bluuebunny/crossref_metadata_2025_split huggingface dataset:
0327 The Effects of Wearable Device Data on Sleep Diary-Derived Metrics of Sleep
Authors: Conklin Sarah , Dietch Jessica , Tenan Matthew , Banerjee Nilanjan , Brooks Justin 
Published: May 2023

Abstract

Introduction
Precision measurement of sleep metrics like sleep onset latency (SOL) and total sleep time (TST) has long been a challenge. Multiple studies have demonstrated significant discrepancies between sleep diaries and wearable device derived sleep metrics especially in patients with subjective-objective sleep discrepancy (SOSD; e.g., some patients with insomnia). Typically SOSD manifests as longer than expected self-reported SOL and shorter than expected TST. Without a method of reconciliation between sleep diaries and wearable devices, the current practice is to rely on sleep diary data which is suboptimal in the context of SOSD, and could contribute to blunted or nonsignificant effects in clinical trials. The current study investigated the effects of providing wearable device data feedback contemporaneously with the completion of the sleep diary, on a daily basis across 288 nights. We expected that by providing wearable device data feedback, participants with SOSD could be identified and potentially self-correct their SOSD.

Methods
A 3 phase, randomized, crossover design study was used in which 24 undergraduate college students without a diagnosed sleep disorder completed week-long periods of control condition (digital sleep diary without wearable device data feedback), washout, and then test phase (diary with device feedback). Participants were randomized to start with control or test conditions.

Results
Within and between subjects analyses were performed to understand the effect of the wearable device data feedback on sleep diary responses. Two participants (8.3%) with SOSD were identified and had marked differences in their estimated SOL (~47 min) that were corrected when provided with their wearable device data. Importantly no subjects copied their wearable device data into their sleep diary. Between subjects analyses revealed no differences in the average or variability of sleep metrics.

Conclusion
These preliminary results suggest that presenting wearable device data during sleep diary completion may impact self-reporting by individuals with SOSD but not by those without SOSD. In the setting of a clinical trial, participants who have significant SOSD may be contributing to non-disease/non-treatment related variability that may be ameliorated by providing wearable device data during sleep diary completion.

Support (if any)
0329 Wake Intrusions in the EEG: A Novel Application of the Odds Ratio Product in Identifying Subthreshold Arousals
Authors: Gratton Matt , Hamilton Nancy , Gerardy Bethany , Younes Magdy , Mazzotti Diego 
Published: May 2023

Abstract

Introduction
Arousal scoring is controversial, due to its lack of objectivity and dependency on other intrinsic characteristics of sleep. Conventional arousal measurements have not consistently predicted insomnia severity. The present study used a novel application of the Odds Ratio Product (ORP), a measure of sleep depth ranging from 0 (deep sleep) to 2.5 (fully awake), to identify subtle wake intrusions in sleep (i.e., subthreshold arousals). We assessed whether these intrusions are better predictors of frequent insomnia symptoms when compared to conventional arousal measurements.

Methods
Using cross-sectional data from the Sleep Heart Health Study with high-quality ORP data (SHHS1; n = 5,771), accessed through the National Sleep Research Resource, we defined ‘wake intrusions’ as the number of times the ORP spiked above a wake threshold of 2.0 (99% agreement in wake scoring among sleep scorers) during sleep. The wake intrusion index (WII) was derived by calculating the quotient of the number of intrusions by total sleep time. Insomnia was defined from self-reported frequency of &gt;15x/month of insomnia symptoms: delayed sleep onset, difficulty maintaining sleep, and/or early morning awakenings (n = 617). Linear models were used to examine the associations between insomnia and WII, as well as arousal index. Analyses were adjusted for age, sex, body mass index (BMI), and apnea-hypopnea index (AHI).

Results
There was a weak, but significant correlation between conventional arousal index and WII (r=0.25, 95%CI [0.22, 0.27], p&lt; 0.001). After adjusting for age, sex, BMI and AHI, frequent insomnia symptoms were associated with WII (β=9.47, 95%CI [2.07, 16.87], p=0.012), but not with arousal index (β=0.16, 95%CI [-0.59,0.91], p=0.217).

