bluuebunny/crossref_metadata_2025_split huggingface dataset:
0312 Sleep and fear of falling, is there a relationship? A cross-sectional study in older adults
Authors: Kakazu Viviane , Andersen Monica , Pinto Rafael , Dokkedal-Silva Vinícius , Fernandes Guilherme , Gobbi Cynthia , Tufik Sergio , Pires Gabriel , Morelhão Priscila 
Published: May 2022

Abstract

Introduction
Excessive daytime sleepiness is a common problem in older people. This population is at higher risk of falls that lead to injuries, which explains the high prevalence of fear of falling among them. The relationship between sleep disturbances and concern about falling is unclear. The aim of this study was to identify whether poor sleep quality and excessive daytime sleepiness are associated with fear of falling in older adults.

Methods
This is a cross-sectional study. Data on age, sex, body mass index, alcohol consumption, mental status, depression, single-leg stance, excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality, comorbidities, and fear of falling (assessed through the Falls Efficacy Scale), were collected from participants aged 60 years and over. Univariable and multivariable linear regression were performed. Logistic regression evaluated the association between excessive daytime sleepiness and high fear of falling.

Results
504 participants were analyzed. The chance of an older person having high concern of falling was 3 times bigger among those with excessive daytime sleepiness when compared to those without excessive daytime sleepiness. The final model, multivariable linear regression showed that excessive daytime sleepiness score was able to predict fall efficacy scale scores (Beta coefficient=0.26; 95%CI: 0.07 to 0.45) adjusted by the following variables: age, single-leg stance, comorbidities, and depression. Our results showed that for each point increase on the Epworth Sleepiness Scale there was an average increase of 0.26 points in the Falls Efficacy Scale, indicating that sleepiness was related to fear of falling.

Conclusion
Having excessive daytime sleepiness increased the chance of older adults showing a high fear of falling. Healthcare workers should be aware that drowsiness can increase the fear of falling among older patients, and this may influence treatment.

Support (If Any)
The study was supported by Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Nível Superior (CAPES, Finance Code 001 to GLF). ST, MLA and RZP received fellowships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). GLF receives funding from CNPq (#141445/2021-1)
0316 Actigraphy-Derived Sleep Health Profiles and Mortality in Older Men and Women
Authors: Wallace Meredith , Lee Soomi , Stone Katie , Hall Martica , Smagula Stephen , Redline Susan , Ensrud Kristine , Ancoli-Israel Sonia , Buysse Daniel 
Published: May 2022

Abstract

Introduction
To identify actigraphy sleep health profiles in older men (Osteoporotic Fractures in Men Study; N=2,640) and women (Study of Osteoporotic Fractures; N=2.430), and to determine whether the identified profiles predict mortality.

Methods
We applied a novel and flexible clustering approach (Multiple Coalesced Generalized Hyperbolic mixture modeling) to identify sleep health profiles based on actigraphy midpoint timing, midpoint variability, sleep interval length, continuity, and napping/inactivity. Adjusted Cox models were used to determine whether profile membership predicts time to all-cause mortality.

Results
We identified similar profiles with different prevalences in men and women: High Sleep Propensity [HSP] (20% of women; 39% of men; high napping and high continuity); Adequate Sleep [AS] (74% of women; 31% of men; average actigraphy levels); and Abnormal Continuity/Timing [ACT] (6% of women; 30% of men; low continuity and late/variable midpoint). In women, ACT was associated with increased mortality risk (Hazard Ratio [HR]=1.59 for ACT vs. AS; 1.75 for IS vs. HSP). In men, ACT and AS were associated with increased mortality risk relative to HSP (1.19 for IS vs. HSP; 1.22 for AS vs. HSP).

Conclusion
These findings suggest several considerations for sleep-related interventions in older adults. For instance, interventions may be developed to target the combination of low continuity with late/variable midpoint. Findings also indicate that high napping/inactivity co-occurs with high sleep continuity in some older adults. Although high napping/inactivity is typically considered a risk factor for deleterious health outcomes, our findings suggest that it may not be inherently problematic when occurring in combination with high sleep continuity.

