bluuebunny/crossref_metadata_2025_split huggingface dataset:
0374 Dimensions of Sleep Health and Mood Disorders in Middle Eastern/North African Women
Authors: Sukhon Ahmad , Ismail Hadi , Irfan Bilal , Sankari Abdulghani , Attarian Hrayr , Herreshoff Emily , Duval Kim , Sankari Safa , Chervin Ronald , Dunietz Galit Levi 
Published: April 2024

Abstract

Introduction
Insomnia symptoms are a common sleep disturbance during midlife. However, emerging evidence suggests that midlife women also experience increased risk of obstructive sleep apnea and short sleep duration. Cohorts of women in midlife have mostly included white women, despite suspected sleep health disparities among women from underrepresented racial and ethnic backgrounds. To address this gap, we conducted a pilot study that examined sleep health among women from Middle Eastern/North African (MENA) ancestry.

Methods
This pilot study enrolled 77 women aged 40-60y from MENA ancestry, recruited mostly from Michigan. Women provided demographic, lifestyle, sleep and health information through interviews with structured and validated questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire (PHQ-9). Risk for obstructive sleep apnea (OSA) was evaluated using the STOP questionnaire+BMI and a subset of the women was tested with Watch-PAT, a one-night home sleep apnea testing device (OSA diagnosis, apnea-hypopnea index pAHI3%&gt;5/h). The menopause rating scale was used to collect data on psychological and physiological symptoms.

Results
Mean age of women was 48y±5 years and mean BMI was 27.6±5 kg/cm2. Anxiety, irritability, and depression symptoms were identified in 33%, 25% and 31% of women. Half reported trouble falling asleep within 30 minutes, and 73% experienced nocturnal and early morning awakenings three or more times per week. Most women (75%) were aware of adequate sleep recommendations, but 54% reported short sleep duration, &lt; 6 hours, and 30% reported &lt; 5 hours of sleep per night. A STOP+BMI score ≥3 was observed in 20% of women. Twenty women were tested for OSA and 75% had it (mean pAHI3%=12.6/h). Moderate and severe OSA was apparent among 20% and 10% of the 20 women. Concurrent OSA and insomnia symptoms were observed among 40% of women. The odds ratio of insomnia were 9-fold and 3-fold for women with depression and anxiety, respectively.

Conclusion
We found a high burden of poor sleep and sleep disorders among midlife women from MENA ancestry. Moreover, poor sleep was associated with symptoms of depression and anxiety, raising the possibility that efforts to improve sleep health could benefit the mental health of these women as well.

Support (if any)
0380 Fatigue, Anxiety and Heavy Menstrual Flow Interfere in Severe Insomnia Symptoms of Women at Reproductive Age
Authors: Ishikura Isabela , Porcacchia Allan , Hachul Helena , Tufik Sergio , Andersen Monica 
Published: April 2024

Abstract

Introduction
Insomnia is the most prevalent sleep disorder worldwide, and women have a greater risk of developing insomnia symptoms than men. The high prevalence of insomnia in women may be due to the hormonal oscillations that occur across the entire course of a woman’s life during the reproductive age. Our aim was to investigate the association between insomnia severity symptoms and menstrual health, fatigue and anxiety symptoms in women at reproductive age.

Methods
We used data from the EPISONO database (2007) with a sample of 282 women. Women completed the Insomnia Severity Index (ISI), the Chalder Fatigue Scale (CFS) and the Beck Anxiety Inventory (BAI) to obtain information about insomnia, fatigue and anxiety symptoms. For menstrual health, we collected information using our institutional women’s questionnaire about menstrual flow and duration, the presence of pain during menstruation and menstrual cycle regularity. The statistical analysis was performed using multinomial logistic regression, considering p&lt; 0.05.

Results
Our results demonstrated that fatigue and anxiety symptoms were statistically correlated with mild, moderate and severe insomnia symptoms (OR=1.43; 95%CI=1.02-1.99; p=0.034; OR=1.10; 95%CI=1.02-1.20; p=0.014, respectively). Heavy menstrual flow was statistically associated with severe insomnia symptoms (OR=13.8; 95%CI=1.58-121.9; p=0.018). Menstrual cycle regularity, pain during menstruation and menstrual duration were not statistically related to insomnia symptoms.