Conclusion
Results suggest that the ORP WII may be more sensitive than the arousal index. Moreover, frequent insomnia symptoms were independently associated with WII in adjusted analysis, while not with the arousal index. The role of the ORP WII as a potential physiological marker of insomnia deserves further investigation.

Support (if any)
NIH (U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL64360, U01HL53938, U01HL53940, U01HL53941, U01HL63463, R24HL114473, 75N92019R002).
0330 Blinded Verses Open-Label Hypnotic Tapering for Hypnotic Discontinuation: A Randomized Clinical Trial
Authors: Edinger Jack , Wamboldt Fredrick , Eldridge-Smith E Devon , Holm Kristen , Johnson Rachel , Simmons Bryan , Wang Eileen , Scherger Rubab 
Published: May 2023

Abstract

Introduction
Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study is testing a blinded tapering approach designed to reduce patients’ anxiety during the hypnotic tapering process.

Methods
Thus far, a sample of 44 (M age = 59.1±14.1 yrs.; 61.4% women) users of benzodiazepine (BZD) or newer generation benzodiazepine receptor agonists (BZRA) have enrolled in this trial and completed a 3-month post-tapering follow-up. Following baseline assessments that included completion of the insomnia severity index (ISI), these enrollees completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of two 10-week, tapering protocols wherein their medication dosage was reduced by 25% every two weeks either in a blinded or open-label manner. Medication usage was assessed and ISI scores were obtained at the end of the tapering phase and at a 3-month follow-up.

Results
A linear mixed model analysis showed only an effect for time in study on ISI scores with both tapering groups showing a significant (F = 36.89; p = .0001) decline in these scores from baseline through the 3-month follow-up. By the 3-month follow-up, a slightly, albeit non-significantly, higher proportion of the blinded tapering group (76.2%) were no longer using their BZD/BZRA hypnotics than in the open label group (60.9%). However, there was a significantly higher BZD/BZRA discontinuation rate by the 3-month follow-up among those who achieved ISI score-determined insomnia remission than among unremitted participants both for the sample as a whole (85% vs. 54.2%; p = .05) and for the open label group (88.9% vs. 42.9%; p = .0397) considered separately. This difference between remitted and unremitted participants was not seen in the blinded tapering group.

Conclusion
Early findings in this trial suggest a slight advantage to blinded over open label hypnotic tapering in achieving hypnotic discontinuation. Moreover, insomnia remission may not be essential for hypnotic discontinuation when blinded tapering is conducted.

Support (if any)
National Institute of Drug Abuse, Grant # 1R01DA047341-01A1
0335 Persistence of Sleep Duration Phenotypes Across Nights of Laboratory and Home Sleep Recording
Authors: Edinger Jack , Krystal Andrew , Lunsford-Avery Jessica 
Published: May 2023

Abstract

Introduction
Vgontzas and colleagues have proposed dividing the population of persons with insomnia disorder into short (&lt; 6 hours/night) and normal (&gt; 6 hours/night) sleep duration phenotypes based on their objective sleep duration as measured by one or more nights of polysomnography (PSG). However, first night effects, homeostatic recovery mechanisms and the site where PSG is conducted may all affect the sleep duration observed on individual PSG nights. The current study evaluated the stability of objective sleep duration phenotyping across multiple laboratory and home-based PSG recordings.

Methods
Seventy-six adults (Mage = 51.8±16.5 yrs.; 50% women) with an insomnia disorder underwent a series of three PSG recordings in the sleep lab and three in their homes in a counterbalanced order. Participants chose their own bed and rising times each night to produce results representative of their usual sleep patterns. Participants were classified into short (ISS: TST &lt; 6 hours) and normal (INS: TST &gt; 6 hours) duration phenotypes using the mean sleep times across all nights.

