bluuebunny/crossref_metadata_2025_split huggingface dataset:
0372 Quetiapine Effect on Sleep, Breathing, and Next Day Performance in People with OSA and Difficulty Maintaining Sleep
Authors: Fauska Cricket , Bastiampillai Tarun , Rawson Georgina , Toson Barbara , Vakulin Andrew , Adams Robert , Wittert Gary , Loffler Kelly , Eckert Danny 
Published: April 2024

Abstract

Introduction
Quetiapine is commonly prescribed "off-label" to people with insomnia symptoms. People with undiagnosed obstructive sleep apnea (OSA) frequently report insomnia symptoms, particularly difficulties in maintaining sleep. In 2020, 10.6 million prescriptions were dispensed for quetiapine in the United States. Yet, there is limited information regarding the effects of quetiapine on breathing, sleep, and next-day performance in people with OSA.

Methods
We performed a double-blind, randomized, placebo-controlled, cross-over study (NCT05303935) in 15 people with OSA who also reported difficulty maintaining sleep. Participants were studied overnight via polysomnography on two separate occasions ~1 week apart and received either 50mg of quetiapine or a placebo (order randomised) just prior to sleep. 10-minute psychomotor vigilance and 30-minute AusEd driving simulator tests were performed each morning.

Results
Participant demographics: 7 women, 8 men, ([Mean±SD] age 61 ± 10 years, BMI 28 ± 4 kg/m2). Quetiapine reduced the apnea/hypopnea index (primary outcome) versus placebo (20±12 vs. 27±16 events/h, p=0.02), arousal index (25±9 vs. 32±16 arousals/h, p=0.02), and increased sleep efficiency (87±9 vs. 80±11, p&lt; 0.01) without worsening hypoxemia (e.g., mean overnight SpO2 94.5±1.5 vs. 94.7±1.2 %, p=0.42). However, next morning vigilance (e.g., median reaction time 382±84 vs. 336±48ms, p=0.02) and driving simulator performance (e.g., steering deviation 95±54 vs. 73±39, p=0.02) were impaired with quetiapine versus placebo.

Conclusion
Consistent with a hypnotic effect, a single night low dose of quetiapine reduces OSA severity as measured via the apnea/hypopnea index and increases sleep efficiency without worsening overnight hypoxemia. However, there is evidence of next day impairment in vigilance and driving simulator performance

Support (if any)
This study was funded by a National Health and Medical Research Investigator Grant (PI Eckert 1196261).
0376 The Hyperarousal Subtype of Insomnia Disorder Is Associated with Depressive Symptoms
Authors: Lyu Dongbin , Qian Ruiyi , Wang Yang , Ma Huajian , Yuan Chengmei 
Published: April 2024

Abstract

Introduction
Both the hyperarousal state and depressive symptoms are associated with insomnia disorder (ID). However, it is unknown whether the characteristics of hyperarousal and depressive symptoms vary across ID subtypes.

Methods
This study (NCT05985512) included 136 participants aged 18 to 65, diagnosed with ID by DSM-5 criteria. We employed psychological assessments of depression using Hamilton Depression Rating Scale (HAMD-17) and one-night polysomnography (PSG) to collect psychological and electroencephalographic (EEG) characteristics including macro sleep structures and spectral features including peak frequency (frequency of the local maximum peak of mean power). Uniform Manifold Approximation and Projection (UMAP) and Variational Bayesian Gaussian Mixture Model (VB-GMM) were applied for data dimensionality reduction and cluster analysis. Dunn’s test were conducted to compare depressive and EEG features across subtypes. Significance was set at P&lt; 0.05.

Results
VB-GMM clustering identified three subtypes of ID: (i) Light Sleep Subtype: This group exhibited moderate HAMD-17 scores and the least amount of N3 sleep (Dunn's test p &lt; 0.001). (ii) Least Depression Subtype: Participants reported the lowest levels of depression and had the most N3 sleep (Dunn's test p &lt; 0.05) with the lowest alpha and beta EEG peak frequencies during NREM sleep (Dunn's test p &lt; 0.05). (iii) Hyperarousal with Depression Subtype: This subtype had the highest level of depressive symptoms (HAMD-17 scores, Dunn's test p &lt; 0.001). Although the third subtype's N3 sleep was more than that in Subtype 1 (Dunn's test p &lt; 0.001), the higher alpha and beta EEG peak frequencies (Dunn's test p &lt; 0.05) during NREM sleep suggested a state of hyperarousal.

