bluuebunny/crossref_metadata_2025_split huggingface dataset:
0433 Targeting Light Sensitivity Parameters to Optimize Circadian Phase Predictions
Authors: Stone J E , McGlashan E M , Cain S W , Phillips A J 
Published: May 2020

Abstract

Introduction
Existing models of the human circadian clock accurately predict phase at group-level but not at individual-level. Interindividual variability in light sensitivity is not currently accounted for in these models and may be a practical approach to improving individual-level predictions. Using the gold-standard predictive model, we (i) identified whether varying light sensitivity parameters produces meaningful changes in predicted phase in field conditions; and (ii) tested whether optimizing parameters can significantly improve accuracy of circadian phase prediction.

Methods
Healthy participants (n=12, 7 women, aged 18-26) underwent continuous light and activity monitoring for 3 weeks (Actiwatch Spectrum). Salivary dim light melatonin onset (DLMO) was measured each week. A model of the human circadian clock and its response to light was used to predict the three weekly DLMO times using the individual’s light data. A sensitivity analysis was performed varying three model parameters within physiological ranges: (i) amplitude of the light response [p]; (ii) advance vs. delay bias of the light response [K]; and (iii) intrinsic circadian period [tau]. These parameters were then fitted using least squares estimation to obtain optimal predictions of DLMO for each individual. Accuracy was compared between optimized parameters and default parameters.

Results
The default model predicted DLMO with mean absolute error of 1.02h. Sensitivity analysis showed the average range of variation in predicted DLMOs across participants was 0.65h for p, 4.28h for K and 3.26h for tau. Fitting parameters independently, we found mean absolute error of 0.85h for p, 0.71h for K and 0.75h for tau. Fitting p and K together reduced mean absolute error to 0.57h.

Conclusion
Light sensitivity parameters capture similar or greater variability in phase as intrinsic circadian period, indicating they are a viable option for individualising circadian phase predictions. Future prospective work is needed using measures of light sensitivity to validate this approach.

Support
N/A
0462 Identifying and Characterizing Insomnia Symptom Groups Across the Deployment Cycle in Current Army Soldiers
Authors: Miller K E , Boland E M , Klingaman E A , Gehrman P R 
Published: May 2020

Abstract

Introduction
Most research conducted on insomnia and its development in military personnel focuses on cross-sectional data, precluding examination of the course of sleep changes over time. The present study characterized Army Soldiers based on insomnia symptom status trajectory from pre to post-deployment and explored baseline factors predictive of these trajectories in a sample of 7,245 soldiers across 3 Brigade Combat Teams.

Methods
Data were analyzed from the Army Study to Assess Risk and Resilience in Service members (STARRS)-All-Army Study (AAS) Pre Post Deployment Study, using surveys that captured 1-2 months pre-deployment, during deployment, and 6-months post-deployment. Insomnia symptom status was defined at each timepoint as insomnia symptoms that interfered with one or more domains of functioning at least some of the time in the past month. Theoretically-derived variables linked to sleep disturbance were selected as predictors of insomnia symptom trajectory and evaluated using a general linear selection model.

Results
Four trajectories characterized the majority of the sample: ‘good sleepers’ (no insomnia symptoms across time; 44.4%), ‘non-remitting new onset insomnia’ (no pre-deployment insomnia, developed insomnia symptoms during deployment that remained at 6 months; 22.8%), ‘deployment-only insomnia symptoms’ (no pre-deployment insomnia, developed insomnia during deployment but recovered by follow-up; 12.8%), and ‘chronic insomnia’ (insomnia both pre- and post-deployment; 7.4%). Several pre-deployment factors predicted insomnia trajectory, the strongest of which were past six-month attention deficit disorder symptoms, number of lifetime exposures to potentially traumatic events, and past month depression symptoms.

Conclusion
Insomnia is one of the most common reasons that military personnel seek behavioral health treatment and is associated with poorer military readiness. Better characterization and identification of insomnia symptoms over time can improve intervention during post-deployment transitions, particularly for those with new onset insomnia that does not remit.

Support
Cooperative agreement U01MH087981 (Department of the Army; U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health); U.S. Department of Veterans Affairs, Clinical Science Research and Development-IK2CX001874-PI:Katherine E. Miller, IK2CX001501-PI:Elaine M. Boland; Rehabilitation Research and Development-1IK2RX001836-PI:Elizabeth A. Klingaman. The views expressed here are those of the authors and do not represent the Department of Veterans Affairs.
0469 Perceptions of an Education Only Control Group in the Osteoarthritis and Therapy for Sleep (OATS) Study: An Ongoing Statewide, Telephone-Delivered CBT for Insomnia (CBT-I) Randomized Trial
Authors: McCurry S M , Vitiello M V , Pike K C , Thakral M , Morin C M , Von Korff M 
Published: May 2020

Abstract

Introduction
Comorbid osteoarthritis (OA) and insomnia is common in older adults. CBT-I is efficacious for improving sleep in older persons with OA but not widely accessible. We examined treatment process data from OATS, a large ongoing clinical trial of telephone-delivered CBT-I.

