bluuebunny/crossref_metadata_2025_split huggingface dataset:
0901 Effects of a Physical Activity Intervention on Sleep Among Cancer Survivors in the Cancer Prevention Study-3
Authors: Zhong Charlie , Grant Amber , Whalen Scott , Reddy Ananaya , Peoples Anita , Patel Alpa , Rees-Punia Erika 
Published: April 2024

Abstract

Introduction
Disruptions to sleep have been reported in many cancer survivors, with lasting impacts reported several years after treatment. Physical activity (PA) has been shown to improve sleep outcomes. We evaluated the effects on self-reported and device measured sleep outcomes within a PA intervention among cancer survivors.

Methods
The Health and Energy through Active Living Every Day (HEALED) intervention was a randomized controlled trial of 415 cancer survivors identified from the American Cancer Society (ACS) Cancer Prevention Study-3 (CPS-3) cohort enrolled in a year-long, web-based, PA intervention to increase social support, improve exercise self-efficacy, and facilitate self-monitoring of PA. Participants were randomized 2:1 to an interactive PA website (intervention) or a static balance and flexibility website (controls). Sleep was assessed through PROMIS 6-item Sleep Disturbance Scale and SATED sleep questionnaire. In addition, participants were provided a Fitbit Charge 5 to self-monitor PA and sleep. We conducted an intent-to-treat analysis and calculated t-tests to evaluate change in sleep outcomes between the two groups at the end of the 1-year study period.

Results
A total of 351 participants completed the year-long intervention. Most participants were White (93%), female (94%), had a history of breast cancer (73%), were on average 62 years old (sd=8) and 6 years (sd=2) post-diagnosis. At baseline, both control (5 (metabolic equivalent task) MET-hours/day) and intervention (4.9 MET-hours/day) self-reported similar levels of moderate to vigorous physical activity (MVPA). Both groups reported good sleep quality at baseline with a SATED score of 8.0 (sd=1.8) and PROMIS of 48 (sd=7.5) in controls and 7.8 (sd=1.8) and 49 (sd=7.6), respectively, in intervention. The intervention group reported higher MVPA after 1 year (6.7 MET-hours/day vs 5.4 MET-hours/day, p=0.01). There were no statistically significant changes in self-reported sleep quality.

Conclusion
Long-term cancer survivors, with relatively healthy sleep quality at baseline, randomized to a PA intervention did report increased MVPA after a year, but this had little impact on sleep. Results with device-based MVPA and sleep measures are forthcoming.

Support (if any)
The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-3 cohort. This analysis was also supported through an unrestricted research grant from Sleep Number Corporation.
0907 Sleep Disturbances in Lung Cancer Patients Based on Patient Reported Outcomes and Polysomnography
Authors: Chan Kathy , Kaous Maryam , Sargsyan Lilit , Balachandran Dave , Bashoura Lara , Sheshadri Ajay , Faiz Saadia 
Published: April 2024

Abstract

Introduction
Sleep disturbances are common in lung cancer patients, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) is lacking. Earlier studies described significant insomnia in this cohort. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders.

Methods
A retrospective review of lung cancer patients undergoing formal sleep evaluation from 4/1/2009 to 7/31/2014 was performed. Clinical characteristics, PROs using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and PSG data were reviewed.

Results
128 patients (58% men, median age 63 years, median BMI 29.9 kg/m2) were identified. Lung cancer stage was 40% early, 22% locally advanced and 38% metastatic disease, and most (48%) were undergoing active treatment. Comorbidities included hypertension (60%), COPD (42%), depression (16%) and anxiety (13%), and 59% were ever smokers. The majority (94%) were referred for sleep-related breathing disorder (SRBD). While 50% did not know when sleep disruption started in relation to their cancer, 33% report symptoms prior to cancer diagnosis, and 14% associate sleep disturbance after cancer diagnosis. Sleep aid use was reported by 26%, and pain medication use in 41%. In the 116 with ESS, daytime sleepiness was noted 56%. In the 101 with PSQI, 65% reported poor sleep. PSG was performed in 52%. Daytime sleepiness was inversely correlated with anxiety (OR 0.3, 95% CI 0.8 to 0.84). Poor sleep was associated with anxiety and COPD, but it was not significant. PROs did not have an impact on overall survival.

