bluuebunny/crossref_metadata_2025_split huggingface dataset:
0611 Treatment Satisfaction and Preferences in People With Narcolepsy Transitioning From Sodium Oxybate to Lower-Sodium Oxybate
Authors: Bae Charles , Zee Phyllis , Leary Eileen , Macfadden Wayne , Fuller Douglas , Candler Shawn , Husain Aatif 
Published: May 2023

Abstract

Introduction
Lower-sodium oxybate (LXB; Xywav®), which contains the same active moiety as higher-sodium oxybate (SXB; Xyrem®) but with 92% less sodium, is approved by the US Food and Drug Administration (FDA) for treating cataplexy or excessive daytime sleepiness in patients ≥7 years of age with narcolepsy. LXB is recognized as clinically superior to SXB in narcolepsy by the US FDA due to lower chronic sodium exposure; however, real-world data describing patient preferences and satisfaction are lacking.

Methods
Transition Experience of persons with Narcolepsy taking Oxybate in the Real-world (TENOR; NCT04803786) was a patient-centric, prospective, observational, noninterventional, virtual-format study of US adults with narcolepsy (type 1 or 2) transitioning from SXB to LXB within the previous/upcoming 7 days. Longitudinal data collected during transition and for 21 weeks thereafter included responses to the Ease of Switching Medications Scale (EOSMS), Forced Preference Questionnaire (FPQ), and Treatment Satisfaction Questionnaire for Medication-version II (TSQM-vII).

Results
The mean (standard deviation [SD]) age of the 85 participants (narcolepsy type 1, n=45; narcolepsy type 2, n=40) was 40.3 (13.0) years; most were female (73%) and White (87%). Mean (SD) time on current SXB regimen was 57.8 (52.1) months. Nearly all participants took SXB (82/85, 96%) twice nightly prior to transition and LXB (82/84, 98%) twice nightly after transition. Most participants (61/73, 84%) reported that switching from SXB to LXB was “extremely easy, not difficult at all” or “easy” on the EOSMS, and most (59/73, 81%) preferred LXB to SXB on the FPQ. Among participants who preferred LXB, lower sodium content (56/59, 95%) and fewer cardiovascular issues (27/59, 46%) were cited as the most common reasons. There were minimal mean (SD) changes in TSQM-vII scores for global satisfaction (1.1 [18.6]), satisfaction with effectiveness (1.0 [16.8]), side effects (4.1 [23.7]), or convenience (−3.9 [15.2]) after transitioning from SXB to LXB.

Conclusion
Overall, most participants indicated that switching from SXB to LXB was “easy” or “extremely easy.” Most participants preferred LXB to SXB, primarily because of its lower sodium content. Satisfaction with oxybate treatment was maintained following transition to LXB.

Support (if any)
Jazz Pharmaceuticals
0613 Actigraphy-Based Sleep Disruption and Diurnal Biomarkers of Autonomic Function in Paroxysmal Atrial Fibrillation
Authors: Khazaie Sepideh , Wang Lu , Araujo Matheus , Chung Mina , Heinzinger Catherine , Van Wagoner David , Mehra Reena 
Published: May 2023

Abstract

Introduction
Sleep architectural disruption is associated with atrial fibrillation (AF), however, associated autonomic influences remain unclear and it is unknown if this detriment persists during wakefulness. We hypothesize diurnal-patterned associations of sleep disruption and autonomic dysfunction in patients with paroxysmal AF

Methods
We analyzed data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study designed to examine paroxysmal AF and sleep apnea involving simultaneous collection of continuous electrocardiogram monitoring (Heartrak Telemetry®) and actigraphy (Actiwatch GTX) for 7-21 days. Heart rate variability (HRV) measures in frequency and time domains were used as surrogates of autonomic function and averaged per sleep/wake per day. A linear mixed-effects model assuming compound symmetry correlation structure was used to assess the relationship of HRV with actigraphy-derived sleep data.

Results
The analytic sample (age 60.1±12 years, body mass index 32.6±6.7 kg/m², 36% female, 75% White) included 108 participants with paroxysmal AF. Significant associations were observed between sleep indices and HRV measures during wakefulness: a) Sleep latency with high-frequency power (HFP), b) total sleep time, wakefulness after sleep onset (WASO) and number of awakenings with low-frequency power (LFP), and c) Sleep efficiency with standard deviation of normal R-R intervals (SDNN) and coefficient of variation (CV). During sleep, a) total sleep time was associated with LFP/HFP ratio (LHR), and b) number of awakenings with LHR. Significant sleep-wake interactions were observed between a) Sleep latency and HFP, b) Sleep efficiency with SDNN and CV, c) WASO with SDNN, CV, and LFP, and d) number of awakenings with CV and LFP.

