Baseline Sleep Quality Research Articles

Cross-sectional and longitudinal association of sleep and Alzheimer biomarkers in cognitively unimpaired adults.

Sleep abnormalities are prevalent in Alzheimer's disease, with sleep quality already impaired at its preclinical stage. Epidemiological and experimental data point to sleep abnormalities contributing to the risk of Alzheimer's disease. However, previous studies are limited by either a lack of Alzheimer's disease biomarkers, reduced sample size or cross-sectional design. Understanding if, when, and how poor sleep contributes to Alzheimer's disease progression is important so that therapies can be targeted to the right phase of the disease. Using the largest cohort to date, the European Prevention of Alzheimer's Dementia Longitudinal Cohort Study, we test the hypotheses that poor sleep is associated with core Alzheimer's disease CSF biomarkers cross-sectionally and predicts future increments of Alzheimer's disease pathology in people without identifiable symptoms of Alzheimer's disease at baseline. This study included 1168 adults aged over 50 years with CSF core Alzheimer's disease biomarkers (total tau, phosphorylated tau and amyloid-beta), cognitive performance, and sleep quality (Pittsburgh sleep quality index questionnaire) data. We used multivariate linear regressions to analyse associations between core Alzheimer's disease biomarkers and the following Pittsburgh sleep quality index measures: total score of sleep quality, binarized score (poor sleep categorized as Pittsburgh sleep quality index > 5), sleep latency, duration, efficiency and disturbance. On a subsample of 332 participants with CSF taken at baseline and after an average period of 1.5 years, we assessed the effect of baseline sleep quality on change in Alzheimer's disease biomarkers over time. Cross-sectional analyses revealed that poor sleep quality (Pittsburgh sleep quality index total > 5) was significantly associated with higher CSF t-tau; shorter sleep duration (<7 h) was associated with higher CSF p-tau and t-tau; and a higher degree of sleep disturbance (1-9 versus 0 and >9 versus 0) was associated with lower CSF amyloid-beta. Longitudinal analyses showed that greater sleep disturbances (1-9 versus 0 and >9 versus 0) were associated with a decrease in CSF Aβ42 over time. This study demonstrates that self-reported poor sleep quality is associated with greater Alzheimer's disease-related pathology in cognitively unimpaired individuals, with longitudinal results further strengthening the hypothesis that disrupted sleep may represent a risk factor for Alzheimer's disease. This highlights the need for future work to test the efficacy of preventive practices, designed to improve sleep at pre-symptomatic stages of disease, on reducing Alzheimer's disease pathology.

Physical activity, sleep and affective wellbeing on the following day: An experience sampling study.

This study aims to investigate the temporal links between physical activity, sleep and affective wellbeing in young adults. In particular, the aim was to examine whether physical activity is associated with sleep indicators in subsequent nights and, in turn, whether sleep was associated with improved affective wellbeing the next morning. Relatedly, moderation by baseline levels of depressive symptoms, sleep quality, habitual physical activity and gender was analysed. One-hundred and forty-seven individuals (85.7% female) aged 18-25 years old participated in an experience sampling study over 14 consecutive days. Participants received seven prompts per day, and answered questions about their physical activity and affective states. Every morning, participants also reported their sleep. Physical activity throughout the day was not related to sleep during the following night or to affective wellbeing the next morning. An exception to that pattern was that physical activity before 14:00 hours was associated with longer subsequent sleep duration. Better subjective sleep quality predicted affective wellbeing the next morning. Associations of physical activity, sleep and affective wellbeing were not moderated by baseline depressive symptoms, sleep quality or habitual physical activity. However, investigation of gender as a moderator revealed that moderate physical activity was associated with better subsequent sleep quality for males, but not for females. Overall, we found that physical activity is associated with better subsequent sleep for males, but not for females. Also, our study provides further evidence that better sleep quality is associated with the next morning's affective wellbeing.

Poor sleep quality is associated with fatigue and depression in early Parkinson's disease: A longitudinal study in the PALS cohort.

