondents had short sleep duration (9h), or met the sleep guidelines (7-9h).

Results

One-way ANOVA revealed differences between the groups on HANDS depression score F(5,23657)=262.5, p<0.001. Nearly half of the sample did not meet both PA guidelines or sleep guidelines of 7-9h (N=10,776; 45.5%). The lowest depression scores were associated with those who met both PA and sleep guidelines (8.3 depression score) compared to those with the highest scores who exceeded sleep recommendations (>9h) and did not meet PA guidelines (14.1 depression score). In addition, met sleep guidelines (10.0) appeared to have a bigger influence than met PA guidelines (11.1) in the absence of the other guideline being met on depression score.

Conclusion

We found those who met both sleep and PA guidelines had the lowest depression scores with those who exceeded the sleep guidelines and did not meet PA recommendations had the highest depression scores. Future research on depression could focus on interventions aimed at improving adherence to both PA and sleep guidelines.

Support (if any):
763 Indicators of delayed circadian rhythms are associated with OCD symptoms
Authors: Cox Rebecca , Olatunji Bunmi
Published: May 2021

Introduction

Increasing evidence implicates delayed circadian rhythms in obsessive-compulsive disorder (OCD). Indeed, eveningness prospectively predicts increased OCD symptoms (Cox, Tuck, & Olatunji, 2018), and several studies have highlighted a link between later bedtimes and OCD symptoms (e.g., Nota et al., 2020; Schubert, Stewart, & Coles, 2019). Notably, no study to date has examined the associations between midsleep or delayed sleep-wake phase disorder (DSWPD) status and OCD symptom severity. The present study sought to address these gaps in the literature by utilizing a multimethod approach to characterize the associations between indicators of delayed circadian rhythms and OCD.

Methods

Adults with (n=57) and without (n=20) elevated OCD symptoms were recruited. Of those with elevated symptoms, 20 met criteria for OCD. Of those who did not meet criteria for OCD, 29 were identified as healthy controls (no diagnoses). On day 1, participants were administered the MINI International Neuropsychiatric Interview (Sheehan et al., 1988) to determine diagnostic status, the Diagnostic Interview for Sleep Patterns and Disorders (Merikangas et al., 2014) to diagnose DSWPD, and the Morningness-Eveningness Questionnaire (Horne & Ostberg, 1976) to measure eveningness tendency. Participants then completed 7 days of sleep monitoring with the Consensus Sleep Diary (CSD; Carney et al., 2012) to measure midsleep. On day 9, participants completed the Obsessive-Compulsive Inventory-Revised (Foa et al., 2002) to measure OCD symptom severity.

Results

Results indicated a significant relationship between OCD and DSWPD status, X2(2, n=49)=13.91, p<.01, such that 40% of those with OCD also met criteria for DSWPD, relative to 0% of healthy controls. Similarly, those with OCD reported significantly increased eveningness tendency (M=40.60, SD=9.54) compared to healthy controls (M=53.66, SD=13.15), t(47)=3.80, p<.01, d=1.14. Among those with elevated OCD symptoms, there was trend level increase in OCD symptom severity between those with DSWPD (M=25.45, SD=11.23) and without DSWPD (M=19.44, SD=9.80), t(52)=1.76, p=.08, d=0.57. Finally, across the whole sample, later midsleep significantly predicted increased OCD symptoms (b=.27, p<.05).

Conclusion

These results replicate and extend the growing literature on delayed circadian rhythms in OCD and suggest that circadian dysregulation may represent a novel target for treatment.

Support (if any):
765 Anxiety and sleep in Generalized Anxiety Disorder with and without Insomnia Disorder
Authors: Mendelsohn Augustus Kram , Daffre Carolina , Oliver Katelyn , Seo Jeehye , Lasko Natasha , Pace-Schott Edward
Published: May 2021

Introduction

Insomnia Disorder (ID) elevates risk of incident anxiety disorders and vice versa. We examined whether ID and poor sleep are associated with greater self-reported anxiety in persons with Generalized Anxiety Disorder (GAD).

