Sleep Experience Research Articles

Sorting out the Relationship between Gastroesophageal Reflux Disease and Sleep.

Gastroesophageal reflux disease is one of the most common conditions encountered by primary care physicians, gastroenterologists, foregut surgeons and otolaryngologists. While approximately 50% of patients experience nocturnal reflux symptoms, the relationship between gastroesophageal reflux disease and sleep is often overlooked. The aim of this review is to provide an update on the current understanding of this relationship and its clinical implications. Recent studies pertaining to the association between GERD and sleep with focus on sleep disturbances, obstructive sleep apnea, extraesophageal manifestations of GERD and treatment are discussed. There is a close relationship between GERD and sleep disturbances, but the nature of this relationship remains to be elucidated. Similarly, new data supports the association between GERD and obstructive sleep apnea, but whether this association is independent of confounding risk factors remains unresolved. Extraesophageal manifestations due to nocturnal GERD are primarily respiratory and can be explained by microaspiration and vagally-induced bronchospasm. Treatment of nocturnal GERD, both pharmacologically and surgically, improves sleep quality. Conversely, pharmacologic treatment of sleep disorders can improve nocturnal GERD symptoms. There is a bi-directional relationship between GERD and sleep. GERD is associated with various sleep disturbances. Sleep deficiency can exacerbate GERD. There is an association between extraesophageal manifestations and nocturnal GERD. Treatment directed towards GERD can improve sleep experience, and treatment directed to improve sleep can improve GERD symptoms.

Appraisals of insomnia identity in a clinical sample

BackgroundInsomnia identity, the conviction that one has insomnia, occurs independently of sleep quality or quantity, and is associated with numerous negative health outcomes. Little is known about factors influencing insomnia identity. This study planned to evaluate insomnia identity, perceived sleep experience, and sleep parameters. MethodIndividuals seeking treatment for an insomnia complaint reported demographics, insomnia identity ratings, and daily sleep diaries. Insomnia complaint and insomnia identity were independently crossed with sleep diary data yielding: complaining good (n = 10) and poor sleepers (n = 51), and good (n = 7) and poor sleepers (n = 40) with insomnia identity. Participants were additionally classified as with (n = 50) and without (n = 14) insomnia identity. Group differences and predictors of insomnia identity were assessed. ResultsComplaining poor sleepers and poor sleepers with insomnia identity reported significantly poorer sleep ratings compared to their counterparts. Insomnia identity severity was predicted by worse sleep quality comparisons and increased helplessness. Analyses revealed poorer sleep parameters among those with an insomnia identity versus without. DiscussionGroup differences may reflect variation in perceived sleep assessment and insomnia identity rating. Results further indicated that not all who complain of insomnia (and seek treatment) endorse insomnia identity. Implications of results and future study directions on insomnia identity are discussed.

Daytime polysomnography to perform titration for upper airway stimulation in patients with obstructive sleep apnea.

PurposeUpper airway stimulation (UAS) is an innovative treatment for patients with obstructive sleep apnea (OSA). UAS titrations are performed 3 months after activation of the device to optimize its effectiveness. In general, these titrations are performed during an in-laboratory overnight polysomnography (PSG). However, overnight titrations are expensive and can be logistically challenging because they are labor-intensive which causes shortage of sleep technicians available for night shifts. In addition, recently, overnight PSGs were postponed and canceled due to the COVID-19 pandemic. We aimed to assess the feasibility of a daytime PSG to perform titration of UAS therapy as an alternative for a conventional overnight PSG.MethodsWe performed a prospective single-center observational cohort study. Patients were included when planned for UAS titration; this was approximately 6 months after UAS activation. Data on sleep architecture, patient experience, and respiratory outcomes were collected to evaluate the feasibility. An overnight follow-up PSG 12 months after implantation was used to compare sleep architecture and therapy response.ResultsOf 23 patients, four were excluded from analysis because of technical issues during PSG. Even though patients slept significantly shorter during the daytime PSG, this was enough time to complete the titration successfully with 30-min sleep in final therapeutic settings in 84% of the patients. Patients (94%) had a positive experience with the daytime titration. Respiratory outcomes were significantly reduced during titration and were maintained at the 12-month follow-up.ConclusionDaytime titrations are a valuable alternative for conventional overnight titrations. Our findings suggest the implementation of daytime titrations as standard of care. This will contribute to easier logistics and better work circumstances for sleep technicians without jeopardizing titration quality.

Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study.

In patients treated with noninvasive ventilation, sleep-related breathing changes can modify patient-ventilator interactions, which could reduce its effectiveness. The aim of this prospective observational study was to determine the impact of sleep/wake state on leaks, upper airway obstructive events, and asynchronies in patients treated by long-term noninvasive ventilation. Stable patients adapted to noninvasive ventilation were considered for nocturnal polysomnography. Unintentional leaks, upper airway obstructive events, and asynchronies were compared between sleep and awake periods. Twenty-eight patients were enrolled. Underlying diagnoses were neuromuscular disease (n = 11), chest wall disease (n = 8), and obesity-hypoventilation (n = 9). Leaks were more frequent in sleep than in awake periods, with a median of 10% (interquartile range [IQR], 0%-75%) vs 1% (IQR, 0%-9%) of time (P < .001), respectively. During sleep, asynchronies with and without associated leak affected 27% of breaths (IQR, 16%-39%) compared with non-leak-related asynchronies that were recorded in 8% (IQR, 3%-25%) of breaths (P < .001). Asynchronies affecting more than 10% of total breaths were more frequent in sleep (25 patients, 89%) than in awake time (8 patients, 29%; P = .25). Eleven patients (39%) presented with 5 or more upper airway obstructive events without reduction in ventilatory drive per hour of sleep. In patients adapted to home noninvasive ventilation, leaks, asynchronies, and upper airway obstructive events are frequent during the night and are concentrated in sleep periods. Asynchronies are often associated with leaks. These findings may have clinical implications considering that in patients with low sleep efficiency respiratory events could be underestimated if sleep is not evaluated. Martí S, Ferré A, Sampol G, etal. Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study. J Clin Sleep Med. 2022;18(1):225-233.

Understanding factors relevant to poor sleep and coping methods in people with schizophrenia

BackgroundSleep disruption is pervasive in people with schizophrenia, but few studies have explored their sleep experiences. This study aims to identify factors relevant to sleep problems and explore coping methods used by community-dwelling people with schizophrenia.MethodsEighteen participants with schizophrenia were recruited from three mental health centers in Taiwan. They completed a semi-structured interview and the Pittsburgh Sleep Quality Index (PSQI) assessment. The Person-Environment-Occupation model offered a framework to assess factors related to sleep. Thematic analysis was used for the qualitative data analysis.ResultsFactors related to sleep were classified under person, environment, and occupation domains. The person domain included three subthemes: psychiatric symptoms, unpleasant emotions, and frustration about sleep. The environment domain included three subthemes: sensory intrusions from the environment, quality of bedding, and roommates. The occupation domain included sleep interruption and sleep preparation. There were notable discrepancies in sleep quality between the participants’ narratives and their PSQI global scores. Regarding coping methods for poor sleep, sleep medication was the primary strategy while some participants also used other strategies, such as modifying the environment, adjusting routines, or engaging in activities that improve sleep quality.ConclusionsPsychiatric symptoms and nightmares were identified as unique sleep disruptions in people with schizophrenia, and poor economic status was also found to impact their sleep. The sleep quality of people with schizophrenia tends to be poor, as identified by the PSQI, even though they may have positive perceptions of their sleep quality. Our participants appeared to prefer to take hypnotics to address their sleep problems, which may be due to limited knowledge about alternatives. Mental health professionals are encouraged to receive training in the application of non-pharmacological approaches to support their clients’ issues related to sleep.