Conclusion
Sleep disturbances can contribute to symptom burden in lung cancer patients. Daytime sleepiness and poor sleep based on PROs was prevalent in our cohort. Although not significant, anxiety and COPD were associated with poor sleep, whereas daytime sleepiness was inversely associated with anxiety. Most of our patients had sleep-related breathing disorder while only a few had insomnia. Education about sleep health and proactive screening for sleep symptoms would be beneficial in lung cancer patients.

Support (if any)
0925 A Multilevel Time-lagged Mediation of Nightmare and PTSD Symptom Severity Across Time in a Combined Treatment
Authors: Paquet Caitlin , Rhudy Jamie , Davis Joanne 
Published: April 2024

Abstract

Introduction
This study sought to contribute to understanding the role of sleep disturbances as a potential hallmark of PTSD through examining the relationship between changes in post-trauma nightmare (PTNM) severity (nightmare frequency and distress) and symptoms of PTSD over time during a combined treatment for PTSD and PTNMs.

Methods
Individuals diagnosed with PTSD and having at least weekly nightmares (n = 84) were randomized into one of three treatment conditions: 12-session Cognitive Processing Therapy (CPT) only (n = 31), CPT followed by 5-session Exposure, Relaxation, and Rescripting Therapy (ERRT) condition (n = 29; CPT+ERRT), or ERRT followed by CPT (n = 24; ERRT+CPT). Multilevel time-lagged mediation models were analyzed to examine if nightmare severity (frequency and distress) measured at an earlier time point (t1; baseline, week 6, week 12) mediated the change in PTSD symptom severity at a later time point (t2; week 6, week 12, or week 17). The reverse relationship was also explored. An exploratory aim focused on examining if the order of treatment (CPT+ERRT or ERRT+CPT) moderated the mediated relationships.

Results
Across all three treatment conditions, there were statistically significant reductions in PTSD symptom and nightmare severity over time. In the unmoderated mediation models, there were no significant indirect effects detected. When treatment order was included as a moderator, there was a conditional effect of treatment order on the indirect effects of time on nightmare severity at t2 through PTSD symptom severity at t1. Only in the ERRT+CPT condition was there a statistically significant negative relationship of time on nightmare and PTSD symptom severity at t1 (ps &lt; .05). Furthermore, only in the ERRT+CPT condition, there was a statistically significant negative relationship between nightmare severity at t1 and PTSD symptom severity at t2. Therefore, only in the ERRT+CPT condition did PTSD symptom severity at t1 mediate the relationship between time and nightmare severity at t2.

Conclusion
These results suggest that earlier increases in PTSD symptom severity are an important mediator of change for the improvement of nightmares specific to receiving ERRT first. Clinicians may glean insight from this study that can impact shared decision making with patients on treatment planning.

Support (if any)
0927 Shining Light on Nightmare Treatment: Expert Panel Recommendations for Cognitive Behavioral Therapy for Nightmares
Authors: Pruiksma Kristi , Miller Katherine , Davis Joanne , Taylor Daniel , Dietch Jessica , Gehrman Philip , Nadorff Michael , Brim William , Campbell Rebecca , Tyler Hannah , Price William , Peterson Alan 
Published: April 2024

Abstract

Introduction
Few providers are trained to deliver Cognitive Behavioral Therapy for Nightmares (CBT-N) despite the impact of nightmares on physical and mental health. Reduced access to treatment is partially due to limited training opportunities. Web-based training resources are valuable because they are easily accessible, are cost-efficient, and can be reviewed by providers as needed. This presentation describes the development, testing, and launch of a web-based provider training for CBT-N.

Methods
Nightmare, trauma, and sleep disorder experts collaborated to develop material for the web-based CBT-N training. Next, 17 providers tested a first draft of the web-site. After feedback was integrated, 50 providers were recruited to complete the updated draft of the website and will complete feedback in January 2024. To assess learning, providers completed multiple-choice questions before and after each of the 10 training modules. Item Response Theory (IRT) analyses were used to identify items of low discrimination and difficulty for further refinement.

Results
Overall, testers had positive reactions to the training content and website. The training content was improved by adding more figures, animations, and therapy demonstration videos and integrating more cultural considerations. Usability was improved by addressing bugs and enhancing intuitive site navigation. Based on IRT analyses of multiple-choice questions, 40 (out of a total 80) items were replaced and will be re-evaluated at the conclusion of beta testing.

