bluuebunny/crossref_metadata_2025 huggingface dataset:
0029 Light Emitted from Media Devices at Night is Associated with Decline in Sperm Quality
Authors: Green A , Barak S , Shine L , Kahane A , Dagan Y , Dagan Y
Published: May 2020

Introduction

The last several decades have been characterized by the widespread usage of digital devices, especially smartphones. At the same time, there have been reports of male fertility decline. The aim of this study was to assess the relationship between evening exposure to the light-emitting screens of digital media devices and sperm quality.

Methods

Semen samples were obtained from 116 men adults aged between 21 and 59 (35.2 ±7.2) undergoing fertility evaluation for the following sperm variables: volume (mL), pH, sperm concentration (n/mL), motility percentage (progressive% + non-progressive motility%) and total sperm count. Exposure to the screens of electronic devices and sleep habits were obtained by means of a questionnaire.

Results

Smartphone and tablet usage in the evening and after bedtime was negatively correlated (p<0.05) with sperm motility, sperm progressive motility, and sperm concentration, and positively correlated with the percentage of immotile sperm. In addition, sleep duration was positively correlated with sperm total and progressive motility and negatively correlated with semen pH (p<0.05). A significant negative correlation was observed between subjective sleepiness and total and progressive motility as well as total motile sperm number (p<0.05).

Conclusion

The results of this study revealed a link between evening and post-bedtime exposure to light-emitting digital media screens and sperm quality. To the best of our knowledge, this is the first study to report these types of correlations between sperm quality and exposure time to SWL emitted from digital media, especially smartphones and tablets, in the evening and after bedtime.

Support

No Support
0078 Influence of Light on Brain Activity Upon Waking From Slow Wave Sleep
Authors: Flynn-Evans E E , Hilditch C J , Chachad R , Bansal K , Wong L R , Santamaria A , Bathurst N G , Feick N H , Garcia J
Published: May 2020

Introduction

Waking from sleep is associated with reduced alertness due to sleep inertia. Light acutely improves alertness during sleep deprivation. In this study we assessed the influence of light on brain activity and connectivity after waking from slow wave sleep (SWS).

Methods

Twelve participants kept an actigraphy-confirmed stable sleep schedule with 8.5 hours for five nights and five hours for one night prior to an overnight laboratory visit. Participants completed two three-minute Karolinska Drowsiness Tests (KDT) before going to bed at their habitual bedtime. They were monitored continuously using high-density EEG (32-channel; Brain Products GmbH). Participants were woken twice and exposed to red light (0.01 melanopic-lux; control) or blue-enriched light (63.62 melanopic-lux) for one hour, in a randomized order, following at least five minutes of SWS. EEG artifact were removed algorithmically and the spectral composition of each electrode (i.e., fast fourier transform, FFT) and effective connectivity (i.e., partial directed coherence, PDC) between each electrode were estimated. A graphical analysis was conducted to extract features relevant to the facilitation of efficient communication between electrodes. All data were averaged within frequency bins of interest that correspond to delta (1-3Hz), theta (4-7Hz), alpha (8-12Hz), and beta (13-25Hz) bands and expressed relative to the pre-sleep baseline.

Results

Compared to the pre-sleep baseline, participants exposed to blue-enriched light experienced reduced theta and alpha activity; however, these results were not significantly different from the control. In contrast, the communication of frontal electrodes significantly increased across all frequency bands compared to the control, and this effect was most prominent in the alpha (t(11)=3.80, p=.005) and beta bands (t(11)=3.92, p=.004).

Conclusion

Exposure to blue-enriched light immediately after waking from SWS may accelerate the process of waking and help to improve alertness by facilitating communication between brain regions. Future analyses will explore the temporal persistence and granularity of the communicative properties associated with this response.

Support

Naval Postgraduate School Grant. NASA Airspace Operations and Safety Program, System-Wide Safety Project.
0084 Sleep Consolidates Incidentally Encoded Information After Deep but Not Shallow Encoding
Authors: Wernette E M , Fenn K M
Published: May 2020

Introduction

Slow wave sleep (SWS) strengthens declarative memory for information studied for a later test. However, research on the effect of sleep on information that is not intentionally remembered is scare. Previous research from our lab suggests sleep consolidates some, but not all, information that has been encoded incidentally, meaning that it has been acted on but not intentionally remembered. It remains unclear what determines which information benefits from sleep-dependent consolidation processes and what aspects of sleep are related to these mnemonic benefits. In two experiments, we test the hypothesis that sleep consolidates strong but not weak memory traces following incidental encoding, and assess the relationship between memory performance and objective sleep characteristics.

Methods

In Experiment 1, participants rated words one (weak traces) or three times (strong traces) in a deep or shallow incidental encoding task. Participants either rated words on a scale from ‘concrete’ to ‘abstract’ (deep) or counted the vowels in the words (shallow). Following a 12-hour period containing sleep or wakefulness, participants took a surprise memory test. In Experiment 2, participants rated words one or three times in the deep encoding task, received an 8-hour sleep opportunity with polysomnography, and took the surprise memory test.

