bluuebunny/crossref_metadata_2025_split huggingface dataset:
0742 Is sleep altered during the menstrual cycle? A polysomnography study from EPISONO
Authors: Ishikura Isabela , Fernandes Guilherme , Hachul Helena , Tufik Sergio , Andersen Monica 
Published: May 2023

Abstract

Introduction
During the reproductive life, woman experiences changes in their hormone levels that characterize her menstrual cycle. This monthly event provides hormonal and body conditions to development of pregnancy and lactation. In addition to alterations in hormones, some women present physical and psychological complaints according to the phase of the menstrual cycle. Sleep has been reported to be deteriorated during menses; however, no conclusive results have been stated. The aim of our study was to evaluate the objective and subjective sleep during 3 different time-points of the menstrual cycle.

Methods
For this study we used the São Paulo Epidemiological Sleep Study (EPISONO) database. Ninety-one women were distributed in follicular (F) phase (N=27), luteal (L) phase (N=39) and menstruation (M, N=25) and undergone a one-night polysomnography. Blood samples and women’s questionnaire data were collected to investigate hormonal levels and information about the menstrual cycle to identify the phase of the cycle during the polysomnography exam. The objective sleep parameters analyzed were: sleep efficiency, sleep latency, REM sleep latency, total sleep time, awakenings index, percentage of stage 1, 2, N3 sleep and REM sleep. The following questionnaires were applied to assess the subjective sleep: Pittsburgh Sleep Quality Index, Insomnia Severity Index, Chalder Fatigue Scale, Beck Anxiety Inventory, Beck Depression Inventory and Epworth Sleepiness Scale. For the statistical analysis we used the Kruskal-Wallis test and post-hoc Dunn, with p&lt; 0.05.

Results
Women in follicular phase exhibited significantly higher sleep efficiency (89.9±9.6%) when compared to luteal (83.7±12.7%; p=0.02) and menstruation (83±10.8%; p=0.008) groups. During the follicular phase the sleep latency was statistically reduced (7.1min) compared to other time-points of the menstrual cycle (L=15.9min; M=22.3min; p=0.02; p=0.03, respectively). The other objective sleep parameters and the results of the questionnaires applied did not present statistical differences during the menstrual cycle.

Conclusion
Women in follicular phase showed better sleep than the other time-points of the menstrual cycle. The sleep latency during menstruation was 3 times longer than the follicular phase, indicating that menstruation may be one of the causes of sleep complaints in women.

Support (if any)
AFIP and CNPq.
0743 Maternal Experiences of Gender Discrimination Are Associated with Worse Postpartum Sleep
Authors: Rayport Yael , Barrera Ana , Thakur Shambhavi , Barnett Natalie , Lucchini Maristella 
Published: May 2023

Abstract

Introduction
Many new mothers experience poor sleep postpartum, which has been found to increase the risk of negative cardiovascular health and mental health outcomes. A few studies have found that experiences of racial/ethnic discrimination are associated with poor maternal sleep, but less is known about the effect of discrimination in other domains. Previous studies have also not accounted for the effect of infant sleep on maternal sleep, which is known to be a major influence in the first year after birth. This study aims to investigate the association between gender discrimination (GD) and postpartum maternal sleep, controlling for infant sleep.

Methods
The cohort comprised 506 mother-child dyads from the customer base of the Nanit Smart Baby Monitor. At 6–12 months postpartum (Mean±SD: 9.2±1.8), maternal experiences of GD (Everyday Discrimination Scale), perceived stress (Perceived Stress Scale (PSS)), and subjective sleep (Pittsburgh Sleep Quality Index) were assessed. Objective measures of infant sleep were obtained using the Nanit Smart Baby-Monitor. Logistic and linear regressions estimated the associations between maternal experiences of GD and maternal sleep, controlling for PSS, household income, infant age and sex, and objective infant sleep duration and wakings.

Results
34.6% of mothers reported experiencing GD. The average PSS score was 15 (± 6.7). Infants had an average sleep duration of 10h (± 1.2) and an average of 3.1 (± 1.4) nighttime sleep wakings. Maternal experiences of GD were associated with shorter sleep duration (OR=1.67, CI=1.07-2.64) and more sleep disturbances (β = 0.77, CI= 0.04-1.49). The PSS was associated with more sleep disturbances (β = 0.11, CI= 0.05-0.16). Objective infant sleep duration was associated with subjective maternal sleep duration (OR=0.57, CI=0.47-0.69).