Conclusion
The subtype of ID with the highest level of depressive symptoms is associated with cortical hyperarousal. Future research is needed to study the causal relationship between insomnia and depression under the hyperarousal model.

Support (if any)
National Natural Science Foundation of China (81971261); Shanghai Shenkang Development Center (SHDC2020CR4074); Shanghai Science and Technology Innovation Action Plan (20Y11906600)
0384 Multicomponent Behavioral Sleep Intervention for Insomnia in Older Adults with Mild Cognitive Impairment
Authors: McPhillips Miranda , Li Junxin , Petrovsky Darina , Brewster Glenna , Coni Jani , Aryal Subhash , Gooneratne Nalaka , Hodgson Nancy 
Published: April 2024

Abstract

Introduction
Insomnia is prevalent in older adults with mild cognitive impairment. Current treatment options are limited due to the nature of cognitive impairment and a paucity of providers. We sought to determine the preliminary effects of a multicomponent behavioral sleep intervention (MBSI) compared to a sleep education control condition on sleep latency, wake after sleep onset, total sleep time and efficiency.

Methods
Participants were enrolled and randomized in a 1:1 ratio to intervention or control in this pilot randomized controlled trial. Inclusion criteria were: self-reported and diary based evidence of insomnia (latency ≥ 30 minutes or wake after sleep onset ≥ 60 minutes) and Modified Telephone Interview for Cognitive Status scores between 28-36. The intervention was delivered virtually via tablet and consisted of sleep hygiene education, meaningful activity in the daytime and relaxation therapy in the evening for 4 weeks. The active control received sleep hygiene education only. Data collection occurred at baseline and immediately post intervention. Sleep variables were averaged over one week at each time point from daily sleep diaries. We used non-parametric Kruskal-Wallis tests to compare intervention and control post-intervention.

Results
We screened 180 potential participants and enrolled 27 older adults with mild cognitive impairment. Our sample was balanced on all key variables, had a mean age of 65.63 ± 6.39, was primarily (81.5%) female, and mixed between white (51.9%), Black (44.4%). Retention rate was high at almost 90%. At baseline, average latency was 46.5 (27.3) minutes for control and 41.4 (33.10) for intervention group. Post intervention, average latency for control group was 47.0 (34.6) and 28.3 (31.8) for intervention (p=0.076) Standardized mean difference (SMD) was 0.56. Average efficiency for control group was 65% (11%) and 70% (12%) for intervention at baseline. Post intervention, efficiency was 68% (14%) for control group and 78% (12%) for intervention (p=0.044). SMD was 0.76. There were no significant differences between groups for wake after sleep onset or total sleep time.

Conclusion
Preliminary evidence supports testing MBSI on a larger scale to improve insomnia symptoms in older adults with mild cognitive impairment and to determine if these effects are sustained over time.

Support (if any)
K23NR018487
0391 Effects of Brief Behavioral Treatment for Insomnia on Insomnia and Sleep Quality in Cancer Survivors
Authors: Dickerson Suzanne , Kwon Misol , Zhu Jingtao , Wilding Gregory E 
Published: April 2024

Abstract

Introduction
Insomnia is prevalent in more than 50% of cancer survivors, occurring during and after their treatment trajectory, potentially leading to subsequent insomnia disorder. Brief Behavioral Treatment for Insomnia (BBTI) aims to assist cancer survivors to self-manage their behaviors to improve their sleep to reduce insomnia symptom burden. This study determined efficacy of BBTI versus a healthy eating program attention control on insomnia severity index (ISI) and sleep quality measures overtime, in a heterogeneous sample of cancer survivors.

Methods
A sample of 132 eligible cancer survivors were recruited and randomized into BBTI (experimental) and control groups. All participants completed baseline demographics and sleep-related surveys (e.g., ISI, Pittsburgh Sleep Quality Index [PSQI]) at: baseline, 1-month, 3-month, and 12-month post intervention. Statistical analysis of ISI and sleep quality at each time point proceeded using fitted ANCOVA models with independent variables including randomized treatment assignment, participant cancer type, the interaction between treatment assignment and cancer type, and baseline outcome level. Tests for treatment effect were performed using an exact permutation testing approach with a two-sided 0.05 nominal significance level.

