bluuebunny/crossref_metadata_2025_split huggingface dataset:
0723 Slow wave activity surrounding K-complexes is associated with long-term all-cause mortality in a large community-dwelling cohort
Authors: Valencia Daphne , Schoenholz Reagan , Bischoff Giles , Berkalieva Asem , Wickramaratne Sajila , Mullins Anna , Kam Korey , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit 
Published: May 2023

Abstract

Introduction
Sleep fragmentation is thought to be associated with adverse long-term consequences including mortality. However, conventional metrics of sleep fragmentation such as time spent in non-REM, REM sleep stages have been inconsistently associated with long-term consequences of sleep fragmentation. Recent studies suggest that morphological features of K-complexes might better describe sleep fragmentation as they are sensitive to effects of sleep disruption and better correlate with short-term outcomes such as daytime sleepiness. We previously demonstrated that the slow wave activity (SWA) surrounding K-complexes (∆SWAK) was a strong predictor of sleepiness in a cohort of sleep apnea subjects, mediated in part by its association with sleep fragmentation, however its association with long-term consequences of sleep fragmentation is not well known.

Methods
We analyzed nocturnal polysomnography (NPSG) data from Sleep Heart Health Study (1995-1998), a well-characterized cohort examining the cardiovascular consequences of sleep-disordered breathing. The primary quantitative EEG (C3-A2) metrics were: SWA (%relative power in 0.5-4 Hz), K-complex density (number/min of N2), and ∆SWAK. K-complexes were detected automatically using previously published open-source method (DETOKS, Parekh et. al., 2015) during stage N2 of sleep only. All EEG metrics were divided into quartiles to explore potential non-linear associations. Death from any cause up until 2011 (mean follow up of 11 years) was the primary outcome. Cox-regression models were used to assess the relationship between EEG metrics and all-cause mortality.

Results
After accounting for missing data, 3,909 NPSG’s with at least 6h of usable EEG were available for analysis (age=64±11 yrs., 53.4% female). In multivariate Cox-regression models adjusted for age, gender, race, severity of sleep apnea, total sleep time, time spent in stage N2, and smoking, all-cause mortality was significantly associated with the highest quartile of SWA (HR_q4=0.77 [0.6-0.9], p=0.01), highest two quartiles of ∆SWAK (HR_q3=0.8 [0.6-0.9], p=0.04; HR_q4=0.6 [0.5-0.8], p&lt; 0.001).

Conclusion
Quantitative EEG measures predict mortality in a large community-dwelling cohort. Specifically, slow-wave activity surrounding K-complexes appear to be strongly associated with all-cause mortality beyond the effect of known covariates. Combined with our previous studies, our data suggest that slow-wave specific EEG measures are predictive of short- and long-term consequences of sleep fragmentation.

Support (if any)
AASM Foundation BS-233-20, NIH-K25HL151912, R21HL165320
0726 Agreement Between an Electroencephalography-Measuring Headband and Polysomnography in Older Adults with Sleep Disturbances
Authors: Miner Brienne , Pan Yulu , Burzynski Chase , Iannone Lynne , Knauert Melissa , Gill Thomas , Yaggi H 
Published: May 2023

Abstract

Introduction
Polysomnography (PSG) is the gold standard for objective sleep measurement but may not reflect habitual sleep patterns, especially in older adults with sleep disturbances. We compared measurements from an electroencephalography(EEG)-measuring headband, averaged over seven nights, to one night of home-based polysomnography.

Methods
In a prospective, observational study among 33 community-living adults ≥65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we collected objective measures of total sleep time [TST], sleep latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE] from an EEG-headband (Dreem; Paris, France) and home-based PSG (NOX-A1 Sleep System; Reykjavik, Iceland). Measures from the EEG-headband were averaged over seven days and compared to measures from one night of PSG. Pearson correlation coefficients compared agreement between the EEG-headband and PSG for TST, SOL, WASO, and SE. Two-sample paired T-tests examined mean differences within subjects for TST, SOL, WASO, and SE between the headband and PSG.