Conclusion
Our data showed that heavy menstrual flow increased the likelihood of having severe insomnia symptoms, while fatigue and anxiety symptoms contributed to the odds of having mild, moderate or severe insomnia symptoms. Menstrual health is an important subject that needs to be further explored by the scientific community in order to provide practices and treatments that can improve women’s sleep and quality of life.

Support (if any)
Our studies are supported by the following funding agencies: AFIP (Associação Fundo de Incentivo à Pesquisa). A.S.P. is a recipient of a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2021/05920-7). M.L.A. is a recipient of a grant from the Conselho Nacional de Desenvolvimento Científico e Tecnológico and FAPESP (2020/13467-8).
0381 Construct Validation of the Perinatal Rumination Scale at Night in Pregnant Patients Seeking Insomnia Treatment
Authors: Kalmbach David , Hirata Mika , Iqal Justin , Bayoneto Alec , Cheng Philip , Reffi Anthony , Pitts D'Angela , Swanson Leslie , Ong Jason , Fresco David , O'Brien Louise , Drake Christopher 
Published: April 2024

Abstract

Introduction
Perseverating on perinatal concerns at night (nocturnal perinatal rumination) increases insomnia, depression, and suicidal ideation (SI) during pregnancy. Poorly sleeping pregnant women identify reducing nocturnal perinatal rumination as critical for alleviating insomnia during pregnancy. However, no validated measures of nocturnal perinatal rumination exist, thereby limiting research in this area. We sought to develop and validate a brief survey to assess nocturnal perinatal rumination.

Methods
This study was a cross-sectional analysis of 223 pregnant women seeking insomnia treatment. Our team developed 11 questions to create the Perinatal Rumination Scale-Night (PRS-Night). Participants rated how intensely they experienced intrusive thoughts related to pregnancy while trying to sleep at night. Responses ranged from 0=not at all to 5=extremely (item examples: worry about your pregnancy or baby; have thoughts or concerns about childbirth). We conducted an exploratory factor analysis (EFA) with varimax rotation to identify the number of latent variables in our measure. Finally, we evaluated the measure’s internal consistency, convergent validity, and discriminant validity.

Results
159 patients (71.3%) screened positive for clinical insomnia (insomnia severity index [ISI]≥11), 88 patients (39.5%) screened positive for PND (Edinburgh postnatal depression scale [EPDS]≥10), and 161 patients (72.2%) screened positive for high cognitive arousal (pre-sleep arousal scale’s cognitive factor [PSASC]≥18). Bartlett’s test of sphericity was significant (p&lt;.001) and KMO was &gt;.90, supporting EFA. The scree plot revealed one factor (Eigenvalue=6.10) consisting of all 11 items. Internal consistency was excellent (Cronbach’s α=.92). The PRS-Night yielded good convergent validity with the PSASC (r=.56, p&lt;.001), ISI (r=.53, p&lt;.001), EPDS (r=.58, p&lt;.001), and perinatal anxiety questionnaire-revised (r=.54, p&lt;.001). SI rates were elevated for pregnant patients with high rumination (PRS-Night median-split high vs low: 19.6% vs 9.5%). The PRS-Night yielded good discriminant validity with the Epworth sleepiness scale (r=.13, ns) and patient-rated chronotype (r=.10, ns).

Conclusion
This study supports the psychometric validity of the PRS-Night for assessing nocturnal perinatal rumination. Given patient stakeholder interest in perinatal rumination at night, the PRS-Night has immense potential to help researchers better understand disease processes related to perinatal rumination and evaluate this construct as an important target mechanism in prenatal insomnia care.

Support (if any)
R34MH130562, PI: Kalmbach.
0382 The Neural Activation Involved in the Emotional Interference of Cognitive Control in Insomnia Disorder
Authors: Kim Sun-Young , Lee Kyung Hwa , Jeon Jeong Eun , Lee Ha Young , Shin Jiyoon , Seo Won Woo , Lee Yu Jin 
Published: April 2024

Abstract

Introduction
This study investigated the altered neural activation underlying emotional interference and its role in linking sleep disturbance in insomnia disorder.

