bluuebunny/crossref_metadata_2025_split huggingface dataset:
0313 Implementation Outcomes from a Multi-Component Lighting Intervention in Shiftworkers on a High-Security Submarine Watchfloor
Authors: Bessman Sara , Harrison Elizabeth , Easterling Alexandra , Preilipper Sebastian , Glickman Gena 
Published: May 2023

Abstract

Introduction
Shiftwork is prevalent in the military and causes circadian health and performance impairments. Negative consequences may be mitigated through evidence-based lighting solutions that optimize timing, spectrum and intensity of exposure; however, the practical utility of these solutions hinges on their implementation and adoption. Therefore, we examined the implementation effectiveness of a multi-component lighting intervention that had demonstrated efficacy for improving alertness and performance in active duty service members working nightshift schedules on a high-security watchfloor.

Methods
Participants worked 12-h shifts (0530-1730) (N=56, 9 females; mean+SE age=28.95 + 0.76). Lighting interventions included two types of LED panels (3,721 cm2) that were either enhanced (SW+) or depleted (SW-) in short wavelength energy (both ~3000 K, ~300 lux at 46 cm from eyes). For both SW+ and SW- conditions, a bank of panels were arranged across the front of the watchfloor and illuminated the entire nightshift. In addition, blue-blocker glasses were worn after nightshifts up until bedtime, and eye masks were worn during sleep for both intervention conditions. Data collection coincided with existing watchfloor schedules: there was an 8-day baseline (BL1) and 8-day SW+ condition, and an 8-day baseline (BL2) and 8-day SW- condition (order within those 16-day periods was pseudo-randomized). Implementation was measured via weekly questionnaires.

Results
Participants who completed BL1, SW+, and SW- conditions (n =24) reported more positive feelings (happy, alert, relaxed) and fewer negative feelings (sad, sleepy, anxious) with both interventions compared to standard lights (BL1) (p&lt; 0.05 for both SW+ and SW-). More negative symptoms (e.g. glare, headache, fatigue) were reported in BL1 versus the intervention conditions (p&lt; 0.01). Most participants reported that alertness was the same or better under intervention conditions (96% SW+, 95% SW-); 75% found both the blue-blocker glasses and eye masks somewhat or very easy to use; and 100% reported sleep as either the same or better with each intervention tool. Finally, most participants reported they would want to keep the intervention lights at the end of the study.

Conclusion
The intervention was generally well-received by participants, thus providing evidence for the feasibility of implementing multi-component lighting strategies to mitigate the negative consequences of shiftwork.

Support (if any)
ONR TS-788
0317 A single-arm proof-of-concept clinical trial of a mindfulness-based intervention for prenatal insomnia
Authors: Seymour Grace , Kalmbach David , Cheng Philip , Ong Jason , Reffi Anthony , Walch Olivia , Fellman-Couture Cynthia , Bayoneto Alec , Roth Thomas , Drake Christopher 
Published: May 2023

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBTI) improves sleep in pregnancy, but its therapeutic benefits may be diminished in pregnancy due to undertreatment of cognitive arousal (i.e., heightened cognitive activity, especially at night). Growing evidence indicates that mindfulness-based interventions produce large reductions in cognitive arousal, which may enhance insomnia therapy outcomes. The present study was a proof-of-concept, single-arm trial of Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness intervention framework and tailors sleep and mindfulness components to pregnancy. We evaluated patient engagement, treatment outcomes, and patient feedback from 12 pregnant women with insomnia who received PUMAS treatment.

Methods
Twelve pregnant women with DSM-5 insomnia disorder were treated with six weekly telemedicine sessions of PUMAS. Patient engagement was operationalized as session attendance. Treatment outcomes were assessed before and after PUMAS, which included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale’s cognitive factor (PSASC), and Glasgow sleep effort scale (GSES). Patients completed the Consumer’s report treatment satisfaction scale and provided treatment feedback.