BackgroundSleep disorders are common in Parkinson's disease (PD). However, the longitudinal relationship between sleep quality and the other non-motor symptoms of PD has not been well characterized, especially in early PD.ObjectiveTo explore the value of baseline sleep quality in predicting the progression of other non-motor symptoms in early PD.Methods109 early PD patients were recruited to the study. Patients were stratified into good and poor sleepers using the Pittsburgh Sleep Quality Index (PSQI). Assessments performed at baseline and 1 year follow-up included the Epworth Sleepiness Scale, Fatigue Severity Scale, Non-Motor Symptom Scale, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, Apathy Scale, Montreal Cognitive Assessment and detailed neuropsychological assessments. Multivariable linear regression was performed at baseline to investigate differences in clinical scores between poor and good sleepers, while multivariable regression models were used to investigate associations between sleep quality and progression of test scores at 1 year follow-up.Results59 poor sleepers and 50 good sleepers were identified. At baseline, poor sleepers had greater HADS anxiety scores (p = 0.013) [2.99 (95% CI 2.26, 3.73)] than good sleepers [1.59 (95% CI 0.75, 2.42)]. After 1 year, poor sleepers had greater fatigue (FSS scores +3.60 as compared to −2.93 in good sleepers, p = 0.007) and depression (GDS scores +0.42 as compared to −0.70, p = 0.006).ConclusionThis study shows a longitudinal association between sleep quality, fatigue, and depression in early PD patients, independent of medication effect and disease severity, this may support the hypothesis that a common serotonergic pathway is implicated in these non-motor symptoms.

Sleep Quality Worsens While Perceived Stress Improves in Healthcare Workers over Two Years during the COVID-19 Pandemic: Results of a Longitudinal Study.

The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) (p = 0.03, Cohen’s d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) (p = 0.001, Cohen’s d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.

Is sleep quality a potential predictor of neurocognitive disorders? A 6-year follow-up study in Chinese older adults.

To investigate the longitudinal association of sleep quality with incidence of neurocognitive disorders in 6years. This was a 6-year follow-up study of community-living older adults who scored a Clinical Dementia Rating (CDR) of 0 at baseline. Sleep quality was assessed by the self-rated Pittsburgh Sleep Quality Index (PSQI) questionnaire, where higher scores indicated poorer sleep quality, and a cutoff score of 5 or above was suggestive of sleep disorder. The study outcome was incident neurocognitive disorders in 6years, as identified by a CDR of 0.5 or above. Poisson regression analysis was conducted to test if baseline sleep quality was independently associated with risk of incident neurocognitive disorders in 6years. Of the 290 participants in this study, 166 (57.2%) developed neurocognitive disorders in 6years. They had poorer sleep quality (mean [SD] total PSQI score: 6.2 [3.8] vs. 4.9 [3.2], p=0.001) and higher prevalence of sleep disorder (100 [60.2%] vs. 56 [45.2%], p=0.01) at baseline than those who remained free of neurocognitive disorder. After controlling for age, gender, education, and physical and psychiatric morbidities, the risk ratios (RRs) for incident neurocognitive disorders were 1.05 (95% confidence interval (CI)=1.00-1.11, p<0.05) for PSQI total score and 1.50 (95% CI=1.05-2.14, p=0.03) for sleep disorder at baseline. Sleep quality might predict the development of neurocognitive disorders. From a clinical perspective, enquiry of sleep quality and screening for sleep disorder should be promoted as part of the neurocognitive disorder risk assessment in older adults.

A Comparative Study of Baseline Heart Rate Variability, Sleep Quality, and Oxidative Stress Levels in Hypertensive Versus Normotensive Subjects: A Cross-Sectional Study.

Objectives: To understand sleep quality, oxidative stress levels, and heart rate variability (HRV) in subjects with hypertension. This study aims to create baseline data in hypertensive subjects to research the possibility of further estimating the risk of developing cardiovascular mortality and morbidity in a patient with hypertension.Design and methods: This analytical cross-sectional study, encompassing 128 study subjects of both genders, with 64 hypertensive subjects, analyse the co-relation of sleep quality, malondialdehyde, and heart rate variability in hypertensive and normotensive subjects. The study was done in a tertiary teaching institute in northern India for 14 months. Descriptive statistics were used, and the independent t-test, Mann-Whitney U test, and Chi-square were used to find the association among the variables. Linear regression was used to estimate the effect of blood pressure on malondialdehyde levels.Results: Subjects with hypertension were found to have poor sleep quality (Global PSQI score ≥5, p=0.0001) and an increased malondialdehyde level (0.30303±0.17193 µM/L, p=0.0001). The hypertensive subjects were found to have lower parasympathetic activity as indicated by low high frequency (2.79463±473.220280; p=0.0001) and increased sympathetic activity; low frequency/high frequency (2.29823±2.792441; p=0.0001). Multivariate linear regression predicts that with one unit increase in systolic blood pressure, the malondialdehyde level increases by 0.006 units (p=0.002; 95% CI).Conclusion: Among the hypertensive group, there is significantly increased oxidative stress level, poor quality of sleep, and increased sympathetic activity, thereby predisposing the subjects to increased risk of cardiac morbidity and mortality.

Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study.

PurposeThe impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression.Patients and MethodsData were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of >5, and persistent poor sleep quality was defined as a PSQI score of >5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes.ResultsPersistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66–5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42–7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months.ConclusionPatients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.

The Effect of Rugby Union Match Play on Sleep Patterns and Subsequent Impact on Postmatch Fatigue Responses.

Sleep is recognized as an important recovery strategy, yet little is known regarding its impact on postmatch fatigue. The aims of this study were to (1)describe sleep and postmatch fatigue, (2)understand how sleep is affected by contextual and match factors, and (3)assess how changes in sleep can affect postmatch fatigue. Twenty-three male rugby union players were monitored across 1 season (N = 71 player-match observations). Actigraphy was used during preseason to establish baseline sleep quality and quantity. Sleep was then measured 1 and 2days after each match day (MD + 1 and MD + 2). Global positioning systems, notational analysis, and rating of perceived exertion represented external and internal load from matches. Subjective wellness and a standardized run were used to characterize postmatch fatigue 2 days prior (baseline) and at MD + 1 and MD + 2. Linear mixed models established the magnitude of change (effect size [ES]) between baseline, MD + 1, and MD + 2 for sleep and postmatch fatigue. Stepwise forward selection analysis ascertained the effect of match load on sleep and the effect of sleep on postmatch fatigue. Each analysis was combined with magnitude-based decisions. Sleep characteristics and neuromuscular and perceptual postmatch fatigue were negatively affected at MD + 1 and MD + 2 (ES = small to very large). Kickoff and travel time had the greatest effect on sleep (ES = small). Wellness and soreness were influenced by sleep (fall-asleep time and fragmentation index) and collisions, respectively (ES = small). Sleep quality and quantity were affected independently of the match load (ie,running activity) sustained, and changes in sleep marginally affected postmatch fatigue.

Abstract P080: Health-related Quality Of Life Predictors Of Exercise Intervention Dropout

Introduction: Though many individuals know the health benefits of participating in exercise, few report sufficient activity to meet the US 2018 Physical Activity Guidelines. Current research assessing predictors of exercise adherence and dropout has primarily focused on cognitive factors, physiological factors, and demographic characteristics. The purpose of this analysis was to determine if baseline self-rated HrQoL measures are predictive of dropout from an exercise intervention across two STRRIDE trials. Methods: A total of 444 adults with dyslipidemia (STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to one of seven exercise interventions, ranging from doses of 10-16 kcal/kg/week (KKW); intensities of 50-75% V̇O 2peak ; and durations of 6-9 months. Six groups included aerobic exercise, two groups included resistance training, and one group included dietary intervention (weight loss goal of 7%). Dropout was defined as a participant who did not complete the exercise intervention due to one or more of several reported reasons (e.g., time, motivation, re-occurring injury). Backwards stepwise logistic regression determined significant baseline HrQoL predictors of exercise intervention dropout, while controlling for age, sex, race, and intervention group assignment. Results: A total of 117 individuals were classified as being exercise intervention dropouts (STRRIDE AT/RT: n=55; STRRIDE-PD: n=62). In STRRIDE AT/RT, the logistic regression identified baseline sleep quality, sleep latency, sleep efficiency, sleep disturbance, bodily pain, and social functioning scores as predictors of dropout (R 2 =0.39). In STRRIDE-PD, the logistic regression identified baseline role-emotional, satisfaction with appearance, and physical component scores as predictors of dropout (R 2 =0.08). Conclusion: Among individuals with dyslipidemia, baseline HrQoL measures were able to explain about 39% of the variance in dropout from an exercise intervention, with primarily sleep measures, bodily pain, and social functioning being identified as important predictors of dropout. In contrast, among individuals farther along the disease spectrum, with prediabetes, baseline HrQoL measures only explained about 8% of the variance in dropout, with emotional well-being, perceived appearance, and physical function being important predictors of dropout. Future research should investigate molecular and biological predictors of dropout in combination with HrQoL, physiological, cognitive, and demographic factors to improve predictive power.

Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic.

