bluuebunny/crossref_metadata_2025_split huggingface dataset:
0351 Protective Factors Buffer the Impact of High Shift Work Disorder Risk on Health Outcomes
Authors: Harris Rachael , Drummond Sean P A , Sletten Tracey L , Wolkow Alexander P 
Published: April 2024

Abstract

Introduction
Shift work disorder (SWD) is a circadian rhythm sleep disorder associated with increased chance of experiencing poor mental health symptoms and physical health complaints. Traditional protective factors, such as resilience, as well as the ability to sleep at different times of the day, known as sleep flexibility, are known to reduce the risk of SWD, and to protect against poor mental health. However, more research is needed to understand how protective factors and SWD risk interact to predict health and wellbeing outcomes. The current study aimed to explore the role of traditional and sleep-specific protective factors in buffering the impact of high SWD risk on mental health and physical health complaints.

Methods
One hundred and twenty-six permanent nightshift workers or those working rotating shift schedules including nightshifts participated in an online cross-sectional study. The SWD-screening questionnaire determined participants’ SWD risk (low vs high). Participants completed validated measures to assess depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder Questionnaire), insomnia (Insomnia Severity Index), excessive sleepiness (Excessive Sleepiness Scale), sleep quality (Pittsburgh Sleep Quality Index), and physical health complaints (Subjective Health Complaints inventory). Participants also completed measures assessing protective factors, including resilience (Resilience Scale), social support (Social Provisions Scale), organisational support (Survey of Perceived Organizational Support), perseverance (Short Impulsive Behaviour Scale), morningness-eveningness (reduced Morningness-Eveningness Questionnaire), and sleep flexibility and languidity (Circadian Type Inventory).

Results
Multiple regression analyses revealed that in individuals with high SWD risk, having high social support was associated with reduced depression symptoms (p=.004). In those at risk of SWD, higher levels of morningness protected against insomnia severity (p=.01) and poor sleep quality (p=.01). Lastly, high perceived organisational support buffered the impact of SWD risk on gastrointestinal (p=.006) and allergy complaints (p=.005).

Conclusion
Improving support systems for shift workers presents an opportunity to prevent poor outcomes when workers are experiencing SWD symptomology. For instance, organisations can implement strategies that support workers to reduce symptoms of depression and physical health complaints. Furthermore, organisations that rely on shift work should consider strategies to support those with low morningness, especially when they are at risk of SWD.

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0353 Shining Light on Photic Measurement for Sleep and Circadian Field Studies
Authors: Bessman Sara , Harrison Elizabeth , Easterling Alexandra , Preilipper Sebastian , Glickman Gena 
Published: April 2024

Abstract

Introduction
Light is the most potent signal for the circadian regulation of sleep. To quantify light’s biological impact via melanopic Equivalent Daylight Illuminance (EDI), photic intensity is weighted based on the spectral sensitivity of melanopsin. This metric for light and time-of-day specific threshold recommendations support development, standardization, and replication of studies of the physiological effects of light. Light measurement outside the lab poses many unique challenges (e.g. greater variability in timing, intensity, spectrum; individual factors; technology limitations). Thus, consistent methods for measurement and reporting are important for maximizing the utility of emerging tools.

Methods
A framework for assessing and reporting light in field studies was developed, incorporating: 1) factors that influence light exposure, 2) methods for capturing the most significant factors, 3) strategies for addressing unique tradeoffs and challenges, and 4) an initial step-by-step protocol for measuring and reporting lighting characteristics in field studies of the physiological effects of light. This framework was applied in multiple study protocols to inform development and refinement.

Results
All studies used both static and continuous measures, along with subjective assessments. In one study, lighting was not homogenous and therefore position and location in the space mattered (melanopic EDI seated vs standing, 133.84 vs 221.91 lux; between workstations (seated), 133.84 vs 62.29 lux). In a second study, lighting was more homogenous but varied by time-on-shift; thus, continuous measures with a stationary meter were used. In a third study, subjective assessment of behaviors that influence photic exposure patterns over the past month indicated individuals likely did not meet nighttime light recommendations (melanopic EDI &lt; 1 lux): 73% used their phone in bed often or always before sleep; and 20% often or always checked their phone if awakened from sleep.

Conclusion
When measuring and reporting light in the field, a one-size-fits-all approach is impossible, but some level of standardization is necessary. The proposed multi-level framework expands on recent lab-based guidelines by making adaptations for field studies, facilitating the evidence-based translation of our fundamental understanding of the effects of light on sleep and circadian health.

