bluuebunny/crossref_metadata_2025_split huggingface dataset:
0608 Characterization of Sleep in Emerging Adults with Cystic Fibrosis on CFTR Modulator Therapy
Authors: Meltzer Lisa , Jump Stephanie , Gross Jane 
Published: May 2022

Abstract

Introduction
Sleep disturbances are common among youth and adults with cystic fibrosis (CF). However, few CF programs regularly screen for sleep disorders beyond sleep disordered breathing. Emerging adults (18 to 25 years) with CF are a unique population, experiencing changes in sleep and life transitions (e.g., education, work, relationships), while also managing a complex chronic illness. CF transmembrane regulator (CFTR) modulator therapies have significantly improved medical and quality of life outcomes, yet the impact on sleep remains to be determined.

Methods
Emerging adults with CF (EA-CF; n=22, 59.1% female) and without CF (EA-Control; n=17, 76.5% female) completed an online survey that queried (1) symptoms of restless legs syndrome, parasomnias, and daytime sleepiness, and (2) frequency of exogenous sleep aid use (i.e., prescription medications, melatonin, over-the-counter [OTC] sleep aids, and marijuana/CBD). EA-CF were also asked about perceived changes in falling asleep, night waking frequency and duration, and daytime sleepiness since starting CFTR modulator therapy.

Results
Sleep disorder symptoms were more frequently reported by EA-CF compared to EA-Control, including restless legs syndrome (31.8% vs. 23.5%, small effect size), parasomnias (40.9% vs. 29.4%, small effect size), and excessive daytime sleepiness/fatigue (50.0% vs. 23.5%, medium effect size). OTC sleep aid use did not differ by group (EA-CF 31.8% vs. EA-Control 35.3%), but the frequency was significantly greater in EA-CF (&gt;once/month: EA-CF 27.3% vs. EA-Control 0%, &lt;once/month: EA-CF 4.5% vs. EA-Control 35.3%, large effect size). More EA-CF reported CBD/marijuana use compared to EA-Control (36.4% vs. 17.6%, small effect size), with 31.8% of EA-CF reporting use of CBD/marijuana at least several nights a week (vs. 5.9% of EA-Control, small effect size). Since starting CFTR modulatory therapy, 27.3% of EA-CF reported falling asleep faster, 31.8% reported fewer night wakings, 36.4% reported shorter night wakings, and 36.4% reported reduced daytime sleepiness.

Conclusion
This study is one of the first to examine sleep in emerging adults with CF on CFTR modulator therapy, with results highlighting the importance of screening for sleep disorders other than sleep disordered breathing, use of exogenous sleep aids to facilitate sleep, and the benefits of CFTR modulator therapy on sleep. Data collection is ongoing.

Support (If Any)
Natalie V. Zucker Award
0616 Retrospective Pain Reports in Obstructive Sleep Apnea Patients Relate to Age, Sex, BMI, Insomnia and Depression Scales, Not to Polysomnographic Measures of Sleep and Respiration
Authors: Dubrovsky Boris , Weingarten Jeremy , Cunningham John , Chen Steven 
Published: May 2022

Abstract

Introduction
OSA was found to alter pain experience, presumably due to apnea-related hypoxia and sleep disturbance. However, types of pain measures, demographic and subjective variables, such as mood, may influence pain experience in OSA. Presently, retrospective pain reports of patients referred for OSA evaluation were analyzed as a function of PSG measures, demographic variables, and self-reported mood and insomnia symptoms.

Methods
On the evening of a diagnostic in-lab PSG, patients reported pain intensity in the preceding 6 months (PI, rage 0-10, Chronic Pain Grade Scale), symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised, CESDR) and insomnia (Insomnia Severity Index, ISI). PI was regressed on age, sex, BMI, total sleep time (TST), sleep stage percentages, sleep efficiency, WASO, awakenings, respiratory arousal index, AHI, SpO2% nadir, time below SpO2 90%, desaturation index, CESDR and ISI using a stepwise entry.

Results
A total of 1293 patients with ≥2 hours of PSG-defined sleep completed the questionnaires; 3% Asian, 42% black, 5% Hispanic, 32% white; 62% women; 66% had OSA (AHI≥5); Mage=58.7±13.8, MBMI=33.8±7.3, MPI=3.5±3.1; MISI=12.9±6.9; MCESDR=14.7±13.1, MAHI=17.6±22.9, MSpO2%nadir=84.9±9.0. Higher PI was associated with female sex (p&lt;0.001, R2=2.6%), older age (p&lt;0.001, R2=3.7%), higher BMI (p&lt;0.001, R2=2.5%), higher ISI (p&lt;0.001, R2=4.5%), higher CESDR (p&lt;0.001, R2=2.3%) and longer TST (p=0.028, R2=0.4%). No other sleep or respiratory variables related to PI. No significant interactions with AHI≥5 were present. No differences between OSA (AHI≥5) and no-OSA groups were present on PI, ISI or CESDR after controlling for age, sex and BMI.