Conclusion
Launching in June 2024, CBTnightmares.org is a comprehensive, engaging, and accessible training after two phases of development and feedback from almost 70 licensed providers. The final phase of testing, to be conducted in April 2024, will examine the equivalence of online training compared to a live virtual workshop (Target N = 100). Providers will complete questionnaires and a mock session with a standardized patient to examine therapist proficiency and fidelity. The hypotheses are that this web-based course will be equivalent to a live virtual workshop. This project directly addresses the dissemination and implementation cliff of empirically supported treatment for nightmares.

Support (if any)
This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Review Medical Research Program under Award No. W81XWH-21-1-0576.
0935 Sleep Disturbances Correlate Significantly with PTSD and Emotional Exhaustion in Humanitarian Aid Workers
Authors: Jou Yuwen Cynthia , Pace-Schott Edward 
Published: April 2024

Abstract

Introduction
International humanitarian aid workers (iHAWs) are professionals often exposed to considerable stress and trauma while delivering humanitarian support to populations in distress. Many studies support the deleterious association between sleep disturbances, alcohol use, posttraumatic stress symptoms (PTSS), and emotional exhaustion (EE). Considering the lack of research on this topic among iHAWs, we conducted an exploratory study to examine relationships among the aforementioned variables in iHAWs.

Methods
One hundred participants reflected on their on-mission experiences retrospectively while completing the Pittsburgh Sleep Quality Index (PSQI), the PSQI addendum for PTSD (PSQI-A), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Maslach Burnout Inventory (MBI), and the quantity-frequency measure for alcohol. Questionnaire completion rates ranged from 33% to 55%. Stepwise regression models were used to analyze the association between two outcome variables, PCL-5 daytime symptoms and EE measured by the MBI, and predictor variables, alcohol use, and PSQI global, and PSQI-A scores. Spearman regressions were used to examine the association between aid worker career length and PSQI global score. False Discovery Rate was adopted to adjust for alpha inflation.

Results
Stepwise regression analyses indicated a significant association between PCL-5 daytime symptoms and PSQI global score after accounting for alcohol use (ΔR2 = 0.139, p = 0.039). Furthermore, PCL-5 daytime symptoms were significantly correlated with PSQI-A score after controlling for PSQI global score and alcohol use (ΔR2 = 0.320, p &lt; 0.000). Additionally, EE was significantly correlated with PSQI after accounting for alcohol use (ΔR2 = 0.140, p = 0.034). Finally, based on Spearman regression, the aid-working career length was significantly associated with the PSQI component five, sleep disturbance (ρ = 0.451, p = 0.003).

Conclusion
Our results corroborate previous findings on the association between sleep disturbances, EE, and PTSS among populations such as first responders, medical professionals, and military personnel. Aid workers and their mental health could benefit from further attention among the research community, especially given the recent increase in conflicts worldwide. While the humanitarian community works on shifting mental health stigmas, sleep health optimization could be an interim step in encouraging iHAWs to seek care.

Support (if any)
R21MH128619
0936 Associations Between Sleep, Cognitive Flexibility, and Attention in Trauma-Exposed Veterans
Authors: Lanthier Malika , Tavakoli Paniz , Higginson Caitlin , Richard-Malenfant Claude , Leveille Chloe , Porteous Meggan , Kaminsky Zachary , Shlik Javok , Robillard Rebecca 
Published: April 2024

Abstract

Introduction
Post-traumatic stress disorder (PTSD) triggers disturbances in sleep such as prolonged sleep onset latency, decreased REM latency, higher amounts of REM sleep and lighter sleep. The impacts of these sleep difficulties on cognitive performance are clear. However, there is a limited understanding on how they may contribute to cognitive challenges that are affecting people living with PTSD. This study aimed to explore how attention and cognitive flexibility relate to sleep architecture in veterans with PTSD.

Methods
A group of thirty-six trauma-exposed veterans underwent psychiatric interviews, including the Clinician-Administered PTSD scale for DSM-5. Polysomnography was recorded on two nights: the first recording was used as an adaptation night and the second one was used for final analysis. On the morning following the experimental night, participants completed the Trail Making Test A and B, a task known to involve complex attention, visuospatial processing, working memory, and psychomotor coordination.

