bluuebunny/crossref_metadata_2025_split huggingface dataset:
775 The Relationship Between Sleep and Suicidal Ideation in College Students
Authors: Taneja Krishna , Tubbs Andrew , Fernandez Fabian-Xosé , Perlis Michael , Grandner Michael 
Published: May 2021

Abstract

Introduction
Suicide is the second-leading cause of death for young adults and insomnia increases suicide risk. However, the data on disrupted sleep and suicidal ideation in college students is mixed, including whether disrupted sleep fits into the framework of the Interpersonal Theory of Suicide. Therefore, the present study explored how four different sleep variables influenced recent suicidal ideation in a collegiate sample.

Methods
Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcome, active suicidal ideation in the last 3 months, was assessed using several self-report questions derived from the Columbia Suicide Severity Rating Scale. The predictors were weekday short sleep (≤6h; assessed by retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models estimated the associations between suicidal ideation and sleep variables in models that were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness (constructs from the Interpersonal Theory of Suicide).

Results
A total of N=121 (23.9%) respondents endorsed suicidal ideation in the last 3 months. Individuals with suicidal ideation were in poorer health (p&lt;0.001) and had more severe depression (p&lt;0.001) and anxiety (p&lt;0.001). In unadjusted models, individuals were more likely to report suicidal ideation if they had short sleep (OR 1.93 [1.23–3.05]), ISI scores of 8 or more (OR 3.01 [1.94–4.74]), and DDNSI scores of 10 or more (OR 2.66 [1.69–4.19]). Higher BRISC scores were associated with lower odds of suicidal ideation (OR 0.53 [0.41–0.68]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate any of these relationships.

Conclusion
Insomnia, short sleep, nightmares, and less perceived sleep control were all associated with recent suicidal ideation in college students. Moreover, these findings were generally independent of the Interpersonal Theory of Suicide. Further research is needed to understand how sleep affects suicide risk in this population, and whether sleep interventions can reduce this risk.
Support (if any):
778 Poor Sleep Quality is Associated with Reduced Myelination in Patients with Psychotic Disorders
Authors: Yuksel Cagri , Chen Xi , Watford Lauren , Gardner Margaret , Lewandowski Kathryn , Du Fei , Ongur Dost 
Published: May 2021

Abstract

Introduction
Recent studies show that sleep favors oligodendrocyte proliferation and myelination, and sleep loss is associated with alterations in white matter structure and decreased myelination. Psychotic disorders are characterized by disrupted white matter integrity, and abnormal axon and myelin structure. Despite common sleep disturbances in these disorders, little is known about the relationship between sleep quality and white matter findings. A novel in vivo neuroimaging technique that combines diffusion tensor spectroscopy (DTS) and magnetization transfer ratio (MTR) allows separately examining the axon structure and glial function, and myelin content, respectively. Using this method, we examined the association of sleep quality with white matter biology in a sample of patients with psychotic disorders and matched healthy controls.

Methods
Participants included patients diagnosed with bipolar disorder with psychotic features (euthymic or depressed, n=12) and schizophrenia spectrum disorders (n=9), and age and sex matched healthy controls (n=20). DTS and MTR data was collected from the right prefrontal white matter at 4T. DTS measures included apparent diffusion coefficients of water, NAA, creatine and choline. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI).

Results
PSQI total score was significantly higher in patients. and patient sample included a higher percentage of poor sleepers (PSQI total score&gt;5). In patients, total PSQI score and sleep onset latency were significantly and negatively associated with MTR (F=6.9, p=0.02 and F=9.7, p=0.007, respectively). There was no difference in any DTS measures between groups.

Conclusion
Our preliminary results show that poor sleep quality is associated with decreased myelin content in the frontal lobe, in patients with psychotic disorders. This finding suggests that sleep loss may be a mediator of white matter alterations in psychosis.

Support (if any)
This work is supported by National Institute of Mental Health K23MH119322 to Cagri Yuksel
782 Sleep restriction reduces feelings of interpersonal connectedness and social motivation
Authors: Palmer Cara , Powell Suzanna , John-Henderson Neha , Deutchman Dagny , Boylan Rebecca 
Published: May 2021

Abstract

Introduction
Feeling socially connected with others is essential for promoting and maintaining psychological health. Emerging research suggests that insufficient sleep may result in deleterious social outcomes such as greater reactivity to stressful social situations. However, little is known regarding how sleep may impact motivation to feel connected with others, and experiences of connectedness after positive social interactions.

