bluuebunny/crossref_metadata_2025_split huggingface dataset:
0390 Cracking the EEG Code on Insomnia: How Odds Ratio Product Architecture Relates to Number of Insomnia Symptoms
Authors: Lambing Kari , Guadagni Veronica , Bender Amy 
Published: May 2023

Abstract

Introduction
Objective markers of insomnia have remained largely elusive. Odds ratio product (ORP; a marker of objective sleep quality), is currently being investigated for a potential role in assisting in insomnia diagnosis. Recent research has shown how patients with insomnia may present with hyperarousal and may be identified by looking at ORP architecture. In the current study, we aimed to investigate how ORP architecture, and specifically time spent in the lowest two (deep sleep) and last decile (full wakefulness) of ORP, relate to the number of insomnia symptoms.

Methods
403 participants (age 46.3±12.3, range 18-79, 172 females) recorded their sleep with in-home PSG using the Cerebra Sleep System and completed sleep questionnaires. Sleep quality was measured using the odds ratio product (ORP) derived from micro-analyzing frontal EEG channels. On the questionnaires, participants reported whether they experienced any of the following insomnia symptoms at least three times a week: trouble falling asleep, trouble staying asleep, and waking up too early. Statistical analyses included number of insomnia symptoms as a dependent variable in a multiple linear regression, time spent in the lowest two deciles of ORP and the highest decile of ORP as independent variables, and age as a covariate in a separate model.

Results
60 participants reported 1 symptom of insomnia, 82 reported 2 symptoms, and 68 reported 3 symptoms. The full model was significant (F2,399=4.675, p=0.010, R=0.228, R2 adj=0.052) and indicated that time spent in the highest decile of ORP was the only significant predictor of number of insomnia symptoms (t399=2.321, p=0.021, β=0.131) after controlling for age. Time spent in the lowest two deciles of ORP (deep sleep) was not a significant predictor (p &gt;0.05).

Conclusion
Time in the highest ORP decile, indicative of full wakefulness, is positively associated with insomnia symptoms after controlling for age. Individuals reporting more insomnia symptoms spent more time in full wakefulness. Time spent in deep sleep was not associated with insomnia symptoms. This may indicate hyperarousal and low sleep drive in participants with subjective insomnia complaints, which is consistent with insomnia etiology.

Support (if any)
0393 Durability of treatment effects for a stepped-care model integrating digital therapy for insomnia
Authors: Bayoneto Alec , Cheng Philip , Iqal Justin , Kalmbach David , Drake Christopher 
Published: May 2023

Abstract

Introduction
A stepped-care model going from digital cognitive behavioral therapy for insomnia (dCBT-I) to clinician-led CBT-I (fCBT-I) has been shown to be acutely effective. However, the sustainability of the effects over longer periods of time has not yet been examined. This study tested the durability of treatment effects of this stepped-care approach two years following the end of treatment.

Methods
1018 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions at step 1: dCBT-I (N=613), or an online sleep education control (N=624). Participants in the dCBT-I condition who did not remit (ISI&gt;9) were further randomized to either face-to-face CBT-I (N=103) or sleep education (N=104). Insomnia remission and treatment gains at 2-year follow-up were compared across treatment conditions.

Results
Among step-1 non-remitters, odds of insomnia remission for those who stepped-up to fCBT-I was almost three times higher (60% in remission) than those who received the step-2 control (33% in remission), OR = 2.95, 95% CI [1.3, 6.7]. Odds of remission was not significantly different between those who remitted at step-1 (64% in remission at year 2) and those who received fCBT-I, OR = 3.53, 95% CI [1.7, 7.5]. The treatment gains were higher in the fCBT-I group (9.6 point improvement from baseline) compared to those who remitted at step-1 (7.7 point improvement from baseline) (Cohen’s d = 0.44).

Conclusion
Preliminary evidence indicate that the treatment effects of this stepped-care model are durable two years after treatment.