Results
Slower performance on the Trail Making Test A (i.e., attentional component of the task) correlated with longer sleep onset latency (r=.35, p=.037), higher amounts of light sleep (NREM1 and NREM2; r&gt;.35, p&lt;.037), and tended to correlate with longer REM sleep latency (r=.32, p=.056). In addition, non-significant trends suggested that higher number of errors committed on the Trail Making Test A were associated with longer sleep onset latency and higher amounts of NREM1 sleep (r=.30, p=.070). Slower performance on the Trail Making Test B (i.e., cognitive flexibility component of the task) tended to correlate with longer REM sleep latency (r=.33, p=.051) and lower sleep efficiency (r=-.31, p=.065).

Conclusion
These preliminary findings display some of the common abnormalities seen in people living with PTSD and how they relate to the severity of the cognitive challenges they are facing. Recognizing the active role of sleep for attentional processes and cognitive flexibility stresses the relevance of exploring whether sleep restoration may mitigate some of the debilitating symptoms of PTSD on cognition.

Support (if any)
This project was funded by a competitive grant from the Canadian National Defence (Innovation for Defence Excellence and Security (IDEaS)).
0943 Bidirectional Relationships Between Daily Sleep and Depression: How Does Shiftwork and Sleep Variability Factor In?
Authors: Kim Kelly , Taylor Daniel , Messman Brett , Dietch Jessica , Slavish Danica , Kelly Kimberly , Ruggero Camilo 
Published: April 2024

Abstract

Introduction
Prior research has established that sleep disturbances and depression are associated. However, notable limitations exist across past studies, including the heavy use of between-person analyses that are often based on single time point measures, use of general “sleep disturbance” over well-defined facets of sleep, overreliance on self-reported sleep, and lack of attention to within-person effects and their interactions with group-level characteristics (e.g., shiftwork). To address these limitations, the current study examined relationships between daily sleep facets and depression in nurses across measurements (self-report, actigraphy) and moderators (shiftwork, intraindividual variability of sleep midpoint).

Methods
Participants were 349 nurses (90.83% female; 76.50% White; 89.20% non-Latinx; Mage = 39.13 years) who wore an Actiwatch and completed the Consensus Sleep Diary and Patient Health Questionnaire-2 for 14 days. Multilevel models examined the bidirectional associations between daily depression and sleep (i.e., sleep efficiency [SE], quality [SQ], duration, midpoint) across self-report and actigraphy measures. Shiftwork (day vs. night shift worker) and intraindividual standard deviation (iSD) of sleep midpoint were included as moderators in models.

Results
Daily depression and subjective SQ and SE were bidirectionally associated after covarying for gender, age, race, and ethnicity. On days when nurses experienced higher depression than their average, they experienced worse subjective SQ (b = -0.10, SE = 0.02, p &lt; .001) and SE (b = -0.47, SE = 0.18, p = .008) on the same day. In turn, when nurses experienced worse subjective SQ (b = -0.07, SE = 0.02, p &lt; .001) and SE (b = -0.01, SE = 0.00, p = .012) than their average, they experienced higher depression on the next day. Daily actigraphy-based sleep facets were not significantly associated with depression. Neither shiftwork nor iSD of sleep midpoint were significant moderators.

Conclusion
Results reveal bidirectional, daily associations between subjective, but not actigraphy-based, sleep and depression. This suggests one's perception of sleep may be more influential on and impacted by depression than how one more objectively slept. Intensive longitudinal approaches to understanding sleep and depression should continue to be utilized to allow for the establishment of temporal precedence and bidirectionality across granular time scales.

Support (if any)
NIAID R01AI128359-01 (PIs: Taylor & Kelly)
0944 National Sleep Foundation’s 2024 Sleep in America Poll: Sleep Health and Depressive Symptoms in Teenagers
Authors: Dzierzewski Joseph , Nielson Spencer , Lopos John 
Published: April 2024

Abstract

Introduction
A mental health crisis has been recognized among US teenagers, highlighted by high rates of mood disturbances. While a well-documented connection exists between sleep and mood, evidence largely comes from convenience samples of adults. Much less is known about the link between sleep and mental health in teenagers and even less is known about this important connection among the general teenage population. The overarching goal of the present study was to examine the associations among sleep health and depressive symptoms in teenagers.