Conclusion
Our novel findings indicate actigraphy-based measures of sleep disruption were associated with autonomic function alterations and these relationships exhibited diurnal variability in patients with paroxysmal AF. Results provide unique insights into differential relationships of immediate (during sleep) versus sustained (during wakefulness) autonomic dysfunction related to sleep disruption which may contribute to atrial arrhythmogenesis

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0623 Effects of bright light therapy on objective and subjective sleep in patients with non-seasonal depression and eveningness
Authors: Chan Joey , Feng Hang Liang , Zhang Jihui , Chan Ngan Yin , Li Tim Man Ho , Chau Steven Wai Ho , Liu Yaping , Li Shirley Xin , Wing Yun Kwok 
Published: May 2023

Abstract

Introduction
This study reported the effect of bright light therapy with gradual advanced timing on the sleep parametersin patients with major depressive disorder (MDD) and eveningness.

Methods
A total of 93 adults were randomized to receive either 10,000 lux bright light therapy (BLT group) or 50lux dim red light therapy (placebo group) for a total of 5 weeks. Timings of both treatments were initiated at their habitual wake time and was advanced gradually each week. Sleep diary data were collected weekly. Actigraphic data were collected at the baseline and during the last week of the 5-week treatment. Sleep parameters including time in bed (TIB), sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE) were extracted. Concordance of the sleep diary and actigraphy sleep parameters were assessed by Pearson’s correlation with p-value adjusted for multiple comparisons. The changes of sleep parameters between the two groups were assessed by linear mixed model.

Results
Significant correlations between sleep diary and actigraphy were found for WASO (r=0.35, p = 0.01) and TST (r=0.40, p=0.01), but no correlation was found for TIB, SOL and SE. A greater advance in the diary-based light-out time (group*time p=0.03, 15 vs 32min) and rise time (group*time p=0.04, 38 vs 53min) was found in the BLT group compared to placebo group, while dairy-based WASO, TST and SE comparably improved with time in both groups. However, there were no significant difference between the two groups in all of the actigraphic parameters after treatment.

Conclusion
Five-week of either type of light therapy with gradual advance in timing improved subjective WASO, TST and SE, while BLT led to a greater advance in the light-out time and rise time when compared to the placebo group. These changes were not captured by the actigraphic measurements. The discrepancies between subjective and objective sleep parameters suggested the need to consider incorporating multiple measures when assessing sleep in patients with depression and eveningness.

Support (if any)
This project was supported by the Health and Medical Research Fund, The Government of Hong Kong SAR (Ref 12131131).
0626 Type of screen time and the relationship between anxiety, depressive and insomnia symptoms in college students
Authors: Brombach Ruth , Dietch Jessica , Sy John , Trevorrow Tracy , Zhou Eric 
Published: May 2023

Abstract

Introduction
Limited and conflicting evidence examines associations between screen time, depression, anxiety and insomnia in adolescents. Surprisingly few studies focus on college students who face unique sleep-related challenges, frequent media use and elevated rates of mental health problems. Therefore, the goal of the present study was to examine the influence of different types of screen time on the relationship between anxiety/depressive symptoms and insomnia symptoms in college students.

Methods
Participants (N = 1,085 college students with a mean age of M = 21.15 [SD = 5.51]) completed questionnaires of demographics, anxiety, depression, insomnia, and daily screen time. Type of screen time was classified as: (1) social, (2) non-social, or (3) productivity. We conducted correlations and used Model 1 of the PROCESS macro version 3.5 was used to determine whether type of screen time moderated the relationship between depressive or anxiety symptoms and insomnia.

Results
Insomnia symptoms were moderately correlated with anxiety (r = .49, p = &lt;.001) and depressive symptoms (r = .60, p = &lt;.001). Anxiety symptoms were correlated with social screen time (r = .09, p = &lt;.01); depressive symptoms were correlated with non-social screen time (r = .13, p = &lt;.001). Social screen time moderated the relationship between anxiety symptoms and insomnia symptoms (b = -.03, SE = .01, p = .01) and the relationship between depressive symptoms and insomnia symptoms (b = -.02, SE = .01, p = .02). Productivity and non-social screen time were not significant moderators.

