bluuebunny/crossref_metadata_2025_split huggingface dataset:
0375 Predictors of Insomnia and Depression in a Randomized Controlled Insomnia Treatment Trial in the COVID-19 Pandemic
Authors: Osorno Raquel , Ahmadi Maryam , Solomon Natalie , O'Hora Kathleen , Morehouse Allison , Lopez Mateo , Kim Jane , Manber Rachel , Goldstein-Piekarski Andrea 
Published: April 2024

Abstract

Introduction
The COVID-19 Pandemic resulted in increases in insomnia risk factors, including elevated sleep reactivity, perceived stress, loneliness, and screen time. Here, we test whether these factors predicted worse subsequent insomnia and depression symptoms as part of a randomized controlled feasibility trial of a brief insomnia intervention early in the pandemic.

Methods
Forty-nine participants with acute pandemic-onset insomnia symptoms were randomized to receive telehealth Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Participants completed baseline measures of sleep reactivity, perceived stress, loneliness, and screen time. Outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 (minus the sleep item) collected at 12 and 28 weeks. As described in the protocol paper, two likelihood ratio tests (one for insomnia and one for depression) were used to test the hypothesis that the risk factors collectively contribute to subsequent insomnia and depression. Specifically, for each outcome, likelihood ratio tests compared a linear mixed effect model containing the 4-baseline risk factor measures and treatment arm as predictors against a model containing only treatment arm. Considering our joint hypothesis test does not address the significance of individual risk factors, we tested whether each risk factor was predictive in isolation using post-hoc mixed effects models (one for each risk factor across insomnia and depression while still controlling for treatment arm). Benjamini-Hochberg adjustment for multiple comparisons was used across the 8 post-hoc models.

Results
Collectively, the insomnia risk factors did not predict subsequent insomnia or depression (p’s&gt;0.25, marginal ΔR2’s&lt; 0.518) above what would be predicted by receiving CBT-I or waitlist control. However, when considered in individual models, perceived stress and loneliness were significant predictors of both outcomes (b’s&gt;0.22, adjusted-p’s&lt; 0.012) above and beyond treatment arm. Screen time and sleep reactivity were not significant predictors of either outcome (b’s&lt; 0.13, adjusted-p’s&gt;0.149).

Conclusion
Although this study was conducted in a relatively small sample, these results suggest that increased loneliness and perceived stress may be associated with worse insomnia and depressive symptoms several months later. Thus, loneliness and perceived stress may represent early intervention targets during periods of acute stress and disruption, like the COVID-19 pandemic.

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0377 Associations of Evening-type and Insomnia Symptoms with Depressive Symptoms Among Adolescents and Young Adults
Authors: Que Jianyu , Chen Si-jing , Chan Ngan Yin , Wu Suying , Zhang Li , Chen Yaoyi , Liu Jingrou , Chen Mingxuan , Chen Lixia , Li Shirley Xin , Lin Duoduo , Liu Farong , Wing Yun Kwok 
Published: April 2024

Abstract

Introduction
Evening-type and insomnia symptoms are closely related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese young people, with a specific focus on the joint effects of the two conditions on depressive symptoms.

Methods
Participants aged between 12 to 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. The reduced Morningness and Eveningness Questionnaire, Insomnia Severity Index, and Patient Health Questionnaire-9 were used to evaluate chronotypes, insomnia and depressive symptoms, respectively. Multivariate logistic regression models were used to examine the independent associations of chronotypes and insomnia symptoms with depressive symptoms, while additive interaction models were used to further explore the joint effects of chronotypes and insomnia symptoms on depressive symptoms.

Results
Of the 6145 eligible participants, the prevalence of evening-type and insomnia symptoms were 24.9% and 29.6%, respectively. Both evening-type (adjusted odds ratio [AdjOR]: 3.62, 95% CI: 3.19-4.11) and insomnia symptoms (AdjOR: 11.75, 95% CI: 10.26-13.47) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk of interaction [RERI]: 12.39, 95% CI: 3.62-21.17). In the subgroup analyses for adolescents (RERI: 10.37, 95% CI: 5.44-15.30) and young adults (RERI: 15.48, 95% CI: 5.49-25.46), positive interactions between evening-type and insomnia symptoms on depressive symptoms remained.

