bluuebunny/crossref_metadata_2025_split huggingface dataset:
0401 Factors Associated with Insomnia in Male University Students
Authors: George Brianna , Garland Sheila 
Published: May 2023

Abstract

Introduction
University students can experience high levels of stress, and this can impact sleep quality and increase insomnia symptomology. Little research has investigated insomnia in male university students. This study examined factors associated with insomnia in male students to address concerns and direct resources.

Methods
Male students aged 18-35 at Memorial University completed an online survey. The Insomnia Severity Index (ISI) was used as the dependent variable to measure insomnia. Participants self-reported demographic and academic variables and also completed the Morning Evening Questionnaire (MEQ), Mindful Attention Awareness Scale (MAAS), Medical Outcomes Study Social Support Survey (MOS-SSS), Kessler Psychological Distress Scale (K10), and indicated sleep medication and stimulant use. Univariate and multivariate linear regressions were used to examine the relationship between insomnia and demographic factors, chronotype, social support, mindfulness, psychological distress, and sleep medication and stimulant use.

Results
The majority of participants (n=564; Mage = 23) were white (77.8%), undergraduates (76.3%), and enrolled full-time (90.7%). The mean insomnia severity score was 7.7 (SD = 5.42). Overall, 46% scored in the no insomnia range, 36% scored in the subthreshold insomnia range, 16% scoring in the clinical insomnia (moderate severity) range, and 2% scored in the clinical insomnia (severe) range. At the univariate level, sleep medication use (β = -.275, p &lt; .001), stimulant use (β = -.158, p &lt; .001), chronotype (β = -.344, p &lt; .001), social support (β = -.244, p &lt; .001), mindfulness (β = -.409, p &lt; .001), and distress (β = .577, p &lt; .001), were significantly associated with insomnia symptom severity. In the multivariate model (Adjusted R2 = .40, p &lt; .001), only evening chronotype (β = -.195, p &lt; .001), greater distress (β = .429, p &lt; .001), and sleep medication use (β = -.139, p &lt; .001) remained significantly related to insomnia.

Conclusion
This study identified factors associated with insomnia in male university students. Addressing insomnia, particularly in those with evening chronotype and those who use sleeping medication, may improve psychological distress and the overall well-being of male university students.

Support (if any)
Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).
0403 Functional Connectivity of Brain Networks Predicts Polysomnographically Measured Sleep
Authors: Killgore William , Jankowski Samantha , Henderson-Arredondo Kymberly , Hildebrand Lindsey , Elledge Heidi , Lucas Daniel , Dailey Natalie 
Published: May 2023

Abstract

Introduction
The arousal hypothesis predicts that increased cognitive and somatic arousal interfere with sleep among patients with insomnia. Evidence suggests that the connectivity of the brain’s default mode network (DMN) may play an important role in this process. Here, we examined the association between whole cortex resting state functional connectivity and subsequent polysomnographically (PSG) assessed sleep the same night in a sleep laboratory among individuals with documented insomnia.

Methods
We collected data from twenty participants (12 female; age=26.9, SD=6.6 years) meeting criteria for insomnia/sleep disorder. Each participant completed a baseline resting state functional connectivity (rsFC) scan in the early evening and then retired to their own private bedroom in a sleep laboratory. Participants were monitored throughout the night with polysomnography and evaluated for various sleep parameters. Data were analyzed using the CONN Toolbox, v17f. Total Sleep Time from PSG was extracted and entered as a covariate into the whole brain connectivity analysis. Connectivity across the regions identified in the Automated Anatomical Labeling Atlas was assessed using the ROI-to-ROI analysis approach, with a peak signal threshold of p &lt; .001 (uncorrected) and False-Discovery-Rate (FDR) correction seed level correction. We focused on the anterior and posterior medial regions of the DMN.

Results
The analysis showed that TST was significantly negatively correlated with numerous regions throughout the brain (p&lt;.05, FDR corrected), while there were no regions of positive connectivity. Consistent with our hypothesis, we found that greater TST was associated with anticorrelated activation between the anterior cingulate cortex and regions associated with language processing (i.e., Heschl’s gyrus), sensory motor function (precentral and postcentral gyri), superior temporal gyrus, parietal occipital gyrus, temporal pole, and occipital cortex.

