bluuebunny/crossref_metadata_2025_split huggingface dataset:
0657 Incidence and Features of Nightmares and Trauma Associated Sleep Disorder in U.S. Military Personnel with Sleep Disturbances
Authors: Tchopev Zahari , Jacobus Brent , Hansen Shana , Mysliwiec Vincent , Brock Matthew 
Published: May 2023

Abstract

Introduction
The incidence and clinical significance of nightmares is difficult to estimate due to varying criteria across studies. The Nightmare Disorder Index (NDI) is a validated measure to evaluate nightmare disorder. However, there is no measure to differentiate trauma-related nightmares compared to trauma associated sleep disorder (TSD), a unique REM parasomnia. The objectives of this study were to (1) determine the incidence of nightmare disorder and TSD in patients referred for a clinically indicated sleep evaluation, and (2) further characterize TSD.

Methods
All initial sleep referrals completed intake questionnaires including validated measures such as the NDI, Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI). Patients who endorsed at least weekly nightmares related to trauma, with vocalizations or disruptive nocturnal behaviors, and autonomic surges additionally received a structured clinical interview focusing on thematic content of dreams, dream enactment behavior, self-reported symptoms of autonomic hyperactivity, and, if previously treated, nightmare severity before and after therapy.

Results
102 new patients completed the NDI and 56.9% (58) met criteria for probable nightmare disorder (ND). Of the 58 patients with probable ND, 13.8% (8) had symptoms consistent with TSD (7.8% of new referrals). Compared to ND patients, TSD patients were more likely to have higher ISI (24.0 ± 3.0 vs. 18.6 ± 5.6) (p=0.023) and total NDI score (15.8 ± 3.5 vs. 10.0 ± 3.7) (p&lt; 0.001), but not ESS (p=0.158). Structured interview revealed all TSD patients had significant daytime distress or impairment. The nature of trauma was combat for 3 individuals, physical assault for 1, and sexual assault for 4 (one occurring while deployed). All individuals reported tachycardia secondary to nightmares and tachypnea and diaphoresis were each reported in 75% of patients. Regarding dream content, 25% endorsed accurate replay of trauma, 25% related to trauma but non-replay, and 50% mixed. For DNB, 87.5% of patients endorsed vocalization (moaning, screaming, or yelling), 87.5% endorsed movements (tossing, turning, or thrashing), and 37.5% endorsed combative behaviors (striking of bed partner).

Conclusion
This study reports a surprisingly high incidence of probable ND among all new sleep medicine patients. TSD appears to be a clinically distinct, more severe parasomnia compared to ND.

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0658 Is Evaluating for Dreams and Nightmares during Clinically Indicated Polysomnography Useful?
Authors: Tchopev Zahari , Jacobus Brent , Hansen Shana , Mysliwiec Vincent , Brock Matthew 
Published: May 2023

Abstract

Introduction
The incidence of nightmares and dreams during clinically indicated polysomnography (PSG) is rarely reported. We sought to (1) describe the incidence of nightmares and dreams during PSG, (2) PSG characteristics of nightmares and dreams, and (3) identify clinical correlates.

Methods
Ninety-three patients undergoing an initial clinically indicated PSG had a post-PSG and initial intake questionnaire reviewed. Questionnaires included Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and Nightmare Disorder Index (NDI), as well as a structured post-PSG dreams and nightmares questionnaire. Dreams were self-reported, and a nightmare was differentiated from a bad dream if the former caused a patient-reported awakening.

Results
Overall, 87.1% were Active Duty and 89.2% reported the presence or absence of dreams. In total, 50.5% (47) reported no dreams, 22.6% (21) reported a dream, 2.2% (2) a bad dream, and 14% (13) a nightmare with 12/13 reporting details of their nightmare. The mean total NDI differed significantly between groups (6 ± 5 vs. 7 ± 6 vs. 12 ± 0 vs. 11 ± 5, respectively) (p=0.029). The groups were not significantly different based on sex, age, BMI, diagnosis of depression, anxiety, PTSD, TBI, chronic pain, being prescribed a sleep aid or psychoactive medication, or their ESS and ISI values. PSG characteristics including REM percentage did not differ significantly between groups. Of those reporting a nightmare 75% (9) reported associated autonomic symptoms and 5 (41.7%) reported a trauma related nightmare (TRN). Of those with a TRN, one was related to combat, one sexual assault, two an accident, and one related to death. Two patients with TRN reported their nightmare was an accurate replay of the trauma, 2 reported a mix of replay/non-replay events, and one did not answer.