Methods
327 Kaiser Permanente Washington members aged 60+ with OA, Insomnia Severity Index scores of 11+, and Brief Pain Inventory scores of 9+ were randomized to individual CBT-I vs. education only control (EOC). Six telephone sessions of CBT-I or EOC were offered over eight weeks. Participants rated their perceptions of treatment (credibility, acceptability, suitability, perceived effectiveness, adherence, and therapeutic relationship) on a 7-point Likert scale after session 1 and at 2-month post-test.

Results
Participants (mean age=70.2 years, 74.6% female) were randomized to the two treatment arms (CBT-I=163, EOC=164). Participants did not differ significantly across arms by age, gender, education, or by sleep, pain, or mood (depression, fatigue) outcome measures at baseline. CBT-I had significantly (p=.03) more white participants (90% CBT-I, 78% EOC). Study retention was 82% and 88% at post-test for CBT-I versus EOC, respectively. There was no difference in number of sessions attended (median=6). CBT-I sessions were somewhat longer than EOC (24.2 vs. 22.8 minutes; p=.005). Most participants in both groups at both time points gave high rankings (5+/7 points) on all six treatment perception ratings (CBT-I range: 75.9-99.3%; EOC range: 69.0-97.9%). Average summed treatment perception ratings improved between Session 1 and post-test for both conditions (mean=5.9 and 6.1, respectively, for CBT-I; mean=5.6 and 5.8, respectively, for EOC).

Conclusion
The OATS EOC group was credible and acceptable to participants, resulting in equivalently high levels of participation and retention compared to CBT-I. Findings suggest the ongoing trial has adequately controlled for nonspecific participant treatment effects that might confound interpretation of efficacy outcomes.

Support
This work was supported by PHS grant 5R01AG053221.
0483 Predictors of Cognitive Behavioral Therapy for Insomnia (CBT) Outcomes in Active Duty U.S. Army Personnel
Authors: Pruiksma K E , Hale W , Mintz J , Peterson A , Young-McCaughan S , Wilkerson A , Nicholson K , Dondanville K , Fina B , Borah E , Roache J , Litz B T , Bryan C , Taylor D J 
Published: May 2020

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged.

Methods
The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active duty service members who received in-person CBTi in a randomized clinical trial.

Results
Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI).

Conclusion
Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes.

Support
This study was conducted with support from the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program award W81XWH-10-1-0828 (PI: Dr Taylor).
0515 Durability of Effects of Forehead Cooling on EEG Sleep Measures in Insomnia Patients from 2- to 30-Nights Use and 6-Month Safety Results
Authors: Rippole D , Schirm J , Nofzinger E 
Published: May 2020

Abstract

Introduction
Forehead cooling has previously been shown to improve EEG sleep measures in insomnia patients when applied for 2 nights. The current study assessed the durability of these effects after 30 days in home use as well as safety over 6 months in home use.

Methods
This was a prospective, open label trial involving 32 adults meeting diagnostic criteria for primary insomnia who previously had participated in a 2 night in lab EEG sleep study. In the current study, participants received an additional 30 nights in home treatment, then had repeat EEG sleep studies performed to determine if effects noted at 2 nights remained durable after 30 days. Subjects also participated in an open label 6-month in-home use safety study.

Results
Baseline, 2-night and 30-night EEG sleep measures for sleep latency were 80.7 ± 73.8, 25.3 ± 22.6, 26.2 ±25.8 minutes (2- to 30-night difference p=0.81, NS) and for sleep efficiency were 67.4 ± 15.7, 81.4 ± 11.2, 83.2 ± 13.6 (2- to 30-night difference p=0.18, NS). Subjective sleep quality (0-100 scale with 100=best) at baseline, 2-night and 30-nights were 29.8 ± 15.2, 48.3 ± 20.2, 57.2 ± 21.1 (linear improvements significant over time p&lt;0.001). No adverse effects were seen across 6-months use.

Conclusion
Forehead cooling demonstrated durability of effects on EEG sleep measures from 2- to 30-nights use. Continuing improvements in subjective sleep quality when measured over time from baseline assessments to the end of the 30-night in-home use period were noted. Forehead cooling was safe over 6 months use in the home as evidenced by no serious device related adverse events.