Results
The mean age was 75 (±6) years, 76% were women, mean scores for the Epworth Sleepiness Scale and Insomnia Severity Index were 6 (±4) and 13 (±4), respectively, and the mean AHI was 19 (±16) events/hr. Correlations for TST, SOL, WASO, and SE between the EEG-headband and PSG were 0.58, 0.51, 0.48, and 0.64, respectively (p values &lt; 0.01). On average, EEG-headband values for objective sleep measures were lower than PSG values. The mean differences for the EEG-headband and PSG within subjects for TST, SOL, WASO, and SE were 25 minutes (p=0.04), 15 minutes (p=0.06), 3 minutes (p=0.74), and 5 percent (p=0.02), respectively.

Conclusion
Among community-dwelling older adults with insomnia and daytime sleepiness, objective sleep measures from an EEG-headband, averaged over a week, were moderately correlated with values from one night of home-based PSG. While further validation of the EEG-headband is needed, these results suggest it may be inappropriate to infer habitual sleep patterns from PSG measures in older adults with sleep disturbances.

Support (if any)
Claude D. Pepper Older Americans Independence Center at Yale (P30AG021342), the Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).
0727 Association of sleep quality with memory functions among dementia-free, middle- and older-age, rural Indians
Authors: Sundarakumar Jonas , Rai Pooja , Divya N M , Issac Thomas 
Published: May 2023

Abstract

Introduction
Sleep is known to be involved in cognitive processes, such as memory consolidation. Poor sleep is a potential risk factor for dementia. However, whether it is associated with decreased memory functions among dementia-free individuals is not well known. This study aims to investigate the effect of sleep quality on memory functions among middle and older-age adults from a rural Indian population.

Methods
Participants were dementia-free, rural Indians (≥ 45 years) recruited as part of an ongoing, prospective, aging cohort study, namely Srinivaspura Aging, NeuroSenescence, and COGnition (SANSCOG) study. Cross-sectional (baseline) data on sleep quality was obtained using Pittsburgh Sleep Quality Index (PSQI). Memory functions (at baseline) were assessed using subtests, namely immediate recall, delayed recall, name-face association, semantic fluency, phonemic fluency, and semantic association, from a culturally validated computerized neurocognitive test battery. Clinical Dementia Rating (CDR) was used to classify subjects based on their cognitive status into cognitively healthy (CDR=0) and MCI (CDR=0.5). Linear regression models, unadjusted and adjusted with cognitive status, age, gender, and depression, were used for analysis.

Results
In the unadjusted linear regression model 1, we found no association between sleep quality and the different subtests of memory. However, in model 2 (adjusting for cognitive status), sleep quality in persons with MCI was significantly associated with memory functions. Model 3 (model 2 + age) found that sleep quality in higher ages in MCI explained a significant variance in the association between sleep and subtests of memory function compared to cognitively healthy individuals. Model 4 (model 3 + gender) suggested that with increasing age, gender was significantly associated with sleep quality and memory among individuals with MCI compared to cognitively healthy individuals. Further, model 5 (model 4+ depression) found that depressed individuals with MCI showed a significant association between sleep quality and memory functions compared to those without depression.

Conclusion
When adjusted for cognitive status, age, gender and depression, there was significant association of sleep quality and memory functions, pointing to the important role of sleep in memory functions among middle and older-aged individuals without dementia.

Support (if any)
SANSCOG study is funded through the Centre for Brain Research by Pratiksha Trust
0729 Grandparents Raising Grandchildren: Does Caregiving Status Moderate the Relationship between Stress and Sleep
Authors: Stearns Melanie , McGovney Kevin , Curtis Ashley , Lee Soomi , Haley William , Szalacha Laura , McCrae Christina 
Published: May 2023

Abstract

Introduction
The close relationship between high stress and poor sleep is well known. Less is known whether this relationship is stronger for a certain population group who may experience more stress. Grandparents responsible for raising their grandchildren are such a vulnerable group, as increased caregiving responsibilities are associated with increased stress levels. To test this hypothesis, we examined whether grandparent caregiving status moderated the relationship between subjective stress and sleep.

