bluuebunny/crossref_metadata_2025_split huggingface dataset:
0407 Physician Heal Thyself – a Novel Approach to Improve Sleep in Post-Graduate Medical Trainees
Authors: Epstein Matthew , Levine Jeffrey , Kellenberger Katherine , Chiu Stephanie , Kendra Moira , Landsman Melissa , Cerrone Federico 
Published: April 2024

Abstract

Introduction
Post-graduate medical training entails long work hours, overnight shift work, nocturnal sleep disruptions and insufficient sleep. Mandatory work hour restrictions have had some benefits, but ongoing acute and chronic sleep deprivation in physician trainees continues to impair physical and mental health, impede work performance and contribute to patient safety concerns. Sleep deprivation is increasingly common regardless of profession, and most adults fail to get adequate sleep, in part due to worsening sleep hygiene. We sought to determine whether physician trainees might be similarly impacted by the plethora of contemporary, maladaptive lifestyle habits and behaviors that contribute to insomnia in the general population.

Methods
We recently developed and validated a comprehensive sleep hygiene survey (Atlantic Sleep Hygiene Questionnaire, ASHQ) consisting of 20 detrimental sleep habits based on a critical analysis of the sleep hygiene literature. The ASHQ was administered to 97 residents and fellows at 2 teaching institutions encompassing 13 different specialties. Trainees 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. Trainees were provided immediate feedback following completion of the survey.

Results
ASHQ and ISI scores were elevated in a majority of the trainees, indicating a high prevalence of detrimental sleep habits and insomnia, respectively. ASHQ scores were significantly associated with SQS and ISI scores, and there was a direct correlation between poor sleep hygiene, worse sleep quality and insomnia.

Conclusion
Detrimental sleep habits were highly prevalent in this cohort of post-graduate medical trainees, and poor sleep hygiene correlated with both subjective sleep quality and insomnia. ASHQ may be a useful instrument to identify and improve poor sleep hygiene in this already sleep-deprived population.

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0410 Daily Shifts in Spiritual and Social Connection Are Associated with Nigh-to-Night Changes in Sleep in Young Adults
Authors: Reese Matthew , Kay Daniel , Duraccio Kara , Yang Chongming , Nielsen Jared 
Published: April 2024

Abstract

Introduction
Feeling connected, both spiritually and socially, contributes to positive health outcomes. In contrast, loneliness, the absence of social connection, is negatively associated with healthy sleep outcomes. Spiritual connection encompasses relationships with oneself, others, a higher power, or nature. The depth of these connections depends on self-awareness and soul-searching, shaping the level of intimacy but these internal feelings about personal spiritual connection are often overlooked.. This study examines the daily associations of feelings of spiritual and social connection with nightly sleep features in young adults (M=23+/-4 years of age).

Methods
This study included individuals with autism (n=33), social anxiety (n=28), and no diagnoses (n=33) Participants completed evening and morning diaries for 9 months while concurrently wearing an actigraph. The evening diary asked about daytime feelings of spiritual and social (digital and in-person) connection. Sleep diary measures included sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency. Multilevel linear modeling was used to explore daily/nightly associations between spiritual and social connection and sleep variables.

Results
Higher spiritual connection was associated with shorter sleep onset latency and (p=0.007) greater total sleep time (p=0.010), measured by sleep diary. Higher in-person social connection was associated with shorter total sleep time (p=0.010), measured by actigraphy. Higher digital social connection was associated with lower sleep efficiency (p=0.005), measured by actigraphy and lower self-reported wake after sleep onset (p=0.002). All other findings examining the daily/nightly associations between connection indexes and sleep variables were non-significant.

Conclusion
This study underscores the importance of considering internal spiritual connections alongside traditional measures of connection. As higher spiritual connection was associated with perceptions of sleep improvements (whereas in-person connection as associated with behavioral observations of sleep), spiritual connection could be a particularly salient intervention target for young adults with insomnia with sleep-state misperception. Digital social connection, however, revealed potential drawbacks, which highlights that even in the presence of connection using digital devices, electronic use may be deleterious to sleep.

