bluuebunny/crossref_metadata_2025_split huggingface dataset:
232 COVID stress and sleep disturbance among a racially/ethnically diverse sample of adolescents: Analysis from the NESTED study
Authors: Seixas Azizi , Honaker Sarah , Wolfson Amy , Wahlstrom Kyla , Owens Judith , Wong Patricia , Saletin Jared , Tsvetovat Maksim , Carskadon Mary , Meltzer Lisa 
Published: May 2021

Abstract

Introduction
Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance.

Methods
Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors.

Results
Sleep disturbance was prevalent among adolescents (89% above average, T-score &gt;50); about two-thirds (64.4%) reported greater stress due to the pandemic. Compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents. Chi-square analysis indicated that both race/ethnicity (□2 = 14.96, p&lt;.05) and SVI (□2 = 8.34, p&lt;.05) had an effect on sleep disturbance. HBLR analysis indicated that compared to pre-pandemic, adolescents reporting “little stress” (OR=.70, 95% CI= .49-.99, p=.04) or “the “same amount of stress” (OR=.64, 95% CI= .47-.89, p=.007) had lower odds of sleep disturbance. Higher depression (OR=1.06, 95% CI=1.04-1.07, p&lt;.001) and anxiety (OR=1.05, 95% CI=1.04-1.07, p&lt;.001) symptoms increased odds of sleep disturbance, while male gender lowered odds of sleep disturbance (OR=.11, 95% CI=.015-.86, p&lt;.05). Overall, race/ethnicity (p=.44) and SVI (p=.45) did not independently predict sleep disturbance. Race/ethnicity stratified analyses indicated that for Black and Hispanic adolescents, being in grades 11/ 12 and depression predicted sleep disturbance; and for Asian adolescents SVI and anxiety predicted sleep disturbance.

Conclusion
COVID-related stress and symptoms of depression and anxiety are associated with sleep disturbance. We observed differences in sleep disturbance across racial/ethnic groups and neighborhood social vulnerability strata, for specific racial/ethnic groups.

Support (if any)
AS was supported by funding from the NIH (K01HL135452, R01HL152453)
254 Validation of a Non-Wearable Sleep Tracking Device in Healthy Adults Under Normal and Restricted Sleep Conditions
Authors: Hsiou David , Gao Chenlu , Pruett Natalya , Scullin Michael 
Published: May 2021

Abstract

Introduction
Polysomnography (PSG) is the gold standard for measuring sleep, but this method is cumbersome, costly, and sometimes does not reflect naturalistic sleep patterns. Leading technology companies have developed non-wearable sleep tracking devices that have attracted public interest. However, the accuracy of these devices has either been shown to be poor or the validation tests have not been conducted by independent laboratories without potential conflicts of interest. Relative to PSG and actigraphy, and under conditions of both normal and restricted sleep, we assessed the accuracy of early and newer versions of a non-wearable sleep tracking device (Beddit, Apple Inc.).

Methods
Participants were 35 healthy young adults (Mage=18.97, SD=0.95 years; 77.14% female; 42.86% Caucasian). We randomly assigned them to go to bed at 10:30pm (normal sleep) or 1:30am (restricted sleep) in a controlled sleep laboratory environment. Lights-on was 7:00am for all participants. Sleep was measured by the early version (3.0) or newer version (3.5) of a non-wearable device that uses a sensor strip to measure movement, heart rate, and breathing. We also measured PSG, wristband actigraphy, and self-report. For each device, we tested accuracy against PSG for total sleep time (TST), sleep efficiency (SE%), sleep onset latency (SOL), and wake after sleep onset (WASO).

Results
While the early version displayed poor reliability (ICCs&lt;0.30), the newer version of the non-wearable device yielded excellent reliability with PSG under both normal and restricted sleep conditions. Not only was agreement excellent for TST (ICC=0.96) and SE% (ICC=0.98), but agreement was also excellent for the notoriously difficult metrics of SOL (ICC=0.92) and WASO (ICC=0.92). This newer version significantly outperformed clinical grade actigraphy (ICCs often in the 0.40 to 0.75 range), and self-reported sleep (ICCs often below 0.40).