Conclusion
The present study provided additional evidence demonstrating the independent and joint contributions of evening-type and insomnia symptoms to depressive symptoms among young people. In particular, there is an interaction effect of evening-type and insomnia symptoms, further increasing the risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.

Support (if any)
This study was supported by grants from Fujian Provincial Health technology project (No. 2022GGB015 and 2022CXB019) and Natural Science Foundation of Xiamen City (No. 3502Z20227148).
0378 Improvements in Prenatal Insomnia Predict Lower Depression Severity During Postpartum in Low- and High-Income Women
Authors: Carmona Nicole , Gumport Nicole , Solomon Natalie , Manber Rachel 
Published: April 2024

Abstract

Introduction
Low socioeconomic status increases the risk of prenatal and postpartum depression. Additionally, women of low-income status are disproportionately impacted by insomnia and poor sleep during pregnancy, which could contribute to poorer mental and physical health. Treating insomnia during pregnancy has the potential to reduce the risk of postpartum depression. We examined whether after accounting for baseline and psychosocial risk of depression, improvements in prenatal insomnia predicted lower postpartum depression in low- and high-income women.

Methods
We selected low- (&lt; $55,000/year; n=35) and high-income (≥$100,000/year; n=59) participants drawn from a randomized, multi-site, controlled trial of CBT-I for perinatal insomnia. The study excluded women with depressive disorders. Treatments consisted of five sessions during pregnancy and one at 6 weeks postpartum. Participants completed the Insomnia Severity Index (ISI), Edinburgh Postpartum Depression Scale (EPDS), and Perinatal Risk Questionnaire (PRQ) at baseline. ISI and EPDS were additionally completed 8 weeks after randomization and at 8, 18, and 30 weeks postpartum. Separate generalized estimating equation models were conducted for each group. Women were included if they completed at least one postpartum assessment.

Results
After accounting for baseline ISI, a 1-unit reduction in ISI at post-treatment was associated with a reduction of .18 units in the average postpartum EPDS scores among participants in the low-income group (p=.048) and .21 units among the high-income group (p=.008). Baseline EPDS was a significant predictor of the average postpartum EDPS in the low-income group, such that a 1-unit increase in baseline EPDS increased postpartum EPDS by .32 units (p=.015), but was not a predictor in the high-income group. Baseline ISI and PRQ and time were not significant predictors (ps&gt;.05).

Conclusion
Predictors of postpartum depression severity were different for low- and high-income pregnant women with insomnia. We found that the effect of treating prenatal insomnia on reducing postpartum depressive symptom severity was stronger for high- versus low-income women and that baseline depression symptoms predicted postpartum depression symptoms among low- but not high-income women. The results suggest that to optimally reduce postpartum depressive symptoms among low-income women, treatment will need to address additional risk factors beyond insomnia.

Support (if any)
NR013662
0379 TADEIC-UNAM: Screening Scale to Identify Insomnia, Depression and Anxiety Among Sleep Clinic Patients in Mexico
Authors: Santana-Miranda Rafael , Barrera-Medina Andrés , De la López Diana Orta , Vargas Ángel Daniel Santana , Sánchez Uriel Peñaloza , Rosenthal Leon 
Published: April 2024

Abstract

Introduction
Insomnia is among the most prevalent symptoms in patients evaluated for sleep disorders. When chronic, it is frequently associated with Depression and Anxiety. This study assessed the "Tamizaje de Ansiedad, Depresión e Insomnio Crónico" (TADEIC) as a screening scale to evaluate insomnia and possible comorbid depression and anxiety.

Methods
Two hundred thirty-three patients with chronic insomnia completed the TADEIC at the UNAM Sleep Disorders Clinic (age: 50.3±15.7; females: n=132 [56.7%]). The internal consistency was evaluated with Cronbach's Alpha, and structural equation modeling was computed to conduct a confirmatory factor analysis (CFA). Convergent validity was assessed with Beck's anxiety and depression inventories (BAI, BDI). The scales were completed at the time of initial consultation.

