bluuebunny/crossref_metadata_2025_split huggingface dataset:
0310 Low light exposure during wake is associated with antepartum depressive symptoms
Authors: Warlick Chloe , Kim Minjee , Reid Kathryn , Grobman William , Mercer Brian , Wapner Ronald , Zee Phyllis 
Published: May 2023

Abstract

Introduction
Antepartum depression affects 7-16% of pregnant women and occurs most frequently in the 3rd trimester. Previous studies have demonstrated a relationship between the level and timing of daytime light exposure and depression in non-pregnant populations. However, much less is known about the relationships between light exposure and depression during pregnancy. Thus, in this study, we tested the hypothesis that exposure to less daytime light will be associated with more antepartum depressive symptoms.

Methods
Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) and the nuMoM2b Sleep Duration and Continuity Substudy were used (N=708). Women enrolled in the substudy wore wrist actigraphy (Spectrum, Phillips Respironics) and completed a sleep log for seven days between 160-230 weeks of gestation. Daytime light exposure was defined as minutes spent at or above the threshold of 50 lux (TAT50) during the wake period, averaged over valid actigraphy recording days. Participants were divided into two groups by TAT50: &gt;25th percentile and ≤25th percentile. The Edinburgh Postnatal Depression Scale (EPDS) was administered during the 1st and 3rd trimesters. A positive screening was defined as an EPDS composite score ≥10 or any endorsement of self-injurious thoughts. Wilcoxon rank sum tests were used to test differences between TAT50 groups.

Results
Low light exposure during the day was associated with antepartum depressive symptoms during the 1st and 3rd trimesters, after adjusting for age, season, race, poverty, sleep midpoint, and sleep duration (OR 1.7, p=0.047). Additionally, later sleep timing, greater day-to-day sleep variability, and increased time spent awake after sleep onset was seen in those exposed to less light (all p&lt; 0.001).

Conclusion
Lower daytime light exposure is associated with poorer sleep quality and may increase risk for antepartum depressive symptoms. These data suggest that in addition to improving sleep quality, promoting daytime light exposure may be a modifiable risk factor for depression during pregnancy.

Support (if any)
Work supported by NHLBI grant R01 HL105549 and NICHD grant U10 HD063036. C.D.W. was funded, in part, by T32HL007909. K.J.R., and P.C.Z. are supported, in part, by R01 HL140580 and P01 AG011412. M.K. is supported, in part, by NIA P30AG059988.
0312 Dynamic Lighting in Memory Care Facilities to Improve Sleep and Mood in Older Adults with Dementia
Authors: Shishegar Nastaran , Alrahyani Mohammed , Yague Ndeye , Fani Mahya 
Published: May 2023

Abstract

Introduction
Of the estimated 5.8 million people in the United States diagnosed with dementia, approximately one-third experience a chronic sleep disorder. Poor sleep quality in older adults is associated with higher levels of depression, anxiety, agitation, and falls as well as lower levels of cognitive and memory performance. Light is the most important environmental element that is not only necessary to fulfill visual tasks but also is the main stimulus that regulates circadian rhythms. This study aims to investigate the effect of a dynamic lighting intervention on sleep quality and mood in older adults with dementia living in long-term care facilities.

Methods
The study is conducted as a within-subject study design over 7 days of conventional lighting (Baseline) followed by 21 days of room lighting (Placebo) and then 21 days of dynamic lighting (Treatment). The dynamic lighting intervention is designed to create an ambient illumination that provides a high level of circadian stimulation in the morning and circadian-neutral lighting in the evenings through delivering varying light intensity and spectrum. The placebo condition exposes participants to a static lighting condition that is equivalent to the average room lighting from morning to evening. The human-lighting interaction occurs in the common areas of the selected memory care facility in Phoenix Greater Area, AZ. Participants of this study are individuals over the age of 65 diagnosed with mild to moderate dementia. Actigraphy is conducted on the last 7 days of each condition to monitor sleep quality. Daily light exposure is tracked continuously throughout the waking day using a non-intrusive wearable sensor. Moreover, caregivers complete two questionnaires (Cornell Scale for Depression in Dementia (CSDD) and Cohen-Mansfield Agitation Inventory (CMAI)) every seven days to assess the short and long-term effects of each condition on mood and agitation.