Support (If Any)
The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH grants U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, UL1 TR000128, R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Study of Osteoporotic Fractures (SOF) is supported by NIH grants R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. This study is also supported by NIH grants R01AG056331 and RF1AG056331 (PI: Wallace), R56AG065251 (PI: Lee), K01MH112683 (PI: Smagula), and R35HL135815 (PI: Redline).
0318 Subjective Sleep and Cognition in Middle-aged and Older Adults: Chronotype and Sex as Moderators
Authors: Musich Madison , Costa Amy , Salathe Victoria , McCrae Christina , Curtis Ashley 
Published: May 2022

Abstract

Introduction
Associations between sleep and cognition are well studied in aging populations. However, less is known regarding the moderating impact of chronotype (morningness vs. eveningness) and sex on these relationships. We aimed to determine the sex-specific moderating impact of subjective chronotype on the association between subjective sleep and subjective cognition in middle-aged and older adults.

Methods
Participants (N=260, 142 men/118 women) aged 50+ completed surveys measuring subjective sleep [Pittsburgh Sleep Quality Scale (PSQI)], chronotype [Morning-Evening Questionnaire (MEQ)], and everyday subjective cognition [Cognitive Failures Questionnaire (CFQ)]. Moderated regressions determined independent and interactive roles of subjective sleep (PSQI-total, sleep disturbances, sleep efficiency), chronotype (MEQ total), and sex on everyday subjective cognition (CFQ scores: total, memory, distractibility, and blunders). Analyses controlled for age, education, depressive/anxiety symptoms, and sleep medication use.

Results
Sex moderated the interactive associations of chronotype and PSQI-total on CFQ-total (p=.005) and CFQ-memory (p&lt;.001). Specifically, higher PSQI-total was associated with higher CFQ-total (B=0.87, SE=0.38, p=.02) and CFQ-memory scores (B=0.33, SE=0.13, p=.009) in men with a tendency for eveningness. Sex also moderated the interactive associations of chronotype and PSQI-sleep disturbances on CFQ-memory (p=.04) and CFQ-blunders (p=.02). In men with a tendency for eveningness, greater PSQI-sleep disturbances were associated with worse CFQ-memory (B=2.65, SE=.84, p=.002) and CFQ-blunders scores (B=1.85, SE=0.83, p=.03). In women with a tendency for morningness, greater PSQI-sleep disturbances were associated with worse CFQ-memory (B=2.65, SE=.81, p= .001) and CFQ-blunders scores (B=2.37, SE=0.81, p=.004).

Conclusion
There are sex-specific patterns regarding the moderating impact of chronotype on associations between sleep and everyday cognition in middle aged and older adults. In men prone to eveningness, worse overall sleep quality and sleep disturbances may exacerbate negative perceptions of overall and memory specific cognitive function. However, in women prone to morningness, greater sleep disturbances may exacerbate negative perceptions of memory and task execution. Further investigating chronotype on objective sleep and cognition in prospective studies may help further explain underlying mechanisms of the impact of sleep on cognition, in addition to sex-specific sleep interventions to mitigate cognitive decline in aging populations.

Support (If Any)
0331 Intersectional discrimination and sleep health among women veterans: a pilot study
Authors: Agrawal Alpna , Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Lee Diane , Mitchell Michael , Zeidler Michelle , Alessi Cathy , Sung Yeonsu , Hamilton Alison , Bean-Mayberry Bevanne , Yano Elizabeth , Washington Donna , Martin Jennifer 
Published: May 2022

Abstract

Introduction
Structural inequalities perpetuate poor health outcomes. Sleep inequality, which is the disproportionate burden of sleep problems among marginalized groups compared to historically advantaged groups, is poorly understood. While racial discrimination is associated with chronic health outcomes, few studies have examined the health impact of discrimination stemming from multiple social vulnerabilities. The current study assessed women veterans’ experiences of intersectional discrimination, specifically the combined impact of gender and racial/ethnic discrimination on sleep health.

Methods
Data were from the WISE (Women Improving Sleep through Education) study. Participants were women veterans with a previous diagnosis of sleep apnea or 1 or more risk factors for sleep disordered breathing (n=39). Data collection was from 3/2021–11/2021. The 9-item Major Discrimination Scale (MDS) and 10-item Everyday Discrimination Scale (EDS) were employed. The MDS included items such as “have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?” and the EDS, “how often on a day-to-day basis are you treated with less courtesy than other people?”. Items were adapted to assess discrimination related to respondents' gender and race/ethnicity separately. Major intersectional discrimination (MDS-gender + MDS-race/ethnicity) and everyday intersectional discrimination (EDS-gender + EDS-race/ethnicity) were computed. Sleep health was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Descriptive statistics and correlational analyses were performed.

