bluuebunny/crossref_metadata_2025_split huggingface dataset:
0642 Effect of Iloperidone on Sleep Symptoms in Bipolar Patients with Manic and Mixed Episodes: A Randomized, Placebo Controlled Study
Authors: Torres Rosarelis , Smieszek Sandra , Xiao Changfu , Czeisler Emily , Polymeropoulos Christos , Birznieks Gunther , Polymeropoulos Mihael 
Published: May 2023

Abstract

Introduction
Iloperidone, a dopamine D2 receptor and serotonin 5HT2A receptor antagonist, was evaluated for the treatment of acute manic and mixed episodes associated with bipolar I disorder in adults in a phase 3 clinical trial. A core symptom of bipolar I disorder is disturbance in sleep. During manic episodes this commonly presents as reduced need for sleep with studies finding that 69%–99% of bipolar individuals report a lessened need for sleep or difficulties in falling and/or staying asleep. Here we present a post hoc analysis evaluating iloperidone effects on the sleep component of the Young Mania Rating Scale (YMRS) in patients with bipolar I disorder which addresses both sleep and the reduced need for sleep in that component.

Methods
This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group study of iloperidone in patients with acute manic or mixed episodes associated with bipolar I disorder. Patients received four weeks of double-blind treatment. The primary analysis demonstrating an overall improvement from baseline YMRS score in iloperidone assigned patients versus placebo assigned patients (p = 0.000008) at the end of the study (week 4). A YMRS item level analysis evaluated changes on YMRS single items including the sleep component in the intent-to-treat population (N = 392) using a mixed-effects model for repeated measures approach.

Results
The least squares mean difference (LSMD) in change from baseline to day 28 was statistically significant on the YMRS sleep component in favor of iloperidone versus placebo (iloperidone = -1.26, placebo = -0.95; p = 0.008).

Conclusion
In addition to improving overall mania symptoms as reported by the YMRS, improvements were also seen in iloperidone treated patients in the sleep component which at baseline included assessments of both decreased sleep and decreased need or denial of the need for sleep.

Support (if any)
This work was supported by Vanda Pharmaceuticals Inc.
0643 Machine Learning Model to Predict Depressive Mood Using Graph Theory Analysis of Polysomnography
Authors: Kim Seung Soo , Yang Kwang Ik 
Published: May 2023

Abstract

Introduction
The authors conducted this preliminary study to discover the brain signal features for subjective depressive mood by the method that combines a machine learning approach and a graph theory analysis.

Methods
The authors retrospectively investigated the records of 13 subjects who had undertaken polysomnography (PSG) and patient health questionnaire-9 (PHQ-9). We divided the data to a training set (10 subjects) and a test set (2 subjects). The predictive modeling was conducted by 3 steps: 1) estimation of the small world coefficient (sigma, omega) of each frequency bands (delta: 0.5-4.0 Hz, theta: 4.0-8.0 Hz, alpha: 8.0-12.0 Hz, sigma: 12.0-16.0 Hz, beta: 16.0-30.0 Hz, gamma: 30.0-100.0 Hz) of electroencephalography (EEG) channel for N1 and N2 sleep, 2) training predictive models, and 3) evaluation of final performance of model by using test set. The authors used mean absolute error (MAE) and mean squared error (MSE) as evaluation metrics. The training was conducted using Python 3.8, and its libraries (MNE-Python, MNE-connectivity, NetworkX, xgboost scikit-learn).

Results
Median value of PHQ-9 score was 6.0 (interquartile range: 5, 8). Lasso regression model showed good performance (MAE 0.6, MSE 0.4). XGBoost model also showed good performance (MAE 0.8, MSE 1.3).

Conclusion
Lasso regression model using small world coefficient of EEG in overnight PSG showed good predictive value for PHQ-9. The further research using a sufficient sample is needed.

Support (if any)
0644 Poor Sleep Quality Predicts Worse Mood Symptoms in Adolescents with Bipolar Disorder: A Longitudinal Randomized Controlled Trial
Authors: Stepan Michelle , Teresi Giana , Franzen Peter , Rode Noelle , Goldstein Tina 
Published: May 2023

Abstract

Introduction
Adolescents with bipolar disorder are at ultra-high risk of suicide and poor psychosocial functioning. Sleep is impaired during periods of depression, mania, and euthymia in adults with bipolar disorder and may be a transdiagnostic risk factor for new onset of mood symptoms. Sleep worsens during adolescence, but less is known about the interrelationships between poor sleep and mood symptoms in adolescents with bipolar disorder.