Support (if any)
Support for this study was provided from the National Institute of Mental Health R56MH115150 and R01MH122636 awarded to Dr. Christopher Drake.
0395 Effects of Insomnia and Rest-Activity on Hospitalizations and Emergency Department Visits in People with Stable Heart Failure
Authors: Jeon Sangchoon , Conley Samantha , Hollenbeak Christopher , O’Connell Meghan , Yaggi H , Jacoby Daniel , Wang Zequan , Tocchi Christine , Redeker Nancy 
Published: May 2023

Abstract

Introduction
People with heart failure (HF) have frequent hospitalizations, and emergency department (ED) visits. We examined the effects of insomnia and rest-activity rhythms (RARs) on time to hospitalizations and ED visits after controlling for other known risk factors among participants in a randomized controlled trial of cognitive behavioral therapy for insomnia compared to heart failure self-management education (attention control).

Methods
The analysis included 168 HF patients who had available medical records for dates of hospitalization, ED visit, transplant, and death from a randomized clinical trial for insomnia of people with HF and insomnia. The known risk factors included age, sex, New York Heart Association (NYHA) Class, ejection fraction, and comorbid conditions. We used the insomnia severity index (ISI) and evaluated the strength of RAR using the ratio of the amplitude to the MESOR estimated with cosinor analysis with activity counts from a wrist-actigraph worn for at least five consecutive days. Cox proportional hazard models were used to examine ­insomnia and the RAR metrics with the known risk factors on time to first hospitalization, ED visit, transplant, and death.

Results
Eighty-five (50.1%) had at least one hospitalization, and ninety-one (54.2%) participants had an ED visit. Approximately 42% of the participants were admitted to the hospital due to cardiac events. Older age, male sex, higher NYHA, and greater comorbidity were associated with earlier hospitalization or ED visits. After controlling for those risk factors, stronger RAR was associated with later time to hospitalization, and ED visit with hazard ratios (HRs) of 0.26 (95% CI=[0.07, 0.91]) and 0.25 (95% CI=[0.07, 0.89]); higher insomnia severity (ISI ≥22) was associated with shorter time to ED visits, with an HR of 2.28 (95% CI=[1.19, 4.38]).

Conclusion
In addition to known demographic and clinical risk factors, insomnia severity and RAR predict hospitalizations and ED visits in people with HF. Further research is necessary to assess the biological mechanism of the associations and examine whether the effects of the risk factors could be modified by improving insomnia severity and RAR in people with HF.

Support (if any)
This study was financially supported by grants R01NR016191 and P20NR014126 from NIH/NINR.
0399 Examining Insomnia Treatment Adherence and Outcomes in Black Women Veterans
Authors: May Kimiko , Erickson Alexander , Mitchell Michael , Washington Donna , Yano Elizabeth , Alessi Cathy , McGowan Sarah Kate , Carlson Gwendolyn , Kelly Monica , Fung Constance , Martin Jennifer , Song Yeonsu 
Published: May 2023

Abstract

Introduction
Black identified women and veterans consistently experience disproportionately higher rates of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) improves sleep outcomes, although higher rates of attrition and sub-optimal adherence in these groups can limit symptom improvement. Few studies have examined CBT-I treatment adherence and outcomes in women veterans, particularly among those who identify as black. . The current study examined differences in adherence and treatment outcomes in Black identified women veterans compared to white identified women veterans who engaged in CBT-I.

Methods
As part of a larger clinical trial (NCT02076165), 26 black and 25 white women veterans with insomnia disorder completed a 5-session CBT-I program. Insomnia Severity Index (ISI) and sleep diaries were completed at baseline, post-treatment, and 3-month follow-up. Multiple and fractional regression models were used to evaluate the association between race and change in ISI, change in sleep diary sleep efficiency (SE), and adherence to bedtime and rise time during CBT-I.