Conclusion
Maternal experiences of GD are associated with worse postpartum maternal sleep, suggesting that sleep could serve as a biological pathway relating GD and postpartum health. Future research is needed to investigate the long-term implications of maternal experiences of GD on maternal-fetal health.

Support (if any)
This research was supported by the Developmental Psychobiology Parent Infant Award and Nanit
0744 Self-reported Sleep Quality and Insomnia Symptoms Mediate the Association between Depression and Physical Activity in Older Adults
Authors: Li Mengchi , Liu Sofia , Calderon Russell , Huang Jing , Tufa Yeabsira , Waszczuk Dan , Li Junxin 
Published: May 2023

Abstract

Introduction
Lack of physical activity (PA) is prevalent and leads to multiple chronic conditions in older adults. Understanding factors contributing to low PA may help develop effective and sustainable PA interventions and promote health in older adults. Depressive symptoms and poor sleep quality have been linked with low PA in older adults. Depression can lead to sleep disturbances. In this study, we tested the association between depression and physical activity in community-dwelling older adults and the possible mediating role of sleep quality in the association.

Methods
We used baseline data collected from an ongoing randomized clinical trial that aims to improve cognitive health in community-dwelling older adults. Participants’ depressive symptoms and level of PA were assessed using the Geriatric Depression Scale Short Form (GDS) and Physical Activity Scale for the Elderly (PASE). Sleep quality and insomnia symptoms were measured by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), respectively. Multiple regression models were used to test the associations between the variables. Baron and Kenny’s approach and the Sobel test were used to examine the mediation effects of participants’ self-reported sleep quality and insomnia symptoms on the association of depression and PA.

Results
The study sample (n=143) had a mean age of 70 years (SD=6), most were female (n=117, 82%), White (n=77, 54%), and had multiple comorbidities (n=98, 69%). After adjusting for covariates (age, sex, education, income, race, and Body Mass Index [BMI]), higher GDS score was associated with lower PASE (β=-3.58, 95% Confidence Interval [CI]: -7.08, -0.79). Mediation analyses showed that both sleep quality (indirect effect: B=-1.98, CI: -3.80, -0.15) and insomnia symptoms (indirect effect: B=-1.97, CI: -3.94, 0.00) significantly mediated the relationship between depression and PA.

Conclusion
Depressive symptoms were associated with reduced PA among older adults. Self-reported sleep significantly mediated this association. Older adults with more depressive symptoms had worse sleep quality and more insomnia symptoms, which were associated with decreased PA. Our findings suggest we pay more attention to sleep health in older adults, and people with depression may benefit from sleep-focused interventions to promote PA and health.

Support (if any)
R00NR016484
0745 Sleep Characteristics and Cardiovascular Disease Risk Among Midlife Thai Women
Authors: Srimoragot Manassawee , Reutrakul Sirimon , Hershberger Patricia , Park Chang , Quinn Lauretta , Balserak Bilgay 
Published: May 2023

Abstract

Introduction
Sleep disturbances (i.e. poor sleep quality, low sleep efficiency, and Obstructive Sleep Apnea (OSA)) are common during menopausal transition and menopause. These disturbances are associated with increased risk of cardiovascular disease (CVD), obesity, hypertension, and diabetes. However, the association of sleep disturbances and CVD risk among midlife Thai women, living in the US, have not been fully explored. Thus, this study examined the association between sleep characteristics and CVD risk in those women.

Methods
In this cross-sectional study, 120 midlife Thai women completed the Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire, and Menopause Rating Scale. The main outcome, 10-year risk of CVD, was determined using the BMI-based Framingham Risk Score (FRS). Descriptive, bivariate, robust regression, and Structural Equation Model (SEM) analysis for mediation model were performed using STATA 15.1.

Results
Among participants, their mean age was 51.53 years (SD=7.73), length of stay in the USA was 21.77 years (SD=12.96) and CVD risk score was 6.56 % (SD=5.74). Twenty participants (17%) were at high risk of CVD. The mean subjective sleep quality measured by PSQI was 4.18 (SD=3.03). The majority of participants were good sleepers (n=97, 80.83%). The mean sleep efficiency was 95.36% (SD=5.96). A small portion of the participants had a high risk of OSA as assessed by Berlin questionnaire (n=17, 14.17%). Among sleep characteristics, only the increased risk of OSA was significantly associated with higher CVD risk (B=4.601, p&lt; 0.001).