Conclusion
Despite rare reports of nightmare capture in sleep labs, our cohort uniquely demonstrated that at least half of first time PSG patients at a military sleep center experience a dream or nightmare during their PSG. Higher NDI scores may predict who is more likely to suffer from a bad dream or nightmare in the sleep lab. Assessing for the occurrence of dreams or nightmares during PSG is likely indicated.

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0660 Identifying Patients at Risk of Acute Sleep Disturbances Within the Immediate Aftermath of Trauma
Authors: Reffi Anthony , Kalmbach David , Seymour Grace , Bayoneto Alec , Sagong Chaewon , Drake Christopher 
Published: May 2023

Abstract

Introduction
Acute sleep disturbances are a common, modifiable consequence of trauma that, if left untreated, increase risk of PTSD by nearly two-fold. This suggests acute sleep disturbances after trauma are an important contributor to the etiology of PTSD that could be targeted early to prevent the disorder. Yet, effective strategies to prevent PTSD cannot currently be implemented because we cannot identify who is most at risk of acute sleep disturbances after trauma, thus obstructing the ability to identify high-risk groups in need of early intervention. This study will test sleep reactivity – a trait predisposition to experience sleep disturbances after stress – as a predictor of posttraumatic sleep disturbances within one month following trauma exposure.

Methods
We recruited patients admitted to Henry Ford Hospital’s intensive care unit in Detroit for traumatic injury (e.g., gunshot wound) (N = 88, M age = 39.53, SD = 14.31). While hospitalized, patients reported their pre-trauma sleep reactivity (Ford Insomnia Response to Stress Test; FIRST) and insomnia symptoms from the past two weeks (Insomnia Severity Index; ISI). Patients then completed the ISI again one month later (n = 48). We tested high sleep reactivity (FIRST &gt; 21) as a prospective predictor of clinically significant posttraumatic sleep disturbances (ISI &gt; 10).

Results
Patients were mostly black men (67%), and nearly half reported an annual income &lt; $20,000 (47.7%). Motor vehicle collisions were the most common trauma that precipitated patients’ hospital admission (42%), followed by assaults with a weapon (30.7%). While adjusting for age and pre-trauma sleep disturbance, high sleep reactivity predicted increased odds of sleep disturbances one month after trauma (b = 2.08, SE = .98, p = .033, OR = 8.01, CI = 1.19 – 54.15).

Conclusion
Individuals with high sleep reactivity are at increased susceptibility of clinically significant sleep disturbances after trauma. The 9-item FIRST is a brief and clinically useful indicator that offers providers the ability to predict the onset of acute sleep disturbances after trauma, which are novel targets for early intervention. This might enable the early identification of potentially vulnerable individuals who might develop PTSD, toward whom sleep-focused preventive efforts can be targeted.

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0662 Digital sleep-health surveillance: Population nightmare frequency is observable in social media
Authors: Mallett Remington , Sowin Laura , Carr Michelle 
Published: May 2023

Abstract

Introduction
Nightmares are a critical component of multidimensional sleep health. Frequent nightmare recallers suffer reduced sleep length, depressed mood, and are more likely to be diagnosed with a psychiatric disorder in the future. Reliable population estimates of nightmare frequency are difficult to obtain and often restricted to rigid timepoints (e.g., once per year). Thus, there is a need for low-cost methods to track population levels of nightmare frequency and their dynamic changes over time. In the current study, we tracked dream content and nightmare frequency using a popular new approach – digital health surveillance – that analyzes language of public and freely-accessible social media posts to track population characteristics.

Methods
To evaluate whether social media could detect known changes in population sleep health, we extracted posts from r/Dreaming, a popular subreddit dedicated to dream sharing. Prior survey studies have shown a reliable increase in nightmare frequency during the first wave of the COVID-19 pandemic. Thus, we quantified the amount of nightmares posted on Reddit surrounding the World Health Organization’s (WHO) declaration of a COVID-19 as a global pandemic. Nightmares were identified using a word-search algorithm that identified nightmare-related words in a post title. Nightmare frequency was compared before and after the WHO declaration using a chi-squared analysis.