Conclusion
Surprisingly, a non-wearable device demonstrated greater agreement with PSG than clinical grade actigraphy. Though the field has generally been skeptical of commercial non-wearable devices, this independent validation provides optimism that some such devices would be efficacious for research in healthy adults. Future work is needed to test the validity of this device in older adults and clinical populations.

Support (if any)
National Science Foundation (1920730 and 1943323)
264 Field Test of Sound Machine Shows Significant Improvement in Perceived Sleep but Not Objective Sleep
Authors: Danoff-Burg Sharon , Rus Holly , Rodriguez Rodolfo , Weaver Morgan , Raymann Roy 
Published: May 2021

Abstract

Introduction
Ambient sound can mask external environmental noise, reducing sleep disturbances. Recently there has been a call for research with objective sleep measures examining noise as a sleep aid. This study investigated whether using a sound machine (Sound+Sleep SE) would improve sleep in healthy adults whose objective sleep data indicated difficulty falling asleep or waking up frequently during the night. In-home field testing provides insight into the effectiveness of sleep products under real-life conditions, yielding more ecologically valid results.

Methods
A within-subjects, pre-post intervention design was implemented, comparing a 2-week baseline period to 2 weeks of nightly product use. Participants (n=30) measured their sleep nightly using SleepScore by ResMed technology. Sleep experience questionnaires were completed before and after product use. Participants were instructed to use their preferred settings and sound options for the duration of the product use period and to refrain from using other types of sounds for sleep. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
Across participants (63% male; age 28-72, avg. 53), there were 725 nights of tracked sleep. Multilevel analyses revealed no significant differences in objectively-measured sleep outcomes. However, improvements were seen in many aspects of self-reported sleep while using the sound machine: 30% decrease in perceived minutes to fall asleep (p&lt;.05); 76% increase in perceived ability to sleep through the night (p&lt;.001); 37% increase in perceived sleep quality (p&lt;.01); and 46% increase in feeling rested upon waking in the morning (p&lt;.001). Additionally, at the beginning of the study, 60% of participants reported having racing thoughts or worrying when trying to fall asleep. While using the sound machine, only 30% of participants experienced this concern.

Conclusion
Participants perceived a variety of benefits from sound machine use, even though these improvements were not observed in their objective sleep data. Given that adjustment to any product used during sleep varies from person to person, it is possible that changes in the objective sleep data might have been observed if the product use period had been longer. This study adds to the ongoing discussion of using noise as a sleep aid.

Support (if any)
ASTI
266 Contact-free Snoring Solution Reduces Objectively-measured Snoring and Improves Bed Partners’ Objectively-measured Sleep
Authors: Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Rodriguez Rodolfo , Raymann Roy 
Published: May 2021

Abstract

Introduction
Snoring can disturb the sleep of snorers as well as their bed partners. Recent technological advances allow objective measurement of sleep and snoring in the comfort of the bedroom. This study examined effects of a non-medical contactless snoring solution on snoring and sleep in snorers and their partners.

Methods
Self-reported snorers (n=29; 72% male; age 25-59 years, avg. 43; BMI&lt;30) with non-snoring bed partners tracked their snoring nightly with the Do I Snore or Grind app while using the snoring solution at home (527 total nights across participants). During this time, partners tracked their own sleep nightly using ResMed S+. In addition, self-report data were collected from both snorers and partners. A within-subjects, pre-post design was used, comparing a 2-week baseline period to 2 weeks of nightly product use. Multilevel regression and paired t-tests were used to test for statistical significance. The snoring solution (Smart Nora) included a pillow insert that gently inflates when early sounds of snoring are detected, enabling breathing to return to normal.

