bluuebunny/crossref_metadata_2025_split huggingface dataset:
707 Association of Self-Reported Anxiety, Informational Support, and Sleep in Sleep Medicine Patients during the COVID-19 Pandemic
Authors: Arentson-Lantz Emily , Debian Ahmad , Kokanda Manasa , Shaib Fidaa , Nowakowski Sara 
Published: May 2021

Abstract

Introduction
Stressful events, such as the COVID-19 pandemic, can have a detrimental effect on sleep. It is important for practitioners to understand how their patients are affected by events to optimize their care. In this study we evaluated associations of anxiety and daily habits with self-reported sleep disturbance among sleep medicine clinic patients.

Methods
Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were asked about changes in their daily habits (sunlight exposure, caffeine consumption). During the 5-month survey completion time window, the weekly average of positive COVID-19 cases in the Houston area was 2,914. Stepwise linear regression was performed using SAS to determine if self-reported anxiety and informational support predicted PROMIS Sleep Disturbance, PROMIS Sleep-Related Impairments and ISI.

Results
Anxiety had a significant effect on Sleep Disturbance (0.43 ± 0.11, p=0.0001), Sleep-Related Impairments (0.53 ± 0.12, p=0.0001) and ISI (0.28 ± 0.08, p=0.0004). Informational support had a significant inverse effect on Sleep Disturbance (-0.29 ± 0.10, p=0.0063), Sleep-Related Impairments (-0.26 ± 0.11, p=0.01) and ISI (-0.31 ± 0.08, p&lt;0.0001) measures. Decreased sunlight exposure during the pandemic contributed to a significant increase in Sleep Disturbance scores (0.06 ± 0.03, p=0.045). Increased caffeine consumption during the pandemic had significant increase in ISI scores (16.3 ± 7.59, p=0.035).

Conclusion
Higher levels of anxiety and lower levels of informational support predicted greater insomnia severity, sleep disturbance, and sleep-related impairments in sleep medicine clinic patients during the COVID-19 pandemic. Decreased sunlight exposure and increased caffeine consumption also predicted greater sleep disturbance and insomnia severity, respectively. Addressing anxiety symptoms and access to accurate information during the pandemic is advised when treating sleep medicine clinic patients.

Support (if any)
This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).
713 Sleep of infants and toddlers during 12 months of the COVID-19 pandemic
Authors: Gupta Gita , O’ Brien Louise , Dang Louis , Shellhaas Renée 
Published: May 2021

Abstract

Introduction
SARS-CoV-2 changed the lives of children and their parents in 2020. To our knowledge, no studies have examined infant and toddler sleep during this pandemic. We sought to compare parent-reported sleep characteristics of infants and toddlers over successive quarters of the past year.

Methods
Parents of children aged 0–36 months were surveyed primarily in the Midwestern USA between 01/17/2020 and 12/07/2020. Each parent responded only once. Age was categorized as: &lt;6 months, 6–12 months, 12–24 months, and 24–36 months. Income was categorized as: &lt;$50,000, $50-100,000, $100-150,000, and &gt;$150,000. The year was divided into quarters. Multivariable linear regression included Total Sleep Time (TST), Sleep Onset Latency (SOL) and parental frustration with sleep (any frustration, scale of 1–5) as dependent variables and year quarter, child’s age, prematurity, child’s comorbidities, maternal age (during their child’s birth), parenting experience, household income, and room sharing as independent variables. Logistic regression included nap consistency (napping at the same time daily) as the dependent variable, and year quarter, child’s age, prematurity, comorbidity, maternal age, parenting experience, household income, and room sharing as independent variables.