Support (if any)
CDMRP JPC-5 Fatigue Countermeasures Working Group (#66619).
0355 Donning Sunglasses at Night: Advancing Fashion and Circadian Phase of Adolescents
Authors: Crowley Stephanie , Misiunaite Ieva , Adams John , Eastman Charmane 
Published: April 2024

Abstract

Introduction
Previously, we reported that evening room light and sleep restriction due to late bedtimes can reduce the expected circadian phase advances in response to morning bright light in adolescents or can shift rhythms later (delay). Here, we examine whether reducing evening light with sunglasses can rescue this effect and help rhythms shift earlier (advance).

Methods
So far, 57 adolescents (29 females; 14.1-18.0 years) completed a 14-day protocol. On days 1-7, they kept individualized 10-h sleep/dark schedules at home. On days 8-14, they lived in the laboratory. On day 8, we measured their Dim Light Melatonin Onset (DLMO). On days 9-10, they went to bed 1.5h, 3.0h, or 4.5h later. Wake time was unchanged; thus, sleep opportunity was 8.5h, 7h, and 5.5h, respectively. In each sleep restriction group, participants remained awake in room light (104±11 photopic lux; 8.5h n=9; 7h n=12; 5.5h n=8) or wore amber-lensed sunglasses (transmitted 14% of light and 10% of short wavelength light; 8.5h n=5; 7h n=4; 5.5h n=9). A control group (n=10) kept their baseline bedtime, so was not exposed to additional evening light or sleep restriction. On days 11-13, sleep/dark was gradually shifted earlier, and adolescents received three 30-min exposures of bright light (8599±885 photopic lux) upon waking. Final DLMO was measured on day 14. Multiple linear regression examined sleep restriction dose, sunglasses, and the dose-by-sunglasses interaction effects on phase shift.

Results
The control group advanced +2.1±1.0h. Greater sleep restriction reduced phase advances (dose: β=-1.31, p&lt;.001), but evening sunglasses attenuated this effect (dose-by-sunglasses: β=1.01, p&lt;.05). When sleep/dark was 8.5h, sunglasses produced larger advances (+1.3±0.6h) compared to no sunglasses (+0.5±0.6h) [t(12)=-2.4, p=.04]. Compared to no sunglasses, evening sunglasses prevented delays when sleep/dark was 7.0h (-0.8±1.1h vs +0.5±0.9; t(14)=-2.2, p=.04) and 5.5h (-2.6±1.2h vs +0.0±1.1h; t(15)=4.8, p&lt;.001). With evening sunglasses and 7.0h or 5.5h sleep/dark, advances were still smaller than control (p’s≤.01).

Conclusion
Reducing evening light with amber-lensed glasses during a phase-advancing protocol with morning bright light facilitates larger advances or prevents delays in adolescents. However, ≤7h sleep/dark reduces phase advances in response to morning bright light even when evening light is reduced.

Support (if any)
R01HL146772 (Crowley)
0359 Comorbid Insomnia and Sleep Apnea: Mortality Trends in a Large National Cohort of US Veterans
Authors: Razjouyan Javad , Crew Earl , Sweetman Alexander , Wallace Douglas , Melaku Yohannes , Azarian Mehrnaz , Sharafkhaneh Amir 
Published: April 2024

Abstract

Introduction
Comorbid insomnia and sleep apnea (COMISA) is a prevalent condition among veterans. Insomnia and sleep apnea (SA) may be diagnosed concurrently or on separate occasions (e.g., concurrent diagnoses, insomnia first, or OSA first). No study has investigated temporal sequences, time intervals, or health-associations of diagnostic intervals in people with COMISA. We examined these patterns of COMISA diagnoses in a large longitudinal clinical database.

Methods
We used ICD 9/10 codes to identify veterans with confirmed diagnosis of insomnia or SA. We used previously validated confirmed diagnosis algorithm. For insomnia, we further required evidence of treatment (medications or CBT-I). Time interval between the two diagnoses was defined in months (30 days), delta-month. We calculated the odds ratio of all-cause mortality followed for 36 months adjusting (aOR) for age, sex, race, ethnicity, Charlson Comorbidity Index (CCI) and exposure time (time from index insomnia or SA diagnosis) using patient with concurrent diagnosis as the reference (delta-month=0).

