bluuebunny/crossref_metadata_2025_split huggingface dataset:
1110 Characteristics Of Untreated Sleep Disturbance During Intensive Outpatient Treatment For Substance Use Disorders: Preliminary Results From A Longitudinal Study
Authors: Wilkerson A K , Taylor D J , Sahlem G L , Simmons R O , Russell A , Book S W , Smith J P , Uhde T W , McRae-Clark A L 
Published: May 2020

Abstract

Introduction
Previous studies have shown that sleep problems are commonly reported during treatment for substance use disorders (SUDs) and sleep complaints have been linked to subsequent relapse. However, most of these findings were in well-controlled clinical trials and may not generalize to the public. Little is known about the natural progression of sleep complaints during treatment in community clinics, the most common treatment approach for SUDs. The aim of this study is to longitudinally assess prevalence of clinically significant sleep disturbance at baseline and post-treatment in a community-based intensive outpatient (IOP) SUD treatment program using a multi-method approach with well-validated measures of sleep.

Methods
Adults beginning IOP SUD treatment completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Nightmare Disorder index (NDI), and one week of actigraphy and sleep diaries. Measures were repeated following treatment (approximately 5 weeks later).

Results
Preliminary analyses on 21 adults who have been enrolled thus far revealed 85.6% of participants experienced sleep disturbance (PSQI &gt; 5) at baseline. 28.5% of participants reached cutoff for moderate-to-severe insomnia symptoms (ISI &gt; 15) and 42.9% reported nightmares more than once per week. Sleep parameters taken from actigraphy and sleep diaries revealed mean sleep efficiency was 77.5% (TST M = 6.2 hours; TIB M = 7.9 hours). These variables did not improve from baseline to post-treatment. Further, most measures indicated a worsening of sleep, though this did not reach significance (all ps &gt; .05).

Conclusion
This preliminary data show a high prevalence of self-reported sleep complaints and objectively measured poor sleep efficiency that do not improve over the course of treatment. Data collection is ongoing and expected to at least double. More robust analyses, including differences between SUD type (e.g., cannabis vs. opioid) and relationship to relapse at post-treatment, will then be completed.

Support
K12DA031794
1113 Physical Activity Moderates The Sleep-emotional Distress Relationship, But Less So Among Blacks Vs. Whites
Authors: Moore J , Williams N , Chung D , Parra Y , Jean-Louis G , Seixas A 
Published: May 2020

Abstract

Introduction
Emotional distress (ED) is associated with poor sleep. Research shows that minority populations experience greater vulnerabilities to both ED and poor sleep. Interventions such as relaxation training and behavioral therapy address this relationship but are not always successful. Research shows that physical activity (PA) is negatively associated with ED and positively associated with sleep duration. However, it is unclear whether PA attenuates the relationship between ED and sleep, and if this relationship differs by race/ethnicity.

Methods
We analyzed data from the 2005-2015 National Health Interview Survey (NHIS), a nationally representative dataset of 416,152 participants. ED, hours of PA per day, and average sleep duration were collected. Regression models with covariates (age, sex, employment status, BMI) were used to analyze the moderation effect of PA within sleep and ED. Regression models were stratified by race/ethnicity.

Results
261,686 participants (45,926 blacks, 17.55%, and 215,760 whites, 82.45%) responded with the required variables for analysis. 63% of participants reported at least some physical activity. The results of the regression showed that a significant amount of variance in ED stemmed from sleep duration; F (7, 121088) = 1,619.72, p &lt; 0.001. PA was found to have a significant main effect, t(121,088) = 9.01, p= &lt;0.001. There was a significant moderation effect of PA, t(121088) =7.26, p &lt; 0.001. Stratification showed that the moderation effect of PA was not significant among blacks t(121,088) = -1.45, p=0.149 and significant among whites b = -.08, t(101,754) = -7.82, p &lt; 0.001.