Methods
Healthy participants (N = 56; 83.9% female, ages 18–30) were randomly assigned to one night of sleep restriction (SR, 4 h) or a night of typical sleep (TS, 8 h) in a controlled laboratory setting and verified with actigraphy. All participants did not have any known or suspected sleep or psychiatric disorders, were free of medical conditions and current medication use known to impact sleep and/or psychological functioning, and wore an actigraph for one week prior to the experimental night to ensure adequate sleep duration. Following the experimental night, participants reported on their motivation for social connectedness (e.g., “Right now, I would like to be close with friends, family, and significant others.”), and completed a task where they spent 5 minutes writing about a positive interpersonal event. After the task, participants reported on their feelings of interpersonal connectedness. Qualitative text analysis was conducted to extract emotional tone and number of social words used during the task.

Results
Compared to TS, participants undergoing SR were less motivated to feel connected with others [t(54) = -2.62, p = .01], and reported feeling less social connectedness after the task [t(53) = -2.06, p = .04]. Text analysis revealed no differences in positive or negative emotional tone, but participants in the SR group used less social words when describing their positive interpersonal event [F(1, 53) = 6.65, p = .01], even after adjusting for differences in total number of words used.

Conclusion
One night of sleep restriction reduces motivation to engage in social interactions, and also results in feeling less connected with others after reflecting on a positive social event. These findings add to a limited body of research on sleep and social experiences and provide further support for the negative psychological effects of sleep loss.
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785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?
Authors: Moore Jesse , Williams Ellita , Popp Collin , Briggs Anthony , Blanc Judite , Jean-Louis Giardin , Seixas Azizi 
Published: May 2021

Abstract

Introduction
Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep.

Methods
Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score &gt;13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models.

Results
On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= &lt;.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=&lt;.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not.

Conclusion
We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED.

Support (if any)
NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)
788 Is Dysphagia a Marker for Obstructive Sleep Apnea (OSA) in Traumatic Brain Injury (TBI) Patients: A VA TBI Model System Study
Authors: Matarese Christine , Nakase-Richardson Risa , Almeida Emily , Whyte John , Nallu Sagarika , Anderson William , Schwartz Daniel , Kieffer Kathryn 
Published: May 2021

Abstract

Introduction
Recent work has highlighted prevalent obstructive not central sleep apnea following traumatic brain injury (TBI). Treatment of comorbid OSA may facilitate neurologic recovery but widespread screening is limited. Mixed support exists for the presence of dysphagia as a biomarker of OSA in the general population and stroke patients. Dysphagia is common following TBI; however, no study has examined the relation between OSA and dysphagia in this cohort. Leveraging data from a recent six-center clinical trial of OSA and TBI during inpatient rehabilitation, this secondary analysis examined the association between OSA severity indices and proxy measures of dysphagia.

Methods
Level 1 polysomnography (PSG) was used to assess OSA (AHI ≥ 5 and ≥ 15) during inpatient rehabilitation for the overall sample (N=248; 203 male; 60.6% severe injury) evaluated at a median of 120.6 days post-TBI and subset ≤ 60 days post-injury. Dysphagia was approximated as the presence of a PEG tube and/or a modified texture diet (MTD) on the day of PSG. Chi square and Fisher’s Exact tests were utilized for group comparisons.

Results
As previously reported, OSA in this cohort was prevalent (68.2% (n=169) at AHI ≥ 5 and 33.5% (n=83) AHI ≥ 15) with predominantly obstructive events. 27.4% (n=68) met criteria for dysphagia combining proxy measures (34 peg; 49 MTD). No significant difference was found for presence of dysphagia across OSA severity cutoffs (AHI ≥ 5 & 15; p=0.1029 & 0.5959). When examining OSA across the individual proxy measures, persons without a peg tube were significantly more likely to have OSA at AHI ≥ 5 (62.5% vs 5.65%; p=0.0003) and AHI ≥ 15 (31.05% vs 2.42%; p=0.0353). When examining participants less than 60 days post-TBI, the group differences remained.

