bluuebunny/crossref_metadata_2025_split huggingface dataset:
0728 The Effects of Yoga on Sleep Quality in Menopausal Women: A Systematic Review and Meta-analysis
Authors: Segsarnviriya Charnsiri , Sugkraroek Pansak , Saokaew Surasak , Chirakalwasan Naricha , Charakorn Natamon 
Published: April 2024

Abstract

Introduction
Sleep disturbance is a common complaint in menopausal women, which could be a consequence of several factors, including reproductive hormonal changes and menopausal symptoms. Previous studies identified the benefits of yoga in alleviating menopausal symptoms. We conducted a systematic review and meta-analysis of menopausal women to assess the effect of yoga on sleep quality and menopausal symptoms.

Methods
PubMed, Scopus, Ovid, the Cochrane Library, and Google Scholar were searched through July 2023. Randomized controlled trials (RCTs) evaluating the effects of yoga in menopausal women, which reported quantitative data on sleep quality and menopausal symptoms, were included. The study protocol was registered on PROSPERO (CRD 42023464468).

Results
Thirteen RCTs (1,649 patients) were eligible for the meta-analysis. The meta-analysis of six RCTs (591 patients) did not demonstrate a statistically significant difference in the total score of the Pittsburgh Sleep Quality Index (mean difference -1.39; 95% CI (-3.69, 0.92); P = 0.24). On the contrary, the meta-analysis of eight RCTs (1,065 patients) revealed a significant improvement in the total score of the Menopausal Rating Scale (MRS) (mean difference -7.10; 95% CI (-11.27, -2.93); P = 0.0008). There were significant differences in the subscale of each symptom comprising the somato-vegetative, psychological, and urogenital subscales (somato-vegetative subscale: mean difference -2.64; 95% CI (-4.93, -0.35); P = 0.02, psychological subscale: mean difference -3.43; 95% CI (-5.76, -1.11); P = 0.004, and urogenital subscale: mean difference -1,25; 95% CI (-2.30, -0.21); P = 0.02).

Conclusion
The pooled results did not demonstrate the significant benefits of yoga on sleep quality in menopausal women. Conversely, the remarkable advantages of yoga in relieving menopausal symptoms were illustrated. To further explain the benefit of yoga on sleep quality in menopausal women, additional longer-duration yoga training or longer-term studies would be required.

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0729 The Influence of Sexual Orientation and Socio-Demographics on Sleep After a Depressive Episode
Authors: Kim Jeffrey , He Michelle , Gunturu Sasidhar , Shahawy Omar El 
Published: April 2024

Abstract

Introduction
Our study addresses the gap in understanding sleep health among adults with depressive episodes, where sleep disturbances are common. We primarily investigate sleep disorder prevalence among sexual and gender minorities (SGM), while also examining the influence of sociodemographic factors in this context.

Methods
Our study analyzes data from the 2020-2021 National Survey on Drug Use and Health (NSDUH). The initial sample was 90,927, with an analytical sample of 15,244 after restricting the analyses to people experiencing depressive episodes. All estimates were weighted to account for the multistage sampling design. Descriptive statistics were used to estimate the prevalence of all variables of interest, including tobacco and nicotine use, age, gender, ethnicity/race, income group, marital status, education, and the year of data collection. Then, to examine these relationships in a multivariable manner, we computed generalized linear models (using Poisson and log-link) to estimate adjusted prevalence ratios for each covariate.

Results
Among participants with a history of depressive episodes, the majority identified as female (61.3%) and non-Hispanic White (71.3%). An estimated 82.3% of these individuals reported sleep difficulties in their lifetime. Within this subset, an estimated 4.63% (95% CI: 4.01-5.33) identified themselves as gay/lesbian, and an estimated 14.1% (95% CI: 13.0-15.2) as bisexual. Compared to heterosexuals, gay/lesbian individuals had 1.06 times the prevalence of sleep difficulties (p = 0.038), and bisexual individuals also had 1.06 times the prevalence of sleep difficulties (p = 0.009). Individuals who had completed a college degree or higher had 0.89 times lower prevalence of sleep difficulties compared to those who had not completed high school (p &lt; 0.001). Finally, Hispanics had a 1.05 higher prevalence of sleep difficulties compared to non-Hispanic Whites (p = 0.015).

