bluuebunny/crossref_metadata_2025_split huggingface dataset:
0453 Longitudinal Relationship Between Insomnia and Work Productivity in Japanese City Government Employees
Authors: Kadotani H , Ito K , Matsuda A , Nishikawa K , Sumi Y , Matsuo M 
Published: May 2020

Abstract

Introduction
“Presenteeism” refers to the decrease in productivity in employees who are present but not functioning at full capacity due to illness or other medical conditions. It is reported that the cost of presenteeism to businesses is 10 times higher than absenteeism (away from work due to illness or disability). Relative presenteeism is a ratio of actual performance to the performance of most workers at the same job. We analyzed effects of insomnia and depression two years before on presenteeism in a Japanese working population.

Methods
Questionnaire survey was conducted as a part of a cohort study named “Night in Japan Home Sleep Monitoring Study (NinJaSleep Study)” in 2016 and 2018. Participants were the city government employees in a rural city in Shiga prefecture, Japan. Presenteeism, insomnia and depression were analyzed by WHO-HPQ (Health and Work Performance Questionnaire), ISI (insomnia severity index) and PHQ-9 (Patient Depression Questionnaire), respectively. Pearson correlation coefficient analyses were performed to determine the strength of the association between two variables. Logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of poor relative presenteeism (the lowest tertile of the relative presenteeism scores) after 2-year follow up.

Results
1143 subjects (participation rate: 61.7%, 36.7% male, 44.5±11.4 years, BMI: 22.3±3.30) participated in both 2016 and 2018. Participants with poor productivity (poor relative presenteeism) in 2018 was significantly associated with ISI in 2016 (OR: 1.050, 95%CI: 1.010-1.090, p=0.013) but not with PHQ-9 in 2016 (OR: 1.008, 95%CI: 0.972-1.045, p=0.664) after adjusting for age, gender and BMI. Positive correlation was found between the total score of ISI and item 3 of PHQ-9 which asks insomnia or hypersomnia symptom (r=0.6122, P&lt;0.0001).

Conclusion
Insomnia may be an independent risk factor for poor presenteeism. ISI may be useful to predict poor productivity in the future.

Support
Supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. / MSD K.K. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. / MSD K.K.”
0463 Cluster Analysis in Perimenopausal and Menopausal Women with Insomnia
Authors: Srisawart P , Wang L , Bena J , Drerup M , Mehra R , Barwick F , Moul D 
Published: May 2020

Abstract

Introduction
Women in perimenopause or menopause report higher rates of insomnia, with depression, pain and sleep apnea common comorbidities. Identifying clinically relevant subtypes of women with similar symptom patterns might help target treatment more precisely and optimize outcomes more successfully.

Methods
Participants were woman &gt;50 years with insomnia (ISI&gt;10) who were recruited from 12,108 patients visiting the Cleveland Clinic Sleep Disorders Center between 2008-2012. Patients completed questionnaires at initial clinic visit, and comorbidity data was extracted from medical records. K-method cluster analysis of cross-sectional data with PAM (portioning around medoids) was performed to identify clusters of patients based on insomnia (ISI), depression (PHQ2), and pain (EQ5D) symptoms as well as presence or absence of diabetes or sleep disorders (OSA, RLS). Silhouette widths and visualization using factoextra in R identified the optimal number of clusters. Characteristics of each cluster were compared using Pearson chi-square, Kruskal-Wallis or ANOVA models in SAS.

Results
Sample comprised 374 women. Average age was 60.5 years and 81.6% were White. A three-cluster solution was the most plausible. Clusters with mild (N=155, ISI=14.1±1.9), moderate (N=131, ISI=19.7±1.6) and severe (N=88, ISI=25.4±1.9) insomnia showed significant differences in characteristic. Clusters differed on depression level (PHQ2≥4 mild 19%, moderate 38%, severe 60%), and pain (ED5D=3 mild 3%, moderate 12%, severe 23%). Although the mild insomnia cluster reported better overall health, it showed higher rates of OSA compared to the moderate insomnia cluster, along with significantly older age and higher BMI.

Conclusion
Perimenopausal and menopausal women divided into three clusters with mild, moderate and severe insomnia, with levels of reported depression and pain symptoms increasing with insomnia symptoms. Clusters also differed on age, BMI and prevalence of OSA, suggesting that specific symptom clusters might indicate more precise and targeted treatment of common comorbid conditions during menopause transition.