Conclusion
The present study found support for moderation of PA in the sleep-ED relationship. However, it found that blacks do not experience the same benefits of PA in this relationship as whites. Further research should be performed to understand the connection of PA to sleep duration and ED.

Support
This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685
1114 Urbanicity And The Sleep-mental Health Relationship
Authors: Moore J , Seixas A , Casimir G , Nunes J , Matadiaby F , Khosrof A , Jean-Louis G 
Published: May 2020

Abstract

Introduction
Inadequate sleep has been found to be associated with poor mental health. This is especially true in low-income and minority populations, who are concentrated in cities. It is not understood to what degree living in a city vs. a rural environment affects sleep and resulting mental health outcomes. This study seeks to understand how living in an urban environment affects the relationship between inadequate sleep and mental health.

Methods
The study used data from the 2018 US Behavioral Risk Factor Surveillance System (BRFSS,) a nationwide health dataset collected by telephone. Respondents were classified as living in either an urban or rural environment based on their zip code. Respondents reported hours of sleep per night and mental health status. This study classified mental health status based on whether the respondent reported one or more incidences of poor mental health in the previous 30 days.

Results
After filtration, 348,540 respondents were split into urban and rural groups. Binary logistic regression was run in each group to compare how much living in an urban environment contributed to the relationship between sleep duration and mental health. Sleep in the analysis was found to significantly contribute to both models; urban X2(15, N=295,796) = 11,485.70, p &lt;0.001 rural X2(15, N=52,744) = 2,465.64, p &lt;0.001. The estimated odds ratio resulted in a decrease of 13.9% [Exp(B) = 0.861] in reported poor mental health for every unit increase of sleep in the urban population, and decrease of 14.9% [Exp(B) = 0.851] in the rural population.

Conclusion
In urban and rural dwellers, sleep duration predicted poor mental health. Contrary to expectations, sleep was more strongly tied to mental health in rural than urban populations. This was true even after controlling for sex, income, and education level. Further research should seek to understand how environment affects sleep and mental health.

Support
This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685.
1123 Sleep, Caregiver Burden, and Life Satisfaction in Parkinson’s Disease Caregivers from Mexico and the US
Authors: Perez E , Perrin P B , Lageman S K , Villaseñor T , Dzierzewski J M 
Published: May 2020

Abstract

Introduction
Sleep problems are frequently reported by caregivers of individuals with Parkinson’s disease (PD) and are associated with greater caregiver burden and poorer caregiver life satisfaction. The primary aim of this study was to examine the pattern of associations among PD patient and caregiver sleep problems, caregiver burden, and life satisfaction in PD caregivers. A secondary aim was to assess whether the pattern of associations differed between Mexican and US caregivers.

Methods
Secondary analyses were performed on data obtained from 253 caregivers (age M=59.92, SD=14.66). A composite score was produced for caregiver and patient sleep problems. The Zarit Burden Interview (ZBI) and Satisfaction with Life Scale (SWLS) measured caregiver burden and life satisfaction, respectively. A structural equation model (SEM) was developed to examine the pattern of associations among sleep problems, caregiver burden, and life satisfaction. An invariance design was employed to assess differences in the associations between Mexican and US caregivers.

Results
Fit indices suggested the SEM fit the data adequately. Path coefficients among all variables were significant (p≤.005), except between patient sleep problems and life satisfaction. Three significant indirect effects were found: caregiver sleep problems were negatively associated with life satisfaction via caregiver burden (p=.003); patient sleep problems were positively related to caregiver burden via caregiver sleep problems (p=.005); and life satisfaction via caregiver burden and caregiver sleep problems (p=.002). Despite noninvariance of error terms for the ZBI (z=2.92) and SWLS (z=3.37) between Mexican and US caregivers, the model was generally invariant across countries.