Conclusion
The study reveals significant disparities in sleep quality among different subgroups of individuals with depressive episodes. Gay/lesbian or bisexual individuals exhibit higher rates of sleep difficulties compared to their heterosexual counterparts. Furthermore, significant correlations were found between sleep difficulties and factors like ethnicity and educational attainment, suggesting a complex interplay of socio-demographic elements. These insights highlight the need for therapeutic strategies in mental health care that are cognizant of sexual orientation, educational background, and ethnicity.

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0739 Does Benzodiazepine Receptor Agonist Use, Insomnia, and OSA Explain Variation in Cognitive Performance?
Authors: Ann Lydia , Mitchell Michael , Alessi Cathy , Martin Jennifer , Dzierzewski Joseph , Josephson Karen , Naeem Saadia , Der-Mcleod Erin , Ghadimi Sara , Zeidler Michelle , Badr M Safwan , Moore Alison , Fung Constance H 
Published: April 2024

Abstract

Introduction
Older adults have multiple risk factors for cognitive impairment including insomnia, benzodiazepine receptor agonist (BZRA) use, and obstructive sleep apnea (OSA). Simultaneously addressing all risk factors is ideal but impractical. Clarifying the relative contribution of each risk factor could help prioritize strategies to reduce risk of cognitive impairment. We sought to quantify the effects of sleep risk factors on cognitive performance above and beyond other common risk factors for cognitive impairment.

Methods
We used clinical trial baseline data from outpatients taking a BZRA hypnotic. In four nested regression analyses, we modeled predictors of Mini-Mental State Examination (MMSE), Trail Making Test (TMT) A, TMT B, and Digit Symbol Substitution Test (DSST). Base Models included age, sex, ethnicity, race, education, vascular risk, depression, traumatic brain injury, and alcohol use. Nested models were: Model 2 = base model + Insomnia Severity Index score (ISI); Model 3 = Model 2 + BZRA hypnotic use; Model 4 = Model 3 + OSA risk; and Model 5 = Model 4 + OSA-BZRA interaction term. We compared changes in R-squared values and used F-tests to examine the fit of nested models.

Results
Of 348 participants (mean age 68.8), 313 were included for MMSE (m=28.2), 298 for TMT-A (m=48.2 seconds), 287 for TMT-B (m=130.2 seconds), and 285 for DSST (m=8.0) analyses. Mean ISI was 14.2 (SD 6.6). Mean 7-day BZRA total dose was 29.5 diazepam equivalents milligrams (SD 31.4). 44% were high-risk for OSA. Base Model R-squared was 0.139 (MMSE), 0.241 (TMT-A), 0.229 (TMT-B), and 0.189 (DSST). Change in R-square from Model 1 to Model 5 was 0.003 (MMSE), 0.005 (TMT-A), 0.010 (TMT-B), and 0.001 (DSST), with p-values &gt;.145 for F-tests comparing changes in R-squared. Change in R-squared for Models 2 to 3, 3 to 4, and 4 to 5 were not statistically significant.

Conclusion
Although our base models account for more than 13% of the variation in cognitive performance, sleep variables did not significantly explain additional variation in cognitive performance. These results suggest that in older adults using BZRAs, interventions targeting common risk factors should be prioritized to address cognitive impairment.

Support (if any)
VAIIR 17-234, NIAR01AG057929, UL1TR001881
0740 Does XX or XY Mark the Spot: Sex-specific Analysis of Polysomnographic Sleep and Cognition in Older Adults
Authors: Curtis Ashley , Costa Amy , Musich Madison , Rzeppa Chloe , McCrae Christina 
Published: April 2024

Abstract

Introduction
Poor sleep health is a proposed risk factor for Alzheimer’s disease (AD). Despite known sex differences in AD prevalence (higher in women), whether sex impacts associations between objective sleep parameters and specific cognitive functions remains underexplored. Such investigations are warranted and will provide information regarding potential sex-specific targets for early intervention and/or markers of AD risk. This study tested whether sex moderates associations between polysomnographic assessed sleep and cognition in older adults.

