Actigraphy-measured Sleep Research Articles

Associations between Recession Hardships and Subjective and Objective Sleep Measures in the Midlife in the United States Study: Race and Gender Differences.

This study investigates the associations of retrospective reports of Recession hardships with 10-year changes in subjective and objective indicators of sleep, and whether these associations differ by race and gender. 501 adults (14.57% Black; 54.49% female) from the Midlife in the United States (MIDUS) study reported on the subjective Pittsburgh Sleep Quality Index (PSQI) across two waves (pre-Recession, collected 2004-2009; post-Recession, collected 2017-2022), as well as Recession hardships since 2008. A sub-sample of 201 adults (25.37% Black; 58.21% female) provided objective actigraphy-measured sleep data (total sleep time, sleep onset latency, sleep efficiency) across the two waves. Descriptive analyses revealed Black participants had higher average Recession hardships, poorer post-Recession PSQI scores, and poorer post-Recession actigraphy sleep quantity and quality compared to white participants. Females had higher average Recession hardships compared to males; and reported poorer post-Recession PSQI, but had better objective post-Recession sleep quantity and quality compared to males. Regression models showed Recession hardships (across overall events, and sub-domains of financial and housing hardships) were associated with poorer PSQI and actigraphy-measured sleep efficiency following the Recession, adjusting for sociodemographic covariates, corresponding pre-Recession sleep variables, and pre-Recession chronic conditions. There was no evidence for significant moderation by race on sleep outcomes. However, gender moderation indicated associations between housing hardships and poorer actigraphy-measured sleep efficiency were more apparent for females than for males. Findings indicate that Recession hardships (particularly in financial and housing domains) may be manifested in poor sleep. Racial and gender groups may have differential exposure and sleep-related reactivity to Recession hardships.

Toddler Screen Use Before Bed and Its Effect on Sleep and Attention

Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance. To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention. This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study. Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual. Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures. A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores. Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians. ISRCTN.org Identifier: ISRCTN58249751.

Association between skin temperature and actigraphic sleep metrics in patients with Parkinson's disease: The PHASE study

Introduction Sleep initiation and maintenance are linked to thermoregulation. In Parkinson's disease (PD), thermoregulatory dysfunction potentially worsens sleep disorders. However, the association between thermoregulation and sleep quality in patients with PD remains unclear. We aimed to examine the association between skin temperature, a measure of heat dissipation, and actigraphic sleep metrics in PD.Methods In this cross-sectional study with 186 outpatients with PD and 580 non-PD controls, we measured wrist skin temperature (WST) and actigraphic sleep quality for seven days in PD and two days in controls in real-life settings. Linear mixed-effect models were used to examine the association between nighttime WST and sleep quality.Results Nighttime WST in PD was significantly lower than that in controls (adjusted difference 0.39 [95 % confidence interval, 0.23–0.54] °C, P < 0.001). In patients with PD, changes in sleep efficiency, wake after sleep onset, total sleep time, and log-transformed fragmentation index per 1 °C increase in nighttime WST were 3.2 (95 % CI, 2.4–3.9) %, −10.3 (95 % CI, −13.6, −7.1) minutes, 13.4 (95 % CI, 9.1–17.8) minutes, and −0.09 (95 % CI: −0.12, −0.06), respectively, independent of potential confounders. Significant interactions were observed between nighttime WST and the presence of PD for sleep efficiency, wake after sleep onset, and total sleep time.Conclusions: Within-individual changes in nighttime WST were significantly associated with changes in actigraphic sleep measures in PD. Interventional studies are necessary that address the limitations and potential biases of this study to elucidate whether cutaneous temperature modulation can enhance the quality of sleep in PD.

Daily Associations Between Sleep Parameters and Depressive Symptoms in Individuals with Insomnia: Investigating Emotional Reactivity and Regulation as Mediators