Results
Of 594 children, mean age was 18.5±9.7 months and 52% were female. Prematurity and comorbidities were reported for 8% and 15%, respectively. Mean maternal age was 31.8±4.5 years. Neither TST (β=-0.488; p= 0.16) nor SOL (β= 0.029; p=0.23) were associated with year quarter. SOL was 3 minutes less for each increase in income category (β =-0.051; p= 0.003). TST (β = -0.994; p&lt;0.001) and SOL (β =0.092; p&lt;0.0001) were most associated with child’s age. Parental frustration was associated with child’s age (β=0.12; p= 0.04), comorbidity (β=0.30; p=0.05) and room sharing (β= -0.38; p=0.006), but not year quarter. Nap consistency was associated with increased child age category (OR 1.47; 95% CI 1.13, 1.94) and lack of room sharing (OR=2.09; 1.10, 3.97), but not year quarter.

Conclusion
Parent-estimated TST, nap consistency and sleep-related frustration did not differ significantly over the first 12 months of the pandemic. Yet, our results underscore that special attention should be given to the sleep of infants and toddlers with comorbidities, who share a room, and who have a lower household income.

Support (if any)
2T32HL110952-06
719 Insomnia in Those Diagnosed with COVID-19
Authors: Taylor Emily , Cloonan Sara , Grandner Michael , Killgore William 
Published: May 2021

Abstract

Introduction
Recent meta-analyses suggest that as many as 75% of COVID-19 patients report sleep problems. Here, we sought to characterize this in terms of self-reported insomnia. We hypothesized that those endorsing a positive COVID-19 diagnosis would also report greater levels of insomnia than those with a negative diagnosis.

Methods
Between April and September 2020 we administered the Insomnia Severity Index (ISI), each month to a total of 6162 English speaking adults in the United States ranging in age from 18–84 (M=36.2 years, SD=12.1; 53.9% female), recruited from all 50 states and the District of Columbia using Amazon Mechanical Turk (MTurk) crowdsourcing platform. Data collections occurred cross-sectionally, approximately one month apart. Data were analyzed using Kruskal-Wallis H tests.

Results
In total, 247 (4.01%) participants responded “Yes” to the question “Have you been formally diagnosed with COVID-19?” (male=128, female=119). Those reporting “yes” had a higher mean score on the ISI (M=14.52, SD=5.56) compared to reporting “no” (M=9.98, SD=6.55). Total ISI scores were higher for those who reported that they were diagnosed with COVID-19 than those that did not, χ2(1)=121.818, p=0.0001. Among those that reported that they were diagnosed with COVID-19, 57.11% had ISI scores indicating moderate to severe clinical insomnia compared to 25.42% of those who were not diagnosed with COVID-19.

Conclusion
Those who reported that they had been diagnosed with COVID 19 had greater insomnia compared to those without such a diagnosis. This could be due to greater stress and anxiety in those who had a positive COVID-19 diagnosis due to the many uncertainties surrounding the short and long-term prognosis as well as potential impacts on the individual’s family and workplace. However, it is important to consider the broader health picture of those diagnosed with COVID-19. This study is limited by the nature of the self-reported data, where we cannot verify a positive COVID-19 test. Causality cannot be inferred due to the cross-sectional nature of this study. Future work will need to determine the extent to which sleep-related factors are due to biological versus psychological factors associated with the diagnosis of COVID-19.
Support (if any):
740 Insomnia, cognitive arousal, and perinatal-focused rumination fuel perinatal depression
Authors: Castelan Andrea Cuamatzi , Kalmbach David , Cheng Philip , Drake Christopher 
Published: May 2021

Abstract

Introduction
Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in non-perinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship.

Methods
Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25–30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, perinatal-focused rumination). Mixed effects models were conducted to test hypotheses.

Results
Women were at elevated risk of screening positive for depression when experiencing high levels of insomnia (OR=2.36, 95%CI=1.28, 4.35), nocturnal cognitive arousal (OR=3.05, 95%CI=1.60, 5.79), perinatal-focused rumination (OR=2.05, 95%CI=1.11, 3.79), and perseverative thinking (OR=7.48, 95%CI=3.90, 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia.