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0411 The Effect of Non-pharmacological Interventions for Sleep During Pregnancy: A Systematic Review and Meta-analysis
Authors: Chen Pei , Wang Yueying , Wang Bixuan , yuan Jinjin , Lenon Pia Pauline , Bourjeily Ghada , Park Chang , Zhu Bingqian , Izci-Balserak Bilgay 
Published: April 2024

Abstract

Introduction
Sleep problems are common during pregnancy. Maintaining good sleep is critical to maternal and fetal health. This systematic review and meta-analysis aimed to quantify the effective non-pharmacological interventions for sleep in the pregnant population.

Methods
This review was performed following PRISMA and registered in PROSPERO (CRD42022372289). Studies were identified from PubMed, CINAHL, Embase, Web of Science, and Cochrane from inception to October 17, 2023 for intervention studies. Studies reporting non-pharmacological interventions and sleep-related outcomes were selected.

Results
Forty-two studies (N=3,378 women) were included. The efficacy of non-pharmacological interventions in terms of sleep quality showed a significant improvement (SMD=-1.17; 95% CI=-1.57 to -0.77; I2=97%; k=34). Interventions during the second trimester (SMD=-2.03; 95% CI=-3.26 to -0.79; I2=92%; k=3), third trimester (SMD=-1.51; 95% CI=-2.56 to -0.46; I2=95%; k=4), and the combined second and third trimester (SMD=-1.20; 95% CI=-1.87 to -0.54; I2=98%; k=18) demonstrated significant improvements in sleep quality. Both exercise (SMD=-0.73; 95% CI=-1.22 to -0.25; I2=90%; k=8) and cognitive behavioral therapy for insomnia (CBT-I) (SMD=-1.41; 95% CI=-2.56 to -0.26; I2=86%; k=3) led to significant improvements in sleep quality. These interventions also resulted in an increase in subjective nocturnal sleep duration (SMD=0.59; 95% CI=0.11 to 1.07; I2=86%; k=8), particularly with the use of eyemasks and earplugs during the third trimester (SMD=0.41; 95% CI=0.22 to 0.60; I2=46%; k=2), and improved subjective sleep efficiency during the combined second and third trimesters (SMD=0.92; 95% CI=0.29 to 1.52; I2=24%; k=2). Additionally, these interventions reduced subjective sleep onset latency (SMD=-0.53; 95% CI=-0.90 to -0.15; I2=49%; k=2). Furthermore, there was an increase in objective total time in bed during the third trimester (SMD=0.30; 95% CI=0.02 to 0.57; I2=0%; k=2). Objective sleep efficiency also saw a significant increase due to the interventions (SMD=0.19; 95% CI=0.01 to 0.38; I2=32%; k=5), especially during the combined second and third trimester (SMD=0.60; 95% CI=0.17 to 1.04; I2=0%; k=2).

Conclusion
Overall, non-pharmacological approaches appear to be beneficial for sleep-related outcomes in pregnant women. Future research should investigate intervention effects across trimesters and explore sleep-related outcomes, incorporating subjective and objective data.

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0414 Dose-response of Daridorexant in Insomnia Disorder: A Meta-analysis of Phase 2 and 3 Studies
Authors: McCall William , Bassetti Claudio , Braunstein Guy , Hedner Jan , Laurent Johann , Olivieri Antonio , Luyet Pierre-Philippe 
Published: April 2024

Abstract

Introduction
Daridorexant is a dual orexin receptor antagonist approved for the treatment of insomnia disorder at two dose levels (25 and 50 mg). Dose-efficacy and -safety response relationships were evaluated using data from Phase 2 and 3 studies.

Methods
Data from one Phase 2 study evaluating daridorexant 5 mg, 10 mg, 25 mg, 50 mg and placebo for 1 month, and two Phase 3 studies investigating daridorexant 10 mg and 25 mg or 25 mg and 50 mg vs placebo for 3 months were used. Dose-response analyses at 1 month of double-blind treatment were performed using two statistical approaches: a linear regression approach based on individual patient data and a two-stage meta-analysis approach based on aggregated data. Efficacy endpoints were polysomnography-determined wake after sleep onset (WASO) and latency to persistent sleep (LPS), self-reported total sleep time and the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) total score (Phase 3 only for the latter endpoint). Safety endpoints were the percentage of patients with at least one adverse event (AE) and at least one AE corresponding to somnolence/fatigue during the first month of the double-blind study periods.