Results
Findings show notable improvements in mood and nighttime sleep duration and efficiency in participants after exposure to the dynamic condition compared to the baseline and placebo.

Conclusion
The outcomes of this study provide strong evidence that ambient lighting in memory care facilities is a significant contributor to improving sleep and quality of life of older adults with dementia.

Support (if any)
None
0315 Phase shifting in response to light flash sequences during sleep
Authors: Lok Renske , Zeitzer Jamie 
Published: May 2023

Abstract

Introduction
The human circadian clock is synchronized to the outside world through regular ocular light exposure. Light does not need to be continuous to be an effective time cue. Light administered as a sequence of light flashes can be more effective than continuous light of the same illuminance. Exposure to a sequence of light flashes while awake is annoying, but such exposure can occur during sleep, without disrupting sleep, when the circadian system is most sensitive to light. As such, the purpose of this experiment was to determine the magnitude of circadian phase shift that could be obtained when exposing individuals to light flash sequences during sleep.

Methods
Healthy young individuals (n=10) participated in a crossover study of two separate 16-d protocols, the order of which was randomized. The first 14 d were an at-home circadian phase/amplitude optimization period, followed by a 37-h in-laboratory stay during which participants had constant routines (CR) on two consecutive evenings. The onset of salivary melatonin determined during the CRs was used as a marker of circadian phase. Light was dim (&lt; 5 lux) or dark between CRs, except for the light flashes (2-ms flashes, ~1500 lux, every 15 s for 1 h) that were administered via custom goggles while participants slept (starting 30 m after habitual bedtime). During the placebo condition, the goggles provided no light. The impact of the light on circadian phase (pre-post) and polysomnographically-measured sleep were assessed.

Results
As compared to the control condition (12±20 minutes), exposure to the flashes engendered substantial shifts (1.13±1.27 h, p&lt; 0.01; d=1.02). There was considerable variability in response to the stimulus, with two individuals not displaying any phase changes, three having a modest phase change (&lt; 1 hour), two having a moderate phase change (1-2 hours) and two having a large phase shift (&gt;2 hours), one of whom shifted more than 6 hours. There were no significant differences in sleep on placebo or flash exposure nights.

Conclusion
Exposure to a sequence of light flashes during sleep has the capacity to engender large changes in circadian timing without necessitating behavior changes during wake to receive phototherapy.

Support (if any)
Department of Defense (W81XWH-16-1-0223)
0316 A Case Report: Comparing Sleep with and without blue light blockers
Authors: Meghpara Sanket , Awad Dana , Niraula Rijesh , DelRosso Lourdes , Keenan Lynn , Van Gundy Karl 
Published: May 2023

Abstract

Introduction
Blue light filtered eyewear is popular. Studies have looked at the effect of using blue light blockers in the evening but data is lacking on the effect of wearing blue light blockers (BLB) through the day. In this study we compared the effects of wearing BLB all day, on sleep and daytime sleepiness.

Methods
This is a single case report. A 32 year male wore an Actiwatch Pro and collected sleep diaries for 18 days. On days 1-9, non-blue light blocking eyewear (NBLB) were used all day. On days 10-18, BLB were used all day. Karolinska Sleepiness Scale (KSS) and Stanford Sleepiness Scale (SSS) during morning, afternoon and before sleep were recorded. IBM SPSS v. 29.0.0 is used for descriptive analysis, Pearson correlation and T-test comparison.

Results
White light exposure was not statistically different from BLB and NBLB. Data measured in minutes. Mean and standard deviation of in-bed duration with NBLB was 477.89±66.17 and with BLB was 518.06±53.06 (p=0.087). Sleep time with NBLB was 431.89±52.05 and with BLB was 471.72±48.49 (p=0.056). Wake After Sleep Onset (WASO) with NBLB was 43.78±18.63 and with BLB 46.33±14.25 (p=0.374). Percent Sleep with NBLB was 90.96±2.83% and with BLB was 91.09±2.29 (p=0.459). KSS scores for morning on NBLB was 1.75±1.035 and 1.00±0 with BLB (p= 0.023), afternoon NBLB 4.13±1.25, BLB 3.67±0.87 (p=0.194), before sleep NBLB 8.5±1.41 and 8.56±0.53 with BLB (p=0.457). SSS scores for morning on NBLB was 1.63±0.744 and 1.00±0 with BLB (p= 0.012), afternoon NBLB 3.38±1.06, BLB 3.56±0.88 (p=0.353), before sleep NBLB 7.00±1.41 and 7.89±0.60 with BLB (p=0.053). There was a strong correlation between white light exposure and increased WASO (Pearson 0.514) and strong negative correlation (Pearson -0.535) between white light exposure and percent of sleep duration.