Results
Eleven of 12 patients completed all six sessions (91.7%). Intent-to-treat analyses revealed very large reductions in ISI (ISI: 14.50±2.50 to 3.67±3.11; p&lt;.001, Cohen’s dz=3.05), resulting in an 83.3% insomnia remission rate (n=10/12). Among the five patients with comorbid depression (EPDS≥10), PUMAS produced large antidepressant effects (EPDS: 14.00±3.32 to 5.00±2.55; p=.004, Cohen’s dz=2.76), and all five patients remitted from depression at posttreatment. PUMAS yielded very large reductions in cognitive arousal (PSASC: 20.75±4.58 to 12.50±4.23, p&lt;.001, Cohen’s dz=2.08) and sleep effort (GSES: 5.92±2.64 to 2.08±1.62; p&lt;.001, Cohen’s dz=2.06). Patients reported the highest rates of treatment satisfaction for improvement in insomnia (100%), energy (90.9%), pregnancy stress (90.9%), mood (90.9%), and coping with stress (83.3%). Patients identified sleep restriction and meditations as the most helpful PUMAS components.

Conclusion
Pregnant women with DSM-5 insomnia disorder are engaged in PUMAS, which produced large reductions in insomnia, depression, cognitive arousal, and sleep effort. Patients reported high satisfaction across several domains of functioning. This trial supports testing PUMAS in a randomized controlled trial.

Support (if any)
0319 Evaluating Illness Severity from Acute to Chronic Insomnia: Is the First the Worst?
Authors: Boyle Julia , Muench Alexandria , Morales Knashawn , Ellis Jason , Vargas Ivan , Grandner Michael , Posner Donn , Perlis Michael 
Published: May 2023

Abstract

Introduction
The Spielman 3P and Perlis 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst when subjects experience acute illness (as compared to the subchronic and chronic phases of the disorder). The 4P model suggests that illness severity crescendos with chronicity. The present analysis uses an archival data set to assess illness severity with new onset illness (i.e.,from Good Sleep [GS] to Acute Insomnia [AI] and from AI to Chronic Insomnia [CI]). Illness severity is quantified in terms of Total Wake Time (TWT). Number of affected days/week is a tabulation of nights/week with clinical insomnia symptoms.

Methods
Subjects were recruited as GSs(N=911), followed up to 1-year with digital sleep diaries, and were classified as GS, AI, or CI based on standardized criteria. Data for CI subjects were anchored to the 1st of 14 days with insomnia so that day-to-day TWT, SL, WASO, and EMA were represented for ~100 days prior-to-and-following AI onset. A similar graphic (+/-Acute onset) was constructed for number of days per week with insomnia. GS data were matched to CI subjects dates (i.e., the data were temporally tethered). Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS and AI period.

Results
883 subjects remained as GSs (Mage=53.1±10.8years;35.1%female;83.0%white), while 28 indi-viduals transitioned to AI and then CI (Mage=53.6±12.6years;39.3%female;89.3%white). Average TWT rose over the course of the first 2 weeks from the AI onset(b=1.6,SE=0.52minutes,p=0.002) and then was stable for 3 months(b=-0.004,SE=0.03,p=0.91). This worsening of sleep continuity was almost entirely related to increased WASO. Average number of affected days was found to be stable from AI to CI (b=0.002,SE=0.002,p=0.20). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident.

Conclusion
These data suggest that, in our sample of CIs with primarily middle insomnia, the average severity and number of affected days was worst with the onset of AI (worst is first) and stable thereafter. Whether this temporal trend applies equally to new onset Initial and Late insomnia remains to be determined. Analyses ongoing.

Support (if any)
R01AG041783
0322 Measuring sleep-wake state discrepancy in a heterogeneous sample of cancer survivors with insomnia symptoms
Authors: Kwon Misol , Zhu Jingtao , Wilding Gregory , Dickerson Suzanne , Dean Grace 
Published: May 2023

Abstract

Introduction
Sleep-wake state discrepancy is a common phenomenon identified among people with insomnia where greater sleep difficulties are self-reported in comparison with estimates obtained from objective assessment. This study provides the investigation into the sleep-wake state discrepancy and correlation between sleep diary (subjective) and actigraphy-derived (objective) sleep measures.

