bluuebunny/crossref_metadata_2025_split huggingface dataset:
0031 Sleep Regularity is Associated with DNA Methylation in Cognitive, Cardiovascular and Mood-related Genes: A GWAS-informed Study in Adolescents
Authors: Larsen Michael , Morales-Ghinaglia Natasha , He Fan , Imamura Yuka , Berg Arthur , Vgontzas Alexandros , Liao Duanping , Bixler Edward , Fernandez-Mendoza Julio 
Published: May 2022

Abstract

Introduction
Adolescence is associated with a delay in the circadian timing of sleep. However, social factors prevent adolescents from adapting to a later sleep-wake pattern, leading to different forms of circadian misalignment that may increase the risk of cardiovascular and mental health disorders. Several GWAS have identified genes associated with sleep and circadian phenotypes, however, little is known regarding the epigenetic basis and significance of sleep timing and its regularity in adolescence.

Methods
We analyzed data from 230 adolescents from the Penn State Child Cohort follow-up study who provided a blood sample for DNA extraction and had complete at-home 7-night (at least 3) actigraphy (ACT) data. ACT-measured sleep midpoint was calculated as the intra-individual mean of the 7-night midpoint (zeroed to midnight) of the sleep period. ACT-measured sleep regularity was calculated as the intra-individual standard deviation of the 7-night sleep midpoint. Epigenome-wide single nucleotide resolution of DNA methylation in cytosine-phosphate-guanine (CpG) sites and surrounding regions were obtained from peripheral leukocytes. This study focuses on methylation sites in GWAS-informed genes previously associated with sleep and circadian phenotypes. Linear regression assessed the association between sleep midpoint and sleep regularity with site-specific methylation levels, adjusting for sex, age, race/ethnicity, body mass index, and psychotropic medication use. Using the Benjamini & Hochberg method to adjust for a false discovery rate. Adjusted p-values are reported as q-values.

Results
Sleep midpoint was not associated with a significant change in methylation at any of the measured intragenic sites. Sleep regularity was significantly associated with differential methylation at 238 intragenic sites in 147 genes with an adjusted p&lt;0.05, of which, three sites were within GWAS-informed sleep/circadian-related genes. Higher sleep irregularity was associated with hypermethylation in MAD1L1 (q=2.4x10-2) and with hypomethylation in CALN1 (q=3.8 x 10-4) and ZNF618 (q=3.8 x 10-2).

Conclusion
Sleep irregularity is associated with altered DNA methylation in genes previously identified in GWAS of sleep/circadian phenotypes. Our data provides evidence for a potential epigenetic link between sleep irregularity and genes involved in neurocognitive functioning (CALN1), internalizing disorders (MAD1L1) and blood pressure (ZNF618).

Support (If Any)
National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0040 Sleeping during the Pandemic: COVID-19-related stressors and their influence on parental sleep, parenting, and children’s psychosocial health
Authors: Peltz Jack , Daks Jennifer , Rogge Ronald 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic has affected millions of parent in the United States by creating physical health-related stress, changes to work and parenting demands, and the possibility of losing a job or not being able to pay bills (Brooks et al., 2020). Such stressors have the potential to disrupt parents’ basic, essential needs, such as sleep (e.g., Sadeh et al., 2004). Although ample research suggests that disturbances to parents’ sleep can have diverse, negative repercussions on their own behavior and functioning (e.g., Grandner et al., 2020), there remains relatively little evidence linking parents’ sleep problems to potentially disrupt parenting processes and children’s behaviors. Given the emerging and established links between these diverse constructs, the proposed study will examine the potential for COVID-19-related stressors to prospectively influence children’s behavior via parents’ sleep quality and subsequent parenting practices.

Methods
The sample is comprised of 1003 parents of school-aged (5-18 years old) children who completed an initial online survey (from March 27th to April 30th of 2020) followed by up to 8 weekly online diary assessments. During the initial survey, parents reported on three forms of COVID-related stress: health-related stress, stress associated with work/parenting demands, and finance-related stress. In the follow-ups, parents completed measures of sleep (i.e., PROMIS sleep disturbance questionnaire), parenting (e.g., Alabama Parenting Questionnaire), and child behavioral problems (i.e., CBCL).