Results
Statistically significant group differences (p-values &lt; 0.05) were observed at all time points for both ISI and sleep quality. Mean differences (95% CI) in ISI (BBTI minus control) were estimated to be -2.2(-4.1, 0.4), -2.1(-4.2, 0.1), and -2.3(-4.4, 0.1) at 1-, 3-, and 12-months, respectively. For sleep quality, the estimated mean differences were -1.4(-2.6, 0.2), -1.8(-3.0, 0.5), and -1.8(-3.3, 0.3), respectively. When adjusting for covariates known to be predictive of outcome, ISI results were robust, with treatment group difference remaining statistically significant except for when adjusting for treatment related surgery where results became borderline non-significant.

Conclusion
BBTI was significantly effective in reducing insomnia severity and improving sleep quality overtime compared to control among cancer survivors with insomnia symptoms. Use of BBTI in cancer survivors can help bridge the gap in addressing insomnia symptoms in survivorship settings.

Support (if any)
NIH/NINR R01NR018215 (Dean/Dickerson), ClinicalTrials-NCT03810365
0393 Insomnia with Short Sleep Duration Is Associated with Hypertension and Endothelial Dysfunction in Young Adults
Authors: Fernandez-Mendoza Julio , Gao Zhaohui , Atha Raegan , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward 
Published: April 2024

Abstract

Introduction
Prior studies have examined the association between insomnia with short sleep duration (ISSD) with hypertension in middle-aged adults. However, no study to date has examined its association with elevated blood pressure (eBP) and flow-mediated dilation (FMD) in young adults.

Methods
We studied 270 young adults (median 25y, 53% female, 24% racial/ethnic minority) from the Penn State Child Cohort who underwent a 9-hour polysomnography (PSG) recording and Doppler ultrasound to asses FMD. The average of three consecutive BP readings was used to calculate resting mean arterial pressure (MAP) in the evening and morning. eBP was defined as systolic BP ≥120 mmHg, diastolic BP ≥80 mmHg, hypertension diagnosis, and/or antihypertensive medication use. Insomnia symptoms were defined as difficulties initiating or maintaining sleep, insomnia diagnosis or complaint, and/or sleep medication use. PSG-measured short sleep duration was defined by the median of the sample (i.e., &lt; 7-h), identifying normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and ISSD. Multivariate general linear models tested mean differences in MAP and FMD across the four groups adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, substance and medication use. A logistic regression model examined the association of the four groups with the presence of eBP, while accounting for the same covariables.

Results
Compared to NSD (84.6±1.2) or INSD (85.7±0.8), ISSD showed significantly higher evening MAP levels (88.0±0.8; p=0.022 and p=0.044, respectively), a finding replicated by morning MAP levels. Neither INSD (p=0.466) nor SSD (86.9±1.3; p=0.190) showed significantly elevated MAP levels compared to NSD. Similarly, ISSD (9.4±0.5; p=0.012), but not INSD (10.3±0.5; p=0.170) or SSD (10.3±0.7; p=0.257), showed significantly lower FMD levels compared to NSD (11.4±0.6). The odds of eBP were significantly increased in ISSD (OR=2.5, 95%CI=1.0-6.2; p=0.044), but not in INSD (OR=1.7, 95%CI=0.7-4.3; p=0.244) or SSD (OR=1.4, 95%CI=0.5-4.1; p=0.580), compared to NSD.

Conclusion
ISSD, but not INSD, is associated with hypertension and endothelial dysfunction in young adults. Clinical trials should examine whether improving insomnia symptoms and lengthening objective sleep duration in this phenotype may lead to favorable cardiovascular outcomes.

Support (if any)
NIH (R01HL136587, R01MH118308, UL1TR00127)
0401 Effects of a 4-week Vinyasa Yoga Intervention on Sleep and Cardiovascular Health in Adults with Insomnia Symptoms
Authors: Cheruka Caitlin , Sherman Sally , Quinn Tyler , Giordano Elizabeth , Lebegern Sophie , Lehrer Matthew , Buysse Daniel , Kline Christopher 
Published: April 2024

Abstract

Introduction
Insomnia is associated with an increased risk for cardiovascular disease. Yoga may have the potential to improve both sleep and cardiovascular health. However, there is limited evidence of how vinyasa yoga (VY), a form of yoga that links breath with movement and exhibits a greater energy expenditure than most other styles, impacts sleep and cardiovascular function. The purpose was to examine the effects of a 4-week VY intervention on sleep and cardiovascular health in adults with insomnia symptoms.