Methods

Twenty-one participants with GAD and ID (GAD+/ID+) having Insomnia Severity Index (ISI) scores ≥ 13 (mean 17.8, SD 3.6) and 14 with GAD but not ID (GAD+/ID-) having ISI scores ≤ 12 (mean 6.4, SD 3.4) completed 14 days of actigraphy and sleep diaries as well as a night of ambulatory polysomnography (PSG) following an acclimation night. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA-T/C, -T/S), the Ford Insomnia Response to Stress Test (FIRST), the Penn State Worry Questionnaire (PSWQ), and the Anxiety Sensitivity Index (ASI). Differences in self-reported anxiety (STICSA, ASI, PSWQ) between GAD+/ID+ and GAD+/ID- were analyzed using t-tests. Relationships of anxiety with retrospective (PSQI, FIRST, ISI), longitudinal (actigraphy, diaries) and physiological (PSG) sleep variables were analyzed using simple regression.

Results

GAD+/ID+ versus GAD+/ID- participants showed trends toward higher anxiety on the PSWQ (p=0.075), ASI (p=0.072) and STICSA-T/S (p=0.078). PSQI scores were positively associated with STICSA-T/S, (R=0.417, p=0.018, N=32). Greater insomnia reactivity (FIRST) was associated with increased worry on the PSWQ (R=0.352, p=0.044, N=33). STICSA-T/C was negatively associated with mean diary (R= -0.440, p=0.015, N=30) and actigraph (R= -0.517, p=0.01, N=24) total sleep time (TST). Actigraph mean TST trended toward lower PSWQ (R= -0.376, p=0.058, N=26) while actigraph mean sleep efficiency (SE) trended toward lesser STICSA-T/C (R= -0.397, p=0.058). Greater REM% was associated with greater STICSA-T/C (R=0.613, p=0.0005, N=28) and STICSA-T/S (R=0.516, p=0.005), a relationship also seen in GAD+/ID+ alone (p=0.03 and 0.015 respectively, N=16). Slow Wave Sleep% (SWS%) was not associated with lesser STICSA-T/S across both groups (p=0.14) but was so in GAD+/ID+ (R= -0.539, p=0.031, N=16).

Conclusion

GAD+/ID+ versus GAD+/ID-, show greater worry, anxiety sensitivity and somatic anxiety. In GAD, shorter and poorer quality sleep measured retrospectively or averaged longitudinally, as well as greater REM%, are associated with greater somatic and cognitive anxiety. Among those with ID, greater SWS% is associated with less somatic anxiety.

Support (if any)

R21MH115279, R01MH109638
771 Sleep Health Knowledge, Attitudes, Beliefs, and Practices among Mothers with a History of Perinatal Depression or Anxiety
Authors: Hash Jonika , Walker Amy , Ward Teresa , Spieker Susan
Published: May 2021

Introduction

Tailored interventions could optimize sleep health for mothers with a history of perinatal depression or anxiety. The purpose of this study was to describe sleep health knowledge, attitudes, beliefs, and practices among mothers who were previously treated for perinatal depression or anxiety, to inform future tailored sleep health interventions.

Methods

Mothers (N = 16) who had previously received treatment for perinatal depression or anxiety from a clinic serving low-resourced communities completed a single-occasion research home visit that included a demographics questionnaire and semi-structured interview. Interview data were analyzed using inductive content analysis, adapted from grounded theory.

Results

Mothers were, on average, 28.19 (SD = 7.71) years and had a child who was between 12 and 36 months. Of the mothers, 43.8% were White, 18.8% Black, 23.5% multiracial, 25.0% other race, 37.5% Hispanic, and 75.0% reported an annual household income of < $40,000. “Needing to focus on sleep” was the core construct that emerged from the interview data, which was comprised of three domains. The first domain, “Having pretty good sleep,” described mothers’ experiences of good sleep health including easily falling and staying asleep, feeling satisfied with their sleep, and feeling well-rested. The second domain, “Trying to get normal healthy sleep,” described mothers’ experiences of poor sleep health and its consequences for physical and mental health. The third domain, “Wondering how to get better sleep with everything going on,” described everyday realities that got in the way of good sleep health including child sleep problems, competing demands on time, irregular work schedules, symptoms of depression or anxiety, and significant life transitions around school/work and pregnancy/postpartum.