Qualitative and psychometric approaches to evaluate the PROMIS pain interference and sleep disturbance item banks for use in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) commonly experience pain despite the availability of disease-modifying treatments. Sleep disturbances are frequently reported in RA, with pain often a contributing factor. The Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Sleep Disturbance item banks were initially developed to provide insights into the patient experience of pain and sleep, respectively, though they were not specifically intended for use in RA populations. This study evaluated the content validity of the PROMIS Pain Interference and Sleep Disturbance item banks in RA and identified relevant content for short forms for patients with RA that achieved high measurement precision across a broad range of health.MethodsA qualitative approach consisting of hybrid concept elicitation and cognitive debriefing interviews was used to evaluate the content validity of the item banks in RA. Interviews were semi-structured and open-ended, allowing a range of concepts and responses to be captured. Findings from the qualitative interviews were used to select the most relevant items for the short forms, and psychometric evaluation, using existing item-response theory (IRT) item parameters, was used to evaluate the marginal reliability and measurement precision of the short forms across the range of the latent variables (i.e. pain interference and sleep disturbance).ResultsThirty-two participants were interviewed. Participants reported that RA-related pain and sleep disturbances have substantial impacts on their daily lives, particularly with physical functioning. The PROMIS Pain Interference and Sleep Disturbance item banks were easy to understand and mostly relevant to their RA experiences, and the 7-day recall period was deemed appropriate. Qualitative and IRT-based approaches identified short forms for Pain Interference (11 items) and Sleep Disturbance (7 items) that had high relevance and measurement precision, with good coverage of the concepts identified by participants during concept elicitation.ConclusionPain and sleep disturbances affect many aspects of daily life in patients with RA and should be considered when novel treatments are developed. This study supports the use of the PROMIS Pain Interference and Sleep Disturbance item banks in RA, and the short forms developed herein have the potential to be used in clinical studies of RA.

EVALUATION OF SLEEP QUALITY INDEX IN POSTGRADUATE MEDICAL STUDENTS IN INDIA

Background: Sleep quality is dened as the satisfaction of the sleep experience, integrating aspects of sleep initiation, sleep maintenance, sleep quantity, and refreshment upon awakening. It is important to measure sleep quality in postgraduate medical students and this study aims to monitor it across the various years of the course. Methodology: A cross-sectional study involving medical postgraduates students at the Postgraduate Institute of Medical Sciences and Research &amp; Dr. Ram Manohar Lohia Hospital, New Delhi was conducted. All rst- to third-year postgraduate students were invited to participate. It was a self rated questionnaire based study using the Pittsburgh Sleep Quality Index (PSQI). Results: Poor sleep quality as observed using raised global PSQI of more than 5 was seen in 104 students (74%). Of this, 39 students belonged to third year (88.6%), 37 students were from second year (74%) and 28 students were from rst year (59.6%). Only 26% of students showed an adequate sleep quality with global PSQI &lt;5.The mean global PSQI scores for students in rst, second and third year were 6.2, 6.6 and 7.8 respectively reecting that third year students were most affected. Conclusion: Postgraduate medical students have more sleep disturbance with impaired sleep quality. Sleep quality has a strong inuence on physical and mental health. Active intervention is required to improve sleep hygiene in these students.

Efektivitas Aroma Terapi Lavender terhadap Insomnia pada Lansia

Insomnia is a condition where it is difficult to initiate sleep, maintain sleep, and sleep that has not been refreshing for 1 month or more. This study aims to determine whether lavender aroma therapy can effectively reduce insomnia in the elderly. The research design used is a literature study, by means of literature articles or comparing several articles. Elderly research subjects who experience insomnia. From the results of research, several articles indicate that before giving lavender aroma therapy, almost all of the elderly experienced poor sleep quality and after giving lavender aroma therapy almost all experienced an increase in sleep quality. It is hoped that further research can pay attention to the level of aromatherapy giving in order to provide more effective results.