Results
Multi-level modeling results, at the between-person level, suggested that the influence of COVID-related financial stress on children’s behavioral problems was mediated by parental sleep disturbance and angry/hostile parenting behaviors. At the within-person level, weekly spikes in parental sleep disturbance were associated with corresponding spikes in angry/hostile parenting, which, in turn, were associated with subsequent spikes in children’s behavior problems.

Conclusion
Our results highlight the longitudinal impact of parental sleep disturbance as a mechanism linking COVID-19-related stressors, parenting, and child functioning.

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0044 Pre-Pandemic Circadian Phase Predicts Pandemic Sleep, Depression, and Alcohol Use Among Adolescents
Authors: Hasler Brant , Wallace Meredith , Graves Jessica , Buysse Daniel , Siegle Greg , Clark Duncan 
Published: May 2022

Abstract

Introduction
Growing evidence links later circadian timing during adolescence to worse sleep, more severe depression, and greater alcohol involvement, perhaps due to circadian misalignment and sleep restriction imposed by early school start times. School schedules initially shifted later during the COVID-19 pandemic, which hypothetically should reduce circadian misalignment and sleep restriction for adolescents with later circadian timing, and thus may mitigate any problems with sleep, depression, and alcohol. Here we used the pandemic as a natural experiment to test whether adolescent drinkers with later circadian timing, relative to those with earlier circadian timing, showed improved sleep, depressive symptoms, and alcohol involvement.

Methods
We studied 42 high school students reporting alcohol use (aged 16-18; 27 female participants), assessing circadian phase via the dim light melatonin onset (DLMO) during pre-pandemic conditions, and then following them over four remote assessments every 3 months during the pandemic. Sleep characteristics were assessed via the Munich Chronotype Questionnaire, depressive symptoms were assessed via the Quick Inventory of Depressive Symptomatology, and alcohol use was assessed via a 90-day Timeline Followback. Mixed-effect models focused on the pre-pandemic baseline, COVID baseline (Apr/May 2020), and COVID-9-mo (Jan/Feb 2021) timepoints, and covaried for age, time between pre-pandemic and COVID baselines, and current school/work status.

Results
In the pre-pandemic period, compared to those with earlier circadian timing, individuals with later circadian timing (later DLMO) got relatively less sleep (shorter total sleep time) on school nights. During the pandemic, earlier and later groups no longer differed on school night sleep. Over the course of the pandemic, compared to the earlier group, individuals with later circadian timing also reported larger increases in alcohol use (number of drinks, drinking days, and maximum drinks). Individuals with later circadian timing reported relatively greater depressive symptoms both pre-pandemic and 9-months into the pandemic.

Conclusion
While individuals with later circadian timing benefitted in terms of more school night sleep during the pandemic, this did not translate to mitigating depression or alcohol use. These findings suggest that later circadian timing may contribute to risk for depression and alcohol use over and above effects due to insufficient sleep.

Support (If Any)
Supported by grants from NIH (R01AA025626; P50DA046346).
0052 A mixed-methods examination of perceived challenges during the COVID-19 pandemic: Associations with sleep health and nightmares among healthcare workers
Authors: Franzen Ronald , Kahlon Ramandeep , Jones Melissa , Agrawal Ritwick , Crew Earl 
Published: May 2022

Abstract

Introduction
The emergence of CoVID-19 has created an immense burden on healthcare systems across the world, placing healthcare workers (HCWs) under significant, additional stress while they also confront multiple personal, family and sociopolitical challenges during the pandemic. Many studies have reported the negative impact of pandemic-related stress on sleep of HCWs. Our mixed-methods investigation sought to extend existing research by characterizing the themes of HCWs’ primary concerns during the early pandemic and identifying the most salient concerns which might be impacting sleep.

Methods
North American HCWs (n = 1331) were surveyed during the “second wave” of CoVID-19 case increases (6/9/2020 – 8/17/2020), which included a questionnaire with measures of sleep health (RU-SATED) and nightmare frequency (PSQI). Additionally, each HCW was asked to openly-describe their most salient concern with regard to the pandemic. Each response was categorized by topic. T-tests were conducted to compare frequencies of each response category with sleep health and nightmare frequency.