Methods
Participants included adolescents with bipolar disorder (n=75, 12-18 years, 65 females) who consented to a randomized controlled trial of Dialectical Behavior Therapy (DBT) vs. Standard of Care (SOC; other evidence-based psychotherapy approaches) at a specialty psychiatric clinic. Participants completed seven assessment visits, five during the year-long treatment period (baseline, 3-months, 6-months, 9-months, 12-months) and two during the post-treatment follow-up (18-months, 24-months). During each visit, participants completed the Pittsburgh Sleep Quality Index (PSQI) and a semi-structured interview to obtain weekly clinician-rated mood symptom ratings for depression, hypomania, and suicidal ideation.

Results
Most participants (75.9%) had a PSQI score &gt;5 at baseline, reflecting poor sleep quality (M=8.86, SD=4.30). Sleep quality improved between baseline and 3-months (Mdiff=-2.01, p=.006) and remained stable thereafter but did not differ between treatment groups. Lag analyses examined whether sleep quality predicted the next month’s average mood symptom ratings. Across treatment group, sleep quality at 6-months predicted next month depression, hypomania, and suicidal ideation severity (ps&lt;.032). For DBT, sleep quality at baseline predicted next month suicidal ideation severity (p=.047), and sleep quality at 9-months predicted next month hypomania severity (p=.003). For SOC, sleep quality at 6-months predicted next month depression severity (p=.027), and sleep quality at 9-months predicted next month suicidal ideation severity (p=.005). Worse sleep quality predicted worse future mood symptoms for all significant lagged effects.

Conclusion
Sleep quality is poor among adolescents with bipolar disorder. Sleep quality predicted future mood symptoms, suggesting that poor sleep may causally contribute to worse mood symptoms, particularly mid to late treatment. Thus, poor sleep could be a critical therapeutic target in future treatments to further improve mood symptoms in this population.

Support (if any)
R01 MH100056.
0646 Psychological distress as predictors of disturbed sleep among college students
Authors: Watson Kennedi , Ji Xiaopeng , Covington Lauren , Brownlow Janeese 
Published: May 2023

Abstract

Introduction
Poor sleep quality is prevalent among college students and has a significant impact on their daily activities. Further, college students are under extreme pressure to excel in an academic, occupational and social context, and psychological distress often exacerbate sleep quality. This study aimed to examine relationships between psychological stress and sleep quality among undergraduate students.

Methods
Baseline data were obtained from students who completed self-report measures as part of a larger study (n=56; mean age 20.23 (1.5); 83.9% females). Poor sleepers were categorized when participants had at least 2 of the following indicators: excessive daytime sleepiness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), and poor sleep quality (Pittsburgh Sleep Quality Index). The Beck Depression Inventory-II assessed depressive symptoms, the PCL-5 determined posttraumatic stress disorder (PTSD) symptomatology, and the Generalized Anxiety Disorder-7 (GAD) scale assessed for anxiety symptoms. Binary logistic regression analyses identified the association between poor sleepers, PTSD, GAD, and depressive symptoms, while adjusting for sex and body mass index (BMI).

Results
Approximately 33.9% of students experienced excessive daytime sleepiness, 30.4% suffered from insomnia, 89.3% had poor sleep quality, and 62.5% of the sample experienced one or more psychological stressors. Forty-eight percent of the students were categorized as poor sleepers. Using binary logistic regression, after adjusting for sex and BMI, students who experienced PTSD (OR= 1.075, 95%CI [1.023, 1.130]), GAD (OR=1.227, 95%CI [1.072, 1.406]), and depressive (OR=1.105, 95%Cl [1.023, 1.192]) symptoms had an increased risk for being poor sleepers.

Conclusion
Findings indicate that mental health is a core component of well-being and sleep health, and that early assessment and treatment of psychological distress may be an important strategy for intervention of poor sleep quality and disturbed sleep among college students.

Support (if any)
This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
0647 Rest-activity pattern in Major depressive disorder - a case control study
Authors: Chen Jie 
Published: May 2023

Abstract

Introduction
Disruption of rest-activity pattern are important behavioral manifestations in patients with major depressive disorder (MDD). Actigraphy provides accessible and objective measurement on physical activity, sleep, and circadian rhythm, but it was not widely used in studying patients with MDD, especially among Asian population.

Methods
Rest-activity pattern was recorded by Actiwatch Spectrum Plus/PRO for 7 continuous days. Physical activity and sleep estimation was processed by Philips Actiware software 6. Circadian rhythm characteristics were generated by using the “cosinor” and “nparACT” packages in R to perform the cosinor and nonparametric analysis respectively.