Results
We identified 303,803 people with COMISA with prevalence of 14.1% (Age 52.5, male 89.2, BMI 32.4±6.1, White 68.3%, CCI≥2 18.5%). 11,396 (3.8%) had both conditions diagnosed concurrently, 153,386 (50.5%) had insomnia followed by later SA diagnoses, and 139,021 (45.7%) had SA followed by later insomnia diagnoses. All-cause mortality rates were lowest among the concurrent diagnosis group (13%) and increased with larger time intervals between diagnoses (either insomnia-first, or OSA-first). Mortality rates increased to 16% from 5 to 14 months and reached 17% in ≥15 months. The aOR for mortality increased with greater delta-month up to 5 months, then plateaued from 5-14 months (1.19±0.03) and further rose and plateaued thereafter (1.24±0.05).

Conclusion
In COMISA, the timing of each diagnosis is heterogenous and may be associated with health outcomes. Mortality rates increase with wider time intervals between the two diagnoses, regardless of which condition is diagnosed first. Further exploration of mechanisms underlying this association of increased diagnostic delta and higher mortality risk in people with COMISA is warranted.

Support (if any)
Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0361 A Novel Longitudinal Approach to Evaluating Comorbid Insomnia and Sleep Apnea in Individuals Tested for Sleep Apnea
Authors: Speer Thomas , Rohrscheib Chelsie , Germain Anne 
Published: April 2024

Abstract

Introduction
Comorbid insomnia and sleep apnea (COMISA) is a debilitating disorder marked by a bi-directional relationship between obstructive sleep apnea (OSA) and insomnia. To explore this relationship, we employed a novel approach to evaluate metrics associated with comorbid-insomnia (sleep maintenance) in individuals who tested for OSA with a longitudinal (multi-night) home sleep test.

Methods
3,370 tests were evaluated (1,358 participants; mean age 49.73 years, SD 15.0; mean tests/participant 3.1, SD 4.5). OSA was measured by apnea/hypopnea index (AHI) and hypoxic burden (HB). ANOVA and PCC (99% CI) were used to evaluate the relationship between SA severity and measures of comorbid-insomnia (total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), #awakenings (#W), %light sleep (%L), %REM sleep (%REM)).

Results
TST (F[3,3357]=5.21; p&lt; 0.001), SE (F[3,3357]=16,12; p&lt; 0.001), and %REM (F[3,3357]=2.84; p=0.014) decreased, and #W (F[3, 3357]=3.20; p&lt; 0.001), WASO (F[3, 3357]=15.22; p&lt; 0.0001) and %Light (F[3,3357]=3.40; p&lt; 0.0001) increased with AHI severity. Between normal (AHI 0-4.99) and mild (AHI 5-14.99) tests, SE (-2%; p=0.005) decreased, and #W (+1.05; p=0.01) and WASO (+10.3 min; p&lt; 0.0001) increased. The largest change occurred between normal and severe (AHI &gt;30) tests (TST -28.65 min; WASO +27.15 min). AHI and HB were positively correlated (r=0.67; p&lt; 0.0001). AHI was weakly, but significantly, correlated with TST (p&lt; 0.0001), SE (p&lt; 0.0001), #W (p&lt; 0.0001), and WASO (p&lt; 0.0001). HB was correlated with SE (p&lt; 0.0001), #W (p&lt; 0.0001), and WASO (p&lt; 0.0001).

Conclusion
Comorbid-insomnia measures increased with SA severity at all levels, suggesting that the presence of OSA at any severity is a risk factor for COMISA. Further analysis is required to determine if the presence of SA and the impact of HB are the primary factors driving COMISA. Contextual issues surrounding the sleep period need to be addressed.

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0362 Obstructive Sleep Apnea, Insomnia and a Novel Approach to Separating Dangerous Bedfellows – Just “ASHQ”
Authors: Epstein Matthew , Chiu Stephanie , Cerrone Federico 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) can lead to numerous adverse health sequelae, increased medical costs and impaired quality of life, and insomnia may have similar consequences. The frequent co-occurrence of OSA and insomnia (comorbid insomnia and sleep apnea, COMISA) results in a bi-directional, synergistic relationship with greater symptomatology and refractory treatment outcomes. Poor sleep hygiene may directly contribute to insomnia, and identifying and correcting maladaptive sleep habits could improve sleep and management of COMISA. Numerous questionnaires are available to measure subjective sleepiness, fatigue and sleep quality, but there are no sleep hygiene surveys to identify the plethora of contemporary, maladaptive lifestyle behaviors that may contribute to insomnia. An instrument to detect detrimental sleep habits could help COMISA patients to optimize sleep hygiene, improve insomnia, and enhance treatment.

