bluuebunny/crossref_metadata_2025_split huggingface dataset:
638 Sleep and circadian markers of BMI in a diverse sample of 9-year old children from the Fragile Families Child and Wellbeing Study
Authors: Chung Alicia , Moore Jesse , Jin Peng , Nunes Joao , Jean-Louis Giardin , Seixas Azizi 
Published: May 2021

Abstract

Introduction
Hispanic and Black school-age children from low-income communities experience disproportionate rates of obesity (26% Hispanic, 22% Black) compared to their White counterparts (14%). Sleep patterns and circadian regulation of biological markers are associated with BMI status. However, little is known about racial and ethnic disparities in circadian regulation among children of color. These suggest that it is important to investigate biological markers that could help delineate associations between sleep-circadian regulation and obesity among children of color. Serotonin transporter gene, a neurotransmitter associated with circadian rhythm regulation, has emerged as an important biological variable. In this study, we investigated whether this factor could serve as a proxy for studying associations of circadian rhythm regulation with weight status in this diverse sample.

Methods
Statistical analysis included descriptive and linear regression analysis of the wave 5, Year 9 cohort of the Fragile Families Child and Wellbeing Study dataset. Interviews were conducted with the participant child around their ninth birthday for data collection on home routines and other parent relationship and school connectedness variables. Biological variables were derived from saliva samples at Year 9 to assess telomere length and DNA methylation levels and changes. Variables of interest included sleep duration, sleep timing, and biological variables 5httlpr (insomnia and sleep quality), skin 2 (serotonin transporter), telomere length (stress) and rs9939609 (fat mass and obesity), with BMI as the outcome.

Results
The final sample of 466 children comprised 52% male were 9 years old. Participants’ race was: 35% White, 46% Black, 20% Hispanic, 4% Asian and 5% other. Median family income was $42,500. Sleep duration obtained from these children was negatively associated with BMI (β = -0.245 with p=0.022). We found that gk5stin212 (serotonin transporter gene) was positively associated with BMI (β = 0.991, p = 0.009), while no significant associations was found for genetic variable gk5stin210.

Conclusion
Circadian rhythm dysregulation may serve as a biological mechanism driving overweight or obesity among minority children. Lifestyle and behavioral interventions aimed at the family unit may be needed to modify household and environmental factors that affect circadian regulation among children.

Support (if any)
NIH (T32HL129953), K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
641 The status of life satisfaction and physical stress experience among children with sleep related issues: PROMIS approach
Authors: Xu Sarah , Miller Michael , Maddalozzo John , Issa Yazan , Bhushan Bharat 
Published: May 2021

Abstract

Introduction
To identify the status of health-related quality of life (HR-QoL) domains in children with sleep disturbance.

Methods
Patients ages 5–17 years visiting sleep laboratory from 09/2019 to 01/2020 for overnight PSG participated in the study. Age and sex matched control participants were seen in general pediatrics during 02/2020 for issues other than sleep disturbance. HR-QoL was assessed by PROMIS V1.0 questionnaires. Statistical analysis was conducted using R 3.6.0.

Results
122 patients were included in the final analysis: 70 males (57.4%). Ninety nine (81.15%) patients were included from the sleep laboratory and 23 (18.85%) controls were recruited from the department of pediatrics. Among the patients visiting sleep laboratory, thirty one (25.4%) had mild OSA, 12 (9.8%) moderate OSA, 19 (15.6%) severe OSA, 37 (30.3%) were diagnosed with No-OSA. Twenty three (18.9%) controls were visiting to the hospital for their routine wellness examination requiring no PSG. Severity of OSA was not correlated with any HR-QoL domain. Patients visiting the sleep laboratory had lower life satisfaction (p=0.05) and higher physical stress experience (p=0.005). Age, BMI were negatively and N3 sleep was positively associated with family relations (p&lt;0.001, 0.03, 0.006, respectively). N3 sleep was positively and age was negatively associated with life satisfaction (p&lt;0.001, p=0.003, respectively). Increase in arousals was associated with increased physical stress experience (p=0.03). N3 sleep and anger were negatively associated with each other (p=0.05).

Conclusion
Children visiting sleep laboratory had higher physical stress experience and lower life satisfaction as compared to controls. Deep sleep was associated with problems with family relations, life satisfaction and anger. Regression analysis suggested that age was negatively associated with family relations and life satisfaction.