Results

In Experiment 1, participants remembered words better after sleep than wake regardless of whether words were encoded one or three times, but only after deep encoding. Sleep did not consolidate information following shallow encoding. Experiment 2 is ongoing, but we predict that the amount of SWS will correlate positively with memory.

Conclusion

Results thus far suggest sleep may have consolidated information based on the strength of memory traces. Because deep encoding results in stronger memory traces than shallow encoding, this work is broadly consistent with theories of memory consolidation that predict sleep is more beneficial for strong memory traces than weak, such as the synaptic downscaling hypothesis.

Support

N/A
0093 Topographical Analysis of Sleep Spindles and Their Coordination with Slow Oscillations
Authors: Malerba P , Whitehurst L N , Mednick S C
Published: May 2020

Introduction

Brain oscillations found during sleep are hypothesized to mediate sleep-dependent memory consolidation, by coordinating cortical-subcortical activity and enabling synaptic plasticity. In particular, sleep spindles (10-16Hz) density and coordination with slow oscillations (SOs, 0.5–1.5 Hz) have been shown to correlate with memory performance post-sleep. In this study, we characterize how spindles are organized on the electrode manifold, and their relation to SO topography.

Methods

We conducted a sleep-memory study where subjects learned word-pair associations in the morning and were tested in the evening and the next morning. Polysomnography was collected during the night. We detected sleep spindles at each electrode independently and study their basic biophysical properties (density, amplitude, frequency, duration) in light sleep (stage 2, S2) and deep sleep (slow wave sleep, SWS) separately, including their co-occurrence with SOs. We categorize spindles that are co-detected across electrodes within a short time window and study how properties change across groups.

Results

We find a gradual increase in average spindle frequency in the frontal-occipital axis, but no bimodality in frequency distribution. Furthermore, spindles paired to SOs (a minority in both stages) are shorter than non-paired spindles. We find that coordination between spindles and SO troughs is frequency but not amplitude selective; and differs between the two sleep stages. In S2, slow spindles precede SOs in frontal electrodes and fast spindles follow SOs in centro-posterior electrodes. Our clusters of spindle topography include a Frontal and a Posterior cluster. These clusters mirror the commonly considered slow-frontal and fast-posterior spindles, but contain less than half of all S2 spindles. Clustering identifies sub-types of spindle-SO complexes whose density is linked to memory performance.

Conclusion

Our study shows that specific sub-types of sleep oscillations, defined by their topography, support the coordination between spindles and SOs which could mediate cortical-subcortical dialogue during sleep.

Support

This work was supported by NIH grant (R01 AG046646) to Sara C. Mednick
0097 Effects of Experimental Sleep Disruption on Morning Cognitive Performance and Alertness
Authors: Chinoy E D , Hirsch D A , Cuellar J A , Snider M N , Dunn T L , Brookfield J S , Markwald R R
Published: May 2020

Introduction

While sleep duration is known to affect next-day cognitive performance and alertness, largely in a dose-response manner, the effects of disrupted sleep (where one is awoken multiple times overnight, common in military settings) are much less understood. Therefore, we examined the effects of experimentally disrupted sleep on morning cognitive performance and alertness.

Methods

We tested 34 healthy participants (12 men, 22 women, 28.1±3.9 years; mean±SD) who slept for 8-hours time-in-bed on three consecutive nights with polysomnography in a controlled sleep lab. The final two nights were randomized and counterbalanced between an undisrupted and a disrupted sleep condition. On the disrupted sleep night, participants were awoken by auditory tones for a 5–10 min period every hour. The following morning, participants completed a cognitive test battery that included Karolinska Sleepiness Scale (KSS), 10-min psychomotor vigilance task (PVT), addition calculations (ADD), go/no-go (GNG), task switching (TS), and working memory (WM). Mixed effects models were used to test factors: condition (undisrupted vs. disrupted), condition-order, and their interaction.

Results

Significant (p<0.05) effects of condition (i.e., disrupted sleep caused worse performance) were found for PVT reaction time (RT), GNG RT, TS RT, WM percent correct, and KSS alertness ratings. Condition was not significant for number or percent correct on ADD, GNG, and TS. Condition-order was significant for TS percent correct, and significant interactions were found for ADD number correct and TS RT.

Conclusion

One night of sleep disruption caused significant negative effects on morning subjective alertness and on several, but not all, cognitive performance domains tested, including RT and WM. Condition-order and interaction effects were also found, indicating that some performance outcomes were impacted by possible learning effects over the study. Sleep disruption factors should be taken into account, especially in operational settings like the military where environmental factors (e.g., noise) disrupt sleeping conditions.