ABSTRACT Objectives Previous research suggests that insomnia and depressive symptoms might be causally related. Emotional reactivity and regulation have been proposed to explain the potential causal relationship between insomnia and depression. However, longitudinal evaluations of their mediating effects are limited. Hence, the current study aimed to examine the mediating effects of emotional reactivity and regulation on the longitudinal associations between daily sleep parameters and depressive symptoms over 14 days in individuals with insomnia. Methods Participants were sixty adults aged 18–65 who had clinically significant insomnia. They filled out a survey each morning and evening and wore actigraphy watches for 14 consecutive days. The five sleep parameters were measured by sleep diary in the morning survey (subjective total sleep time, subjective sleep efficiency, and sleep quality) and actigraphy watches (objective total sleep time and objective sleep efficiency). Emotional reactivity and emotion regulation strategy use during the day were assessed in the evening survey using the International Positive and Negative Affect Schedule Short Form, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire. Depressive symptoms of the day were evaluated in the evening survey with the Center for Epidemiologic Studies Depression Scale. Results Results showed that sleep quality and depressive symptoms, as well as actigraphy-measured sleep efficiency and depressive symptoms, predicted each other in individuals with insomnia, mediated by negative reactivity but not emotion regulation. Conclusions The present findings support the mediating role of negative emotional reactivity in the bidirectional, daily relationship between sleep parameters and depression in individuals with insomnia.

Concordance between subjective and actigraphy-measured sleep duration among Ghanaian schoolchildren in the Accra School Health and Environmental Study (ASHES)

Concordance between subjective and actigraphy-measured sleep duration among Ghanaian schoolchildren in the Accra School Health and Environmental Study (ASHES)

Sleep quality and the cortisol and alpha-amylase awakening responses in adolescents with depressive disorders.

Depressive disorders in adolescents affect all aspects of life and impose a very large burden of disease. Sleep is frequently affected by depression and is crucial for facing challenges during development. One of the postulated reasons for depression-induced sleep disruption is dysregulation of the physiological stress system. To investigate the links of adolescent depressive disorders with subjective sleep quality, objective sleep quality, and the course of cortisol and alpha-amylase after awakening. We compared subjective sleep quality (via daily questionnaires) and objective sleep quality (via actigraphy measurement) of 35 adolescents with depressive disorders and 29 healthy controls over 7 consecutive days. In addition, saliva samples were collected on 3 days to examine cortisol and alpha-amylase patterns after awakening. No significant differences in cortisol or alpha-amylase awakening responses were observed between participants with depressive disorders and healthy controls. We found severe reductions in subjective sleep quality in the depression group (Z = -5.19, P < 0.001, d = 1.80) and a prolonged actigraphy-measured sleep onset latency (Z = -2.42, P = 0.015, d = 0.64) compared with controls. Reductions in subjective sleep quality were partially correlated with objective sleep measures (sleep onset latency: r = -0.270, P = 0.004, sleep efficiency: r = 0.215, P = 0.017). Sleep onset latency seems to aggravate depressive symptoms and to have an important role in perception of sleep quality. Adolescents with depressive disorders should be supported regarding the establishment of good sleep hygiene and avoiding activities that may impede falling asleep.

Sleep Composition of Patients With Colorectal Cancer and Their Sleep-Partner Caregivers: Physical Health Correlates of Sleep Diary and Actigraphy Measurements.

Disturbed sleep is frequently identified in adult patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraph-measured sleep patterns are similar between patients and their sleep-partner caregivers, and how these different modes of sleep measurements are related to physical health. Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads) completed a questionnaire for physical functioning and collected saliva samples for seven consecutive days, from which cortisol slope was quantified. Additionally, participants completed a daily sleep diary and wore actigraph for 14 consecutive days, from which sleep duration, sleep onset latency (SOL), and duration of wake after sleep onset (WASO) were calculated. Participants reported sleep patterns that fell within or close to the optimal range, which were similar between patients and their caregivers. Self-reported and actigraph-measured sleep duration had moderate levels of agreement (ICC=0.604), whereas SOL and WASO had poor agreement (ICC=0.269). Among patients, longer self-reported WASO was associated with poorer physical health and flatter cortisol slope (p≤0.013). Among caregivers, longer self-reported SOL was associated with poorer physical functioning, actigraph-measured WASO was associated with steeper cortisol slope, and longer self-reported sleep markers studied than actigraph-measured were associated with poorer physical functioning (p≤0.042). Findings suggest that employing multiple assessment modes for sleep and physical health is vital for comprehensive understanding of sleep health. Furthermore, when addressing patients' sleep health, it may be beneficial to include their sleep-partner caregivers who may experience similar disturbed sleep.

Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

ABSTRACT Objectives Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism. Methods Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected. Results High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions. Conclusions Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one’s vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

Abstract 24: Actigraphy-Measured Sleep Irregularity Increases the Risk of Incident Cardiovascular Disease and Cardiovascular Mortality in Older Women

Background: Cardiovascular disease (CVD) is the leading cause of death for U.S. women. Our understanding of how poor sleep health contributes to CVD is limited by reliance on cross-sectional studies, self-reported sleep measures, and predominately non-Hispanic white samples. Our objective was to prospectively investigate actigraphy-measured sleep health and incident CVD and CVD mortality in a cohort of older multiethnic women. Methods: Women (n=3,992; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in May 2012-April 2014 and were followed through February 2022 for physician-adjudicated incident CVD (definition in Table footnote) and CVD mortality. Sleep duration, timing, efficiency, irregularity, and continuity were derived from accelerometers (definition in Table footnote). Women with prior CVD at baseline were excluded from analyses. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Minimally adjusted models included age, race and ethnicity. Models were additionally adjusted for education, smoking, alcohol consumption, comorbid conditions, self-rated health, and CVD risk factors. Results: Over a median of 8.3 years of follow-up, 636 incident CVD cases occurred, including 395 CVD deaths. In minimally adjusted models, longer sleep duration, greater sleep irregularity, and more wake after sleep onset were associated with increased CVD risk (Table 1). In models further adjusted for CVD risk factors, the HR (95% CI) for a 60-minute increase in sleep irregularity was 1.18 (1.01-1.37) for incident CVD and 1.30 (1.07-1.58) for CVD mortality. Conclusions: Greater sleep irregularity was associated with higher risk of incident CVD and CVD mortality in a diverse cohort of older women. These results support the importance of maintaining regular sleep for cardiovascular health.

Objective and Subjective Intraindividual Variability in Sleep: Predisposing Factors and Health Consequences.

We investigated the factors that predispose or precipitate greater intraindividual variability (IIV) in sleep. We further examined the potential consequences of IIV on overall sleep quality and health outcomes, including whether these relationships were found in both self-reported and actigraphy-measured sleep IIV. In Study 1, 699 US adults completed a Sleep Intra-Individual Variability Questionnaire and self-reported psychosocial, sleep quality, and health outcomes. In Study 2, 100 university students wore actigraphy and completed psychosocial, sleep, and health surveys at multiple timepoints. In cross-sectional analyses that controlled for mean sleep duration, predisposing/precipitating factors to greater IIV were being an underrepresented racial/ethnic minority (Study 1: F = 13.95, p < .001; Study 2: F = 7.03, p = .009), having greater stress (Study 2: r values ≥ 0.32, p values ≤ .002) or trait vulnerability to stress (Study 1: r values ≥ 0.15, p values < .001), and showing poorer time management (Study 1: r values ≤ -0.12, p values ≤ .004; Study 2: r values ≤ -0.23, p values ≤ .028). In addition, both studies showed that greater sleep IIV was associated with decreased overall sleep quality, independent of mean sleep duration (Study 1: r values ≥ 0.20, p values < .001; Study 2: r values ≥ 0.33, p values ≤ .001). Concordance across subjective and objective IIV measures was modest ( r values = 0.09-0.35) and similar to concordance observed for subjective-objective mean sleep duration measures. Risk for irregular sleep patterns is increased in specific demographic groups and may be precipitated by, or contribute to, higher stress and time management inefficiencies. Irregular sleep may lead to poor sleep quality and adverse health outcomes, independent of mean sleep duration, underscoring the importance of addressing sleep consistency.

The influence of sleep on subjective well-being: An experience sampling study.

Previous research has associated sleep with subjective well-being (SWB), but less is known about the underlying within-person processes. In the current study, we investigated how self-reported and actigraphy-measured sleep parameters (sleep onset latency, sleep duration, sleep satisfaction, social jetlag, and sleep efficiency) influence SWB (positive affect [PA], negative affect [NA], and life satisfaction [LS]) at the within- and between-person levels. Multilevel analyses of data from 109 university students who completed a 2-week experience sampling study revealed that higher within-person sleep satisfaction was a significant predictor of all three components of next day's SWB (ps < .005). Higher between-person sleep satisfaction was also related to higher levels of PA and LS (ps < .005), whereas shorter self-reported between-person sleep onset latency was associated with higher PA and LS, and lower NA (ps < .05). However, longer actigraphy-measured within-person sleep onset latency was associated with higher next day's LS (p = .028). When including within- and between-person sleep parameters into the same models predicting SWB, only within- and between-person sleep satisfaction remained a significant predictor of all components of SWB. Additionally, we found an effect of higher self-reported within-person sleep onset latency on PA and of shorter self-reported within-person sleep duration on LS (ps < .05). Our results indicate that the evaluative component of sleep-sleep satisfaction-is most consistently linked with SWB. Thus, sleep interventions that are successful in not only altering sleep patterns but also enhancing sleep satisfaction may stand a better chance at improving students' SWB. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Short-term and long-term phenotypic stability of actigraphic sleep metrics involving repeated sleep loss and recovery.