Conclusion
Retrospective reports of pain intensity were unrelated to PSG measures of sleep and respiratory disturbance. Female sex, older age and higher BMI related to higher PI regardless of the OSA diagnosis and collectively accounted for 8.8% of the PI variance. Symptoms of insomnia and depression related to higher PI independently of OSA, accounting for 4.5% and 2.3% of the PI variance, respectively. As in prior research OSA was associated with insomnia and depression, these variables may mediate the relationship between OSA and pain.

Support (If Any)
None
0653 Poor sleep quality is associated with burnout in emergency medicine healthcare workers
Authors: Norful Allison , Belloir Joseph , Firew Tsion , Miranda Maody , Shaw Kaitlin , Schwartz Joseph , Macron Kathryn , Schultebraucks Katharina , Sullivan Alexandra , Chang Bernard , Shechter Ari 
Published: May 2022

Abstract

Introduction
Prolonged exposure to stressful environments is associated with adverse psychological outcomes, including sleep disturbance and burnout. Burnout rates have increased substantially during the unprecedented challenges faced by healthcare workers (HCWs) during the COVID-19 pandemic. Since burnout has been associated with significant health risk and adverse organizational outcomes, it is important to identify factors that inform preventive or therapeutic approaches to mitigate adverse outcomes in HCWs.

Methods
Participants were HCWs (physicians, nurses, advanced practice providers, technicians etc.) from 4 emergency departments in New York City who completed a cross-sectional electronic survey (completed at study enrollment between November 2020-October 2021). The Pittsburgh Sleep Quality Index (PSQI) assessed global sleep quality. The Maslach Burnout Inventory (MBI) assessed 3 burnout dimensions: emotional exhaustion (EE; feelings of being emotionally overextended and exhausted by one's work); Feelings of depersonalization (DP; unfeeling and impersonal response towards patients); and reduced personal accomplishment (PA; feelings of competence and successful achievement in one's work). Descriptive statistics were calculated and separate binary logistic regressions were used to predict poor global sleep quality (PSQI &gt;5) from individual MBI subscales (dimensions of burnout), while controlling for age, race, ethnicity, and gender.

Results
Ninety-one participants, studied to date, were included in the analysis (51% non-Hispanic/Latino White, 63% female, mean age: 40 [SD: 9.6] y). Poor global sleep quality was reported by 68%. High EE (score &gt;9), DP (score &gt;6) and reduced PA (score &lt;9) were reported by 44%, 27%, and 18% of participants, respectively. Poor global sleep quality was significantly associated with presence of elevated EE (OR: 3.04, 95% CI: 1.07-8.63, p=0.037), but not with elevated DP (OR: 1.35, 95% CI: 0.44-4.10, p=0.603) or reduced PA (OR: 3.29, 95% CI: 0.65-16.44, p=0.146).

Conclusion
During the COVID-19 pandemic, poor sleep quality was reported by the majority of participants and associated with increased burnout in HCWs. Poor global sleep appears to have the most influence on the burnout dimension EE, thus suggesting new evidence about associations between sleep and emotional regulation in HCW during the pandemic. Future trials should test whether existing (or novel) interventions can improve sleep and thereby support HCWs in high stress periods.

Support (If Any)
R01HL146911
0654 Sleep, Mental Health, and Stress in College Students: Impact of COVID-19
Authors: Okun Michele , Dupy Cameron , Sollenberger Alaric , Raval Foram , Blide Jordyn , Gooding C Calvin , Feliciano Leilani 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has had an unparalleled impact on sleep, mental health, and stress globally. This has been particularly true among college students. While Universities recognize the surge in mental health visits and high stress, few have evaluated sleep, even though poor sleep is a known contributor to poor mental health and stress.

Methods
To address this gap, data from 116 college students were examined for sleep disturbance (Pittsburgh Sleep Quality Index (PSQI)), as well as stress, depression, and anxiety scores from the Depression, Anxiety and Stress Scale (DASS-21). Data were collected between May 2020-October 2021.