Support
0466 Evolution of Nonrestorative Sleep and Its Interactions with Insomnia Symptoms in a Longitudinal Survey of the American Population
Authors: Ohayon M M 
Published: May 2020

Abstract

Introduction
Nonrestorative sleep (NRS) is one of the sleep disturbances that is under-appreciated. Some studies have set its prevalence at around 10% of the general population but definitions are heterogenous. Despite its frequency, studies that paid attention to that symptom are disparate and have often taken many routes. Our aim is to examine its prevalence, its incidence and its predictive factors.

Methods
The initial study was carried with 15,929 individuals from 15 US States. The longitudinal study was carried on in eight of these states. A total of 12,218 subjects were interviewed by phone during the first wave (W1) and 10,930 at the second wave (W2) three years apart. The analyses were carried on the subjects who participated in both interviews (N=10,930). NRS was assessed using a series of five questions. The global score determined the presence/absence of NRS.

Results
A total of 14.7% (CI95%: 14%-15.4%) reported NRS at W1. At follow-up, 13.1% (CI95%: 12.5%-13.7%) reported NRS. The incidence per year was 2.3%. NRS was chronic in 28.9% of cases. NRS occurred alone (i.e. without any other insomnia symptoms) in 5% of the sample at W1 and 3.6% at W2. 22.2% of those with NRS alone at W1 reported other insomnia symptoms at W2. Sleep duration was at least 6h30 in 81.6% of NRS alone cases at W1 and 76.5% at W2. Daytime repercussions were reported by 66.2% of NRS alone at W1 and 52.8% at W2. NRS alone (RR: 2.4) or in combination with insomnia symptoms (RR: 3.4) was one of the strongest predictors for developing a Major Depressive Disorder at W2.

Conclusion
NRS is a sleep disturbance that has some unique features that distinguish it from insomnia symptoms. Nonetheless, it can have a profound impact on daily life and can lead to further difficulties in other areas if not addressed properly.

Support
Arrillaga Foundation
0485 Experience and Attitudes About Prescription Insomnia Medications: Results from an Online Survey of Individuals with Sleeping Difficulties and Insomnia
Authors: Sheehan D , Zee P C , Steinberg K , Ginovker A , Atkins N , Moline M 
Published: May 2020

Abstract

Introduction
This survey explored several topics related to living with insomnia/sleeping difficulties. Reported here are patient experience, attitudes, and perspectives about and understanding of prescription medications for insomnia.

Methods
The online survey was conducted by The Harris Poll in the U.S. between February 14 and March 8, 2019. Survey respondents (“patients”) were adults age ≥18y who had been diagnosed with insomnia (11% of respondents), or had experienced sleeping difficulties (defined as difficulty falling asleep or staying asleep for ≥3 nights/week for ≥3 months; 89% of respondents). Raw survey data were weighted by relevant factors to be representative of the total U.S. adult population with insomnia/sleeping difficulties.

Results
Among 525 patients (mean age 46y; 55% female) who completed the survey, 83 were currently using prescription medication, 45 used prescription medication previously, and 397 had no prescription medication history. The majority of all patients “somewhat” or “strongly” agreed they were “concerned about the safety risks of sleep medications currently available by prescription” (79%); felt “there have got to be better medications that help people sleep” (74%); and that they “wish there were more medications to choose from” (67%). Within the group of respondents with current/past prescription history (n=128), 63%, 23%, and 14% had tried 1-2, 3-4, or ≥5 different prescription medications, respectively. Among reasons for missing/skipping a dose, ~20% of respondents with current/past prescription history selected for each response that they “do not feel my medication is effective”; “do not like the way my medication makes me feel when I wake up the next morning”; and “prefer not to take my medication every night unless absolutely necessary.”

Conclusion
Results from this online survey provide insights into patient attitudes toward pharmacotherapy and indicate that a significant number of insomnia patients feel dissatisfied with medication treatment options, including concerns regarding safety and side effects.

Support
Eisai Inc.
0488 Pilot Evaluation of an Actigraphy Watch Compared to Polysomnography in a Clinical Trial of Suvorexant for Treating Insomnia in Patients with Alzheimer’s Disease
Authors: Svetnik V , Wang T , Ceesay P , Snyder E , Ceren O , Bliwise D , Budd K , Hutzelmann J , Stevens J , Lines C , Michelson D , Herring W 
Published: May 2020

Abstract

Introduction
Suvorexant, an orexin receptor antagonist, improved total sleep time (TST) in a sleep laboratory polysomnography (PSG) study of patients with Alzheimer’s disease (AD) and insomnia. The study included a pilot evaluation of an actigraphy watch for continuously recording patient’s sleep and daytime activity. We report on the utility of the watch for assessing sleep in relation to gold-standard PSG.