Results
Mean change from baseline to 3-month follow-up in ISI score for black and white women were -7.31 and -7.97 and mean change in diary SE was +14.9% and +10.8%, respectively. Race did not impact change-scores for ISI or SE (1.09 &lt; F &lt; 1.8, p&gt;.05); however, in the fractional regression model, (Χ2=6.9, p=.008; pseudo R2=.058) race was a significant predictor (OR=.27, p=.009) of adherence to prescribed bedtime in the second week of CBT-I, with black women less likely to adhere to prescribed bedtime than women. Race was not a significant predictor of wake time adherence.

Conclusion
Both black and white women veterans benefitted from CBT-I; however, early adherence to the recommended sleep schedule was lower in black women. Future research could expand on these findings by examining potential barriers in early adherence to recommendations, and how to improve early adherence to ensure that therapy meets the needs of all patients.

Support (if any)
VA/HSR&D IIR-HX002300 (PI: Martin), NIH/NHLBI K24HL143055 and VA HSR&D RCS 20-191. Dr. May supported by the VA Office of Academic Affiliations.
0400 Examining the Effectiveness of Telehealth Delivered Cognitive Behavioral Treatment of Insomnia
Authors: Kautzmann Jeremie , Gehrman Philip , Findley James , Kayser Matthew , Weljie Aalim 
Published: May 2023

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be an effective tool in improving symptoms of insomnia, however access is limited. One option for increasing access is the use of telehealth. We conducted a randomized trial comparing CBT-I delivered in-person to over video telehealth and found that telehealth treatment was non-inferior on self-reported insomnia severity. The objective of this study was to extend this analysis to secondary outcomes of subjective and objective measures of sleep as further assessment of the efficacy of telehealth compared to in-person treatment.

Methods
Individuals with DSM-5 insomnia disorder (n=60) were randomized to telehealth CBT-I, in person CBT-I, or 8-week waitlist control, although this analysis only compared the CBT-I groups. CBT-I was delivered over 6-8 weekly sessions by video telehealth or in-person in an outpatient clinic. Follow-up assessment was at 2 weeks post-treatment. Both objective and subjective outcomes of sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST) were collected via actigraphy and sleep diaries. Random effects mixed models were used to determine the effects of group, treatment, and their interaction.

Results
The mean change in SE, SOL, WASO, and TST for objective measures from baseline to follow-up was 0.43% and -17.7 minutes, -6.8 minutes, -31.0 minutes, respectively, for in person CBT-I and 0.01%, -15.1 minutes, -2.1 minutes, -9.5 minutes, respectively, for telehealth. For subjective measures, the mean change was 0.16% and -27.0 minutes, -22.7 minutes, 28.9 minutes, respectively, for in person CBT-I and 0.15%, -23.4 minutes, -23.4 minutes, 51.6 minutes respectively for telehealth. The differences between the CBT-I groups were not statistically significant, nor were there significant interaction effects.

Conclusion
In both objective and subjective measures of insomnia, there is no evidence that outcomes from telehealth delivery of CBT-I is worse than in person treatment. Subjective effects were much larger than objective effects for insomnia possibly indicating a discrepancy between how sleep and more particularly insomnia is perceived by oneself and measured in the lab.

Support (if any)
This research was supported by grant 167-SR-17XYZ from the American Sleep Medicine Foundation and a Doris Duke Charitable Foundation Clinical Scientist Development Award.
0404 Heart Failure Nurses’ Perceptions of Cognitive Behavioral Therapy for Insomnia and the Feasibility of Providing it to Patients
Authors: O'Connell Meghan , Feder Shelli , Nwanaji-Enwerem Uzoji , Redeker Nancy 
Published: May 2023

Abstract

Introduction
People with heart failure (HF) often report insomnia. Despite strong evidence to support treatment with Cognitive Behavioral Therapy for Insomnia (CBT-I), few with HF have access to CBT-I programs. Access may be improved if it is offered where HF patients receive their medical care, but little is known about the feasibility of doing so. The purpose of this focus group study was to explore HF Nurses’ perceptions of: the importance of insomnia and the value of CBT-I to their patients; the feasibility of making CBT-I available in clinic settings and its delivery by HF nurses; and preferences for alternative modes of delivery.