Conclusion
Anxiety symptoms were only correlated with social screen time whereas depressive symptoms were only correlated with using non-social screen time. Moderation analyses revealed social screen time moderated the relationship between anxiety/depressive symptoms and insomnia symptoms. Elevated social screen time was associated with elevated insomnia symptoms among participants with less anxiety/depressive symptoms. Distinguishing between non-social and social screen time may be relevant when examining the influence of screen time on depressive/anxiety symptoms and their relationship with insomnia symptoms. Further research could address these findings in a clinical sample and examine whether intervening on specific types of screen time impacts the relationship between depression/anxiety and insomnia.

Support (if any)
None
0628 Retinal responsivity increases after light therapy and is associated with improved depression: Preliminary findings from a RCT
Authors: Wescott Delainey , Klevens Alison , Franzen Peter , Siegle Greg , Roecklein Kathryn , Rohan Kelly 
Published: May 2023

Abstract

Introduction
Light therapy is a first line treatment for seasonal depression but is not effective for everyone. Understanding mechanisms of light therapy may help predict who will successfully respond to treatment. Individual differences in the retina’s responsivity to light may underlie differences in treatment response given prior work linking reduced retinal responsivity in seasonal depression. This study tested if retinal responsivity changed across a light therapy intervention and whether changes in retinal responsivity were associated with improved depression.

Methods
Participants diagnosed with Major Depressive Disorder, With Seasonal Pattern were randomized to 6 weeks of light therapy or cognitive behavioral therapy for seasonal affective disorder (CBT-SAD). Participants in the light therapy group (N=52) were on average 41.9 years (SD=14.8) and predominantly women (72%). Retinal responsivity was assessed using the post-illumination pupil response (PIPR), measured mid-day in winter pre- and post-treatment. The net PIPR (red minus blue) was calculated as a percent of baseline 10-30 seconds post stimulus. Depression severity was measured using the Structured Interview Guide for the Hamilton Depression Rating Scale – Seasonal Affective Disorder version (SIGH-SAD). Using multilevel models, we tested 1) if the PIPR changed from pre- to post-treatment and 2) if changes in the PIPR predicted improvements in depression. All analyses included a random intercept of participant ID and controlled for age, gender, time of testing, and the pupillary light reflex (PLR).

Results
There was a significant main effect of time on the PIPR, such that PIPR increased from pre- to post-light treatment (b=0.29; SE=0.13; p=0.03). There was a significant negative association between changes in PIPR and changes in depression, such that increases in PIPR were associated with decreases in depression symptom severity (b= -0.18; SE=0.06; p=0.01).

Conclusion
Retinal responsivity increased across a light therapy intervention and increases in retinal responsivity were associated with improved depression. It is possible an upregulation in retinal responsivity drives antidepressant effects of light therapy, either through direct or circadian pathways. However, changes in retinal responsivity measured throughout treatment are required to discern whether these changes are mechanistic.

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0629 Correlates of sleep quality among individuals with chronic pain after moderate to severe traumatic brain injury
Authors: Martin Aaron , Almeida Emily J , Hoffman Jeanne M , Pinto Shanti M , Walker William C , Douglas Megan E , Wittine Lara , Schwartz Daniel J , Takagishi S Curtis , Kane Georgia , Nakase-Richardson Risa 
Published: May 2023

Abstract

Introduction
Sleep disturbance and chronic pain are very common after moderate to severe traumatic brain injury (msTBI). Despite having a bidirectional and mutually exacerbating relationship, there is a dearth of literature examining factors involved in the sleep-pain relationship following msTBI. Psychiatric symptoms (e.g., post-traumatic stress, depression) are also prevalent following injury and know to be related to sleep, as well as poor adjustment to chronic pain. The purpose of this study was to examine associations between sleep, psychiatric symptoms, and pain-beliefs among msTBI survivors who have comorbid chronic pain.