Support

Office of Naval Research, Code 34
1011 Sleep Duration Moderates the Association Between Next-Day Physical Activity and Pain Intensity Among Women with Fibromyalgia
Authors: Whibley D , Williams D A , Clauw D J , Kratz A L
Published: May 2020

Introduction

Suboptimal sleep has been consistently associated with greater next-day pain intensity among women with fibromyalgia. In contrast, associations between physical activity and same-day pain in this population are contradictory. Given this inconsistency, we aimed to determine whether the daily physical activity-pain association is modified by sleep parameters.

Methods

This micro-longitudinal study used data collected using wrist-worn triaxial accelerometers over seven consecutive days by 44 adult women with fibromyalgia. Derived variables included sleep duration, sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and maximum daily physical activity count. Participants also completed digital diaries of refreshed sleep upon awakening (scale 0-100), and pain intensity (5x/day, scale 0-100). Multilevel linear regression models with interaction terms were used to investigate moderating effects of sleep on the next-day person-centered maximum physical activity-average pain intensity association.

Results

The sample mean age was 44 (SD 14). A total of 304 days of data were available for analysis. Mean sleep duration was 471min(SD 66); mean SOL 10min(SD 10); mean WASO 31min(SD 17), and mean SE 90%(SD 5). Sleep duration moderated the next-day maximum physical activity-pain association (Wald statistic p=0.01). After nights of both shorter (<7 hours) and longer sleep (>8 hours), higher levels of next-day maximum physical activity (compared to the participant’s overall study average) were associated with days of greater average pain. In contrast, after nights of 7-8 hours of sleep, higher levels of next-day maximum physical activity were associated with days of lower average pain.

Conclusion

An association between higher maximum physical activity and lower levels of pain was only observed after nights of 7-8 hours sleep. Engaging in physical activity is recommended for fibromyalgia-related pain management. Optimizing sleep duration may be useful in minimizing physical activity-related pain in this clinical population.

Support

DW is supported by a Foundation Fellowship Versus Arthritis. The study that provided data was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number K01AR064275;PI:ALK). The Michigan Institute for Clinical & Health Research provided subject recruitment support through the UMHealthResearch.org website (MICHR:NIH award number UL1TR002240).
1024 Associations Of Low Back Pain And Sleep Among Nursing Staff
Authors: Zhang Y , Thind H , Kim S , Nunes R , Reidy J , Punnett L , Duffy J
Published: May 2020

Introduction

Nursing is one of the top occupations suffering musculoskeletal disorders, especially low back pain (LBP). Nursing staff also experience short and disturbed sleep. Although there is a known relationship between pain and sleep, the specific associations between different aspects of LBP (e.g., duration, frequency, intensity) and sleep have not been studied. The objective of this study is to examine different aspects of LBP and their cross-sectional associations with sleep among nursing staff.

Methods

Online Qualtrics surveys were distributed among nurses and nursing assistants at a community hospital in the northeast U.S. LBP was assessed in terms of duration, frequency, intensity, and intensity change from before to after the work shift. Sleep duration and disturbances were assessed with validated scales.

Results

Among the 541 participants (94% female; age 43±13y), more than a third reported short sleep duration (≤6hrs/day; 38%) or sleep disturbances (38%), and more than half (60%) reported LBP in the past 6 months. Among those with LBP, 82% had ongoing pain for at least 6 months; 44% had ongoing pain for at least half the days in the past 6 months; 39% had LBP intensity ≥4 out of 10; and 79% reported post-shift LBP intensity increased of at least 1 level. Short sleep duration was associated with ongoing LBP for at least half the days in the past 6 months, intensity ≥4, and post-shift LBP intensity increase. Sleep disturbances were associated with prevalent LBP and intensity ≥4.

Conclusion

Nursing staff reported a high prevalence of LBP as well as short and disturbed sleep. Overall, poor sleep was associated with higher LBP prevalence, frequency, intensity, and post-shift increase. Future longitudinal studies are needed to clarify the causal directions of these relationships. Workplace interventions should address the widespread problems of LBP and sleep deficiency of nursing staff.

Support

Drs. Yuan Zhang and Jeanne F. Duffy were supported by NIH grant R01 AG044416.
1037 One Year Trajectory of Insomnia and Comorbid Symptoms in Women With Early Stage Breast Cancer
Authors: Mahon K , Garland S N , Tulk J , Rash J , Seal M , Laing K
Published: May 2020

Introduction

Insomnia symptoms are a common problem and are often comorbid with hot flashes, fatigue, anxiety, and depression following a breast cancer diagnosis. The present study examined changes in insomnia severity and comorbid symptoms in the year following diagnosis.

Methods

This study is part of a larger prospective observational cohort study of 100 women with early stage breast cancer. Insomnia symptoms were measured using the Insomnia Severity Index, fatigue was measured using the Multidimensional Fatigue Symptom Inventory-Short Form, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and hot flashes were assessed using the Hot Flash Related Daily Interference Scale. Assessments were performed shortly after diagnosis, 4, 8, and 12 months. A series of repeated measures within subjects ANOVAs were performed to assess changes in symptoms over time.