Support
Ebb Therapeutics, Pittsburgh, PA 15222
0526 Objective Total Sleep Duration Do Not Predicting the Effectiveness of Cognitive-Behavioral Therapy for Insomnia (CBT-I)
Authors: Galbiati A , Sforza M , Leitner C , Filice A , Manconi M , Ferini Strambi L , Castronovo V 
Published: May 2020

Abstract

Introduction
Several studies investigated the role of objective sleep markers, in particular of Total Sleep Time (TST) in identifying different subtypes of Insomnia Disorder (ID) and in evaluating the efficacy of treatments. Based on objective TST two phenotypes of ID are usually distinguished in the literature: normal sleepers (objective sleep duration ≥ 6 hours) and short sleepers (objective sleep duration &lt; 6 hours). Aim of our study was to evaluate in normal and short sleepers (objective sleep duration was assessed by both Polysomnography and Actigraphy) possible different response to Cognitive-Behavioral Therapy for Insomnia (CBT-I).

Methods
53 ID patients (females = 50.9%; mean age = 56.53±11.43) were divided into “Short Sleep duration” and “Normal Sleep duration” groups. All patients underwent 7-sessions group CBT-I. Main clinical outcome was Insomnia Severity Index questionnaire (ISI); secondary outcomes were Sleep Efficacy (SE), Sleep Latency (SL), Wake After Sleep Onset (WASO), Number of Awakenings (N°awk) according to sleep diaries.

Results
All ID patients showed significant improvements after treatment for all clinical outcomes. Non-significant effects of CBT-I between “Short Sleep duration” and “Normal Sleep duration” measured by patients were found in terms of ISI, SE, SL, WASO and N°awk, neither using Polysomnography nor Actigraphy. Furthermore, no accordance between these two objective measurements was found for the identification of the two subgroups.

Conclusion
Our findings suggest that the use of objective TST (both by Actigraphy and Polysomnography) is not a consistent predictor for CBT-I effectiveness. Moreover, only a small percentage of patients were classified as short or normal sleepers according both to Polysomnography and Actigraphy. These findings underline the instability and poor reliability of using objective TST in subtyping insomniacs.

Support
No
0543 Implementing Insomnia Care Paths for Older Adults and People with Dementia
Authors: Benca R , Ferziger R , Wickwire E M , Bertisch S , Biddle J , Boustani M , Culpepper L , Gooneratne N , Lett J , Manderscheid R , Mehra R , Reynolds C , Grandner M A 
Published: May 2020

Abstract

Introduction
Despite the high prevalence of insomnia in older adults and those with dementia, screening and treatment remain inconsistent and suboptimal. Implementing a care path in a health system, though, is difficult. To determine what issues are relevant for implementation, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building.

Methods
All N=20 participants, representing a wide range of stakeholders including research, industry, sleep, primary care, implementation science, and others, voted whether they agreed or disagreed with 36 different statements regarding what issues are important for implementing geriatric insomnia care paths. These represented a range of items addressing strategies for identifying and incentivizing stakeholders, identifying patients in most need and who would receive benefit, addressing comorbidities and multiple specialties, understanding how specific organizations make decisions about and changes to care, size and scope of the care path, determining the process for implementation, how it will improve outcomes, addressing specific needs of primary care, and addressing costs, reimbursements, and liabilities. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree).

Results
Despite the diversity among attendees, median rate of agreement for was 95% (IQR=90-95%). All items were endorsed by &gt;=80% of respondents. Mean score was 0.48 (SD=1.85). 95%CIs were computed for each proportion and compared to the mean. The only item that significantly differed from the mean score indicated that understanding benefits of a care path to the general community is less important of an issue than others (M=0.85).

Conclusion
Implementing an insomnia care path for older adults in an institution will likely require addressing a wide range of issues, including questions about stakeholders, the health system/context, patients, and practical considerations.

Support
Merck Research Labs provided support
0550 Insomnia is Associated with Greater Arterial Stiffness and Cardiac Dysfunction
Authors: Petrov M E , Youngstedt S D , Mookadam F , Jiao N , Lim L M , Wong B , Angadi S S 
Published: May 2020

Abstract

Introduction
Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls.

Methods
Persons with insomnia (met ICSD-III criteria) and good sleeping controls (&lt;8 Insomnia Severity Index, mean 8-night SOL and WASO&lt;31min) were recruited from the community. Twenty-two adults (21-39y; 55% women) with no history of CVD, diabetes, inflammatory conditions, significant hypertension, or current sleep-disordered breathing (WatchPat200, Itamar Medical) were enrolled and underwent fasting cardiovascular testing. Testing included: Central augmented aortic pressure (AP) and carotid-femoral pulse wave velocity (cfPWV) for vascular stiffness; brachial artery flow mediated dilation (FMD) to assess endothelial function; and 2D echocardiography to assess ejection fraction (EF%), left ventricular global longitudinal strain (LVGLS), left atrial volume index (LAVI), mitral valve E/e’ ratio (E/e’), and lateral e’. ANCOVA models, adjusting for age, comparing persons with insomnia (n=6) to good sleeping controls (n=16) on each cardiovascular measure were conducted.

