Sleep Dimensions Research Articles

Poor sleep quality is associated with worse self-rated health in long sleep duration but not short sleep duration

Unhealthy sleep duration, either short or long, is associated with worse health and central subjective dimensions of sleep and health such as fatigue. It has been argued that the link between sleep duration and health may depend on the quality of the slept hours, and on its functional impact (ie, fatigue). The present study therefore assessed whether the relationship between last night's sleep duration and general self-rated health (SRH) differs as a function of sleep quality, and secondly, whether current fatigue and sleep quality are factors linking sleep duration and SRH.The present cross-sectional dataset involved 1304 individuals (57% female, Mage = 28.8, range 18–79). Participants completed surveys for general SRH, previous night's sleep duration and sleep quality, and current fatigue.Results showed the expected inverted U-shaped (ie, quadratic) relation between last night's sleep duration and SRH and a linear relation between last night's sleep quality and SRH. However, long sleep duration was only associated with poorer SRH in individuals who also reported poor sleep quality. Further, the quadratic relationship between sleep duration and SRH was partially mediated by fatigue and sleep quality.The results of this multi-study analysis suggest that SRH is particularly poor in those who slept both long and with poor quality the night before, while good sleep quality may protect those with a long sleep duration from poor SRH. Thus, last night's long sleep does not seem to be associated with poor subjective health unless it is coupled with poor sleep quality. Furthermore, fatigue and sleep quality are potential pathways linking short and long sleep duration with SRH. Different dimensions of sleep interact in their association with health, and future research will benefit from an integrative approach.

Influence of circadian rhythm habit on academic performance and body mass index among the medical students in Qassim University, Saudi Arabia

Objective: Based on the significance of sleep quality on academic performance among medical students, this research was conducted to determine the influence of sleep circadian rhythm categories and their impact on the academic performance of medical students and relationship to body mass index (BMI). Methods: A cross-sectional self- administered questionnaire was conducted from September to October 2018 at the College of Medicine in Qassim University. The survey was designed to assess their circadian rhythm habit, academic performance and Body mass index (BMI). The circadian rhythm habit was evaluated using the morningness-eveningness questionnaire (MEQ). Results: The analysis of the BMI with MEQ scores revealed a significant relationship between circadian rhythm habit and BMI (p-value 0.016). The majority of normal weight students fall in intermediate category (71%). Among overweight category 20.5% of the participants fall in moderate evening while 10.3% of the students fall in moderate morning. All the definite morning participant were underweight. There were 126 (62.1%) male students, and 77 (37.9%) female students. For academic performance there were 80 students (39.4%) who had “high” performance, 64 students (31.5%) had “good” performance, 32 students (15.8%) had “normal” performance and 2 students (1%) had “low” performance. Conclusion: This study revealed several sleep dimensions such as sleep-wake schedules, and individual circadian rhythms characteristics may be associated to the deranged BMI and academic results achieved by university students.

Sleep patterns of US healthcare workers during the first wave of the COVID-19 pandemic.

Purpose During the first few months of the COVID-19 outbreak, healthcare workers (HCW) faced levels of personal risk, emotional distress, and professional strain not seen in their lifetimes. This study described how these stressors influenced various aspects of their sleep patterns.MethodsFrom May 19 to June 20, 2020, an electronic, cross-sectional survey was administered to a convenience sample of in- and outpatient HCW in a large, nonprofit healthcare system. Respondents described the pandemic’s initial impact on personal and professional life and various sleep dimensions: regularity, efficiency, duration, timing, quality, and daytime sleepiness.ResultsTwo hundred seven providers responded, representing 17 different healthcare roles. Most (82%) were women with a median age of 39 years (IQR1–3, 31–53). A majority of respondents (81%) worked in an inpatient setting, with half (46%) primarily on the “frontline.” Approximately one-third of respondents (37%) were physicians and one-quarter (28%) were nurses. Overall, 68% of HCW reported at least one aspect of sleep worsened during the beginning of the pandemic; the most impacted were daytime sleepiness (increased in 43%) and sleep efficiency (worse in 37%). After adjusting for COVID exposure and burnout, frontline providers had twofold higher odds of poor pandemic sleep, aOR 2.53, 95%CI 1.07–5.99. Among frontline providers, physicians were fivefold more likely to develop poor pandemic sleep compared to nurses (OR 5.73, 95%CI 1.15–28.57).ConclusionsDuring the initial wave of COVID-19, a majority of HCW reported a decline in sleep with an increase in daytime sleepiness and insomnia. Frontline workers, specifically physicians, were at higher risk.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11325-021-02515-9.