Methods
The sample was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and stress variables of interest. Participants included grandparents who reported having been responsible for the care of their grandchildren for at least 1 year (N=63, age M=61.80, 64% female) and grandparents who were not responsible for their grandchildren (N=423, age M=62.98, 56.2% female). Multiple regressions (SPSS PROCESS) examined whether caregiving status (1=yes, 0=no) moderated associations between subjective stress (Perceived Stress Scale) and sleep (subjective Sleep Onset Latency-SOL and sleep quality) over the past month. Analyses controlled for age and gender.

Results
Caregiving status interacted with stress (t(1, 484)=3.81, p=.04) in its association with SOL (R2=.15, p=.001). Specifically, increased stress was associated with greater SOL in caregiving grandparents and to a lesser (but not significant) extent in non-caregiving grandparents (Z =1.49, p=.13). Caregiving status interacted with stress (t(1, 484)=5.76, p=.02) in its association with sleep quality (R2=.33, p&lt; 001). Specifically, increased stress was associated with worse sleep quality in caregiving grandparents and to a less extent in non-caregiving grandparents (Z =2.67, p=.01).

Conclusion
These results suggest that caregiving status may contribute to an increase in the positive relationship between subjective stress and sleep problems. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships as well as examine physiological measures of stress. In addition, studies should investigate whether addressing stress in behavioral sleep treatments may improve caregiving grandparents’ sleep.

Support (if any)
National Institute on Aging (P01AG020166, R37AG027343; McCrae, PI: R01AG061976)
0730 Polysomnographic characteristics among transgender adults; Influence of gender-affirming hormone therapy
Authors: Romero Ronald Gavidia , Padia Hiral , Matlen Lisa , Hershner Shelley 
Published: May 2023

Abstract

Introduction
Gender differences in polysomnographic characteristics (PC) among cisgender people may be influenced by gonadal hormones. Data on PC among transgender people (TP) receiving or not gender-affirming hormone therapy (GAHT) is sparse. This study aimed to describe PC among TP and explore associations between gender identity (GI), GAHT, and PC.

Methods
This cross-sectional study identified TP at a large academic sleep medicine center through medical record review. We included TP aged ≥18 years with available polysomnography data. The sample was stratified by GI (transfeminine and transmasculine) and further classified by GAHT use. Descriptive statistics were calculated for GI and GAHT groups. Linear regression models adjusted for age, obstructive sleep apnea, and depression diagnoses were utilized to examine associations between GI, GAHT, and PC (total sleep time [TST], sleep onset latency, rapid eye movement sleep latency [REMSL], arousal index, wake after sleep onset [WASO], sleep stage rapid eye movent [REM], non-REM [N] 1, 2, and 3 percentage, sleep efficiency, and periodic limb movement index [PLMI]).

Results
Seventy-seven individuals met inclusion criteria. Of these, 52% were transfeminine, mean age was 39.2±13.3 years, mean body mass index was 35.1±9.0 Kg/m2, and 56% used GAHT. Transmasculine people had significantly higher stage N3% (13.9±13.6 vs 7.7±10.0%), and lower PLMI (3.5±5.8 vs 10.6±18.6/h) compared to transfeminine participants. Among transmasculine people, REMSL was shorter in participants using GAHT compared to those not on GAHT (145.0±66.9 vs 217.1±104.1 minutes). In transfeminine people, stage N3% and REMSL were increased in those on GAHT compared to individuals not on GAHT (10.6±11.5 vs 4.9±7.7%; 214.8±126.9 vs 133.6±85.5 minutes, respectively), although not statistically significant. Adjusted analysis showed associations between transmasculine identity and decreased TST (β=-42.8, 95% CI [-84.7, -0.9] minutes), feminizing GAHT use and longer REMSL (β=84.2, 95% CI [0.1, 168.4] minutes), and suggested decreased REMSL and WASO with masculinizing GAHT use (β=-59.4, 95% CI [-134.2,15.3]; β=-28.7, 95% CI [-72.5, 15.0] minutes respectively).