Results
A total of 70 MDD subjects, and 59 age- and sex-comparable controls were included in the actigraphy data analysis. The mean age of MDD subjects was 51.24 ± 10.39 years, and 71.4% of MDD subjects were female. Of these MDD subjects, 54.3% were unremitted for their depressive illness. For sleep and circadian features, MDD subjects had higher Insomnia Severity Index (ISI score, MDD: 10.29 ± 5.70; controls: 6.05 ± 5.20, P &lt; 0.001) and lower reduced Morningness-Eveningness questionnaire (rMEQ score, MDD: 13.19 ± 4.62; controls: 16.07 ± 3.28, P &lt; 0.001) than controls. The percentage of mobility measured by actigraphy was significantly lower in MDD patients than controls (MDD: 58.58%; controls: 62.27%, P &lt; 0.001), albeit the difference only occurred during rest period. MDD subjects had later acrophase (P = 0.024), M10 midpoint (P = 0.040) and a trend of delayed sleep midpoint (P = 0.076) and longer sleep duration (P = 0.067) than controls. When the comparison was performed among three groups, unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint than remitted MDD group (P = 0.021) and higher intra-individual variability for sleep duration than controls (P = 0.016).

Conclusion
MDD subjects had increased insomnia and eveningness than controls, which was supported by the acitgraphy data at which MDD had a tendency of longer major rest interval and delayed circadian phase. Unremitted MDD subjects showed a higher intra-individual variability of sleep midpoint and sleep duration. These actigraphy parameters may be useful markers for phenotyping and monitoring of MDD.

Support (if any)
0648 Retinal responsivity is associated with light and season-related cognitions in older adults with seasonal depression
Authors: Klevens Alison , Wescott Delainey , Taylor Maddison , Roecklein Kathryn 
Published: May 2023

Abstract

Introduction
Maladaptive cognitions associated with lower light availability in winter and the changing of the seasons are elevated in winter depression and are treatment targets in psychotherapy. Mechanisms underlying the development of SAD-specific cognitions may be related to seasonal variation in melanopsin-driven retinal responsivity to light. Prior work has shown reduced retinal responsivity to light during the winter in seasonal depression. We hypothesized maladaptive seasonal cognitions would be associated with reduced retinal responses to light. We also tested whether age moderated this relationship, hypothesizing that this learned association may only appear in older individuals who have experienced a greater number of seasonal depressive episodes.

Methods
Participants ages 19-65 (M=36.13, SD=12.81) with seasonal depression (n=37) and non-depressed controls (n=32) completed assessments in winter months (21st December to 21st March). Maladaptive seasonal cognitions were measured by the Seasonal Beliefs Questionnaire (SBQ). Melanopsin-driven retinal responsivity was assessed using the post illumination pupil response (PIPR). Net PIPR as a percent of baseline was averaged across the 10-30 seconds post-stimulus for use in analyses. Using multiple regression, we tested (1) if seasonal beliefs predict the PIPR and (2) if an interaction between seasonal beliefs and age predicts the PIPR, controlling for gender, the pupillary light reflex (PLR), and circadian time of testing from Dim Light Melatonin Onset.

Results
Seasonal beliefs were not associated with the PIPR (b= -0.86e-5, SE=0.27e-3, p=0.98). There was a significant interaction between seasonal beliefs and age on the PIPR (b= -0.56e-4, SE=0.23e-4, p=0.02), in which greater seasonal beliefs were associated with reduced PIPR in older individuals but not younger individuals. The Johnson-Neyman interval indicated that in participants above age 49, greater seasonal beliefs were significantly associated with lower retinal responsivity (PIPR; p&lt; 0.05).

Conclusion
Greater seasonal beliefs were associated with reduced retinal responsivity, but only in older adults with seasonal depression. It is possible that reduced retinal responsivity creates learned maladaptive schemas regarding seasonal changes that are reinforced with annually recurring winter depressive episodes. However, longitudinal data focused on changes in seasonal beliefs resulting from reduced retinal sensitivity is necessary to test whether retinal responsivity is a mechanism in the formation of these seasonal-specific cognitions.

Support (if any)
0650 Sleep and Mental Health Symptoms at the Population Level: Differences by Race/Ethnicity
Authors: Ghani Sadia B , Valencia Dora , Jean-Louis Girardin , Killgore William D S , Grandner Michael 
Published: May 2023

Abstract

Introduction
There is a bidirectional relationship between sleep duration and mental health. This relationship may be impacted by race/ethnicity, indicating differential risk profiles across groups. Therefore, we aimed to determine whether race/ethnicity play a role in the relationship between sleep and mental health at the population level.