Conclusion
Perseverating at night, particularly on perinatal concerns, fuels insomnia. In turn, lying awake at night provides ample opportunity for perseverating. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.
Support (if any):
743 Differences in the prevalence of sleep disturbance and associated risk factors in alcohol use disorders and major depression
Authors: Kolla Bhanu Prakash , Coombes Brandon , Mansukhani Meghna , Biernacka Joanna 
Published: May 2021

Abstract

Introduction
Sleep disruption is common in patients with alcohol use disorders (AUD) and major depressive disorders (MDD). Our understanding of the differences in the rates of sleep disturbance and overall sleep duration in patients with AUD, MDD, and comorbid AUD and MDD is limited. Furthermore, it is unknown whether there is variation in demographic and clinical characteristics associated with sleep disturbance and duration in these diagnostic groups.

Methods
This study utilized data from the UK Biobank (UKB). Depression status was determined based on review of International Classification of Diseases (ICD) codes and health records. AUD status was based on AUDIT scores (score ≥8 was defined as AUD) and sleep disturbance was evaluated utilizing a self-reported questionnaire. The sample was categorized into those with MDD alone (MDD+/AUD-)(n=18,154), AUD alone (MDD-/AUD+)(n=6123), both (MDD+/AUD+)(n=9027), and controls with neither (MDD-/AUD-)(n=27,573). We used generalized linear models (GLMs) to compare rates of sleep disruption and duration among the groups and determine the clinical predictors of sleep disturbance/duration in the four groups as well as test whether these factors differed among the groups.

Results
The prevalence of sleep disturbance in the control sample (MDD-/AUD-) was 26.4% and the self-reported sleep duration in this sample was 7.209±0.919. Subjects with AUD and/or MDD had greater rates of sleep disturbance and shorter sleep duration. Among the different diagnostic categories, the prevalence of sleep disturbance was highest in subjects with MDD+/AUD+ (36.5%) followed by those with MDD+/AUD- (35.6%) and MDD-/AUD+ (27.9%)(all p&lt;0.0001). Similarly, the sleep duration was shortest in subjects with MDD+/AUD+ (7.143±1.016), followed by MDD+/AUD- (7.158±1.050) and by MDD-/AUD+ (7.202±0.891)(all p&lt;0.0001). Subjects with sleep disturbance were more likely to be older, female, and with higher body mass index, Townsend deprivation index, and neuroticism scores across all four groups (all p&lt;0.05).

Conclusion
In a large population-based cohort, MDD with and without comorbid AUD was associated with greater rates of sleep disturbance and shorter sleep duration than AUD alone. The clinical and demographic factors associated with sleep disturbance did not differ in these diagnostic categories, indicating possible similar underlying risk factors.

Support (if any)
NA
744 Correlates to improvement in sleep in acute mania
Authors: Golebiowski Raphael , Mansukhani Meghna , Kolla Bhanu Prakash 
Published: May 2021

Abstract

Introduction
Sleep disruption and reduced sleep duration are potential triggers and also core symptoms of a manic episode. Our understanding of how sleep duration changes during the course of a manic episode and its potential association with symptom improvement is limited. We examined the natural course of sleep duration and its association with time to discharge and other clinical and demographic factors in patients with mania.

Methods
This was a retrospective study conducted in patients admitted to an acute care psychiatric unit with a manic episode. Sleep duration was determined based on observer report as logged by nursing staff. Sleep duration at admission and discharge were determined by averaging the total sleep time on day 2/3 of hospitalization and day 3/2 preceding discharge date. We obtained data on possible confounders including antipsychotic (chlorpromazine equivalents), benzodiazepine (diazepam equivalents) and other hypnotic medication doses administered at admission and discharge. We examined the associations between the change in sleep duration from admission to discharge with length of hospitalization and other clinical and demographic characteristics.