Support (if any)
None
646 The Impact of the COVID-19 Pandemic on Nighttime Room Entries and Sleep Disruptions for Pediatric Patients
Authors: Riehm Joseph , Arora Vineet , Tatineni Swetha , Erondu Amarachi , Mozer Christine , Cook David , Byron Maxx , Mordell Lisa , Ye Fanheng , Orlov Nicola 
Published: May 2021

Abstract

Introduction
Sleep is critical to children’s health and recovery, but pediatric inpatient sleep is often disrupted by nonessential overnight interruptions. The COVID-19 pandemic necessitated social distancing policies which minimized contact with low-risk patients. These policies have the potential to decrease overnight disruptions and improve sleep for hospitalized patients.

Methods
This cohort study compared sleep disruptions for pediatric inpatients admitted prior to (Sep 2018 – Feb 2020) and during (Apr 2020 – Aug 2020) the COVID-19 pandemic at a single site, urban academic medical center. Objective disruptions were measured as room entries detected by hand hygiene sensors for occupied rooms pre-pandemic (n_average=56) and during the pandemic (n_average=48) for 69 and 154 nights, respectively. Subjective reports of overnight disruptions, sleep quantity, and caregiver mood were measured by surveys adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale. Caregivers of a convenience sample of pediatric general medicine inpatients completed surveys. Caregivers pre-pandemic were surveyed in person, and during the pandemic, surveys were conducted over the phone.

Results
293 pre-pandemic (age_patients=4.1±4.4 years) and 154 pandemic (age_patients=8.7±5.6 years) surveys were collected from caregivers. The majority (71% pre-pandemic and 52% pandemic) of the study population identified as Black/African American. Nighttime room entries initially decreased 36% (95% CI: 30%, 42%, p&lt;0.001), then returned towards pre-pandemic levels as the COVID-19 hospital caseload decreased. Despite this, caregivers reported more disrupted patient sleep (p&lt;0.001) due to tests (21% vs. 38%) as well as stress (30% vs. 49%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 minutes less (95% CI: 12 min, 110 min, p&lt;0.001) and had more awakenings. Caregivers self-reported feeling more sad and weary, less calm, and worse overall (p&lt;0.001 for all).

Conclusion
Despite fewer objective room entries, caregivers reported increased sleep disruptions and an hour less nighttime sleep with more awakenings during the pandemic for pediatric patients. Caregivers also self-reported worse mood. This highlights the importance of addressing subjective perceptions and experiences of hospitalized children and their caregivers during hospitalization.
Support (if any):
649 Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic
Authors: Tracy Eunjin , Chin Brian , Matthew Lehrer H , Carroll Lucas , Buysse Daniel , Hall Martica 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic is an enormous stressor that can impact various dimensions of health, including sleep health. Older adults may be particularly vulnerable. Coping strategies to manage stress can also impact health outcomes by modifying the relationships between perceived stress and health outcomes. This study examined concurrent and longitudinal associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether coping strategies moderate these associations.

Methods
Older adults (n = 115; Mage = 68.62, 58.3% female) reported perceived stress (PSS), coping strategies (Brief COPE), global sleep quality (PSQI global sleep quality score and dichotomous good/poor sleep quality), depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12) before and during the COVID-19 pandemic.

Results
The number of individuals with poor sleep quality was greater during the COVID-19 pandemic than before (50% vs. 36.5%). Participants also reported poorer physical health during the COVID-19 pandemic than before. Hierarchical linear regression and hierarchical logistic regression revealed that higher perceived stress was cross-sectionally associated with poorer sleep (e.g., higher total PSQI score and dichotomous sleep quality category). Higher perceived stress was associated with worse depressive symptoms and global mental health concurrently and longitudinally. Coping strategies moderated the relationships between perceived stress and physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health for those who have lower problem-focused coping—but not for those with higher problem-focused coping—both concurrently and longitudinally.

Conclusion
Perceived stress influences cross-sectional and longitudinal measures of sleep health and general health among older adults during the COVID-19 pandemic. Coping strategies can moderate the effects of perceived stress on health outcomes. Older adults may benefit from prevention and intervention strategies targeting stress management and problem-focused coping strategies.