Conclusion

Findings showed a range of maternal sleep health experiences. Mothers’ sleep health overlapped with mental health and wellbeing, children’s sleep health, and social determinants of health. Future sleep health interventions for mothers with a history of perinatal depression or anxiety could include tailored approaches that build on existing maternal strengths, integrate with existing mental health care services and child sleep health interventions, address social determinants, and attend to significant life transitions.

Support (if any)

2018 Sigma/Rosemary Berkel Crisp Award; NINR (T32NR016913); NICHD (R01HD080851, U54HD083091).
777 Sleep and non-suicidal self-injury in college students
Authors: Hendershot Sierra , Tubbs Andrew , Fernandez Fabian-Xosé , Perlis Michael , Grandner Michael
Published: May 2021

Introduction

Non-suicidal self-injury (NSSI) can increase suicide risk and is highly prevalent among young adults, including college students. While there is mounting evidence that disrupted sleep increases suicide risk, it is unclear how sleep influences NSSIs. Therefore, the present study explored how sleep variables were associated with NSSIs in a college sample.

Methods

Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey of college students. The primary outcome, lifetime NSSI, was assessed using a self-report question derived from the Columbia Suicide Severity Rating Scale. The predictors were weekday short sleep (≤ 6h; assessed by retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models estimated the associations between NSSI and sleep variables in models that were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness from the Interpersonal Theory of Suicide.

Results

A total of N=142 (28.1%) respondents endorsed lifetime non-suicidal self-injury. Individuals with NSSI were more likely to be female (p=0.015), in poorer health (p<0.001), and have more severe depression (p<0.001) and anxiety (p<0.001) than those without NSSI. In unadjusted models, higher BRISC scores were associated with lower odds of NSSI (OR 0.55 [0.43–0.71]), DDNSI scores of >=10 increased the odds of NSSI (OR 2.65 [1.70–4.11], and ISI scores of >=8 increased the odds of NSSI (OR 2.05 [1.38–3.08]), while short sleep was not associated with NSSI. Adjusting for age, sex, race, ethnicity, and thwarted belongingness did not eliminate any of these relationships but adjusting for perceived burdensomeness rendered the association between insomnia and NSSI non-significant.

Conclusion

Individuals with significant insomnia symptoms or nightmares were more likely to report a history of NSSI, while individuals with greater perceived control of sleep had lower odds of NSSI. These findings were generally independent of the Interpersonal Theory of Suicide. Further research is needed regarding the timing of NSSI (i.e., do they occur more often during nocturnal wakefulness) and whether sleep interventions can reduce the risk of NSSI.

Support (if any):
780 Perceived Deprivation Of Social Touch And Sleep Symptoms: Results From A Pre-COVID19 Community Study
Authors: Gupta Madhulika , Begin-Dyck Haylee
Published: May 2021

Introduction

The impact of social isolation and touch deprivation on sleep symptoms (insomnia, nightmares) during the SARS-CoV-2 (COVID19) pandemic has been recognized. These results however may have been confounded by various other disease-related factors that can directly impact sleep eg., medical complications associated with COVID19; trauma response and the economic impact of the pandemic. We examined previously unpublished data, from an earlier Canadian community-based survey (1997–1998) of psychosomatic factors (including sleep symptoms), associated with perceived touch deprivation (PTD).

Methods

360 consecutive consenting participants (316 community volunteers,44 psychiatric outpatients; 270 women; 94% white; mean±SD age: 38.3±14.5 years) completed a large battery of questions related to psychosomatic factors and the skin. The methods are described in previous publications [Gupta MA 2004; Gupta MA 2006] from this study. PTD was measured with the following item (rated on a 10-point Likert-type scale where “0” denoted “not at all” and rating of “9” denoted “very markedly”): “At the present time I wish I could get more hugs from others”’. Some of the sleep ratings in the survey read as follows: Insomnia1: “How long do you generally take to fall asleep at night?”(rating of “1” denoted “immediately”, “2” denoted ”1hour”). Secondly, participants rated how frequently they experienced the following sleep symptoms using a 4-point scale: “Awakenings from sleep”(Insomnia 2); “Dreams”; “Nightmares: “Snoring”; and “Jerking of arms or legs” (rating of “1” denoted “Never”, “2” denoted “Sometimes”, “3” denoted “Often”, 4 denoted “Always”).