Conclusion
The incidence of dysphagia in TBI patients, as indexed by a modified diet or presence of a feeding tube, was not elevated in those with OSA. Sample bias (for undergoing Level 1 PSG and improvement facilitating inpatient rehabilitation admission) may have contributed to findings. Finally, future work with more sensitive indices of dysphagia is needed to accurately evaluate this association.

Support (if any)
PCORI (CER-1511–33005), NIIDLRR (90DPTB0004)
791 Association of Obstructive Sleep Apnea Severity and Novel Plasma Biomarkers of Alzheimer’s Disease Pathology
Authors: Bubu Omonigho , Turner Arlener , Umasabor-Bubu Ogie , Kam Korey , Mullins Anna , Parekh Ankit , Williams Ellita , Blanc Judite , Williams Natasha , Rapoport David , Varga Andrew , Ayappa Indu , Jean-Louis Giardin , Osorio Ricardo 
Published: May 2021

Abstract

Introduction
Recent evidence suggests novel plasma Alzheimer’s Disease (AD) pathology biomarkers have high potential for AD risk prediction. We determined whether obstructive sleep apnea (OSA) severity is associated with plasma levels of Aβ40, Aβ42, Aβ42/Aβ40, Tau, tau/Aβ42 and NfL and whether this relationship is dependent of amyloid burden.

Methods
Cross-sectional analysis of baseline data from 120 community-dwelling, cognitively normal older-adults, selected from ongoing NYU prospective longitudinal studies on memory, sleep and aging. Of the 120 participants, 70 had baseline CSF-Aβ42 (measured using ELISA). OSA-severity was defined using AHI4% criteria. Levels of plasma Aβ40, Aβ42, Tau and NfL were determined using single molecule array technology ultra-sensitive assays. Associations of OSA-severity and plasma AD-biomarker levels (n=120) were assessed using Pearson correlation analysis. The association of OSA-severity and AD plasma biomarkers dependent on CSF-Aβ42 levels (n=70) was assessed using generalized linear models. Analyses were adjusted for age, sex, BMI, race, education and APOE4.

Results
Of the 120 participants, 80 (67%) were women. Mean (SD) age was 69.1 (7.2) years. Mean (SD) AHI was 14.3/hr. (16.3) {48 (40%) had AHI &lt;5, 30 (25%) had AHI: 5 to ≤ 15, 18 (15%) had AHI: 15 to ≤30, and 22 (18%) had AHI &gt;30}. Independent of amyloid-burden, OSA-severity was associated with higher levels of plasma Aβ40 (r=.21, p-value=.02), plasma Aβ42 (r=.26, p-value=.01), plasma Aβ42/Aβ40 (r=.20, p-value=.05), but not plasma Tau, plasma tau/Aβ42 or plasma NfL. The association of OSA-severity and plasma levels of Tau, Tau/Aβ42 or NfL dependent on CSF-Aβ42 levels revealed significant interactions between CSF-Aβ42 levels and AHI (p-value &lt;.05 for all), with β-estimates suggesting that with combined increases in AHI and decreases in CSF-Aβ42 levels, there were corresponding increases in plasma levels of Tau, plasma Tau/Aβ42 or plasma NfL. The analysis was not powered for generating dichotomized strata specific (i.e. OSA+/Aβ+, OSA+/Aβ-, OSA-/Aβ+ and OSA-/Aβ-) estimates.

Conclusion
In this sample of cognitively-normal older- adults, OSA-severity was associated with levels of plasma Aβ40, Aβ42, Aβ42/Aβ40 and showed a synergistic effect with CSF Aβ42 on plasma levels of tau and NfL. Larger cohorts are necessary to delineate mechanisms and examine for OSA/Aβ strata-specific estimates.

Support (if any)
NIH/NIA/NHLBI (L30-AG064670, CIRAD-P30AG059303-Pilot, NYU-ADRC-P30AG066512-Developmental-Grant, AASM#231-BS-20)
806 Barriers to screening and diagnosis of obstructive sleep apnea during inpatient traumatic brain injury rehabilitation
Authors: Cotner Bridget , Nakase-Richardson Risa , Gius Becky , Fournier Lauren , Watach Alexa , Hoffman Jeanne 
Published: May 2021

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders.

Methods
Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation.

Results
Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures.

Conclusion
Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes.

