bluuebunny/crossref_metadata_2025_split huggingface dataset:
0732 Poor Perinatal Sleep Quality Is Associated with an Elevated Cortisol Awakening Response
Authors: Okun Michele , Segerstrom Suzanne , Ross Kharah , Schetter Chris Dunkel , Coussons-Read Mary 
Published: April 2024

Abstract

Introduction
The perinatal period is a time of disrupted sleep. Sleep quality progressively worsens across gestation and into the postpartum. A mechanism linking poor sleep with certain adverse pregnancy outcomes is dysregulation of the HPA axis resulting in atypically elevated cortisol production. Although total cortisol output normally increases across pregnancy, the cortisol awakening response (CAR) attenuates as pregnancy progresses, with normalization in the first couple of weeks after delivery. The objective of this study was to evaluate longitudinal associations between maternal sleep quality and indices of cortisol across the perinatal period.

Methods
Data were collected as part of the HB3 study. PSQI and saliva were collected at four time-points (8-16 weeks, 30-36 weeks, 6 months postpartum, and 1-year postpartum). Participants (N = 230) who had sleep and cortisol data from at least 1 of 4 time-points were included in analyses. Multi-level models were run to predict cortisol parameters based on deviations in average maternal sleep quality at each wave. Values below the detectable limit were imputed and samples taken &lt; 20 minutes or &gt; 60 minutes were excluded.

Results
Multilevel (time, wave, and person) modeling indicated an average positive CAR slope (g=0.29, p=.02) that was affected by whether sleep quality was better or worse at that wave (p=.04). When PSQI scores were higher than the woman's own average, the CAR slope was steeper (+1 point in PSQI, g=0.32), and when scores were lower than average, the CAR slope was flatter (-1 point, g=0.25). CAR slope was not affected by average sleep quality across waves (p=.21). Diurnal slope was not affected by sleep quality being better or worse at that wave (p = .82) or by average sleep quality across waves (p=.61).

Conclusion
Women with poorer sleep quality than their average had a larger CAR than women with better sleep quality than their average. There was no association between sleep quality and the diurnal slope. These data suggest that greater variability in sleep quality significantly increases the amount of cortisol secreted upon awakening. Further examination is needed to determine if sleep quality is associated with adverse pregnancy/delivery outcomes via HPA axis dysregulation.

Support (if any)
NICHD R01HD073491-01
0733 Associations Between Multiple Dimensions of Sleep and Cognition by Race/Ethnicity and Gender
Authors: Zendels Philip , Gaston Symielle , Payne Christopher , Jackson W Braxton , Jackson Chandra 
Published: April 2024

Abstract

Introduction
Sleep disturbances (including unhealthy duration, insomnia symptoms, and poor sleep quality) have been associated with impairments to memory and concentration. Although racially minoritized groups and women generally have poorer sleep quality and faster cognitive decline, few studies have investigated associations between multiple sleep dimensions and cognition by race/ethnicity and gender.

Methods
To investigate multiple sleep dimensions in relation to cognitive impairment, overall and by race/ethnicity and gender among US adults aged ≥40 years, cross-sectional data were pooled from the 2011-2018 National Health Interview Survey. Participants self-reported short (&lt; 7 hours) and long (&gt;9 hours) sleep duration and sleep disturbances (i.e., insomnia symptoms: trouble falling asleep and/or staying asleep 3+ nights/week; non-restorative sleep: waking up not feeling rested 4+ nights/week). Cognitive impairment (yes vs. no) was self-reported in one item of the Washington Group Short Set on Functioning and defined as either not being able to or having a lot of difficulty remembering and concentrating. Using Poisson regression with robust variance and adjusting for sociodemographic, health behavior, and clinical characteristics, we estimated prevalence ratios for associations between sleep dimensions and cognitive impairment, overall and by race/ethnicity and gender.