Support (if any)
This research was supported by the National Institute of Aging (R01AG047139), the National Heart, Lung, and Blood Institute (T32HL007560; T32HL082610), and the National Institute of Mental Health (T32MH019986)
658 Adjusting Fire - Piloting an Online Sleep Class in a U.S. Air Force Population in Response to COVID-19 Patient Care Restrictions
Authors: Patience Marc , Estevez Burns Rosemary , Cassidy Daniel 
Published: May 2021

Abstract

Introduction
Sleep problems remain problematically prevalent among U.S. service members. In 2015 over 60% of sampled service members reported getting less than 7 hours of sleep per night, 31.4% getting 5 hours or less, and nearly 50% reported subthreshold insomnia symptoms on the Pittsburgh Sleep Quality Index. Ongoing COVID-19 service delivery restrictions necessitate a rapid shift to virtual health solutions and illuminate barriers to the delivery of sleep interventions. This process improvement pilot was a proof-of-concept during uncertain times.

Methods
From September to January 2020, 10 weekly 1-time, 60-min virtual sleep classes were held over Microsoft Teams. Interventions were consistent with Motivational Interviewing and Brief Behavioral Treatment for Insomnia. Participants completed the STOP BANG and Insomnia Severity Index (ISI) before each class, and accomplished the ISI again at a 2-week contact during which they rated progress toward problem resolution and were offered additional clinical services as-needed.

Results
Forty-six participants attended the class. 67% responded to the post-class survey. 74% responded to the two-week follow-up. A majority (84%) indicated either agreement or strong agreement with the statement ’I plan to CHANGE a behavior or TRY an intervention I learned to better my sleep’, and many proceeded to establish a more consistent sleep schedule (n=14; 45%), remove electronics from the bedroom (n=13; 42%), and/or go to bed only when sleepy (n=11; 35%). 84% would recommend this class to others with similar concerns. Scaled from 1 (‘no change’) to 10 (‘full resolution’), participants reported having derived modest benefit from the intervention (M = 4.1, SD=1.7). Eleven (35%) denied need for additional sleep-related services, and 84% expressed intent to recommend the class to others with similar concerns.

Conclusion
Results suggest a military population is receptive to a 1-time, virtual sleep class consistent with social distancing strictures. This service provided patients rapid access to care while contemporaneously reducing demand for time-intensive one-to-one appointments. As hypothesized, receipt of the intervention was associated with intention to modify sleep-relevant behavior, and with meaningful progress toward resolution of sleep difficulty as assessed at 2-week follow-up. Broadly disseminated, this intervention could introduce an internet-based, stepped-care approach to management of sleep insufficiency across the DoD.
Support (if any):
661 Chronotype, Mood, and Diabetes-Related Distress in Adults with Type 2 Diabetes
Authors: Jeon Bomin , Chasens Eileen 
Published: May 2021

Abstract

Introduction
Chronotype refers to an individual’s preferred timing of sleep and wakefulness, which can be classified as ‘normal’ or ‘late’ chronotypes. The purpose of this study was to examine whether late sleep timing was associated with impaired mood and diabetes-related distress in persons with type 2 diabetes (T2D).

Methods
The study is a secondary analysis of pooled cross-sectional baseline data from two studies of treatment of obstructive sleep apnea (R01-DK96028) and insomnia (K24-NR016685) in persons with T2D. Sleep timing was measured by the bedtime from a 7-day sleep diary. “Normal” sleep timing was defined as bedtime between 9PM to 12AM ≥ 85% per week. “Late” sleep timing as bedtime after 12AM with normal sleep timing &lt; 85% per week. Other sleep variables evaluated were sleep duration, daytime sleepiness (Epworth Sleepiness Scale [ESS]), and OSA severity (apnea-hypopnea index [AHI]). The Profiles of Mood States measured Total Mood Disturbance (TMD) and the subscales of Tension-Anxiety (T-A), Depression-Dejection (D-D), Anger-Hostility (A-H), Vigor-Activity (V-A), Fatigue-Inertia (F-I), and Confusion-Bewilderment (C-B). Diabetes-related distress was measured by the Problem Areas in Diabetes (PAID). Hierarchical multiple regression was performed to determine whether sleep timing was associated with mood and diabetes-related distress.