Results
The study sample comprised 1331 HCWs (91.7% female; 74.5% non-Hispanic white; 64.31% with exposure to CoVID-19 patients; 85.1% working in-person). Primary concerns were grouped into 8 categories including combinations of personal/familial-level concerns (e.g. concern about CoVID-19 infection/spread), and work-related stressors (e.g. increased workload). Concerns about lack of PPE/equipment was significantly associated with lower scores on RU-SATED (t = -2.69; p = .007) and increased nightmare frequency (t = 2.70; p = .007). Additionally, concerns about increased workload were significantly associated with lower scores on both RU-SATED (t = -2.79; p = .005) and increased nightmare frequency (t = 5.24; p = .000). Individually, primary concerns for CoVID-19 infection/spread was significantly associated with more-frequent nightmares (t = 2.01; p = .045). Neither sleep measure was associated with categories involving societal-level concerns (e.g. sociopolitical concerns) among the sample.

Conclusion
Our results indicate that the HCWs most concerned about workplace stressors during the pandemic indicated poorer sleep health and more frequent nightmares. Further analyses could help guide proper stratification of therapeutic approaches to improve sleep health and related distress for HCWs.

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0055 Bidirectional Associations Between Sleep and Daily Behaviors in Urban American Indian/Alaska Native (AI/AN) Youth
Authors: Dong Lu , D'Amico Elizabeth , Dickerson Daniel , Brown Ryan , Palimaru Alina , Johnson Carrie , Troxel Wendy 
Published: May 2022

Abstract

Introduction
American Indian/Alaska Native (AI/AN) individuals experience health disparities that emerge early in life. This is the first study to prospectively examine associations between sleep and daily behaviors in urban AI/AN adolescents.

Methods
Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep health characteristics were measured with actigraphy (total sleep time [TST], sleep efficiency [SE]) and daily diary (bedtime, wakeup time, sleep quality, alertness) over 7 days. Daily behaviors (caffeine consumption, physical activities, participation in traditional cultural activities, electronic use after 8PM, and mood) were measured via daily diary. Multilevel models examined the degree to which nightly sleep predicted next day’s behaviors and, reversely, daily behaviors predicted nightly sleep, controlling for age, gender, and weekday/weekends. Weekday/weekend was tested as a moderator.

Results
Earlier bedtime (b = -0.11, p = 0.03) and wakeup time (b = -0.18, p &lt; 0.001) were associated with more physical activity the following day. Earlier wakeup time (b = -0.17, p = 0.048) and shorter TST (b = -0.004, p = 0.03) were associated with greater participation in cultural activities. Later wakeup time (b = 0.96, p = 0.004), better sleep quality (b = 0.38, p &lt; 0.001), longer TST (b = 0.02, p = 0.001), and higher alertness (b = 0.28, p &lt; 0.001) were associated with higher mood rating.When examining the reverse direction, greater daytime caffeine consumption was associated with later wakeup time (b = 0.17, p = 0.01). More physical activity was associated with earlier bedtime (b = -0.12, p = 0.002) and wakeup time (b = -0.12, p = 0.01), but only during weekdays. Participation in cultural activities was associated with later bedtimes (b = 0.14, p = 0.02). More electronic use after 8 PM was associated with later bedtime (b = 0.38, p &lt; 0.001) and wakeup time (b = 0.32, p &lt; 0.001), shorter TST (b = -8.24, p = 0.001) and lower SE (b = -0.94, p = 0.002), with stronger effects on the weekdays than weekends.

Conclusion
Findings highlight dynamic associations between sleep and daily behaviors in AI/AN adolescents and may elucidate novel pathways for intervention and future research.