Results

PTD scale scores (mean±SD: 3.81±2.85; range 0–9) correlated significantly with the following: Insomnia1 (r=0.219, p<0.001); Insomnia2 (r=0.130, p=0.014); Nightmares (r=0.118, p=0.018); Limb jerking (r=0.209, p<0.001), and age (r=-0.208, p<0.001). Stepwise multiple regression analysis using PTD as dependent variable and all sleep ratings, age and sex as independent variables revealed the following predictors for PTD: Insomnia1(β=0.171,t=3.3267, p=0.001), Limb jerking (β=0.151,t=2.876, p=0.004), age (β= -0.179, t= -3.456, p=0.001).

Conclusion

In a pre-COVID19 community study, PTD was more problematic among the younger age group, and correlated with sleep onset and maintenance difficulties, nightmares and limb jerking, highlighting the importance of social touch in sleep.

Support (if any)

None
781 Insomnia is Associated with Anger Expression in an Army Population
Authors: Estabrook Grace , Goldschmied Jennifer , Miller Katherine , Klingaman Elizabeth A , Gehrman Philip
Published: May 2021

Introduction

Emotion-regulation and sleep-related difficulties are intertwined. Most research has focused on the impact of poor sleep on internalizing symptoms (e.g. depression, anxiety) but a few studies have found a that increased insomnia is associated with more externalizing symptoms (e.g. anger). This relationship may be particularly salient for military personnel, for whom poor sleep is endemic. It is important that this relationship be further investigated in order to understand the issues that Army servicemembers face.

Methods

Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; 18–61 years old; 86.5% male). Participants completed the Brief Insomnia Questionnaire, an 11-item irritability and anger-related questionnaire and a 10-item questionnaire on anger attacks. Pearson correlations were used to examine the relationship between insomnia symptoms and emotional and behavioral components of anger, while controlling for depressive symptom severity.

Results

Insomnia severity in the past 30 days was significantly correlated with both emotional and behavioral expressions of anger (all p<0.001, r = .2 to .4). Overall insomnia severity and early morning awakenings (EMA) had the strongest relationships. These relationships were still significant after controlling for depression severity.

Conclusion

In a nationally-representative sample of Army servicemembers, insomnia severity, particularly EMA, was associated with higher levels of irritability and anger (outbursts and anger attacks) over and above the effects of depression. These findings highlight the importance of treating insomnia in order to regulate anger expression within a military population.

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.
784 Naturalistic Measurement of Sleep/Wake Disturbance in Adults Receiving Methadone Treatment for Opioid Use Disorder
Authors: Skeiky Lillian , Hansen Devon , Layton Matthew , Quock Raymond , Van Dongen Hans , Wilson Marian
Published: May 2021

Introduction

Individuals with opioid use disorder (OUD) report significant sleep/wake disturbance, which continues even after stabilization on medication-assisted treatment (MAT). However, the nature of sleep/wake disturbance in this population has not been well documented objectively. Here we analyze naturalistic wrist actigraphy recordings in individuals with OUD receiving methadone-based MAT.

Methods

Seven adults undergoing methadone treatment for OUD (ages 26–50; 4 women) wore a wrist actigraph (Actiwatch-2, Philips Respironics) continuously for 7 days. They were asked to adhere to their normal sleep schedule in order to obtain naturalistic observations. Reference data were collected in a separate study of healthy controls, in which 14 hospital nurses (ages 20–60; 13 women) wore a wrist actigraph continuously for 7 days. In this reference group, 7 participants had a day shift schedule (07:00–19:00) and 7 had a night shift schedule (19:00–07:00), with six 12h shifts in a 2-week period. Actigraphic data were collected in 1min epochs, and the sleep/wake status for each epoch was estimated using Actiware 6.0.9 (Philips Respironics). The estimated sleep/wake patterns were subjected to cosinor analysis to assess 24h rhythmicity and analysis of the distribution of inactive periods to assess sleep continuity.