Conclusion
The findings of this study indicated that an increased risk of OSA is associated with the risk of CVD among midlife women. Sleep duration, sleep quality, or sleep efficiency neither mediated nor moderated CVD risk. Future studies should use objective measures of sleep, such as actigraphy, to better elucidate the effects of sleep parameters on cardiovascular risk.

Support (if any)
0746 Designing Realistic Management of Insomnia in Teens (DREAM-IT): Perspectives on CBT-I from Teens, Parents, and Providers
Authors: McQuillan Maureen , Meltzer Lisa , Khan Shajna , Honaker Sarah 
Published: May 2023

Abstract

Introduction
Cognitive Behavioral Therapy for Insomnia (CBT-I) has been established as effective for adults, but less research has been done on its appropriateness for teens. Using a patient-centered approach, we aimed to elicit perspectives on the acceptability and feasibility of CBT-I for teens.

Methods
Teens and parents were recruited via social media, and behavioral sleep medicine providers were recruited via listservs. Focus groups discussed utility, barriers, parent involvement, and potential adaptations for each CBT-I component. We conducted 10 teen focus groups (N = 76, 51% female, 21% male, 28% non-binary; 55% White), 6 parent groups (N = 51, 55% female, 43% male, and 2% non- binary, 47% White), and 2 provider groups (N = 18, 78% female, 17% male, 5% non-binary, 83% White). Providers were predominantly psychologists (78%) and were in practice for M = 9.9 years, SD = 8.09.

Results
Over 60% of teens were “not at all likely” to follow the stimulus control guideline of only using their bed for sleep; a notable barrier included lack of access to other spaces in the home. However, 65% of teens reported willingness to practice sleep restriction, with the adaptation of a two-hour later weekend wake time. Parents were very willing to enforce and/or implement recommendations with their teens, but most teens wanted little or no parent involvement. Providers reported only using sleep logs with teens either “not at all” (14%), “occasionally” (57%), or “half the time” (29%). Similarly, 72% of providers stated that they only discuss cognitive restructuring with teens either “occasionally” or “half the time”. For sleep restriction, most providers (83%) supported taking a more naturalistic, flexible approach. Across stakeholders, limiting screens after bedtime was considered more feasible than before bedtime, and distraction (e.g., listening to audio) was preferred over formal relaxation techniques.

Conclusion
Stakeholder perspectives highlighted the need to adapt CBT-I components for teens, and identified adaptations that were acceptable for teens, and already utilized by providers. Additional focus groups will further assess the acceptability and feasibility of adaptations prior to implementation in an RCT.

Support (if any)
Grant #: 249-SR-21 from the American Academy of Sleep Medicine Foundation.
0749 Adolescents’ Self-Reported Insomnia, Subjective Experiences And Objective Sleep Measures During The COVID-19 Pandemic
Authors: Gruber Reut , Somerville Gail , Saha Sujata , Gauthier-Gagne Gabrielle , Little Charlotte 
Published: May 2023

Abstract

Introduction
Studies examining adolescents’ sleep during the COVID-19 pandemic yielded inconsistent results, with some studies finding a significant increase in insomnia symptoms but others finding no change. A majority of these studies used retrospective or concurrent reports of insomnia symptoms and did not include objective sleep measures, making it impossible to know the extent to which the reported symptoms were associated with actual sleep patterns. In addition, these studies did not account for factors that might have biased adolescents’ subjective reporting of insomnia such as negative emotions or high levels of pre-bedtime cognitive arousal. The goal of the present study was to examine the associations of self-reported symptoms of insomnia among typically developing adolescents with their emotional experiences, cognitive arousal at bedtime, and objective sleep measures during the COVID-19 pandemic.

Methods
Participants. Seventy-six adolescents (33 female, M(SD) age = 13.74(0.87) years). Procedure. Each participant’s sleep pattern was assessed in the home environment using actigraphy and a sleep log for seven consecutive nights in 2021. Adolescents provided information regarding their experiences during the COVID-19 pandemic using the COVID-19 Adolescent Symptom & Psychological Experience (CASPE) questionnaire; information regarding their arousal at bedtime using the Pre-Sleep Arousal Scale and information regarding the insomnia symptoms using the Insomnia Severity Index.

