bluuebunny/crossref_metadata_2025_split huggingface dataset:
0372 Disparities in Sleep Timing in the US: Data From the National Health and Nutrition Examination Survey 2015-2016
Authors: Mota Villalobos K , Seixas A A , Williams N J , Jean-Louis G , Killgore W D , Wills C C , Grandner M A 
Published: May 2020

Abstract

Introduction
Several studies have demonstrated population-level disparities in sleep duration and sleep quality. Population-level estimates of bedtime and waketime have been unavailable. Considering the important role of circadian rhythms in health, population-level disparities in timing have important public health implications.

Methods
Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) from the CDC were used (N=4,491). Typical time in and out of bed were assessed and were converted to minutes. Race/ethnicity was self-reported and coded as non-Hispanic White, Black/African-American, Mexican-American, Other Hispanic/Latino, Asian, and Multiracial/Other. Covariates included age, sex, education level, income/poverty ratio, body mass index, and overall health. Additional models controlled for habitual sleep duration, frequency of sleep disturbance, depressed mood, and daytime tiredness/fatigue. Multiple linear regression analyses with time as an outcome were weighted using CDC-provided NHANES sample weights.

Results
In adjusted analyses, compared to non-Hispanic Whites, Blacks/African-Americans went to bed 29.4 mins later (p&lt;0.0005), Asians went to bed 37.0 mins later (p&lt;0.0005) and woke 27.7 mins later (p&lt;0.0005), and Mexican-Americans woke 16.3 mins earlier (p=0.018). After further adjustment for sleep duration and sleep disturbances, Blacks/African-Americans went to bed 22.1 mins later (p&lt;0.0005) and woke 22.2 mins later (p&lt;0.0005), and Asians went to bed 36.1 mins later (p&lt;0.0005) and woke 40.6 mins later (p&lt;0.0005). These relationships remained generally unchanged when depressed mood and daytime tiredness/fatigue were adjusted in the model.

Conclusion
This is the first nationally-representative study to demonstrate population-level disparities in sleep timing. Specifically, Blacks/African-Americans and Asians present with delayed sleep, even after adjusting for other aspects of sleep.

Support
Dr. Grandner is supported by R01MD011600
0380 Association of Day-to-Day Variability in Rest-Activity Circadian Rhythm with Sleep Quality Among Law Enforcement Officers
Authors: Fekedulegn D , Service S , Ma C , Gu J , Violanti J , Andrew M 
Published: May 2020

Abstract

Introduction
Poor sleep quality may be attributed to several occupational factors and has been linked to adverse health outcomes, including cardiovascular disease. Recent epidemiologic studies suggest rest-activity circadian rhythm (RAR) as a possible determinant of poor sleep quality. The focus of these studies has been on the magnitude of the parameters of RAR with little attention to the impact of their day-to-day fluctuation. We examined association of daily variation in parameters of RAR with sleep quality.

Methods
Participants (n=280) were officers from the Buffalo Cardio-metabolic Occupational Police Stress Study (2004-2009). Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI). Participants wore wrist actigraph for a minimum of seven days. A cosine curve was fit to measure goodness of fit and estimate the mean values of the three parameters of RAR: Mesor, Amplitude, and Acrophase. Day-to-day variability of the parameters were assessed by fitting the cosine function separately for each day and computing the sample standard deviation across the days. Poisson regression models were conducted adjusting for demographic, lifestyle, and occupational factors.

Results
The prevalence of poor sleep quality was 50.3%. Poor sleep quality was 56% higher in officers with the largest day-to-day variability in Mesor (PR=1.56, 95%CI:1.11 - 2.19) compared to those with the lowest daily variation. Similar estimates were found for Amplitude (PR=1.42, 1.03 - 1.95), Acrophase (PR=1.86, 1.29 - 2.67), and measure of goodness of fit (PR=1.54, 1.13 - 2.11). On the other hand, mean values of RAR parameters were not significantly associated with poor sleep quality.