Conclusion
Patient sleep problems were associated with caregiver sleep problems, leading to increased burden in caregivers and poorer life satisfaction. The findings highlight a potential opportunity for empirically-supported sleep interventions in both individuals with PD and their caregivers which may initiate a cascade of salubrious effects on caregiver burden and overall life satisfaction.

Support
Dr. Dzierzewski’s effort on this project was supported in part by the National Institute on Aging (K23AG049955 to J.M.D).
1135 Longer And More Frequent Naps Predict Incident Alzheimer’s Dementia In Community-based Older Adults
Authors: Li P , Gao L , Gaba A , Yu L , Buchman A S , Bennett D A , Hu K , Leng Y 
Published: May 2020

Abstract

Introduction
Excessive napping duration has been associated with cognitive decline. The effect of napping frequency is less understood, and little is known about the development of Alzheimer’s dementia associated with napping. We tested whether longer or more frequent naps in the elderly are linked to the development of incident Alzheimer’s dementia.

Methods
We studied 1,180 older adults (age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 14 years. Motor activities of up to 10 days were recorded at baseline to assess napping characteristics objectively. We defined daytime napping episodes as motor activity segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Alzheimer’s dementia diagnosis was determined using the criteria of the National Institute of Neurological and Communicative Disorders and Strone and the Alzheimer’s Disease and Related Disorders Association. Cox proportional hazards models were performed to examine the associations of daily napping duration and frequency with incident AD.

Results
Of 1,180 non-demented participants at baseline (including 264 with mild cognitive impairment), 277 developed Alzheimer’s dementia within 5.74±3.36 years. On average, participants napped for 38.3±1.0 (SE) min and1.56±0.04 (SE) times per day at baseline. After adjustment for age, sex, and education, every 30-min increase in daily napping duration was associated with a 20% increase in the risk of incident AD (95% confidence interval [CI]: 9%-31%; p=0.0002). One more nap per day was associated with a 19% increase in the risk of AD (95% CI: 8%-30%; p=0.0003). These associations remained after further adjustment for total sleep time.

Conclusion
Longer and more frequent daytime naps predict a higher risk of incident Alzheimer’s dementia. Future studies are needed to examine specific underlying mechanisms.

Support
This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.
1136 Polysomnography Is Feasible During Inpatient TBI Rehabilitation
Authors: Drasher-Phillips L , Schwartz D , Ketchum J , O’Connor D , Calero K , Diaz-Sein C , Wharton L , Almeida E , Dahdah M , Bell K , Nakase-Richardson R 
Published: May 2020

Abstract

Introduction
A recent meta-analytic report highlighted that obstructive sleep apnea was 12 times more prevalent in TBI (mixed severity) than in community-based samples. Recent studies highlight prevalent obstructive sleep apnea during acute inpatient rehabilitation which is a time of critical neural repair. Acute sleep disturbances are associated with therapy cooperation due to effects on daytime sleepiness and are associated with key rehabilitation outcomes. Given the high rates of OSA and risk for negative morbidity, this analysis sought to examine the feasibility of administering polysomnography (PSG) with EEG to diagnose sleep apnea during inpatient rehabilitation in persons with moderate to severe TBI.

Methods
This is a secondary analysis from a prospective diagnostic comparative effectiveness clinical trial (NCT03033901) that took place at six NIDILRR and one VA TBI Model System Centers. Participants were included if they met the TBI Model System case definition and slept at least 2 hours per night prior to PSG. PSG was conducted following AASM procedures in the participant’s hospital bed on the inpatient rehabilitation unit. Studies were scored by RPSGT staff and interpreted by a board certified sleep medicine physician at a centralized sleep scoring center in Tampa, FL.

Results
Of 896 potential TBI participants, 449 met initial eligibility and 345 consented for further screening; a final sample of 263 (76%) completed PSG during hospitalization. Primary reasons for not completing PSG included early discharge or medical instability (n=59) and last-minute withdrawal of consent for PSG (n=23). Of the 263 participants who completed PSG, 3 were excluded from analysis due to technical issues and 12 were excluded as the total sleep time (TST) was less than 120 minutes. Of the 248, 85.5% of the PSGs were rated as interpretable/scoreable by RPSGT and sleep physicians.