Results
CFA revealed four factors with moderate model fit: "Insomnia (two items), "Anxiety" (five items), "Dysthymia" (three items), and "Melancholy" (three items). After two adjustments, seven of the initial twenty items were discarded to support a good model fit. The model was assessed with the Comparative Fit Index of 1.683, Standardized Root-Mean-Square Residual (SRMR).044, Root-Mean-Square Error of Approximation (RMSEA)=.035. The internal consistency was high (α= .859). Anxiety intercorrelations with insomnia, dysthymia, and melancholy were moderate to high (r=.44-.65*, p&lt;.001), insomnia intercorrelations with dysthymia and melancholy and were low to moderate (r=.27-.45, p&lt;.01), Dysthymia and Melancholy intercorrelations were moderate (r=.55, p&lt;.001). Convergent validity of the anxiety factor was moderate with the BAI (r=.587, p&lt;.01) and moderate (.4-.64, p&lt;.01) for the melancholy and dysthymia factors with the BDI.

Conclusion
The TADEIC showed adequate internal reliability and external validity. It consists of four dimensions that allow clinicians to identify insomnia, anxiety dysthymia, and melancholy. The availability of such a screening tool will facilitate identifying psychiatric morbidity among patients with chronic insomnia.

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0383 Common Pathways Between Distress and Impairment Related to Insomnia, Pain, and Stress
Authors: Dickens Harrison , Vance Abi , Phelps Claire , Floyd Veronica , Walker Jamie , Egeler Mara , Assar Arash , Vargas Ivan 
Published: April 2024

Abstract

Introduction
Insomnia, chronic pain, and stress are highly comorbid, contributing to significant distress and impairment. Research on measures of insomnia, such as the Insomnia Severity Index, have revealed a two-factor structure consisting of both severity of insomnia symptoms and perceived distress and impairment. Prior research suggests that this perceived distress and impairment factor may represent a cognitive vulnerability that may impact other domains, including experiences of pain and stress. Pain catastrophizing, “a negative cognitive–affective response to anticipated or actual pain” and sleep reactivity, a trait-like degree to which stress exposure disrupts sleep, are both constructs that tap into similar elements of perceived distress and impairment. This study aimed to examine associations between perceived distress and impairment from insomnia, pain catastrophizing, pain interference, and sleep reactivity.

Methods
Participants from an online database were asked to complete the Insomnia Severity Index (ISI), Pain Catastrophizing Scale, McGill Pain Questionnaire, PROMIS Pain Interference Questionnaire, and the Ford Insomnia Response to Stress Test. Participants (n =398) were predominantly female (79%) and White (74%). The ISI was analyzed as two separate factors (i.e., F1 or the insomnia symptoms factor = items 1-3 and F2 or the insomnia-related impairment factor = items 4-7).

Results
Multiple adjusted regressions revealed that perceived insomnia distress and impairment (i.e., F2) was significantly related to pain catastrophizing (t = 2.18, p = .03) and pain interference (t = 3.55, p &lt;.001), independent of insomnia and pain severity. Sleep reactivity was also significantly related to pain catastrophizing (t = 3.71, p &gt; .001), even after adjusting for insomnia and pain severity.

Conclusion
Results suggest that the perceived distress and impairment resulting from insomnia, pain, and stressful events may represent a transdiagnostic vulnerability. Future research is needed to determine whether this pattern of distress and impairment extends to objective measures, such as actigraphy. This pattern of perceived distress and impairment could represent a viable intervention target.

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0386 Feasibility of a Hypnosis Intervention for Sleep Quality in Caregivers of Individuals with Alzheimer's Disease
Authors: Elkins Gary , Padilla Victor , Sanford Keith , Benge Jared , Stevens Alan , Scullin Michael , Corlett Christopher 
Published: April 2024

Abstract

Introduction
Poor sleep quality is a common health issue in caregivers of adults with Alzheimer’s Disease and Related Dementias (ADRD). Nonpharmacological treatment options such as hypnosis have been proposed for improving sleep in this population since pharmacological measures can impair their ability to wake up readily to provide care. The present study aimed to determine the feasibility of a hypnosis intervention program for improving sleep quality in caregivers of individuals with ADRD.

Methods
A sample of 21 eligible adults were randomly assigned to either a self-administered hypnosis or a sham hypnosis group.

Results
The findings indicated feasibility of accrual, randomization, and intervention delivery. The mean satisfaction rating scores were 8.75 (SD = 1.28) and 7.50 (SD = 1.77) in the treatment and control groups, respectively, on a 0-to-10 numerical rating scale (0 = highly dissatisfied, 10 = highly satisfied). The mean ease of use rating was 8.50 (SD = .93) in the treatment condition and 8.75 (SD = 1.39) in the control condition. There was good adherence to actigraphy and self-report measures of sleep duration and sleep quality. Although the study was not powered for efficacy testing, trends indicated significant improvements in sleep quality (t(4) = 3.500, p = .025, d =1.57) and sleep duration (t(4) = -4.648, p = .010, d = 2.08) for the hypnosis intervention.