Conclusion
This report highlights differential associations between GI, GAHT, and PC in TP. Despite some enhanced PC, transmasculine identity significantly decreased TST. In addition, feminizing GAHT contributed to mixed PC outcomes, while masculinizing GAHT appeared to improve them.

Support (if any)
None
0735 Restorative sleep restores sleep loss and excessive time in bed in middle-aged and older adults
Authors: Yoshiike Takuya , Utusumi Tomohiro , Matsui Kentaro , Nagao Kentaro , Saitoh Kaori , Otsuki Rei , Aritake-Okada Sayaka , Suzuki Masahiro , Kuriyama Kenichi 
Published: May 2023

Abstract

Introduction
Associations of sleep duration with health outcomes could differ depending on whether sleep is restorative. Age-related changes in the relationship between sleep need and sleep opportunity could also influence these associations.

Methods
Using data from 5804 participants of the Sleep Heart Health Study, a multicenter population-based prospective cohort study, we examined the longitudinal association of feeling rested after sleep combined with in-home polysomnographymeasured total sleep time (TST) or time in bed (TIB) with allcause mortality.

Results
A total of 223 (7.1%) and 991 (37.0%) deaths were reported in 3128 middle-aged (40–64 years) and 2676 older adults (≥ 65 years) with a mean (standard deviation) age of 54.5 (6.6) and 73.3 (5.7) years at baseline over a median (interquartile range) follow-up time of 12.3 (11.3–13.5) and 11.3 (8.2–12.2) years, respectively. Among middleaged adults, compared with the interquartile TST range (331 to &lt; 414 min) with feeling rested, the lowest TST quartile (&lt; 331 min) with feeling unrested was associated with higher mortality (adjusted hazard ratio [aHR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile (≥ 414 min) with feeling rested was associated with lower mortality, independently from health and sleep covariates (aHR, 0.55; 95% CI 0.32–0.97). Among older adults, TIB, but not TST, was consistently associated with mortality. Compared with the interquartile TIB range (404 to &lt; 482 min) with feeling rested, the highest TIB quartile (≥ 482 min) with feeling unrested was associated with higher mortality (aHR, 1.57; 95% CI 1.23–2.01).

Conclusion
The results suggest the role of restorative sleep in differentiating the effects of sleep duration on mortality outcomes for middle-aged and older adults. Our findings further suggest that there is a need to change the way to optimize sleep hygiene according to age groups: in middle-aged adults maintaining a substantial amount of sleep is more critical, whereas in older adults optimizing sleep opportunity is more critical to determine the sleep–mortality relationship.

Support (if any)
This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #19FA1009 and #21FA1002).
0736 Adherence to marianismo as a moderator in the relationship between family relationship quality and insomnia among Latina women
Authors: Giorgio Luciana , Diaz Sarah Valentina 
Published: May 2023

Abstract

Introduction
Studies have highlighted the detrimental impact of family conflict and the beneficial effects of family cohesion on insomnia. Given the Latinx cultural value of familism, which emphasizes the centrality of close, warm family relationships, the quality of family relationships may be an especially important risk or protective factor of insomnia among Latinas. Additionally, a high adherence to marianismo, the constellation of Latinx female gender expectations, may amplify the effects of family relationships on insomnia because it emphasizes the woman’s responsibility in maintaining harmonious family relationships. Our aims were to (a)examine the association between family conflict, family cohesion, and insomnia severity and (b)test the moderating effects of marianismo among Latinas.

Methods
Using a subsample of cross-sectional data from Latinas participating in the Hispanic Community Health Study/Study of Latinos(HCHS/SOL) Sociocultural and Sueño ancillary studies(n=604), we conducted weighted, linear regression analyses to test the association among family conflict(Conflict), family cohesion(Cohesion), and insomnia severity(IS). Adjusted models controlled for age, marital status, education, and English/Spanish language preference. A final adjustment was made for depressive symptoms. We conducted moderation analyses(marianismo*Conflict; marianismo*Cohesion) in minimally and fully adjusted models. Conflict was measured using the Family Cultural Conflict subscale of the Hispanic Stress Inventory. Cohesion was measured using a subscale of the Family Environment Scale. Marianismo was operationalized as adherence to the family pillar subscale of the Bem Sex Role Inventory. We used the Insomnia Severity Index to measure IS.