Results
The sample (N=296) had 61% with late sleep timing (n=181). Persons with normal vs late sleep timing were similar in age, sex, race, and education (p &gt;.05). Persons with late sleep timing were less likely to be partnered, had shorter sleep duration and greater mood impairment (TMD and T-A, D-D, A-H, C-B subscales) than those with normal timing (all p values &lt;.05); there was no significant difference by sleep timing in PAID scores (p=.256). Hierarchical regression analyses adjusting for demographics (age, sex, race, marital status, education level), clinical (HbA1c, BMI), and sleep variables (sleep duration, ESS, AHI) revealed that late sleep timing was not significantly associated with impaired mood (TMD and subscales) or PAID. However, ESS was statistically significant in predicting greater TMD (β=.310, p &lt;.001), mood subscales (all p-values &lt;.05) and PAID (β =.222, p &lt;.001).

Conclusion
Daytime sleepiness, not late sleep timing, is a significant sleep-related symptom for increased mood impairment and diabetes-related distress in persons with T2D.
Support (if any):
667 Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: A pilot study
Authors: Reutrakul Sirimon , Martyn-Nemeth Pamela , Quinn Laurie , Danielson Kirstie , Rydzon Brett , Baron Kelly , Duffecy Jennifer 
Published: May 2021

Abstract

Introduction
Experimental and epidemiological data have linked insufficient sleep to increased diabetes risk. Women with a history of gestational diabetes (GDM) have a 7-fold greater risk of developing type 2 diabetes. This pilot study explored the feasibility of a sleep extension intervention in women with a history of GDM and short sleep, and the effects on glucose metabolism.

Methods
Women age 18–45 years with a history of GDM (at least 1 year postpartum) and actigraphy confirmed short sleep duration (&lt;7h/night) on weekdays were randomized at a ratio of 1 control (healthy living information) to 2 cases (6 weeks of “Sleep Extend” intervention: use of a Fitbit, weekly digital content, interactive tools, and coach delivered feedback in order to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording and questionnaires were obtained at baseline and 6 weeks (at the end of the intervention).

Results
Twelve women (mean (SD) age 40.3 (4.5) years) participated (n=8 Sleep Extend, n=4 control). Compared to baseline, nightly sleep duration increased in Sleep Extend group (+30.6 (48.8) minutes) but decreased in the control group (-6.8 (22.9) minutes). Both fasting and 2-h glucose levels from OGTT increased in both groups but were greater in the control group (Sleep extend vs. healthy living: fasting glucose +2.1 (9.8) vs. +12.8 (7.3) mg/dL; 2-h glucose +8.2 (21.9) vs. +20.0 (19.4) mg/dL). Self-reported sleep quality improved in both groups. When compared controls, Sleep Extend participants reported improved fatigue symptoms (Promis fatigue score change -5.1 (9.3) vs. 7.0 (1.0), p=0.008), and self-reported physical activity tended to increase (+1614 (3659) vs. -2900 (3922) MET-minutes/week). Combining all participants, an increase in sleep duration correlated with a decrease in fatigue (r= -.62, p=0.04) and anxiety symptoms (r= -.69, p=0.02).

Conclusion
Sleep extension through coaching and use of remote monitoring is feasible in women with a history of GDM. It appears to decrease fatigue and may improve glucose metabolism and physical activity.

Support (if any)
NIDDK P30 DK092949
672 COVID-19 Anxiety and Sleep in Middle-aged and Older Adults: Impact of Age and Sex
Authors: Jagannathan Sadhika , Rodgers Mikayla , McCrae Christina S , Miller Mary Beth , Curtis Ashley 
Published: May 2021

Abstract

Introduction
COVID-19 is an infectious respiratory illness that was declared a pandemic in March 2020. During the course of COVID-19, studies have demonstrated worsening sleep quality and anxiety. No studies have examined age-related and sex-specific associations between COVID-19 anxiety and sleep in aging populations. We examined associations between COVID-19 anxiety and sleep, and evaluated age and sex as moderators, in middle-aged/older adults.

Methods
Two hundred and seventy-seven middle-aged/older adults aged 50+ (Mage=64.68, SD=7.83; 44% women) living in the United States who were cognitively healthy (no cognitive impairment/dementia/neurological disorders) completed an online Qualtrics survey in July/August 2020 measuring sleep (Pittsburgh Sleep Quality Index; PSQI) and COVID-19 anxiety (Coronavirus Anxiety Scale; CAS). Multiple regressions examined whether CAS was independently associated with or interacted with age or sex in its associations with PSQI total score/subscores (sleep quality, sleep duration, sleep efficiency, daytime dysfunction), controlling for age, education, number of medical conditions, sleep/pain medication use, and COVID-19 status.