Results
Twenty-eight participants were classified as the ISS phenotype and 48 were classified as the INS phenotype with equal numbers of men and women in each group. A linear mixed models analysis showed only significant main effects for phenotype classification (F = 119.72; p &lt; .0001) and recording night (F = 4.29; p &lt; .025). The ISS mean TST was 326.8 minutes whereas the INS mean TST was 396.8 minutes. Mean TST across both groups was significantly shorter on the first PSG night (Mean = 353.0 min.) across settings than on night 2 (Mean = 372.4 min.). The majority of the ISS group (78.6%) and INS group (77.1%) had TST &lt; 6 hours and TST &gt; 6 hours, respectively, on 4 or more nights of sleep recordings.

Conclusion
ISS and INS sleep duration phenotypes have relative stability in their objective sleep times across nights and recording sites. These findings support the growing literature suggesting the distinctiveness of these subtypes of insomnia disorder.

Support (if any)
Funding support from the Department of Veterans Affairs Merit Review Grant Program
0348 Cognitive Behavioral Therapy for Insomnia in African Americans: A Pilot Study
Authors: Thompson Michelle , Muench Alexandria , Boyle Julia , VanCliff Camya , Seewald Mark , Jemmott John , Grandner Michael , Jean-Louis Girardin , Posner Donn , Perlis Michael 
Published: May 2023

Abstract

Introduction
Co-morbid sleep continuity disturbance (SCD) and insufficient sleep duration (ISD) disproportionately affect the sleep health of Black Americans (BA). Simultaneously, treating SCD and ISD may improve health and reduce disparities experienced by this community. Although standard cognitive behavioral therapy for insomnia (CBT-I) ranges from six to eight sessions and directly addresses SCD, standard CBT-I does not appreciably increase total sleep time (TST) and therefore does not adequately address ISD during treatment. This report presents the overall study outcomes of CBT-I (without respect to dose of CBT-I) in BA.

Methods
Twelve BA adults (83% female, Mage 46.0±13.9yrs) were recruited from the Philadelphia area. CBT-I was provided by one of four master CBT-I therapists via telehealth for up to 16 sessions. Two follow-up assessments were conducted at 3 and 6 months. Participants completed daily measures of sleep continuity (sleep diaries) and weekly measures of insomnia severity (ISI).

Results
Overall, 75% of participants exhibited a treatment response corresponding to a reduction of 58% (effect size [ES]=-2.3) on the ISI. With respect to sleep continuity (measured in minutes), there was a 61% (ES=-1.4) reduction in sleep latency (30.1 to 11.8), 76% (ES=-1.7) reduction in wake-after-sleep onset (32.4 to 7.8), 81% (ES=-1.2) reduction in early morning awakenings (32.2 to 6.3), 7% (ES=0.3) increase in TST (381.3 to 408.0), a 9% (ES=-0.6) reduction in time in bed (476.0 to 433.7), and an overall 16% (ES=2.9) improvement in sleep efficiency.

Conclusion
Results from this pilot study indicate that standard CBT-I produces robust effects in BA with insomnia. Analyses are ongoing and will examine group interactions and treatment durability at follow-up.

Support (if any)
K24AG055602
0349 Contribution of Insomnia After Trauma to Depression and Posttraumatic Stress Disorder in Women Service Members
Authors: Carlson Gwendolyn , Sharifian Neika , Jacobson Isabel , LeardMann Cynthia , Rull Rudolph , Martin Jennifer 
Published: May 2023

Abstract

Introduction
Trauma can lead to mental health disorders, such as posttraumatic stress disorder (PTSD) and depression. Historically, insomnia was thought of as a secondary symptom of these mental health disorders, but current research suggests insomnia can be an independent clinical disorder and can contribute to the development and severity of PTSD and depression among civilians. However, previous studies examining insomnia and mental health symptoms among service members are limited by cross-sectional designs, reliance on retrospective data, or inclusion of predominately male ­samples. We prospectively examined associations among trauma exposure, insomnia, and mental health symptoms in an exclusive sample of women service members and veterans.

Methods
We analyzed 2 waves of survey data (2011-2013, Time 1 [T1], and 2014-2016, Time 2 [T2]) from 26,443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas (combat experience and sexual trauma) in the past 3 years, probable insomnia at T1, and probable PTSD and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia.

