bluuebunny/crossref_metadata_2025_split huggingface dataset:
0423 Insomnia Management Program in Primary Care Can Improve Subjective Sleep Quality and Insomnia Severity Index (ISI)
Authors: Hussaini Fareeha , Stachura Amanda , Szalacha Laura , Canalejo Lilly 
Published: April 2024

Abstract

Introduction
Insomnia is the most common sleep disorder affecting up to 30% of the US population with Chronic Insomnia at 10%. Cognitive behavioral therapy for insomnia (CBT-I) has been recommended as the first line treatment and standard of care by the American College of Physicians and American Academy of Sleep Medicine. The goal of CBT-I is to help remedy symptoms and improve sleep quality with the aim of eliminating the reliance on prescription medications. Nonetheless, the use of CBT-I is limited while the use of sleep medications remains high, up to 8% of the US population. The aim of this pilot was to test the use of self-guided CBT-I using mobile app (CBT-I Coach) to reduce chronic insomnia and decrease the need for new sleep aide prescriptions.

Methods
The one-arm pilot was conducted in a diverse, large university-based family medicine practice. Family medicine providers (n=11) received education on insomnia and recommended primary management with CBT-I. Patient recruitment was completed in 8 weeks and included both referrals and from chart reviews (ICD 10 codes for insomnia). Participants received sleep education including sleep hygiene education and insomnia management with a CBT-I mobile app.

Results
The 23 participants, aged 25 to 64, reported significant improvement in ISI from moderate to sub-threshold insomnia (baseline M=19.26, SD=3.60 to final M= 14.04, SD=7.0, paired t-test=4.47, df=22, p&lt;.001, Cohen’s d=.93). In response to the intervention, 54.5% assessed their insomnia as “improved”, 36.4% as “stable”, and only 9.1% as "worse.” 71.4% of those taking prescribed medications rated their insomnia as “stable”, 66.7% of those taking Melatonin rated their insomnia as “improved” and 66.7% of those taking nothing at all rated their insomnia as “improved.” Notably, for those taking any sleep aide or medication, there was neither an increase in dosage nor a new prescription during this study.

Conclusion
Primary care implementation of a self-guided insomnia management program delivered through the app CBT-I Coach can improve sleep quality and insomnia severity. This intervention can especially be beneficial for those taking nonprescription sleep aide (melatonin) or no medication at all.

Support (if any)
0424 Evaluating Sedative-Hypnotics Education Across Diverse Communities Using Community Alignment Theory
Authors: Chang Jungchen , Hsieh Yow-Wen , Wu Chen-I , Hsu Kaifanf , Hung Hsiao-Mei , Li Chun-Ta , Chen You-An , Wang Tzu-Chueh , Ting Hsien-wei , Chang Fong-Ching , Chi Hsueh-Yun 
Published: April 2024

Abstract

Introduction
Since the late 1990s, misuse of prescription sedative-hypnotics like benzodiazepines (BZDs) and non-benzodiazepines (non-BZDs) has surged, becoming a significant public health issue. To address this, a community health program was evaluated for its effectiveness in raising awareness, providing preventive education, and implementing interventions. The study assessed a comprehensive health promotion initiative involving healthcare providers, trained community members, and volunteers to encourage responsible use of sedative-hypnotics among diverse populations.

Methods
The study employed Community Alignment Theory to emphasize the significance of cohesive collaboration among community members, organizations, and institutions, aiming to achieve sustainable and impactful outcomes. Eight experienced institutions across various regions, proficient in implementing individual and population health education programs, were selected with support from academic universities and non-governmental organizations (NGOs). These entities actively participated in developing and executing comprehensive programs. To assess awareness regarding the accurate use of sedative-hypnotics, five-item questionnaires were developed. These questionnaires exhibited a high content validity index of over .85, determined by eight experts, and demonstrated strong internal consistency reliability of .89.

Results
Eight institutions across diverse regions collaborated with 161 stakeholders and enrolled 875 participants, comprising 447 males (51.1%) with an average age of 58.3 ± 17.6 years. The current prevalence of insomnia, occurring at least three days a week, stood at 15.2% (n=133), with over half of the participants (n=466, 53.3%) having sought medical assistance for insomnia. Following the execution of 646 educational programs conducted in 275 locations and 13,348 participants attended, there was a significant improvement in awareness regarding insomnia and the appropriate utilization of sedative-hypnotics (p&lt;.001). This enhancement encompassed various aspects such as daytime naps, sleep hygiene, prescription adherence, and awareness of hypnotics' adverse effects.