Conclusion
Results suggest larger daily variation in parameters of RAR is associated with a decrease in sleep quality. Given that day-to-day variation in RAR may increase the odds of poor sleep quality, future studies ought to address risk factors for higher daily fluctuations in RAR which could aid in developing intervention measures.

Support
CDC/NIOSH grant 1R01OH009640-01A1
0411 Association Between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men
Authors: van Egmond L T , Tan X , Benedict C 
Published: May 2020

Abstract

Introduction
Ageing is often accompanied by an increased prevalence of sleep problems. Healthy lifestyle choices, including diet, are especially important to mitigate such impairments. To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects. Therefore, we investigated in a Swedish older male population, whether adherence to the Mediterranean Diet (MD) or the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) is linked to a decrease in sleep disturbances.

Methods
We studied 970 men (age: 71 ± 1yr) from the ULSAM dataset. Sleep initiation or maintenance problems were evaluated by self-reporting questionnaires. Dietary intake was recorded with a pre-coded seven-day food diary. To calculate the adherence scores, intake of dietary components was assessed. Traditional MD components included fat quality, vegetables, fruits, cereals, fish, meat, dairy, and alcohol. The HDI components included saturated-, polyunsaturated fatty acids, proteins, carbohydrates, sucrose, fiber, fruits and vegetables, cholesterol, and fish. Reasonable dietary reporting was calculated to identify possible under- or over-reporters.

Results
When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort).

Conclusion
Our findings do not suggest that older men can mitigate perceived sleep problems by adhering to the MD or HDI. Whether low consumption of dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep, such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake.

Support
This research was funded by Novo Nordisk Foundation (NNF14OC0009349), Swedish Brain Foundation, Swedish Research Council (2015-03100), Åke Wiberg Foundation (M17-0088), Fredrik and Ingrid Thuring Foundation (2017-00313) and the Swedish Medical Research Society.
0450 Screening Method for Obstructive Sleep Apnea Syndrome by Patients’ Exhalant with TD-GC-MS System
Authors: Yao D , Chieng L , Chiang R 
Published: May 2020

Abstract

Introduction
Human exhaled breath test is getting more important for non-invasive health monitoring and detecting method nowadays. The diagnosis of obstructive sleep apnea syndrome (OSAS) is often difficult to be confirmed from the daytime presentation and usually need the overnight polysomnography. The methods for OSAS screening are therefore potentials for the clinical practice in the near future.

Methods
In this research, a method of thermal desorption (TD) tendon with gas chromatography-mass spectrometry (GC-MS) system has been developed for screeing of OSAS patients. We detected the volatile organic compounds (VOCs) from the special designed experimental bags which collected exhaled gas. Then we compared the VOCs from normal control and OSAS group in order to find out the biomarkers which could be used to screen OSAS patients. Furthermore, the Reliable Number(N) was used to see how often the VOC identified in all the experients in OSAS group and was defined as the times of a single VOC identified devided by the times of total experiment in a single OSAS patient.

Results
While the reliable number been set as &#8805;50%, we found 8 VOC markers, including Pentane and Cyclopentyl acetylene, appeared more often in OSAS patients. When we raise N to &#8805;70%, we have only 3 markers remaining.

Conclusion
Based on this result, we utilize the artificial intelligence method, deep learning, to figure out whether the peak intensity of different biomarkers are related to the severity of OSAS.

Support
Thanks for Da-Jeng Yao Lab’s support
0476 Readiness and Stages of Change in a Behavioral Sleep Medicine Clinical Sample: From Pre-Contemplation to Struggling to Maintain Change
Authors: Amatrudo G , Puzino K , Bourchtein E , Calhoun S L , Fernandez-Mendoza J 
Published: May 2020

Abstract

Introduction
Stages of change in the transtheoretical model are used to assess a patient’s readiness to change, which may help providers tailor behavioral treatment (BT). As research has focused on substance abuse, there is a significant lack of data in individuals presenting for behavioral sleep medicine (BSM) treatment.