Results

For the reference group, nurses working day shifts displayed strong 24h rhythmicity, whereas nurses working night shifts showed blunted 24h rhythmicity (F[1,12]=66.11, p<0.001). However, both day and night nurses exhibited high sleep continuity (KS test, p=0.82). By contrast, for the group with OUD receiving methadone, the strength of 24h rhythmicity was reduced to between that of the day and night shift nurses in the reference group, indicating weak regularity of sleep/wake patterns (F[2,18]=33.79, p<0.001). Furthermore, individuals with OUD receiving methadone experienced low sleep continuity compared to the reference group (KS test, p=0.030).

Conclusion

These naturalistic observations confirm the presence of sleep/wake disturbance, resulting from both irregular sleep/wake patterns and low sleep continuity, in individuals receiving methadone-based MAT for OUD. Sleep/wake disturbance may interfere with the ability to achieve OUD recovery goals, and comparing sleep disturbance in MAT populations to reference data highlights the need to consider sleep in these populations as a clinical priority.

Support (if any)

State of Washington Initiative Measure No. 171
787 OSA Risk is Associated with Number of White Matter Hyperintensities, But History of Mild TBI is Not: A LIMBIC-CENC Study
Authors: Garcia Amanda , Wilde Elisabeth A , Tate David , Reljic Tea , Kenney Kimbra , Troyanskaya Maya , Agyemang Amma , Walker William C , Nakase-Richardson Risa
Published: May 2021

Introduction

Individuals with a history of mild traumatic brain injury (mTBI) have higher risk levels for obstructive sleep apnea (OSA). However, no studies have examined the association between OSA and white matter hyperintensities (WMHs) in this group. The purpose of this study is to explore the relationship between OSA risk, mTBI, and WMHs in a military cohort with a history of combat deployment.

Methods

Secondary analyses were conducted from a large clinical database of a multi-center, longitudinal study of current and former military personnel. Participants were included who had complete STOPBANG (sleep apnea risk) data and MRI. Univariable and multivariable regressions were conducted, including age, race, gender, education, hypertension, diabetes, history of mTBI, and STOPBANG score in the models.

Results

The final sample (N=1017) included participants with (n=823) and without (n=194) a history of mTBI. The sample was predominantly male (87%) with a median age of 38 (IQR; 32–48). WMHs were reported in 37% of the sample. Univariate analyses revealed that increasing age, female sex, hypertension, diabetes, and higher sleep apnea risk score were each positively associated with higher number of WMHs, while a history of lifetime mTBI exposure was not associated. Multivariable analyses revealed that of these factors, only age remained associated with WMH presence. When restricting the sample to the 37% with WMHs, OSA risk and female sex were each associated with higher number of WMHs (p<.05), but history of mTBI was not.

Conclusion

Consistent with the literature in non-brain injured populations, age was the strongest predictor of WMH presence and number. In those with identified WMHs, OSA risk was a significant predictor of WMH number, while history of mTBI was not. Thus, in persons with mTBI, presence of WMHs may be linked to sleep comorbidities, providing potential treatment targets. Limitations include assessment of OSA rather than established diagnosis.

Support (if any)

Defense and Veterans Brain Injury Center (HT0014-19-C-004), DOD(W81XWH-13-2-0095), VA(I01 CX001135). The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICoEinfo@mail.mil. UNCLASSIFIED
796 Quantitative EEG Analysis in Angelman Syndrome
Authors: Hosamane Nishitha , Levin Yuval , McNair Taylor , Sidorov Michael
Published: May 2021

Introduction

Angelman syndrome (AS) is a neurodevelopmental disorder resulting from decreased expression of the maternal copy of the imprinted UBE3A gene on chromosome 15. This disorder is characterized by intellectual disability, impaired speech and motor skills, and sleep abnormalities but currently lacks any treatment. However, mouse models have shown that un-silencing the dormant paternal copy of UBE3A has been an effective mechanism to restore the functionality of the UBE3A protein, thus clinical trials using this approach are on the near horizon. Developing biomarkers is essential for assessing responses to treatment when clinical trials begin, and quantitative EEG analysis has shown great promise as a biomarker for AS.