Conclusion
The utilization of the community alignment theory serves as a fundamental framework for steering educational initiatives within communities, demonstrating advantageous impacts on promoting the precise utilization of sedative-hypnotics.

Support (if any)
The Food and Drug Administration, Ministry of Health and Welfare, Taiwan, supported the study (Project number MOHW112-FDA-D-114-000641).
0427 Assessment of First-Night Effect in Patients with Insomnia Using the Odds-Ratio-Product (ORP)
Authors: Lambing Kari , Guadagni Veronica , Gerardy Bethany , Bender Amy , Younes Magdy , Bastien Celyne 
Published: April 2024

Abstract

Introduction
Studies on first-night effect using conventional sleep metrics have been inconclusive. ORP is an objective index of sleep depth and wake propensity ranging from 0 (very deep sleep) to 2.5 (full wakefulness). ORP provides more in-depth information about sleep. We compared several ORP-derived metrics measured during three consecutive PSGs in patients with and without insomnia.

Methods
Participants (n=119) were screened with the Insomnia Severity Index and clinical interviews and assigned to either control (n=50) or insomnia (n=69) groups. Participants completed 3 nights of in-laboratory polysomnography. After each PSG, participants answered the question “How was your night in the lab compared to a night at home?” on a 1 (much better) to 5 (very mediocre) scale. The following variables were compared across the three nights with repeated-measures ANOVA. Questionnaire response (Q); average ORP during stages wake (ORPW), NREM (ORPNR) and REM (ORPREM) sleep; percent of recording time in deep sleep (ORP&lt; 0.5) and in full wakefulness (ORP&gt;2.25); average instantaneous difference between right and left ORP (R/L ORP difference), a measure of interhemispheric dissociation in sleep depth; frequency (hr-1) of transient increases (&gt;2.0) in ORP during NREM sleep (WII); along with total sleep time (TST), % time awake (%wake), minutes in stages NREM3 (N3 time) and REM sleep (REM time); arousal index (AI).

Results
There were no differences between nights 2 and 3 in any variable. Q decreased beyond night-1, indicating improvement relative to home. The following significant changes were observed in night-2 in both insomnia and control groups (Tukey’s test): ORPNR and ORPREM decreased (deeper sleep); more time in deep sleep (ORP&lt; 0.5) and less time in full-wakefulness (ORP&gt;2.25); less WII. The following significant changes were observed in night-2 only in participants with insomnia: Lower ORPW, indicating less alertness during stage W, and less R/L ORP differences. TST marginally increased and N3 time and AI marginally decreased in insomnia while %wake decreased marginally in both groups.

Conclusion
This study demonstrated clear first-night effects in several EEG microstructure variables in both control and insomnia participants, while the latter also showed reduced alertness and improved R/L agreement in sleep depth beyond night-1.

Support (if any)
0429 Sleep Misperception in Insomnia Phenotypes Based on Objective Sleep Duration in Young Adults
Authors: Atha Raegan , Lenker Kristina , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio 
Published: April 2024

Abstract

Introduction
Prior research has suggested that the underestimation of total sleep time (TST), i.e., so-called sleep misperception, may be a trait feature of those with insomnia. Prior studies have also shown differences in the degree of sleep misperception across insomnia phenotypes, however, these findings have not been replicated in population-based samples of young adults.

Methods
We studied 270 young adults (median 25 years, 53% female, 24% racial/ethnic minority) from the Penn State Child Cohort who underwent a 9-hour polysomnography (PSG) recording, clinical history, and self-report surveys. Insomnia symptoms were defined as reports of difficulties initiating or maintaining sleep, insomnia diagnosis or complaint, and/or sleep medication use. PSG-measured short sleep duration was defined by the median of the sample (i.e., &lt; 7-h), identifying normal sleep duration (NSD), short sleep duration (SSD), insomnia with normal sleep duration (INSD) and insomnia with short sleep duration (ISSD). Subjective TST was ascertained from a morning questionnaire completed immediately upon awakening from the PSG as well as from a retrospective survey of habitual sleep at home. A general linear model tested mean differences in TST-discrepancy across the four groups, while adjusting for sex, race/ethnicity, age, waist circumference, sleep apnea, cardiometabolic disorders, medication and substance use.