Conclusion
Although there were no statistically significant differences between the sleep parameters between NBLB and BLB, we found a strong correlation between sleep time and white light exposure and negative correlation. When using BLB morning alertness was better.

Support (if any)
0321 Manually scoring actigraphy in the absence of a sleep diary: Reliability analysis in Gulf War veterans
Authors: Howell Mary Katherine , Breneman Charity , Allen Nathaniel , Vivino Anthony , Klingaman Elizabeth , Reinhard Matthew 
Published: May 2023

Abstract

Introduction
Sleep disturbance and chronic health conditions are common in military and veteran populations. These individuals may have difficulty accurately and consistently completing sleep diaries, which traditionally have been used as a prominent data input in scoring actigraphy. While actigraphy is considered an objective sleep measure, the process of manually scoring actigraphy data can be subjective, particularly in military/veteran and clinical populations. Few studies utilize and report clear actigraphy scoring guidelines. To promote internal consistency and replicability in actigraphy scoring procedures, this study developed a detailed actigraphy scoring protocol for cases without sleep diary data and performed an inter-rater reliability analysis using a sample of veterans with Gulf War Illness (GWI).

Methods
One hundred fifty-nine nights of actigraphy (Phillips Respironics) data from a random subsample of 25 veterans with GWI were independently, manually scored using the protocol. Mean values for the start and end of rest intervals and derived sleep parameters—time in bed (TIB), total sleep time (TST), and sleep efficiency (SE)—and mean differences were calculated. Inter-rater reliability was evaluated using intra-class correlation (ICC).

Results
No significant differences were observed between manual scorers for mean values for the end of manually scored rest intervals and derived sleep parameters (TIB, TST, and SE). There were significant differences in the start of a rest interval, though the magnitude of the difference (0:06 ± 28) was less than the clinically important 15-minute difference noted in the literature. ICC demonstrated excellent agreement between manual scorers for rest interval start (0.98) and end times (0.99), TIB (0.94), TST (0.98), and SE (0.97).

Conclusion
This protocol may serve as a reproducible set of guidelines for researchers manually scoring actigraphy and enhance internal consistency for studies using this actigraphy scoring software, especially for those working with military populations and clinical populations with significant sleep disturbance and related difficulties yielding quality sleep diary data.

Support (if any)
Veterans Affairs, Office of Research and Development, Clinical Science Research and Development under Merit Review Grant #SPLD-013-13S.
0325 Reducing nocturnal cognitive arousal and rumination mediate treatment effects of digital cognitive behavioral therapy for insomnia
Authors: Iqal Justin , Sagong Chaewon , Kalmbach David , Cheng Philip , Fellman-Couture Cynthia , Ruprich Melissa , Peterson Edward , Roth Thomas , Drake Christopher 
Published: May 2023

Abstract

Introduction
High cognitive arousal—i.e., heightened cognitive activity often in the form of perseverative thinking—is a central feature insomnia. Emerging evidence from randomized controlled trials (RCTs) support alleviating cognitive arousal as a mechanism by which cognitive behavioral therapy for insomnia (CBTI) reduces symptoms of insomnia and depression. However, few RCTs have published CBTI data on cognitive arousal outcomes. The present study tested whether CBTI alleviates cognitive arousal symptoms, and whether reducing cognitive arousal symptoms mediate CBTI effects on insomnia and depression.

Methods
434 patients with clinical insomnia symptoms (Insomnia Severity Index [ISI] ≥ 15) were randomized to digital CBTI or digital sleep education control. Study outcomes included insomnia (ISI), depression (quick inventory of depressive symptomatology self-report 16-item survey, QIDS-SR16), and two indices of cognitive arousal (pre-sleep arousal scale’s cognitive factor [PSASC] and daytime insomnia symptoms response scale [DISRS]). Treatment effects and mediation analyses were conducted using multivariate linear regression.