Results
Principal-component analysis produced a three-factor solution for the CASPE labeled as Negative-Anxious, Negative-Angry and Positive Emotions. Hierarchical regression analysis was conducted to examine the cross-sectional associations among adolescents’ emotional responses and subjective and objective sleep measures during the COVID-19 pandemic. Being a girl, reporting high level of pre-bedtime cognitive arousal and high Negative-Anxious emotions accounted the explained variance in adolescents’ self-reported insomnia symptoms. Actigraphy measured sleep efficiency, latency or duration did not increase significantly the explained variance.

Conclusion
These findings suggest that documentation of adolescents’ insomnia during the COVID-19 pandemic might have captured adolescents’ negative emotions rather than their objective sleep patterns. Limitations The cross-sectional design of this study limits the ability to determine causality.

Support (if any)
CIHR, SSHRC
0754 Sleep Ecology in Low-Income Mexican American Toddlers
Authors: Meltzer Lisa , Martinez Suzanna , Tschann Jeanne , Tietbohl Caroline , Jimenez-Zambrano Andrea , Reedy Julia , Valdes Estefania Miramontes , Thompson Darcy 
Published: May 2023

Abstract

Introduction
Healthy sleep is critical for child development, yet disparities exist, with Latino children disproportionately affected by deficient sleep. Most of what is known about sleep ecology and interventions to improve sleep in young children is based on studies of primarily White, non-Latino, and economically-advantaged families. To ensure the effectiveness of interventions, it is important to understand the contribution of socioecological factors on sleep among toddlers in low-income Mexican American families.

Methods
This study employed in-depth interviews with a purposeful sample of low-income Mexican American Spanish-speaking (n=10) and English-speaking mothers (n=10) of toddlers (18-34 months old). Interviews focused on daily sleep routines, perceptions of toddler sleep behaviors, and environmental contributors. Transcripts were coded by two investigators and analyzed using a content analytic approach.

Results
For sleep-related parenting practices, 70% of mothers reported late child bedtimes (≥9:00 pm), 75% reported room/bed sharing, and almost a third of children fell asleep at bedtime with a bottle or cup. Maternal beliefs about child sleep included concerns that child crying during the night might disturb neighbors or wake siblings, and child sleep quality improved when the child is not hungry. Contextual factors impacting sleep included schedules, neighbors, and siblings. Specifically, later weekday bedtimes were attributed to maternal (but not paternal) work schedules, while wake times were often a result of a sibling’s school schedule. Weekend bedtimes were commonly reported to be delayed for toddlers due to families watching movies. Noisy neighbors, in particular upstairs neighbors, were identified as disrupting children’s sleep. Siblings were identified as both facilitating sleep (e.g., helping with routines) and disrupting sleep (e.g., distracting child at nap time).

Conclusion
Findings provide insights on socioecological factors and parental beliefs about sleep ecology in low-income Mexican American toddlers that have implications for the design of interventions to improve child sleep. For example, commonly used behavioral sleep interventions have children sleeping in their own room, or require some crying during the night. However, these approaches may not be a good fit or feasible for this population. To address sleep health disparities, further work is needed to understand socioecological factors that require inclusive adaptations to pediatric sleep interventions.

Support (if any)
R01HL163859
0757 Associations between Objective Sleep Health and Cardiovascular Health in Adolescents with Type 1 Diabetes
Authors: Holtman Sydney , Cooper Emily , Brinton John , Dobbin Mia , Cree-Green Melanie , Snell-Bergeon Janet , Nadeau Kristen , Simon Stacey L 
Published: May 2023

Abstract

Introduction
Adolescents with type 1 diabetes (T1D) are at risk for early-onset cardiovascular disease due to increased arterial stiffness, decreased endothelial function, and early-stage hypertension compared to healthy peers. Poor sleep health has been associated with greater glycemic variability, increased insulin resistance, and poorer cardiovascular health; however, the relationship between sleep and vascular health has not been studied in adolescents with T1D. The aim of this study was to evaluate associations between objectively measured sleep and cardiovascular health in this population. We hypothesized that better sleep health would correlate with better cardiovascular health.