Methods
We used a descriptive qualitative study design. We recruited focus group participants via electronic invitation to members of the American Association of Heart Failure Nurses and through requests to local nurse collaborators to distribute within their networks. We conducted virtual focus groups. After providing a brief description of the components of CBT-I and its efficacy in the HF population, we elicited participant perceptions of the value of providing CBT-I for HF patients in the clinic setting, facilitators and barriers to implementation, and ways to increase access to CBT-I. We audio-recorded the focus group discussions and used a professional transcription service. Two researchers coded the data and performed thematic content analysis.

Results
We conducted four focus groups with registered nurses and advanced practice nurses employed in HF clinics (N=23). Nurses endorsed the importance of sleep to HF patients, their interest in addressing sleep, perceived benefits of CBT-I, and the need for increased resources to address sleep in the clinic setting. They favored multiple modes of CBT-I delivery extending beyond the clinic. All nurses believed they had a role to play in addressing sleep, but differed in their views about the possibility of becoming CBT-I interventionists and the training and support needed to do so.

Conclusion
HF nurses recognize the importance of insomnia and support the implementation of CBT-I. Implementation studies are needed to identify effective methods of increasing access to evidence based CBT-I in the HF clinic setting, including appropriate support and training for nurses with interest in CBT-I delivery.

Support (if any)
R01NR01691
0405 How Well Does Sexual Activity Improve Sleep When Compared With Pharmacologic Sleep Aids?
Authors: Kirsch Douglas , Khosla Seema 
Published: May 2023

Abstract

Introduction
Insomnia is a common sleep disorder with negative impacts on psychological and physical health. Films and books for the general public have commonly suggested that sexual activity is followed by increased sleep drive. Our initial survey was done to assess the perceived impact of sex and orgasm on sleep in people with insomnia in comparison to the use of sleeping pills.

Methods
An 8-question survey was created with Qualtrics. The link to the survey was shared via social media, including Twitter. Explanation was given about the purpose of the survey. Ages under 18 were excluded from the study.

Results
53 individuals completed the survey, 53% were female. The survey skewed to younger adults, 89% between 25-49 years of age. 75% of respondents reported that they slept better after sex/orgasm close to bedtime and the majority reported a moderate improvement in sleep on those nights. Medication was utilized to improve sleep by 66% of the individuals. In comparison to sex/orgasm, the majority of those surveyed felt that medication had similar or worse effect on their sleep (64%).

Conclusion
This was a preliminary survey of a general audience about the impacts of sex/orgasm on sleep and the comparison to medications. It appears that sex/orgasm had a positive impact on sleep in both males and females in the surveyed population and was used not infrequently to improve sleep. Although this survey demonstrated largely positive impact of sex/orgasm on sleep, negative associations with sexual activity were not explored and people with these negative associations (such as those with sexual-related trauma) may not have been well represented. Limited research has been done about the relative impacts of sex and orgasm on the quality of sleep, however, this survey suggests that media depictions of falling asleep faster after sex may be accurate in the general population. Given the above findings, further thoughtful examination of the impact of sexual activity on sleep is warranted, recognizing that there are many in whom sexual activity prior to bedtime is a negative experience and may worsen sleep.

Support (if any)
0406 Impact of comorbid insomnia and nocturia on subjects' lives as assessed through a concept elicitation study
Authors: Phillips-Beyer Andrea , Olivieri Antonio , Marco Tobias Di , Kimel Miriam 
Published: May 2023

Abstract

Introduction
The lived experiences of individuals with insomnia and comorbid nocturia are not properly understood. This study explored the lived experiences of individuals with insomnia and comorbid nocturia to identify relevant concepts that could be reflected in patient-reported outcome (PRO) endpoints in clinical studies.