Methods
Participants included 136 cancer survivors with insomnia symptoms (M age = 63.8 ± 10.0; 55.9% female; 87.5% White) from baseline data in an ongoing clinical trial. Demographics, Insomnia Severity Index (ISI), 7-consecutive days of sleep diary and actigraphy data were obtained. Sleep measures included time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%). Mean bias was defined as the discrepancy between sleep diary and actigraphy-derived sleep measures. The agreement between sleep diary and actigraphy-derived sleep measures were graphically assessed using the Bland-Altman plot. Using the mixed linear model approach, the estimated bias and 95% limits of agreement (LOA) were computed. Further, the Pearson correlation coefficient and concordance correlation coefficient (CCC), computed via maximum likelihood methods, were obtained.

Results
Self-reported TST and SE were shorter than derived by actigraphy (TST: 6.8 min. [95%CI: -18.7, 5.13]; and SE%: 0.7% [95%CI: -3.0, 2.0], respectively). Self-reported TIB, SOL, and WASO were longer than derived by actigraphy (TIB: 8.6 min. [95%CI: 3.7, 13.5]; SOL: 14.8 min. [95%CI: 9.4, 20.2]; and WASO: 20.7 min. [95%CI: 9.4, 20.2], respectively). Moderate to high agreement and correlation were found between the sleep diary and actigraphy-derived TIB (CCC=0.78; r=0.73) and TST (CCC=0.58; r=0.51). In contrast, SOL (CCC=0.48; r=0.35), WASO (CCC=0.36; r=0.18), and SE% (CCC=0.39; r=0.22) showed only fair or poor agreement and correlation. Calculated Bland-Altman LOA between sleep diary and actigraphy derived measures were as follows: TIB (95%LOA: -121.5, 138.7), TST (95%LOA: -197.9, 184.3), SOL (95%LOA: -82.5, 112.1), WASO (95%LOA: -123.5, 164.8), and SE% (95%LOA: -0.37, 0.36).

Conclusion
Among a heterogeneous sample of cancer survivors with insomnia symptoms, average self-reported sleep duration and efficiency were shorter and self-reported TIB, SOL, and WASO were longer than objectively measured sleep measures. Agreement between two methods varied across different measures.

Support (if any)
NIH/NINR R01NR018215 (Dean), ClinicalTrials-NCT03810365
0323 Natural Evolution of Insomnia in Major Depressive Disorders
Authors: Ohayon Maurice , Cote Marie-Lise 
Published: May 2023

Abstract

Introduction
Insomnia is a fairly common sleep disturbance affecting nearly one third of the general population. Although its predictive value for major depressive disorder (MDD) has been well documented, little is known about its role in the appearance of a first episode or in the recurrence. In this study, we examine the predictive value of insomnia symptoms in the incidence and recurrence of MDD.

Methods
In this longitudinal study, 2 interview waves were conducted between 2002 and 2015. The initial interviews (wave 1 [W1]) were carried out with 12,218 individuals aged ≥18 years from the general population in 8 US states. At follow-up 3 years later (wave 2 [W2]), 10,931 of the initial participants agreed to be interviewed again. Data were analyzed for the individuals who participated in both interviews (N=10,931). A diagnosis of MDD was made according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Insomnia symptoms were defined according to DSM-5 criteria A, C, and D for insomnia disorder.

Results
The 12-month prevalence of MDD was 9.5% (95% CI, 9.0%-10.0%) and 12.1% (95% CI, 11.5%-12.7%) in W1 and W2, respectively. Over the course of the study, 2.6% of participants experienced recurrence of depression (95% CI, 2.3%-2.9%). After adjusting for age, gender, race, and body mass index, participant characteristics in W1 that predicted recurrent MDD in W2 included early morning awakenings (EMA) (relative risk [RR], 3.2; 95% CI, 2.3-4.4), being dissatisfied with one’s sleep (RR, 2.8; 95% CI, 2.1-3.7), nocturnal awakenings (RR, 2.4; 95% CI, 1.8-3.2), and difficulty initiating sleep (DIS) (RR, 2.0; 95% CI, 1.5-2.9). MDD incidence was predicted by DIS (RR, 3.8; 95% CI, 2.5-5.9), being dissatisfied with one’s sleep (RR, 2.1; 95% CI, 1,4-3.2), and EMA (RR, 2.0; 95% CI, 1.2-3,2) at W1.