Support (if any)
PCORI-NCT03033901
812 Competency Based Goals for Sleep Medicine Curriculum in Undergraduate Medical Education in India: A Survey
Authors: Nagendra Puneet , Thanasekaran Lingadevi 
Published: May 2021

Abstract

Introduction
Sleep is recognized the world over as very important in health and disease. But there is no articulated curriculum in undergraduate (UG) medical education in India. Whence incorporated, these learning objectives serve as an important bridge across multiple medical faculties like pulmonary medicine, neurology, ENT, psychiatry, and basic sciences.

Methods
After obtaining informed consent, a questionnaire-based electronic survey was circulated to clinical/non-clinical teaching medical faculties in December 2020. They were asked to prioritize the objectives of the sleep medicine curriculum for the UG medical education program. The objectives were listed under knowledge and skill-based competencies each having 9 and 10 questions respectively, scale rated 1–5. Objectives were enlisted from the previous studies, consensus statements and modified according to the local needs after face to face meetings with faculties involved in UG curriculum development.

Results
Out of 400 faculty members from different medical schools all over India, 127 had responded. None of the Indian institutions had sleep medicine in their UG curriculum. 112 (88%) members showed their interest to begin a UG program. The suggested sleep medicine curriculum proposes a vertical integration of competency-based goals into the core curriculum with a clinical angle which will require skill and knowledge-oriented modules. Amongst the knowledge-based competency, sleep loss and its health effects (77%) was more preferred than distinguishing sleep in newborns and adults (36%). Whereas in the skill-based competency providing advice on sleep hygiene (71%) was more preferred than sleep disturbances during pregnancy and menopause (33%). When our curriculum gets implemented, it is possible to provide exposure to sleep-related disorders early on for the UG’s. This will invoke their interest and thus serve to bridge the lacunae caused by the shortage of trained sleep specialists in India.

Conclusion
From our study, the learning objectives of the sleep medicine curriculum have been prioritized and are ready for implementation. The survey has also created awareness and interest amongst the Indian medical teaching faculty.
Support (if any):
813 Patient and Provider Experiences with CBT-I Administered In-Person or via Telemedicine
Authors: Gunter Paul , Gehrman Philip , Findley James , Kayser Matthew , Kuna Samuel , Frasso Rosemary 
Published: May 2021

Abstract

Introduction
CBT-I is the gold standard treatment for insomnia, but access to in-person care is limited, which has worsened due to the recent COVID-19 pandemic. While providers across spheres of care have rapidly pivoted to telehealth there have been few systematic comparisons of in-person treatments to telemedicine approaches. The current study, launched pre-COVID, aimed to examine the perspectives of patients who were randomly assigned to receive CBT-I in-person or via telemedicine. Additionally, provider reflections were collected.

Methods
Individuals with DSM5 Insomnia Disorder (n=60) were randomized to in-person CBT-I, telemedicine CBT-I or a wait-list control group. CBT-I was delivered over 6–8 weekly sessions by video telemedicine or in-person. This nested qualitative study addressed patient and provider perspectives on treatment approaches. A sample of participants from each group (n=36) were interviewed 3 months post-treatment. Phone interviews were audio recorded, transcribed and analyzed using a directed content analysis approach. Results were organized into thematic categories including 1) participant experience with CBT-I, 2) access issues and 3) accountability issues related to delivery approach. Additionally, participating providers (n=7) were interviewed and shared their reflections on delivering CBT-I in-person vs. telemedicine.

Results
Patients reflected positively on CBT-I, and this did not vary across treatment groups. Patients and providers noted telemedicine benefits related to access that included, but were not limited to, reducing transportation barriers to treatment and improved continuity of care (e.g. not having to cancel an appointment if a patient was traveling). Patients and providers shared concerns they had anticipated pre-treatment about possible telemedicine related technological hurdles and barriers to establishing meaningful rapport on-line. However, they reported that these concerns did not prove to be barriers to effective telemedicine visits.

Conclusion
This qualitative study allowed patients and their providers to reflect on their experience delivering in-person vs telemedicine CBT-I. CBT-I was accepted well regardless of delivery approach. Telemedicine is currently being deployed widely and this study provides a systematic comparison between approaches.

Support (if any)
This study was supported by the American Sleep Medicine Foundation.