Results
Among, 73,477 participants, mean age was 58.3±0.7 years, and most (86.7%) attained high school or higher education. Overall, 2.2% had cognitive impairment (by race/ethnicity: Latinx (2.5%), Asian (1.6%), Black/African American (2.5%), and White (2.1%); by gender: women (2.4%), men (1.9%)). Short sleep was associated with higher prevalence of cognitive impairment only among White adults (PR=1.30 [95% CI:1.10-1.55] vs. range: PR-Asian=0.69 [95% CI:0.33-1.45] to PR-Latinx=1.14 [95% CI:0.75-1.73];p-interaction&lt; 0.05) Although long sleep duration was associated with a higher prevalence of cognitive impairment among the overall population (PR=4.10 [95% CI:3.48-4.83]), associations were strongest among Asian adults (PR=5.27 [95% CI:2.84-9.80]; p-interaction&lt; 0.05). Both insomnia symptoms (PR=1.40 [95% CI:1.40-1.87) and non-restorative sleep (PR=1.67 [95% CI:1.44-1.94) were associated with a higher prevalence of cognitive impairment across racial/ethnic groups. No associations varied by gender.

Conclusion
Short and long sleep, insomnia symptoms, and non-restorative sleep were associated with cognitive impairment with potential differences by race/ethnicity for sleep duration. Future studies identifying factors driving observed disparities by race/ethnicity and gender are warranted.

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0735 A Preliminary Comorbidity Profile for Patients with Insomnia and Daytime Sleepiness in VA Subacute Rehabilitation
Authors: Boeve Angelica , O'Malley Kelly , Moye Jennifer , Ruopp Marcus , Boyle Julia 
Published: April 2024

Abstract

Introduction
Insomnia symptoms during inpatient rehabilitation are associated with slower recovery progression and longer lengths of stay. In addition to addressing environmental and behavioral factors, understanding medical and psychiatric comorbidities may help clinicians identify patients in most need of insomnia-related assessment, monitoring, or treatment. The present preliminary analysis aimed to characterize the comorbidity profiles of patients with insomnia symptoms and daytime sleepiness newly admitted to a VA subacute rehabilitation neighborhood.

Methods
48 Veterans (Mage=72.8±12.1; 97.9%male; 79.2%white) were admitted to the neighborhood following hospital discharge during a 6-month period. Reasons for admission included short-term rehabilitation following acute illness or injury or worsening of an existing medical condition. Within 7 days of admission, Veterans completed the Insomnia Severity Index(ISI) and Epworth Sleepiness Scale(ESS). Medical and psychiatric diagnoses were obtained from electronic medical records. Comorbidity profiling was determined through frequency analyses.

Results
52.1%(n=25) of Veterans endorsed at least subthreshold insomnia (ISI≥8), and 33.3% (n=16) of Veterans endorsed excessive daytime sleepiness (ESS&gt;10). For Veterans with at least subthreshold insomnia OR excessive daytime sleepiness, the following medical comorbidities were most prevalent: circulatory disease (e.g., coronary artery disease, hypertension) (80%;93.8%) and pain disorder (e.g., spinal stenosis) (76%;75%), respectively. For Veterans with at least subthreshold insomnia OR excessive daytime sleepiness, the following psychiatric comorbidities were most prevalent: anxiety disorder (44%;68.8%), and history of substance use disorder (e.g., alcohol use disorder) (44%;43.8%), respectively. Prevalence of circulatory disease (89%) and pain disorder (90.1%) were more pronounced among Veterans with clinical insomnia (n=11)(ISI ≥ 15), though these findings were not significant.

Conclusion
While this work is preliminary, the findings support that it may be beneficial for clinicians to assess sleep difficulties upon admission to subacute rehabilitation settings. This may be especially important for patients with medical comorbidities, such as circulatory disease and pain disorders, and/or psychiatric comorbidities, such as anxiety disorder and substance use disorder. Future evaluations should include larger, more diverse samples and longitudinal designs to identify which comorbidities are primary risk factors for greater insomnia severity and daytime sleepiness during subacute rehabilitation. Understanding these risk factors would be essential to addressing insomnia and daytime sleepiness during rehabilitation in order to optimize recovery.

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0741 Effects of Light Exposure on Sleep, Rest-Activity Rhythms, and Cognitive Function in Adults with Heart Failure
Authors: Wang Zequan , Jeon Sangchoon , Conley Samantha , LaFleur Kelley , Redeker Nancy 
Published: April 2024

Abstract

Introduction
Sleep disturbance and circadian rhythm disruptions are common among adults with chronic heart failure (HF), and are related to cognitive impairment. Although light levels are known to influence sleep quality, cognition, and the circadian system, little is known about the role of light among adults with HF. The purpose of this study is to investigate the association between light exposure and sleep, diurnal rest-activity rhythms (RAR), and cognitive function among adults with HF.