Results
Racial/ethnic minority women veterans comprised 54% of the study sample. Prevalence of major intersectional discrimination was 67% and everyday intersectional discrimination, 92%. Compared to other racial/ethnic groups, the proportion of Black women veterans reporting major intersectional discrimination was highest (78%). Major intersectional discrimination was positively correlated with ISI (p=0.04) and PSQI (p=0.01). Everyday intersectional discrimination was not correlated with sleep health (p&gt;0.05).

Conclusion
Pilot study findings highlight the potential role of discrimination on sleep health, particularly multiple forms of discrimination. High prevelence of intersectional discrimination related to women veterans' gender and racial/ethnic identities was observed. Major intersectional discrimination, not everyday intersectional discrimination, was associated with higher insomnia severity and poorer sleep quality.

Support (If Any)
LIP VA HSRD IIR16-244, RCSA20-191, LIP65-177, NIH/NHLBI K24HL143055, VAGLAHS GRECC, VAGLAHS CSHIIP, RCS 21-135, CIN 13-417, RCS 05-195
0335 Sleep patterns and experiences in older night shift nurses
Authors: Zhang Yuan , Murphy Audra , van der Holst Heidi Lammers- , Barger Laura , Swaminathan Neha , Granfield Catherine , Palacios Arturo Arrona , Duffy Jeanne 
Published: May 2022

Abstract

Introduction
Working at night can lead to misalignment between the timing of the biological clock and the work/sleep schedule, resulting in sleepiness, inattention, and impaired performance during the night shift and poor quality, shortened sleep during the day. These adverse effects are reported to be worse in older workers due to their decreased ability to sleep during the daytime. Although numerous quantitative studies have examined these associations, there are few qualitative studies to describe the sleep patterns and experiences from older night workers’ perspectives.

Methods
Four virtual focus groups were conducted with 12 nurses aged 50-65, working regular 8-hr night shifts, to learn about their sleep patterns and experiences, and factors affecting their sleep and non-sleep activities before, between, and after consecutive night shifts. Two facilitators and two research assistants reviewed and coded the focus group transcripts for consistent themes among participants.

Results
Eight common themes were identified: (1) sleep patterns are self-selected based on family and childcare responsibilities; (2) sleep timing switches between nights and days from before- to between- to after-consecutive night shifts; (3) frequent extended (24+ h) wake before and after consecutive night shifts; (4) difficulty maintaining long and sound sleep during daytime; (5) family, social, health, and environmental disturbances interrupt daytime sleep; (6) more satisfaction with sleep quantity and quality in participants with split sleep than those with one episode; (7) sleep is considered less important compared to childcare, family, and social activities; (8) better on-shift alertness and performance when the main sleep episode or a nap immediately precedes night shift.

Conclusion
Sleep patterns and experiences reported by older night shift nurses are helpful in understanding their priorities and challenges to obtaining adequate sleep. This information is critical for the future design and implementation of feasible and acceptable interventions to improve sleep in this occupational group.

Support (If Any)
This study was supported by NIH grant R01 AG044416.
0339 A possible role for the circadian system in aggression in dementia
Authors: Van den Bulcke Laura , Vaessens Rebecca , Van Den Bossche Maarten 
Published: May 2022

Abstract

Introduction
Growing evidence suggest a bidirectional relationship between circadian and sleep regulation, and the pathology and progression of dementia. Behavioral and psychological symptoms of dementia (BPSD) are very prevalent, and lead to an enormous disease burden in patients, families and caregivers. Indications for a possible disruption of circadian regulation of emotions and behavior in dementia, can be found in the phenomenon known as ‘sundowning’, exacerbation of neuropsychiatric symptoms during the late afternoon and early evening. Aggression in particular can be a very debilitating symptom of dementia, and previous animal and human studies point to a possible role of the circadian rhythm in the propensity for aggressive behavior. Therefore, we examine here the timing of aggression in a dementia cohort.