Methods
Data were used from adults age 18+ from the combined 2015-2020 (pre-pandemic) National Health and Nutrition Examination Survey (NHANES) (N=16,399). Habitual sleep duration was self-reported in half-hour increments and categorized as &lt; 5h, 5.5-6.5h, 7-8h, 8.5-9.5h, or 10+h. Mental health symptoms in the past 2 weeks were reported as “not at all,” “several days,” “&gt;half of days” or “nearly every day” and included depressed mood, anhedonia, feelings of guilt, appetite dysregulation, and suicide ideation. Race/ethnicity was self-reported as Non-Hispanic White (N=5499), Black/African-American (N=3975), Mexican-American (N=2337), Other Latinx (N=1846), Asian/Pacific-Islander (N=1984), or Multiracial/Other (N=758). Additional covariates included age and sex. NHANES sample weights were used for all analyses. Ordinal logistic regressions examined mental health outcomes associated with sleep duration stratified by race/ethnicity.

Results
Sleep duration by race/ethnicity interactions were seen for depression (p=0.006), guilt (p=0.009), appetite dysregulation (0.049), and suicide ideation (p&lt; 0.0005), with a trend for anhedonia (p=0.185). Non-Hispanic Whites demonstrated U-shaped relationships with all mental health variables. Blacks/African-Americans demonstrated U-shaped relationships for depressed mood and anhedonia and relationships with short sleep for guilt, appetite, and suicide ideation. Mexican Americans demonstrated a U-shaped association with guilt and an association between long sleep and depressed mood, anhedonia, and suicide ideation. Other Latinx showed a U-shaped association with guilt and appetite, and long sleep relationships with depressed mood, anhedonia, and suicide ideation. Asians/Pacific-Islanders showed short sleep associations with depressed mood and appetite. Multiracial/Others showed a short sleep relationship with guilt and a long sleep relationship with suicide ideation.

Conclusion
Both short and long sleep duration were associated with worse mental health. However, this pattern of relationships depends on race/ethnicity, as different groups show different patterns of vulnerability. Future work should explore mechanisms of differential vulnerability and develop targeted interventions based on risk profile.

Support (if any)
0651 Sleep Reactivity as a Vulnerability Factor for Depressive Symptoms
Authors: Egeler Mara , Dickens Harrison , Hire Veronica , Walker Jamie , Vargas Ivan 
Published: May 2023

Abstract

Introduction
Insomnia and depression are closely linked. While poor sleep is often classified as a symptom of depression, research now supports that insomnia often precedes and predicts the onset of depression. One factor that may explain this relationship is sleep reactivity, or the tendency to experience sleep disturbances in response to stressful life events. Sleep reactivity is considered a vulnerability factor for insomnia. This study aimed to replicate recent findings that suggest sleep reactivity is also independently related to depression.

Methods
Survey data was collected from 236 U.S. adults (69.1% White, 61.9.3% Female, 18-85 y) regarding demographic information, sleep patterns, and general health and well-being. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD). Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). Sleep reactivity was assessed using the Ford Insomnia Response to Stress Test (FIRST). A hierarchical multiple regression was conducted with total CESD scores as the dependent variable. Total ISI scores and gender were entered as covariates in model 1 and total FIRST scores as the predictor variable in model 2.

Results
The fitted regression for model 1 was statistically significant (R2 = 0.37, F(2,233) = 64.47, p &lt; .001). It was found that both greater ISI and being female gender predicted depression scores (β = 1.04, p &lt; .001, and β = 1.64, p = .05). For model 2, the regression was also significant (R2 = 0.38, F(3,232) = 47.60, p &lt; .001). Greater FIRST scores were related to greater depressive symptoms (β = 0.23, p = .02), even after controlling for both insomnia symptoms and gender.

Conclusion
Sleep reactivity is independently related to depression symptoms, independent of insomnia. Future studies examining how multiple types of stress reactivity impact an individual’s risk for developing depression should be considered.