Conclusion
For a majority of participants, polysomnography is feasible during inpatient rehabilitation. Participants with shorter lengths of stay, medical instability, prolonged agitation may require polysomnography follow-up after discharge.

Support
Supported by PCORI (CER-1511-33005), VA TBIMS, DVBIC with subcontract from GDIT/GDHS (W91YTZ-13-C-0015, HT0014-19-C-0004), and NIDILRR (90DPTB00070, 90DPTB00130100, 90DPTB0008, 90DPT8000402, 90DPTB0001).
1141 Daytime Napping Trajectory Over Time And Its Association With Cognitive Aging: A 13-year Community-based Longitudinal Study Of Older Adults
Authors: Li P , Gao L , Gaba A , Buchman A S , Bennett D A , Hu K , Leng Y 
Published: May 2020

Abstract

Introduction
Daytime napping is common in elderly adults and has been associated with cognitive impairment. Prior studies have assessed napping at one time point, making it difficult to examine the longitudinal progression of napping and its association with cognitive aging. We examined objectively measured daytime napping longitudinally across different stages of Alzheimer’s disease (AD): from no cognitive impairment (NCI), to mild cognitive impairment (MCI), and to Alzheimer’s dementia.

Methods
We studied 1,066 participants (female: 810; age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 13 years. Motor activities of up to 10 days were recorded annually and used to assess napping objectively. We defined daytime napping episodes as segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Cognitive and clinical evaluations were administered annually to render a clinical diagnostic classification of NCI, MCI, or Alzheimer’s dementia. To examine how napping duration and frequency change with the progression of AD, we performed linear mixed-effects models with 2 change points anchored at the diagnoses of MCI and AD while adjusted for age, sex, and education.

Results
At baseline, participants had 1.44±0.04 (mean±standard error) naps with an accumulated duration of 35.0±1.1 min per day. Napping duration increased by 5.2±0.3 min and frequency increased by 0.21±0.01 times every year (both p&lt;0.0001). The rate of increase was more than doubled after MCI diagnosis with an annual increase of 11.4±0.7 min in duration and 0.40±0.02 times in frequency (both p&lt;0.0001); these were doubled further after AD diagnosis with an annual change of 26.3±3.1 min in duration and 0.84±0.08 times in frequency (both p&lt;0.0001).

Conclusion
Daytime napping duration and frequency increase with aging, and the increase was accelerated with AD progression.

Support
This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.
1143 Wake-up Stroke In Hispanic Veterans: Clinical Characteristics
Authors: Colon-Feliciano M , Prats N , Sierra-Gonzalez A , Jovet G , Jimenez L 
Published: May 2020

Abstract

Introduction
Wake-up stroke (WUS) is a stroke that occurs during sleep and accounts for 14-29.6% of all acute ischemic stroke (AIS) cases. The use of intravenous alteplase, the therapeutic standard, requires identifying time of stroke onset. Recent studies suggest that obstructive sleep apnea (OSA) is an independent risk factor for WUS. This study aims to describe a population of Puerto Rican Veterans with WUS and to evaluate clinical differences between patients WUS and non-WUS (NWUS).

Methods
The study was a cross-sectional analysis of all patient records with AIS from April 2018 to July 2019. One hundred forty records were reviewed. Patients who woke up with new AIS symptoms were labeled as WUS. Study variables included demographics, comorbidities, medications, sleep disorders, prior stroke, administration of alteplase and the National Institute of Health Stroke Scale (NIHSS).