Results
Women who experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI, 1.24-2.10), sexual harassment (OR = 1.22; 95% CI, 1.05-1.41), or combat (OR = 1.34; 95% CI, 1.20-1.49) at T1 had greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI, 2.31-3.06) and PTSD (OR = 2.57; 95% CI, 2.27-2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes.

Conclusion
Insomnia contributes to subsequent mental health symptoms following trauma. The diagnosis and treatment of post-trauma insomnia during military service should be prioritized to mitigate the development of posttraumatic mental health symptoms. Sleep health in women service members remains an understudied area of research and should also be prioritized.

Support (if any)
Millennium Cohort Study: Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs. VA HSR&D (RCS-20-191, Martin); NHLBI (K24HL143055, Martin).
0355 Insomnia Identity’s Association with Insomnia Problem Chronicity and Treatment History
Authors: Boeve Angelica , Boyle Julia , Muench Alexandria , Emert Sarah , Vargas Ivan , Thompson Michelle , Grandner Michael , Perlis Michael 
Published: May 2023

Abstract

Introduction
Insomnia identity is defined as the “conviction that one has insomnia” or self-identifies as an “insomniac.” The present study sought to evaluate whether insomnia chronicity and past insomnia treatment predicts whether someone identifies as an “insomniac” in a large sample of adult participants with sleep complaints.

Methods
This study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area. The data were drawn from 2,950 adults between 18 and 90 years of age who specifically reported problems with total sleep time (TST). All participants answered questions regarding age of problem onset, insomnia treatment history, and insomnia identity (“Do you think of yourself as an ‘insomniac’?”).

Results
Of the 2,863 participants included in this analysis (Mage=53.5±10.7; 76.6% female; 91.2% White), 45.1% identified as an “insomniac.” Binary logistic regression was used to examine whether TST problem chronicity (Myears=12.3±10.0) and treatment history (36.6%) were associated with the likelihood of identifying as an “insomniac.” Outliers were removed and assumptions were met. The model was statistically significant X2=(2, N=2,863)=172.4, p&lt; 0.001, suggesting that it could distinguish between those who did and did not identify as an “insomniac.” The model correctly classified 60.9% of cases. TST problem chronicity (OR=1.04, 95% CI [1.027, 1.043]) and treatment history (OR=0.51, 95% CI [0.435, 0.596]) significantly contributed to the model.

Conclusion
Participants were 4% more likely to identify as an “insomniac” with each year of TST problem chronicity and were 49% less likely to identify as an “insomniac” if they engaged in prior insomnia treatment. Findings align with a recent study that also found that individuals with insomnia identity reported longer insomnia chronicity and that individuals with and without insomnia identity seek insomnia treatment. Future analyses should consider additional variables including insomnia frequency (days per week), severity (e.g., total nocturnal wakefulness [TWT]), daytime symptomatology, perceived sleep need, and demographic factors including age, sex, and race.

Support (if any)
K24AG055602
0362 Sleep Medication Use in Hospitalized Geriatric Patients and Associated Outcomes
Authors: Vaught Malcolm , Petteruti Audrey , Anagnostopoulos Antonios , Hussain Laila , Fleishman Samuel 
Published: May 2023

Abstract

Introduction
Disturbances in the diurnal sleep-wake cycles are prevalent within the geriatric population, consequently increasing the development of insomnia. Although insomnia is commonly treated in the inpatient setting, many pharmacologic interventions are classified as potentially inappropriate medications for the geriatric population, as defined through the Beers Criteria; potentially increasing the risk for adverse events (AEs) in this population.

Methods
A retrospective review and comparative analysis of medications used for the treatment of insomnia (diphenhydramine [DPH], hydroxyzine [HDX], trazodone [TZD]) in 121 hospitalized geriatric patients (≥65 years old) in our facility during the month of October 2021 was conducted. Multiple regression analysis was used to identify associations between selected medication use and AEs including inpatient falls, new or worsening delirium, and new onset urinary retention. Comparative analysis using individual T-testing between groups, and Kruskal-Wallis Testing for total comparison was used to identify significance between group outcomes.