Methods
We retrospectively analyzed baseline data from a randomized controlled trial of cognitive behavioral therapy for insomnia for adults with HF and insomnia. We measured light levels and sleep with 24-hour wrist actigraphy and computed the circadian quotient, inter-daily stability, and intra-daily variability (strength of the RAR) using cosinor and non-parametric methods. We computed time above threshold (TAT) (100, 500, and 1000 lux), ratio of light exposure in daytime to evening (AUC ratio), and light regularity index (LRI) (20, 50, and 100 lux) to assess the intensity and consistency of light exposure patterns. Lapses in performance on the Psychomotor Vigilance Task (PVT lapse) measured cognitive function. Multiple linear regressions tested if the light exposure metrics could predict the RAR, sleep efficiency, and PVT lapses after adjusting for age, sex, and comorbidities.

Results
The sample included 167 participants (M age=63.8 (SD =12.9) years; 45.5%female). The AUC ratio and TAT500 were associated with a stronger circadian quotient in males (0.339 ± 0.095, p=.0005; 0.296 ± 0.085, p=.0006) compared to females (0.058 ± 0.106, p=.5800; -0.061 ± 0.128, p=.6364), after controlling for age and comorbidities. TAT500 was associated with better inter-daily stability (0.221 ± 0.077, p=.0044) than the other thresholds. Higher light exposure intensity (TAT100) (0.129 ± 0.065, p=.0492) and a greater circadian quotient (0.267±0.076, p=.0006) were associated with improved sleep efficiency. TAT100 was associated with fewer PVT lapses (-0.229 ± 0.082, p=.0061), after controlling for total sleep time, circadian quotient, and demographics.

Conclusion
Light exposure, particularly at certain intensities and regularity, predicted RARs, sleep efficiency, and cognitive function in adults with HF. Future tailored light interventions with varying intensities and regularity may improve HF outcomes.

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0744 Metrics of Sleep Apnea Severity and Sleep-Dependent Memory Consolidation
Authors: Holloway Breanna , Harding Christian , DeYoung Pamela , Kwan Crystal , Ancoli-Israel Sonia , Banks Sarah , Malhotra Atul 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is common in older adults and has recently been implicated in the pathogenesis of Alzheimer’s disease (AD). Sleep disruption is a possible reversible cause of memory impairment. Furthermore, quality of sleep has been determined to be one of the most important variables affecting overnight memory consolidation. As part of a larger study, data are presented evaluating correlations between markers of sleep apnea severity and sleep-dependent memory consolidation.

Methods
Seventy-one older adults ages 65-83 (M=70, SD=4.1) with normal cognition underwent polysomnography (PSG) and completed sleep questionnaires as part of a larger study. The sample was 54.9% women, 83.1% White, and 91.5% Non-Hispanic. Severity of sleep apnea was assessed using several metrics: Daytime sleepiness measured by the Epworth Sleepiness Scale (ESS), apnea-hypopnea index (AHI) based on American Academy of Sleep Medicine recommended, Total Sleep Time with Oxygen Saturation below 90% (T90), the lowest level of oxygen saturation reached during sleep (SPO2 Nadir), and hypoxic burden. Sleep-dependent memory consolidation was assessed using the Word-pairs Association (WPA) task, which shows semantically related word pairs for 5 seconds for the participant to learn, and the next morning, post-sleep, the delayed recognition test is performed.

Results
Descriptive analyses showed a median daytime sleepiness of 7 (SD=3.1), AHI of 28 (SD=24.3), and body mass index of 27 (SD=7.1). Nonparametric correlations were performed to assess markers of sleep apnea severity as correlates of sleep-dependent memory consolidation. There were no significant associations between objective measures of OSA severity, particularly AHI, hypoxic burden, T90, and SPO2 Nadir. However, there was a significant negative association between subjective daytime sleepiness (ESS) and sleep-dependent memory consolidation (r=-0.30, p=0.01).

Conclusion
This study provides preliminary insights into the association between daytime sleepiness and sleep-dependent memory consolidation. The observed finding that lower daytime sleepiness is related to better sleep-dependent memory consolidation warrants further investigation into the underlying mechanisms and to assess whether alternate cognitive measures may be associated with objective severity metrics. Future research should assess relations with psychological factors, such as mood and coping, as these factors can impact memory and are not captured by PSG.

