bluuebunny/crossref_metadata_2025_split huggingface dataset:
634 Impact of Changing School Start Times on Drowsy Driving and Teen Motor Vehicle Crashes: A Longitudinal Examination
Authors: Meltzer Lisa , Rizvi Sarah , Chapman Julie 
Published: May 2021

Abstract

Introduction
Early high school start times are associated with insufficient adolescent sleep, which in turn is associated with motor vehicle crashes [MVC]. This analysis examined the impact of a 70-minute delay in high school start times on student-reported drowsy driving and department of transportation MVC rates before and for 2 years after start time changes.

Methods
Self-reported sleep duration and drowsy driving data were drawn from a longitudinal study of changing high school start times (n=2099–4092/year) in the Cherry Creek School District (Arapahoe County [AC]). The Colorado Department of Transportation provided frequency/timing of weekday MVC data for teen (16–18 years) and adult drivers in AC and four neighboring counties in metro Denver (Other Counties [OC]). MVC rates per 1000 licensed drivers were calculated. Outcomes are reported for three school years: 2016–17 (pre-change), 2017–18 (post change), and 2018–19 (follow-up). Chi-square analyses examined drowsy driving frequency (at least once/week vs. less than once/week) by sufficient weeknight sleep duration (&lt;8 hours vs. 8+ hours). Two-proportion z-tests compared MVC rates by county, as well as teens vs. adults.

Results
Compared to pre-change (29.3%), fewer students reported drowsy driving at post-change (20.3%) and follow-up (23.7%). Students who reported insufficient sleep also reported more frequent drowsy driving across all years (p’s&lt;0.001 to 0.037). AC’s teen crash rate decreased from 78.9/1000 to 76.6/1000 post-change, with a further reduction to 68.7/1000 at follow-up. Pre-change crash rates did not differ between counties (p=0.444); however, they were significantly lower in AC vs. OC at both post-change (p=0.048) and follow-up (p=0.046). Adult crash rates remained consistent over three years in both counties. Morning crash rates per hour did not differ pre-change; at both post-change and follow-up OC’s morning crash rates peaked one hour earlier than AC’s (7:00-7:59am vs. 8:00-8:59am).

Conclusion
This study extends previous reports by finding that later school start times are associated with decreased drowsy driving and fewer teen motor vehicle crash rates for up to 2 years post-change. Early school start times is an important public policy that benefits adolescent sleep, health, and well-being through decreased drowsy driving and motor vehicle crashes.

Support (if any)
Robert Wood Johnson Foundation’s Evidence for Action Program
643 Rest Activity Rhythms, Symptom Burden, and Glucose Variability in Young Adults with Type 1 Diabetes
Authors: Griggs Stephanie , Strohl Kingman , Margevicius Seunghee , Grey Margaret , Hickman Ronald 
Published: May 2021

Abstract

Introduction
Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and diabetes physical symptom burden) and glucose variability in young adults with T1D.

Methods
Using convenience sampling, young adults with T1D underwent concurrent actigraphy and continuous glucose monitoring for 6–14 days to generate the following RAR parameters: (MESOR, amplitude, acrophase, and circadian quotient) and glucose variability indices (coefficient of variation and time in range). Participants completed the 8-item Epworth Sleepiness Scale, 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, and 34-item Diabetes Symptom Checklist-Revised. Cosinor analysis was used to compute the RAR parameters and linear regression modeling procedures were performed to determine the associations among the study variables.

Results
The sample included 46 young adults (mean age 22.3±3.2; 32.6% male; 84.8% non-Hispanic White, A1C mean 7.2±1.1%, BMI 27.0±4.4 kg/m2). A more robust rhythm (higher amplitude) was associated with a lower diabetes symptom burden (ß=-0.31, p=.035). A higher circadian quotient was associated with less daytime sleepiness (ß=-0.41, p=.004). All associations between the RAR parameters and symptom measures remained statistically significant (p&lt;.05) after adjustment for sex and BMI. The associations between the RAR parameters and glucose variability indices were not significant.