Evaluation of the Сolor Pulse Reflexology and Autogenous Training Effectiveness in Complex Rehabilitation Programs for Patients with Myocardial Infarction after Coronary Artery Bypass Grafting in Сlinical Sanatorium Conditions

Aim. To evaluate the effectiveness of the color pulse reflexology (CPR) methods and autogenous training (AT) in rehabilitation programs for patients after myocardial infarction (MI) and coronary artery bypass grafting (CABG). Material and methods. The study included 157 male patients with coronary artery disease aged 53.7 + 4.3 years who had undergone myocardial infarction and CABG surgery for 1 to 2 months. The patients were prescribed a standard program of sanatorium-resort treatment using natural factors and necessary medicines. The first – the control group of patients (CG, 63 people) was added to the AT treatment program, and the second – the main group (MG, 52 people) – the CPR method – 10 sessions of each method. The apparatus «Amulet 201» was used to correct the psycho-emotional state of patients with signals of the green and yellow ranges of the optical spectrum through a visual analyzer. Results. In the first group of patients, people with anxiety-depressive and asthenic syndromes experienced “restructuring” of the personal values scale: significantly reduced irritability, mental and physical fatigue, which contributed to the elimination of astenization, the restoration of nervous and physical potential, the behavioral functions and sleep normalization after a course of the treatment. In the second group of patients with cardiophobic and anxiety-sensing syndromes, there was improvement in well-being, sleep, decreased fatigue and phobic experiences, internal tension and anxiety, intensity and frequency of pain in the heart after the treatment. The majority of patients who took CPR and were re-admitted to sanatorium-resort treatment within 12 months after MI showed a significant improvement in their general condition and quality of life. Conclusion. When identifying asthenic, anxiety-depressive and agrypnia syndromes with an average daily non-dipper curve in cardiac surgery patients, the use of AT and CPR against the background of complex sanatorium-resort treatment in most cases gave a good and stable therapeutic effect, helped to correct the psychological and hemodynamic profiles, restore efficiency and improve the quality of life.

Impaired alpha rhythm in bad sleeper during nap: A high-density electroencephalogram study.

As the pace of life accelerates, poor sleep quality has become a common health problem. A wealth of sleep studies based on electroencephalogram (EEG) have found that poor sleep quality has decreased alpha rhythm during night-time sleep. However, whether the EEG rhythm during an afternoon nap has a similar impairment has seldom been investigated. By recruiting 35 subjects for a 90-min nap, we explored the relationship between sleep quality and the alpha rhythm, and the contribution of naps to subjective sleep experience. We found that the power of alpha rhythm in the occipital lobe negatively correlated with sleep quality. However, there was no correlation between the sleep quality at night and the sleep duration of the nap, nor the sleep quality and the proportion of each sleep period of a nap. Our present results indicated that the quality of night-time sleep did not affect the macrostructure of the nap. Interestingly, the negative correlation between the alpha rhythm of a nap and sleep quality at night continuously existed in Wake, N1 sleep, and N2 sleep, and had the most substantial value during N2 sleep of a nap. This implies that an impaired occipital lobe alpha rhythm is a robust biomarker for poor sleep. The research is of particular significance for developing electrical neural stimulation therapy to improve sleep quality, especially for the stimuli regions for selection and the time windows for implementation.

Greater adolescent tiredness is related to more emotional arousal during a hyperventilation task: An area under the curve approach

IntroductionApproximately 36% of adolescents report sleep problems (Crowley et al., 2018). Understanding the relation between sleep and emotional experience is crucial in understanding the high incidence of mental health concerns during adolescence. The current study sought to expand understanding in the area by testing the hypothesis that baseline tiredness ratings would predict greater emotional arousal and negative valence across the course of emotional response elicited by a voluntary hyperventilation procedure. MethodsA community sample of 110 youth (10–18 years; 47.8% girls) provided baseline tiredness ratings and ratings of emotional valence and arousal, 2 min before, immediately after, and 3 min after a hyperventilation task. The area under the curve (AUC) was calculated using the repeated measures of valence and arousal, and correlations between the response curves and baseline tiredness were examined. Results and conclusionsFindings indicated baseline tiredness was positively associated with AUC arousal (r = 0.23), but not valence. This suggests daytime tiredness is associated with the degree of emotional arousal elicited by a psychobiological stressor. By extension, adolescents may experience more arousing emotional reactions when tired, and thus the common sleep deprivation observed during this developmental period may increase risk for mental health problems associated with elevated emotional reactivity.