Results
INSD consistently underestimated TST, regardless of whether it was assessed upon awakening in the lab (-37.9±7.7 min; p&lt; 0.001) or by reports of habitual sleep (-41.5±9.1 min; p&lt; 0.001), while ISSD showed relative accuracy when TST was assessed upon awakening in the lab (8.9±7.8 minutes) and clear overestimation (85.9±9.2 minutes) when assessed by reports of habitual sleep.

Conclusion
Sleep misperception is a trait feature of individuals with INSD, who underestimate their sleep duration regardless of method of measurement used. These data suggest that the INSD phenotype may respond better to therapies addressing the cognitive and cortical underpinnings of this phenomenon.

Support (if any)
NIH (R01 HL136587, R01 MH118308, UL1 TR00127)
0434 Effect of Dynamic Binaural Beats on Sleep Quality: A Proof-of-Concept Study with Questionnaire and Biosignals
Authors: Paik Sang Min , Lee Hwa Ah Ni , Park Hyo Jin , Han Sun-Kyu , Kim Jae Rim , Lee Woo-Jin , Hwang Han-Jeong , Yun Chang-Ho 
Published: April 2024

Abstract

Introduction
The key pathomechanism of insomnia involves hyperarousal, which increases anxiety, stress, and alertness during the pre-sleep initiation period and interferes with the ability to initiate or maintain sleep. Hyperarousal is associated with disrupted autonomic nervous system (ANS) regulation during the process of sleep initiation. Binaural beat (BB) sounds subjectively perceived by listeners when each ear is presented with a small frequency difference. BB has been investigated as a potential modality to enhance sleep quality and to reduce sleep latency. In this study, we introduce a new form of BB, referred to as dynamic BB (DBB), which incorporates dynamically changing carrier frequency differences between the left (fixed at 100 Hz) and right (oscillates between 100-103 Hz) ears, yielding a frequency difference range of 0 to 3 Hz. We evaluated the effects of DBB on sleep quality using polysomnography (PSG) parameters, electroencephalography (EEG), and ANS function regulation measured using heart rate variability (HRV).

Methods
Ten healthy participants were included in a cross-over design, where they experienced both DBB and a SHAM (absence of sound) condition across two consecutive nights, with PSG evaluation. DBB was administrated during pre-sleep initiation, sleep onset, and transition from rapid-eye-movement (REM) to non-REM stage (non-REM transition). Sleep latency, sleep efficiency, relative portion of each sleep stage on PSG, relative power of each frequency band in EEG, and mean HRV and its low/high frequency power were compared to evaluate the effect of DBB.

Results
DBB significantly reduced sleep latency as well as marginally increase sleep efficiency compared to the SHAM condition. Moreover, HRV was significantly lower for the DBB condition than the SHAM condition in both pre-sleep initiation and sleep onset periods, and LF power did in sleep onset period, indicating its ability to suppress the activity of the sympathetic nervous system—associated with arousal—and to enhance the parasympathetic nervous system, consequently facilitating a swifter transition into sleep.

Conclusion
DBB might be effective in improving the sleep quality, suggesting its possible application in insomnia treatments.

Support (if any)
0435 Continuous Theta-burst Stimulation Lowers the Impact of Anxiety on Sleep Duration in Individuals with Insomnia
Authors: Desai Shivani , Reich-Fuehrer Melissa Melissa , Huskey Alisa , Yakpogoro Nekabari , Henderson-Arredondo Kymberly , Patel Salma , Jankowski Samantha , Trapani Christopher , Hildebrand Lindsey , Franca Gabriela , Grandner Michael , Chen Yu-Chin (Allison) , Chou Ying-Hui , Dailey Natalie , Killgore William 
Published: April 2024

Abstract

Introduction
Repetitive Transcranial Magnetic Stimulation (rTMS) is a procedure by which a magnetic coil is used to stimulate specific regions of the brain to bring about alterations in function. Continuous theta-burst stimulation (cTBS) is a form of rTMS that was used to suppress cortical excitability and lower within network connectivity in the Default Mode Network (DMN). Connectivity within the DMN is associated with rumination and mind-wandering. Prior research indicates that pre-sleep anxiety is associated with increased sleep latency and decreased sleep continuity. As part of a larger project, we hypothesized that pre-sleep anxiety would negatively impact total sleep time, as measured by polysomnography (PSG), but that this effect would be reduced or eliminated in the active cTBS condition compared to sham.