Methods
We studied the timing of aggression incidents on a university psychiatric hospital unit treating patients with dementia and additional behavioral problems. During a 6-month period (November 2020 - April 2021) 84 patients were admitted to the ward. Data of these patients were retrospectively analyzed. During this period 335 individual incidents of aggression (verbal and/or physical) were reported by the nursing staff.

Results
Among the 84 subjects, 42 (50%) had at least one aggression incident during hospital admission. 41% of all incidents occurred between 4-10pm. (5-9pm (36.4%), 9pm-1am (11.6%), 1-5am (5.7%), 5-9am (22.7%), 9am-1pm (10.7%), 1-5pm (12.8%)). In every investigated month, a peak in number of incidents could be seen between 7 and 8pm. Aggression incidents were most likely to occur in Alzheimer’s dementia (OR: 3.75). Patients who exhibited aggression had worse cognitive impairment (difference in mean MMSE: 4.57 ± 2.1 , p=0.034).

Conclusion
Aggression incidents were most prevalent during the late afternoon and evening. Furthermore, the severity of cognitive impairment and type of dementia negatively impacted the prevalence of aggression.Our study thus confirms a possible role of the circadian rhythm in aggression. The role of the circadian rhythm in the pathophysiology of neurodegenerative disorders, and specifically in their neuropsychiatric symptoms, warrants further research.

Support (If Any)
Supported by the Funds Malou Malou, Perano, Georgette Paulus, JMJS Breugelmans and Gabrielle, François and Christian De Mesmaeker, Managed by the King Baudouin Foundation of Belgium, No. 2021-J1990130-222081.
0345 Comforter Designed for Warm Sleepers Improves Objectively-Measured Sleep for Adults in Midlife and Older
Authors: Danoff-Burg Sharon , Rus Holly , Weaver Morgan , Rodriguez Rodolfo , Gavrilova Larisa 
Published: May 2022

Abstract

Introduction
Bedding can aid in maintaining a comfortable thermal state in the sleep environment. Research is needed to bring scientific rigor to document these benefits and their potential for promoting better sleep. This study examined effects of a comforter designed for warm sleepers used at home.

Methods
Healthy adults (96% female, ages 23-74) who reported sleeping hot, experiencing night sweats, or having hot flashes during the night participated in a 6-week field study, using a pre-post intervention design. Intervention consisted of using a comforter designed for warm sleepers, made of 300 thread count viscose from bamboo fiber with Tencel/polyester fill. During the 3-week baseline period, participants used their regular bedding. During the 3-week intervention period, they used the comforter without a top sheet to have direct contact with the comforter. Sleep was measured objectively using SleepScore Max every night and by daily and pre-post self-report. Multilevel regression and paired t-tests were used to test for statistical significance.

Results
There were over 1,000 nights of tracked sleep across all participants. In the full sample (n=31), self-reported sleep (e.g., perceived sleep quality, feeling well-rested) but not objectively-measured sleep showed improvements. Therefore, and given that this type of product may provide the most benefit for sleepers in midlife or older, additional analyses were conducted for the subgroup of participants who were 45 years old and above (n=15). Results indicated increased time in bed (+11 minutes, p=.017), total sleep time (+12 minutes, p=.010), and deep sleep (+6 minutes, p=.005) during the intervention compared to baseline. Improvements also were observed in SleepScore, a measure of overall sleep quality (p=.002), and BodyScore, a measure of deep sleep (p=.002).

Conclusion
Self-reported but not objectively-measured sleep improved among healthy adults using a comforter designed for warm sleepers. However, looking specifically at those aged 45 and older, objectively-measured time in bed, total sleep time, deep sleep, and overall sleep quality all increased significantly when using the comforter compared to baseline.