For the first time, we determined whether actigraphic-assessed sleep measures show inter-individual differences and intra-individual stability during baseline (BL) and recovery (REC) phases surrounding repeated total sleep deprivation (TSD). We conducted a 5-day experiment at Months 2 and 4 in two separate studies (N = 11). During each experiment, sleep measures were collected via wrist actigraphy during two BL 8 h time-in-bed (TIB) nights (B1, B2) and during two REC 8-10 h TIB nights (R1, R2). Intraclass correlation coefficients (ICCs) assessed actigraphic measure long-term stability between 2 and 4 months for (1) the pre-experimental phase before BL; and (2) the BL (B1 + B2), REC (R1 + R2), and BL and REC average (BL + REC) phases; and short-term stability at Month 2 and at Month 4; and (3) between B1 versus B2 and R1 versus R2 in each 5-day experiment. Nearly all ICCs during the pre-experimental, BL, REC, and BL + REC phases were moderate to almost perfect (0.446-0.970) between Months 2 and 4. B1 versus B2 ICCs were more stable (0.440-0.899) than almost all R1 versus R2 ICCs (-0.696 to 0.588) at Month 2 and 4. Actigraphic sleep measures show phenotypic long-term stability during BL and REC surrounding repeated TSD between 2 and 4 months. Furthermore, within each 5-day experiment at Month 2 and 4, the two BL nights before TSD were more stable than the two REC nights following TSD, likely due to increased R1 homeostatic pressure. Given the consistency of actigraphic measures across the short-term and long-term, they can serve as biomarkers to predict physiological and neurobehavioral responses to sleep loss.

The association between timing of dietary macronutrient and sodium consumption and sleep duration and quality.

The objective of this study was to examine the association between the timing of dietary macronutrients and sodium intake and sleep quantity and quality. This was a cross-sectional study that included 34 adults between 21 and 50 years of age. The main outcome measures were objective sleep measures assessed from three nights of wrist actigraphy including sleep duration, fragmentation, and wake after sleep onset (WASO), and one night of polysomnography (PSG), including rapid eye movement (REM) sleep, non-REM stage 2 (N2), stage 3 (N3), and WASO. Multiple linear regression models and linear mixed models were used to estimate the associations between sleep measures and dietary measures (carbohydrates, fats, saturated fats, proteins, and sodium). Dietary timing was examined in two ways: (1) the average amount of each nutrient consumed within 3 hours of sleep start, and (2) the interval between the final intake of each nutrient and sleep. Average fat intake within 3 hours of sleep was associated with greater WASO from PSG (β = 4.48, p = 0.01). No other associations were found between the macronutrients or sodium intake (p > 0.05) within 3 hours of sleep and the sleep parameters from PSG or actigraphy. Similarly, no associations were found between any of the PSG or actigraphy sleep measures and the interval between final nutrient intakes and sleep with sleep duration. The study suggests that greater fat but not carbohydrate, protein, saturated fat, or sodium intake close to sleep may be associated with greater sleep disruption; however, no other associations were observed.

Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway.

Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-participants pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioral therapy for insomnia (CBTi). Assessment measures for insomnia, well-being, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake, and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to posttreatment in insomnia severity (d = -1.81, 95% CI: 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, well-being, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Measuring Sleep Among Cancer Survivors: Accelerometer Measures Across Days and Agreement Between Accelerometer and Self-Reported Measures

Background: The associations between subjective (self-reported) and objective (actigraphy) sleep measurements are not well documented among survivors of cancer. The purpose of this study was to examine actigraphy measurements across days and the associations of two self-reported sleep measures with actigraphy-measured sleep measures. Methods: Sleep data were collected using self-reported sleep diary, the Pittsburgh Sleep Quality Index, and hip-worn actigraphy at baseline for a subsample participating in the Lifestyle Intervention for oVarian cancer Enhanced Survival (N = 516) randomized controlled trial. Intraclass correlation coefficients were used to evaluate consistency of actigraphy sleep measures across days of wear and associations of sleep diary with actigraphy for total sleep time (TST), time asleep, and time awake. Bland–Altman plots were used to assess the associations of sleep duration and sleep efficiency derived from Pittsburgh Sleep Quality Index and actigraphy. Results: Participants were aged 60.3 years (SD 9.3 years). For TST, the associations were strongest after 3 weekdays of consecutive actigraphy wear (ICC = .43 95% CI [.35, .51]), and actigraphy-measured daily TST was longest (617, SD 135 min) compared with self-reported measures. Sleep diary versus actigraphy associations for TST, time asleep, and time awake were weak to moderate. Pittsburgh Sleep Quality Index versus actigraphy association was weak for all sleep constructs. Conclusion: The strength of association between self-reported and actigraphy measures of sleep ranged from weak to very strong, depending on the sleep construct. Impact: Results highlight the importance of selecting an appropriate measurement tool for estimating individual sleep constructs among survivors of cancer.