Results
Objectively-measured average snoring reduced from 10% of the night when not using the product to 9% during the first week of use and 7% during the second week of use (p&lt;.05). Partners perceived the snoring as less loud and less severe when the product was used. At the end of the study, no partner described the snoring as severe. Objectively-measured sleep of partners revealed a 16% decrease in wake after sleep onset (p&lt;.05). Prior to product use, they spent an average of 38 minutes awake after falling asleep (approximately 9% of their sleep period). This decreased to 34 minutes during the first week of product use and to 32 minutes during the second week. Product use also led to improvements in the perceived sleep of snorers and their partners, including ability to sleep through the night without waking up, overall sleep quality, and feeling rested upon waking in the morning (all ps&lt;.05).

Conclusion
By reducing the amount of snoring, the contactless snoring solution improved objectively-measured sleep in snorers’ bed partners. Also, the perceived sleep of both snorers and their partners improved.

Support (if any)
Smart Nora
276 The Actigpatch: validation of a novel adhesive monitor against PSG and wrist-actigraphy
Authors: Saletin Jared , McGeary John , Carskadon Mary 
Published: May 2021

Abstract

Introduction
Wrist actigraphy is a gold-standard method for estimating sleep patterns in the field. Actigraphy adherence is limited when participants remove the device for daily activities (e.g., showers, exercise). Here we evaluate the validity of a novel water-resistant wearable, the “Actigpatch,” compared to polysomnography and traditional actigraphy.

Methods
Seven adults (4F; aged 22-54 years [m: 31.1±13.1]) slept in the laboratory for a total of 33 nights. Participants wore a Micro Motionlogger actigraphy (Ambulatory Monitoring Inc., Ardley, NY) on the non-dominant wrist and the Actigpatch—a 0.5in2 circuit board enclosed in a water-resistant adhesive (Circadian Positioning Systems, Newport, RI)—on the triceps. Both devices recorded tri-axial accelerometry, with sleep-wake estimates produced in 1-minute epochs (Sadeh algorithm). Simultaneous PSG data were reduced to 1-minute resolution favoring wake, keeping with recent recommendations. We computed epoch-by-epoch confusion matrices and derived 2 validation parameters: sensitivity (e.g., ability to detect sleep) and specificity (e.g., ability to detect wake). Finally, we compared total sleep time estimates (TST) to evaluate the bias of each device. Nested mixed models (nights within individuals) compared device performance.

Results
The Actigpatch demonstrated high sensitivity (.95; 95%CI: [.92 .98]) and specificity (.89; [.86, .91]) against polysomnography. Similar sensitivity (.96; [.94, .99]) and specificity (.84; [.78 .91]) were found comparing the Actigpatch to the Motionlogger. Comparing the devices’ validity with PSG, sensitivity was not statistically different between the Actigpatch and Motionlogger (b=.0041, t=0.56; p=.58); however, the Motionlogger demonstrated higher specificity (.95; [.92, .97]) compared to the Actigpatch (b=0.065, t=4.69; p&lt;.001). To that end, TST estimates were longer (p=.016) for the Actigpatch (449min; [428, 471] relative to the Motionlogger (438min; [416, 459]).

Conclusion
These data indicate that the adhesive “Actigpatch” is as sensitive to detect polysomnographic-confirmed sleep as a common research-grade actigraph. The Actigpatch may be less capable of detecting wake episodes. Unlike traditional actigraphs, the Actigpatch can be worn continuously for 3 weeks without risk of water or impact damage. Participants are not responsible for remembering to wear the device. Field studies, or studies in populations struggling with adherence (e.g., children) may benefit from wearable monitors such as the Actigpatch.

Support (if any)
R01AA025593, Circadian Positioning Systems
279 WACSAW: A Statistical and Individually Adaptive Method to Determine Sleep and Wakefulness from Activity
Authors: Vandegriffe Austin , Samaranayake V A , Thimgan Matthew 
Published: May 2021

Abstract

Introduction
Technological innovations have broadened the type and amount of activity data that can be captured in the home and under normal living conditions. Yet, converting naturalistic activity patterns into sleep and wakefulness states has remained a challenge. Despite the successes of current algorithms, they do not fill all actigraphy needs. We have developed a novel statistical approach to determine sleep and wakefulness times, called the Wasserstein Algorithm for Classifying Sleep and Wakefulness (WACSAW), and validated the algorithm in a small cohort of healthy participants.

