bluuebunny/crossref_metadata_2025_split huggingface dataset:
0470 Pre-treatment Objective Short Sleep is Associated with Poor Treatment Response in Patients with Insomnia and Major Depression: A Report from the TRIAD Study
Authors: Edinger Jack , Eldridge-Smith E Devon , Buysse Daniel , Thase Michael , Krystal Andrew , Wisniewsk Stephen , Manber Rachel 
Published: May 2022

Abstract

Introduction
Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral insomnia therapy insomnia (CBT-I) but such studies have not included patients with comorbid conditions. This study was conducted to determine whether pre-treatment sleep duration moderates the response of patients with major depression (MDD) and insomnia (ID) disorders to a combined CBT-I and antidepressant medication treatment.

Methods
This study involved a secondary analysis of data from the TRIAD trial that tested combined CBT-I/antidepressant medication treatment of patients with MDD and ID. Participants (N=99; 70 women; Mage = 47.7 +/-12.4 yrs.) completed pre-treatment polysomnography (PSG) and were randomly assigned to a 12-week treatment comprised of antidepressant medication combined with CBT-I or a sham quasi-desensitization therapy for insomnia (DTI). Short and longer sleepers were defined using PSG total sleep time cutoffs of &lt;5, &lt;6 and &lt;7 hours for short sleep. Insomnia and depression remission determined respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned.

Results
Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of &lt;5 hours of sleep was used to define “short sleep.” CBT-I recipients with &gt; 5 hours of sleep were significantly more likely to achieve insomnia remission than were either the DTI recipients with &gt; 5 hours of sleep (OR = 6.72; 95% CI = 2.03 – 22.26) or the CBT-I recipients with short sleep (OR = 18.92; 95% CI = 2.03 – 178.69). The longer sleeping CBT-I group was also more likely to achieve insomnia and/or depression remission than was either the longer sleeping DTI group (OR = 3.12 95% CI = 1.11 – 9.53) or the shorter sleeping CBT-I group (OR = 8.464; 95% CI = 1.40 – 51.12).

Conclusion
Sleeping &lt;5 hours may dispose patients with comorbid MDD/ID to a poor response to combined CBT-I/antidepressant medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted.

Support (If Any)
National Institutes of Health, Grant Numbers MH078924, MH078961, MH079256 and HL096492.
0471 Identifying Trauma-Informed Adaptations to Cognitive Behavioral Therapy for Insomnia among Women Veterans: Results of an Expert Panel
Authors: Carlson Gwendolyn , Saldana Kathryn , Kelly Monica , McGowan Sarah Kate , DeViva Jason , McCarthy Elissa , Pigeon Wilfred , Martin Jennifer 
Published: May 2022

Abstract

Introduction
Trauma-informed care is an emerging area of health services research. While trauma-focused care specifically targets symptoms of posttraumatic stress disorder (PTSD), trauma-informed care involves tailoring interventions to meet the unique needs of patients who have experienced trauma. Insomnia and PTSD are common comorbid disorders, but no known previous studies have identified trauma-informed adaptations to cognitive behavioral therapy for insomnia (CBT-I).

Methods
We identified PTSD clinical presentations that may interfere with the delivery of effective CBT-I and possible adaptations to standard CBT-I that may address these clinical presentations based on a literature review. We then incorporated trauma-informed adaptations into a 5-session CBT-I protocol. Four Veterans Affairs (VA) Expert Trainers in CBT-I were sent the trauma-informed CBT-I materials and rating forms. They were asked to rate the extent to which PTSD clinical presentations serve as barriers to CBT-I (1=low barrier; 5=high barrier), the feasibility of possible adaptations (1=low feasibility; 5=high feasibility), and to provide qualitative feedback. A 60-minute panel meeting was convened and aggregated data from rating forms were presented and discussed. We then revised the trauma-informed CBT-I materials. Panelists reviewed the revised trauma-informed CBT-I materials and completed post-panel rating forms.