Results
Pooled efficacy analyses included 2153 patients randomized to placebo (n=678), daridorexant 5 mg (n=60), 10 mg (n=365), 25 mg (n=679) and 50 mg (n=371). The dose-response was significant for both statistical approaches in the observed range of 0 to 50 mg at Month 1 for all four efficacy endpoints (p&lt; 0.01). All dose-response relationships were linear except for LPS (two-stage meta-analysis) which showed a change in slope after daridorexant 10 mg, without reaching a plateau. No significant dose-response relationship was observed for any AEs during the first month; results were consistent across methods (p&gt;0.05). AEs corresponding to somnolence/fatigue were low at all doses and relaxing the linear assumption (two-stage meta-analysis) showed no evidence of dose-dependency (p=0.369).

Conclusion
The data support a favorable benefit-risk balance for daridorexant 25 mg and 50 mg at 1 month of treatment. The greater efficacy and similar safety at 50 vs 25 mg support the use of daridorexant 50 mg as a starting dose in patients with insomnia disorder.

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Idorsia Pharmaceuticals Ltd
0415 Real-world Data and Health-related Quality of Life in Treatment of Chronic Insomnia with Daridorexant
Authors: Winter Yaroslav , Apel David , Fietze Ingo 
Published: April 2024

Abstract

Introduction
Daridorexant was approved by FDA and EMA for the treatment of chronic insomnia. It is a new dual orexin-receptor anatgonist, which demonstrated its clinical efficacy and safety in randomized controlled trials. The real-world data including its influence on the health-related quality of life (HrQol) are not yet available. In this prospective observational study we investigate the influence of daridorexant on HrQol in patients with chronic insomnia.

Methods
Patients with chronic insomnia diagnosed following the DSM V criteria were included in the observational study in terms of the Mainz Sleep Registry (MAINZ-SLEEPREG). All patients received the standard dosis of daridorexant of 50mg/night. The evaluation of clinical parameters and HrQoL was performed before, as well as three and six months after the initiation of daridorexant. The collected night-time efficacy endpoints included wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time and self-reported total sleep time. The EuroQol5D (EQ5D Index and EQVAS: visual analogue scale) was used to evaluate HrQol.

Results
Study participants (n=63) were 52.7±11.0 years old and 58.7% of them were females. All applied night-time efficacy measures (WASO, LPF, total sleep and self-reported sleep time) showed a significant improvement by approximately 20-40% at the time points after three and six months (p&lt; 0.05). At the follow-up after three and six months the EQ5D Index values (0.71±0.17 and 0.72±0.15, correspondingly) improved on daridorexant by 18% in comparison to baseline (0.61±0.17, p&lt; 0.05). Similar increase of HrQol was observed on EQVAS (62.2±16.5 at baseline versus 73.9±19.8 and 74.6±18.9, p&lt; 0.05).

Conclusion
The data from this real-word study shows that daridorexant not only significantly improves the night-time sleep of patients with chronic insomnia but it also increases their HrQol. These findings encourage farther real-world studies to investigate the role of daridorexant in the treatment of chronic insomnia in broader populations.

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0419 The Publication Profile of Randomized Clinical Trials for the Treatment of Insomnia
Authors: Kakazu Viviane , Assis Marcia , Bacelar Andrea , Bezerra Andréia , Ciutti Giovanna , Galduróz José , Conway Silvia , Drager Luciano , Khoury Mariana , Leite Ingrid , Luciano Ygor , Poyares Dalva , Tufik Sergio , Pires Gabriel 
Published: April 2024

Abstract

Introduction
There is a continuous need for the development and refinement of therapeutic interventions for insomnia. The implementation of these new treatments depends on robust results, and the publication of randomized controlled trials (RCTs) is often a requirement. The aim of this study is to describe the publication profile of randomized controlled trials (RCTs) about therapeutic interventions for insomnia.

Methods
A systematic review was performed on PubMed and Web of Science, searching for RCTs about pharmacological and non-pharmacological treatments for non-comorbid insomnia in adults. A bibliographic analysis was performed based on the publication year and the characteristics of the treatments evaluated in each included study.