Support (If Any)
This work was supported by NIMHD R01MD012190 (WMT, EJD, DLD).
0063 Biopsychosocial Predictors of Sleep Health in Black, Asian, and Hispanic/Latinx Samples
Authors: Nielson Spencer , Dautovich Natalie , Dzierzewski Joseph 
Published: May 2022

Abstract

Introduction
Sleep health is an important aspect of sleep and is associated with biopsychosocial factors such as physical health, mental health, and social functioning. Disparities in sleep health are widely prevalent in individuals who identify as Black, Asian, and Hispanic/Latinx. Investigating unique associations between general sleep health and biopsychosocial factors may elucidate underlying associations and lead to innovative approaches to promote sleep health in these historically marginalized populations.

Methods
3,284 adults participated in an online study investigating sleep longitudinally across normal development (ISLAND). These analyses were conducted in the samples of individuals who self-identified as Black (n = 263, Mage = 40.6 years, 52.1% female), Asian (n = 208, Mage = 34.8 years, 39.9% female), and Hispanic/Latinx (n = 216, Mage = 35.8 years, 44.4% female). Participants were stratified across the lifespan, with equal numbers of men and women recruited. Participants completed several questionnaires including demographics, the RU-SATED, Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and the De Jong Gierveld Loneliness Scale. Multiple regression analyses were conducted within each group to determine whether biological (PHQ-15 without the sleep item), psychological (composite score of PHQ-2 and GAD-2), and social (social loneliness factor of the De Jon Gierveld Loneliness Scale) predictors of sleep health while controlling for demographic variables (i.e., age, sex, education).

Results
Within the Black sample, lower mental health functioning was associated with poorer sleep health (p=0.008). Within the Asian sample lower physical functioning and lower mental health functioning were significantly associated with poorer sleep health (p’s&lt;.001). Within the Hispanic/Latinx sample, lower physical functioning was significantly associated with poorer sleep health (p&lt;.001).

Conclusion
Sleep health was observed to be associated with biopsychosocial factors within Black, Asian, and Hispanic/Latinx samples. Unique patterns of associations were observed within each sample. Future research would benefit from employing longitudinal designs or using more objective measurements to further elucidate these associations.

Support (If Any)
National Institute on Aging of the National Institutes of Health under Award Number K23AG049955 (PI: Dzierzewski).
0068 Impact of OSA Therapy on Healthcare Economics: Actuarial Analysis of OSA Prevalence, Therapy Adherence, Co-morbidity, and Costs in a Large CMS Population Cohort
Authors: Fernandez Chris , Rusk Sam , Glattard Nick , Turkington Fred , Nygate Yoav , Kaiser Mark , McClurg Jen , Richard Maggie , Duncan Ian , Watson Nathaniel 
Published: May 2022

Abstract

Introduction
Research studying the economics of OSA therapy faces confounds including the prevalence of undiagnosed OSA, rate of diagnosed patients declining therapy, spectrum of treatment adherence, and effects of concurrent co-morbidity. We provide an actuarial analysis to study the economic impact of OSA therapy, accounting for these confounds, using the 2016-2018 Medicare 5% LDS Analytical File, a random sample of Medicare Claims containing approximately 2.9 million patients/year, resulting in N=2,001,538 eligible Fee-For-Service patients excluding managed care patients and incomplete data.

Methods
We segmented the study population into three cohorts and three 12-month time-periods. The cohorts analyzed were A) patients with OSA diagnosis and &gt;12 months treatment, B) patients with OSA and &lt;12 months treatment, and C) patients with OSA diagnosis who never received treatment, resulting in 1,351,838 patient-months. We analyzed the healthcare costs in each cohort in the year before treatment, the first year of treatment, and following treatment year. We applied actuarial risk adjustment within each cohort and time-period to provide a risk-adjusted cost comparison. Results were analyzed cross-sectionally given zero-to-seven co-morbidities among obesity, hypertension, type-II diabetes, depression, COPD, CHF, and/or prior stroke, facility-vs-home testing, and with-or-without surgical procedures.

Results
The average per-patient-per-month (PPPM) total medical spending was highest in the diagnosed-but-never-treated cohort-C ($1,375), second highest in &lt;12-months treatment cohort-B ($1,005), and lowest in &gt;12-months treatment cohort-A ($983). In both cohorts that started therapy, average/quantile costs decreased from pre-treatment year to post-treatment year, and from the first-to-second year on therapy. Compared to no-therapy cohort-C, costs were 29% lower in cohort-A and 27% lower in cohort-B. Among co-morbid, 75th quartile of cost members, we observed similar differences (18% and 16%) but larger absolute dollars. Patients undergoing surgical procedures had higher costs but lower spend reduction in initial and following year of therapy (22% and 5%).