Methods
146 consecutive patients (46.1±16.0 years, 61.6% female, 19.9% minority) who were evaluated at the BSM program of Penn State Hershey Sleep Research & Treatment Center completed the University of Rhode Island Change Assessment Scale (URICA) assessing readiness to change (RtC) and pre-contemplation (P), contemplation (C), preparation/action (A) and struggling to maintain (M) stages of change. Subjects also completed the Insomnia Treatment Acceptability Scale (ITAS) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS).

Results
The average RtC score was 9.4, with 21.9% of the sample in stage P, 56.2% in C and 21.9% in A. The average P (53.2±7.6), C (49.1±10.1), A (48.8±12.3) and M (37.7±9.1) scores suggested an overall “contemplation cluster profile”. Higher RtC (r=0.37), C (r=0.31) and A (r=0.24) scores were associated with greater acceptability of BT, while higher P scores were associated with lower acceptability of BT (r=-0.22). In contrast, higher M scores were associated with greater acceptability of pharmacological treatment (r=0.21) as well as higher DBAS scores, including sleep medication expectations (r=0.23).

Conclusion
Patients attending a BSM program typically present at a contemplation stage, which indicates intention to start changing sleep behaviors within the next few months with some ambivalence in regards to pros/cons of such change. A significant proportion of patients struggle to maintain change and present with higher acceptability for pharmacological interventions, which may hinder the effectiveness of BT and may require specific therapeutic approaches.

Support
Department of Psychiatry, Penn State College of Medicine
0477 Characteristics of Insomnia Subjects Screened for Transitioning from Zolpidem Tartrate to Lemborexant in a Multicenter Pilot Study
Authors: Ahmad M , Malhotra M , Amchin J , Kumar D , Perdomo C , Moline M 
Published: May 2020

Abstract

Introduction
Patients who take insomnia medication may change medications for reasons including lack of efficacy, adverse events, and dependence concerns. A pilot study (NCT04009577, E2006-A001-312) assessed a dosing approach for transitioning patients from zolpidem tartrate (ZOL; immediate or extended-release) to lemborexant, a dual orexin receptor antagonist. Here we describe characteristics of subjects who entered the study Screening Period and their reasons for wanting to change medications.

Methods
This multicenter pilot study was conducted in the U.S. and enrolled subjects age ≥18y with insomnia diagnosed per DSM-5 criteria, and who used ZOL (self-reported intermittently [3-4 nights/week] or frequently [≥5 nights/week]) as their only insomnia treatment. Subjects entered a 3-week Screening Period, during which frequency/dose of ZOL taken was recorded; subjects also wore an actigraph continuously. Eligible subjects thereafter entered the Treatment Phase to determine lemborexant dosing (5 or 10mg during a 2-week Titration Period with assignment to 1 of 3 treatment schedules based on ZOL usage frequency during Screening), followed by a 12-week Extension (Maintenance) Phase and a 4-week Follow-up Period.

Results
Forty-nine subjects entered the Screening period and completed the Chief Complaint Form through November 2019; mean(SD) age was 57.1(13.8)y, 67.3% were female, 69.4% were white, and 28.6% were black. 31 subjects reported using ZOL frequently and 15 reported using ZOL intermittently (3 missing). The most common sleep complaint was waking up too early (n=33), followed by difficulty staying asleep (n=13), and difficulty falling asleep (n=3). Reasons for wanting to switch from ZOL included: ZOL not working (n=19), concerns about taking ZOL (n=14), wanting to try something new/potentially better (n=6), side effects (n=5), and residual daytime sleepiness (n=4). 43/49 subjects completed screening through this period.

Conclusion
This study offers the opportunity to understand patients’ current use of insomnia medication and their motivation for wanting to change insomnia medications.