Results
The highest-ranked clinical presentations based on rating forms and panel consensus included: sleep avoidance/nighttime arousal, sleep-related self-efficacy, substance/medication use to induce sleep, and safety behaviors intended to reduce nighttime arousal. Panel meeting consensus identified the following trauma-informed adaptations to CBT-I: PTSD-related nighttime hyperarousal psychoeducation, identification of alternatives to PTSD-related safety behaviors, nightmare psychoeducation, psychoeducation about PTSD avoidance in the context of substance/medication use, cognitive techniques, and behavioral tracking to challenge beliefs and avoidant behaviors. Panelists agreed the revised trauma-informed CBT-I materials adequately addressed the PTSD clinical presentations that may limit the effectiveness of standard CBT-I for patients with comorbid PTSD.

Conclusion
This was the first study to use an expert panel to identify trauma-informed adaptations to CBT-I. Trauma-informed adaptations, including supplemental materials, may improve CBT-I outcomes for patients with comorbid PTSD. Future studies should incorporate feedback from patients with insomnia and PTSD to refine trauma-informed adaptations to CBT-I further.

Support (If Any)
VA HSR&D (RCS-20-191, Martin), NHLBI (K23HL143055, Martin)
0478 The Impact of Non-pharmacological Insomnia Therapy on Mood and Sleep in Morning and Evening Chronotypes in Older Adults
Authors: Lopez Mateo , Krause Adam , O'Hora Kathleen , Hernandez Beatriz , Lazzeroni Laura , Zeitzer Jamie , Friedman Leah , Posner Donn , Kushida Clete , Yesavage Jerome , Goldstein-Piekarski Andrea 
Published: May 2022

Abstract

Introduction
As individuals age, the circadian-driven timing of their sleep shifts to an earlier hour. Whether such a shift moderates the effectiveness of insomnia treatment on sleep disturbances and mood in older adults is unknown.

Methods
We tested the hypothesis that circadian preference moderates improvements in mood and insomnia symptoms following a non-pharmacological insomnia treatment. Older adults (N=111, age=69±6.4 years, female=65%) with insomnia (Insomnia Severity Index (ISI) score &gt;10) received a 6-session treatment regimen. Circadian preference was measured at baseline with the Composite Scale of Morningness (CSM mean score=41.2±7.3, median=42). Chronotypes were classified based on a median split of CSM scores. Depression, (Geriatric Depression Scale, GDS), insomnia severity (ISI), cognitive arousal (Glasgow Content of Thoughts Inventory, GCTI), and time in bed (TIB), total sleep time (TST), and sleep efficiency (TST /TIB=SE) from sleep diaries were collected pre- and post-treatment. Tests of proportion were used to characterize differences in demographic variables between chronotypes. Ranked correlation tests were used to test associations between circadian preference and variables of interest at pre- and post-treatment. T-tests with unequal variance were used to examine whether treatment outcomes differed between chronotypes.

Results
In this study, 58% of females and 38% of males were later chronotypes (p=0.04). Later chronotype was associated with greater pre-treatment TIB (p=0.01), and earlier chronotype was associated with higher post-treatment cognitive arousal (p=0.04). Later chronotypes had greater reduction in depression symptoms (Cohen’s d=0.43, p=0.04), cognitive arousal (d=0.39, p=0.05), and a trend for greater reduction in TIB (d=0.37, p=0.07). Earlier chronotypes had a greater increase in TST (d=0.42, p=0.04). However, both chronotypes saw equivalent changes in SE (d=0.12, p=0.58).

Conclusion
Later chronotypes had a greater reduction in TIB, while earlier chronotypes demonstrated a significant increase in TST due to insomnia treatment, and both chronotypes had improved SE. These patterns suggest that treatment equivalently improves the consolidation of sleep, but the mechanism of this treatment effect differs by chronotype. That is, a moderating effect of circadian preference on the mechanism of improved sleep consolidation by insomnia treatment in older adults. These results suggest greater attention to age-related changes in chronotype in insomnia treatment.