Conclusion
RAR was associated with daytime sleepiness, as well as symptom burden in young adults with T1D even after consideration of sex and BMI. Future investigators should clarify the causality of these associations and the potential for improving the strength and stability of RAR in the mitigation of daytime sleepiness and symptoms.

Support (if any)
This research is or was partially supported by grants from the American Academy of Sleep Medicine (220-BS-19), National Institute of Nursing Research (K99NR018886 & T32NR0008346), Sigma Theta Tau International, and Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have a device.
645 Acute Insomnia Disorder in Health Care Workers Before and During COVID-19: Rates and Predictive Factors
Authors: McCall William , Mensah-Bonsu Demetra , Withers Allison , Gibson Robert 
Published: May 2021

Abstract

Introduction
Pandemics such as COVID-19 create population-wide stressors that create a natural laboratory for acute insomnia research. This study investigated risk factors and estimated rates of acute insomnia disorder in health care workers at the onset of the COVID-19 pandemic.

Methods
A Qualtrics survey of more than 2300 health care providers was conducted in a single academic health system on May 15th 2020, comprised of practicing attending physicians, residents and fellows in training, advanced practice providers, and nurses. Six hundred and sixty eight responded (29% response rate). The Research Diagnostic Criteria for Insomnia Disorder was used to diagnose Acute Insomnia Disorder.

Results
573 respondent had no missing data pertaining to sleep, with a mean age of 43.4 + 12.5 years and 72% women. The rate of Insomnia Disorder before COVID-19 was 44.5%, while after COVID-19 it was 64.0% - a statistically significant increase. 10.2% of persons with Insomnia Disorder before COVID-19 stated it had resolved during COVID-19, while 43.4% of persons who did not have Insomnia Disorder before COVID-19 developed Acute Insomnia Disorder during COVID-19 (χ2=145.2; df=1; P&lt;0.0001). New cases of Acute Insomnia Disorder increased with female gender, advancing age, and less time spent in direct patient care.

Conclusion
Insomnia Disorder showed high baseline prevalence before COVID-19, followed by a striking increase in incidence in this sample of tertiary care health care workers. The effects of gender and age were similar to what has been previously published as risk factors for insomnia. The surprising finding that less time spent in direct patient care was associated with more cases of Acute Insomnia Disorder might be related to the poorly understood stresses of working from home during COVID-19.
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663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic
Authors: O’Hora Kathleen , Lopez Mateo , Morehouse Allison , Cordero Andrea , Osorno Raquel , Manber Rachel , Goldstein-Piekarski Andrea 
Published: May 2021

Abstract

Introduction
The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown.

Methods
At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework.

Results
There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p &lt; 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102).

Conclusion
This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample.
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665 Insufficient sleep and mortality among persons who inject drugs (PWID)
Authors: Sun Jing , Maher Brion , Spira Adam , Mehta Shruti , Rabinowitz Jill , Sosnowski David , Kirk Gregory 
Published: May 2021

Abstract

Introduction
Insufficient sleep is associated with all-cause mortality in the general population. Illicit drugs have pronounced effects upon sleep, and insomnia symptoms are common among people with HIV (PWH), suggesting persons who inject drugs (PWID) with HIV may be at higher risk of adverse outcomes from insufficient sleep.

Methods
Participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, a cohort of PWID with or without HIV, completed the Sleep Adequacy subscale of the Medical Outcomes Study (MOS) semi-annually from 2005-present. Two questions queried participants about the frequency over the past four-weeks of: 1. getting sufficient sleep to feel rested on awakening; 2. obtaining needed amount of sleep. Six-Item responses ranged from “all of the time” to “none of the time”. Participants with mean subscale scores below the sample median were considered to have insufficient sleep. Mortality data were obtained through the National Death Index through 2018. Hazards of all-cause and cause-specific mortality were evaluated using Cox-regressions accounting for repeated measurements of insufficient sleep, respectively. Models were adjusted for sociodemographics, HIV and HCV infection, severe depressive symptoms (Center for Epidemiological Studies Depression [CESD]≥23), number of comorbidities (0, 1, ≥2), active injection drug use, current tobacco and alcohol use.