Support (if any)
K23 HL141581
0654 TRAUMA LEADS ASSOCIATION BETWEEN SLEEP AND SUICIDAL IDEATION IN YOUTH
Authors: Vera Miranda , Miranda Regina , Dennis-Tiwary Tracy , Baroni Argelinda 
Published: May 2023

Abstract

Introduction
Sleep disturbances are established risk factors for youth suicidal ideation. Trauma is known to exacerbate sleep disturbances and suicide ideation severity. Given these relationships, it is worth examining the impact of trauma on the association between sleep and suicidal ideation as little research to date has explored this relationship in youth. The current study addresses this knowledge gap by investigating how trauma impacts youth suicidal ideation via sleep in an acutely suicidal, clinical sample of adolescents.

Methods
113 adolescents between ages 12 and 17 years old (M = 14.6, SD = 2.2) were recruited after presenting to public New York City hospitals for suicidal ideation or a suicide attempt within the preceding 2 weeks. This clinical sample is diverse, with 76% identifying as a racial minority, 61% as a Hispanic/Latino, 87% as a gender minority, and 75% as a sexual minority. Participants completed self-report measures via an online questionnaire measuring their suicide ideation severity (Suicidal Ideation Questionnaire-Junior; SIQ-JR), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and trauma symptoms (Child Trauma Screen; CTS). Partial correlations were conducted to examine the relationship between sleep quality and suicide ideation severity controlling for trauma symptoms.

Results
As expected, poorer sleep quality was associated with greater suicide ideation severity (r[103] = .244, p = .012). However, this association disappeared when controlling for trauma symptoms (r[102] = .064, p = .516). Of the 7 PSQI subscores, sleep quality, sleep latency, and daytime dysfunction correlated significantly with suicide ideation severity (r[103-110] = .195-.298, p = .001-.039). Ninety-percent of participants reported trauma symptoms.

Conclusion
These findings suggest that trauma affects the association between sleep and suicidal ideation. However, given the prevalence of trauma symptoms in this sample, future research should seek to differentiate sleep and trauma effects on suicidal thoughts and behaviors and how specifically targeted treatments may ameliorate outcomes.

Support (if any)
1RF1MH120846 from NIMH/NIH (Regina Miranda, PI)
0655 Whose Mind after Midnight? Demographic and Clinical Variation in Nocturnal Suicide Risk
Authors: Gorovoy Suzanne , Tubbs Andrew , Fernandez Fabian-Xosé , Klerman Elizabeth , Basner Mathias , Chakravorty Subhajit , Perlis Michael L , Grandner Michael 
Published: May 2023

Abstract

Introduction
Although suicides are more prevalent during the day, the risk of suicide is highest at night when adjusted for population wakefulness. It is unclear how nighttime patterns of suicide risk vary by demographic and clinical subgroups.

Methods
Population wakefulness data were combined with time of fatal injury data for 78,647 suicides from 2003-2017. The primary outcome was number of suicides per hour with wakefulness as an offset/exposure term. Subgroups included sex, race, ethnicity, military service, blood alcohol category and marijuana positive on autopsy, current depressed mood or partner conflict, and prior suicidal ideation or suicide attempts. Formal interaction tests identified significant subgroup variations adjusted for age, sex, race, and ethnicity where appropriate. Groups with significant interactions were subsequently examined using robust Poisson regression models to measure incident risk ratios (IRRs).

Results
There were subgroup interactions for age (p &lt; 0.001), ethnicity (p = 0.014), blood alcohol level on autopsy (p &lt; 0.001), and current partner conflict at time of fatal injury (p &lt; 0.001). There was a sharp peak in risk around 4AM for individuals aged 15 to 24 (aIRR: 3.11 [2.39, 4.05]) and 25-34 (aIRR 2.15 [1.63, 2.86]), and at 6AM for individuals aged 65 to 74 (aIRR: 1.78 [1.40, 2.25]) and 75+ (aIRR: 2.25 [1.69, 3.00]). Hispanic individuals had an elevated risk between 10PM and 3AM with a maximal 232% increase at 2am (aIRR: 2.32 [1.67, 3.23]). Current partner conflict increased risk from 8PM to11PM and from 1AM to 3AM with a peak risk at 11PM (aIRR: 1.53 [1.24, 1.89]). Individuals with a BAL &lt; 0.08 mg/dL showed a sustained increased risk for suicide between 8PM and 4AM; individuals with a BAL of 0.08 mg/dL or more showed greater risk (aIRR 2.33 [1.88, 2.89] at 1AM) than those with a BAL &lt; 0.08 mg/dL (aIRR: 1.68 [1.40, 2.01] at 12AM).

Conclusion
Nighttime suicide risk varied significantly by age, ethnicity, blood alcohol level on autopsy, and current partner conflict. Military service was not associated with greater nighttime risk, which contrasts with prior findings.

Support (if any)