Results

Among 100 women with breast cancer, 45% reported at least mild insomnia symptoms. There were significant quadratic effects of time on insomnia severity, F(3, 297)= 12.776, p ≤ .001, depression (F[3, 297]= 4.409, p = .005), and fatigue (F[3, 297]= 7.995, p ≤ .001). These symptoms initially worsen and then improve throughout the year, but they do not rebound to pre-treatment levels. Interference from hot flashes worsens and endures for longer than other symptoms but does begin to show improvement one year post-diagnosis (F[3, 297]= 12.110, p ≤ .001). The were no time effects for anxiety (F[3, 297] = 1.4, p = .243).

Conclusion

In general, women treated for breast cancer can expect insomnia and comorbid symptoms to worsen then improve, but not recover, during the first year after a breast cancer diagnosis. Early efforts to educate women and manage symptoms could prevent insomnia and other issues from becoming persistent problems.

Support

Dr. Garland is supported by a Scotiabank New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).
1041 Sleep Quality Mediates The Relationship Between Fear Of Cancer Recurrence And Psychological Distress In Young Adults With Cancer
Authors: Daniel L C , Garland S , Zhou E , Chalifour K , Eaton G , Dunmyer L
Published: May 2020

Introduction

Fear of cancer recurrence is common in young adults with cancer and also related to poorer psychological outcomes. Sleep may be disrupted by anxious thoughts about cancer, causing long-term psychological distress. Thus, the current study tests sleep as a putative mediator of the association between fear of cancer recurrence and overall psychological distress in young adult cancer survivors.

Methods

In a national cross-sectional survey of Canadians, 436 young adults diagnosed with cancer between the ages of 15-39 (current age range 20-39, m=32.39, SD=4.70; 88% female) completed the Pittsburgh Sleep Quality Index, the Fear of Cancer Recurrence Inventory—Short Form, and the Kessler 10 Distress Inventory. Mediation was estimated using PROCESS. Age, sex, and on/off treatment status were entered into models as covariates.

Results

In the current sample, average fear of cancer recurrence was above the clinical cut-point (m=22.92, SD=6.84), psychological distress was high (m=25.18, SD=7.81), and sleep quality was poor (m=9.11, SD=3.95). Females reported significantly higher fear of cancer recurrence than males [F(1, 435)=15.49, p <.001]. Patients on treatment reported significantly higher fear of cancer recurrence [F(1,435)=11.43, p=.001], poorer sleep quality [F(1,435)=6.48, p=.011], and greater psychological distress [F(1,435)=4.73, p <.001] than patients off treatment. Using a bootstrapping model with covariates, higher fear of cancer recurrence was related to poorer sleep quality and, in turn, higher psychological distress as indicated by the indirect effect’s confidence interval not containing 0 (indirect effect=.13; 95%CI=0.081, 0.189).

Conclusion

Sleep quality may play an important role in connecting the common experience of fear of cancer recurrence to psychological distress in young adult cancer survivors. Future longitudinal research is needed to examine this possible mediator of young adult cancer patients’ psychological distress outcomes over time.

Support

This research was supported by a grant from the Newfoundland and Labrador Support for People and Patient-Oriented Research and Trials (NL-SUPPORT) Unit. Sheila Garland is supported by a Scotiabank New Investigator Award from the Beatrice Hunter Cancer Research Institute (BHCRI).
1049 Sleep Fragmentation And Sleep Restriction Are Associated With Increased Energy Intake Among Individuals Who Have Involuntarily Lost Their Jobs
Authors: Mayer C M , Liu Y , Thomson C A , Glickenstein D A , Haynes P L
Published: May 2020

Introduction

Obesity is a major public health concern disproportionately affecting people of lower socioeconomic status. Involuntary job loss is a predictor of economic hardship and unemployment has been associated with poor sleep quality. Little is known about daily sleep and energy intake in this high-risk population. We hypothesized that disrupted, short sleep would be associated with increased energy intake among individuals who experienced involuntary job loss within the last 90 days.

Methods

Complete baseline data were analyzed from the ongoing Assessing Daily Activity Patterns through occupational Transitions (ADAPT) study. Over the same two-week period, participants (n = 191; 117 female; 63 Hispanic) were instructed to complete 14 days of daily sleep diaries and up to three 24-hour dietary recalls, conducted by trained interviewers using the Nutrition Data System for Research. The primary sleep variable was a composite score summarizing standardized number of awakenings and reversed-scored total sleep time; higher scores represented worse sleep. Energy intake was estimated as average 24 hour reported kcals/day. Linear regression was employed with age, gender, and body mass index as covariates.

Results

Higher sleep composite scores were associated with higher self-reported intake in kilocalories (kcal), B = 84.83, SE = 38.01, t = 2.23,  p  < .05. Wake time after sleep onset, sleep onset latency, and sleep efficiency were not associated with energy intake. Interestingly, higher subjective sleep quality was associated with consumption of more average daily kcals.