Methods
Older adults (Mage=68.2±5.5; 44 women/29 men) completed overnight polysomnography (Sleep Profiler) and cognitive tasks [NIH Toolbox: Pattern Comparison (processing speed), Oral Symbol Digit Test (attention and processing speed), List Sorting (working memory), Auditory Verbal Memory Task (episodic memory), Flanker (inhibition), Dimensional Change Card Sort (cognitive flexibility)]. Multiple regressions examined whether sleep metrics (sleep onset latency, wake time after sleep onset, sleep efficiency, total sleep time), macro-architecture (%N1-N3, %REM) or micro-architecture (sleep spindle duration and index) interacted with biological sex in associations with cognition, controlling for age, education and apnea-hypopnea index.

Results
Sleep onset latency (R-squared=.06, p=.03) and sleep spindle duration (R-squared=.05, p=.05) interacted with sex in their associations with cognitive flexibility. Specifically, in women (not men), longer sleep onset latency (B=-.01, SE=.002, p=.03) and longer spindle duration (B=-.08, SE=.03, p = .005) were associated with worse cognitive flexibility.

Conclusion
The link between polysomnographic sleep and cognitive flexibility in older adults may be sex dependent. Sleep onset latency cognitive (rumination/worry) and neural (physiological arousal/pre-frontal activation) mechanisms may interact with female sex-steroid alterations (post-menopausal drops in circulating estrogen and progesterone) and exacerbate its negative impact on cognitive flexibility. We also speculate that longer sleep spindle duration in the presence of dysfunctional cognitive flexibility may reflect compensatory thalamo-prefrontal cortical regulation (greater need for nighttime cognitive/cortical arousal reduction) that is further influenced by prefrontal sex-steroid mechanisms. Longitudinal studies in larger samples of cognitively healthy and impaired older adults are needed to further understand whether polysomnographic sleep metrics represent sex-specific markers of future cognitive decline.

Support (if any)
This research was made possible by awards (PI:Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.
0747 Tired and Lonely: An Exploration of Insomnia Symptoms and Loneliness Across the Adult Lifespan
Authors: Boyle Julia , Nielson Spencer , Dzierzewski Joseph 
Published: April 2024

Abstract

Introduction
Prior research has identified associations between poor sleep and loneliness; however, this research predominantly focused on a limited age range within adult populations. Very few studies have explored associations between insomnia symptoms (e.g., sleep disturbances, daytime dysfunction) and loneliness and how age might influence these associations across the adult lifespan. As such, the present study evaluated the association between insomnia symptoms and loneliness across the adult lifespan.

Methods
This online study surveyed adults across the lifespan (N=2297, Mage=44 years, 49% female) with the Insomnia Severity Index and the Gierveld Loneliness scale. Correlation and linear regression analyses were utilized to examine direct associations between insomnia symptoms, age, and loneliness. The Gierveld Loneliness total score and subscales (emotional and social loneliness) were used to investigate if aspects of loneliness were differentially associated with insomnia symptoms. Moderation analyses examined if the association between insomnia symptoms and loneliness differed by age. Each loneliness outcome (i.e.,total, emotional, and social) was included in a separate moderation model, with insomnia symptoms, age, and their interaction as predictors.

Results
Greater insomnia severity and older age were both significantly associated with higher loneliness total and subscale scores (all p’s&lt;.05). Age significantly moderated the association between insomnia symptoms and total and emotional loneliness scores (b = -0.02, t = -2.30, p=.02; b = -0.002, t = -2.88, p=.004, respectively); but did not moderate the association between insomnia symptoms and social loneliness (b = -0.001, t = -1.25, p=.212). Specifically, the strength of the association between insomnia severity and loneliness differed by age, with older adults displaying weaker associations between insomnia symptoms and loneliness compared to younger ages.

Conclusion
Insomnia symptoms are associated with loneliness across the lifespan. However, age moderated this association such that in older age cohorts the link between insomnia symptoms and loneliness, while still significant, was weaker than in younger cohorts. Efforts aimed at reducing loneliness in older adults should incorporate components of evidence-based insomnia treatments. Given the cross-sectional nature of this study, future research is needed to determine if lower levels of loneliness might be protective against developing insomnia in older adulthood.