Methods
This is a secondary analysis of TBI Model Systems study data of 1,567 individuals reporting chronic pain after msTBI (M=8.5 years, SD=7.1). Participants were 46.8 years old on average (SD=27.9), predominantly male (72.7%) and completed measures of sleep (Pittsburgh Sleep Quality Index; PSQI), post-traumatic stress disorder (PTSD Checklist; PCL-5), depression (Patient Health Questionnaire; PHQ-9), anxiety (General Anxiety Disorder; GAD-7), pain-related catastrophizing (Coping Strategies Questionnaire; CSQ) and self-efficacy (Pain Self-Efficacy Questionnaire; PSEQ-2). Measures were adjusted for overlapping constructs. Relationships between sleep, psychiatric symptoms and pain beliefs were examined through Pearson correlations.

Results
Average PSQI total score for our sample was 8.78 (SD=4.4), indicating poor sleep quality, with an estimated 6.40 (SD=1.9) hours of sleep on average. Over two-third (68.5%) of our sample attributed some of their sleep disturbance to chronic pain and nearly half (47.4%) met cutoff (&gt;8) for clinically significant poor sleep quality. PSQI scores were positively correlated with PCL (r = .44, p &lt;.0001), PHQ-9 (r = .12, p &lt;.0001), GAD-7 (r = .08, p &lt;.01), CSQ (r = .34, p &lt;.0001) and negatively correlated with PSEQ-2 (r = -0.23, p &lt;.0001).

Conclusion
Poorer sleep quality in individuals with chronic pain after msTBI is associated with more psychiatric symptoms, increased pain-related catastrophizing, and lower pain self-efficacy. Results highlight sleep quality as an important modifiable target for intervention in this at-risk clinical population and suggest that behavioral treatments to improve psychiatric comorbidities and adjustment to pain may be beneficial.

Support (if any)
National Institute on Disability, Independent Living, and Rehabilitation Research (NCT03033901).
0631 Overnight Emotional Memory in Insomnia versus Good Sleepers
Authors: Tse Katrina , Tamm Sandra , Maurer Leonie , Espie Colin , Kyle Simon 
Published: May 2023

Abstract

Introduction
“Sleep to forget and sleep to remember” model postulates that the content of emotional memory is strengthened during sleep while the arousal component is attenuated. Experimental sleep deprivation studies in healthy individuals have supported the model, but it is not known if sleep in individuals with insomnia, a condition of chronic poor sleep, provides the same effect on emotional memory.

Methods
Individuals reporting insomnia and good sleepers (n = 76 and n = 83 respectively; 83% female, mean age of 43.2 years) completed a picture-rating task to assess a) emotional valence ratings pre and post sleep and b) recognition accuracy post-sleep. In addition, an autobiographical memory task was completed during the day to assess a) the number of recalled memories in a 2-minute period for good and bad past events respectively, and b) emotional intensity ratings of the retrieved memories at the time the event occurred and how they feel now.

Results
Wilcoxon rank-sum test was used to assess group differences. Sleep diary variables on the experimental night showed that individuals with insomnia experienced a significantly more disrupted sleep than good sleepers (SOL: r = 0.537; WASO: r = 0.620; TST: r = 0.669). In the picture-rating task, there was no significant group difference for recognition accuracy (neutral stimuli: r = 0.016; negative stimuli: r = 0.018) or change in emotional valence pre-to-post sleep (neutral stimuli: r = 0.003; negative stimuli: r = 0.008). In the autobiographical memory task, individuals with insomnia remembered significantly fewer good days (r = 0.245) and rated their bad days at the time of its occurrence as significantly worse than good sleepers (r = 0.235). There was no significant group difference in the extent to which emotional intensity faded more for bad days than good days (r = 0.113).

Conclusion
We have shown that autobiographical memory is altered in insomnia which may have important influence on mental health. Our findings also suggest that overnight memory consolidation for negative stimuli is not affected in insomnia versus good sleepers. This may be a reflection of our one-night protocol; future work is needed across consecutive days.

Support (if any)
Dr-Mortimer-&-Theresa-Sackler-Foundation
0639 Delayed Presentation of Sleep Disruption and Depressive Symptoms in Males Post Mild Traumatic Brain Injury (mTBI)
Authors: Reich-Fuhrer Melissa , Hildebrand Lindsey , Franca Gabriela , Desai Shivani , Grandner Michael , Killgore William 
Published: May 2023

Abstract

Introduction
The relationship between sleep disruption and depressive symptoms is well established. Mild traumatic brain injury (mTBI) is commonly associated with emotional dysregulation and decreased sleep quality. Less is known about the course of mTBI and its association with mood symptoms over time. We hypothesized that those in acute stages of mTBI (2W; 1M) would significantly differ in sleep quality and depressive symptoms compared with healthy controls. As there are often sex differences in sleep and depression, we focused here exclusively on males with mTBI.