Results
The sample comprised 64 RCTs related to pharmacological and 74 to non-pharmacological treatments. The individual interventions with the greatest publication outputs are digital cognitive-behavioral therapy (dCBTi, n=35), in person CBT-I (n=28) and zolpidem (n=22). Regarding zolpidem, the first RCT was published in 1993, the median publication year is 2008 and 0.71±0.97 RCTs were published per year. The first RCT about in-person CBTi was published in 2001, the median publication year is 2018 and 0.90±1.1 RCTs were published per year. The first RCT about dCBT-I was published in 2009, the median publication year is 2019 and 1.13±1.91 RCTs were published per year.

Conclusion
The publication output for pharmacological interventions has been substantial for zolpidem and DORAs only, while most other drug categories have not been analyzed by a significant number of studies. A remarkable increase in the amount of RCTs about CBT-I (especially dCBT-I) has been observed. The possibility of sponsorship bias should be considered as an important driver for the development of new digital interventions for insomnia.

Support (if any)
VAK, AGB, GLRC, MPK, IGAL, YML, DP, ST and GNP are supported by the Associação Fundo de Incentivo à Pesquisa (AFIP). VAK, MPK and YML are grant recipients from the São Paulo Research Foundation (FAPESP; grant 2022/00328-5, 2023/07603-4, 2022/08677-9). GLRC, JCG and DP are fellowship recipients from the is Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. This work was funded by the Brazilian Sleep Association (Associação Brasileira do Sono – ABS).
0420 Clinician Experience with Implementing Brief Behavioral Treatment for Insomnia
Authors: Hough Caroline , Beyer Nicole , Hruska Kristina , Rodriguez Keri , Bramoweth Adam 
Published: April 2024

Abstract

Introduction
Chronic insomnia significantly affects health, functioning, and quality of life for many Veterans, yet access to evidence-based behavioral insomnia care remains limited. This Hybrid III stepped-wedge trial aims to test the implementation and treatment effectiveness of delivering Brief Behavioral Treatment for Insomnia (BBTI) into the VA Primary Care Mental Health Integration (PCMHI) setting.

Methods
Enrolled clinicians, across the four sites (n=16) were interviewed after the 12-month implementation phase. The semi-structured qualitative interview focused on clinician experiences during the implementation phase, how access to the bundle of implementation strategies influenced their delivery of BBTI in PCMHI, specific strategies that were most or least helpful, and barriers that impeded implementation efforts. Interviews were transcribed and summarized using rapid qualitative analysis. Interview data was synthesized and organized into a template based on applicable Expert Recommendations for Implementing Change (ERIC) strategies.

Results
Participating clinicians rated BBTI as highly compatible in PCMHI settings, adaptable in its delivery, and an important intervention for meeting Veterans’ needs. Clinicians felt supported during the implementation of BBTI through access to a variety of educational resources. The most frequently cited barrier to implementation was work infrastructure difficulties, including high caseloads and inadequate staffing. Another common barrier was Veterans’ co-morbid diagnoses and other health issues taking precedence over insomnia care. Lastly, multiple sites struggled to engage primary care, and other referring, providers. To facilitate sustainable delivery of BBTI in the future, clinicians requested continued access to BBTI resources and education materials and recommended ongoing group discussion and consultation amongst PCMHI clinicians.

Conclusion
Clinicians rated BBTI as a high-quality intervention with high mission alignment and were eager to continue providing BBTI after the study’s conclusion, despite implementation barriers. When integrated with implementation outcomes (i.e., reach, effectiveness, adoption, implementation, maintenance), front-line clinician perspectives and feedback can support efforts to foster sustainable delivery of BBTI and can inform a larger-scale rollout of BBTI into the VA PCMHI setting.

Support (if any)
VA Health Services Research and Development (I01 HX003096; PI Bramoweth)
0421 Do Online Trainings Really Work? One Year Follow-up of Providers Who Completed CBTI Training Through CBTIweb
Authors: Wilkerson Allison , Taylor Daniel , Lin Tao , Pruiksma Kristi , Dietch Jessica , Wardle-Pinkston Sophie 
Published: April 2024

Abstract

Introduction
Online trainings to learn new skills and interventions are growing in popularity for mental health practitioners. Such platforms show promise for exponentially improving dissemination of evidence-based treatments and subsequent accessibility for individuals in need of effective care. However, minimal research has been done on the long-term impact of these trainings. CBTIweb was developed to train providers in cognitive behavioral therapy for insomnia (CBTI) and launched on April 1, 2020. The aim of the present study was to assess retention of knowledge about insomnia and CBTI and implementation of CBTI by providers approximately one year following their completion of CBTIweb.