SummaryThe coronavirus disease 2019 (COVID‐19) pandemic is a global health crisis with the potential to elicit and worsen psychiatric symptoms, particularly post‐traumatic stress disorder (PTSD) symptoms. Identifying modifiable protective factors is critical for preventing and treating PTSD symptoms both during and following the COVID‐19 pandemic. The present study examined associations of self‐reported sleep quality and anticipatory threat appraisals of the pandemic with PTSD symptoms 6 months later in a sample enriched for pre‐pandemic trauma exposure and PTSD. The sample included 590 adults (mean age 38.2 years) who completed a baseline survey in August/September 2020 and follow‐up survey in March/April 2021. The sample was recruited from a pool of participants interested in a prior study about traumatic stress. Participants self‐reported sleep quality and pandemic‐related anticipatory threat appraisals at baseline. PTSD symptoms were assessed at baseline and follow‐up. Baseline sleep quality was associated with PTSD symptoms at follow‐up controlling for baseline PTSD symptoms (B = −2.49, p = 0.001). Perceived anticipatory threat of the pandemic moderated this association such that worse sleep quality was related to more severe PTSD symptoms at follow‐up for participants with higher (B = −4.07, p < 0.001) but not lower (B = −0.43, p = 0.679) anticipatory threat about the COVID‐19 pandemic. These findings suggest that poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those individuals who perceived the pandemic as threatening for their future. Treatments that address sleep problems may be beneficial for reducing trauma‐related symptoms during and following the global health crisis.

Effect of Short-Term Practice of Left Nostril Breathing on Various Sleep Parameters in the Medical Students.

Background:Various recent studies have reported that exclusive right nostril breathing (RNB) and left nostril breathing (LNB) has an immediate and sustained effect under various medical conditions. In the present study, we evaluated the effect of short-term left nostril breathing on various sleep parameters in medical students.Methods:We hypothesized that the increase in vagal tone because of LNB can help in improving the quality of sleep. The baseline sleep quality was documented before the start of study in the case and the control group using the ’Pittsburgh Sleep Quality Index’ (PSQI) questionnaire. A PSQI global score of more than 5 indicates poor sleep quality. The case group practiced LNB in a graduated manner for a period of 4 weeks. Thereafter, sleep quality was documented for both the groups using the PSQI questionnaire.Results:Practicing LNB significantly lowered all the seven component scores (p < 0.05) and the global PSQI score in the case group (p-value < 0.0001), suggesting that this practice effectively improved the sleep quality in the individuals of this group.Conclusions:Overall, this study suggested that exclusive LNB practice could serve as an important lifestyle modification that can be incorporated in the routine of medical students for improving their sleep quality.

Bidirectional Association Between Sleep Quality and Low Back Pain in Older Adults: A Longitudinal Observational Study

ObjectiveTo investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP). DesignA prospective longitudinal cohort study with a 6-month follow-up period. SettingCommunity. ParticipantsOlder adults with LBP aged 60 years or older (N=215). InterventionNot applicable. Main Outcome MeasuresData collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed. ResultsA total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (β coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (β coefficient, 0.14; 95% CI, 0.01-0.26). ConclusionOur findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP.

Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample.

Children with overweight or obesity are more likely to experience sleep disorders, although the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pretreatment insomnia severity and global sleep problems and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment. Participants included 1,133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age-adjusted and sex-adjusted body mass index Z-score. Among adolescents, regression analyses found that higher body mass index Z-score modestly predicted baseline insomnia severity (P = .021) and worse sleep hygiene (P < .001). For children, higher body mass index Z-score was modestly associated with baseline total sleep problems (P = .006) but not insomnia severity (P = .792). Across ages, body mass index Z-score predicted neither treatment status nor insomnia improvement (P > .05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight. Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status. Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med. 2022;18(4):1083-1091.

Effects of surgery and general anaesthesia on sleep-wake timing: CLOCKS observational study.