Multidimensional sleep health in a diverse, aging adult cohort: Concepts, advances, and implications for research and intervention

PurposeTo illustrate 2 frameshifts of multidimensional sleep health: i) use of composite sleep metrics; and ii) the correlations among sleep dimensions. Participants735 adults of diverse backgrounds aged <65 years who participated in the Multi-Ethnic Study of Atherosclerosis. MeasuresIn-home polysomnography, 7-day wrist actigraphy, and validated questionnaires. MethodsThe Buysse Ru SATED model—sleep regularity, satisfaction, alertness, timing, efficiency, duration—was operationalized, then extended by including additional measures of sleep architecture and sleep apnea from polysomnography and difficulties initiating sleep from questionnaire and sleep onset latency and duration [ir]regularity from actigraphy. We dichotomized sleep variables, operationalizing optimal and nonoptimal ranges as 1 and 0, respectively, summed into a sleep health score, and computed global sleep health scores via principal components analysis. FindingsParticipants showed low prevalence of sleep regularity in timing (<30 minutes standard deviation [SD]; 21.4% favorable) and duration (<60 minutes SD; 36.9%). Although 62.7% of participants demonstrated favorable sleep duration by actigraphy, few met criteria for favorable levels of % N3 (11.4%) or %R (34.1%). The average Sleep Health Score was 5.6 of 13 (higher is better). Sleep variables were variably intercorrelated (r = 0 to r = −0.72). The first principal component for each operationalization of sleep health was interpretable as a “health” score; all summary scores captured variable but systematic shifts towards more favorable sleep in each sleep variable. ConclusionsMultidimensional sleep health can be measured by complementary composite scores as well as consideration of multiple individual dimensions.

Multidimensional sleep health is associated with mental well-being in Australian adults.

The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well-being in Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18-90years. Composite scores of self-reported healthy sleep were based on Ru-SATED (R-SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1hr) or 1 (<1hr). Mental well-being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ-5D-5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well-being with sleep dimensions, and total R-SATED (range 0-11) and SATED scores (0-10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well-being. A 1unit increase in the total SATED score (mean [SD] 6.6[2.1]) was associated with less problems on the EQ-5D-5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08-1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17-1.23). These estimates did not differ when the total R-SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well-being.

Racial-ethnic Differences in Actigraphy, Questionnaire, and Polysomnography Indicators of Healthy Sleep: The Multi-Ethnic Study of Atherosclerosis.

A paradigm shift in sleep science argues for a systematic, multidimensional approach to investigate sleep's association with disease and mortality and to address sleep disparities. We utilized the comprehensive sleep assessment of the Multi-Ethnic Study of Atherosclerosis (2010- 2013), a cohort of U.S. White, Black, Chinese, and Hispanic adults and older adults (n=1,736; mean age=68.3), to draw 13 sleep dimensions and create composite Sleep Health Scores to quantify multidimensional sleep health disparities. After age and sex adjustment in linear regression, compared to White participants, Black participants showed the greatest global sleep disparity, then Hispanic and Chinese participants. We estimated relative 'risk' of obtaining favorable sleep compared to White adults at the component level by race/ethnicity (lower is worse). The largest disparities were in objectively-measured sleep timing regularity (RRBlack [95% CI]: 0.37 [0.29,0.47], RRHispanic: 0.64 [0.52,0.78], RRChinese: 0.70 [0.54,0.90]) and duration regularity (RRBlack: 0.55 [0.47,0.65], RRHispanic: 0.76 [0.66,0.88], RRChinese: 0.74 [0.61,0.90]), after sex and age adjustment. Disparities in duration and continuity were also apparent, and Black adults were additionally disadvantaged in %N3 (slow wave sleep), sleepiness, and sleep timing (24-hour placement). Sleep timing regularity, duration regularity, duration, and continuity may comprise a multidimensional cluster of targets to reduce racial-ethnic sleep disparities.