Sleep, Mental Health, and Cognition Across Diverse Adult Populations

Abstract Sleep is often impaired in late life, raising concerns about the effect of poor sleep on mental and cognitive health in aging individuals. This symposium brings together five rigorous studies that show how poor sleep may be an under-recognized risk factor for mental health and cognitive outcomes in the second half of life. Specifically, this symposium showcases data from a variety of study cohorts (including Midlife in the United Study, Einstein Aging Study, and Study of Muscle, Mobility, and Aging), using diverse indicators of subjective and objective sleep. Paper 1 focuses on healthcare workers (HCWs), a group critical for the delivery of quality patient care, and examines both individual and joint associations of poor sleep and pain with mental health in HCWs vs. non-HCWs. Paper 2 investigates the association between EEG-measured sleep and depressive symptoms in older adults. Paper 3 explores the relationship between intra-individual variability of sleep and mild cognitive impairment (MCI) and identifies gender differences in these associations. Paper 4 establishes the associations of actigraphy-measured sleep and circadian rest-activity rhythms with multiple domains of cognition in older adults. Paper 5 examines the effect of latent dose/duration patterns of common sleep medications on development of Alzheimer’s disease and related dementias. The discussant, Dr. Adam Spira, will integrate key findings from these studies, discuss their contributions to the literature, and consider opportunities for future research. This is a Sleep, Circadian Rhythms and Aging Interest Group Sponsored Symposium. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias, Geroscience, and Health Behavior Change Interest Groups.

Tailored lighting intervention (TLI) for improving sleep-wake cycles in older adults living with dementia.

Introduction: Sleep disturbance is a hallmark of Alzheimer's disease and related dementias, and caregiver stress caused by patients' nighttime wandering, injuries, and agitation are frequently at the root of decisions to move them to assisted living facilities, where typically dim institutional lighting can further exacerbate their sleep problems. This study explored the effects of a circadian-effective lighting intervention on actigraphic sleep measures and subjective assessments of sleep disturbance, depression, and sleep-disturbed behaviors. Methods: Fourteen older adult (≥60years) participants (11 females, mean age = 84.1 [SD 8.9]), all diagnosed with moderate to severe dementia and sleep disturbance, were recruited from 3 assisted living and memory care facilities. Following a crossover, placebo-controlled design, 3 different lighting modes were used to deliver high levels of circadian stimulus to the participants' eyes for two 8-week intervention periods in a counter balanced order with a 4-week washout between the study's 2 conditions (dim light control vs. active intervention). Actigraphy and questionnaire data were collected over 7-day assessment periods that preceded (baseline weeks 1 and 9) and concluded (post-intervention week 9 and 22) the intervention periods. Actigraphic outcomes included sleep duration, sleep time, sleep efficiency, sleep start time, and sleep end time. Subjective assessments included the Cornell Scale for Depression in Dementia (CSDD), Pittsburgh Sleep Quality Index (PSQI), and Sleep Disorders Inventory (SDI) instruments. Results: Under the active condition, sleep duration significantly (p = 0.018) increased and sleep start time significantly (p = 0.012) advanced after the intervention compared to baseline. Also under the active condition, PSQI (p = 0.012), CSDD (p = 0.007), Sleep Disorders Inventory frequency (p = 0.015), and SDI severity (p = 0.015) scores were significantly lower after the intervention compared to baseline. Discussion: This study demonstrates that a circadian-effective lighting intervention delivering bright days and dark nights improves measures of sleep and mood in dementia patients living in controlled environments.

Associations between actigraphy-measured sleep duration, continuity, and timing with mortality in the UK Biobank.