Results
Of 2612 participants (33% HIV+), mean age at baseline was 45.8 years, 32.4% were female, 75% Black, 45% had ≥high school education, and 33% had an annual income &gt;$5,000. At baseline, the majority were current smokers (84%), alcohol drinkers (59%), or actively injecting drugs (56%), while 25% had severe depressive symptoms and 21% had ≥2 comorbidities. After adjustment for covariates, insufficient sleep was associated with a 37% increased hazard of all-cause mortality (HR: 1.37, 95% confidence interval [CI]: 1.13–1.65). Insufficient sleep was associated with a 93% increased hazard of death from HIV or infectious disease-related deaths (HR: 1.93, 95% CI: 1.26–2.97).

Conclusion
Insufficient sleep was independently associated with all-cause mortality and specifically with death from HIV or infectious diseases-related causes among PWID. Interventions consider targeting sleep behaviors among PWID hold promise for improving health and longevity in this population.

Support (if any)
National Institutes of Health grants: U01-DA-036297; R01-DA-047064; R01-HL-90483; K24-AI-118591; T32-DA007292; R01-DA039408.
678 Predictors of Sleep Health among Older Adults During the Initial Months of the Covid-19 Pandemic
Authors: Lorenz Rebecca , Stallings Devita , Palmer Janice , Lach Helen 
Published: May 2021

Abstract

Introduction
Since the first COVID-19 case was reported in January 2020 in the United States, there have been more than 18.8 million cases and 330,000 deaths. In order to minimize the risk of potential COVID-19 transmission, many states instituted stay at home orders and closed churches, gyms, and other places that older adults often participate in social gatherings. Little is known about sleep health among older adults during this time. The purpose of this study was to examine the relationship between older adult’s personal factors, health behaviors, and sleep health during the initial months of the Covid-19 pandemic.

Methods
Adults age 60 and older participated in an online anonymous survey recruited through email lists of community senior organizations and university alumni using a snowball approach. Personal factors included age (years), gender (female=0, male=1), living situation (living alone=0, living with others=1), education (≤12 years = 0, &gt;12 years = 1), and income (75000=1), and depressive symptoms (CESD-10). Health Behaviors included moderate physical activity (0=none, 1=yes), smoking (0=no, 1=yes), drinking (number of drinks). Sleep Health was assessed using the multidimensional SATED scale (Satisfaction, Alertness, Timing, Efficiency, and Duration). Backward stepwise regression analysis was used to test if personal factors and health behaviors significantly predicted participants’ sleep health.

Results
Participants included 509 adults (392 Females; mean age=75.6 years; SD=5.0; range 63–93 years). The majority were white (n=466; 92%) and 93% (n=471) had a college education. Seventy-four percent (n=71) participated in moderate exercise, 94% (n=478) did not smoke, and 58% (n=286) did not report drinking alcohol. Sleep Health was variable with 179 (36%) reporting poor sleep health (mean=7.4; SD=2.1). Regression results indicated that gender, years of education, living situation, income, depressive symptoms and moderate exercise explained 17% of the variance in sleep health (R2=0.169, F,6=14.4, p=0.000).

Conclusion
These findings suggest that many older adults experienced poor sleep health associated with depressive symptoms and exercise participation during the initial months of the pandemic. Future studies should examine the long-term effects of the pandemic on the sleep health of older adults.

Support (if any)
Saint Louis University COVID-19 Rapid Response Fund (OpenWater 1804).
683 Comparison of Telemedicine and In-Person Psychotherapy for CPAP Adherence in a population of Veterans
Authors: Keer Nikky , Sharma Pralhad , Shrestha Rabin , Freire Amado , Robinson Katie , Morris Katherine 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions.