Conclusion
These findings are encouraging and indicate a need for a fully powered randomized clinical trial for efficacy testing.

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0387 Sleep-SMART for Veterans with Mild Cognitive Impairment (MCI) and Insomnia: A Pilot Study
Authors: Mack Abigail , Orff Henry , Twamley Elizabeth , Pittman James O E , Almklov Erin 
Published: April 2024

Abstract

Introduction
Mild cognitive impairment (MCI) is an important public health concern for aging Veterans as it is a known risk factor for progression to dementia. Insomnia is common in MCI occurring in up to 60% of patients. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended treatment for insomnia, however, cognitive impairments experienced by individuals with MCI may limit the ability of some individuals to adequately understand and actively participate in CBT-I. In this study a modified CBT-I treatment Sleep-SMART (Sleep Symptom Management and Rehabilitation Therapy) was developed and pilot tested with Veteran input. Sleep-SMART incorporates supportive cognitive strategies into a CBT-I protocol to enhance CBT-I learning and adherence.

Methods
14 Veterans completed the 6-week Sleep-SMART intervention. Each participant was assessed on the Insomnia Severity Index (ISI) and the Pittsburgh Quality Sleep Index (PSQI) at pre- and post-treatment (Weeks 0 and 6 respectively). Veterans also completed weekly sleep diaries for the duration of the 6-weeks of treatment. Independent t-tests were performed comparing pre and post-treatment scores for the ISI, PSQI, and sleep diary variables (sleep efficiency [SE], total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], and early morning awakening [EMA]). Treatment acceptability was examined using the average rating on the Acceptability of Intervention Measure (AIM; 1–5-point Likert type scale, with higher scores indicating greater acceptability).

Results
Participants (11M/3F, age=71.8+/-6.9yrs) showed significant symptom improvement on both ISI (pre=18.25/post=10.83,p&lt;.001) and PSQI (pre=11/post=8.73,p=.034) total scores. This improvement was further illustrated in the sleep diary measures which showed significant improvement across all metrics: SE (pre=70%/post=89%,p&lt;.001), TST (pre=5.40hrs/post=6.49hrs,p=.007), WASO (pre=50.53mins/post=20.73mins,p&lt;.001), and EMA (pre=61.29mins/post=15.16mins,p=.003). Importantly, the Sleep-SMART treatment protocol was viewed as acceptable to Veterans (AIM; M=4.46,SD= 0.62).

Conclusion
The Sleep-SMART intervention was viewed as acceptable and produced significant improvements in insomnia symptoms. These findings suggest that Sleep-SMART has the potential to be an effective modified form of CBT-I treatment that is uniquely tailored to aging Veterans with cognitive challenges. Future randomized controlled trials are warranted to investigate the efficacy of Sleep-SMART more broadly.

Support (if any)
This research supported by SPiRE Award 1 I21 RX003721-01A1 (D3721-P) from Department of Veterans Affairs Rehabilitation Research and Development Service.
0388 Lemborexant Effect on Sleep Parameters in Adults with Moderate or Severe Chronic Obstructive Pulmonary Disease
Authors: Zammit Gary K , Cheng Jocelyn Y , Hall Nancy , Moline Margaret 
Published: April 2024

Abstract

Introduction
Several commonly prescribed hypnotics may worsen respiratory function, especially in the elderly. Lemborexant (LEM) is a competitive dual-orexin-receptor-antagonist approved to treat adults with insomnia. In Study E2006-A001-113 (NCT04647383), LEM demonstrated respiratory safety in participants with untreated moderate-to-severe chronic obstructive pulmonary disease (COPD). This post hoc analysis evaluated sleep variables from this study.

Methods
This double-blind, placebo (PBO)-controlled, crossover study enrolled adults (45–90y) with untreated moderate or severe COPD, assessed by Global Initiative for Obstructive Lung Disease spirometry recommendations (apnea hypopnea index &lt; 15 was allowed). Participants were randomized to LEM 10mg (LEM10) or PBO in two 8-night treatment periods (separated by ≥14d). Latency to persistent sleep (LPS), sleep efficiency, wake after sleep onset (WASO), and total-sleep-time (TST) were assessed using in-laboratory polysomnography on Days 1 (D1) and 8 (D8).