Methods
We administered cTBS to 20 participants with insomnia symptoms (Nmales = 8, Mage=31.6, SD=6.7) (Nfemales =12, Mage=23.8, SD=4.3). Participants then underwent one administration of sham stimulation and one administration of active cTBS to the left angular gyrus node of the DMN in a randomized order separated by one week. The State Trait Anxiety Inventory (STAI-S) was administered immediately before each session, and PSG data was collected during overnight laboratory stays following the TMS sessions. We ran two linear regressions between STAI-S scores and total sleep time - one analysis for the sham condition and another for the active condition.

Results
Elevated STAI-S scores (M=41.6, SD=6.984) predicted decreased total sleep time (Mean minutes=393.75, SD=48.45) for the sham cTBS condition (F(1,18)=8.689, p=.009; β=-.571, p=.009). In contrast, the relationship between STAI-S scores (M=40.9, SD=50.35) and total sleep time (Mean minutes=403.8, SD=5.34) was not significant for the active cTBS condition (F(1,18)=2.409, p=.138; β=-.344, p=.138).

Conclusion
Prior data presented from this trial revealed that active cTBS improved TST overall. However, here we further demonstrated that higher pre-sleep anxiety predicted a lower sleep duration for the sham cTBS condition but not for the active cTBS condition, suggesting that the active cTBS may mitigate the effects of anxiety on sleep. These findings support the applicability of continuous theta-burst stimulation in treating psychiatric conditions related to sleep difficulties, such as anxiety.

Support (if any)
US Army Medical Research Acquisition Activity Grant: W81XWH2010173
0436 Combining Insomnia Therapy with Sleep Tracking Using Wearables: Effects of a CBT-I-based App on Sleep - A RCT Study
Authors: Hinterberger Alexandra , Eigl Esther-Sevil , Schwemlein Robyn , Topalidis Pavlos , Schabus Manuel 
Published: April 2024

Abstract

Introduction
Due to the gap in non-pharmacological insomnia treatment, effective and validated digital solutions are urgently needed. So far, digital cognitive behavioral therapy for insomnia (CBT-I) options are comprised of a therapy program and subjective measurements in form of a sleep diary. Objective sleep measurements are usually not included. Here, we evaluate an innovative smartphone app (NUKKUAA®), combining i) a CBT-I-based sleep training with ii) subjective as well as iii) objective sleep monitoring via a wearable heart rate (HR) sensor, and iv) feedback based on such objective data. A RCT study was conducted to investigate effects on sleep and subjective-objective sleep discrepancies (SOSD).

Methods
Fifty-seven self-reported poor sleepers (20-76 years; MAge=45.67±16.38; 39 female) were randomly assigned to an experimental group (EG, n=28) or a waitlist control group (CG, n=29). During a 6-week intervention phase, the EG used the CBT-I-based app program including subjective and objective sleep monitoring as well as feedback on their sleep, while the CG used sleep monitoring only. Sleep was measured i) subjectively with questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), ii) objectively with ambulatory polysomnography (PSG), and iii) continuously via a HR sensor and sleep diaries.

Results
Analyses revealed interactions for ISI (p=.003, ƞ2part=.11) and PSQI (p=.050, ƞ2part=.05), indicating training-specific improvements for EG, yet not for CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p=.061, d=0.55). Regarding changes in SOSD, results indicate a SOSD reduction during intervention for total sleep time in both groups, while improvements for sleep efficiency, sleep onset latency and WASO were found in EG only (p’s≤.022, d≥0.46).

Conclusion
The findings indicate beneficial effects of an innovative smartphone app on sleep and SOSD. More scientific evaluation of such digital programs is needed in order to ultimately help reducing the gap in non-pharmacological insomnia treatment and provide affected individuals with sufficient treatment options and effective, low-threshold support for their sleep problems.

Support (if any)
PT was partly supported by the FWF/Austrian Science Fund (W 1233-B).
0438 Optimizing Virtual Insomnia Therapy for Women: Insights from an Insomnia Pilot Program in Australia
Authors: Lee Bao Hui , Gan Hui Leng , Medalie Lisa , Wimms Alison 
Published: April 2024

Abstract

Introduction
Insomnia, a prevalent sleep disorder, poses unique challenges for women, often compounded by coexisting women’s health and mental health conditions. This study explores the accessibility and viability of a virtual insomnia therapy program tailored for women, leveraging cognitive behavioural therapy for insomnia (CBT-i) delivered via telehealth.