Methods
WACSAW functional routines: 1) Conversion of the triaxial movement data into a univariate time series; 2) Construction of a Wasserstein weighted sum (WSS) time series by measuring the Wasserstein distance between equidistant distributions of movement data before and after the time-point of interest; 3) Segmenting the time series by identifying changepoints based on the behavior of the WSS series; 4) Merging segments deemed similar by the Levene test; 5) Comparing segments by optimal transport methodology to determine the difference from a flat, invariant distribution at zero. The resulting histogram can be used to determine sleep and wakefulness parameters around a threshold determined for each individual based on histogram properties. To validate the algorithm, participants wore the GENEActiv and a commercial grade actigraphy watch for 48 hours. The accuracy of WACSAW was compared to a detailed activity log and benchmarked against the results of the output from commercial wrist actigraph.

Results
WACSAW performed with an average accuracy, sensitivity, and specificity of &gt;95% compared to detailed activity logs in 10 healthy-sleeping individuals of mixed sexes and ages. We then compared WACSAW’s performance against a common wrist-worn, commercial sleep monitor. WACSAW outperformed the commercial grade system in each participant compared to activity logs and the variability between subjects was cut substantially.

Conclusion
The performance of WACSAW demonstrates good results in a small test cohort. In addition, WACSAW is 1) open-source, 2) individually adaptive, 3) indicates individual reliability, 4) based on the activity data stream, and 5) requires little human intervention. WACSAW is worthy of validating against polysomnography and in patients with sleep disorders to determine its overall effectiveness.
Support (if any):
289 Rack curtains improve sailors’ sleeping conditions in berthing compartments of the United States Navy (USN) ships
Authors: Matsangas Panagiotis , Shattuck Nita , Clifton Heather 
Published: May 2021

Abstract

Introduction
Ambient light is one of the primary factors affecting sailor sleep in berthing compartments on USN ships. Each “rack” (i.e., bunk) has a curtain, however, intended only for privacy. Current rack curtain specifications do not address light-blocking properties. We assessed the effects of replacing existing, standard rack curtains with enhanced rack curtains that provide superior light-blocking in the sleeping environment.

Methods
Longitudinal (~2 weeks), naturalistic observation of sailors (N=52; 41 enlisted personnel) on a USN destroyer during deployment. The standard curtain was used for one week followed by one week with the enhanced light-blocking curtain. Sleep-related attributes (Epworth Sleepiness Scale–ESS, Insomnia Severity Index–ISI, Pittsburgh Sleep Quality Index–PSQI) were assessed at the end of each week. Actigraphy and rack temperature data (both inside and outside the rack) were collected throughout the study. Results are presented as median±median absolute deviation.

Results
Participants slept on average 6.8±1.0 hours/day. ESS scores improved with decreases from 9.0±3.0 with standard curtains to 7.0±3.0 with the enhanced curtains (p=0.020). Sailors with normal daytime sleepiness improved from 33 (63.5%) with standard curtains to 40 (76.9%) with the enhanced curtains. ISI scores decreased from 11.0±3.0 to 8.0±2.0 in the two conditions (p&lt;0.001). The number of Sailors with ISI scores ≥15 decreased from 11 (21.2%) with standard curtains to 8 (13.5%) with the enhanced curtains (p=0.103). PSQI scores (8.0±2.0), however, did not change between the control and the intervention periods (p=0.527). Preliminary analysis showed that, compared to outside the rack, temperature inside the rack was slightly warmer on average with new curtains (~1 °F; p=0.096).

Conclusion
Our results suggest that the enhanced curtains reduced average daytime sleepiness and severity of insomnia symptoms. A greater difference in rack temperature with the enhanced curtains was observed; however, this may be attributed to the ship sailing in southern latitudes during the intervention period. Ongoing analysis will provide more insight on the utility of the enhanced curtains and their efficacy in improving sleeping conditions.