Conclusion

In a sample population of adults experiencing stress and economic hardship related to job loss, sleep continuity and quantity were associated with higher energy intake. With further prospective support, these findings suggest that public health interventions for obesity may benefit from behavioral sleep intervention components targeting both sleep fragmentation and sleep restriction.

Support

#1R01HL117995-01A1
1059 Sleep Parameters In People With Type 2 Diabetes With And Without Insomnia Symptoms
Authors: Alshehri M , Alkathiry A , Alenazi A , Alothman S , Rucker J , Phadnis M , Miles J , Kluding P , Siengsukon C
Published: May 2020

Introduction

There is an increasing awareness of the high prevalence of insomnia symptoms in people with type 2 diabetes (T2D). Past studies have demonstrated the importance of measuring sleep parameters in both averages and variabilities using subjective and objective methods. Thus, we aimed to compare the averages and variability of sleep parameters in people with T2D with and without insomnia symptoms.

Methods

Actigraph measurements and sleep diaries were used in 59 participants to assess sleep parameters, including sleep efficiency (SE), sleep latency, total sleep time, and wake after sleep onset over seven nights. Validated instruments were used to assess the symptoms of depression, anxiety, and pain. Circular data were used to describe the distribution of bed distribution with SE as a magnitude for both groups. Mann Whitney U test was utilized to compare averages and variability of sleep parameters between the two groups. Multivariable general linear model to control for demographic and clinical variables. For the secondary aim, multiple linear regression tests were utilized to assess the association between averages and variability values for both groups.

Results

SE was found to be lower in average and higher in variability for participants with T2D and insomnia symptoms, than those with T2D only subjectively and objectively. SE variability was also the only sleep parameter higher in people with T2D and insomnia symptoms, with psychological symptoms potentially playing a role in this difference. We observed that people in T2D+Insomnia tend to go to bed earlier compared to the T2D only group based on objective measures, but no difference was observed between groups in subjective measures. The only significant relationship in both objective and subjective measures was between the averages and variability of SE.

Conclusion

Our findings suggest a discrepancy between subjective and objective measures in only average of total sleep time, as well as agreement in measures of variability in sleep parameters. Also, the relationship between averages and variabilities suggested the importance of improving SE to minimize its variability. Further research is warranted to investigate the complex relationship between sleep parameters and psychological factors in people with T2D and insomnia symptoms.

Support

None
1070 An Examination of the Relationship Between Language Use in Post-Trauma Nightmares and Psychological Sequelae in a Treatment Seeking Population
Authors: Paquet C , Davis J
Published: May 2020

Introduction

Studying language use in dreams and nightmares has become an increasingly used tool to understand underlying emotional and cognitive processes. Specifically, in regards to post-trauma nightmares (PTNMs), nightmare transcriptions can offer a lens to understand a survivor’s interpretation of their trauma. The current study will utilize a method of quantitative text analysis to analyze the relationship between specific psychological constructs and symptoms of posttraumatic stress disorder (PTSD) and nightmare qualities. It is hypothesized that there will be a positive correlation between words related to perceptual processes and negative emotions in nightmares and PTSD symptom and nightmare severity. There will be a negative correlation between cognitive processes and positive emotion words, and PTSD symptom and nightmare severity.

Methods

Fifty-three nightmares were collected from participants that were recruited from the community in a Midwestern city as part of an ongoing investigation of the effectiveness of a brief cognitive-behavioral intervention for PTNM, Exposure, Relaxation, and Rescripting Therapy (ERRT). All participants were over the age of 18, have experienced a criterion A trauma, and have nightmares at least once weekly. Linguistic Inquiry and Word Count (LIWC) was utilized to analyze the nightmare transcriptions. The Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Trauma-related Nightmare Survey (TRNS) were used to measure symptom severity. A Pearson’s correlation analysis was used for this exploratory study.

Results

Words related to perceptual processes were significantly positively correlated with PTSD symptom and nightmare severity (p<.05) Neither negative nor positive emotion words were significantly related to PTSD and nightmare symptoms (p>.05). Cognitive processing words were significantly negatively correlated with PTSD and nightmare symptoms (p<.05).

Conclusion

The results of this study support the hypothesis that language use in nightmares reveals important information about underlying cognitive and emotional functioning. The results of this study may have an important impact on treatment considerations for those who have experienced trauma. Analyzing language use in PTNM may help to understand the etiology and maintenance of PTSD symptoms.

Support

Support for this study comes from the University of Tulsa Institute of Trauma, Adversity, and Injustice.
1087 Early Session Effects of CBT-I on Insomnia and Depression
Authors: Bishop T M , Crean H F , Funderburk J S , Speed K J , Pigeon W R
Published: May 2020

Introduction

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to reduce depressive symptomatology among patients with co-occurring insomnia and depression. Brief forms of CBT-I have been tested in various settings including primary care. As delivery formats of CBT-I broaden, it is important to enhance our understanding of what doses and what components of CBT-I, provide the optimal balance of treatment efficacy and brevity. In the present study, we examine session-by-session effects of CBT-I on insomnia and depression.