To examine the associations between sleep duration, continuity, timing, and mortality using actigraphy among adults. Data were from a cohort of 88 282 adults (40-69 years) in UK Biobank that wore a wrist-worn triaxial accelerometer for 7 days. Actigraphy data were processed to generate estimates of sleep duration and other sleep characteristics including wake after sleep onset (WASO), number of 5-minute awakenings, and midpoint for sleep onset/wake-up and the least active 5 hours (L5). Data were linked to mortality outcomes with follow-up to October 31, 2021. We implemented Cox models (hazard ratio, confidence intervals [HR, 95% CI]) to quantify sleep associations with mortality. Models were adjusted for demographics, lifestyle factors, and medical conditions. Over an average of 6.8 years 2973 deaths occurred (1700 cancer, 586 CVD deaths). Overall sleep duration was significantly associated with risk for all-cause (p < 0.01), cancer (p < 0.01), and CVD (p = 0.03) mortality. For example, when compared to sleep durations of 7.0 hrs/d, durations of 5 hrs/d were associated with a 29% higher risk for all-cause mortality (HR: 1.29 [1.09, 1.52]). WASO and number of awakenings were not associated with mortality. Individuals with L5 early or late midpoints (<2:30 or ≥ 3:30) had a ~20% higher risk for all-cause mortality, compared to those with intermediate L5 midpoints (3:00-3:29; p ≤ 0.01; e.g. HR ≥ 3:30: 1.19 [1.07, 1.32]). Shorter sleep duration and both early and late sleep timing were associated with a higher mortality risk. These findings reinforce the importance of public health efforts to promote healthy sleep patterns in adults.

Racial/ethnic and sex differences in the association between light at night and actigraphy-measured sleep duration in adults: NHANES 2011-2014

ObjectiveHistorically minoritized individuals experience greater exposure to light at night, yet it is unclear whether the association between light at night and sleep duration vary by race/ethnicity or sex. We examined the association between light at night and sleep duration by race/ethnicity and sex. MethodsParticipants (N = 6089, mean age=49.5, 52% women, 13% Asian, 27% Black, 14% Mexican, 46% White) in the 2011-2014 National Health and Nutrition Examination Survey underwent 9-day of actigraphy. Light at night was defined as light exposure within the 5-hour activity nadir (L5). Sleep duration within a 24-hour period was analyzed as short (<7 hours) or long (>9 hours) compared to recommended (≥7 and <9 hours). Poisson models were fit to estimate the association between light at night and sleep duration after adjustment for covariates. ResultsLight at night was most common among Black participants, who also had the shortest sleep duration. Overall, light at night was associated with 80% higher prevalence of short sleep duration [1.80 (1.49, 2.18)]. Compared to no-light at night, low and high light at night were associated with higher prevalence of short sleep duration, [1.61 (1.31, 1.98) and 2.01 (1.66, 2.44), respectively]. Associations varied by race/ethnicity and sex. Light at night was associated with shorter sleep duration in Black, Mexican and White females and Mexican and White males only. Black males exposed to light at night vs. no-light at night had lower prevalence of long sleep duration. There were no associations between light at night and sleep duration among Asian participants. ConclusionLight at night was associated with shorter sleep duration, particularly among females. Targeting light exposure may help to improve sleep duration.

Concordance in parent-child and sibling actigraphy-measured sleep: Evidence among early adolescent twins and primary caregivers

Study objectivesGrowing evidence suggests concordance between parent and youth sleep. However, no known study has simultaneously examined concordance among siblings’ sleep patterns. This study investigated daily and average concordance in (1) parent-youth and (2) sibling actigraphy-measured sleep, as well as the degree to which sibling concordance varied by sleeping arrangements. Methods516 twin siblings (Mage = 10.74, 51% female; 30% monozygotic (MZ) twin pairs, 37% same-sex dizygotic pairs (DZ-ss), 33% opposite-sex DZ pairs (DZ-os)) and their primary caregivers (Mage = 40.59, 95% female) wore wrist-based accelerometers for 7 consecutive nights to measure sleep duration, efficiency, midpoint time, and latency. Primary caregivers also reported on demographics, youth pubertal status, and room-sharing. Two-level multilevel models were estimated to examine daily and average concordance in parent-youth and sibling sleep. ResultsDaily concordance was observed between parent and youth sleep duration and midpoint; average concordance was found for sleep duration, midpoint, and latency. Within sibling dyads, daily and average concordance was evident across all sleep parameters (duration, efficiency, midpoint, latency), with generally stronger concordance patterns for MZ than DZ twin pairs, and for twins who shared a room with their co-twin. ConclusionsThis is the first known study to document concordance among parent-youth and siblings’ actigraphy-measured sleep within the same study (i.e., triad). Our findings can help inform the development of family-level interventions targeting daily and overall sleep hygiene.