Methods
This was a randomized, double-blind, 4-week trial (ClinicalTrials.gov NCT02750306). Participants who met diagnostic criteria for both probable AD dementia and insomnia were randomized to suvorexant 10-20mg or placebo. Overnight sleep laboratory PSG was performed on 3 nights: screening, baseline, and Night-29 (last dose). An actigraphy watch (Garmin vívosmart® HR) was worn continuously by the patient. Separate analyses were performed for PSG and watch. We compared treatment effects on change-from-baseline in PSG-TST at Night-29 and WATCH-TST at Week-4 (average TST per night over Week-4). We also analyzed Night-29 data only with watch data restricted to the PSG recording time.

Results
A total of 274 participants were included in the Night-29 PSG analysis (suvorexant=135, placebo=139) and 223 in the Week-4 watch analysis (suvorexant=113, placebo=110). Suvorexant improved Night-29 PSG-TST by 28 minutes versus placebo (p=0.001) and Week-4 WATCH-TST by 17 minutes versus placebo (p=0.144). In the subgroup who had usable data for both assessments at Night-29 (suvorexant=57, placebo=50), the watch overestimated TST compared to PSG (e.g. placebo baseline scores = 412 minutes for WATCH-TST and 265 minutes for PSG-TST) and underestimated change-from-baseline treatment effects: the suvorexant versus placebo difference was 35 minutes for PSG-TST (p=0.057) and 20 minutes for WATCH-TST (p=0.405).

Conclusion
The watch was less sensitive than PSG for evaluating treatment effects on TST. However, results obtained with the watch were directionally similar to PSG in indicating a benefit of suvorexant versus placebo for improving TST in AD patients with insomnia.

Support
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
0506 Short and Long-Term Effects of Trazodone vs. Cognitive-Behavioral Treatment on EEG Power During NREM Sleep in Chronic Insomnia
Authors: Li Y , Vgontzas A , Fernandez-Mendoza J , Fang J , Puzino K , Basta M , Bixle E 
Published: May 2020

Abstract

Introduction
Both trazodone and cognitive-behavioral treatment of insomnia (CBT-I) are widely used to treat patients with chronic insomnia. Animal studies have shown that trazodone increases slow wave sleep (i.e., increased EEG delta power). However, no study to date has compared the long term effects of trazodone vs. CBT-I on spectral EEG activity during sleep in humans.

Methods
We addressed this question in a sample of 19 middle-aged men and women who received either trazodone (n=8) or CBT-I (n=11) treatment for 9 months. We examined delta (0.39-3.91 Hz), theta (4.30-7.81 Hz), alpha (8.20-11.72 Hz), sigma (12.11-14.84 Hz), beta (15.23-35.16 Hz) and gamma (35.55-49.61 Hz) relative power during NREM sleep after 3-month and 9-month of treatment.

Results
Compared to CBT-I, trazodone significantly increased relative delta power (p=0.05) and decreased relative sigma (p=0.004) and beta (p=0.05) power during NREM sleep across 9-month treatment. Furthermore, compared to CBT-I, trazodone significantly increased relative delta power (3-month: Δ2.00 ± 3.27 vs. Δ-2.63 ± 5.88, p=0.006, Cohen’s d=0.93; 9-month: Δ2.63 ± 4.11 vs. Δ-1.10 ± 3.93, p=0.006, Cohen’s d=0.93), while decreased relative sigma power (3-month: Δ-1.55 ± 1.75 vs. Δ0.90 ± 1.82, p=0.009, Cohen’s d=1.37; 9-month: Δ-1.33 ± 1.95 vs. Δ1.05 ± 1.79, p=0.014, Cohen’s d=1.28) during NREM sleep in 3-month and 9-month, respectively. Relative beta power (3-month: Δ-0.85 ± 0.60 vs. Δ0.35 ± 1.14, p=0.016, Cohen’s d=1.03;) was significantly decreased in 3-month treatment in trazodone group compared to CBT-I. Moreover, across 9-month treatment, relative sigma (p=0.040, ω p2 = 0.29) and beta (p=0.021, ω p2 = 0.12) power during NREM sleep were significantly decreased within trazodone group, while relative sigma power (p=0.096, ω p2 = 0.230) increased within CBT-I group.

Conclusion
Our findings suggest that trazodone, but not CBT-I, even after 9-month of use increases slow wave sleep and decreases high-frequency EEG power during NREM sleep. This effect may explain the long-term usefulness of trazodone in chronic insomnia patients with physiologic hyperarousal i.e., activation of the stress system. Further studies should examine this effect in large samples of insomnia.