Support
Eisai Inc.
0478 A Multicenter Pilot Study to Evaluate Next-Dose Transition from Zolpidem to Lemborexant for the Treatment of Insomnia
Authors: Rosenberg R , Amchin J , Kumar D , Perdomo C , Moline M , Malhotra M 
Published: May 2020

Abstract

Introduction
Switching of medications for insomnia occurs often in clinical practice based on a variety of reasons. However, few clinical studies have examined methods for transitioning patients between different insomnia medications. This is especially important to consider when the classes of drugs are different (e.g., GABA-ergic agonism vs orexin receptor antagonism); thus, clinical guidance would be valuable. The safety and efficacy of the dual orexin receptor antagonist lemborexant (LEM) for the treatment of insomnia was confirmed in two Phase 3 studies, SUNRISE-1 (NCT02783729, E2006-G000-304) and SUNRISE-2 (NCT02952820, E2006-G000-303). This pilot study (NCT04009577, E2006-A001-312) was designed to assess pre-specified dosing approaches for directly transitioning from the sedative-hypnotic zolpidem (ZOL), a commonly prescribed sleep aid, to LEM.

Methods
This multicenter pilot study has enrolled subjects age ≥18 years with an insomnia diagnosis (DSM-5 criteria), who used ZOL (intermittently or frequently) as their only insomnia treatment. Following a 3-week Screening period, eligible subjects enter the Treatment Phase (2-week titration period: assigned to 1 of 3 treatment arms based on ZOL use during Screening), and then the Extension Phase (maintenance period up to 12 weeks). During both the Treatment and Extension Phases, the dose of LEM is flexible between 5 and 10 mg, depending on efficacy and tolerability. The primary endpoint is to evaluate the proportion of subjects taking ZOL who successfully transition to LEM (lemborexant 5 mg [LEM5] or lemborexant 10 mg [LEM10]) after 2 weeks of LEM treatment.

Results
Enrollment began July 15, 2019. It was initially projected that approximately 110 subjects would be screened to provide about 60 subjects for randomization across 3 treatment arms. Interim data will be presented (planned cutoff date Jan 08, 2020).

Conclusion
This pilot study will help inform on dosing guidance when transitioning a patient from a GABA-ergic drug to an orexin receptor antagonist.

Support
Eisai Inc.
0482 A Preliminary Study on the Efficacy of Forehead-Cooling for Relieving Menopausal Sleep Difficulties and Hot Flashes
Authors: Baker F C , de Zambotti M , Chiappetta L , Nofzinger E 
Published: May 2020

Abstract

Introduction
Many women experience sleep difficulties in the approach to menopause and post-menopause, with about 25% experiencing severe symptoms that impact daytime functioning and quality of life. Hot flashes contribute to these sleep difficulties, being associated with nocturnal awakenings, poorer sleep quality, and chronic insomnia. New non-pharmacological sleep solutions have become available, including a forehead cooling device designed to target elevated brain metabolism in insomnia sufferers. Here, we explored whether this device was effective in improving subjective sleep and hot flashes in menopausal-age women with insomnia symptoms.

Methods
This study was an open-label, in-home investigation of the efficacy of nightly treatment with a forehead cooling device in 20 women (55.1 ± 4.2 years) with insomnia symptoms and daily hot flashes. Participants completed daily diaries assessing sleep quality and hot flashes across a baseline week (no treatment) followed by 4 weeks of treatment. They also completed questionnaires before and after treatment including the insomnia severity index and the hot flash related daily interference scale.

Results
Women reported better sleep quality with a shorter sleep onset latency and fewer awakenings (between 14-30% improvement) during the first week of device use, with further improvements over time, relative to baseline (p &lt;0.001). Women also reported fewer nocturnal hot flashes that were less severe during treatment (p&lt;0.001). They had lower insomnia severity scores post-treatment (9.3±5.8) compared to pre-treatment (20.0±5.7) (p&lt;0.001), with 17 participants showing a reduction of 6 points or greater on the insomnia severity index. There was also a significant reduction in hot flash related daily interference post-treatment (p&lt;0.001).

Conclusion
Use of a forehead cooling device during the night improved subjective sleep quality and reduced insomnia symptoms and hot flash frequency and severity in this preliminary study of menopausal-age women. Further large scale randomized controlled trials are required to determine efficacy.