Conclusion
Findings suggest that the connectivity of the anterior DMN with language, sensory, motor, and emotional processing regions is related to subsequent PSG measured sleep. Prior work has suggested that stronger anticorrelations between the DMN and task-positive regions is associated with better cognitive performance. Our findings also suggest that stronger anticorrelations between the anterior DMN and these other cortical regions are highly related to sleep among individuals with insomnia.

Support (if any)
W81XWH2010173
0407 Impact of Lemborexant on Daytime Ratings of Sleepiness/Alertness in Subjects with Insomnia Disorder and Baseline Sleepiness
Authors: Ancoli-Israel Sonia , Moline Margaret , Cheng Jocelyn , Kumar Dinesh 
Published: May 2023

Abstract

Introduction
Since the use of sleep-promoting drugs can also lead to residual morning sleepiness, it is important to determine if a new hypnotic is associated with such a carryover effect of treatment. To this end, an assessment of sleepiness/alertness was included in lemborexant (LEM) phase 3 studies. LEM is a competitive dual orexin receptor antagonist approved in several countries for the treatment of adults with insomnia. This post-hoc analysis of Study 304 (E2006-G000-304; NCT02783729) assessed the impact of LEM on morning sleepiness/alertness in subjects who reported at least mild/moderate morning sleepiness at baseline.

Methods
Study 304 was a randomized controlled study in adults ≥55y with insomnia disorder (N=1006). Subjects received bedtime doses of placebo (PBO), LEM 5mg (LEM5), LEM 10mg (LEM10), or zolpidem tartrate extended release 6.25 mg (not reported here) for 1 month. A daily Sleep Diary assessed morning sleepiness, within 90 min of waketime, with the question “How alert/sleepy do you feel this morning?” rated from 1 (extremely sleepy) to 9 (extremely alert). Scores were averaged over 7-day periods for baseline (single-blind run-in) and first and last 7 days of treatment. Chi-square tests were used to compare the shift from sleepy (≤3) to more alert (&gt;3) between PBO and treatment groups.

Results
At baseline, 59/203 (29.1%), 66/261 (25.3%), and 79/265 (29.8%) of the PBO, LEM5, and LEM10 subjects reported a score ≤3, indicating at least mild/moderate morning sleepiness. At the end of 1 month of treatment, 37/57 (64.9%) of the PBO subjects rated themselves as less sleepy and more alert (&gt;3), compared with 50/64 (78.1%; P=0.11) LEM5- and 58/76 (76.3%; P=0.15) LEM10-treated subjects.

Conclusion
In this study, ~28% of subjects reported morning sleepiness at baseline. More subjects who reported sleepiness at baseline and received LEM reported improved morning alertness during the last week of treatment compared with PBO subjects. These data are concordant with previous findings of a lack of effect of LEM on tasks requiring alertness in the morning.

Support (if any)
Eisai Inc.
0412 Multimethod Remote Assessment of Cognition Among Older Adults with Insomnia
Authors: Adornetti Julianna , Zhao Zhiwei , Wilckens Kristine , Wade Christine , Verceles Avelino , Chen Shuo , Buysse Daniel , Wickwire Emerson 
Published: May 2023

Abstract

Introduction
Cognitive complaints are common among older adults with insomnia. However, previous research is inconsistent regarding the association between insomnia and objective cognitive function. The purpose of this study was to compare subjective and objective cognitive function between older adults with insomnia and healthy sleepers. We hypothesized that relative to healthy sleepers, older adults with insomnia would display diminished subjective and objective cognitive function as measured via multiple remote assessment methods.

Methods
Participants were recruited from an academic medical center through multiple pathways. Cognitive assessments were administered via several approaches. First, subjective cognitive function was assessed via the 5-item Alert Cognition subscale of the psychometrically derived Daytime Insomnia Symptoms Scale (DISS), completed via smartphone 4x/day throughout a two-week study period (i.e., 56 administrations over 14 days). Second, objective cognitive function was assessed via telephone using the Brief Test of Adult Cognition by Telephone (BTACT), which assesses memory, reasoning, verbal fluency, and executive function. Finally, the psychomotor vigilance task [PVT], Stroop test, and a task-switching exercise were administered remotely via participant’s home desktop computer.