Results
Participants included N = 10 (8.7%) males and 106 (91.3%) females, Mage = 23.1 (6.5) years. MPSQI scores = 7.8 (2.0) and 7.0 (3.9), for males and females, respectively. As a comparison, pre-pandemic data from 866 undergraduates from Dietch et al (2016) found a MPSQI = 5.64 (SD = 2.79). Examination of individual components indicate that MTST = 7.06 (1.65) hours, with a range of 1-12. Average bedtime = 10:25PM (44.0 minutes) with a range between 9:00PM-5:00AM, and average waketime = 7:45AM (.09 minutes) with a range between 4:30AM – 2:00PM. SOL was high with 48 (41.0%) indicating an average of 16-30 minutes and 41.8% reporting 31+ minutes. Sixty-seven (57.3%) indicated that they had fairly bad or a very bad time initiating sleep in the past month, while 54 (46.2%) reported difficulty staying asleep at least 2x/week. Medication use at least 3x/week was noted in 20 (17.1%) of the sample and 50 (42.7%) stated that keeping up their enthusiasm was somewhat or a big problem. MDASS-21 scores indicate that this sample was in the moderate to severe range for Depression =14.9 (11.4), Anxiety = 12.9 (10.0), and Stress = 19.1 (9.8). As a comparison, Kia-Keating et al., (2018) assessed 1400+ undergraduates and reported depression (M = 4.1, SD = 4.3), anxiety (M = 3.9, SD = 3.6), and stress (M = 6.0, SD = 4.1).

Conclusion
Regrettably, undergraduates are experiencing “long-haul’ impacts on sleep, mental health, and stress. Recognition of the enduring struggles is critical if we intend to mitigate a major health crisis among college students.

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0657 Evening chronotype moderates the relationship between maternal and offspring’s depressive symptoms in a clinical population of adolescents
Authors: Sun Wanqi , Jiang Yanrui , Wang Guanghai , Wei Wenjing , Wu Hongying , Yuan Chengmei , Fan Juan , Li Shirley , Jiang Fan 
Published: May 2022

Abstract

Introduction
Although depression has shown a strong familial aggregation tendency, there are some moderators between parental and offspring’s depression. Meanwhile, it is known that evening chronotype is a risk factor for depression. Therefore, this study aimed to evaluate the moderating role of chronotype in the relationship between maternal and adolescent depressive symptoms in a clinical sample.

Methods
Seventy-five adolescents who visited a sleep or psychiatric clinic with a major complaint of sleep disturbance or emotional problems agreed to participate, 51 adolescents and at least one biological parent who completed questionnaires were included in the current analysis (17 male adolescents, aged 9-17 yrs). Adolescent’s chronotype were measured by the reduced Morningness-Eveningness Questionnaire (rMEQ). Depressive symptoms in adolescents and parents were assessed by the Depression Self-Rating Scale for Children (DSRSC) and the Patient Health Questionnaire (PHQ-9), respectively. General linear models were applied to examine the interaction between parental depression and adolescent’s chronotype on adolescent’s depression, in which age and gender were entered as covariates.

Results
Mothers of adolescents with clinical depression (DSRSC&gt;15, n=38) also reported more depressive symptoms (PHQ-9: 4.81±4.37 vs. 2.69±2.46, t=-2.14, p=0.039). But father’s depressive symptoms were not related with adolescent’s depression. In the current clinical sample, the prevalence of evening chronotype in adolescents was up to 45.1% (n=23). Adolescents with either non-evening or evening chronotype reported comparable level of depressive symptoms (DSRSC: 20.37±6.26 vs. 19.00±8.42, t=0.66, p=0.513). There was a significant interaction between maternal depressive symptoms and chronotype on offspring’s depressive symptoms (F=4.05, p=0.044). Specifically, maternal depressive symptoms were associated with offspring’s depressive symptoms only in adolescents with evening chronotype.

Conclusion
Our study suggested that adolescents with evening chronotype might be at an elevated risk of the transgenerational transmission of depression. Hence, our findings supported the need to consider circadian factors and maternal depression in identifying at-risk adolescents.

Support (If Any)
This work was supported by the Shanghai Sailing Program awarded to Dr. Wanqi Sun (Shanghai Science and Technology Committee, 19YF1442200).
0671 Nightmare type and its association with suicide attempts among veterans
Authors: Bishop Todd , Youngren Westley , Ashrafioun Lisham , Carr Michelle , Pigeon Wilfred 
Published: May 2022

Abstract

Introduction
Research has begun to distinguish between idiopathic (no known origin), trauma-related (recurring after a trauma), and complex nightmares (trauma-related nightmares that recur comorbidly with sleep disordered breathing). Nightmare type may impact symptom severity as well as treatment outcomes among various patient groups. Thus, we sought to examine the individual effects of nightmare type on suicide re-attempts and, secondarily, on treatment utilization.