Support
Ebb Therapeutics
0496 Self-Reported Sleep During Discontinuation of Chronic Hypnotic Use
Authors: Verkler J , Koshorek G , Roth T , Roehrs T 
Published: May 2020

Abstract

Introduction
Inability to discontinue chronic hypnotic use by people with insomnia remains a clinical concern. Self-reported sleep in an on-going “blinded” clinical trial in which people with insomnia are instructed to discontinue their study medication after 6 months of nightly use was examined and compared to objective actigraphic recordings of their sleep.

Methods
DSM-V diagnosed people with insomnia (n=31, 26 females), aged 26-61 yrs, with a polysomnographic sleep efficiency of ≤85%, no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the clinical trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (blinded groups A: n=11, B: n=9, C: n=11). After 6 months, over a 2-week choice period, they were given the instruction to discontinue their nightly hypnotic use with an opportunity, if necessary, to self-administer either 1, 2, or 3 capsules of their assigned medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). On post-sleep questionnaires they reported sleep latency (LAT), wake after sleep onset (WASO), and sleep quality (Q:1-5; best - worst).

Results
15 subjects stopped taking study medication when told to discontinue. The 16 subjects who took study medication had shorter LAT on nights they took capsules then on nights they did not (31 vs 38 min, p&lt;.03), less WASO (22 vs 44 min, p&lt;.02) and better Q (2.3 vs 3.2, p&lt;.002). In contrast, actigraphic recordings of sleep showed no differences in LAT, WASO, or SE.

Conclusion
For subjects who took study medication during the nights they were instructed to discontinue, they reported better sleep than on the nights they used no medication, although objectively their sleep did not differ.

Support
NIDA, grant#: R01DA038177 awarded to Dr. Roehrs
0508 Transcranial Magnetic Stimulation Shows Favorable Response for Insomnia in Depression with Greater Response in Males and in Those Less Than 65 Years of Age
Authors: Stultz D J , Osburn S , Burns T , Stanley N , Walton R , Cope A , Pawlowska-Wajswol S 
Published: May 2020

Abstract

Introduction
Transcranial Magnetic Stimulation (TMS) is FDA approved for the treatment of resistant depression and multiple studies have demonstrated improvement of insomnia in both those with and without depression.

Methods
50 patients were studied while undergoing TMS treatment for resistant depression and utilizing the Patient Health Questionnaire-9 (PHQ-9), the Beck Depression Inventory (BDI), the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI) for evaluation of benefit. Using the Brainsway dTMS system over the LDPFC at 120% MT for an average of 31 treatments, our study demonstrated benefit for both mood and insomnia. We observed an improvement on the PHQ-9 from 17.3 to 7.53, on the BDI from 30.44 to 11.75, on the ISI from 13.47 to 9.31, and on the PSQI from 11.78 to 9.08. Focusing specifically on the insomnia response, we compared an equal number of both male versus female patients, and those &gt; and &lt; than 65 years of age.

Results
Using paired t-test comparisons, men and those less than 65 demonstrated statistically significant improvement. The male population demonstrated statistically significant decreases of t=2.39, 13df, P=.03 on the ISI, and t=2.59, 13df, P=.02 on the PSQI. For women the result was t=1.35, 13df, P=.20 on the ISI, and t=2.05, 13df, P=.06 on the PSQI. In the elderly (&gt;65) decreases were not statistically significant at t=.62, 14df, P=.54 on the ISI, and t=1.26, 14df, P=.23 on the PSQI. For those &lt; 65 years old statistically significant decreases observed were t=3.37, 14df, P=.005 on the ISI, and t=3.5, 14df, P=.004 on the PSQI.

Conclusion
TMS treatment of depression resulted in statistically significant benefits on co-existing insomnia in males and those less than 65 years of age. As insomnia may be a precipitating or perpetuating factor in depression and may result in depression relapse, attention to this symptom is of clinical benefit.

Support
**No support was given for this study. Dr. Stultz is a speaker for Harmony Biosciences and has served on their advisory committee. She is also a speaker for Jazz Pharmaceuticals. She is the co-editor for the Clinical TMS Society Newsletter and on the education committee.