Methods
Thirty-four insomnia patients (female 73.53%, mean age 50.76±11.98 years) and 33 controls (female 63.64%, mean age 42.73±11.90) were included in this study. They completed self-reported questionnaires (Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Dysfunctional Beliefs and Attitudes about Sleep (DBAS)) to assess subjective sleep quality, sleepiness and faulty sleep-related cognition. The sleep diary was used as a tool for the evaluation of subjective sleep parameters, whereas actigraphy and polysomnography were employed to assess objective sleep parameters. Depressive/anxiety symptoms were assessed using Beck Depressive inventory and Beck Anxiety inventory, respectively. All participants performed the emotional Stroop task in two blocks (negative emotional and neutral words) during functional magnetic resonance imaging (fMRI) assessments. We compared brain activation during the emotional Stroop between two group. Also, we analyzed correlations between altered neural activation and sleep/ emotion-related variables which show a difference between two groups.

Results
When performing the emotional Stroop task with negative emotional words, insomnia patients showed lower neural activation in the right occipital (MNI coordinates = 30,-88,-10; cluster size= 275; p=0.001) and right superior temporal (MNI coordinates =42,-28, 8; cluster size=174; p=0.007) area compared to controls. These decrease neural activations during negative emotional words were negatively correlated with the levels of subjective sleep quality and faulty sleep-related cognition (right occipital area: PSQI CE= -0.38, FDR corrected p=0.002; ISI CE= -0.32, FDR corrected p=0.032; DBAS CE= -0.39, FDR corrected p=0.009, right superior temporal area: PSQI CE= -0.34, FDR corrected p=0.030; DBAS CE= -0.45, FDR corrected p=0.002, respectively)

Conclusion
In insomnia patients, there may be a diminished capacity to perceive negative emotional stimuli and cognitive control under emotional interference associated with decreased activity of the right occipital and right superior temporal areas. This tendency is associated with subjective sleep disturbance and faulty sleep-related cognition.

Support (if any)
This study was supported by National Research Foundation (NRF) of Korea (Study no. NRF-2018R1D1A1B07049704 and no. NRF-2022R1A2C1008209).
0385 Hypnosis Intervention for Sleep Disturbances in Individuals with Mild Cognitive Impairment
Authors: Elkins Gary , Padilla Victor , Otte Julie , Sanford Keith , Benge Jared , Stevens Alan , Scullin Michael , Corlett Christopher , Ekanayake Vindhya 
Published: April 2024

Abstract

Introduction
Poor sleep quality is highly prevalent among individuals with mild cognitive impairment (MCI). Further, poor sleep quality is associated with reduced quality of life, increased stress response, memory impairments, and progression to dementia among individuals with MCI. Pharmacological treatments for sleep have mixed efficacy and can lead to dependency. Therefore, alternatives to pharmacological treatments for improving sleep among individuals with MCI are needed. The present study reports on the feasibility of a non-pharmacological. It was hypothesized that the hypnosis intervention program would be feasible and have acceptable levels of adherence to daily hypnosis practice.

Methods
A two-armed randomized controlled pilot trial was conducted using a sample of 21 adults with MCI. Eligible participants were randomly assigned to listen to either hypnosis audio recordings or sham hypnosis recordings for five weeks. Program feasibility, program adherence, pain intensity, stress, and sleep quality were measured using a daily home practice log, questionnaires, and wrist actigraphy.

Results
The results found mid or higher levels of treatment satisfaction, ease of use, and perceived effectiveness at one-week follow-up, with participants in the hypnosis arm reporting greater perceived benefit. Adherence to assigned audio recordings and meetings were likewise within acceptable margins in both groups. No intervention-related adverse events were reported in either treatment condition. Significant improvements in sleep quality, sleep duration, and daytime sleepiness were found for the hypnosis intervention.

Conclusion
The results of this study can be used to inform future research on the effects of hypnosis on sleep quality in adults with MCI.

Support (if any)
0389 A Computerized Cognitive Behavioral Therapy Randomized, Controlled, Pilot Trial for Insomnia in Epilepsy
Authors: Mouchati Christian , Andrews Noah , Bena James , Morrison Shannon , Foldvary-Schaefer Nancy 
Published: April 2024

Abstract

Introduction
Insomnia is the most common sleep-wake complaint in adults with epilepsy (AWE), impacting quality of life and potentially seizure control. Cognitive behavioral therapy for insomnia (CBTI) is the first-line treatment, although often costly and inaccessible. We conducted a Pilot Trial using web-based CBTI for Insomnia in AWE.