Results
While controlling for baseline symptoms, CBTI patients, relative to controls, reported lower levels of insomnia (b=-2.45, p&lt;.001), depression (b=-1.13, p&lt;.001), nocturnal cognitive arousal (b=-2.37, p&lt;.001) and insomnia-focused rumination (b=-3.43, p&lt;.001) after treatment. Posthoc independent samples t-tests showed that CBTI produced small-medium effects on nocturnal cognitive arousal (Cohen’s d=.40) and insomnia-focused rumination (Cohen’s d=.31). Mediation analyses showed that reducing nocturnal cognitive arousal (PSASCT2-T1) mediated 29.0% of CBTI effects on insomnia (αβ=-.709, 95%CI=-1.09, -0.38), and 35.1% of CBTI effects on depression (αβ=-.397, 95%CI=-0.65, -0.19). Mediation analyses showed that reducing insomnia-focused rumination (DISRST2-T1) mediated 10.6% of CBTI on insomnia (αβ=-.261, 95%CI=-0.50, -0.08), but did not mediate antidepressant effects (αβ=-.300, 95%CI=-1.46, 0.72).

Conclusion
Digital CBTI effectively alleviated nocturnal cognitive arousal and insomnia-focused rumination. Moreover, alleviating nocturnal cognitive arousal was a mechanism by which CBTI reduced symptoms of insomnia and depression. By comparison, reducing insomnia-focused rumination mediated a small proportion of CBTI effects on insomnia and was uninvolved in depression effects. Although reducing cognitive arousal facilitated insomnia and depression outcomes, CBTI is likely limited by its modest effects on cognitive arousal symptoms. Improving insomnia therapy benefits for cognitive arousal may enhance patient outcomes.

Support (if any)
This RCT (NCT03322774) was supported by NIMH R01-MH122636.
0326 Symptom trajectories in adults with stable heart failure and insomnia: Evidence from a randomized controlled trial of CBT-I
Authors: Conley Samantha , Jeon Sangchoon , Wang Zequan , Tocchi Christine , Linsky Sarah , O'Connell Meghan , Redeker Nancy 
Published: May 2023

Abstract

Introduction
Cognitive behavioral therapy for insomnia (CBT-I) improves individual symptoms of fatigue and daytime sleepiness; however, little is known how CBT-I improves multiple co-occurring daytime symptoms. The purposes of this study are to (1) identify daytime symptom trajectories in adults with insomnia and stable chronic heart failure (HF) over one year, and (2) determine how symptom trajectories vary based on participation in CBT-I or HF self-management education (attention control condition).

Methods
We conducted a retrospective analysis of data from a randomized controlled trial that looked the sustained effects of CBT-I compared to HF self-management over one year (NCT02660385). We measured daytime symptoms (fatigue, depression, anxiety, dyspnea, pain, and daytime sleepiness) at baseline (pre-treatment) and 3, 6 and 12 months. Symptom cluster trajectory were identified using group-based trajectory modeling, and the association with CBT-I was examined using logistic regressions.

Results
We randomized 175 participants (M age=63.0 (12.9) years, 57% men). We found four daytime symptom cluster trajectories, (A) low improving symptoms (N = 67, 38.3%); (B) low psychological symptoms and high improving physical symptoms (N = 40, 22.8%); (C), high improving symptoms (N = 42, 24.0%); and (D) high not improving symptoms (N = 26, 14.9%). There was no statistically significant difference between CBT-I and HF self-management across 4 symptom trajectories (p = .2509). However, people who received CBT-I vs. HF self-management education had higher odds of belonging to trajectory A compared to B/C/D after controlling for baseline fatigue (OR = 3.27 95% Confidence Intervals [1.39, 7.68]).

Conclusion
Most participants experienced improved daytime symptom profiles over 12 months after both interventions. Participants in the CBT-I group experienced symptom improvement even when they started with low symptoms.