Results
The sample consisted of 35 patients (54.3% male) aged 32 ± 9.96 years with an average length of hospitalization of 20.63 ± 18.62 days. The mean sleep duration on admission was 6.23 ± 1.77 hours and was 7.45 ± 1.49 hours on discharge, with a mean change of 1.23 ± 1.93 hours. The change in sleep duration was positively correlated with length of hospitalization (r=0.42; p=0.01). Other clinical factors including benzodiazepine or antipsychotic dose on admission, age, sex, and use of mood stabilizers were not correlated with the change in sleep duration.

Conclusion
There was a substantial improvement in the total sleep duration in patients with mania over the course of hospitalization. Overall, the change in sleep duration was only correlated to the length of stay and did not appear to be impacted by other clinical and demographic characteristics.
Support (if any):
760 Does Obstructive Sleep Apnea Increase Suicidality in Patients with Bipolar Disorder?
Authors: Reddy Abhishek , Mansuri Zeeshan , Trivedi Chintan , Vadukapuram Ramu 
Published: May 2021

Abstract

Introduction
Bipolar disorder (BPD) is associated with suicidality in adult population. There are several risk factors for suicide, however the relationship between Obstructive Sleep Apnea (OSA) and suicidality in patients with BPD has not been explored. Hence, we decided to perform this study with primary objective of comparison of suicidality by OSA diagnosis in patients with BPD.

Methods
We used inpatient hospitalization data from National Inpatient sample dataset year 2016–2018. Our primary population (BPD + OSA) was composed of adult patients admitted to the hospital with the primary diagnosis of Bipolar Disorder and secondary diagnosis of Obstructive sleep apnea. Age-gender matched (1:4 matching) control population was selected with primary diagnosis of BPD having no OSA (BPD-OSA). Data on suicidality (suicidal ideation/attempt) were collected and compared between the groups using logistic regression analysis methods by including OSA, age, gender, race, substance use disorder and personality disorder as predictors.

Results
From the dataset, 17895 patients were obtained for the BPD + OSA group (average age: 50.5 years, male 45.5%). After 1:4 age-gender matching, 71575 patients were included in the BPD-OSA group. In the unadjusted analysis, suicidal ideation was significantly high BPD+OSA group compared the BPD-OSA group (38.4% vs. 31.9%, p &lt; 0.001). Rate of suicide attempt and self-inflicted injuries were similar in two groups (3.5% vs. 3.3%, p: 0.27). In the adjusted logistic regression analysis odds of suicidality were 36% more in BPD+OSA group compared to BPD-OSA (Odds Ratio: 1.36, 95% Confidence interval: 1.25–1.48, p &lt; 0.001).

Conclusion
In adult patients with BPD, diagnosis of OSA significantly increases the odds of suicidality. Addressing OSA in patients with BPD, can improve management, and potentially reduce the incidence of suicide. We believe our study will be helpful in guiding future research and development on this issue.

Support (if any)
None
762 Bedtime Procrastination but Not Total Sleep Time Mediates the Association Between Anxiety and Sleep Problems
Authors: Campbell Rebecca , Ledesma Roselee , Guzman Linda , Bridges Ana 
Published: May 2021

Abstract

Introduction
There is a high rate of sleep disorders and anxiety in primary care settings and patients are most likely to report such issues to their primary care provider. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems when covarying for age and attitudes about sleep.

Methods
308 adult primary care patients seen at either a university integrated primary care clinic (n = 147; 47.7%) or federally qualified health center (n = 161; 52.3%) from August 2019 to March 2020 completed intake paperwork including questions assessing psychiatric symptoms and sleep.