Methods
This was a cross-sectional, qualitative observational study. Data were collected from a sample of 10 adult subjects from the US suffering from insomnia disorder (DSM-5) and comorbid nocturia (≥2 nocturnal voids). Interviews were conducted using semi-structured guides, lasted 60–90 minutes, and assessed patient-relevant concepts of interest for their insomnia and nocturia. Institutional review board approval and web-based informed consent were obtained prior to the interviews.

Results
Overall, 10 participants were included, and the mean age was 61 years (SD=6). Most participants were female (8/10), White (9/10), and lived with a partner/spouse, family, or friends (8/10). Almost all participants experienced insomnia symptoms at least 5 nights per week (9/10), most often impacting their emotional (10/10), social (10/10), physical (9/10), cognitive (9/10), and work and productivity (6/10) functioning. Almost all participants reported that decreasing the impact of insomnia would be meaningful (8/10), most often mentioning improvements in physical impacts such as having more energy or feeling less exhausted (7/10). All participants experienced nocturia at least 6 nights per week (10/10), often impacting their emotional (7/10), social (6/10), physical (6/10), cognitive (4/10), and work and productivity (4/10) functioning. Participants reported that going to the bathroom less often (i.e., two times per night, once per night, or not at all; each 2/10) and being able to sleep through the night (2/10) would be meaningful improvements.

Conclusion
Individuals with insomnia and nocturia experience disrupted sleep patterns that impact their emotional, social, physical, cognitive, and work functioning. Feeling less tired, being able to sleep through the night, and getting up less often to use the bathroom would be meaningful to patients living with both conditions.

Support (if any)
Funded by Idorsia Pharmaceuticals Ltd.
0409 Is insomnia with objective short sleep duration related to insufficient sleep drive or physiological hyperarousal?
Authors: Yang Chien-Ming , Huang Ya-Chuan , Kao Yu-Hsuan , Lee Hsin-Chien 
Published: May 2023

Abstract

Introduction
IInsomnia with objective short sleep duration (OSSD) was found to be associated with higher risks of cardiometabolic disorders, and was therefore proposed to be a phenotype associated with higher physiological hyperarousal. Previous studies further reported that insomnia with OSSD had higher autonomic arousal as measured by heart rate variability (HRV) during sleep. Since sleep duration could be determined by the interplay of arousal and sleep drive and HRV during sleep could be influenced by sleep staging and quality, the present study examined the level of arousal and sleep drive prior to sleep with EEG power and HRV to further understand the phenotyping of insomnia.

Methods
Ninety-four insomnia patients participated in the study and went through one night of 8-hour PSG recording. They were divided, with a cut-off of PSG total sleep time of 6 hours, into two groups: an OSSD group (N=26; mean age=37.0 ±10.3; M:F=7:19; TST=286.21±87.21 min) and an objective normal sleep duration (ONSD) group (N=68, mean age=32.95 ±10.05, M:F=12: 56, TST=414.4±28.9 min). Resting-state EEG and EKG were recorded for a 6-min period, 3-min eye-opened (EO) with fixation focus and 3 mins eye-closed (EC), prior to bedtime.

Results
T-tests showed no significant difference in HRV measures (SDNN, RMSD, LF, HF, LF/HF) between the two groups, but shorter R-R interval for OSSD group than ONSD group. Mann-Whitney tests for EEG power showed significantly lower theta power at F3, F4, C3, C4, and O2, and higher sigma power at F3, C3, C4, O1, and O2 during EC, as well as lower theta power at C3 and higher sigma power at O2 during EO for OSSD group in comparison to ONSD group.

Conclusion
The results partially support that insomnia with OSSD is associated with physiological hyperarousal as indicated by faster heart rate and higher high frequency EEG power prior to sleep. However, the lower EEG theta power prior to sleep suggest that lower homeostatic sleep drive may also play a role for the insomnia with short objective sleep duration.

Support (if any)
Supported by Taiwan National Science and Technology Council