Methods

Fifty-four Veterans with insomnia and co-occurring depression or posttraumatic stress disorder were randomized to either four sessions of CBT-I or treatment as usual in a published parent study. We report here on the effects among those who received CBT-I (n =22). At each session participants provided a completed sleep diary and completed the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 for depression (PHQ-9).

Results

At baseline, participants endorsed a moderate level of both insomnia (ISI score = 18.5 [SD=4.2]) and depression (PHQ-9 score = 15.6 [SD=5.2]). A mean decrease of 4.0 points in ISI total score was observed between sessions 1 and 2 [t(21)=-3.88, p<.001] and a 3.3 points between sessions 2 and 3 [t(19)=-2.63, p<.05]. Mean PHQ-9 scores decreased by 2.9 points between sessions 1 and 2 [t(21)=-2.84, p<.01] and a 2.8 points between sessions 2 and 3 [t(19)=-2.77, p<.05]. In contrast, changes in ISI and PHQ-9 scores between baseline and session 1, and sessions 3 and 4 did not reach significance.

Conclusion

The majority of improvements in both insomnia and depression were observed following sessions 1 and 2 of CBT-I. Findings suggest that even a limited exposure to CBT-I may have a clinically significant impact on functioning across multiple domains. Whether such early improvements represent an optimal balance compared with the more modest additional improvements achieved by adding more sessions is discussed.

Support

This work was supported by the VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC.
1121 Nonmotor Symptoms Affect Sleep Quality in Early-Stage Parkinson’s Disease Patients With or Without Cognitive Dysfunction
Authors: Zhang L , Zhu J
Published: May 2020

Introduction

Parkinson’s disease (PD) patients frequently present with sleep disorders. This study was designed to assess the impact of nonmotor symptoms (NMSs) on subjective sleep quality in early-stage PD patients with and without cognitive dysfunction.

Methods

A sample of 389 early-stage PD patients (Hoehn and Yahr score ≤2.5, duration ≤5 years) was recruited for the present study. The Non-Motor Symptoms Questionnaire (NMS-Quest) was used to screen for global NMSs. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD). PD motor symptoms were measured with the Unified PD Rating Scale (UPDRS), part III. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive status, and the PD Sleep Scale (PDSS) was used to quantify sleep quality. Logistic regression models were built to identify factors associated with sleep disturbances.

Results

In our sample, approximately one-quarter of the PD patients suffered from sleep disturbances (23.7%). Our results also confirmed the high prevalence of cognitive dysfunction in patients with PD (39.8%). In total, the patients who suffered from NMSs, such as depressive symptoms, anxiety symptoms, urinary tract symptoms and hallucinations/delusions, had poorer sleep quality. Better cognition may protect against sleep disorders. In patients with cognitive dysfunction, the NMS-Hallucinations/delusions score was the most important risk factor for sleep disorders. In patients without cognitive dysfunction, NMSs such as anxiety and cognition and medication were related to sleep disorder.

Conclusion

NMSs in early-stage PD are highly associated with and are determinants of subjective sleep quality. Future studies should focus on elucidating the pathophysiology of these symptoms.

Support

Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant No. BE2018610)
1132 Pediatric Sensory Safe Sleep Study: How to Reduce Sensory Stimulation and Cultivate Compliance Among Children With Special Needs. A New Concept
Authors: Rice B , Albertario C , Veler H
Published: May 2020

Introduction

Children with neurodevelopmental disabilities (NDD) frequently suffer from sleep disturbances causing further worsening of behavior, developmental and day-to-day functioning. The important tool used to assess sleep and sleep disorders is polysomnography (PSG). While PSG provides children a less invasive option, children with NDD and/or sensory disorders are often more resistant to this overwhelming and dysregulating procedure. As a result, many children in need of PSG will avoid scheduling a study, or have inconclusive results due to noncompliance. Previous research had shown a program of desensitization improves the number of successfully completed PSGs in NDD children. Our goal is to develop best practice standards to accommodate the individualized need of patients in the sleep lab, in a way that will be available and practical to any center treating NDD children.

Methods

Children with NDD require more individualized care tactic therefore, we developed staff education and a process that would help troubleshoot the possibility of patient non-compliance by reducing triggering sensations and unaccommodating technician behaviors. Our process is made up of several key steps to address the behavioral needs of patients: (1) identify patients at risk upon referral; (2) referral to a child life specialist to identify individualized preparation strategies and complete a brief behavioral questionnaire for documentation; (3) mail a preparation kit to the family with a summary of preparation techniques and procedural steps; and (4) ensure sleep technicians have been provided with thorough information to best accommodate the unique patient needs. In addition, PSG conducted with a truncated montage to reduce the number of stimulating sensors applied to the patient and the lab is equipped with sensory toys to provide a relaxing environment.