Results
The percentage of dreams posted on Reddit that were identified as nightmares was higher after the WHO declaration than before (p &lt; .05). Additionally, the amount of anxiety in all dreams posted on Reddit was higher after the WHO declaration than before (p &lt; .05). Weekly change in dream anxiety was positively correlated with the percentage of COVID-19 news headlines (p &lt; .05).

Conclusion
We observed an increase in nightmares shared on Reddit immediately following the WHO’s declaration of COVID-19 as a global pandemic. This novel approach to tracking nightmares might offer the field of sleep medicine a low-cost and real-time system for monitoring population sleep health. Other recent work suggests this method might be viable for tracking other components of sleep health.

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0663 Rates and Predictors of Rapid Eye Movement Sleep Behavior Disorder Symptoms in Post-9/11 Veterans
Authors: Jones Melissa , Tea Juliann , Meyers Matthew , Li Ruosha , Agrawal Ritwick , Villalon Audri , Aloor Fuad , Jorge Ricardo 
Published: May 2023

Abstract

Introduction
Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), both prevalent conditions in post-9/11 Veterans, have been linked to rapid eye movement sleep behavior disorder (RBD). We administered a validated screening instrument for RBD to post-9/11 Veterans enrolled in the Houston branch of the Translational Research Center for TBI and Stress Disorders (TRACTS) to investigate rates of RBD symptoms and clinical predictors of positive screens in this cohort.

Methods
In this cross-sectional analysis, the English translation of the Rapid Eye Movement Behavior Disorder Questionnaire - Hong Kong (RBDQ-HK) was administered with the standardized TRACTS battery. A systematic chart review was performed to assess for known sleep disorders. Fisher’s exact and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively. Multivariable logistic regression was conducted, including as covariates the most significant clinical variables from univariable analyses. A p-value &lt; 0.05 was considered statistically significant.

Results
Of the 119 subjects with available RBDQ-HK screens, 71 (59.66%) scored above the recommended total cut-off of ≥21 for psychiatric RBD. When positive screens were defined as a cut-off of ≥8 on Factor 2 of the RBDQ-HK, 65 of 119 (54.62%) subjects screened positive. Univariable analyses indicated that global sleep quality, number of TBI exposures, and current PTSD severity were most consistently associated with positive screens. Multivariable logistic regression analysis using a total cut-off score of ≥21 showed that PTSD severity (OR 1.06, 95% C.I. 1.02-1.10, p=0.003) and number of lifetime TBIs (OR 1.63, 95% CI 1.16-2.41, p=0.01) were independent predictors of positive screens, whereas global sleep quality was no longer significant (OR 1.10, CI 0.97-1.26, p=0.149). Multivariable logistic regression analyses were repeated using a cut-off score of ≥8 on Factor 2 and showed similar results.

Conclusion
Given the high positive screening rates for RBD in our cohort, future efforts are needed to validate RBD screening instruments; enhance interdisciplinary sleep assessments; and investigate pathophysiological relationships between PTSD, TBI, and parasomnias.

Support (if any)
Center for Alzheimer's and Neurodegenerative Diseases, Baylor College of Medicine; RR&D Veterans Administration (B9268-X)
0671 Identifying Disruptive Nocturnal Behaviors in Trauma Associated Sleep Disorder with Video-Polysomnography on Consecutive Nights
Authors: Jacobus Brent , Tchopev Zahari 
Published: May 2023

Abstract

Introduction
Trauma associated sleep disorder (TSD) manifests with trauma-related nightmares, disruptive nocturnal behaviors (DNB), and autonomic hyperactivity. Although patients with TSD frequently report DNB, events are infrequently identified during in-lab polysomnography (PSG), possibly due to a sense of safety imparted by a monitored environment. It is unknown if patients with TSD acclimate to the lab environment if studied on consecutive nights. Given the infrequent and potentially subtle nature of DNB and REM sleep abnormalities, the objective of this study was to compare self-reported and PSG characteristics from two consecutive nights of PSG in patients with TSD.

Methods
Individuals were initially screened for TSD with the Pittsburgh Sleep Quality Index Addendum. Those reporting trauma-related nightmares and DNB underwent a structured clinical interview to confirm the diagnosis. Patients with TSD completed 2 consecutive nights of attended in-lab PSG with post-PSG dream/nightmare questionnaire. Video-PSG analysis was performed including detailed review of movements, excluding epochs with sleep disordered breathing. REM sleep analysis included quantifying “any” electromyographic (EMG) activity as an objective measurement for REM without atonia. ANOVA was used for statistical analysis.