Support (if any)
NIA - K23AG049955 (PI: Dzierzewski).
0753 Relationship Between OSA and Sleep Biomarker Based Neurodegenerative Disorder Risk in a Clinical Cohort
Authors: Mazeika Gandis , Cho Yeilim , Anderson Jack , Levendowski Daniel , Walsh Christine , Lee-Iannotti Joyce , Tsuang Debby , Neylan Thomas , Lewis Simon , Louis Erik St 
Published: April 2024

Abstract

Introduction
In this pilot study, sleep biomarker-based neurodegenerative disorder (NDD) risk was assessed in a clinical cohort of patients diagnosed with varying severity of obstructive sleep apnea (OSA).

Methods
Consecutive in-home multi-night Sleep Profiler records from a community sleep clinic were screened for age &gt;54 years old. Cases with comorbid restless leg syndrome, hypersomnia, missing apnea-hypopnea indexes (AHI), AHI&lt; 5 or single-night recordings were excluded. The 67 remaining records were 40% female, ages 63 + 7.4 years and up to 84 years old. NDD risk was assigned using a machine-learning algorithm combining age and nine sleep biomarkers to assign group probabilities: for Alzheimer’s disease, Lewy Body disease, prodromal synucleinopathy and controls (CG). Sleep biomarkers included: time-REM, non-REM hypertonia, autonomic-activation index, spindle-duration, atypical-N3, time-supine, sleep-efficiency, relative-theta, and theta/alpha. Those with CG probability score &gt;70% were classified as “Probably-normal”. Those with CG probability between 45 - 70% were classified as “Likely-normal”. Insomnia severity &gt;14 and a PHQ 9 &gt; 5 were used as cutoffs for clinical insomnia and depression. Mann-Whitney U-tests were used to evaluate group differences.

Results
This cohort had 37% mild, 34% moderate, and 29% severe OSA. Self-reported comorbid insomnia and depression were present in 43%. Seventy-three percent of patients were classified as “Probably-normal”, 16% “Likely-normal”, 11% “Likely-NDD” or “Probable-NDD”. The “Probably-normal” group was younger than the rest of the cohort (62 + 6.2 years vs. 68 + 8.6 years, p&lt; 0.01). Of those classified as “Probably-normal” (n=49), OSA was mild in 16, moderate in 17 and severe in 16. Mean AHI trended higher in the “Probably-normal” group than in those with elevated NDD risk (29 + 23.9 vs. 19 + 13.6 events/h, p=0.085).

Conclusion
Approximately 89% of the clinical cohort was classified as “Probably-normal” or “Likely-normal”. NDD risk was age-dependent. Interactions between OSA severity and NDD risk were not apparent in these findings, possibly related to group-wide effects. NDD risk, as measured by this model, did not appear to be adversely biased by untreated OSA. These results suggest a need for longitudinal studies to compare NDD risk in untreated OSA versus controls without sleep disordered breathing.

Support (if any)
NIH grants R44AG050326, R44AG054256, RO1AG060477, R33AG064271, ULRR024150, and R34AG056639.
0756 Validity of Self-reported Sleep in the Cancer Prevention Study – 3
Authors: Donzella Sidney , Masters Matthew , Phipps Amanda , Patel Alpa , Zhong Charlie 
Published: April 2024

Abstract

Introduction
Self-reported sleep measures are widely used in epidemiology research and may be influenced by a variety of factors, potentially introducing measurement error. We examined the one-year test/re-test concordance and validity of survey-assessed sleep duration.