Results
AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’.

Conclusion
Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning.

Support
American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18
0565 Obstructive Sleep Apnea, But Not Short Sleep Duration, is Independently Associated with Insulin Resistance: A Large-Scale Cohort Study
Authors: Yin S , Xu H , Zou J , Zhang C , Guan J , Yi H 
Published: May 2020

Abstract

Introduction
Both short sleep duration and obstructive sleep apnea (OSA) seem to be associated with insulin resistance. However, the majority of previous studies addressing the relationship between OSA and insulin resistance did not evaluate short sleep duration, and vice versa. In this study, we used a large-scale hospital-based cross-sectional dataset, including 5,447 participants, to examine 1) whether objectively measured short sleep duration and OSA are independently associated with insulin resistance, and 2) whether the presence of OSA modulates the association between sleep duration and insulin resistance.

Methods
Participants were consecutively enrolled from our sleep center during the period from 2007 to 2017. The index of homeostasis model assessment insulin resistance (HOMA-IR) was calculated from insulin and glucose. Sleep duration was determined by standard polysomnography. The associations between sleep duration and insulin resistance were estimated by logistic regression analyses.

Results
A total of 5,447 participants (4507 OSA and 940 primary snorers) were included in the study. In comparison to primary snorers, OSA combined with extremely short sleep duration (&lt; 5 hours) increased the risk of insulin resistance by 34% (OR, 1.34; 95% CI, 1.01-1.77) after adjusting for confounding factors that are frequently associated with insulin resistance and OSA. In subgroup analysis stratified by sleep duration, the risk of insulin resistance in patients with a short sleep duration (5-6 hours or &lt; 5 hours) was increased in those with OSA compared to primary snorers, but not in the other three sleep duration groups (6 - 7, 7 - 8, and &gt; 8 hours).

Conclusion
OSA, but not short sleep duration, was independently associated with insulin resistance. It is worth noting that OSA combined with extremely short sleep duration showed a greater detrimental effect than OSA itself with regard to insulin resistance.

Support
This study was supported by grants-in-aid from Shanghai Municipal Commission of Science and Technology (Grant No.18DZ2260200).
0566 Assessment of Soft Palate Muscle Fatigue and its Effect on Velopharyngeal Upper Airway (UA) Mechanical Properties
Authors: Li W , Gakwaya S , Masse J , Series F 
Published: May 2020

Abstract

Introduction
Soft palate muscles are crucial in the maintenance of UA patency. This study aimed to investigate the fatigability of soft palate muscles and to quantify its effects on velopharyngeal UA dynamic properties in OSA patients and control subjects.

Methods
8 control (AHI ≤ 10 /h), 21 OSA patients (13 with mild/moderate disease: 10 /h &lt; AHI ≤ 20 /h and 8 with moderate/severe: AHI &gt; 20/h) were included in the study. Subjects were asked to develop repetitive intra-oral positive pressure during cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened. Subjects were asked to develop sustained maximal bulging pressure for 5 sec every 10 sec until the peak pressure could not reach 85% of baseline maximal pressure for 2 consecutive times. UA dynamic properties were assessed by measuring instantaneous airflow and velopharyngeal pressure in response to phrenic nerve magnetic stimulation (PNMS) performed before, immediately and every 3 minutes after the fatiguing protocol for a maximum of 30 minutes’ recovery time. UA closing pressure (Pcrit) was estimated by modeling the flow/pressure relationship in response to PNMS.

Results
The sex, age, BMI and the soft palate mechanical properties (including the baseline strength, endurance time, total muscle work) did not significantly differ between the 3 groups. Maximal peak bulging pressure measured using cheek-bulging maneuver significantly changed following the fatigue task (p &lt; 0.05). Baseline velopharyngeal Pcrit were less negative in moderate/severe OSA group compared to mild/moderate OSA (-6.5±2.6 vs. -11.9±3.2, p &lt; 0.05). In mild/moderate OSA patients, PNMS-induced drop in maximal instantaneous airflow tend to increase 3 mins after the fatiguing trial compared to baseline (22.7±21.1 l.s-1vs. 9.6±5.8 l.s-1, p &lt; 0.1), and their Velopharyngeal linear resistance 3 mins after the fatiguing trial tend to be higher than the moderate/severe OSA group (3.9 ± 5.0 cmH2O·l−1·s−1 vs. 1.8 ± 1.1 cmH2O·l−1·s−1, p&lt; 0.1).

Conclusion
The cheek-bulging maneuver could induce soft palate muscle fatigue, with no difference observed in soft palate mechanical performances among patients with different OSA severity. The fatiguing maneuver could further alter velopharyngeal UA mechanical properties in patients with mild/moderate OSA.

Support
SBD from IUCPQ Foundation