Support (If Any)
NIMHR01MH101468-01; MIRECC at the VAPAHCS
0482 Virtual Reality Guided Imagery for Insomnia (iVR): Preliminary Feasibility and Outcomes
Authors: McCrae Christina , McGovney Kevin , Berry Jasmine , Simenson angelynn , Dillon McCann 
Published: May 2022

Abstract

Introduction
Chronic insomnia affects approximately 10% of adults and is associated with reduced quality of life, fatigue, impaired cognition, and increased risk for illness. Cognitive behavioral therapy for insomnia (CBT-I) is a recommended frontline treatment for chronic insomnia, but is not widely accessible as the number of trained CBT-I clinicians (&lt;500) falls significantly short of the number of patients needing treatment. Digital delivery holds great potential for increasing access to CBT-I as well as other behavioral treatment approaches. Our team recently developed and conducted preliminary testing of a novel, brief virtual reality guided imagery for insomnia (iVR) in adults with chronic insomnia.

Methods
12 adults (Mage=38.2 years, SD=20.7, 50% female) with chronic insomnia completed 4-weeks of iVR delivered via Oculus Go headsets equipped with blue light blocking lenses and pre-loaded with a guided relaxation application, sleep hygiene instructions, and modified stimulus control instructions. Participants completed a Satisfaction Survey at post-treatment and the following outcome assessments at baseline, post-treatment, and 1-month follow-up: Insomnia Severity Index, State-Trait Anxiety Inventory, Fatigue Severity Scale, and 1-week of sleep diaries (sleep onset latency, wake time after sleep onset, total sleep time, sleep quality [1-poor, 5-excellent]). [KM1] Paired one-tailed t-tests were used to examine preliminary outcomes. Effect sizes (ES) are reported as Hedges G.

Results
Adherence (#treatment weeks completed, M=3.5, SD=0.78) and Satisfaction (greater &gt;8.8/10 on average for overall experience and likelihood of recommending to a friend) were high. Insomnia severity (7/28, ES=1.13, p&lt;0.01), wake time after sleep onset (12 mins, ES=0.40, p=0.03), sleep onset latency (10 mins, ES = 0.36, p=0.04), and sleep quality (0.5/5, ES=1.08, p&lt;0.01) improved following treatment. Gains were maintained at 1-month along with additional improvements in total sleep time (36 mins, ES=0.67, p=0.03) and trending improvement in fatigue (9/100, ES=0.46, p=0.05). State Trait Anxiety Inventory and Fatigue Severity Scale scores did not improve.

Conclusion
Our pilot findings suggest iVR is feasible and promising treatment for chronic insomnia. Because the intervention can be pre-installed, iVR may be particularly useful for individuals with limited internet access (e.g., rural populations, military). Future research with a larger sample, randomized controlled design, and longer-term follow-up appears warranted.

Support (If Any)
Healium, Inc-PI McCrae
0486 Sleep patterns of children with cri du chat syndrome and autism spectrum disorder during the COVID-19 pandemic
Authors: Xavier Sandra , Silva Vinícius , Pires Gabriel , Fernandes Guilherme , Tufik Sergio , Andersen Monica 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has subjected most of the world population to changes in daily life activities, mostly related to social isolation, family distancing and home confinement. Children with autism spectrum disorder (ASD) and other neurodevelopmental syndromes, such as cri du chat syndrome (CDC) might be especially sensitive to the consequences of the pandemic, as they usually require a predefined and strictly controlled routine. Even before the pandemic, sleep disorders and complaints were more frequent in these children compared with neurotypical (NT) children. This study aimed to evaluate the sleep pattern of children with CDC and ASD before and during the pandemic, comparing it with NT children.

Methods
Children and adolescents between 0-18 years` parents or legal guardians were asked to answer the adapted Brief Infant Sleep Questionnaire, related to both before and during the COVID-19 pandemic.

Results
Before quarantine, children with CDC and ASD had increased chances of sleeping in their parents’ bed, of needing parental assistance to fall asleep, of taking &gt;30min to fall asleep and of having a wake after sleep onset time &gt;30min compared to children with typical development. Being part of the CDC group significantly increased the odds of having awakenings during the night. After quarantine, there were a decrease in the proportion of children sleeping in their own bedrooms and an increase in the odds of awakening during the night in all groups. Children with CDC and ASD had increased chances of sleeping in their parents’ bed and had a significantly higher chance of taking more than 30min to fall asleep. Both the CDC and ASD group presented worse sleep patterns during the COVID-19 pandemic.