Methods
We recently developed a sleep hygiene questionnaire (Atlantic Sleep Hygiene Questionnaire, ASHQ) consisting of 20 detrimental sleep habits based on a critical analysis of the current sleep hygiene literature. In a prior validation study, ASHQ score strongly correlated with sleepiness, fatigue and subjective sleep quality in 700 adult patients with various sleep-related diagnoses. We now administered the ASHQ to a new cohort of 80 patients with only OSA. Patients also completed a single item sleep quality assessment (Sleep Quality Score, SQS) and a screening tool for insomnia (Insomnia Severity Index, ISI). ASHQ scores were summarized and compared to SQS and ISI survey results, and correlations were analyzed for each assessment.

Results
ASHQ and ISI scores were elevated in a majority of OSA patients, consistent with COMISA. ASHQ scores were significantly associated with SQS and ISI scores. There was a direct correlation between detrimental sleep habits, sleep quality and insomnia, confirming the validity of the ASHQ to assess sleep hygiene and its potential risk in patients with OSA and COMISA.

Conclusion
The ASHQ is a novel instrument to assess sleep hygiene, and ASHQ scoring strongly correlates with both sleep quality and insomnia in patients with OSA. ASHQ may be a useful tool to identify COMISA, improve sleep hygiene and concomitant insomnia, and facilitate treatment of underlying OSA.

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0363 Insomnia with Short Sleep Duration Is Associated with Increased Catecholamine Secretion in Young Adults
Authors: Fernandez-Mendoza Julio , Atha Raegan , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward 
Published: April 2024

Abstract

Introduction
Prior studies have shown insomnia to be associated with increased sympatho-adrenal-medullary (SAM) axis activity, as indexed by higher 24-hour urinary catecholamine secretion. These studies also showed that the activity of both axis of the stress system in those with insomnia is positively related to the degree of polysomnography (PSG)-measured sleep disturbance, ascertained by four consecutive nights. However, these pathophysiologic findings have not been replicated in population-based samples.

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 PSG recording, clinical history, self-report scales and provided a urine sample upon awakening from the PSG to assay for 8-hour release of catecholamines (i.e., epinephrine, norepinephrine, and dopamine). 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 total sleep time of the sample (i.e., &lt; 7-h), and identified normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and insomnia with short sleep duration (ISSD). A multivariate general linear model tested mean differences in catecholamine levels across the four groups while adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, medication and substance use.

Results
Compared to NSD (18.8±1.5) and INSD (20.9±1.1), ISSD showed significantly higher total epinephrine/norepinephrine levels (24.0±1.1; p=0.007 and p=0.046, respectively). This association was primarily driven by higher norepinephrine levels in ISSD (3.1±0.3) compared to NSD (2.2±0.5; p=0.018). Neither INSD (p=0.260) nor SSD (21.4±1.7; p=0.255) showed significantly elevated levels compared to NSD. There were no significant differences in dopamine levels across groups [e.g., NSD (238.1±10.8) vs. ISSD (241.6±7.6); p =0.809].

Conclusion
ISSD, but not INSD, is associated with higher morning norepinephrine levels, suggesting hyperactivity of the SAM axis of the stress system and increased risk for cardiovascular and psychiatric disorders.

Support (if any)
NIH (R01HL136587, R01MH118308, UL1TR00127)
0370 Short Sleep Duration Modifies the Association of Obstructive Sleep Apnea and Insomnia Symptoms with Biomarkers
Authors: Pejovic Slobodanka , Vgontzas Alexandros , He Fan , Fernandez-Mendoza Julio , Karataraki Maria , Elmslie Gwendolynne , Bixler Edward 
Published: April 2024

Abstract

Introduction
Co-morbid insomnia and obstructive sleep apnea (COMISA) have been shown to be associated with higher risk of cardiovascular disease than its individual components. Insomnia with objective short sleep duration (ISSD) has been associated with adverse cardiometabolic impact i.e., hypertension or diabetes. The aim of this study is to examine whether objective short sleep duration modifies the effect on clinical (hypertension) and preclinical inflammatory and metabolic biomarkers in patients with mild-to moderate OSA (mmOSA) and insomnia symptoms.