Methods
The Activity Validation Sub Study (AVSS) included 751 participants of the Cancer Prevention Study-3 study to further investigate rest/activity cycles. Sleep duration was collected using three

methods
survey, Daysimeter device, and sleep diary. Survey-assessed sleep duration was collected in categorical and continuous formats. Selected participants (n=170) were asked to wear a device for seven consecutive days for two non-consecutive quarters and recorded sleep duration in sleep diaries for each night. Of the 170 study participants assigned a device, participants were excluded from the current study due to incomplete AVSS survey data, implausible device data, reported working night shift, insufficient days of device wear or diary entries, or reported less than 3 hours or greater than 14 hours of sleep for any of the sleep measures. We calculated concordance of pre- and post-survey sleep duration for both survey question using Spearman correlation. We used the method of triads to estimate the validity coefficient (VC) between the three sleep duration measurements in the present study and the “true” latent sleep duration measure, and bootstrapped 95% confidence intervals (95% CI). This was done for both survey-assessed sleep duration measures.

Results
A total of 117 participants were included in the study (53% male). Test-retest correlation for the pre- and post-survey showed strong and moderate correlations for sleep duration collected continuously and categorically, respectively. The VC for survey-assessed continuous sleep duration and the latent sleep duration was 0.83 (95% CI 0.72, 0.90) for weekday and 0.62 (95% CI 0.42, 0.78) for weekend. Performance of the VC was slightly weaker for survey-assessed categorical sleep duration (weekday VC=0.60 95% CI 0.45, 0.73; weekend VC=0.44 95% CI 0.29,0.61).

Conclusion
Performance of survey-assessed sleep duration as compared to device and diary measures varies based on how the question is asked and/or the response structure.

Support (if any)
The American Cancer Society funds the CPS-3 cohort. This work was supported through an unrestricted research grant from Sleep Number Corporation.
0759 Insomnia with Reduced Sleep Is a Risk Factor for Global Cognitive Decline in Cognitively Unimpaired Older Adults
Authors: Carvalho Diego , Fought Angela , Kolla Bhanu , Louis Erik St , McCarter Stuart , Przybelski Scott , Machulda Mary , Boeve Bradley , Petersen Ronald , Jack Clifford , Graff-Radford Jonathan , Vemuri Prashanthi 
Published: April 2024

Abstract

Introduction
Meta-analytic studies support that insomnia is a risk factor for cognitive decline and dementia, but limited accounting of confounders reduces their validity. Further, it is unclear whether these associations are driven by specific insomnia phenotypes. In this study, we aimed to assess the relationship between insomnia and longitudinal global cognitive decline in community-dwelling older adults after considering self-reported sleep duration changes and other important characteristics.

Methods
From the Mayo Clinic Study of Aging (MCSA) cohort, we identified all (age&gt;=50yo) cognitively unimpaired participants at baseline without comorbid neurological disease with at least two previous comprehensive neuropsychological evaluations. Participants with at least two occurrences of insomnia ICD diagnosis (by EMR and Rochester Epidemiological Project data) at least 30 days apart were classified as having insomnia, and those without any instance of diagnosis were considered negative for insomnia. Changes in sleep duration were assessed using the question #16 of BDI-2 and categorized in reduced sleep (yes/no). We fit mixed-effect regression models to assess whether insomnia was associated with standardized global cognitive scores, after adjusting for age, sex, education, APOEe4, composite cardiovascular and metabolic conditions scores, anxiety/depression, reduced sleep, OSA (ICD diagnosis), alcoholism (CAGE≥2), and pain (NSAIDs use). Number of cognitive assessments and time from baseline were included as both fixed and random effects. Multiple interactions (e.g. insomnia*reduced sleep) were included. A backward stepwise procedure maintaining the hierarchical principal for interactions was utilized to reach the most parsimonious models.

Results
3063 participants (50.24% males, aged 70±9.73 at baseline) were included. Insomnia alone was not associated with a decrease in global cognition, but when combined with subjective reduction in sleep duration at baseline it was associated with a -0.19 (95% CI: -0.32, -0.07; interaction p=0.01) reduction in global cognitive scores. This was equivalent to approximately 3 additional years of age or 6 cardiometabolic comorbidities at baseline. The effect size was greater than those associated with baseline cognition for having any APOE e4 allele (-0.12) and alcoholism (-0.15).

Conclusion
Insomnia with reduced sleep duration phenotype is a potentially modifiable risk factor for cognitive decline in older adults. Further studies with objective sleep measures are necessary for objective confirmation.

Support (if any)
NIA/NIH