Results

Results will be determined based on comparing the number of successfully completed overnight sleep studies for children with NDD in the years prior to intervention, to the total success rate following the implementation of the intervention process. As a secondary goal, we will gather parent satisfaction scores via morning questionnaires.

Conclusion

Research has proven across many modalities that adequate preparation and behavioral modifications produce successful encounters when working with the pediatric population.

Support

None
0115 The Effect of Zolpidem on Sleep Dependent Emotional Memory Consolidation
Authors: Simon K C , Whitehurst L , Zhang J , Mednick S
Published: May 2020

Introduction

Psychopharmacological treatment is widely promoted for insomnia treatment. Zolpidem (ZOL) is a GABA A agonist that depresses the central nervous that has demonstrated unexpected benefits, specifically increased sleep-dependent verbal memory via increased phase-amplitude coupling between slow oscillations and sleep spindles (Niknazar et al., 2015). Here we investigated if ZOL improved sleep-dependent emotional memory consolidation.

Methods

Using a within-subjects, cross-over design, we counterbalanced the administration of zolpidem (ZOL) or placebo (PBO) to 37 subjects in a double-blind study. Prior to drug or placebo administration, subjects rated their subjective physiological arousal of negative and neutral pictures. Subjects were tested on their recognition of the pictures twice, before (PM) and after (AM) a night of sleep. All subjects were monitored polysomnographically across the night.

Results

We analyzed emotional picture recognition using 2-by-2 ANOVA (emotion x drug condition). We found a main effect of emotional picture PM performance, such that negative pictures were remembered better than neutral pictures. There was a significant main effect of sleep on AM false alarm rate, with greater false alarms for negative than neutral pictures, a significant interaction between drug and emotion on AM dprime, and a significant interaction for the difference between AM and PM performance and drug condition. Specifically, we found memory maintenance for both emotional picture types in ZOL but negative picture memory decline in PBO. Across the night, ZOL showed greater memory performance than PBO if subjects had greater N2 SWA and N2 sigma activity (12-15Hz).

Conclusion

Zolpidem benefits sleep-dependent emotional memory consolidation by decreasing overnight forgetting. Further, it appears that spindle activity may play a key role in ZOL’s memory effect.

Support

NIH AG046646
1146 Interaction Of Mild Cognitive Impairment And Late-life Depression In Actigraphy And Self Report Of Sleep Problems
Authors: Aronis J , Daigle K , Almaghasilah A , Gilbert C , Fremouw T , Singer C , Abedi A , Hayes M
Published: May 2020

Introduction

Late-life depression has been proposed as a precursor to amnestic Mild Cognitive Impairment (aMCI), the prodrome of Alzheimer’s disease. Both conditions are associated with sleep and cognitive problems. We hypothesized that MCI and current depressive symptoms would co-occur more frequently, but express distinct sleep phenotypes.

Methods

Independently living older adults (N=80), age 62-90 (M=71.78, SD=5.98), were recruited from a geriatric psychiatry clinic and the community for a home sleep study. A clinical decision board and neurocognitive battery were used to determine MCI status. Participants completed the CES-D and depression history interview where endorsement of current depression was considered positive. Sleep was examined with wrist actigraphy for 7 days. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS) provided subjective sleep quality.

Results

Based on these criteria, 41.2% of the sample were determined to be MCI (n=33); the remainder were deemed normative for age (NC; n=47). Chi-square analyses showed a higher frequency of MCI were positive for current depression than expected (14.2%; p=0.017). Repeated-measures MANOVA, using current depression symptoms and MCI as factors, revealed MCI was associated with longer sleep latency (p=0.035) and wake bout time (p=0.039); whereas, current depression was associated with longer sleep latency, more fragmentation/WASO, and lower sleep efficiency (p’s<0.05), self-report of poorer daytime dysfunction (p=0.005), and greater daytime sleepiness (p=0.001). MCI x current depression interactions were found for sleep latency (p=0.029); and PSQI sleep disturbances (p=0.005) and sleep medication (p=0.025).

Conclusion

Despite distinct sleep disordered phenotypes, the interaction of MCI and current depression is associated with delayed sleep onset, use sleep medication and report of sleep disturbances.

Support

This project was sponsored by: NASA, Maine Space Consortium; AG 056176, AG 053164 Vice President for Research, U. Maine; Maine Technology Institute; DoD Phase I SBIR and R44AG059536-01 SBIR Phase II Award.
1156 Polysomnographic Total Sleep Time: A Novel Biomarker For Dementia
Authors: Nowakowski S , Razjouyan J , Naik A D , Agrawal R , Velamuri K , Singh S , Sharafkhaneh A , Kunik M E
Published: May 2020

Introduction

Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined whether total sleep time (TST) derived from attended overnight polysomnography (PSG) studies is associated with an increased prevalence of dementia diagnosis and determined the optimal cut-point.