Support (if any)
1R01AG063925-01A1 and T32MH018399
0749 A Social Ecological Perspective on Sleep Hygiene Habits in Older Adults with HIV
Authors: Davey Christine Horvat , Webel Allison , Ruksakulpiwat Suebsarn , Foradori Megan , Griggs Stephanie , Ward Teresa , Anthony Donald , Gripshover Barbara , Erlandson Kristine 
Published: April 2024

Abstract

Introduction
Nearly 75% of people with HIV (PWH) report poor sleep quality, a risk factor for impairment in daily activities, poorer quality of life, and declines in physical and mental health. However, little is known about the multifactorial causes of poor sleep, rendering it difficult to treat. We examined sleep hygiene habits in PWH through qualitative and quantitative methods.

Methods
Using qualitative analyses, we examined sleep hygiene habits in older virally suppressed PWH on antiretroviral therapy who enrolled from December 2021 to September 2022 in this cross-sectional study. Individuals participated in semi-structured telephone interviews regarding sleep hygiene habits. Interviews were recorded, transcribed verbatim, and coded by three independent coders, codes were adjudicated and analyzed for common themes using Dedoose 9.0.82 software. The Social Ecological Model constructed with five levels: individual, interpersonal, organization, community, and policy served as the framework. Self-reported sleep quality data was measured with the Pittsburgh Sleep Quality Index (PSQI).

Results
Among 50 PWH, the mean age was 54 years, 32% were female (n=16), and 62% identified as African American/Black (n=31). The mean PSQI was 9 (median: 9, interquartile range: 5-14). The individual level themes identified were: 1) Shorter Sleep Duration and the Ripple Effect; 2) Poor Bedtime Habits; 3) The Sleep and Physical Activity Connection; and 4) Late Night Bites. The interpersonal level themes identified were: 1) Family Ties: The Impact of Family on Sleep; 2) Balancing Act: The Interplay between Work and Sleep; and 3) The Impact of Aging and Stimuli on Sleep. The theme at the organizational level identified was Sleep Health Neglect, that refers to a lack of adherence and continuity of sleep health care.

Conclusion
Poor sleep habits including lack of physical activity and late-night eating, family, work, aging, internal and external stimuli compete with the opportunity to sleep and contribute to inadequate amounts of sleep and/or poor quality sleep. Moreover, the lack of adherence and continuity of sleep health care also negatively impacts the perceived sleep quality of aging PWH. Future studies should consider a multimodal intervention approach to mitigating poor sleep quality in this population.

Support (if any)
National Institutes of Nursing Research grants: K23NR019744 and R01NR018391.
0751 Comparability of Self-Reported & Wearable-Measured Sleep & Predictors of Agreement in a Preconception Cohort
Authors: Coleman Chad , Wesselink Amelia , Bethea Traci , Rothman Kenneth , Kuriyama Andrea , Pothen Jacob , Kossowsky Joe , Bertisch Suzanne , Wise Lauren 
Published: April 2024

Abstract

Introduction
Agreement between self-reported and device-estimated sleep duration has not been well studied among pregnancy planners. As data from wearables provide complementary information to self-reported sleep, assessment via wearable devices may improve characterization of sleep in naturalistic settings and better inform research on sleep health and reproductive outcomes.

Methods
We analyzed data from Pregnancy Study Online, an Internet-based prospective preconception cohort study. From 2021-2023, we invited U.S. residents aged 21-45 years with pregnancy attempt times ≤6 months at enrollment to participate in a study of wearable sleep-tracking devices. Enrolled participants wore a study-issued Fitbit Inspire 2/3 for 24 hours/day for up to two months and completed all other parent study activities. We examined agreement between self-reported sleep duration in the month before enrollment and device-estimated 30-day average sleep duration (hours/day) within two months after enrollment using Bland-Altman plots and Kappa statistics (one-hour intervals). We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for predictors of agreement.