Results
We diagnosed 15 individuals (11 males; 14 service members, 1 Veteran; average age 32.2 years) with TSD. Traumatic exposures were combat-related in 40% and physical or sexual assault related in 60%. There was a significant difference between proximal limb movements on night 1 vs night 2 (1.0 ± 1.73 vs 10.3 ± 4.04; p=0.02). There was a significant difference in the amount of increased EMG tone using 3 second REM mini epochs between the 2 nights (153 ± 147.8 mini epochs vs 417 ± 35.1; p=0.04). No difference was detected between nights for vocalizations or sleep parameters including total REM sleep time and percentage. Nightmares were reported by 33% during their first night PSG vs 66% during their second PSG.

Conclusion
In patients with TSD, there was an increase in the number of proximal limb movements, total mini epochs of “any” REM EMG activity, and nightmares during the second night of consecutive in-lab PSG testing. More than one night of in-lab PSG evaluation is likely required to best characterize the severe nocturnal disruptions of TSD.

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0672 Nightmare Disorder & Insomnia Severity in Complex Posttraumatic Stress Disorder
Authors: Christian Regan , Slavish Danica 
Published: May 2023

Abstract

Introduction
Most adults experience a traumatic event at some point in their lifetime, and some also go on to develop posttraumatic stress disorder (PTSD). Sleep disorders such as insomnia and nightmares are common in PTSD, which may be due to hyperarousal and distressing memories that disrupt the sleep-wake cycle. Complex PTSD (C-PTSD) is a new distinct diagnosis of PTSD that includes three new symptom domains: emotional dysregulation, negative self-cognitions, and interpersonal hardships. Despite evidence linking PTSD and sleep disturbances, this work has yet to be extended to C-PTSD. To address this gap, the current study examined the association between nightmares, insomnia, and C-PTSD symptoms, as well as explored gender and the time elapsed since the traumatic event as moderating variables.

Methods
Data were obtained from a sample of 243 trauma-exposed participants recruited online. Most participants identified as White (n = 207; 85%), non-Hispanic (n = 219; 90%), and female (n = 135; 56%), with an average age of 37.26 years (SD = 11.39). The Complex Trauma Inventory (CTI) and International Trauma Questionnaire (ITQ) were utilized to measure C-PTSD symptoms.

Results
Greater C-PTSD symptoms measured via the CTI were associated with greater insomnia symptoms (b = 3.22, 95% CI [2.46, 3.97]) and nightmare disorder symptoms (b = 2.14, 95% CI [1.57, 2.72]). Similarly, greater C-PTSD symptoms measured via the ITQ were also associated with greater insomnia symptoms (b = 0.28, 95% CI [0.22, 0.34]) and nightmare disorder symptoms (b = 0.18, 95% CI [0.13, 0.23]). No moderating effects of gender or time elapsed since trauma were found.

Conclusion
Results underscore that C-PTSD symptoms are strongly linked to nightmares and problems falling asleep, staying asleep, and waking up too early—regardless of a person’s gender identity or how long ago they experienced a traumatic event. Findings may inform more targeted, sleep-focused cognitive-behavioral treatments for C-PTSD.

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0674 The role of PTSD symptoms in the relationship between sleep quality and pain following Moderate-to-Severe Traumatic Brain Injury
Authors: Martin Aaron , Rudd Robert , Luongo Kristen , Almeida Emily J , Hoffman Jeanne M , Pinto Shanti M , Walker William , Douglas Megan E , Wittine Lara , Schwartz Daniel J , Takagishi S Curtis , Kane Georgia , Nakase-Richardson Risa 
Published: May 2023

Abstract

Introduction
Poor sleep quality and chronic pain are common after moderate-to-severe traumatic brain injury (msTBI). Prior studies have not examined the role of PTSD symptoms in the relationship between sleep quality and chronic pain experience (i.e., severity and pain-related interference) in those with msTBI. Yet, PTSD is known to be associated with both sleep and pain. The purpose of this analysis is to determine the role of PTSD symptoms in the sleep-pain relationship among this at-risk clinical population.