Nightly Variation in Sleep Influences Self-efficacy for Adhering to a Healthy Lifestyle: A Prospective Study.

Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study. This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night's sleep were collected in real-time using ecological momentary assessment. The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values < .001). Ourfindings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan.

Ten kHz spinal cord stimulation for the treatment of chronic peripheral polyneuropathy: 12-Month results from prospective open-label pilot study.

The goal of this study was to demonstrate that the paresthesia-independent 10kHz spinal cord stimulation (SCS) can provide long-term pain relief in patients with peripheral polyneuropathy (PPN). Clinically diagnosed subjects with PPN refractory to conventional medical management were enrolled in this prospective, multicenter study between November 2015 and August 2016, after institutional review board approval and patient informed consent were obtained. Subjects underwent trial stimulation utilizing 2 epidural leads, and if successful, were implanted with a permanent 10kHz SCS system and followed up for 12months post-implant. Outcome measures included adverse events, pain, neurological assessments, disability, function, quality of life, pain interference, sleep, satisfaction, and global impression of change. Data are presented as descriptive statistics. Permanent implant population results are reported as mean±standard error. Twenty-one of the 26 trialed subjects had a successful trial and 18 received a permanent implant. All subjects had the leads placed anatomically without the need for paresthesia. Subjects experienced significant and sustained pain relief (at least 65% at all timepoints) whereas physicians noted improvements in neurological function. Significant improvements in disability, function, sleep, sensory, and affective dimensions of pain were reported at all timepoints. All adverse events were resolved without sequelae. Findings from this study suggest that 10kHz SCS may provide sustained pain relief and disability improvements in patients suffering from PPN.

A mysterious sensation about sleep and health: the role of interoception

BackgroundInteroception is mental awareness, recognition and acknowledgement of physiological body signals. Understanding the role of sleep and interoception may provide a better understanding surrounding the sleep-health connection. Our primary objective was to examine the potential relationships between subjective sleep quality and multiple dimensions of interoceptive abilities in a large sample of young adults, a group who are vulnerable to sleep impairment and its widespread health consequences.MethodsWe conducted an online cross-sectional survey targeting young adults, aged 18–25 years. The Pittsburgh Sleep Quality Index (PSQI) was used to identify subjective sleep quality and the Multidimensional Assessment of Interoceptive Awareness Version 2 was used to assess eight domains of interoception. We conducted a series of Spearman’s bivariate correlations to assess the relationships between global sleep quality as well as the seven PSQI sub-components in relation to the eight interoception outcomes. We then conducted quantile regression to assess if global PSQI score was an independent predictor of interoception. Participants (n = 609) consented and provided data.ResultsAfter adjustment, the global PSQI was a significant predictor of ‘Non-Distracting’, ‘Emotional Awareness’ and ‘Trusting’, where β = − 0.10 (95% CI: − 0.14, − 0.07), β = 0.05 (0.01, 0.09), and β = − 0.10 (− 0.14, − 0.05), respectively.ConclusionsOur findings reveal a small, significant relationship between sleep quality and interoceptive abilities amongst young adults. Sleep impairment may inhibit interoceptive skills, thus adding value to the mechanistic explanation of the sleep-health relationship. Experimental and prospective studies are needed to determine temporal associations.

Sleep Health in U.S. Military Women: A Scoping Review of the Literature, 2000-2019.