Conclusion
Insomnia symptoms appear to play an important part in predicting both the development of a first depressive episode as well as the recurrence of depression.

Support (if any)
Data analysis study were funded by Takeda Pharmaceutical Company.
0332 Improving Sleep with Continuous Theta Burst Transcranial Magnetic Stimulation (TMS) of the Default Mode Network
Authors: Killgore William , Jankowski Samantha , Henderson-Arredondo Kymberly , Hildebrand Lindsey , Trapani Christopher , Lucas Daniel , Suckow Emmett , Desai Shivani , Reich-Fuhrer Melissa , Franca Gabriela , Reign Deva , Huskey Alisa , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie 
Published: May 2023

Abstract

Introduction
Chronic insomnia is a disorder associated with increased cognitive arousal. Insomnia is also associated with activation/connectivity within the default mode network (DMN) of the brain, consistent with the hyperarousal theory. We hypothesized that suppression of the DMN with a type of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS) would lead to improved overnight sleep.

Methods
Twenty participants (12 female; age=26.9, SD=6.6 years) meeting criteria for insomnia/sleep disorder completed a counterbalanced sham-controlled crossover study in which they served as their own controls on two separate nights of in-laboratory polysomnography (PSG) monitored sleep. In-lab visits occurred on separate weeks at least 5 days apart. Sessions included two resting state functional magnetic resonance imaging (fMRI) sessions separated by a brief 40 second cTBS rTMS session applied over an easily accessible cortical surface node of the DMN located at the left inferior parietal lobe. After scanning/stimulation, participants were allowed an 8-hour sleep opportunity from 2300 to 0700 monitored with PSG.

Results
One session of active cTBS significantly altered functional connectivity (p&lt;.05, FDR corrected) within the DMN, while the sham condition produced no changes in functional connectivity from pre- to post-treatment. After controlling for age and IQ, active treatment was associated with significant (p&lt;.05) improvements in PSG measured Total Sleep Time (TST; ηp2=.28), latency to Slow Wave Sleep (SWS; ηp2=.23), Sleep Efficiency (SE; ηp2=.28), and a lower Arousal Index (ηp2=.22). Overall, individuals obtained 16 minutes more sleep after active cTBS compared to sham. Moreover, changes in brain connectivity following cTBS significantly (p&lt;.05) predicted sleep outcomes, including TST, sleep latency, SE, minutes of wake, SWS, number of awakenings, arousals, and arousal index, and a trend toward increased REM (p=.06).

Conclusion
A brief targeted 40-second stimulation with cTBS altered DMN brain functioning, and improved PSG measured sleep outcomes during the night following stimulation. The effect sizes often exceeded those reported for other established treatments such as cognitive behavioral therapy for insomnia or hypnotic sleep medications. Further work involving multiple stimulations over several days or weeks will be necessary to demonstrate the potential utility of this approach as a treatment for insomnia.

Support (if any)
W81XWH2010173
0337 24-Month Patterns of Sleep Medication Use with a Prescription Digital Therapeutic for Chronic Insomnia – A Retrospective Analysis
Authors: Mahon Rowan , Velez Fulton , Thorndike Frances , Maricich Yuri 
Published: May 2023

Abstract

Introduction
Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, but sedative-hypnotic medications are often used first, despite contraindications and risk of misuse. This study assessed change in sedative/hypnotic use/dosage in patients with chronic insomnia treated with Somryst® (tested as SHUTi), a prescription digital therapeutic (PDT) delivering CBT-I.