Methods
33 insufficiently active adults (84.8% female; 78.8% White; age=34.9±10.6 y; body mass index=28.9 kg/m2) with at least mild insomnia symptoms (Insomnia Severity Index [ISI]≥10) were randomized to a 4-week VY intervention (n=17) or non-active control (CON; n=16). VY practiced 3x/week following pre-recorded 60-minute videos and CON maintained their current lifestyle. Resting daytime measures of blood pressure, heart rate (HR) and heart rate variability (HRV) were obtained at baseline and post-intervention. Sleep was measured using the ISI, 7 nights of actigraphy, and a sleep diary. On one night during the sleep assessment, participants wore a chest HR monitor overnight to assess HRV. HRV was standardized for sleep duration, with root mean square of successive differences (RMSSD) the primary HRV outcome. Analyses compared changes in daytime cardiovascular health, sleep, and nocturnal HRV from pre- to post-intervention between groups using linear mixed models and Cohen’s d effect sizes.

Results
The change in ISI score from baseline to post-intervention did not differ between VY (15.18±0.96 to 9.93±1.00) and CON (16.63±0.98 to 13.87±0.98) (p=0.11) despite a medium-sized between-group effect size (d=-0.70) favoring VY. Among highly adherent participants, VY reduced ISI scores to a greater extent than CON (p=0.002). Changes in nocturnal RMSSD HRV and daytime resting cardiovascular measures were not statistically significant between groups (each p≥0.30). However, daytime resting HR decreased for VY (72.41±2.92 to 69.50±2.60 bpm) and increased for CON (70.47±2.54 to 72.93±2.60 bpm) (p=0.047).

Conclusion
Insomnia symptom reductions may be most apparent among those who consistently practice VY. VY had minimal impact on acute indications of cardiovascular health, suggesting changes may not occur with an intervention that is relatively short duration and/or low frequency.

Support (if any)
0412 Long-Term Treatment Outcomes for CBT-I in Black Americans: 3 & 6-Months Pilot Study Results
Authors: Thompson Michelle , Vancliff Camya , Seewald Mark , Muench Alexandria , Gallop Erin-Leigh , Scott Sadeaqua , Boyle Julia , Grandner Michael A , Jean-Louis Girardin , Posner Donn , Jemmott John , Perlis Michael 
Published: April 2024

Abstract

Introduction
In the US, Black Americans (BA) are disproportionately impacted by sleep continuity disturbance (SCD; i.e. insomnia) and insufficient sleep duration (ISD; i.e., &lt; 6hrs). Simultaneously, treating SCD and ISD may improve health and reduce sleep disparities experienced by BA. However, Increased risk for, and severity of, SCD and ISD in BA suggests that BA may respond differently to cognitive behavior therapy for insomnia (CBT-I). The primary reason is that standard CBT-I ranges from six to eight sessions (i.e., directly addresses SCD) but does not increase total sleep time and therefore may not adequately address ISD during acute treatment. A pilot study was conducted to assess the acceptability of CBT-I to treat insomnia in BA, and address whether increasing sessions of CBT-I (i.e., &gt; standard 8) will effectively address ISD. This study evaluates insomnia severity and sleepiness outcomes at 3- and 6- months post CBT-I treatment follow-ups.

Methods
Twelve BA adults (83% female, Mage 46.0±13.9yrs) were recruited from the Philadelphia area to receive CBT-I treatment by a master CBT-I therapist via telehealth for up to 16 sessions. Participants completed daily measures of sleep continuity (sleep diaries) and weekly measures of insomnia severity. Follow-up assessments were conducted at 3 and 6 months. Descriptive statistics are provided to show change in insomnia severity and sleepiness from baseline to post, baseline to 3-months and baseline to 6 months among the sample. Analyses were conducted using SPSSv27.

Results
Overall, on average, insomnia severity was reduced by 58% (effect size [ES]=1.3) at post, 61% (ES=1.8) at 3 months, and 67% at 6 months (ES=1.9). For sleepiness, on average, severity was reduced by 18% (ES=.2) at post, increased to 38% (ES=.7) at 3 months, and reduced to 28% (ES=.4) at 6 months.

Conclusion
Results from this pilot study indicate that standard CBT-I may produce robust effects. Reductions in insomnia severity and sleepiness remained durable at 6 months follow-up. Future studies with larger sample sizes are needed to explore further the use of CBT-I to treat sleep health problems in BA.

Support (if any)
K24AG055602; T32HL166609-02
0428 Comparative Analysis of Sleep Physiology Using Qualitative and Quantitative Criteria for Insomnia Symptoms
Authors: Lee Ruda , Larson Olivia , Younes Magdy , Gerardy Bethany , Pack Allan , Keenan Brendan , Gehrman Philip 
Published: April 2024

Abstract

Introduction
Insomnia is diagnosed based on subjective difficulty falling asleep, staying asleep, and early morning awakenings. Evidence of objective EEG abnormalities is mixed, in part due to small sample sizes and variable definitions of insomnia. This study aimed to explore these issues by comparing the insomnia case group and the control group on sleep physiology objectively measured depending on separate qualitative and quantitative self-reported insomnia symptoms.