The link between dissociative tendencies and hyperassociativity

Background and objectivesAnecdotal and research evidence suggests that individuals with dissociative symptoms exhibit hyperassociativity, which might explain several key features of their condition. The aim of our study was to investigate the link between dissociative tendencies and hyperassociativity among college students. MethodsThe study (n = 118) entailed various measures of hyperassociativity, measures of dissociative tendencies, depressive experiences, unusual sleep experiences, cognitive failures, and alexithymia. ResultsWe found a positive association between dissociative experiences (i.e., depersonalization) and hyperassociativity specific for associative fluency and associative flexibility tasks (including neutral and valenced material), but not for a remote association task. We also found tentative evidence for cognitive failures and alexithymia explaining the link between hyperassociativity and daytime dissociation and nighttime unusual sleep experiences. LimitationsLimitations include the use of hyperassociation tasks limited to verbal associations vs. imagistic associations, the lack of a measure of trauma history, and a sample limited to college students. ConclusionOur study reports a link between depersonalization and hyperassociativity on tasks that allow for free associations across different semantic domains, potentially explained by alexithymia and cognitive failures. This finding may, with replication, open the pathway to applied intervention studies.

Epidemiology of Sleep Disturbances and Their Effect on Psychological Distress During the COVID-19 Outbreak: A Large National Study in China.

Background: The purpose of the current study was to assess the prevalence of sleep disturbances among Chinese people during the COVID-19 pandemic in a large national survey, analyze the relationship between sleep disturbances and mental health status, and explore the influencing factors of the relationship between sleep disturbances and mental health status.Methods: An online survey was accessed by 19,740 people throughout China from February 14 to 21, 2020. The survey included the Depression Anxiety Stress Scale-21 (DASS-21) to measure psychological distress and two questions about sleep disturbances. Logistic regression analyses and moderation analysis were performed.Results: (1) Among the 14,505 respondents included in analyses, 3,783 (26.08%) reported sleep disturbances at least 3 days during the past week. (2) Sleep disturbances increased the risk of depression, anxiety, and stress (p < 0.05). (3) Gender, age, education, occupation, frequency of attending to epidemic information, nervousness about supplies, receiving provisions of living necessities from the service department during the outbreak, number of correct responses to questions about the epidemic, and isolation/quarantine affected the risk of mental health problems among participants experiencing sleep disturbances (p < 0.05). (4) A moderation analysis found that sleep problems were more likely to affect depression, anxiety, and stress scores in men than women during the COVID-19 outbreak.Conclusion: During the COVID-19 outbreak, 26.08% people surveyed experienced sleep disturbances, and the presence of sleep disturbances was positively related to depression, anxiety, and stress, especially among front-line anti-epidemic workers, younger people, people living in isolation/quarantine, people with a college or greater education, and males.

Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

(1) Background—Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifaceted illness characterized by profound and persistent fatigue unrelieved by rest along with a range of other debilitating symptoms. Experiences of unrefreshing and disturbed sleep are frequently described by ME/CFS patients. This is the first systematic review assessing sleep characteristics in ME/CFS. The aim of this review is to determine whether there are clinical characteristics of sleep in ME/CFS patients compared to healthy controls using objective measures such as polysomnography and multiple sleep latency testing. (2) Methods—the following databases—Pubmed, Embase, Medline (EBSCO host) and Web of Science, were systematically searched for journal articles published between January 1994 to 19 February 2021. Articles that referred to polysomnography or multiple sleep latency testing and ME/CFS patients were selected, and further refined through use of specific inclusion and exclusion criteria. Quality and bias were measured using the Joanna Briggs Institute checklist. (3) Results—twenty observational studies were included in this review. The studies investigated objective measures of sleep quality in ME/CFS. Subjective measures including perceived sleep quality and other quality of life factors were also described. (4) Conclusions—Many of the parameters measured including slow- wave sleep, apnea- hypopnea index, spectral activity and multiple sleep latency testing were inconsistent across the studies. The available research on sleep quality in ME/CFS was also limited by recruitment decisions, confounding factors, small sample sizes and non-replicated findings. Future well-designed studies are required to understand sleep quality in ME/CFS patients.