Support
NIH C06 RR016499, UL1 TR 000127
0517 Integrated Cognitive Behavioral Therapy (CBT) and Mindfulness Group Treatment Protocol for Insomnia and Chronic Pain
Authors: Barwick F , Poupore-King H , You D 
Published: May 2020

Abstract

Introduction
Chronic pain and insomnia are highly comorbid, and CBT is a recommended treatment for both. CBT protocols that treat these conditions together, however, show improvements in sleep but not pain. As mindfulness, an acceptance-based approach, has been used successfully to treat chronic pain, integrating mindfulness into a combined CBT treatment protocol may help improve outcomes for chronic pain as well as insomnia.

Methods
An integrated CBT/Mindfulness weekly 6-session group protocol for chronic pain and insomnia was developed and piloted. Treatment components included education about pain neuroscience as well as sleep and circadian biology, relaxation, time-based pacing, tracking 24-hour time in bed, sleep compression, stimulus control, cognitive reframing, and mindfulness. Pre-post measures evaluating insomnia symptoms, sleep hygiene, pain acceptance, pain catastrophizing, and unhelpful beliefs about sleep and pain were analyzed using frequency analyses and paired sample t-tests.

Results
Two groups were completed for a total of 16 participants, 94% of whom attended at least 5 sessions. Average age was 56 years, 75% of the sample was female, 88% were White, 6% Asian, and 6% Latino. Post-treatment outcomes showed significant improvement in insomnia symptoms (ISI Mdiff=6.6, SDdiff=5.3, p=.01, ES=1.2), sleep hygiene (SHI Mdiff=3.8, SDdiff=4.6, p=.02, ES=.83), pain acceptance (CPAQ Mdiff=5.2, SDdiff=7.8, p=.03, ES=.67), pain catastrophizing (PCS Mdiff=5.1, SDdiff=7.5, p=.03, ES=.68), and unhelpful beliefs about sleep (DBAS Mdiff=31.4, SDdiff=21.2, p=.009, ES=1.5) and pain (PBAS Mdiff=11.6, SDdiff=10.7, p=.02, ES=1.1).

Conclusion
An integrated CBT/Mindfulness group protocol for chronic pain and insomnia showed significant improvements in post-treatment sleep and pain measures. As previous combined CBT-only protocols showed pre-post improvement in sleep but not pain, the current study demonstrates that including mindfulness might improve outcomes for chronic pain. Future studies should compare CBT protocols for chronic pain and insomnia with and without mindfulness to determine the clinical benefits of including an acceptance-based component.

Support
Poster presented as part of collaborative conversation with Skye Margolies, PhD, Department of Anesthesiology, University of North Carolina School of Medicine.
0518 Sleep Facilitation by Artificial Carbonated Bathing in Healthy Elderly; EEG, Core, Proximal, and Distal Temperature Evaluations
Authors: Uemura S I , Kanbayashi T , Imanishi A , Terui Y , Satake M , Shioya T , Nishino S 
Published: May 2020

Abstract

Introduction
Bathing, especially with hot spring with various mineral compositions, is known to facilitate / improve sleep by warming the body. Artificial carbonated bathing (ACB) is known to keep the body warm too. Previous our study examined that ACB before sleep more specifically affected body temperature and sleep on healthy young subjects. In this study, we evaluated the effects of usual (plain hot water; PH) and artificial carbonated bathing, on sleep using clinical thermometers and EEG in healthy elderly subjects.

Methods
Nine healthy elderly women (average age 71.3 years old) were divided into 2 groups ACB (858 ppm, Awacomachi, Danrei Co.) and PH with a week interval. Subjects soaked in the bath (38 C degree) deep enough their chests touched the water for 10 min. From the time they finished bathing to the next morning, we measured their distal skin temperature (top side of the foot), proximal skin temperature (lower part of the clavicle) and EEG using a single channel portable device (Brain wave sensor, Proassist Co.). Subjects were told to sleep from 23:00-6:00. As the same time, subjects were examined with visual analog scale (VAS) and clinical flicker fusion test (CFF).

Results
There was no significant difference in body temperature (proximal, distal, distal-proximal temperature gradient: DPG) before and during sleep between ACB and PH. The condition of the ACB tended to have less light sleep compared to PH (150min vs 201min, p=0.08), but there was no significant difference in the SWS (44.1min vs 39.1min, ns), EEG delta power analysis, VAS and CFF.
In the previous study, bathing was performed for 15 min at a water temperature of 40 C degree, but this condition was considered to be a high risk for the elderly. The reason why there was no significant difference in body temperature. The effects of ACB were not fully demonstrated due to changes in hot water temperature and bathing time.