Results
The analysis set comprised 30 adults with moderate (n=25) or severe (n=5) COPD (mean [SD] age, 69.2 [6.3]y; 70.0% female). Six (20%) participants had a medical history of insomnia. Least squares mean (LSM; standard error [SE]) LPS was significantly shorter (improved) with LEM10 compared with PBO on D1 (LEM10, 30.9 [9.0] min; PBO, 51.5 [9.0] min; P&lt; 0.01) and D8 (LEM10, 27.0 [7.0] min; PBO, 46.6 [7.0] min; P&lt; 0.001). LSM (SE) sleep efficiency was significantly higher (improved) with LEM10 compared with PBO on D1 (LEM10, 81.0% [2.6%]; PBO, 66.6% [2.6%]; P&lt; 0.0001) and D8 (LEM10, 77.1% [2.9%]; PBO, 69.4% [2.9%]; P&lt; 0.0001). LSM (SE) WASO was significantly lower (improved) with LEM10 compared with PBO on D1 (LEM10, 68.2 [9.6] min; PBO, 114.6 [9.6] min; P&lt; 0.0001) and D8 (LEM10, 90.4 [9.9] min; PBO, 106.1 [9.9] min; P&lt; 0.0001). LSM (SE) TST was significantly longer (improved) with LEM10 compared with PBO on D1 (LEM10, 388.9 [12.4] min; PBO, 319.5 [12.4] min; P&lt; 0.0001) and D8 (LEM10, 370.1 [13.7] min; PBO, 332.9 [13.7] min; P&lt; 0.0001). LEM was well-tolerated.

Conclusion
In participants with untreated moderate-to-severe COPD, most of whom did not have a medical history of insomnia, LEM improved sleep onset, sleep maintenance, and TST compared with PBO, suggesting LEM may be a potential treatment option for patients with COPD and insomnia.

Support (if any)
Eisai, Inc.
0390 Efficacy of Suvorexant for Insomnia Disorder in Well-controlled Restless Legs Syndrome
Authors: Winkelman John , Zackon Jordana 
Published: April 2024

Abstract

Introduction
Sleep disturbance remains common in patients with a history of Restless Legs Syndrome (RLS), even after RLS symptoms are sufficiently controlled with medication. Multiple potential causes for treatment-refractory sleep disturbance exist, including conditioned insomnia and poor sleep habits due to chronic RLS-related sleep disturbance, and comorbid medical and psychiatric illness. We conducted a placebo-controlled crossover trial to examine the efficacy of suvorexant in improving sleep quality and quantity in patients with well-controlled RLS and persistent insomnia.

Methods
In this double-blind, randomized, placebo-controlled crossover trial, 34 patients with well-controlled RLS were randomized to placebo or suvorexant (10-20 mg) for 6 weeks, followed by a 2-week washout and then the opposite treatment. Well-controlled RLS was defined as a score of less than 15 on the International Restless Legs Syndrome Study Group Rating Scale (IRLS) and Insomnia Disorder was defined by a self-reported combined Sleep Onset Latency (SOL) and Wake After Sleep Onset (WASO) of greater than 45 minutes and a Total Sleep Time (TST) of less than 7 hours. The primary outcome was actigraphically-derived TST, and secondary outcomes were Insomnia Severity Index (ISI) score and actigraphically-derived WASO. Data for all sleep metrics were collected at baseline and for the last two weeks of each treatment period.

Results
There were no significant improvements in actigraphically-derived TST (p = 0.58) or WASO (p = 0.99) while taking suvorexant compared to placebo. However, there was a significant reduction in insomnia symptoms, measured by the ISI, while taking suvorexant (p = 0.03). Moreover, exploratory analyses revealed a significant increase in self-reported TST (p = 0.01) and a significant reduction in nightly variability in TST (p = 0.03) while taking suvorexant. The most commonly reported side effect of suvorexant was fatigue (29.4%).

Conclusion
Though we did not observe a significant change between treatments in our primary endpoint of actigraphically-derived TST, our secondary and exploratory findings revealed promising support for suvorexant’s positive impact on self-reported quantity and quality of sleep in people with well-controlled RLS who continue to suffer from insomnia.

Support (if any)
Funded by an investigator-initiated grant from Merck Pharmaceuticals.