Support (if any)
Supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.
291 A Pilot Study of Light Management in the US Navy
Authors: Shattuck Nita , Matsangas Panagiotis 
Published: May 2021

Abstract

Introduction
Exposure to light at appropriate times can improve alertness and mood; however, light can also interfere with sleep if exposure occurs before bedtime. Therefore, light management is important for sailor well-being and operational performance. One approach to administer light in field settings is to use personal wearable devices. This pilot study assessed the challenges in using the blue-light blocking goggles (BLBG) and light emitting goggles (LEG) for crewmembers of a US Navy ship while underway.

Methods
Longitudinal (~2 weeks) assessment of sailors (N=18) during deployment. Sailors completed a questionnaire asking whether they used the devices, reasons (if any) they may have had for not using the devices, what they liked/did not like about the devices, and whether wearing the devices made a difference in terms of fatigue, alertness, ability to fall asleep, and reported sleep quality.

Results
Sailors reported that the LEGs seemed to increase alertness (n=8) and helped wake up faster (n=5), but the devices were bulky/heavy (n=9), too bright (n=4), and made it difficult to see in dim light (n=2). The reported reasons for not using the devices include: the devices were heavy/uncomfortable (n=5), they caused eye strain (n=4), and the LEGs interfered with sailor ability to see while on watch (n=3). Also, wearing the LEGs made sailors feel less tired (71%) and more alert (59%). Sailors reported that the BLBGs kept them drowsy before bed (n=3) and reduced eye strain (n=5). Sailors complained, however, that BLBGs were bulky/inconvenient (n=3). When not wearing the BLBGs, it was because the devices were easy to forget (n=2), sailors had to work after their shift (n=2), and other reasons (n=3). Wearing the BLBGs during watch made falling asleep easier (47%) and improved sleep quality (47%).

Conclusion
This study provided valuable insight regarding the use of personal wearable light management devices in field settings. Even though not conclusive, our results are promising. We will continue assessing the utility of such devices with a goal of improving sailor well-being and operational performance.

Support (if any)
Supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.
292 Rest Schemes and Inflight Sleep Duration on Long Range and Ultra-Long Range Commercial Airline Routes
Authors: Rempe Michael , Rasmussen Ian , Belenky Gregory , Lamp Amanda 
Published: May 2021

Abstract

Introduction
Pilots flying long range (LR; 8-16 hour) and ultra-long range (ULR; 16+ hour on 10% of trips) commercial airline routes use a variety of work/rest schedules during flights, resulting in a wide distribution of total inflight sleep time (TIFS) amounts. Since sleep is a strong predictor of performance, it is important to quantify TIFS and determine rest scheme patterns that optimize sleep opportunity and subsequent alertness and performance. Here we report rest schemes for pilots on LR and ULR routes and longer TIFS values than previously reported. These rest schemes can serve as templates to increase TIFS and improve pilot performance, particularly on ULR routes.

Methods
427 commercial airline pilots provided data for this sub-study that was part of a larger study on Fatigue Risk Management System (FRMS) routes. Inflight sleep timing and duration were measured on 3 LR and 5 ULR routes. Inflight sleep times were self-reported in a sleep/work logbook and verified using actigraphy.

Results
Most outbound and inbound landing crews took one break during the second half of the flight (average LR TIFS=4.0 hr; average ULR TIFS=4.9 hr), while most outbound and inbound relief crews consequently took one break during the first half of the flight (average LR TIFS=3.5 hr; average ULR TIFS=4.5 hr). However, three of the five ULR routes used more complex split rest schemes for landing and relief crews, primarily on outbound flights (average TIFS=5.0 hr). Across all routes and both crews, the maximum average TIFS reached ~6 hours.

Conclusion
Our results indicate that pilots on average are sleeping inflight more than previous studies demonstrated. Additionally, we found that crews on some ULR flights used more complicated rest schemes, but still generally preferred 2 or 3 breaks. These findings have implications for airline procedures and aviation policies by showing that pilots may be sleeping longer than originally expected on LR and ULR flights. Recommending rest schemes that allow for the greatest inflight sleep opportunity may provide the best chance for inflight recuperation, especially before the Top of Descent critical phase of flight.

Support (if any)
United Airlines