Conclusion
Our results indicated that the ASD and CDC groups usually have more sleep problems and complaints than NT children. The CDC group showed worse sleep parameters overall, even before quarantine.

Support (If Any)
Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.
0490 Longitudinal associations between sleep and behavior and cognition in preschoolers from five European birth-cohorts
Authors: Guerlich Kathrin , Cadman Tim , Charles Marie-Aline , Fernandez-Barres Silvia , Guxens Monica , Heude Barbara , Inskip Hazel , Julvez Jordi , Lawlor Deborah , Salika Theodosia , Koletzko Berthold , Grote Veit , Plancoulaine Sabine 
Published: May 2022

Abstract

Introduction
There has been little focus on sleep and its relation to behavior and cognition in preschool-aged children. We aimed to investigate the association between sleep duration in early preschoolers (» 3.5 years of age) and later behavioral and cognitive outcomes (» 5 years of age) in European children.

Methods
We used harmonized data from five cohorts from the EU Child Cohort Network, established by the LifeCycle Project (n=16.444 children): ALSPAC and SWS from UK, EDEN and ELFE from France and INMA from Spain. Within all cohorts, total sleep duration per day and behavioral and cognitive information were reported by parents. Internalizing and externalizing behaviors were measured with the Strengths and Difficulties Questionnaire and treated as percentile scores. Verbal and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or with the McCarthy Scales of Children’s Abilities depending on the cohort and treated as standardized scores. All scores were cohort specific. Associations between sleep duration during early preschool age and later behavior and/or cognition were estimated using linear regression and pooled with two-stage individual participant data meta-analysis adjusted for child, maternal and household information. Analyses were done in DataSHIELD.

Results
Global mean sleep duration was 11h54 ± 1h00 per day at mean age 3.5 years but differed by country, with children from France showing longer sleep duration than children from the UK or Spain. In multivariate meta-analysis, 1 hour of additional sleep duration per day at mean age 3.5 years was associated with reduced internalizing and externalizing behavior percentile scores at mean age 5.1 years (internalizing behavior: badjusted= -1.05, 95%-CI [-1.93, -0.18], I2: 30.3%; externalizing behavior: badjusted= -2.12, 95%-CI [-2.78, -1.47], I2: 0.0%). No association was observed between sleep duration and subsequent verbal or non-verbal intelligence

Conclusion
Longer sleep duration in early preschool age (» 3.5 years of age) was associated with subsequent lower internalizing and externalizing behavior scores (» 5 years of age), but not with verbal or non-verbal intelligence. Adequate sleep duration at an early age is important for children’s later mental health.

Support (If Any)
KG was granted a LifeCycle fellowship.
0502 Harmony in the Sleep Lab: A Focus on Recognition of Hypoventilation and Direct Feedback Improves Quality of Pediatric Titrations
Authors: DiMaria Michelle , Schultz Brian , Falvo Jennifer , Matthews Edward , Ward Michelle , Land Jordan , Tauber Danna , Beck Suzanne 
Published: May 2022

Abstract

Introduction
Over 350 pediatric polysomnogram titrations (T-PSGs) are performed each year at the Sleep Laboratory at Children’s Hospital of Philadelphia in three locations by 24 different polysomnography technologists (PSGTs) on a diverse patient population, typically performed as outpatient procedures and occasionally at the bedside as inpatients. PSGTs are responsible for titration of continuous or bilevel positive airway pressure based on flow, work of breathing, arousals, and/or gas exchange. PSGTs have varying degrees of experience; thus, maintaining quality of T-PSGs is challenging. We hypothesized that a quality improvement (QI) approach to reviewing T-PSGs with interdisciplinary education and regular feedback would improve T-PSGs. Our goal was to have &gt;/= 80% of titrations of optimal quality.