Results
A structural equation model was used. To test for statistical mediation, we performed 500 bootstraps and examined bias-corrected estimates. The model evidenced good fit, X2 (16) = 22.53, p = .127, CFI = .98, TLI = .95, SRMR = .03, RMSEA = .04 [90% CI: .00, .07]. All manifest variables loaded significantly onto their latent factors (standardized loadings &gt; .40, p values &lt; .05). The model explained 14.7% of the variance in total sleep time (TST), 14.8% in sleep procrastination, and 54.0% in sleep problems. Anxiety was negatively associated with TST (β = -.36, p &lt; .001) and positively associated with bedtime procrastination (β = .35, p &lt; .001) and greater sleep problems (β = .63, p = .006). The association between anxiety and sleep problems was not statistically mediated by TST. There was a significant indirect effect of anxiety on sleep problems through bedtime procrastination. The total effect of anxiety on sleep problems was significant (β = .70, p = .003). We found a significant direct association between age and TST, and age and bedtime procrastination. However, there was no significant direct association between age and sleep problems (β = .00, p = .984). Sleep attitudes were unrelated to any of the primary study variables. None of the exogenous variable covariances were significant. The covariance between TST and bedtime procrastination was significant.

Conclusion
Sleep problems are pervasive and complex. This study highlights factors related to sleep problems and support anxiety and pre-bedtime behaviors as treatment targets.

Support (if any)
D40HP29826 (PI: Ana J. Bridges).
772 Examining sleep difficulties and suicide ideation among those reporting abuse and dependence on illicit drugs and alcohol
Authors: Robbins Rebecca , DiClimente Ralph J , Weaver Matthew , Gangi Catherine Di , Chalem Isabel , Quan Stuart , Klerman Elizabeth 
Published: May 2021

Abstract

Introduction
Sleep disturbance is associated with poor mental health and may contribute to initiating or continuing use/abuse of alcohol and drugs. Using data from a nationwide survey, we examined the relationship between sleep disturbance and suicide behaviors among youth and adults, including those who report drug/alcohol use and abuse.

Methods
We analyzed data from the 2018 National Survey on Drug Use and Health (NSDUH), an annual survey collecting information about the use of illicit drugs and alcohol among non-institutionalized U.S. youth (age 12–17) and adults (age&gt;17). The 2018 survey included 9,398 youth and 43,026 adult respondents. Depression was assessed in adults with the Kessler-6 and in youth with several questions assessing psychological distress. Those who scored at risk for psychological distress were also asked about sleep disturbance and suicidal behaviors (i.e., ideation, planning, attempt). All were asked to report their drug/alcohol use and/or abuse. Our study population included those who reported psychological distress. We conducted binary logistic regression to examine the relationship between suicidal behavior and sleep disturbance in this population. We also conducted sub-analyses to explore the relationship between suicidal behavior and sleep disturbance among those reporting drug/alcohol use and abuse.

Results
Youth were 29% male and 71% female, adults were 36% male and 64% female. Adult participants, 39% were 18 to 25, 22% were 26 to 34, and 39% were age 35 and older. Among those with psychological distress, suicidal behavior was more likely among those who reported sleep disturbance (youth: OR=2.7, 95%CI:1.8–4.0; adults: OR=1.3, 95%CI:1.2–1.5). Also, among those with psychological distress, suicidal behavior was more likely among those who reported concomitant sleep disturbance and either alcohol abuse/alcoholism (youth: OR:3.3, 95%CI:1.6–7.0; adults: OR=1.4, 95%CI:1.1–1.7); illicit drug abuse (youth: OR=3.5, 95%CI:1.6–7.4; adults: OR=1.3, 95%CI:1.0–1.6); or alcohol and illicit drug abuse (youth: OR=3.2, 95%CI:1.5–6.9; adults: OR=1.4, 95%CI:1.1–1.7).

Conclusion
Youth and adults with psychological distress and sleep disturbance are more likely to also report suicidal behaviors. Alcohol and drug use or abuse increase their risk for suicidal behavior compared to those who do not report sleep disturbance. Future work should include examination of causality and of interventions.

Support (if any)
NIH K24-HL105664, P01-AG009975, T32-HL007901, K01HL150339, 1R56HL151637