Methods
We identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran’s average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts.

Results
Compared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p&lt;0.001).

Conclusion
In a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.
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684 Contribution of Pulmonary Diseases to COVID-19 Mortality in a Diverse Community of New York City
Authors: Jean-Louis Giardin , Seixas Azizi , Cejudo Jaime Ramos , Osorio Ricardo , Avirappattu George , Reid Marvin , Parthasarathy Sairam 
Published: May 2021

Abstract

Introduction
New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID-19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID-19-related mortality independent of other medical conditions, health risks, and sociodemographic factors.

Methods
We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white; cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease); pulmonary disease (e.g., COPD, sleep apnea, or asthma); autoimmune disease; and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses.

Results
Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05; 95%CI:1.04–1.05), ethnic minority (HR=1.26; 95%CI:1.10–1.44), low household income (HR=1.29; 95%CI:1.11, 1.49), and male sex (HR=0.85; 95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27; 95%CI:1.02–1.58), obesity (HR=1.19; 95%CI:1.04–1.37) and peripheral artery disease (HR=1.33; 95%CI:1.05–1.69). We observed a significantly higher rate of COVID-19 cases (43.8% vs 39.6%, p&lt;0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p&lt;0.01).

Conclusion
Patients with COPD had the highest odds of COVID-19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

Support (if any)
K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453
689 Objective Assessment of Inpatient Sleep Patterns and Quality: A Pilot Study
Authors: Sussman Sarah , Ananth Ashwin , Fares Elie , Boon Maurits , Huntley Colin , Fast Zhanna 
Published: May 2021

Abstract

Introduction
Sleep disruption is common among hospitalized patients due to psychological, physiological, and environmental reasons including illness, pain, anxiety, invasive interventions, frequent monitoring, and stimuli, especially noise and light. The AASM has published guidelines for the use of actigraphy in the outpatient setting, but there is a paucity of literature evaluating the validity of actigraphy in inpatients. The aim of this study is to evaluate sleep in hospitalized general medicine patients undergoing sleep medicine consultation using actigraphy and qualitative surveys.

Methods
A single-site prospective study in hospitalized medicine patients. Patients were observed with a Fitbit® Charge3 wrist actigraphy device overnight, then administered 7 surveys: Richards-Campbell Sleep Questionnaire (RCSQ), qualitative questionnaires assessing sleep history, sleep hygiene, barriers to sleep, STOP-BANG, Epworth Sleepiness Scale (ESS), and Patient-Health Questionniare-2 (PHQ-2). Actigraphy data including total sleep time, slow wave sleep time, and number of awakenings was compared with patient-reported data.

Results
In preliminary analysis, six patients met inclusion criteria and underwent sleep medicine consultation, overnight actigraphy, and completed 7 surveys. Based on subjective sleep history questionnaires, average total sleep time was 437 + 215 minutes. Actigraphy revealed average total sleep time was 228 + 80 minutes with an average of 3.6 nocturnal awakenings. Increased number of awakenings on actigraphy was not correlated with increased number of awakenings by survey. The most frequently reported barriers to sleep on patient surveys were pain and being woken up for labs or vital signs. The average STOP-BANG score was 6 out of 8 and average ESS was 14 out of 24.

Conclusion
Restorative sleep warrants consideration alongside complex medical care during hospitalization. Patients experience decreased total sleep time and increased number of awakenings while in the hospital compared with their subjective estimates of sleep at home. Actigraphy provides a non-invasive and reliable way to monitor some sleep parameters in the inpatient setting. An elevated STOP-BANG score could represent sleep disordered breathing and impact perceptions of sleep quality. Patient-identified barriers to sleep are targets for quality improvement. Future studies should compare inpatient actigraphy data to polysomnographic data and the effect of sleep-directed interventions on sleep quality in the hospital.
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