Methods
Providers who completed CBTIweb within the first three months following the launch (N = 624) were contacted via email. Upon consent they were asked to answer the same test questions that were given as part of the CBTIweb training and complete an online survey. The survey included number of patients receiving CBTI in past year, items related to self-efficacy for CBTI delivery, barriers to implementing CBTI into their practice, and desire for resources that would increase effective implementation.

Results
Of the 624 providers who were contacted, 233 completed the test questions and survey. The vast majority passed the test (87%) and reported using CBTI in their practice since completing training (73%). Self-efficacy was positively associated with CBTI use. The most commonly cited facilitator of implementation was ease of access to handouts and other web-based tools designed to improve interaction with patients. The most common barriers were time required to prepare for sessions, difficulty finding supervision, accommodating comorbid conditions, and low patient buy-in.

Conclusion
The majority of providers who completed CBTIweb retained the information they learned in the training and implemented CBTI into their practice, indicating this online training format is a useful avenue for disseminating and implementing CBTI and other evidence-based treatments. Development of resources that would streamline delivery of CBTI, including simplifying patient handouts to minimize therapist preparation time, would likely lead to an increase in use of CBTI. Other barriers, including accessibility of supervision and low patient buy-in, warrant further investigation.

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W8IXWH1710165
0422 Cognitive Behavioral Therapy for Insomnia: The First Line Treatment for Insomnia Remains Elusive
Authors: Floyd Veronica , Turney Cameron , Assar Arash , Dickens Harrison , Egeler Mara , Walker Jamie , Vargas Ivan 
Published: April 2024

Abstract

Introduction
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly efficacious behavioral intervention for insomnia. However, no one has quantified to what extent United States citizens are familiar with or have used CBT-I (compared to other treatments like medication). This descriptive analyses study assessed the proportion of Americans that were familiar with and have used forms of sleep intervention, including CBT-I.

Methods
3,082 participants across the United States were surveyed through Cloudresearch Connect. The mean age was 39.6 (Range = 18-85). The sample comprised of 48.7% women and 71.3% identified as White. Participants were asked (on a 7 point Likert scale) questions about sleep health. Participants were asked about their familiarity with insomnia treatments including: prescription and over-the-counter (OTC) medications, Melatonin, CBTI, Sleep Hygiene, Sleep Restriction Therapy (SRT), Stimulus Control Therapy (SCT), Relaxation or Mindfulness Meditation Therapy, and Light Therapy. Participants were asked if they had used any treatments prior to or within the past 12 months. Participants also completed the Insomnia Severity Index (ISI).

Results
Participants rated the importance of sleep on their physical (M = 6.2; SD = 0.99) and mental (M = 6.4; SD = 0.96) health. 52.7% of the participants had at least subthreshold insomnia (ISI score &lt; 8). 17.7% had clinically elevated insomnia (ISI score &gt; 15). As for familiarity with various sleep treatments, 65.5% recognized prescription medications (e.g., Ambien), 69.3% recognized OTC medications (e.g., antihistamines), 80.5% recognized melatonin, 15.1% recognized CBT-I, 26% recognized sleep hygiene, 4.4% recognized SRT, 5% recognized SCT, 47% recognized Relaxation or Mindfulness Meditation Therapy, and 26.4% recognized Light Therapy. Among participants with at least subthreshold levels of insomnia, only 3.6% used CBT-I in the past 12 months, and 5% had used it at least once. In the past 12 months, 49.2% had used OTC medication and 13.8% had used prescription medications.

Conclusion
The data shows that CBT-I remains under-utilized. The majority of participants only knew of medication (prescription and OTC) treatments for insomnia. Efforts to identify and address the barriers to increasing awareness and availability of CBT-I are important and could help struggling insomniacs compared to other methods previously attempted.

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