Results
CAS interacted with age (B=-.008, SE=.003 p=.02, R-squared=.02), not sex (p=.31), in its association with sleep duration. Higher CAS was associated with shorter sleep duration in oldest-older adults (~73 years old; B=.12, SE=.05, p=.01) and younger-older adults (~65 years old; B=.07, SE=.03, p=.02), not middle-aged adults (~57 years old, p=.47). CAS interacted with age (B=.01, SE=.004, p=.02), not sex (p=.56), in its association with sleep efficiency. Higher CAS was associated with worse sleep efficiency in oldest-older adults (B=.14, SE=.05, p=.009) and younger-older adults (B=.08, SE=.04, p=.03), not middle-aged adults (p=.60). Higher CAS was associated with greater daytime dysfunction (B=.26, SE=.07, p&lt;.001) and higher PSQI total score (B=.82, SE=.33, p=.01), and did not interact with age or sex (ps&gt;.05).

Conclusion
Increased COVID-19 anxiety is associated with several aspects of worse sleep (shorter sleep duration, sleep efficiency) in older adults but not middle-aged adults. Generally, in middle-aged/older adults, higher COVID-19 anxiety is associated with worse daytime dysfunction and overall sleep quality. Sex does not moderate these associations. Increased COVID-19 morbidity and mortality in aging populations may translate to increased anxiety and subsequent sleep disruptions. Interventions aimed at mitigating negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults.
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674 Changes in Objectively-Measured Adolescent Sleep and Light Exposure During the COVID-19 Pandemic
Authors: Simon Stacey , Vetter Celine , Hunt Larissa , Bowen Anne , Rynders Corey , Higgins Janine , Melanson Edward , Nadeau Kristen , Wright Kenneth 
Published: May 2021

Abstract

Introduction
U.S. adolescents have high rates of insufficient sleep. School closures and stay-at-home orders were implemented to mitigate disease spread during the Coronavirus 2019 (COVID-19) pandemic. Without the restriction of imposed early school start times, we hypothesized that adolescents would have longer, later, and less variable sleep compared to pre-COVID-19. We further hypothesized these changes would be associated with increased and later light exposure.

Methods
High school students age 14–19 years with &lt;7h sleep on school nights completed two weeks of at-home monitoring. The Pre-COVID-19 week took place between October 2018-February 2020 and the COVID-19 week occurred in May 2020 during state-wide stay-at-home orders. Participants wore an accelerometer to assess sleep and light exposure while completing a concurrent sleep log. Paired-samples t-tests examined differences in sleep and light between Pre-COVID-19 and COVID-19. Pearson correlations assessed associations between change in sleep and change in light.

Results
Participants (N=16) were 16.5 ±1.2-years-old at Pre-COVID-19, 70.6% female, 68.8% White, and 25.1% Hispanic. Youth were participating in online learning due to in-person school closures and only 2 participants (14.3%) had a set start time, while the remainder reported learning per their own schedule. Youth obtained approximately one hour more weekday sleep per night during the COVID-19 week compared to Pre-COVID-19 (p&lt;0.001). Bed and waketimes were significantly delayed on weekdays and weekends during COVID-19 compared to Pre-COVID-19 (p&lt; 0.01). The greatest change was a delay in weekday waketime of 2.9□0.9h (p&lt;0.001). Social jetlag during COVID-19 was reduced by 1/3 compared to Pre-COVID-19 (p=0.02). Average 24h lux levels were 2.5x higher during the COVID-19 week compared to Pre- COVID-19 (p=0.008). Change in average lux and timing of light were not significantly associated with change in sleep duration or timing.

Conclusion
An unintended effect of the switch to online learning may have been affording adolescents the opportunity to obtain longer and more regular sleep. Understanding the impact of these changed sleep behaviors on daytime functioning, academic performance, and health outcomes is particularly urgent as schools plan for the remainder of the academic year and eventual return to in-person learning.

Support (if any)
K23DK117021 to SLS