Methods
A clinical sample of 164 adults (52.76±13.08 years old) with mmOSA (5 ≤ AHI &lt; 30) underwent polysomnography or home sleep testing, measures of blood pressure (BP), body mass index (BMI), fasting blood glucose, insulin, CRP and IL-6 plasma levels, and completed Epworth Sleepiness Scale (ESS) and Pittsburg Sleep Quality Index (PSQI). Presence of EDS was defined as ESS score ≥ 11. Insomnia symptoms were defined as a self-report of more than 3 nights/week over the past 4 weeks of at least one of the following symptoms in the PSQI: “Cannot get to sleep within 30 minutes” or “Wake up in the middle of the night or early morning”. Objective short sleep duration was defined as &lt; 6.8-hours sleep based on the median total sleep time. Participants were classified into 4 clinically meaningful groups: asymptomatic mmOSA (control group), mmOSA with EDS, mmOSA with insomnia symptoms and objective short sleep duration (COMISA-SSD) and mmOSA with insomnia symptoms and objective normal sleep duration (COMISA-NSD). Univariate general linear models were conducted controlling for age, gender and BMI.

Results
Mean average systolic and diastolic BP were elevated in COMISA-SSD group compared to COMISA-NSD group (p=.042, p=.055, respectively). Plasma lnCRP and lnIL-6 concentrations were significantly elevated in COMISA-SSD group compared to control group (p=.010, p=0.014 respectively). Also, lnHOMA and insulin resistance (lnGlucose/insulin ratio) were significantly increased in COMISA-SSD group compared to COMISA-NSD group (p=.031, p=.046, respectively).

Conclusion
These findings show that the additive adverse cardiometabolic effects of COMISA phenotype are primarily driven by the insomnia short sleep duration phenotype, which appears to respond better to medication than psychological interventions.

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0371 The Odds Ratio Product: A Novel Tool to Identify Features of Comorbid Insomnia and Sleep Apnea
Authors: Hanif Umaer , Cairns Alyssa , Guadagni Veronica , Lambing Kari , Duke Guy , Mysliwiec Vincent 
Published: April 2024

Abstract

Introduction
Many patients presenting with either OSA or insomnia symptoms exhibit signs of the other condition. This overlap, known as COMISA, is often undetected due to differing diagnostic

methods
PSG for OSA and clinical symptoms for insomnia. The lack of objective diagnostic criteria for COMISA contributes to its low diagnosis rate. We sought to address this gap by investigating whether the Odds Ratio Product (ORP) algorithm can accurately distinguish between individuals with COMISA, OSA patients, and controls.

Methods
2000 patients (50% male/female) were selected from a large clinical cohort, equally grouped into 5 categories of 400 patients: clinic controls (AHI &lt; 5, no insomnia), mild OSA (AHI 5-15), mild OSA and insomnia (defined by presence of self-reported complaints of difficulty initiating sleep, maintaining sleep, experiencing restless sleep, and daytime fatigue), moderate-severe OSA (AHI ≥ 15, ODI ≥ 15), and moderate-severe OSA and insomnia. The OSA and COMISA subgroups were matched by AHI. The ORP was computed using a 3-second sliding window, averaged across each 30-second epoch of PSG total recording time (TRT). Extracted ORP features included mean, minimum, and percent TRT spent in ORP deciles 1-10 (1=deepest sleep; 10=fully awake). Univariate ordinal regression was utilized to classify disease subgroups using each ORP feature as input.

Results
Each disease subgroup was compared to clinic controls (reference group) and statistically presented in the following rank-ordered format (mild OSA, mild COMISA, moderate-severe OSA, moderate-severe COMISA). Significant discriminatory ORP features for disease subtype were mean ORP in NREM (ORs: 3.51, 9.35, 17.3, 43.8, p &lt; 0.001), minimum ORP (ORs: 5.67, 6.33, 5.62, 12.3, p &lt; 0.001), and percent TRT spent in decile 2 “deep sleep” (ORs: 0.982, 0.969, 0.963, 0.947, p &lt; 0.01) and 7 “transitional sleep” (ORs: 1.05, 1.08, 1.09, 1.11, p &lt; 0.01).

Conclusion
This study demonstrates the potential utility of the ORP algorithm to identify and discriminate between OSA and COMISA subgroups, the latter being underdiagnosed and inadequately treated in the routine sleep clinic paradigm. These findings suggest that ORP may be a valuable tool in the polysomnographic assessment of comorbid sleep disorders, offering a pathway towards an objective assessment and targeted treatment strategies.

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