Results
Participants included 31 older adults who met DSM-V diagnostic criteria for insomnia disorder (67.5 [sd 6.6] years) and 33 older adults without sleep disorders (70.5 [sd 5.7] years). Large between-group differences were observed in the Alert Cognition subscale of the DISS (p-values &lt; 0.0001); compared to healthy sleeper controls, participants with insomnia reported worsened forgetfulness, concentration, alertness, clear-headedness, and cognitive effort. No between-groups differences were observed in any domain of the BTACT or PVT. A numeric but not statistically significant between-groups difference was observed in overall response speed (e.g., Incongruent Response Time) on the Stroop test (p-values &gt; 0.125).

Conclusion
Remote assessment of cognition is feasible among older adults with insomnia. Significant differences in subjective but not objective cognitive function, likely due to low statistical power, as cognitive deficits in insomnia tend to have small effect sizes. Overall, findings highlight the importance of multimethod assessments of cognition in older adults with insomnia and need for large sample sizes when evaluating objective cognitive function.

Support (if any)
Research was supported by an investigator-initiated research award from Merck Investigator Studies Program (PI: EMW).
0413 Neuroticism interacts with stressful experiences during deployment to predict post-deployment insomnia
Authors: So Christine , Miller Katherine , Gehrman Philip 
Published: May 2023

Abstract

Introduction
Negative affect traits, such as neuroticism, have been shown to be associated with greater risk for insomnia. These trait-based factors are theorized to increase stress reactivity, which can be a predisposing factor to insomnia. Military personnel represent a unique population that are subject to stressors as a nature of their occupations and may therefore be particularly vulnerable to the onset and persistence of insomnia. The present study examined prospective associations among trait-based emotional reactivity and neuroticism, exposure to stressful experiences during a combat deployment, and insomnia symptoms at 9-months post-deployment.

Methods
Data were obtained from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers included in these analyses (n = 1448) completed surveys prior to deployment to Afghanistan, immediately after deployment, and 9-month post-deployment. The survey included measures of insomnia symptoms, deployment-related stressors and trait-based personality measures. Logistic regression was used to examine the relationships among emotional reactivity, neuroticism and deployment stress with post-deployment insomnia.

Results
Higher trait-based neuroticism and greater exposure to deployment-related stressors were independently associated with greater risk of probable insomnia at 9-months post-deployment, but not trait-based emotional reactivity . However, there were significant interaction effects, such that among those with greater range of stressful events, neuroticism was associated with higher risk of post-deployment insomnia, while emotional reactivity was associated with lower risk.

Conclusion
A trait disposition for negative affect (i.e., neuroticism) may predispose individuals to chronic insomnia in the face of acute stressors . While neuroticism includes negative emotional reactivity, it also encompasses other characteristics (e.g., negative self-perception) that may be a stronger predictor of persistent insomnia symptoms. Service members with higher baseline neuroticism may benefit from pre-deployment skills trainings to better cope in the face of stressors and prevent/mitigate long-term problems.

Support (if any)
This study is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.
0421 Synchronous Virtual Cognitive Behavioral Therapy for Insomnia: Preliminary Results of Sleep Pattern Changes among Cancer Survivors
Authors: Hall Kimberly Arditte , Ma Yan , Goldstein Michael , Cunningham Tony , Park Elyse , Gorman Mark , Comander Amy , Hall Daniel 
Published: May 2023

Abstract

Introduction
For cancer survivors, insomnia is a frequent and distressing concern. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment, yet in-person care can be difficult for cancer survivors to access for a variety of socioeconomic, medical and logistical reasons. In a pilot randomized clinical trial, four, weekly sessions of virtually-delivered, synchronous CBT-I were feasible, acceptable, and seemingly efficacious for reducing insomnia among cancer survivors (vs. an enhanced usual care control). The aim of this secondary analysis was to characterize daily patterns in sleep diary metrics during the intervention phase.

Methods
Adults who had completed treatment for any non-metastatic cancer and had chronic insomnia (DSM-5 criteria and Insomnia Severity Index score &lt;=15) and were randomized to receive CBT-I completed daily assessments of sleep quality (SQ), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), and waking after sleep onset (WASO) for 21 days (i.e., from Session 1-4). Linear mixed models were used to compute trajectories of change for each sleep metric and -2 log likelihood, AIC, and BIC fit indices.

Results
Among 20 cancer survivors who received CBT-I (mean age 51.2 ± 17.1 years, 90% female), model fit indices indicated that across sleep metrics, linear growth models provided a better fit to the data than either quadratic or cubic growth models. Significant linear improvement was observed for SQ (B = 0.02, t = 3.60, p &lt; 0.001), SE (B = 0.16, t = 2.01, p = 0.046), and SOL (B = -0.41, t = -2.47, p = 0.01), but not TIB, TST, or WASO (ts &lt; 1.12, ps &gt; 0.26).