Results
Among 140 participants predominantly male (98.6%), 27.1% had WUS. The mean age was 75 (range 21-89). NIHSS mean was 5.9. Comorbidities for WUS vs NWUS were as follows: overweight or obese (60% vs 62.6% p=0.667), hypertension (100% vs 95.1% p=0.323), hyperlipidemia (95% vs 93% p=0.999), diabetes mellitus (55.3% vs 67% p=0.212), atrial fibrillation (26.3% vs 24.5% p=0.826), anxiety (36.8% vs 33.3% p=0.697), depression (55.3% vs 51.0% p=0.652), non-smokers (89.% vs 89%), smokers (10.5% vs 11.1%), and prior stroke (34.2% vs 35.3% p=0.905). Insomnia was observed in 42% vs 40% (p= 0.838) and 24% vs 23% (p=0.955) had OSA.

Conclusion
There were no significant differences in clinical characteristics between patients with WUS and NWUS in this sample of Puerto Rican Veterans. OSA was less prevalent than previously reported. Lack of recognition of OSA as a risk factor for stroke and under-diagnosis of OSA might explain the study results.

Support
1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults
Authors: Agudelo C , Tarraf W , Wu B , Wallace D M , Patel S R , Redline S , Daviglus M L , Zee P C , Simonelli G , Levin B E , Mossavar-Rahmani Y , Sotres-Alvarez D , Zeng D , González H M , Ramos A R 
Published: May 2020

Abstract

Introduction
Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline.

Methods
We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use).

Results
At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p&lt;0.01), verbal learning (β=-0.0028, p&lt;0.001) and verbal memory (β=-0.036, p&lt;0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p&lt;0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change.

Conclusion
Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline.

Support
This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).
1148 Conceiving A Connected, Preventative Treatment Stance Across The Brain-gut-microbiota Axis In Prodromal Parkinson’s Disease: The Power Of Preventative Sleep Health
Authors: Chandler J F , Bullock M M , Chandler N G , Nelson S M , Hoyle S P , Guice J O 
Published: May 2020

Abstract

Introduction
Early non-motor symptoms of Parkinson’s Disease (PD) include sleep and digestive disturbances that share a common pathology via alpha-synuclein (AS) deposition in the central nervous system (CNS) and formation in the enteric (ENS). The concept of prodromal PD as expressed by the brain-gut-microbiota axis continues to gain credibility across multiple literatures; yet, no unified treatment plan has been suggested. Disconnected, symptomatic treatment of prodromal PD may unintentionally hasten its development via compromise of REM sleep quality and reciprocal gut health. A more connected, comprehensive approach is needed. We conducted a systematic literature review to hypothesize next steps in treatment research for prodromal PD.

Methods
A systematic literature review using the Boolean combinations of “ALPHA-SYNUCLEIN” & - “SLEEP”, “GUT MICROBIOME”, and “EXERCISE” in all fields, restricted to the last 5 years, focusing on specification of prodromal PD, was conducted. Results were combined with an examination of current treatment practices in PD.

Results
38 articles met inclusion criteria. Results were categorized through a presupposed primacy of sleep.

Conclusion
Due to the emerging nature of the prodromal PD idea, current treatment practice is myopic and may contribute to the progression of PD. Specifically, 1) sedative-hypnotic sleep interventions suppress REM, where clearing of CNS alpha-synuclein occurs, and 2) proton-pump inhibitors (PPI) cause significant gut dysbiosis, which may contribute to initial AS misfolding in the gut. Early identification of prodromal PD symptoms via cross-referenced clinical interview may allow for early behavioral interventions that underlie healthy brain-gut-microbiota axis functioning. Results outline specific measures that may slow PD-related synucleinopothies. The highest impact practices in this regard are REM-focused sleep hygiene and cardiovascular conditioning in a reciprocal relationship, highlighting the necessity of an early-intervention, preventative health model for conquering PD.

Support
This work was made possible in part by a donation from Drs. Shane Pitts and Michelle Hilgeman in support of Birmingham-Southern College’s Southern Sleep Laboratory.