Sleep, critical to military operational effectiveness, is among the top five outpatient conditions for which military women seek care, yet sleep research in active duty servicewomen is sparse. We conducted a scoping review to 1) describe literature focused on sleep disorders and promotion of sleep health among U.S. active duty servicewomen and 2) identify opportunities for future health policies and research that may improve sleep health and decrease incidence of disordered sleep in servicewomen. The PRISMA-ScR guidelines for scoping reviews informed this project. We searched Ovid; MEDLINE and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions; Embase; CINAHL; Cochrane Central; the Cochrane Database of Systematic Reviews; PsycInfo; and the Web of Science, and several sources of grey literature, from January 2000 through March 2019. We used a three-step screening and data extraction process: 1) title and abstract screening, 2) full-text article screening, and 3) data extraction from included articles. Seventeen of 1464 articles met the inclusion criteria. Most articles were retrospective, descriptive, or observational research. No intervention studies were identified. Sleep diagnoses and dimensions included insomnia, obstructive sleep apnea, disordered sleep quality and duration, and narcolepsy. Sex/gender differences were documented in screening, diagnosis, risk factors, and conditions associated with disordered sleep, for example, pregnancy and postpartum status. Actionable leverage points involve military culture, training, education, treatment, and self-care behaviors related to sleep health. Although we identified leverage points where policy changes have the potential to improve sleep health in active duty servicewomen, there is an urgent need for intervention research to address the gaps in knowledge about sleep health in this population.

A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study.

Poor sleep is associated with increased hypertension risk, but few studies have evaluated multiple sleep dimensions or investigated racial/ethnic disparities in this association among women. We investigated multiple sleep dimensions (sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping and difficulty falling or staying asleep) and hypertension risk among women, and determined modification by age, race/ethnicity and menopausal status. We used data from the Sister Study, a national cohort of 50 884 women who had sisters diagnosed with breast cancer in the United States enrolled in 2003-2009 and followed through September 2018. Of 33 497 women without diagnosed hypertension at baseline (mean age ± standard deviation: 53.9 ± 8.8 years; 88.7% White, 6.4% Black and 4.9% Hispanic/Latina), 23% (n = 7686) developed hypertension over a median follow-up of 10.1 years [interquartile range: 8.2-11.9 years]. Very short, short or long sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping, insomnia, insomnia symptoms as well as short sleep and exploratory cumulative poor sleep score were associated with incident hypertension after adjustment for demographics factors. After additional adjustment for lifestyle and clinical factors, insomnia [hazard ratio = 1.09, 95% confidence interval (95% CI): 1.03-1.15] and insomnia symptoms plus short sleep (hazard ratio = 1.13, 95% CI: 1.05-1.21) remained associated with incident hypertension. These associations were stronger in younger (age<54 vs. ≥54 years) and premenopausal vs. postmenopausal women (all P-interaction < 0.05). Associations did not differ by race/ethnicity (all P-interaction > 0.05). Thus, screening for multiple sleep dimensions and prioritizing younger and premenopausal women may help identify individuals at high risk for hypertension.

Psychometric properties of the Sleep Hygiene Index in a large Italian community sample

Objective/backgroundPoor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach. Patients/methodsParticipants (n = 6276; M = 33.62, SD = 13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables. Results and conclusionsCFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω = 0.752). Test-retest reliability at 8–10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice.

Association between multiple sleep dimensions and functional bowel disorders among Chinese college freshmen