Results
Participants were Mage 41.38(SD=13.41). Most women were married(44.74%), earned &gt;high school diploma(39.71%), and preferred to speak Spanish(76.03%). The mean IS score was 8.02(SD=6.76). Conflict was not statistically significantly associated with IS(SE=0.05, p&gt;.05). One SD increase in Cohesion was associated with a 0.10 decrease in IS in minimally adjusted models(SE=0.05, p=0.04), but was not statistically significant after adjusting for depressive symptoms. Marianismo did not moderate these associations.

Conclusion
Greater cohesion emerged as a robust predictor of reduced insomnia severity in one of the first large-scale studies examining the effects of sociocultural factors on Latinas’ sleep. If replicated using longitudinal data, findings suggest that developing family-based interventions amplifying cohesion, rather than decreasing conflict, may be more beneficial for reducing insomnia among Latinas.

Support (if any)
0739 Effect of Obstructive Sleep Apnea and Insomnia on Cognitive Impairment in World Trade Center (WTC) Responders
Authors: Ravi Sri Saranya , Mullins Anna , De Resende Adriana , Hyung David Kim Do , Legard Alicia , Romero-Castillo Horacio , Parekh Ankit , Black Kathleen , Rapoport David , de la Hoz Rafael , Udasin Iris , Sunderram Jag , Ayappa Indu , Lu Shou-En 
Published: May 2023

Abstract

Introduction
Mild Cognitive Impairment (MCI) is defined as a noticeable decline in cognitive abilities that doesn't interfere with daily activities; MCI may be a precursor of Alzheimer’s disease and related dementia. Elevated risk of MCI has been shown in subjects with obstructive sleep apnea (OSA) in a sleep clinic population and in subjects with insomnia in a general population. OSA and Insomnia both have a high prevalence among members of the World Trade Center Health Program General Responders’ Cohort (WTCHP GRC). Previous research indicated they had a high prevalence of MCI but did not examine sleep. We examined the association between MCI with OSA and/or Insomnia in the WTCHP GRC.

Methods
We assessed MCI by the Montreal Cognitive Assessment (MoCA) in English (n=115) and Spanish (n=27). MoCA &lt; 26 defines MCI. OSA defined by AHI4&gt;=5 or RDI&gt;=15 events/hr, was assessed by home sleep test or in-lab NPSG. A score&gt;7 on the Insomnia Severity Index (ISI) defined insomnia. Education was categorized as &lt; or &gt; bachelor’s (BA/BS) degree; subjects were categorized as Latino or not. Variables were analyzed using linear correlation, t-tests and chi-square tests as appropriate.

Results
The study population consisted of 142 subjects (80%M/20%F, age 58±8 years, BMI=29.7±5 kg/m2., Non-Latino/White=57%, Latino/any race=35%, &lt; BA/BS=65%). OSA prevalence was 65.5% (mean AHI4=10.8±12.5/hr and RDI=21.42±16/hr). Insomnia prevalence was 48% (ISI=8.8 + 6). 48% (n=68) of subjects were classified as MCI. No correlation was observed between MoCA and OSA severity (r=0.1,p=0.24) or ISI (r=-0.1,p=0.1). Subjects without OSA had higher MCI prevalence (MCI_OSA=21.5% vs MCI_noOSA=37%, p=0.018). Lower educational level, race/ethnicity, and language (Spanish/English) (p&lt; 0.001) were associated with MCI.

Conclusion
In this heterogenous cohort, we showed an unexpected lower MCI prevalence in OSA subjects. As shown by others, MCI defined by the MoCA was highly impacted by race/ethnicity, language and education. This suggests that our findings may be influenced by differences in the MoCA scoring and MCI cutoffs in Hispanic populations. To understand the relationship between MCI and sleep disorders in the WTC population, future studies should re-assess the cutoffs used in MoCA scoring or use tools to assess MCI less dependent on ethnicity and educational level.

Support (if any)
NIOSH/CDC U01OH011481, K24HL109156