SummarySurgery and general anaesthesia have the potential to disturb the body’s circadian timing system, which may affect postoperative outcomes. Animal studies suggest that anaesthesia could induce diurnal phase shifts, but clinical research is scarce. We hypothesised that surgery and general anaesthesia would result in peri‐operative changes in diurnal sleep–wake patterns in patients. In this single‐centre prospective cohort study, we recruited patients aged ≥18 years scheduled for elective surgery receiving ≥30 min of general anaesthesia. The Munich Chronotype Questionnaire and Pittsburgh Sleep Quality Index were used to determine baseline chronotype, sleep characteristics and sleep quality. Peri‐operative sleeping patterns were logged. Ninety‐four patients with a mean (SD) age of 52 (17) years were included; 56 (60%) were female. The midpoint of sleep (SD) three nights before surgery was 03.33 (55 min) and showed a phase advance of 40 minutes to 02.53 (67 min) the night after surgery (p < 0.001). This correlated with the midpoint of sleep three nights before surgery and was not associated with age, sex, duration of general anaesthesia or intra‐operative dexamethasone use. Peri‐operatively, patients had lower subjective sleep quality and worse sleep efficiency. Disruption started from one night before surgery and did not normalise until 6 days after surgery. We conclude that there is a peri‐operative phase advance in midpoint of sleep, confirming our hypothesis that surgery and general anaesthesia disturb the circadian timing system. Patients had decreased subjective sleep quality, worse sleep efficiency and increased daytime fatigue.

Assessing sleep quality in gynecologic oncology patients after surgery

<h3>Objectives:</h3> High quality sleep is important for maintaining immune function, wound healing, and physical and emotional well-being. Our objective was to determine the quality of sleep in women admitted for post-operative recovery after surgical management for a suspected gynecologic malignancy. <h3>Methods:</h3> We surveyed women who were admitted to the hospital for at least one midnight after undergoing a surgical procedure for a suspected gynecologic malignancy between September 2020 and October 2020. The Pittsburgh Sleep Quality Index (19 item self-report questionnaire) was used to assess baseline sleep quality in the month prior to the planned procedure. The Richards-Campbell Sleep Questionnaire (5 item self-report survey) was used to assess nightly sleep quality during the subject's hospitalization. A chart review was also completed to assess for patient or surgical factors associated with poor sleep. <h3>Results:</h3> Twenty-three patients met the study criteria, of which 20 (87%) agreed to participate. The mean age was 58 (SD = 15), the mean BMI was 32.2 (SD = 8.3). Eighty percent of patients underwent surgery for confirmed malignancy, with uterine cancer (30%) and ovarian cancer (25) comprising the majority of diagnoses. The median admission length was 2 days interquartile range (IQR = 1-4.5), fifty percent of patients underwent an open procedure. Based on Pittsburgh Sleep Quality Index (PSQI) results, 15 patients (75%) reported poor sleep quality in the month prior to their surgery. The total RCSQ score was the worst on the first post-operative day (38.3, SD=28.3). Sleep quality improved on post-operative day 2 (67.3, SD=12.2), but then declined over the remainder of the hospitalization. <h3>Conclusions:</h3> Sleep quality is poor in women hospitalized after surgery with gynecologic oncologists. Sleep is an under recognized factor in optimizing postoperative recovery. The high prevalence of poor sleep during hospital-based post-operative recovery among gynecologic oncology patients warrants the development of evidence-based interventions for improving sleep and sleep quality.

Sleepy Surgeons: A Multi-Method Assessment of Sleep Deprivation and Performance in Surgery

Minimum rest is mandated in high stake industries such as aviation. The current system of healthcare provision permits on-call surgeons to work in sleep deprived states when performing procedures. Fatigue has been demonstrated to negatively affect performance. This study aimed to explore measurements of sleep deprivation and their impact on simulated performance. This was a single site study conducted between September 2019 and February 2020. Surgical trainee and consultants were conveniently sampled from a single site. All testing was done between 7 AM and 9 AM. Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing for objective sleep measurement, the Pittsburgh Sleep Quality Index, Chalder Fatigue Scale and Epworth Sleepiness Scale for subjective sleep measurement. The Psychomotor Vigilance Task and the SIMENDO simulated tasks were used for standardized performance assessment. Surgeons entered sleep in 6 min, on average pre-call. This significantly decreased to an average of 164 s post-call (P=0.016). Pittsburgh Sleep Quality Index scoring was 5, indicating poor baseline sleep quality. There was higher self-reported fatigue and sleepiness in post-call states. Performance decrements were noted in cognitive performance reaction time and aspects of technical instrument proficiency. Surgeons are objectively sleep deprived pre-call according to internationally recognized guidelines. This sleep deprivation increases significantly in post-call states. Tasks with higher cognitive demands showed greater levels of diminished performance compared to those with lower cognitive demands. Current models of provision of surgical on-call are not conducive to optimizing sleep in surgeons. Prioritization of workload in post-call states, focusing on preserving individuals cognitive resources and utilizing lower cognitively demanding aspects of work is likely to have positive impacts on performance outcomes.

Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment

Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes. Our sample consisted of 100 Iraq/Afghanistan era Veterans with PTSD and history of mild to moderate TBI who were randomized to one of two trauma-focused treatments: 1) Cognitive Processing Therapy (CPT) or 2) combined CPT and Cognitive Symptom Management and Rehabilitation Therapy (SMART-CPT). Self-reported sleep quality, psychiatric symptoms (PTSD and depression), and neurobehavioral concerns were assessed at multiple timepoints throughout the study. Multilevel modeling showed sleep quality did not improve, regardless of treatment condition. However, worse baseline sleep quality was associated with less improvement in PTSD symptoms and cognitive complaints. There was no effect of baseline sleep quality on change in depression symptoms. These findings suggest that more targeted treatments to address sleep quality either prior to or in conjunction with trauma-focused therapy may help to improve treatment outcomes for Veterans with comorbid PTSD and TBI history.

Sleep quality and outcome of exposure therapy in adults with social anxiety disorder.

Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship. Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions. Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.

131 Sleep Quality as a Pathway from Stress to Cold Symptom Severity

Abstract Introduction Stress is a known contributor to immune system suppression associated with higher illness susceptibility, including acute infectious respiratory illness, or the common cold. Sleep quality, shown to impact immunity, is an additional mechanism that may underlie the association between stress and cold symptomatology. Although the associations between stress and sleep and cold symptomatology have been examined separately, little is known about the mechanistic role of sleep in these associations. The present study examined sleep quality as a potential pathway between stress and cold symptomatology difference scores. Methods Archival data from the Common Cold Project (Pittsburgh Cold Study 3) were utilized for the present study. Participants were 213 adults (Mean Age=30.1 yrs., SD=10.9 yrs., 42.3% female) who completed a 5-day viral challenge and self-report measures of cold severity (Jackson Symptom Score; measured from beginning to end of viral challenge), baseline sleep quality (PSQI), and perceived stress as part of study participation. SPSS v 27 and Hayes’ PROCESS mediation macro were used to assess study aims. Age and sex were included as covariates. Results Greater perceived stress was significantly associated with worse sleep quality [B=.15, 95% CI .10, .21]. Sleep quality fully mediated the association between stress and changes in symptomatology; better sleep was associated with larger changes in cold severity [B=-.23, 95% CI -.43, -.04], defined as differences in symptomatology from beginning to end of the viral challenge, beyond stress alone. Zero-order correlation analyses revealed a trend level (r=.04, p=.06) association between sleep quality and aggregate cold severity, suggesting that as sleep improves, symptoms decrease. Conclusion Within the present sample, sleep quality surfaced as an indirect pathway linking stress to changes in cold severity. Better sleep was associated with greater changes in cold severity above perceived stress. These findings, together with the trend level, positive association between sleep quality and cold symptomatology, suggest that better sleep may be associated with less severe symptomatology. Future research should attend to mechanisms underlying the associations between stress, sleep, and cold symptomatology. Support (if any):

Effect of the use of earplugs and eye masks on the quality of sleep after major abdominal surgery: a randomised controlled trial.

Significant sleep disturbance can occur following major abdominal surgery. We aimed to evaluate the effectiveness of earplugs and eye masks in improving sleep quality and patient satisfaction, reducing nursing demands and in the incidence of delirium in patients after major abdominal surgery. We conducted a randomised controlled trial in 100 patients undergoing major abdominal surgery. We randomly allocated participants to sleep with or without earplugs and eye masks on postoperative days 1-3. The primary outcome measure was sleep quality as measured by the Richards-Campbell Sleep Questionnaire. Secondary outcomes were patient satisfaction, frequency of nursing demand and incidence of delirium measured by the Neelon and Champagne Confusion Scale. Median (IQR [range]) sleep scores were 64 (38-74 [0-100] and 60 (44-82 [18-100]) for the control and intervention groups, respectively (p=0.310). Age and Pittsburgh Sleep Quality Index scores were found to be significant factors affecting sleep quality. There were no differences in patient satisfaction, reduction in frequency of nursing demands or incidence of delirium on postoperative days 1-3 after major abdominal surgery. The compliance rate in the intervention group was 60-65%. This study has demonstrated that the use of earplugs and eye masks did not contribute to improvements in sleep quality. Of note, sleep quality was moderate, with higher age and worse baseline sleep quality contributing to worse sleep scores. More studies are needed to investigate interventions to improve sleep quality after major abdominal surgery.