BackgroundAlthough sleep disorder is thought as a risk factor for functional bowel disorders, its impact role in adolescents remains unknown and the contribution of different sleep dimensions may deserve further attention. This study aimed to evaluate the relationship between multiple sleep dimensions and functional bowel disorders among Chinese college freshmen. MethodsA cross-sectional survey was conducted in college freshmen from Huazhong University of Science and Technology in Wuhan, China in September 2019 with random cluster sampling method. All participants completed questionnaires about living habits, sleep and digestive symptoms. Diagnosis of irritable bowel syndrome and functional constipation were based on the Rome IV criteria. Univariate and multivariate logistic regression models were applied to assess the association of sleep dimensions with irritable bowel syndrome or functional constipation. ResultsBased on the 3335 individuals who completed the questionnaire, the overall prevalence of irritable bowel syndrome and functional constipation in college freshmen were 2.5% and 1.7%, respectively. Multivariate analysis revealed that compared with individuals reporting good sleep quality, those reporting poor (OR = 7.269, 95%CI: 2.876–18.370) were associated with increased risk of irritable bowel syndrome. Similarly, those reporting fair (OR = 2.068, 95%CI: 1.010–4.236) and poor (OR = 5.664, 95%CI: 1.864–17.205) were associated with increased risk of functional constipation. There was no statistically significant association between other sleep dimensions (sleep duration, sleep timing, or sleep latency) and irritable bowel syndrome or functional constipation. ConclusionSelf-reported poor sleep quality was a stronger independent predictor of functional bowel disorders than other sleep dimensions among Chinese college freshmen. Future intervention studies should consider the role of sleep quality for the prevention of FBDs in adolescents.

318 Area Deprivation and Sleep Health among White, Black, and Hispanic/Latina Women

Abstract Introduction Although neighborhood environments have been shown to affect sleep health, few studies have directly measured multiple indicators of both neighborhood deprivation and sleep while considering modification by race/ethnicity. Methods Among 49,833 eligible U.S. women enrolled in the Sister Study from 2003 to 2009, we investigated associations between neighborhood deprivation (e.g., percentage of residents unemployed, household crowding) and multiple sleep dimensions. Participants’ addresses were linked to U.S. census block group level Area Deprivation Index rankings (range: 1–100) for the year 2000, and participant rankings were divided into quintiles where the highest quintile represented the highest deprivation level. Participants self-reported habitual sleep duration, sleep debt, frequent napping, and insomnia symptoms. Adjusting for sociodemographic and clinical characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions among participants within quintiles (Qs) 2–5 vs. Q1. Interaction terms were used to assess modification by race/ethnicity. Results Mean age ± standard deviation was 55 ± 9 years. Women with higher neighborhood deprivation were more likely to self-identify as a racial/ethnic minority and had higher unadjusted prevalence of poor sleep dimensions. After adjustment, higher ADI was positively associated with very short sleep (≤5 hours), and race/ethnicity was a modifier (e.g., race-stratified results for Q5 vs. Q1:PRWhite=1.31 [95% CI: 1.14–1.51], PRBlack=0.91 [0.71–1.18], PRHispanic/Latina= 1.17 [0.68–2.04], p-interaction &amp;lt;0.05). Although race/ethnicity did not modify remaining associations, women with higher neighborhood deprivation also had a higher prevalence of sleep debt, frequent napping, and insomnia symptoms. When compared to White women with the lowest neighborhood deprivation, Black women across all deprivation levels and Hispanic/Latina women in Q2-Q5 were substantially more likely to report each poor sleep dimension (PR range: 1.21 to 5.01). Conclusion A multidimensional measure of neighborhood deprivation was associated with poor sleep and sleep disparities among a diverse cohort of U.S. women. Support (if any):