Conclusion
The effect of ACB on the body temperature of healthy elderly people could not be confirmed. However, a tendency to reduce light sleep was observed.

Support
This work was supported by JSPS KAKENHI Grant Number JP19K11294
0538 What Happens After Prescription of Insomnia Medication Among Older Adults?
Authors: Jobe S L , Albrecht J S , Scharf S M , Johnson A M , Wickwire E M 
Published: May 2020

Abstract

Introduction
Despite consensus recommendations regarding need for caution and careful management, sedative hypnotic insomnia therapies remain commonly prescribed among older adults. Further, sleep medications are often prescribed in the absence of a thorough sleep history or evaluation. However, little is known about delivery of sleep-related care following prescription of insomnia medications. Thus, the purpose of this study was to characterize the course of sleep-related care following a prescription fill for insomnia medication among older adults.

Methods
Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Insomnia medications were identified by searching the Part D prescription drug claims and included FDA-approved insomnia-related medication classes and drugs. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of insomnia medication users who received sleep disorder diagnoses.

Results
A total of 33,252 Medicare beneficiaries without prior history of sleep disorders received at least one FDA-approved insomnia medication fill between 2006-2013. Of these, 43.2% (n=14,354) eventually received a sleep disorder diagnosis. Among those receiving a sleep diagnosis after being prescribed insomnia medication, insomnia was the most common disorder (71.0%; n=10,198). Further, 15.0% (n=2,149) of individuals who were prescribed insomnia medication received an obstructive sleep apnea diagnosis, 6.6% (n=947) were diagnosed with sleep disturbances, and 5.9% (n=845) were diagnosed with restless legs syndrome. Of those who received a sleep disorder diagnosis, 95.1% (n=13,649) were diagnosed with one sleep disorder, 4.5% (n=639) were diagnosed with two sleep disorders, and 0.4% (n=66) were diagnosed with three or more sleep disorders.

Conclusion
Fewer than half of Medicare beneficiaries prescribed FDA-approved sedative hypnotic insomnia medications ever received a formal sleep-related diagnosis. These results suggest that clinicians prescribe sedative hypnotics without thoroughly evaluating sleep complaints.

Support
This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).
0544 Reconsidering Stimulus Control: Activities in Bed Associated with Sleep-Related Outcomes
Authors: Phan S , Perlis M L , Hale L , Branas C , Killgore W D , Wills C C , Grandner M A 
Published: May 2020

Abstract

Introduction
The typical advice is that in order to avoid insomnia, people should avoid activities in bed other than sleep. Yet, activities such as reading and watching TV in bed are common.

Methods
Data were obtained from the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) Study, N=1,007 adults age 22-60. Sleep hygiene was assessed using items from the Sleep Practices and Attitudes Questionnaire (SPAQ), which asked whether respondents agree/disagree that they do the following in bed: Read, Watch TV, Eat, Work, Worry, and/or Argue. These were analyzed in relation to Insomnia Severity Index (ISI) score, Pittsburgh Sleep Quality Index (PSQI) score, Epworth Sleepiness Scale (ESS) score, Fatigue Severity Scale (FSS) score, and self-reported sleep duration (TST), sleep latency (SL), and wake after sleep onset (WASO). Covariates included age, sex, education, and income.

Results
Those that frequently engaged in activities were: reading (75%), watching TV (63%), eating (42%), working (32%), worrying (82%), and arguing (23%). Reading was associated with less WASO (B=-14min, p=0.02). Watching TV was associated with higher ISI (B=1.22, p=0.04), PSQI (B=1.04, p=0.007), and ESS (B=0.87, p=0.049), and less TST (B=-0.29, p=0.04). Eating was associated with higher ISI (B=1.75, p=0.01), PSQI (B=1.23, p=0.008), and FSS (B=4.36, p=0.002). Working was associated with higher ISI (B=1.82, p=0.019), PSQI (B=1.65, p=0.001), and ESS (B=1.78, p=0.002). Worrying was associated with higher ISI (B=7.34, p&lt;0.0005), PSQI (B=4.40, p&lt;0.0005), ESS (B=2.53, p=0.001), FSS (B=9.51, p&lt;0.0005), and SL (B=19.39, p&lt;0.0005), and less TST (B=-0.55, p=0.023). Arguing was associated with higher ISI (B=3.78, p&lt;0.0005), PSQI (B=3.15, p&lt;0.0005), ESS (1.47, p=0.023), and SL (B=10.97, p=0.013), and lower TST (B=-0.71, p=0.001).

Conclusion
Individuals who perform mentally distressing activities such as worrying and arguing experience especially worse sleep, and those who read in bed have fewer awakenings.

Support
The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.