Conclusion
We observed significant differences in cost between OSA patients that started treatment versus those that did not, and those differences further increased the year following therapy onset. These findings imply that receiving treatment for OSA reduces a patients overall medical spend. In terms of mean cost, the &gt;12-month and &lt;12-month cohorts costs fell in both follow-up treatment years.

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0071 A Mexican Spanish Version of the Circadian Energy Scale
Authors: Valencia Dora , Begay Tommy , Granados Karla , Delgadillo Marcos , Ghani Sadia , Molina Patricia , Alfonso-Miller Pamela , Fernandez Fabian-Xosé , Wills Chloe , Grandner Michael 
Published: May 2022

Abstract

Introduction
Circadian health is increasingly recognized for the contributions it makes to general health. Few instruments assessing circadian rhythms have been translated into Spanish, however. The present study describes a Spanish translation of the Circadian Energy Scale (CIRENS). The instrument was designed according to the language norms of those living along the US-Mexico border by a bilingual research team. The CIRENS was completed by both English and Spanish speaking border residents, in their preferred language.

Methods
Data were collected from a sample of N=100 individuals of Mexican descent living in Nogales, Arizona. CIRENS is a 2-item scale that assesses chronotype by examining overall energy level in the morning and evening. Translation of the instrument into Spanish was done according to the following process: (1) a bilingual study team member attempted an initial translation; (2) a bilingual community member edited the translation; (3) a certified medical translator edited the revision; (4) a focus group of N=5 bilingual community members made further contextual edits; (5) a back-translation was performed; (6) an additional bilingual focus group examined the final version for compatibility; and (7) the medical translator certified the accuracy of the final version. T-tests examined differences between those who completed the measure in Spanish vs English.

Results
Of the N=100 survey respondents, N=42 completed the CIRENS in Spanish. No significant differences were observed in overall chronotype determination between those who took the Spanish versus English version (p=0.22) of the instrument. As a continuous score, the respondents in Spanish demonstrated slightly more morningness (p=0.01). Per the individual items, no differences were seen for evening energy levels (p=0.22), but Spanish respondents reported slightly higher morning energy scores (2.76 vs 2.17, p=0.008).

Conclusion
The individuals that completed the CIRENS in Spanish reported higher morning energy scores but no significant differences in chronotype. Future studies can use the Spanish CIRENS to evaluate circadian factors across cultural/linguistic groups.

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0080 Influence of neighborhood safety on stress and sleep
Authors: Corona Frida , Mednick Sara 
Published: May 2022

Abstract

Introduction
Our health is influenced by the environment in which we live. Due to socioeconomic differences, disparities exist across neighborhoods, with certain groups experiencing higher detriments to their health compared to others. Emotional distressing experiences due to the neighborhood in which we live cause stress levels to rise. Given the psychological and physiological impact of stress, high levels of stress can be a contributing factor for poor sleep. We investigated the influence of feelings of neighborhood safety on stress and sleep and the ethnic differences found in each of these outcomes. In addition, we ask whether feelings of neighborhood safety mediate the association between stress and sleep.

Methods
1,606 participants were recruited online through Amazon Mechanical Turk to participate in a questionnaire. Components of this survey included demographic data, the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), and the Neighborhood Questionnaire Neighborhood Safety Subscale.

Results
We found that as neighborhood safety levels rise, stress levels lower. Further, ethnic differences were found for feelings of neighborhood safety, stress, and sleep: Latino participants had the lowest feelings of neighborhood safety, highest stress levels, and worst sleep. We also found that stress mediates the association between neighborhood safety and sleep.

Conclusion
Our results highlight the contribution of feeling safe in one's own neighborhood on stress and sleep outcomes. Given the ethnic differences present in each of our outcomes, future work should investigate neighborhood characteristics influencing neighborhood safety as possible areas of intervention benefitting sleep.

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