Conclusion
Findings elucidate how sleep may be expected to change over the course CBT-I, in particular for the growing population of cancer survivors seeking virtual care for insomnia. The strengths, limitations, and potential modifications to optimize the intervention across sleep metrics will be discussed.

Support (if any)
This work was conducted with support from the American Cancer Society (Massachusetts General Hospital Institutional Research Grant, PI: Hall).
0424 Visualizing insomnia phenotypes using dimensionality reduction techniques
Authors: Bouchequet Paul , Andrillon Thomas , Solelhac Geoffroy , Rouen Alexandre , Sauvet Fabien , Léger Damien 
Published: May 2023

Abstract

Introduction
A large number of features can be extracted from a single hypnogram, such as stages durations, onsets, or transitions probabilities. Those numerous indicators can turn a collection of sleep records into a high dimension space. Dimensionality reduction techniques are then useful to reveal patterns in data. We used 3 dimensionality reduction techniques to visualize insomnia phenotypes from a dataset of insomnia and control sleep records: principal component analysis (PCA), t-distributed stochastic neighbor embedding (t-SNE) and uniform manifold approximation and projection (UMAP).

Methods
519 sleep records have been included with the following diagnoses: 46 sleep onset insomnia, 83 sleep state misperception, 223 sleep maintenance insomnia, 117 sleep onset and maintenance insomnia and 50 controls (good sleep). We limited the feature extraction to the hypnogram as macrostructure constitute the primary source of information used for diagnosis in polysomnography. We used common macrostructure indicators such as wake after sleep onset (WASO), as well as more intricate features such as stages transitions probabilities. A first set of 54 features per hypnogram was computed. Those features were then projected in a 2 dimensional space using PCA, t-SNE and UMAP.

Results
Co-ranking matrix of the projections was computed for the 3 techniques (PCA: Kmax=103, Qlocal=0.38; tSNE: Kmax=20, Qlocal=0.44; UMAP: Kmax=160, Qlocal=0.44). UMAP was the technique that projected the hypnograms feature sets in the most meaningful way, by reflecting the individual diagnoses. Interestingly in the UMAP representation, group outliers, such as controls having nevertheless experienced nocturnal awakenings were projected next to similar insomnia subjects, which indicate a fine-grained capture of sleep quality at the individual level.

Conclusion
Dimensionality reduction and unsupervised techniques are promising methods when approaching high dimensionality spaces. A fine analysis of projected clusters could show subgroups in already known phenotypes. As literature showed robustness and applicability of those methods to larger datasets, dimensionality reduction of insomnia records could be improved by the addition of new features computed from hypnodensities generated by machine learning algorithms, or by spectral features extracted from polysomnographic signals.

Support (if any)
None
0425 A Novel Acceptance-Based Approach for PAP Adherence in Women Veterans: Improvements in Measures of Sleep Quality
Authors: Carlson Gwendolyn , Gogineni Swetha , Mitchell Michael , Josephson Karen , Zeidler Michelle , Swistun Dominika , Lee Diane , Song Yeonsu , Fung Constance , Kelly Monica , Erickson Alexander , Washington Donna , Yano Elizabeth , Alessi Cathy , Martin Jennifer 
Published: May 2023

Abstract

Introduction
While positive airway pressure (PAP) therapy is the most efficacious and widely used treatment for sleep disordered breathing (SDB), the initial discomfort associated with PAP use and the poor sleep experienced by patients with SDB contribute to treatment non-adherence. Women with SDB report poorer sleep quality and have lower PAP adherence rates than men. Previous interventions to improve PAP adherence have rarely targeted women. Acceptance and Commitment Therapy (ACT) utilizes patient values and mindfulness techniques to promote sustained behavior change. An ACT-based approach, in combination with behavioral sleep improvement recommendations, may improve sleep quality and reduce barriers to PAP adherence.