Methods
This randomized controlled trial was conducted at Cleveland Clinic comparing the efficacy of web-based CBTI Go to Sleep (GTS) to controls who received an informational sheet on sleep hygiene. The primary outcome was a change in the Insomnia Severity Index (ISI). Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and self-reported total sleep time (TST) were also evaluated. GTS adherence was measured by % of modules (total of 6) completed. Change in survey scores was assessed using ANOVA tests with Pearson’s correlations between baseline and 8 weeks post-randomization.

Results
A total of 35 subjects (GTS: N=18; control: N=17) were included; mean age 40.9±10.9, 77.1% female, ISI 21.6±3.4, FSS 46.3±9.5, ESS 9.6±5.9, PHQ-9 12.8±5.2, TST 6.1±1.8 hr. At baseline, all patients had ISI of 15+. At follow-up, 33.3% of GTS and 47.1% of controls had scores of 15+(p=0.88). ISI change was greater in GTS than in controls (-9.0 (-11.3,-6.6) vs. -5.8 (-8.4,-3.3); p=0.079). Changes in other patient-reported outcomes (PROs) and TST between groups were not significant. However, decreases in ISI were associated with decreases in ESS, p=0.004 and PHQ-9, p&lt; 0.001, but not FSS or TST. Eleven (61.1%) of GTS patients completed the 6-module program. 75% reported satisfaction with the audio components and content of the program and found GTS very easy to use. Completion of lessons was associated with a decrease in FSS, p=0.031.

Conclusion
Comparable improvement in insomnia symptoms and other PROs were observed in AWE engaging in web-based CBTI and sleep hygiene education. Program adherence was good. Despite sample size limitations, these findings support the role of non-pharmacological insomnia treatment in AWE.

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0392 Insomnia with Short Sleep Duration Is Associated with Heart Disease and Stroke: Evidence from the UK Biobank Cohort
Authors: Vgontzas Alexandros , Shang Yimeng , He Fan , Fernandez-Mendoza Julio , Pejovic Slobodanka , Lenker Kristina , Kong Lan 
Published: April 2024

Abstract

Introduction
Evidence on the association of insomnia short sleep duration phenotype (ISSD) with heart disease and cerebrovascular disease (CBVD) is limited and based on cohorts using polysomnography. The aim of this study is to assess the risk of ISSD with incident heart disease and CBVD including stroke in the large UK biobank cohort based on self-reported insomnia and objectively measured habitual sleep duration by accelerometer.

Methods
We identified 96219 participants from the UK Biobank who underwent a 1-week objective sleep measure during 2013-2016. Short sleep duration was defined as ≤ 7.3 hours/night (i.e., median), after excluding participants who slept ≤ 3 hours/night or ≥11 hours/night. Self-reported insomnia symptoms obtained ± 1-year within the objective sleep measure, which was available from 4156 participants, was used to define insomnia status. Participants reported “Usually” having insomnia symptoms (vs. Never/Rarely/Sometimes) were categorized as having insomnia. Four sleep phenotypes based on the presence of short sleep duration (Yes/No) and/or insomnia symptoms (Yes/No) were created. Major confounding factors, including age, sex, BMI, smoking, and alcohol intake, were extracted from the study visit closest to the objective sleep measure. To evaluate the associations between the sleep phenotypes with incident heart and CBVD, multivariable-adjusted Cox proportional hazards models were used. The effective sample sizes for analysis on heart and cerebrovascular diseases were 3630 and 4064, respectively.

Results
Compared to normal sleepers with normal sleep duration, only ISSD phenotype was associated with significant risk for heart disease (HR=1.77, 95%CI=1.25-2.49, P=0.001) whereas neither the insomnia normal sleep duration group nor the normal sleepers short sleep duration group were associated with increased risk for heart disease. Similarly, compared to normal sleepers with normal sleep duration, only the ISSD group was associated with increased risk for CBVD including stroke (HR=2.18, 95%CI=1.21-3.92, P=0.009) whereas there was no association between the other two sleep groups and CBVD.

Conclusion
These data from the large UK biobank database using an ecologically friendly method to assess habitual objective sleep duration suggest that it is the combination of insomnia plus short sleep duration (ISSD), that increase significantly the risk for heart disease and stroke.

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0395 Effectiveness of a Digital Clinical Decision Support Platform to Augment CBTI Capability Gaps in the DHA/DoD
Authors: Germain Anne , Wolfson Megan , Star John Blue , Espejo Emmanuel , Mysliwiec Vincent 
Published: April 2024

Abstract

Introduction
Insomnia is the most prevalent sleep disorder among active duty service members (ADSMs) and compromises readiness. Cognitive-behavioral therapy for insomnia (CBTI) is the DoD/VA recommended treatment, but access and delivery of CBTI is impeded by gaps between high patient demand for care and clinical capabilities. We evaluated the effectiveness of a digital clinical decision support (CDS) platform to overcome current CBTI capability gaps.