Support (if any)
National Institute of Nursing Research [R01NR016191 and P20NR014126].
0328 The Natural History of Insomnia: High Sleep Reactivity Interacts with Greater Life Stress to Predict the Onset of Acute Insomnia
Authors: Walker Jamie , Vargas Ivan , Drake Christopher , Ellis Jason , Muench Alexandria , Perlis Michael 
Published: May 2023

Abstract

Introduction
Previous studies have shown that stressful life events are the primary trigger in the development of insomnia. One etiological model of insomnia suggests that sleep reactivity, or the vulnerability to stress-related sleep disturbance, may be an important moderator of this association. That is, some individuals have a predisposition to experience insomnia following acute stressors (i.e., sleep reactivity). The goal of the present study was to provide a proof of concept and, specifically, additional empirical evidence that the link between stressful life events and the onset of acute insomnia is moderated by sleep reactivity.

Methods
1,225 adults with a history of good sleep (Mage = 53.2 years, 68% female, 83% white) were recruited nationwide for an online study on sleep health. Participants completed surveys to assess sleep reactivity (baseline), sleep patterns (daily sleep diaries), and stressful life events (weekly survey). This high-density data (daily/weekly measures) allowed for a close examination of whether sleep reactivity predicts acute insomnia and how the association between stressful life events and sleep disturbance varies as a function of sleep reactivity. Due to the high variability of stressful life events and sleep over time, frequent data points were needed to test this etiological model of insomnia. Sleep diary data were used to identify sleep initiation/maintenance difficulties, including whether they met criteria for acute insomnia at any point during the one-year interval.

Results
Participants with high sleep reactivity, compared to low sleep reactivity, were at 76% increased odds of developing acute insomnia during the one-year interval. In general, greater weekly stressful life events were associated with greater insomnia during the subsequent week. Additionally, those participants with high sleep reactivity demonstrated a stronger relationship between weekly stressful life events and insomnia, such that they reported the greatest levels of insomnia following weeks where they experienced a greater number of stressful life events.

Conclusion
These results further support the sleep reactivity model of insomnia, and specifically, provide evidence that sleep reactivity predicts the incidence of acute insomnia in a sample of participants with no history of insomnia.

Support (if any)
Perlis: R01AG041783, K24AG055602; Vargas: K23HL141581, R25HL10544
0331 Effects of Cognitive Behavioral Therapy for Insomnia (CBTI) on Daytime Cognitive Functioning: A Report from the AIR Trial
Authors: Edinger Jack , Manber Rachel , Simmons Bryan , Johnson Rachel , Horberg Roxane , Depew Ann , Abraibesh Aysha , Eldridge-Smith E Devon , Strand Matt , Kushida Clete , Tsai Sheila 
Published: May 2023

Abstract

Introduction
Prior studies have shown that CBTI improves patient reported outcomes including daytime fatigue, mood status and quality of life, yet there are limited data concerning the effects of therapy on objective measures of daytime function. The current study tested the effects of CBTI on measures derived from the psychomotor vigilance test (PVT) in a sample of patients with comorbid insomnia disorder and sleep apnea.

Methods
Patients with insomnia and comorbid OSA, who were prescribed PAP therapy (N =155; Mage= 56.8±12.5 yrs.; 58.1% women) were randomized to digital CBTI (dCBTI) or Sleep Hygiene (CTRL). They completed PVT at baseline and after 8 weeks of treatment. Patients in the dCBTI arm who reached remission were offered no additional insomnia treatment, whereas those who did not were randomly assigned to 8 weeks of continued access to dCBTI or to a therapist delivered CBTI. Patients again completed the PVT after this second 8-week treatment phase. PVT outcome measures included mean reaction time, attentional lapses and efficiency scores. Linear mixed models were used to compare the PVT measures of patients receiving either of the CBTI treatment sequences with those assigned to the CTRL.

Results
Analyses showed significant group x time interactions for PVT attentional lapses (F = 3.04; p &lt; .05) and for efficiency scores (F= 4.06; p&lt; .025). Those who received either of the CBTI treatment sequences showed a greater reduction in attentional lapses and greater improvement in their efficiency scores from baseline to the post-treatment assessments than did those assigned the CTRL.

Conclusion
Findings indicate that CBTI improves objective indices of daytime cognitive functioning among those with comorbid apnea and insomnia disorder. Further tests of CBTI’s effects on these and other measures of cognitive functioning are warranted in other samples of insomnia patients who do and do not have medical, psychiatric and sleep disorder comorbidities.

Support (if any)
Funding support from the National Heart, Lung and Blood Institute, Grant # 1R01HL130559-01A1.