Methods
Each T-PSG record was reviewed by a sleep physician for optimal quality, defined as appropriate signal integrity, titration, and documentation to permit definitive interpretation. Exclusion: RAM cannula use, illness, or external signal interference. Titration QI (T-QI) comments were reviewed by the sleep lab QI team bi-weekly to plan feedback. Improvement interventions for PSGTs included didactic education: lectures, presentations, and cases focusing on recognition of hypoventilation; direct feedback with teaching points by sleep physician and small group sessions with clinical supervisors to review areas for improvement; and communication of specific titration goals. Satisfaction surveys regarding recognition/titration for OSA/hypoventilation, transcutaneous CO2 signal integrity, and documentation were administered to sleep physicians.

Results
From September 2020-November 2021, PSGT education included: 1 synchronous and 2 asynchronous didactic presentations; 1:1 review of didactics with each night PSGT (n=24); T-QI feedback (2/week); and small group review sessions (4/week). 408 titrations were completed; 42 (10.3%, 2.8/month) were excluded; 366 (89.7%, 24.4/month) were reviewed for T-QI. 54.8% [50,71%] were deemed optimal during the first three months (pre-intervention) vs. 80.1% [63,96%] during the intervention period. QI satisfaction survey showed improvement in 3 of 4 domains.

Conclusion
Quality of T-PSG is enhanced by QI review of each titration, highlighting teaching points and areas for improvement via direct feedback and small group review. Education and communication among physicians, supervisors and technologists are important to support development which can result in better titrations and satisfaction.

Support (If Any)
none
0503 The Relationships between the Impact of COVID-19 Pandemic, Parent Insomnia, Infant Temperament, and Infant Sleep: a Path Analysis
Authors: Jiao Nana , Pituch Keenan , Petrov Megan 
Published: May 2022

Abstract

Introduction
Increased sleep problems in adults have been repeatedly reported during the COVID-19 pandemic. However, infant sleep was understudied. We aimed to examine the relationships between the impact of the COVID-19 pandemic, parent insomnia, infant temperament, and infant sleep during the COVID-19 pandemic.

Methods
Parents from the Phoenix metropolitan area with a full-term healthy infant (&lt;1 year) were recruited through social media from 2/27/2021 to 8/7/2021. A sample of 70 parents (baby age 5.5±3.5mo; parental age: 31.7±5.0y) completed the COVID-19 Exposure and Family Impact Survey Part 2 (CEFIS-Part 2, range: 12-60), a measure of the impact of the COVID-19 pandemic on families with higher scores indicating greater negative impact/distress; the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), with higher scores indicating better sleep quality, more positive sleep perception, and parent behaviors promoting healthy sleep; and the Insomnia Severity Index (ISI, range: 0-28, cutoff: 10). Infant temperament was assessed with the Infant Behavioral Questionnaire-Revised (IBQ-R), including the subscale Negative Affect. Path analyses were conducted based on the Transactional Model of Infant Sleep to identify the direct effect of CEFIS scores, and indirect effects of parent ISI scores and infant IBQ-R Negative Affect scores on BISQ-R scores, with z scores of all variables and infant age as a covariate.

Results
The parent sample was predominantly female (94.3%), identified as White (72.9%), had obtained a bachelor’s degree or above (71.5%), was married or in a domestic partnership (98.6%), and had household incomes &gt; US$70,000 (57.1%). More than one third (35.7%) experienced insomnia symptoms. The means of CEFIS, ISI, IBQ-R subscale Negative Affect, and BISQ-R scores were 29.3±9.5, 8.7±5.2, 4.1±1.1, and 68.8±12.7, respectively. After adjusting for infant age, the COVID-19 related family impact was not directly associated with BISQ-R scores, whereas parent ISI scores (β=-0.11, 95%CI [-.25, -.01]) and infant IBQ-R Negative Affect scores (β=-0.10, 95%CI [-.25, -.002]) significantly mediated the relationship.

Conclusion
The study highlighted the indirect effects of parent insomnia symptom severity and infant negative affect on infant sleep from the family impact of the COVID-19 pandemic. Future research should investigate how best to support healthy sleep for families during global crises.

Support (If Any)