Methods
The pilot, conducted from May to August 2023, was advertised through email and social media campaigns. Basic demographic information and sleep issues were collected. Respondents were then given the opportunity to engage in a pilot program involving telehealth CBT-i sessions and digital sleep diaries. Information on women’s sleep attitudes and issues were collected. Participation rates, therapy adherence, and participant feedback were analysed to evaluate program effectiveness and identify barriers to therapy.

Results
61 women, predominantly aged 40 and above (90%), all experiencing sleep challenges for over three months responded to the campaign. Of the 61 women, five chose to actively engage in the pilot program. Of these, 1 completed treatment, 1 had trouble obtaining a GP referral, 2 dropped out due to travel/competing priorities, and 1 did not want to pay upfront out-of-pocket cost. Despite these challenges, the participants reported high satisfaction (average score: 8.9 out of 10) and a strong likelihood to recommend the program (Net Promoter Score: 100). Notably, all participants had coexisting women's health and mental health conditions, and 60% had a previous diagnosis of obstructive sleep apnea (OSA).

Conclusion
The pilot demonstrated the potential and challenges of engaging women with complex health needs in virtual CBT-i for insomnia through targeted advertising. Although satisfaction among participants was high, indicating its effectiveness, the modest engagement rate highlights the need for strategies that not only reach women but also enhance their understanding of insomnia and its treatment. This suggests that while targeted advertising is a promising approach for providing direct access to insomnia treatment, it needs to be complemented with other strategies, such as healthcare referrals and comprehensive psychoeducation about insomnia and CBT-i to enhance treatment access and adherence, especially for women with complex health needs.

Support (if any)
ResMed.
0441 Sleep Disturbance in MCI: A Pilot Study of a Cognitive Behavioural Therapy Digital Intervention (SUCCEED)
Authors: Hoyos Camilla , Espinosa Nicole , Marshall Nathaniel , LaMonica Haley , Gordon Christopher , Rainey-Smith Stephanie , Grunstein Ronald R , Naismith Sharon 
Published: April 2024

Abstract

Introduction
Insomnia is common in older adults with mild cognitive impairment (MCI) and predicts future cognitive decline. Cognitive Behavioural Therapy for insomnia (CBT-I) is the first-line treatment for insomnia but is often unavailable. We tested the feasibility of a randomised controlled trial comparing 12-weeks of digital CBT-I vs wait-listed control in older adults with MCI and insomnia.

Methods
This was an investigator-initiated (NCT05568381), parallel open-label randomised-controlled feasibility trial. Participants were randomised to digital CBT-I (Sleepio, 6-weekly sessions) or a wait-listed control (3 fortnightly online modules of a sleep health education package) via a secure centralised platform which was also used to collect the outcome data. This study was undertaken remotely without in-person visits. Potential participants were recruited through online advertising and a memory clinic in Sydney, Australia. Those who met initial eligibility were invited to a screening and informed consent telehealth consultation. Inclusion criteria included adults aged ≥50 years, with an Insomnia Severity Index (ISI)&gt;10, who met the clinical criteria of MCI on a neuropsychological battery (performed over telehealth for participants recruited online). The primary outcomes were the proportion of participants who met screening and randomisation criteria. A secondary outcome was the effect sizes and 95%CIs of the difference in ISI between the groups at week 12.

Results
Recruitment occurred March 23, 2023 to August 11, 2023 stopping when we reached our pre-defined sample size (digital CBT-I=19; control=21; 30 females; mean [SD] age=59.7 years [7.3]; ISI=17.0 [3.7]). 37% of participants issued a pre-screening number (n=246), were eligible to attend online screening. 47% of those issued a screening number (n=90) were eligible to be randomised (n=42). All randomised participants (n=40) were recruited through the online pathway. At 12-weeks there was a difference in ISI between the digital CBT-I (mean±SE 7.8±1.1 points) and control groups (13.7±1.05 points) (Cohen’s D [95%CI] -1.6 [-2.4 to 2.1]). 79% of participants completed ≥4 out of the CBT-I 6 sessions. All adverse events were minor and transient.

Conclusion
This population can be recruited through online pathways and follow the protocol as well as adhere to the intervention of this remotely conducted trial.

Support (if any)
CogSleep CRE Seed Funding Grant. BigHealth- intervention in-kind.