Methods

Here, we sought to define EEG biomarkers directly linked to sleep impairments seen in up to 90% of individuals with AS (Trickett). We analyzed nine overnight sleep studies from patients with AS with age and sex matched Down syndrome and neurotypical controls. We specifically examined low-frequency delta rhythms and sleep spindles during NREM sleep.

Results

We confirmed that low- delta rhythms are increased during overnight sleep in AS, and that this biomarker appears more reliable than possible changes in sleep spindles.

Conclusion

Our results suggest that quantitative measurement of delta rhythms during sleep can be used as a potential biomarker for treatments in Angelman syndrome clinical trials.

Support (if any):
802 Seizure-Associated Central Respiratory Events: What’s Sleep Go To Do With It?
Authors: Mingbunjerdsuk Prompan , Andrews Noah , Wang Lu , Aboussouan Loutfi , Mehra Reena , Grigg-Damberger Madeleine , Foldvary-Schaefer Nancy
Published: May 2021

Introduction

Seizure-related respiratory dysfunction has been reported in patients with epilepsy(PWE) on scalp EEG. We assessed this in Stereo-EEG(SEEG) recordings in patients with pharmacoresistant focal epilepsy.

Methods

PWE undergoing SEEG wore temperature/pressure-based airflow,RIP belts, SpO2, and EtCO2/TcpCO2. Interpretable recordings required SpO2 and at least one airflow and effort channel. Respiratory events including apneas, hypopneas(3%) and central pauses (5 to<10sec). Respiratory events, respiratory rate(RR), SpO2 nadir, total desaturation time, Peak EtCO2/TcpCO2, and hypercapnia duration were analyzed surrounding seizures. Frequency and duration of central events were compared in sleep-onset and awake seizures. Linear mixed-effects models evaluated relationships between respiratory variables and the frequency and duration of central events associated with seizures and compared respiratory variables between seizures with and without events.

Results

44 seizures were recorded in 23 patients. Seizures were focal-onset in 79.5%(n=35), GTC in 20.5%(9). Respiratory events accompanied 61.4%(27) of the seizures with median duration/seizure duration of 0.40(IQR: 0.27, 0.61). Of the 47 respiratory events, 42 were central events, and 66.6%(28) were central apneas. Respiratory events occurred during the seizure in 73.8%, postictal in 26.2%; median SpO2 nadir was 90%(77.0, 93.0), total desaturation duration 104.3(50.3, 195.0)sec, peak TcpCO2 41.3(38.7, 44.8) mmHg, hypercapnia duration 157.6(51.0, 367.9) sec, and ictal-postictal RR change 3.3 ± 4.0bpm. For every 1 sec duration increase in central event duration, there was a significant increase in peak TcpCO2 0.35(95%CI [0.09,0.62],p=0.015) and TcpCO2 change 0.25(95%CI [0.02,0.49],p=0.037). Presence of central events were associated with increased peak TcpCO2(9.82[3.77,15.9], p=0.006). Seizures with central events trended greater changes in RR, SpO2, and EtCO2/TcpCO2, desaturation and hypercapnia time, with negative changes in SpO2 nadir. No significant difference on central event frequency was found between sleep-onset and awake seizures.

Conclusion

Central events including apneas and pauses are common in focal seizures arising from sleep and wake and are associated with hypercapnia. In addition to the significant association between TcpCO2 and the frequency and duration of central events, there is a positive trend of association of other respiratory dysfunction parameters. These findings suggest that central events may lead to a cascade of respiratory disturbance that may participate in the pathophysiology of sudden unexplained death in epilepsy.