160 Underlying Factors Contributing to Sleep Health Among Middle-aged and Older Adults

Abstract Introduction Although poor sleep is not inherent with aging, an estimated 50-70 million adults in the US have insufficient sleep. Sleep duration is increasingly recognized as incomplete and insufficient. Instead, sleep health (SH), a multidimensional concept describing sleep/wake patterns that promote well-being has been shown to better reflect how sleep impacts the individual. Therefore, focusing on the underlying factors contributing to sleep health may provide the opportunity to develop interventions to improve sleep health in middle-age and older adults. Methods Data from the 2014 wave of the Health and Retirement Study (HRS) were used. Sample size was restricted to those who completed an additional questionnaire containing sleep variables. A derivation of the SH composite was constructed using eight selected sleep variables from the HRS data based on the five dimensions of sleep: Satisfaction, Alertness, Timing, Efficiency, and Duration. Total score ranged from 0-100, with higher scores indicating better SH. Weighting variables were based on complex sampling procedures and provided by HRS. Machine learning-based framework was used to identify determinants for predicting SH using twenty-six variables representing individual health and socio-demographics. Penalized linear regression with elastic net penalty was used to study the impact of individual predictors on SH. Results Our sample included 5,163 adults with a mean age of 67.8 years (SD=9.9; range 50-98 years). The majority were female (59%), white (78%), and married (61%). SH score ranged from 27-61 (mean=50; SD=6.7). Loneliness (coefficient=-1.92), depressive symptoms (coefficient=-1.28), and physical activity (coefficient=1.31) were identified as the strongest predictors of SH. Self-reported health status (coefficient=-1.11), daily pain (coefficient=-0.65), being middle-aged (coefficient=-0.26), and discrimination (coefficient=-0.23) were also significant predictors in this model. Conclusion Our study identified key predictors of SH among middle-aged and older adults using a novel approach of Machine Learning. Improving SH is a concrete target for health promotion through clinical interventions tailored towards increasing physical activity and reducing loneliness and depressive symptoms among middle-aged adults. Support (if any) This study was supported by National Heart, Lung, and Blood Institute (NHLBI) UB Clinical Scholar Program in Implementation Science to Achieve Triple Aims-NIH K12 Faculty Scholar Program in Implementation Science

140 Short and Long Sleep Duration, Poor Sleep Quality, and Later Sleep are Associated with Lower Odds of Adolescents Eating Breakfast

Abstract Introduction Sleep health is linked to dietary choices, and skipping breakfast is associated with risk of negative health outcomes in adolescents. However, there is a lack of research on whether dimensions of sleep at night predict adolescents eating breakfast the next day. We investigated within- and between-person associations of multiple aspects of sleep with adolescent breakfast consumption. Methods Data were collected from a subset of the age 15 wave of the Fragile Families and Child Wellbeing Study (n=590). Teens wore an actigraphy device and completed daily surveys for ~1 week (mean=5.9 days). Surveys assessed subjective sleep quality (low–high) and consumption of breakfast (no/yes). Mixed models assessed whether actigraphy-measured sleep timing (onset, midpoint, and offset) and subjective sleep quality predicted odds of breakfast consumption in both within- and between-person models. A curvilinear association between sleep duration and breakfast consumption was also assessed. Irregularity of sleep duration and timing were tested as additional predictors, calculated as SD per person (in between-person models only). Analyses included random intercepts for participants and covariates: school day, boredom, loneliness, happiness, depressive symptoms, sex, race/ethnicity, body mass index, and household income. Results Within-person analyses revealed a significant curvilinear association between sleep duration and breakfast consumption, such that on nights when teens slept shorter or longer than their average, they had lower odds of eating breakfast the next day (p=.005). Additionally, on nights when teens had a later sleep midpoint or offset than their usual, they tended to skip breakfast the next day (both p&amp;lt;.05). Between-person models showed that teens who on average had later sleep timing (onset, midpoint, and offset) and who reported lower sleep quality had lower odds of eating breakfast (all p&amp;lt;.04). Lastly, teens with greater irregularity of sleep duration and sleep timing (midpoint and offset) had lower odds of eating breakfast (all p&amp;lt;.009). Conclusion Findings indicate that multiple dimensions of adolescent sleep health, including long and short sleep duration, later sleep timing, and poorer sleep quality, are associated with lower odds of eating breakfast. These sleep and dietary behaviors in adolescence may consequently impact future metabolic health. Support (if any) R01HD073352