Methods
Analyses are based on questionnaires and PSG data from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Two distinct insomnia case groups were defined. A qualitative insomnia case was defined as self-reported difficulty falling or staying asleep at least 3 nights/week for more than 3 months and moderate or greater impairment in daytime function due to poor sleep (n=350, 58% female; 48.47±14.38 years). The quantitative case definition required average self-reported sleep latency or wakefulness after sleep onset &gt;30 minutes combined with the frequency and impairment criteria. (n=196, 62% female; 48.77±13.74 years). We also defined control groups without insomnia. Participants were excluded if they had sleep apnea (apnea-hypopnea index [AHI] &gt; 5 events/hour) or were shift workers. Multivariate analysis of variance (MANOVA) models, adjusted for age and sex, were separately conducted to compare the insomnia and control groups. The focus was on traditional sleep architecture variables, EEG power within specific frequency bands, and odds ratio product (ORP, representing sleep depth) metrics.

Results
The MANOVA analysis indicated significant group differences, with post-hoc tests identifying key variables responsible for these distinctions. In qualitative criteria, sleep onset latency, sigma, beta1, and beta2 in EEG1 and EEG2, along with REM and NREM ORP, were significant contributors to the observed differences. In quantitative criteria, besides the same result in qualitative criteria, REM stage and alpha in EEG1 and EEG2 played significant roles. Effect sizes were consistent across both qualitative and quantitative criteria.

Conclusion
While the analyses depending on qualitative and quantitative criteria did not have different effect sizes, some variables contributed to the group differences. As such, the results of this study support the idea that qualitative and quantitative criteria measure the same dimensions for physiological differences related to insomnia.

Support (if any)
0430 Odds Ratio Product as a Biological Marker of Hyperarousal in Insomnia with Short Sleep Duration
Authors: Lambing Kari , Guadagni Veronica , Gerardy Bethany , Bender Amy , Younes Magdy , Bastien Celyne 
Published: April 2024

Abstract

Introduction
Odds-Ratio-Product (ORP) is an objective, continuous index of sleep depth and wake propensity ranging from 0 (very deep sleep) to 2.5 (full wakefulness) and measured in consecutive 3-second epochs. We investigated differences in ORP metrics in 69 insomnia patients with objectively short and normal sleep duration, and 50 controls.

Methods
Participants were recruited from the community and were screened with the Insomnia Severity Index and clinical interviews and assigned to either control or insomnia groups. Participants completed three nights of in-laboratory overnight polysomnography and the Odds Ratio Product (ORP) was computed from central EEG signals. Using average total sleep time (TST) of nights 2 and 3, patients with insomnia were divided into those with short sleep duration (&lt; 6 hours; ISSD; n=20) or normal sleep duration (INSD, n=49). Percent of TRT spent in different ORP deciles was calculated along with average ORP over wake time (ORPWAKE, higher values reflect greater alertness), and NREM sleep (ORPNREM, higher values reflect lighter sleep). We also measured the frequency of wake intrusions (transient increases (&gt;2.0) in ORP per hour of NREM sleep).

Results
Patients with ISSD had higher ORPwake than controls (p=.017) when controlling for age, spent more time in full wakefulness (decile 10, ORP&gt;2.25) than the other groups (p&lt;.001), less time in deep sleep (ORP&lt; 0.5) than INSD (p=.018), and had a higher wake intrusion index than patients with INSD (p=.015). Absolute misperception of sleep onset latency was associated with ORPNREM (p=.003), ORPTRT (p=.008), and wake intrusions (p=.012) in ISSD, and ORPTRT (p=.009) and wake intrusions (p=.025) in controls, such that a greater degree of misperception was associated with elevated ORP and greater disruption to sleep.

Conclusion
Patients with insomnia and short sleep duration had evidence of physiological hyperarousal in EEG measured by ORP compared to controls and patients with insomnia and normal sleep duration. Sleep fragmentation, measured with ORP, was also associated with misperception of sleep onset latency in patients with short sleep duration and controls. These results can assist with the characterization of insomnia phenotypes. Differences in physiological hyperarousal within phenotypes of insomnia could suggest more targeted treatment pathways.

Support (if any)