Support (if any):
805 Towards a more perfect union: interrater reliability between telemedicine and in-person evaluators in sleep disordered breathing
Authors: Yurcheshen Michael , Pigeon Wilfred , Marcus Carolina , Marcus Jonathan , Messing Susan , Nguyen Kevin , Marsella Jennifer
Published: May 2021

Introduction

Telemedicine has rapidly changed the landscape of all of clinical practice, and is now widely employed in sleep medicine. To date, the accuracy of telemedicine in identifying patients at risk for obstructive sleep apnea (OSA) is still unknown. Given differences in technique and fidelity, a perfect correlation between these two types of encounters cannot be assumed. We studied how providers using a telemedicine platform compared to providers using traditional in-person encounters in identifying risk for sleep disordered breathing.

Methods

90 participants referred to a comprehensive university sleep program were randomized to this interrater reliability study. Subjects were representative of the gender and ethnic breakdown of the outlying community. The subjects were evaluated by an in-person clinician investigator, then randomized to a second clinician investigator who performed an evaluation online using a common teleconferencing platform. Both types of evaluations included a history and physical exam. The primary outcome was pretest probability for obstructive sleep apnea. Secondary comparators included level of daytime sleepiness, snoring volume, apneas witnessed by a third party, modified Mallampati score, presence/absence of tonsils, degree of overjet bite, and severity of apnea based on home sleep testing.

Results

Interrater reliability for pretest probability of OSA was reflected in a weighted kappa value of 0.414 (SE 0.090, p=0.002). This suggests moderate agreement between the an in-person and telemedicine evaluator. Kappa values of our secondary outcomes ranged from -0.044 (degree of maxillary overjet) to 0.702 (apneas witnessed by a third party), and were generally higher for historical elements and lower for physical exam findings.

Conclusion

Evaluation for pretest probability for sleep apnea via telemedicine has a moderate interrater correlation with in-person assessment. A relatively high degree of interrater reliability for historical elements suggests that the accuracy of telemedicine for OSA is tempered by a suboptimal physical exam. Telemedicine evaluations might become more accurate through standardization. For instance, using validated scales for OSA or templated encounter scripts may help with risk-stratification, and ultimately lead to more uniform management.

Support (if any)

This study was supported by an AASM Foundation Focused Project Award
807 Diagnostic Pathways of Patients Authorized for Obstructive Sleep Apnea Testing and Treatment: A Retrospective Claims Analysis
Authors: Nguyen Binh , Gordon Aliza , Blake Stefanida , Kalluri Lakshmi , Chi Winnie , Power Thomas
Published: May 2021

Introduction

Obstructive Sleep Apnea (OSA) has been shown to reduce health-related quality of life and is associated with cardiovascular disease and other negative health outcomes. However, many patients with suspected OSA are never tested, thereby remaining undiagnosed and untreated. In this study, we explore the diagnostic pathways and eventual treatment of individuals with suspected OSA.

Methods

We conducted a retrospective, observational study, linking claims and prior authorization data of a large, geographically diverse health insurer’s commercial and Medicare Advantage members. Our sample included adults with suspected OSA and no prior OSA history, whose diagnostic testing had been approved through prior authorization (N=75,011). Using a 3-month time window following authorization, we searched for a claim to match the authorized service (home or laboratory sleep testing). We also looked for subsequent prior authorization for OSA treatment (Positive Airway Pressure (PAP) or oral appliance) and corresponding claims for those treatments within the 3-month authorization window.

Results

Among the study sample (N=75,011), 40,002 (53.3%) had home testing only, 17,319 (23.1%) had laboratory testing only, and 6,053 (8.1%) had a home test followed by a laboratory test. Only 476 (0.6%) had a home test after the date of a lab test. 11,161 individuals (14.9%) did not complete any sleep test. Of the 63,850 individuals with any sleep testing, 39,062 (61.2%) received prior authorization for initiating OSA treatment, and 36,158 (92.6%) of them had a corresponding claim for treatment.

Conclusion

One in eight adults with suspected OSA for whom diagnostic testing was authorized did not undergo testing; among those who tested, home testing was most common. While it is clinically appropriate to follow a negative home test with a lab test since a home test cannot rule out OSA (only confirm it), the study notes that a significant number of those with a home test require follow-up laboratory testing. Together, this represents an opportunity for reducing barriers to testing and improvement in home testing technology.

Support (if any)

This study was funded by Anthem, Inc.