534 Food Insecurity and Sleep Health by Race/Ethnicity and Age Group in the United States

Abstract Introduction Food insecurity may influence sleep through poor mental health (e.g., depression) and immune system suppression. Although prior studies have found food insecurity to be associated with poor sleep, few studies have investigated the food security-sleep association among racially/ethnically diverse participants and with multiple sleep dimensions. Methods Using National Health Interview Survey data, we examined overall, age-, sex/gender-, and racial/ethnic-specific associations between food insecurity and sleep health. Food security was categorized as very low, low, marginal, and high. Sleep duration was categorized as very short (&amp;lt;6 hours), short (&amp;lt;7 hours), recommended (7–9 hours), and long (≥9 hours). Sleep disturbances included trouble falling and staying asleep, insomnia symptoms, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CI) for sleep dimensions by very low, low, and marginal vs. high food security. Results The 177,435 participants’ mean age was 47.2±0.1 years, 52.0% were women, 68.4% were Non-Hispanic (NH)-White. Among individuals reporting very low food security, 75.4% had an annual income of &amp;lt;$35,000 and 60.3% were ≥50 years old. After adjustment, very low vs. high food security was associated with a higher prevalence of very short (PR=2.61 [95%CI: 2.44–2.80]) and short (PR=1.66 [95% CI: 1.60–1.72]) sleep duration. Very low vs. high food security was associated with both trouble falling asleep (PR=2.21 [95% CI: 2.12–2.30]) and trouble staying asleep (PR=1.98 [95% CI: 1.91–2.06]). Very low vs. high food security was associated with higher prevalence of very short sleep duration among Asians (PR=3.64 [95% CI: 2.67–4.97]), Whites (PR=2.73 [95% CI: 2.50–2.99]), Blacks (PR=2.03 [95% CI: 1.80–2.31]), and Hispanic/Latinxs (PR=2.65 [95% CI: 2.30–3.07]). Conclusion Food insecurity was associated with poor sleep in a diverse sample of the US population. Support (if any):

540 Age Trends in Sleep Across the Lifespan: Findings from the Pittsburgh Lifespan Sleep Databank

Abstract Introduction Sleep continuously changes over the human lifespan and it does so across multiple dimensions, including duration, timing, efficiency, and variability. Although studies focused on specific developmental periods have shown age-related changes in sleep, methodological differences make it difficult to synthesize information across studies to fully understand precisely when these sleep changes occur. Our goal was to use individual-level actigraphy and self-report sleep data from a single site to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human lifespan. To accomplish this goal, we developed the Pittsburgh Lifespan Sleep Databank (PLSD), a large aggregate databank of participants from sleep research studies conducted at the University of Pittsburgh. Methods In the present analysis, we included N=1,070 PLSD participants from 21 studies without a major psychiatric, sleep, or medical condition. We used Generalized Additive Models to examine flexible, potentially non-linear relationships between age and sleep dimensions (actigraphy and self-report duration, efficiency, and timing; actigraphy variability) from ages 10 to 87. We also examined whether these sleep characteristics differed by sex across the lifespan. Results The most dramatic age-related trends were observed in sleep timing. Actigraphy and self-report sleep onset time shifted later between ages 10–18 and then shifted earlier again during the 20s. Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s. Self-report duration became shorter from approximately ages 10–20. Self-report sleep efficiency and actigraphy variability both decreased over the entire lifespan. Relative to males, females tended to have earlier self-report sleep onset, higher actigraphy sleep efficiency, and longer actigraphy duration. Conclusion By focusing on lifespan sleep rather than specific age segments of the samples, we can provide a unified assessment of age-related changes and sex differences from childhood through older adulthood. An understanding of age trends and sex differences in sleep in healthy individuals – and explicating the timing and nature of these difference – can be used to identify periods of sleep-related risk or resilience and guide intervention efforts. Support (if any) University of Pittsburgh Clinical and Translational Science Institute (UL1TR001857).