Methods
Secondary analyses were performed on data (n=1537) from the TBI Model Systems follow-up study. Participants were an average age of 46.21 years old, predominantly male (72.61%), and followed at an average of 8.5 years post injury. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index; PSQI), pain severity and interference (Brief Pain Inventory; BPI), depression (Patient Health Questionnaire-9; PHQ-9) and PTSD symptoms (PTSD Checklist, PCL-5). Analysis of covariance (ANCOVA) was used to examine differences in pain outcomes controlling for relevant covariates, adjusting for item redundancy prior to analyses.

Results
Sleep quality and pain interference are associated such that “good sleepers” (PSQI≤8, mean=4.92±2.17) have lower pain interference scores than “poor sleepers” (PSQI&gt;8, mean=12.63±2.87), with a mean pain interference of 3.41±2.32 vs 5.26±2.45 (p&lt; 0.0001). “Good sleepers” also had lower pain severity (4.22±1.78 vs 5.28±1.84, p&lt; 0.0001), lower PTSD symptoms (14.62±13.46 vs 28.35±17.82, p&lt; 0.0001), and less depression symptoms (5.32±4.97 vs 10.57±6.22, p&lt; 0.0001) when compared to “poor sleepers.” Pain interference and severity were significantly related to all covariates at a &lt;.001 level. Further, a significant effect of PSQI score cut-off (“good” v “poor sleeper”) in both pain interference and severity remained after controlling for the effect of age, depression, and PTSD symptom scores.

Conclusion
In patients with msTBI, sleep quality and pain interference are positively associated such that better sleep quality corresponds with lower pain interference, a relationship which remains when controlling for PTSD and multiple covariates. Addressing the sleep needs of patients with msTBI through behavioral intervention (e.g., cognitive behavioral therapy for insomnia), even in the presence of additional psychiatric comorbidities, may assist those who experience chronic pain following injury.

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0675 Levels of Depression Differentially Affect Sleep in People Who Have Had Cancer: Findings from the National Health Interview Survey
Authors: Moore Jesse , Carrasco Mary , Hollimon Laronda , Fiegenbaum Rachel , Landron Leo , Taylor Kayla , Rogers April , Jean-Louis Girardin , Seixas Azizi 
Published: May 2023

Abstract

Introduction
Cancer survivors experience an increased stress burden. Twenty-five percent (25%) of cancer survivors experience persistent depressive and anxiety symptoms and 40% are afflicted with chronic sleep problems. Analysis of this relationship between survivors’ mental health and sleep may elucidate components of stress burden in a particularly vulnerable population. This study examined the relationship between anxious and depressive symptoms and frequency predicting sleep patterns, comparing individuals with a cancer history versus those without.

Methods
Data emanated from the 2020 National Health Interview Survey dataset (n=31,568). Six percent (n=1936) of respondents reported a cancer history. The primary outcome was sleep duration, based on the average hours of sleep per night an individual reported over the past month, which was coded into “healthy” (7-8 hrs.) vs “unhealthy” (&lt; 7 hrs. or &gt; 9 hrs.) sleep. Level of anxiety and depression as well as frequency of reported symptoms were included in the models as predictors. Binary logistic regression models were performed to determine the discrete impact of depression and anxiety on sleep duration among individuals with and without a cancer history. Adjusted models included the demographic covariates of age, sex, education, household income, and race.

Results
In adjusted models, frequency of anxious feelings (OR = 1.19, p&lt;.01,), frequency of depressive feelings (OR =1.29, p&lt;.01,), level of anxious feelings (OR = 1.38, p&lt;.01,), and level of depressive feelings (OR=1.15, p&lt;.01) significantly predicted unhealthy sleep in the full sample. However, among individuals with a cancer history, frequency of anxious feelings (OR =1.16, p&lt;.01,), level of anxious feelings (OR = 1.28, p&lt;.01,) and frequency of depressive feelings (OR = 1.23, p&lt;.01,) significantly predicted unhealthy sleep duration, but level of depressive feelings did not (OR = 1.08, p=.13,).

Conclusion
Mental health and sleep are closely and bidirectionally connected in the general population, but among individuals with a history of cancer the link between level of depression and healthy sleep were not significant. Further research is needed to understand the complex relationship between mental health and sleep among people with a cancer history.

Support (if any)
K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007.