Methods
This study included 56 healthy males, split into six groups. The sample included 15 healthy males (Mage=23.67, SD=5.066) and 41 males (Mage=26.88, SD=8.509) with mTBI, at differing stages post-injury: 2 weeks and 1, 3, 6, and 12 months. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Index (BDI-II) to assess sleep disturbance and mood, respectively. Higher scores on both measures indicate a more severe presentation of disruptive symptoms. We conducted a one-way ANOVA to examine how the mean score for both measures varied at each time point.

Results
Compared to healthy controls there was no significant variance in average depression scores at 2W, 1M, 6M, and 12M (p&gt;.05). However, at 3M post-mTBI males reported significantly higher depression scores than healthy controls M =9.8, SD=9.48, p=.035. Participants with mTBI reported greater sleep disruption when compared to healthy controls at 3M M =7.30, SD=3.16, p=.035 and 12M M=7.0, SD=3.39, p=.037, but not at other time points.

Conclusion
Contrary to our hypotheses, we found that males did not significantly vary from healthy controls for either measure in the acute stages of mTBI. These results indicate that males may not initially present depressive symptoms and sleep disruption post-mTBI, which could result in an inaccurate assessment of injury severity and an improper treatment plan moving forward in recovery. Further research conducted with a larger sample size would be useful in establishing that males suffering from mTBI experience the most severe presentation of symptoms roughly 3M after injury. Future work will need to examine whether these same trends are present among females.

Support (if any)
W81XWH-12-1-0386
0656 Evaluating the Interrelationship Between Insomnia, Sleep Apnea and Nightmares in Veterans With Posttraumatic Stress Disorder
Authors: Stuewe Elena , Malcolm Katherine , Woodward Steven H , Yack Leslie M , Metzler Thomas J , Baquirin David P G , Udupa Nikhila S , Staggs Emily J , Neylan Thomas C , Richards Anne 
Published: May 2023

Abstract

Introduction
Observational research demonstrates a strong association between nightmares, insomnia, and sleep apnea in veterans with posttraumatic stress disorder (PTSD), supportive of the notion of a “complex sleep disturbance”. Relations between sleep disturbances and PTSD are often bi-directional and disturbed sleep affects non-sleep PTSD outcomes. We aimed to examine relationships between nightmares, respiratory events, CPAP use, and insomnia in trauma-exposed veterans with frequent nightmares.

Methods
Three weeks of app-based daily sleep diaries and weekly insomnia severity index (ISI) reports were collected from 41 veterans with a history of trauma and frequent nightmares. Relationships between weekly nightmares (total number), CPAP use, sleep efficiency, and ISI scores were analyzed using linear regression with standard errors adjusted for clustering of weeks within participants. Of the 41 participants, a subset of 15 participants completed 6-9 nights of at-home objective sleep measurements (Sleep Profiler) to examine the relationship between apnea events and nightmare awakenings. Measurements involved EEG integrated with airflow, respiratory effort, oxygen saturation, and actigraphy with event marker for real-time reporting of nightmares preceding awakenings.

Results
41 veterans (mean age 48 (SD=16), 30% female) participated. Higher prior week ISI score predicted reduced CPAP adherence (β=-.53, p=.005). In turn, increased frequency and duration of CPAP use was associated with a significant increase in sleep efficiency the same week (β=.53, p=.018 and β=.56, p=.026, respectively). Analysis of respiratory events indicates that 20 of the 64 nightmare awakenings (31%) were preceded (i.e., within seconds of awakening) by apnea or hypopnea events. Of these 20, 11 events were reported by participants with a diagnosis of OSA and a CPAP device. Amongst these 11 events, 7 (64%) occurred on nights during which the participant reported use of their CPAP.

Conclusion
Analyses demonstrated statistically significant and clinically meaningful relationships among insomnia, nightmares, respiratory events and CPAP adherence in our sample, highlighting their interrelationships in trauma subjects. These data support the hypothesis that OSA contributes to nightmare experiences by demonstrating an immediate temporal relationship between apnea/hypopnea events and nightmare awakenings, and they underscore the importance of detecting and adequately treating sleep apnea for the treatment of nightmares in veterans.

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