Results
Patients treated with DPH or HDX showed significantly higher rates of AEs compared to patients treated with TZD (p&lt; 0.001); but showed no significant difference in frequency of AEs between themselves (p=0.816). 54.8% of patients treated with DPH and 57.7% of patients treated with HDX had at least one recorded AE during their hospital stay. The most common AE in all treatment groups was new or worsening delirium at 31.0%, 38.5%, and 15.6% in DPH, HDX, and TZD groups respectively. Both DPH and HDX groups showed AEs of falls (4.8% and 11.5%) and new onset urinary retention (14.3% and 7.7%) respectively, whereas the TZD group showed neither of these AEs. Analysis yielded secondary outcomes with AE of new onset constipation occurring only within the DPH group at 11.9%. Further, secondary analysis showed treatment with DPH had a significant increase in hospital length of stay (HLOS) compared to TZD use (p&lt; 0.01), but not compared to HDX use (p=0.755).

Conclusion
Treatment of insomnia in hospitalized geriatric patients is complex. Use of anticholinergic medications (DPH/HDX) substantially increases the risk for AEs within this population. Further, the use of DPH showed significant increased HLOS, possibly as a direct result of AEs incurred with the use of these medications.

Support (if any)
0363 Sound vs. Sight: A Modality-Specific Preliminary Investigation of Sleep-Related Attentional Bias in Older Adults
Authors: Curtis Ashley , Costa Amy , Musich Madison , Nowakowski Lauren , Young Kobe , Rzeppa Chloe , McCrae Christina 
Published: May 2023

Abstract

Introduction
Increased attention to sleep-related stimuli (i.e., “sleep-related attentional bias”) may contribute to the persistence of insomnia symptoms. Despite high prevalence of insomnia disorder in older adults, studies investigating this phenomenon in this population are lacking. Additionally, it is unclear whether this bias occurs only for visual stimuli or more broadly, such as for auditory stimuli. This study examined whether auditory and visual sleep-related attentional bias differed as a function of insomnia disorder in older adults.

Methods
Sixty-one older adults (Mage=68.2±5.9; 41 women/) with (n=22) and without (n=39) insomnia (met DSM-5 criteria plus reported 6+nights/14 of &gt;30 mins sleep onset latency or wake after sleep onset on daily diaries) completed modified Posner Cueing and Dot Probe tasks. Task cues included sleep-related auditory (e.g., alarm clocks, snoring), visual (e.g., clocks set to bedtimes, person awake in bed) and non-sleep (auditory: pure tones; visual: neutral images from the International Affective Picture system) stimuli. For Posner, valid [non-cued reaction time (RT) minus validly-cued RT] and invalid (non-cued RT minus invalidly-cued RT) sleep and non-sleep related visual and auditory cueing effects were calculated. For Dot Probe, valid (non-sleep/neutral cued RT minus sleep-related validly-cued RT) and invalid (non-sleep/neutral cued RT minus sleep-related invalidly-cued RT) visual cueing effects were computed. Independent t-tests examined whether auditory/visual mean cueing effects for sleep and non-sleep stimuli differed by insomnia status.

Results
Posner valid auditory sleep-related cueing effects were larger (p=.04) for those with insomnia (104.6±47.6ms) vs. without (80.7±57.3ms). Valid auditory non-sleep related cueing effects were also larger (p=.001) for insomnia (118.9±48.8ms) vs. without (67.9±77.2ms). For Dot Probe, there was a trending difference (p=.07) between visual sleep-related valid cueing effects for insomnia (14.7ms±6.7ms) vs. without (-1.8ms±7.1ms).

Conclusion
Preliminary findings suggest older adults with insomnia experience larger visual sleep-related attentional bias than those without insomnia. Further, greater auditory attentional bias in insomnia may reflect general auditory cortex hypervigilance. Aging adults with insomnia may benefit from stimulus desensitization towards insomnia triggers across sensory modalities to potentially facilitate sleep.

Support (if any)
This research project was made possible by an award (PI:Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.