Methods
We analyzed data from women veterans with SDB (mean age=53.2 years [range 26-80]; n=90) who participated in a clinical trial of interventions to improve sleep quality and PAP adherence. Participants were randomly assigned to a PAP educational control intervention or an ACT-based intervention, Acceptance and the Behavioral Changes to treat Sleep Apnea (ABC-SA). We measured: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and subjective and objective (actigraphy) sleep efficiency (SE), total sleep time (TST; minutes), and number of awakenings using sleep diary and actigraphy data, respectively. Using mixed-effects models, we examined changes in sleep quality measures at post-treatment and 3-month follow-up, as compared to baseline.

Results
Women assigned to the ABC-SA intervention reported significantly greater improvements on PSQI total score (p &lt; 0.001), ISI total score (p&lt; 0.001), diary SE (p&lt; 0.001), and actigraphy SE (p&lt; 0.041), and a decrease in actigraphy TST (p&lt; 0.013) at post-treatment compared to women assigned to the control intervention. These observed changes for the ABC-SA intervention relative to the control intervention were maintained at 3-month follow-up (p≤0.001-0.017). No group differences were observed for diary TST or number of awakenings on diary or actigraphy at post-treatment (p≥0.115) or 3-month follow-up (p≥0.248).

Conclusion
An ACT-based approach improved sleep quality in women veterans with SDB, thereby reducing a known barrier to PAP adherence. Future studies should replicate current findings in other at-risk patient groups.

Support (if any)
This research was supported by the VA HSR&D IIR 16-244. Dr. Martin was supported by VA HSR&D RCS 20-191 and NIH/NHLBI K24 HL143055
0428 Area Deprivation Index, Sleep Disordered Breathing and Incident Major Cardiovascular Events and Mortality in a Large Cohort
Authors: Orbea Cinthya Pena , Bruckman David , Schold Jesse , Foldvary-Schaefer Nancy , Thornton Daryl J , Alberts Jay L , Mehra Reena 
Published: May 2023

Abstract

Introduction
Epidemiological studies have shown a strong association between sleep disordered breathing (SDB) and increased incidence of cardiovascular morbidity and mortality, however, to date, the variation of SDB across the socioeconomic spectrum and how this variation is associated with major cardiovascular events (MACE) and mortality is unknown.

Methods
A retrospective cohort study was conducted using the Cleveland Clinic Sleep Laboratory Registry and included MACE-naïve adults who underwent polysomnography or home sleep apnea test. Area Deprivation Index (ADI), a biomarker of neighborhood socioeconomic disadvantage, was calculated by national rank, i.e. 25th, 50th and 75th percentiles; higher quartiles reflecting greater deprivation (ADI-Q1,2,3,4). ANOVA with pairwise testing was used to compare variables across ADI quartiles. Composite of MACE included heart failure, stroke, atrial fibrillation and myocardial Infarction or death. Cox proportional hazard regression models tested the association between ADI and SDB-measures of apnea hypopnea Index (AHI) and sleep-related hypoxia (total sleep time spent&lt; 90%SaO2, T90) with MACE. Covariates included demographics, medications, smoking status, Elixhauser Comorbidity Score, and comorbidities. Censoring was sleep study date or last encounter in the electronic medical record. Asterisk (*) indicates statistical significance after pairwise testing. Interaction testing used competing risk (Fine & Gray method).

Results
Of 72,443 patients, those living in ADI-Q4, compared to those living in ADI-Q1, were more likely to be younger (*48.9± 3.9 vs 50.4±14.2), female (*59.9% vs 40.1%), African American (*49% vs 4.9%), with lower AHI (*13.5[5.4, 34.1]vs15.1[6.2,33.1]) and lower degree of hypoxia (T90:*2.9[0.40,19.01] vs 4.4[0.50, 25.6]). Model adjusted risk for MACE or death for those in ADI-Q4 was 79% greater than ADI-Q1 (HR=1.79,95%CI:1.51-2.12,p&lt; 0.0001). Likewise, increased AHI severity and T90 above median were associated with 13% and 21% increased risk of MACE or death (HR=1.13,95%CI:1.07-1.19,p&lt; 0.0001; HR=1.21,95%CI:1.51-1.27,p&lt; 0.001) respectively. Interactions were observed between T90 and ADI with the risk of MACE (p=0.0016) or death (p=0.0051).

Conclusion
Living in areas of increasing socioeconomic deprivation confers an increased risk for MACE or death. Moreover, sleep-related hypoxia seems to modify this association. ADI appears to be useful to identify populations at risk for worse cardiovascular outcomes and to inform risk stratification for targeted interventions to decreased sleep-health disparities.

Support (if any)