Methods
Mental healthcare providers (MHCPs) at military clinics were offered access to a novel CDS platform (COAST, NOCTEM® Health, Inc) to treat patients they deemed appropriate for this CBTI delivery mode. The platform consists of (1) clinician portal to remotely monitor and manage patients’ symptoms, progress, and adherence to algorithm-based, MHCP-approved treatment recommendations; (2) patient app that prospectively collects sleep diaries and displays MHCP-approved treatment recommendations (e.g., stimulus control, sleep restriction). The primary outcomes were treatment response (50% reduction in sleep latency (SL) or wake after sleep onset (WASO); increase of &gt; 10% in sleep efficiency (SE)) and insomnia remission (response & SL & WASO &lt; 30 minutes with SE &gt; 85%) at the end of treatment. The magnitude of changes in diary-based SL, WASO, and %SE were compared from baseline and at the final intervention was quantified using Cohen’s d effect sizes.

Results
Nineteen MHCPs at 7 Air Force Bases, 2 Naval hospitals, and 1 Army medical center utilized the platform with 245 ADSMs presenting with insomnia (M age =32.6 + 8.0 y.o.; 27.3% women, 78% Sailors/Marines, 19% Airmen, 3% Soldiers). Average treatment duration was 5 ±1 weeks. The mean completion rate of diaries was 77% + 20%. Post-treatment, 83.5% of ADSMs met treatment response criteria, and 70.3% met remission criteria. From baseline to the last intervention, clinically meaningful improvements in SL, WASO, and %SE were observed (all Cohen’s d &gt; .5).

Conclusion
Augmentation of CBTI capabilities among MHCP using a digital CDS platform is feasible and yields rapid and clinically meaningful improvements in sleep among ADSMs with insomnia. CDS-enabled services may facilitate the scalability of DoD/VA insomnia management practices and reduce CBTI capability gaps.

Support (if any)
MTEC-2019-406, AFMRA (29700-0007), Leidos (P010268077).
0402 Mediating Effects of Social Support on Associations Between Stress and Insomnia
Authors: Elvariste Stessie , Gallop Erin-Leigh , Blanc Judite , Oliveira Bruno , Casimir Georges , Nunes joao , Seixas Azizi , Jean-Louis Girardin 
Published: April 2024

Abstract

Introduction
Insomnia is a common sleep disorder that is linked to environmental/social factors and medical illnesses. Insomnia is associated with stress, defined as the mental or emotional pressure experienced when an individual is faced with adverse or demanding circumstances that are perceived to or exceed their ability to cope. While stress can lead to insomnia, it is hypothesized that social support could affect the association between stress and insomnia. To understand this mechanism, the presented study examines the relationship between stress and insomnia among blacks, highlighting the role of social support in this demographic.

Methods
Black Participants (N=618; female= 65%, male= 35%), ages 18 and older, from 2 NIH-funded studies, ESSENTIAL and MOSAIC, provided sociodemographic data and completed questionnaires on behavioral and social determinants of sleep and health. Perceived stress, insomnia and social support were evaluated using the perceived stress scale, the insomnia severity index, and the multidimensional scale of perceived social support questionnaire, respectively. Descriptive and linear regression analyses were performed to explore the association between insomnia, stress, and social support. Mediation analysis was conducted to establish and understand the effect of social support on stress score and ISIScore. All analyses were performed using SPSS 29.

Results
Regression analysis revealed stress as the strongest predictor of insomnia in blacks [β= .227; p&lt; .001]. The model adjusted for sex, age, and states (New York vs Florida). Perceived social support was significantly associated with a decrease in stress score and insomnia, [β= -.152; p&lt;.001]. Mediation analysis revealed that the effect between Stress Score and ISIScore via the intermediary variable of Social Support is statistically significant (p=0.0005).

Conclusion
Stress is a robust predictor of insomnia among blacks. However, social support mediates this relationship by decreasing both stress and insomnia. Further research should investigate the importance of social support to promote better overall health and sleep.

Support (if any)
NIH R01AG067523, R01HL142066, K01HL135452