Methods
This is a secondary analysis of electronic medical record data. Data were extracted for all Veterans with a documented suicide attempt (using ICD-10 codes) during FY13-14. A 1:1 case control was then created using age, sex, and prior year behavioral health treatment utilization. The present sample is comprised of all Veterans from that parent dataset who carry an ICD-10 diagnosis of nightmare disorder (n = 3207). Groups were defined as follows: 1) Idiopathic (n = 589; nightmare disorder only); 2) Trauma (n = 3207; nightmare disorder plus ICD-10 diagnosis of PTSD); 3) Complex (n = 576; nightmare disorder + PTSD + ICD-10 diagnosis of a sleep-related breathing disorder).

Results
Multiple logistic regression revealed that only trauma-related nightmares were positively associated with suicide re-attempts (B = 0.16, SE = 0.06, p &lt; 0.01), with an estimated odds ratio of 1.27 (95% CI of 1.02-1.57). Regarding treatment utilization, regression analyses revealed that both complex nightmares (B = 0.36, p &lt; 0.05) and trauma-related nightmares (B = 0.31, p &lt; 0.05) were significantly associated with mental healthcare utilization (total days).

Conclusion
Our results revealed that both complex and trauma-related nightmares are associated with mental health treatment utilization. Only trauma-related nightmares were significantly associated with suicide re-attempts. Trauma-related nightmares may be distressing because of their trauma-related content, therefore making them more likely to predict reattempts. Overall, results suggest that nightmares are positively associated with suicide re-attempts and increased treatment utilization.

Support (If Any)
This work was supported by the VA Center of Excellence for Suicide Prevention in teh Finger Lakes Healthcare System.
0672 Twenty-Four Hour Activity Patterns, Pain, and Mental Health Trajectories After a Traumatic Event
Authors: Straus Laura , An Xinming , Cakmak Ayse , Clifford Gari , Neylan Thomas , McLean Samuel 
Published: May 2022

Abstract

Introduction
Among those who experience trauma, some individuals develop Adverse Posttraumatic Neuropsychiatric Sequelae (APNS). Identifying biomarkers associated with APNS is critical for predicting trajectories of recovery and informing interventions to reduce the impact of trauma. In this study, we examined objective 24-hour activity patterns and APNS in the weeks following a traumatic event.

Methods
Participants (n = 2,021) were recruited from emergency departments after experiencing trauma. Over 8 weeks, they wore wrist accelerometry devices to measure 24-hour activity patterns, and completed surveys assessing 10 Research Domain Criteria (RDoC) constructs associated with APNS. We aimed to 1) examine the relationship between 24-hour activity patterns and APNS symptoms, and 2) examine how 24-hour activity patterns changed over time in relation to changes in APNS over the 8-week period. A bivariate linear mixed model approach was used to model the cross-sectional and longitudinal associations with each of the 10 RDoC constructs.

Results
Overall, participants reporting more pain in the weeks following trauma also showed objectively less 24-hour activity variance (Pearson correlation = -0.14, p = 0.001). An improving pain trajectory over the 8 weeks was associated with increases in daily activity (Pearson correlation = -0.14, p &lt; 0.001) variability in activity (Pearson correlation = -0.12, p &lt; 0.001), and increases in sleep consolidation (Pearson correlation = 0.013, p &lt; 0.001). Within subjects, an increasing number of transitions between sleep and wake over the study period was also associated with worsening self-reported anxiety (Pearson correlation = 0.06, p = 0.003) and sleep problems (Pearson correlation = 0.10, p = 0.003)

Conclusion
After a traumatic event, several 24-hour activity biomarkers were associated with APNS. Results suggest pain, activity, and sleep highly influence each other in the weeks following a traumatic event, and 24-hour activity patterns should be considered when making predictions about who is likely to recover from trauma. Targeted interventions for sleep and pain may promote recovery in the other domains.