Methods
Twenty-four adolescents with T1D completed the study during the academic year. Sleep was monitored for one week at home with actigraphy. Watchpat-assessed apnea hypopnea index (AHI) and vascular measures were obtained during an overnight study visit. EndoPAT estimated reactive hyperemia index (RHI) and augmentation index (AI). Dynapulse measured systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), heart rate (HR), pulse wave velocity (PWV), and brachial distensibility and resistance (BrachD, BrachR). Correlations between sleep and vascular measures were examined.

Results
Participants were an average age of 15.5±1.1 years (54.2% female, 83.3% White non-Hispanic, BMI 58.8 ±25.8%ile, HbA1c 7.5±1.2%). Average school night (weekday) sleep duration was 6.7±0.8 hours and average sleep efficiency (SE) was 82.8±6.9%. The majority (87.5%) of participants slept less than the clinical recommendation of 8-10 hours per night. Worse actigraphy-estimated SE was associated with higher DBP (r=-0.52, p=0.02; mean= 59.2±6.7mmHg) and MAP (r=-0.46, p=0.04; mean= 79.5±7.5mmHg). Higher AHI was associated with higher BrachR (r=0.81, p&lt; 0.001). No significant associations were identified between sleep variables and RHI, AI, HR, PWV, or BrachD (all p&gt;0.05).

Conclusion
Poorer SE and higher AHI were associated with poorer indicators of vascular health in adolescents with T1D, consistent with prior literature linking poorer sleep health with risk factors for hypertension in adults with T1D. Further research is needed to determine if improving sleep can improve cardiovascular comorbidities in adolescents with T1D.

Support (if any)
JDRF 2-SRA-2019-848-S-B; JDRF 2-SRA-2022-1144-M-B; Ludeman Center for Women’s Health Research COVID-19 Relief Supplemental Grant; Colorado Clinical & Translational Research Center Maternal & Child Health Pilot Award; CTSA UL1 TR002535
0759 Multidimensional Sleep Health is Associated with Emotional Well-being in Adolescents
Authors: Nyhuis Casandra , Calhoun Susan , He Fan , Liao Jason , Vgontzas Alexandros , Bixler Edward , Liao Duanping , Fernandez-Mendoza Julio 
Published: May 2023

Abstract

Introduction
Multidimensional sleep health (MSH) is a population-based approach to capture the 24-hour experience of sleep by incorporating measures of nighttime sleep and daytime functioning that promote physical and mental well-being. We have updated the existing adolescent MSH model to incorporate objective and subjective sleep measures and, in the present study, examined its utility in identifying associations between MSH and behavioral and emotional well-being.

Methods
We studied 377 adolescents (16.4 ± 2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Using the RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – we derived an MSH composite score based on actigraphy-measured and self-reported sleep data. We examined the associations between MSH and scores on both the adolescent version of the Child Behavior Checklist (CBCL) and on the Pediatric Behavior Scale (PBS). CBCL’s internalizing, externalizing, thought and attention problems scores were self-reported, while similar behavioral and emotional cluster scores on the PBS were parent-reported.

Results
Higher MSH scores were associated with lower thought (r=-0.21, p&lt; 0.001), externalizing (r=-0.18, p&lt; 0.001), attention (r=-0.16, p&lt; 0.01) or internalizing (r=-0.12, p&lt; 0.05) problems. Higher MSH scores were associated with lower scores on the rule-breaking (r=-0.27, p&lt; 0.001) and aggressive (r=-0.21, p&lt; 0.001) externalizing subscales. For the internalizing subscales, higher MSH scores were associated with lower anxious-depressed (r = -0.17, p&lt; 0.01), withdrawn-depressed (r=-0.14, p&lt; 0.01), and somatic complaints (r=-0.12, p&lt; 0.05) scores. Analyses based on parent reports on the more fine-grained PBS cluster scores replicated CBCL’s associations; for example, higher MSH scores were associated with lower depression (r=-0.19, p&lt; 0.01) and inattention (r=-0.12, p&lt; 0.05) as observed by parents.

Conclusion
Optimal sleep health, when considered as a multidimensional construct, is associated with emotional well-being and better behavioral outcomes in adolescents. Our MSH model, derived from objective and subjective sleep metrics, is able to capture similar trends from self-report and parent-report measures of emotion and behavior.

Support (if any)
National Institutes of Health (R01HL136587, UL1TR000127)