Methods

We identified 69,847 PSG sleep studies using CPT code 95810 from 2000-19 in the US Department of Veteran Affairs (VA) national database of patient care. We used natural language processing to verify PSG reports and extract TST values from the patient free-text notes. We examined a TST of 240-420 minutes in 10-minute increments using a run chart (time series) approach to determine the optimal cut-point for determining greater odds of dementia.

Results

Patients had a mean age of 55.4±13.8, 91.5% were male, and 64% were Caucasian. PSG studies revealed a mean TST of 310.6±79.5 minutes. The run chart time series analysis revealing < 360 minutes being the optimal cut-point for increased odds of dementia (OR: 1.64, 95% CI: 1.36-1.99, p<.05).

Conclusion

Lower TST predicted higher prevalence of dementia diagnosis. TST of 360 minutes may serve as the optimal cut-point to determine greater odds of dementia. This is an important study examining PSG sleep duration and the prevalence of dementia across 19 years in the largest integrated healthcare system in the US. TST may function as a potential biomarker for developing dementia.

Support

This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).
1159 Sleep Traits And Incident Delirium During A Decade Of Follow-up In 173,000 Participants
Authors: Gao L , Li P , Cui L , Johnson-Akeju O , Hu K
Published: May 2020

Introduction

Delirium is an acute decline in attention and cognition that is with associated long-term cognitive dysfunction in elderly patients. Accumulating evidence points to strong associations between sleep health and disorders of the brain. We tested whether baseline sleep duration, chronotype, daytime dozing, insomnia or sleep apnea predict incident delirium during hospitalization.

Methods

We studied participants from the UK Biobank who have been followed for up to 10 years until 2017. We included 173,221 participants (mean age 60±5; range 50-71 at baseline) who had at least one episode of hospitalization/surgery and were free from prior episodes of delirium. Delirium diagnosis, hospitalization and surgical events were derived using ICD-10 coding. Multivariate logistic regression models were performed to examine the associations of self-reported baseline sleep duration (<6hrs/6-9h/>9h), daytime dozing (often/rarely), insomnia (often/rarely) and presence of sleep apnea (ICD-10 and self-report) with incident delirium during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, and major confounders (number of hospitalizations/surgical procedures, BMI, diabetes, major cardiovascular diseases and risk factors, major neurological diseases, major respiratory diseases, cancer, alcohol, depression/anxiety, sedatives/sleep aides, antipsychotics, steroids and opioids).

Results

In total, 1,023 (5.7 per 1,000 subjects) developed delirium. A prior diagnosis of sleep apnea (n=1,294) saw almost a two-fold increased odds (OR 1.96, 95% CI: 1.30-2.30 p=0.001) while those who often had daytime dozing were also at increased risk (OR 1.35, 95% CI: 1.02-1.80, p=0.025). Both these effects were independent of each other. No independent effects on incident delirium were observed from sleep duration, insomnia, or chronotype.

Conclusion

Certain sleep disturbances, in particular sleep apnea and daytime dozing, are independently associated with an increased risk for developing delirium. Further work is warranted to examine underlying mechanisms and to test whether optimizing sleep health can reduce the risk of developing delirium.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.
1184 Evaluation Of A Novel Sleep Medicine Educational Program For The Primary Care Provider
Authors: Lang R , Keenan B T , Kneeland-Szanto E , Rosen I M
Published: May 2020

Introduction

Inadequate exposure to and insufficient training in sleep medicine across the medical education continuum contributes to a lack of patient access to sleep care. We created a self-directed learning curriculum in sleep medicine aimed at practicing primary care providers.

Methods

In this pilot study, primary care providers, including physicians (PCP) and advanced practice nurses (APP-N), were invited to complete 3 application (app)-based core sleep educational modules in exchange for free continuing education and maintenance of certification credits. The modules were case-based and fully autonomous. Individuals had access to discussion boards moderated by a board-certified sleep physician and were given the option to complete two additional modules on advanced sleep topics. We assessed participants’ opinions on the course and any effect on behavior, measured as change in the number of sleep-related orders.

Results

Nineteen providers (12 PCP, 7 APP-N) completed the 3 required core modules. Five participants completed at least one additional module. A total of 94.4% reported they would recommend this curriculum to a colleague. Fifteen participants had prior experience with online courses; 93.3% noted that the sleep online modules provided a similar or better experience. Upon completion, 77.8% of learners anticipated this educational activity would contribute to either a great degree or completely to improvements in the health outcomes of their patients. All participants achieved the post-test score of 80% required to receive 1 CME/CNE credit per module completed. The number of sleep consultations or sleep study orders in the 4 months after course completion increased by 24.2% on average compared to the 4 months prior to the course (p=0.0157).

Conclusion

Based on Kirkpatrick’s model, this novel, app-based curriculum met levels 1-3 (positive reaction, knowledge transfer, and impact on behavior). Larger, longer-term studies are needed to assess the benefits of increasing knowledge in sleep medicine on patient care (Kirkpatrick Level 4).

Support

Funded by NIH NHLBI 5-R25-HL-120874-04