Results
Of the 1,523 invited participants (1,178 females and 345 males), 948 (62%) consented to participate (females: 67% vs. males: 47%). Self-reported sleep duration (median: 7.5; interquartile range [IQR]: 7.0-8.0 hours/day) was longer than wearable-measured (median: 7.2, IQR: 6.3-8.0 hours/day). Self-reported and wearable-measured sleep duration showed poor agreement (weighted Kappa: 0.12; 95% CI: 0.07-0.17). Comparing self-reported to wearable-measured sleep duration, the Bland-Altman plot yielded a mean difference of 0.2 hour/day (95% CI: -3.3-3.8). Outliers from the Bland-Altman plot indicate that participants with shorter wearable-estimated mean sleep duration overestimated their self-reported sleep duration, while participants with longer wearable-estimated mean sleep duration underestimated this measure. Among females, predictors of poorer agreement in short sleep duration (&lt; 7 hours/day) included older age (≥35 years, PR: 0.71; 95% CI: 0.50-1.00), rural residence (PR: 0.64; 95% CI: 0.35-1.16), menstrual irregularity (PR: 0.80, 95% CI: 0.54-1.18), and shift work (PR: 0.83; 95% CI: 0.56-1.23). There were no strong predictors in agreement among males.

Conclusion
Self-reported and wearable-measured sleep duration showed poor agreement in a preconception cohort. Age, rurality, menstrual irregularity, and shift work predicted poor agreement in short sleep duration among females.

Support (if any)
R01-HD086742, R01-HD105863
0752 Regional Cerebrovascular Pathology Is Associated with Local Disruptions in Non-rapid Eye Movement Sleep Expression
Authors: Berisha Destiny , Rizvi Batool , Chappel-Farley Miranda G , Dave Abhishek , Meza Novelle , Sattari Negin , Lui Kitty K , Chen Ivy Y , Tustison Nicholas , Neikrug Ariel , Benca Ruth , Yassa Michael , Mander Bryce 
Published: April 2024

Abstract

Introduction
Aging is associated with disruptions in non-rapid eye movement (NREM) sleep expression, but the mechanisms driving this effect remain unclear. Cerebral small vessel disease (CSVD) burden increases with age and is associated with clinical sleep disturbance, but little is known about its relationship with local expression of oscillatory activity during NREM sleep. Here, we explore associations between CSVD burden and local electroencephalography (EEG) measures during NREM sleep in older adults.

Methods
Fifteen cognitively intact older adults (mean age 71.8±6.3 years, 10 female, Apnea Hypopnea Index (AHI)=7.82±7.95) completed T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging on a 3T scanner to quantify total and lobar white matter hyperintensity (WMH) volumes using a validated semi-automated toolbox and an in-lab overnight polysomnography with 128-channel EEG, separated by 1.95±1.02 years. EEG was preprocessed and multi-tapered to derive absolute spectral power. Topographical correlations between NREM multi-tapered absolute spectra bands were run with 5000-permutation threshold free cluster enhancement.

Results
Older age was associated with lower absolute posterior total (all p&lt; 0.016, r&gt;-0.61) and slow sigma power (all p&lt; 0.018, r&gt;-0.60) and slow wave activity (SWA) (all p&lt; 0.017, r&gt;-0.61) over centro-posterior EEG derivations. Age was also positively associated with frontal (τ=0.51, p&lt; 0.01) and parietal (τ=0.49, p&lt; 0.01) but not occipital (τ=0.33, p=0.092) or temporal (τ=0.36, p=0.064) WMH burden. Occipital WMH burden was also not associated with AHI (τ=0.038, p=0.843). Occipital WMH burden was associated with global reductions in alpha activity (all p&lt; 0.043, τ&gt;-0.78), centro-posterior reductions in SWA (all p&lt; 0.043, τ&gt;-0.63) and Delta (all p&lt; 0.009, τ&gt;-0.63), frontal reductions in total (all p&lt; 0.043, τ&gt;-0.71) and fast sigma power (all p&lt; 0.004, τ&gt;-0.57), global reductions in slow sigma power (all p&lt; 0.043, τ&gt;-0.71), and central reductions in theta activity (all p&lt; 0.042, τ&gt;-0.57).

Conclusion
Collectively, these findings indicate that WMH burden in older adults is associated with local disruptions in NREM sleep expression in multiple frequency bands associated with sleep-dependent cognitive functions. Future studies should examine the role of NREM sleep expression in cognitive decline associated with CSVD burden.

Support (if any)
Supported by NIH grants R01AG053555, R21AG079552, K01AG068353, F31AG074703, P30AG066519, and the AASM Foundation SRA-1818