Support (If Any)
Blue Ridge Home Fashions
0346 Differentiation of Naturalistic Sleep in Chronic Insomnia vs. Healthy Controls Using a Non-Contact Measurement Device
Authors: Hansen Devon , Finlay Myles , Peterson Mary , Gottlieb Elie , Raymann Roy , Buchwald Dedra , Van Dongen Hans , Watson Nathaniel 
Published: May 2022

Abstract

Introduction
Individuals with insomnia report poor sleep quality and non-restorative sleep, and often exhibit irregular sleep patterns over time. First night effects and logistical challenges make it difficult to accurately measure these sleep characteristics in the laboratory. Also, sensitivity to sleep disruption from obtrusive devices confounds sleep measurements in people with insomnia in their naturalistic setting. Non-contact devices (NCDs) may address these issues and enable ecologically valid, longitudinal and unobtrusive characterization of sleep in individuals with insomnia. We present results from a NCD, previously validated against polysomnography, – SleepScore Max (SleepScore Labs) – assessing the sleep of individuals with chronic insomnia, compared to healthy sleeper controls, in their home setting.

Methods
A total of 112 individuals participated in an at-home sleep monitoring study including 83 with chronic insomnia (ages 19-65, 58 females) and 29 healthy sleeper controls (ages 19-54, 21 females). Enrollment criteria included being 18-65 years of age and, for the insomnia group, meeting International Classification of Sleep Disorders (3rd edition; ICSD-3) criteria for chronic insomnia with no other clinically relevant condition contributing to sleep disturbance. Participants used the NCD to record their sleep periods each night for 8 weeks. Sleep measurements were analyzed for group differences in both means (characterizing sleep overall) and within-subject standard deviations (characterizing night-to-night sleep variability), using mixed-effects regression controlling for systematic between-subject differences.

Results
On average, individuals with chronic insomnia exhibited increased total wake time, wake after sleep onset, and decreased sleep efficiency relative to healthy sleeper controls (F&gt;6.8, p&lt;0.01). Additionally, they demonstrated greater night-to-night variability in time in bed, total sleep time, sleep latency, total wake time, wakefulness after sleep onset, sleep interruptions, sleep efficiency, and light and deep sleep (F&gt;4.4, p&lt;0.05).

Conclusion
In our sample of individuals with chronic insomnia, a NCD naturalistically detected differences from healthy sleeper controls in multiple sleep parameters, both on average and in terms of night-to-night variability. Capturing night-to-night variability in the home setting adds an important dimension to our understanding of poor sleep and provides a more comprehensive, ecologically valid characterization of chronic insomnia as experienced in daily life.

Support (If Any)
NIH grant KL2TR002317; research devices provided by SleepScore Labs
0355 Which hospitals are the quietest at night? It’s not The US News Top 20 Institutions
Authors: Gulati Jasmine , Arora Vineet , Orlov Nicola , Mason Noah , Affini Murtala , McDaniel Lauren 
Published: May 2022

Abstract

Introduction
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey distributed by The Center for Medicare and Medicaid (CMS) services measures patient perceptions of hospital experience and impacts annual CMS reimbursement. This study focuses on the “Quiet at Night” variable, to identify the top box institutions and identify the key characteristics that enable their success.

Methods
Using the Linear Mean Scores and the Star Ratings’ inherent clustering algorithm and RStudio™, the top box scorers amongst the 5 Star Rated hospitals were isolated and grouped together as CMS Top Rated “Quiet at Night” Hospitals. These Star Ratings and the key characteristics of these institutions were compiled and compared to the US News Honor Roll Hospitals (2019-2020) to ascertain trends and determine the predictive value of the HCAHPS “Quiet at Night”' hospitals' characteristics.

Results
The mean Star Rating for CMS Top Rated “Quiet at Night” Hospitals was 5.00 compared to that of the US News Honor Roll Hospitals which was 2.67. An unpaired t-test of this data found a two-tailed P value of less than 0.0001, which is considered statistically significant under all conventional significance levels (Table 1). In comparing the key characteristics for these two lists documented by the American Hospital Directory a stark difference emerged between these groups with those that scored well on the “Quiet at Night'' question identifying as predominantly privately controlled, specialized, surgical facilities with very few total hospital beds.

Conclusion
This study was the first of its kind to critically analyze hospitals that score well on the CMS “Quiet at Night” and compare them to the US News Honor Roll Best Hospitals. With the knowledge that these scores impact CMS reimbursement, it is important to determine the cultural and organizational shifts that enable hospitals to be top performers on the “Quiet at Night” metric. A greater understanding of how top CMS hospitals so efficiently provide care in a sleep protective way may help inform larger institutions about Best Practices.

Support (If Any)