187 Mental health clusters during COVID-19 pandemic are associated with multiple dimensions of sleep in a sample of pregnant women

IntroductionSleep and mental health have a bidirectional relationship. During pregnancy, poor sleep health, depression and stress are common and have been associated with poor maternal and fetal outcomes. The COVID-19 pandemic has introduced additional physical and psychological risk factors, due to high mortality rate, and economic and social repercussions. This study examines whether prenatal maternal mental health clusters are associated with multiple dimensions of sleep during pregnancy in the context of the COVID-19 pandemic.MethodsFrom June-December 2020, participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) Cohort at Columbia University (N=188; at recruitment gestational age: 32.2±8.2 weeks; age: 32±6.75 years; N=74 Hispanic, N=65 White non-Hispanic, N=27 Black/African American, N=22 other). Survey data on maternal depression (PHQ-9), perceived stress (PSS), Covid-related stress, and sleep health (PSQI) were collected. Using hierarchical clustering, we created maternal mental health clusters (MMHC). Regressions analyses were implemented to estimate the associations between multiple dimensions of sleep based on MMHC.Results\\We derived three MMHC: Low-risk (no depression, no Covid-stress, low-moderate perceived stress), Covid-stress (no depression, moderate Covid-stress, low-moderate perceived stress) and high-risk (moderate depression, moderate Covid-stress, moderate to high perceived stress). Maternal age, gestational age, income, and race were not significantly different across clusters. The Covid-stress cluster compared to the low-risk cluster reported worse subjective sleep quality (ß=0.34±0.11, p=0.0025), longer sleep latency (ß=0.44±0.13,p<0.000), more sleep disturbances (ß=0.67±0.18, p=0.004) and an overall higher PSQI score (ß=0.32±0.13,p=0.017). Compared to the low-risk group, the high-risk group reported worse subjective sleep quality (ß=0.96±0.3,p<0.000), longer sleep latency (ß=0.79±0.13,p<0.000), shorter sleep duration (ß=0.67±0.18,p=0.0003), lower sleep efficiency (ß=0.67±0.25,p=0.008), more sleep disturbances (ß=0.59±0.10, p<0.000), higher daytime dysfunction (ß=0.85±0.10, p=0.000) and an overall higher PISQI score (ß=1.15±0.16, p<0.000).ConclusionOur results indicate that the COVID-19 pandemic has affected mental health profiles during pregnancy, with evidence of a high-risk cluster presenting Covid-stress and depressive symptoms and a Covid-stress cluster presenting Covid-stress without depressive symptoms in a multi-ethnic sample of pregnant women. Both were associated with poorer sleep health outcomes compared to the low-risk cluster. These results have important implications for screening and treatment for the sleep health and obstetric communities during these unprecedented times.Support (if any):

590 Neighborhood Safety and Sleep During Childhood

Abstract Introduction Neighborhood safety has been associated with sleep health among adults; however, few studies have investigated its association with sleep characteristics during childhood. Methods Using data from 1,693 Black/African-American women enrolled in the Study of Environment, Lifestyle and Fibroids from 2010 to 2012, we investigated associations between neighborhood safety and sleep at age 5 years. Participants, aged 23–35 years, reported childhood neighborhood safety (unsafe, somewhat safe, very safe) and light sleep (yes/no). Participants, with assistance from their mothers or others, provided information on participants’ frequency of good sleep hygiene as a child (i.e., to bed by 8 p.m. in a quiet, dark room) as always/most of the time, sometimes, or rarely/never. Adjusting for relative childhood household income and both mother’s and father’s age at participant’s birth, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to compare sleep characteristics for participants who reported unsafe vs. very safe neighborhoods. Results While 20% of participants reported living in an unsafe neighborhood, 41% reported a somewhat safe neighborhood and 39% reported a very safe neighborhood at age 5 years. The unadjusted prevalence of always/most of the time going to bed by 8 p.m. in a quiet, dark room was highest among participants who reported very safe neighborhoods. After adjustment, participants in unsafe neighborhoods were substantially more likely than those in very safe neighborhoods to only sometimes (vs. always/most of the time) go to bed: by 8 p.m. (PR=1.57 [95% CI:1.21–2.03]), in a quiet room (PR=2.11 [1.43–3.11]), and in dark room (PR=1.44 [1.09–1.90]). Patterns were similar for frequencies of rarely/never and often practicing good sleep hygiene. Light sleep was not associated with neighborhood safety. Conclusion Perceived neighborhood safety was associated with multiple sleep dimensions in childhood. Support (if any):