Methods
A random sample of 1,124 US teenagers aged 13 to 17 years were recruited to complete surveys online in English or Spanish, including the Sleep Health Index, the Sleep Satisfaction Tool, and the Patient Health Questionnaire-9 for adolescents, a commonly employed screening tool assessing the presence and frequency of depressive symptoms in adolescents. Data were weighted via iterative proportional fitting to approximate population distributions. Analyses included both z-tests and t-tests to examine depressive symptom differences between individuals with varying levels of sleep health. Results have a margin of sampling error of plus or minus 4.1 percentage points.

Results
Thirty-seven percent of 13- to 17-year-olds reported symptoms consistent with at least mild levels of depression and just 8 percent of teens reported achieving nightly sleep durations recommended by the National Sleep Foundation (i.e., 8-10 hours). Teens with minimal or no depressive symptoms reported significantly more weekday sleep (7.4 hours) compared to those with mild (7.0 hours) and moderate-to-severe depressive symptoms (6.6 hours; p’s&lt;.05). Teens who were dissatisfied with their sleep were 22 percentage points more apt than sleep-satisfied teens to report moderate-to-severe depressive symptoms (27 vs. 5 percent, p&lt;.05). Seventy-three percent of teens reported their emotional well-being was negatively impacted when they slept less than usual.

Conclusion
Sleep health and mental health are strongly linked in teens. When considering avenues to curb the teen mental health crisis, sleep health education should be a priority. Public health campaigns aimed at improving sleep health in teens should include efforts to start school later, reduce nighttime electronic use, and encourage family prioritization of sleep health.

Support (if any)
0952 Subjective Sleep Improvements Following Daily Theta-burst Stimulation for Treatment-resistant Depression
Authors: Cuda Jennifer , Smith David , Chaves Arthur , Taylor Reggie , Drodge Jessica , Shim Stacey , Nasr Youssef , Fonseca Karina , Brender Ram , Antochi Ruxandra , McMurray Lisa , Robillard Rebecca , Tremblay Sara 
Published: April 2024

Abstract

Introduction
Sleep disturbances are commonly observed in individuals with depression, and are associated with severity of depression, treatment outcomes, and risk of relapse. Repetitive transcranial magnetic stimulation, including newer optimized theta-burst stimulation (TBS) protocols, is recognized as a safe and effective intervention for treatment-resistant depression (TRD). Presently, little is known about the impact of TBS treatments on sleep in individuals with depression. We examined changes in subjective sleep and depression in individuals with TRD receiving daily TBS treatments, and the relationship between changes in these symptom domains.

Methods
50 participants (50% female, mean age 46.82 years) with TRD received four or six weeks of daily TBS treatments targeting the left or bilateral dorsolateral prefrontal cortex while participating in a randomized, double-blind clinical trial. Sleep disturbances and depression severity were measured at baseline, session 20 and session 30 using the Leeds Sleep Evaluation Questionnaire and 17-item Hamilton Rating Scale for Depression (HRSD-17), respectively. Linear mixed models examined whether scores changed significantly throughout treatment. Spearman’s correlations investigated whether changes in depression and sleep were associated.

Results
HRSD-17 scores improved significantly from baseline to weeks 4 and 6 (p&lt; 0.001). We also observed significant improvements in quality of sleep (QOS), ease of awakening from sleep (AFS), and behaviour following wakefulness (BFW) after 4 and 6 weeks of TBS (p&lt; 0.001). After 4 weeks of TBS, improvements in HRSD-17 significantly correlated with BFW scores (p= 0.008). After 6 weeks of TBS, improvements in HRSD-17 scores significantly correlated with improvements in both AFS and BFW scores (p&lt; 0.005).

Conclusion
Participants reported improvements in depression, sleep quality, ease of waking, and daytime alertness following TBS. Furthermore, improvements in several aspects of sleep and depression were correlated. These findings suggest that TBS may be an effective intervention for individuals experiencing comorbid depression and sleep disturbances. This also strengthens the view that sleep enhancement may contribute to better mental health outcomes.

Support (if any)
Support was provided by the Royal’s Institute of Mental Health Research’s Emerging Research Innovators in Mental Health award, the Fonds de Recherche en Santé – Québec Research Scholar Junior 1 grant (grant number 297133), and an anonymous donation.