Methods
A retrospective claims data analysis was conducted with chronic use of prescribed sedatives/hypnotics (days’ supply: 8-200; units dispensed: &gt;12) in patients with self-identified sleep problems who initiated the PDT (index) between June 2016 and December 2018, and who had available closed claims data 24 months pre- and post-index. Eligible medications were used at least once in the year prior to initiation of the PDT, or 90 days after PDT initiation. Outcomes evaluated: dose change, stoppage/initiation, or medication switch, using nearest pre-index medication and furthest post-index medication. Dose change was evaluated using total strength per day: medication dose quantity dispensed/day's supply. Medication switch was evaluated as post-index cessation of a pre-index medication, accompanied by a post-index initiation of a different sedative/hypnotic.

Results
Of the 248 individuals observed, 131 (52.8%) utilized an eligible sedative/hypnotic medication. On average, individuals were on 1.5 (median of 2, range 1-6) sedative/hypnotic medications. In 59 individuals (45% of the cohort), there was either a decrease in dosage (13 patients, 9.9%), a full stopping of a medication (52 patients, 39.7%), or a stopping of all medications (41 patients, 31.3%). In 32 individuals (24% of the cohort), there was either an increase in dosage (8 patients, 6.1%) or an initiation of a new medication (28 patients, 21.3%). Twenty-two patients (16.7%) switched to a different medication in the post-index period. Forty-three patients (32%) experienced no changes in a specific medication and its dosage, including 25 (19%) patients who had another medication already counted in the groups described above, and 18 (13.7%) patients not counted elsewhere.

Conclusion
Real-world evidence from a PDT delivering digital CBT-I demonstrated dose reduction and/or stoppage of sedative/hypnotic medications in almost half of the population, with almost a third of patients stopping all such medications.

Support (if any)
This study was funded by Pear Therapeutics (US), Inc.
0340 AASM Insomnia Summit 2022
Authors: Schotland Helena , Leu Roberta , Khosla Seema , Ong Jason , Lewin Daniel , Dawson Spencer , McCrae Christina , Lee-Iannotti Joyce , Wickwire Emerson , Martin Jennifer 
Published: May 2023

Abstract

Introduction
Significant challenges exist in access to high-quality care for insomnia disorder. After the recent publication of clinical practice guidelines on behavioral/psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a virtual one-day summit in September 2022 to discuss improving care for patients with insomnia disorder.

Methods
Fifty attendees representing a variety of organizations (e.g., medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the Summit.  Videos highlighting patient perspectives and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions: (1) barriers to care, (2) facilitators of high-quality care, and (3) future directions and innovations. After 3-4 brief topical presentations by content experts, summit participants divided into seven breakout groups to brainstorm and prioritize issues. Each breakout highlighted 3-5 priorities and reported back to the broader group following each thematic session.

Results
The top barriers to care for insomnia disorder identified by summit participants included (1) limited access to care, (2) limited awareness of insomnia treatment options, (3) limited treatment formats, (4) low perceived value of insomnia treatment, and (5) insufficient number of trained clinicians to provide care.  The top facilitators of care included (1) increased education and awareness, (2) novel models to increase access to care, (3) developing and expanding the insomnia patient care workforce, (4) incorporating research into practice, and (5) increasing reimbursement. Top priorities for future directions included (1) increasing awareness among patients and healthcare providers, (2) increasing the number of skilled behavioral sleep medicine providers, (3) increasing advocacy efforts to address insurance issues (e.g., billing, reimbursement, and performance measures), and (4) working collaboratively with multidisciplinary organizations to achieve common goals for insomnia disorder care.

Conclusion
The AASM and participants from partnering organizations successfully engaged in a summit and identified prioritized strategies to improve access to high-quality care for insomnia disorder across diverse clinical settings (e.g., private practice, academic institutions, and rural areas).  The priorities are to improve access to care for insomnia disorder, which require advocacy efforts to increase awareness of treatment options, improve reimbursement, and grow the skilled workforce for treating insomnia disorder.

Support (if any)
AASM