Support (If Any)
NIMH U01MH110925, US Army Medical Research and Material Command, the One Mind Foundation, The Mayday Fund, Verily Life Sciences. LDS is supported by a Department of Veterans Affairs Career Development Award (IK2CX002032).
0682 Cognitive-behavioral therapy for insomnia alleviates and prevents suicidal ideation
Authors: Kalmbach David , Cheng Philip , Reffi Anthony , Ahmedani Brian , Peterson Edward , Seymour Grace , Sagong Chaewon , Sultan Zain , Drak Christopher 
Published: May 2022

Abstract

Introduction
Patients with insomnia disorder are at increased risk for suicidal thoughts and behaviors. Early evidence suggests that insomnia therapeutics may reduce suicidal ideation (SI). However, the role of digital insomnia therapeutics in both the alleviation and prevention of SI remains unclear.

Methods
A total of 658 community adults with DSM-5 insomnia disorder enrolled into a single-site RCT evaluating the efficacy of digital cognitive behavioral therapy for insomnia (CBTI) relative to attention control. Before treatment, 126 patients endorsed SI, whereas 532 patients denied SI. First, we tested whether CBTI can reduce SI in patients with baseline SI. Second, we tested whether CBTI reduces risk for SI development in those without baseline SI.

Results
Among those with baseline SI, just 30.0% of CBTI patients reported SI after treatment, which was lower than the 54.5% of controls with posttreatment SI (OR=2.81, p=.006). Among those without baseline SI, CBTI did not reduce risk for developing SI after treatment (p=.681). However, a multivariate logit model regression odds for SI onto condition (p=.140) and posttreatment remission status (OR=5.68, p=.007) indicated that patients who remitted from insomnia exhibited a reduction in SI risk. Importantly, CBTI was associated with a 6.29 odds increase of insomnia remission relative to control. PRODCLIN estimation of the indirect effect indicated that CBTI prevents SI, but that the effect is fully mediated by the extent to which CBTI produces insomnia remission (αβ=-3.13=5, 95% CI=-5.28, -0.96).

Conclusion
Digital CBTI reduces risk for SI development in insomnia patients without pretreatment SI. These data support a role for digital insomnia therapeutics in SI prevention in this high-risk patient population. Moreover, digital CBTI reduces SI in insomnia patients with SI. These data indicate that digital CBTI can alleviate SI, but it possible that adjunct treatment directly targeting SI may enhance suicide risk reduction.

Support (If Any)
Robert Wood Johnson Foundation
0683 Smoking and Perceived Stress: Examining Associations with Subjective Symptoms of Obstructive Sleep Apnea through Parallel Mediation Analyses
Authors: Chana Sofia Mildrum , Thomas S , Gamble Karen , Cropsey Karen 
Published: May 2022

Abstract

Introduction
Cigarette smoking is known to have a negative effect on individuals’ sleep quality. Specifically, evidence shows that smoking can exacerbate sleep disorders such as obstructive sleep apnea (OSA) by increasing irritation and inflammation of the upper respiratory conducts. Furthermore, previous research highlights a complex bidirectional positive association between cigarette smoking and perceived stress. Sleep quality may be an important aspect intervening in the association between smoking and perceived stress, given that individuals who report high stress also report more sleeping issues and increased risk for OSA. Further research is needed to elucidate the impact of smoking and OSA on perceived stress.

Methods
The present cross-sectional survey of N=459 (75.8% female; 60.3% non-Hispanic White) current smokers and non-smokers investigated the associations between smoking status and perceived stress through the indirect effects of subjective OSA symptoms. A parallel mediation analysis using PROCESS Macro Model 4 was conducted with three mediators: risk for OSA based on subjective symptoms (assessed using the STOP portion of the STOP-BANG questionnaire), average sleep propensity (evaluated using the Epworth Sleepiness Scale), and overall subjective sleep quality (assessed with the Pittsburgh Sleep Quality Index). Race, sex, employment, and income were added to the model as covariates.

Results
Analyses supported a significant indirect effect of risk for OSA based on subjective symptoms (B = -0.55, 95% CI [-1.07, -0.09]) and overall subjective sleep quality (B = -1.39, 95% CI [-2.16, -0.74]) on the relationship between smoking status and perceived stress. However, average sleep propensity was not found to mediate this association (B = -0.09, 95% CI [-0.45, 0.21]). The direct effect of smoking status on perceived stress was also not statistically significant (B = 0.06, t = 0.09, p = 0.93).

Conclusion
Findings illustrate that smokers tend to be at greater risk for OSA and overall report worse sleep quality, which in turn increases their reported levels of perceived stress. Further research is necessary to understand possible demographics-based differences behind these findings as well as potential clinical implications.

Support (If Any)
This project was financially supported by the National Institute of Drug Abuse (R01DA046096-02S1).