204 Changes in Physical Activity During the COVID-19 Pandemic Associated with Changes in Sleep

IntroductionThe COVID-19 global pandemic has likely led to changes in physical activity as behavioral patterns were disrupted. This is important because sleep and physical activity are interrelated and promote health, and well-being. This study examined whether changes to physical activity were related to changes to sleep health as a result of the COVID-19 pandemic.MethodsA sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked to estimate the number of minutes per day they engaged in physical activity during the pandemic, as well as before. These were subtracted from each other, and a difference score was computed. Then, responses were categorized as no change (<=15 mins difference), 16-45 minutes more or less activity, or 46+ minutes more or less activity (5 categories total). Outcome variables included the degree to which participants believed that due to the pandemic, they experienced (1) more schedule regularity, (2) better sleep, (3) worse sleep, (4) more difficulty falling asleep, (5) more difficulty maintaining sleep, (6) more sleepiness, and (7) more napping. Ordinal regressions were adjusted for age, and sex.ResultsThose who increased their activity by over 45 minutes per day reported that they were less likely to experience more daytime sleepiness (oOR=0.28, p<0.02). Those who decreased their activity by over 45 minutes per day reported that they were more likely to experience worse sleep (oOR=2.38, p<0.01) and less likely to experience a more regular schedule (oOR=0.37, p<0.003) than prior to the pandemic.ConclusionOverall, those who increased their physical activity since the beginning of the pandemic reported less daytime sleepiness; and those who decreased their physical activity reported worse sleep experiences and a more irregular schedule. The relationship between physical activity and sleep during the pandemic may be bidirectional.Support (if any)R01MD011600, R01DA051321

722 Sleep Loss in Healthcare Workers During the COVID-19 Pandemic

IntroductionDuring the pandemic, healthcare workers have shared their stresses on social media, including regarding sleep disturbances. However, an assessment of sleep using validated measures among healthcare workers on social media is lacking.MethodsA restricted, self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days targeting healthcare workers who were clinically active during COVID-19. In addition to demographics and career information, participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index. Poor sleep quality was defined as PSQI > 5. Moderate-to-severe insomnia was defined as an ISI > 14. Multivariate logistic regression tested the association between demographics and career characteristics and sleep outcomes.ResultsOf the 983 who clicked our link, 906 completed the survey. Participants were mostly white (70%), female (75%), physicians (64%). Mean sleep duration was 6.1 (SD1.2) hours. Nearly 90% experienced poor sleep (PSQI). One third reported moderate or severe insomnia. Many (60%) reported sleep disruptions due to device usage or due to bad dreams at least once per week (45%). In multivariable regression, non-physicians (OR 3.5, CI: 2.5, 5.0), Hispanic ethnicity (OR 2.2; CI: 1.44, 3.45), being single (1.5, CI: 1.03, 2.21), and youngest age group (18–24) (OR 9.9; CI: 1.44, 68.09) had increased odds of insomnia. In open-ended comments, sleep disruptions mapped to 5 categories: (1) Work demands (“The volume of calls and messages from my patient and caregiver population is through the roof”); (2) Pandemic related (“I never had sleep issues prior to the COVID-19 pandemic. Suddenly I had issues with sleep initiation.”; (3) Children and family (“COVID plus home stress plus stress over my kids, my job, my marriage.”); (4) Personal health (“Insomnia predating COVID, but worsened with COVID.”); (5) Responses to the pandemic (“I worry about how COVID is being managed by the President...This does keep me awake at night.”).ConclusionDuring the COVID-19 pandemic, 90% of healthcare workers surveyed on social media reported poor sleep, with over one-third of participants reporting moderate-severe insomnia. Online sleep interventions for healthcare workers are urgently needed.Support (if any):

209 Nightmare Content During the COVID-19 Pandemic: Influence of COVID-Related Stress and Sleep Disruption

IntroductionNightmares are often associated with psychiatric disorders, though acute stress can also induce them. This study explores how the COVID-19 pandemic may have influenced the frequency and content of nightmares.MethodsA sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked the degree to which they agree with statements including that due to the COVID-19 pandemic, they have greater general stress, worse overall sleep, and more middle-of-the-night insomnia. They were also asked if they experienced nightmares during the pandemic on a range of topics, including confinement, claustrophobia, suffocation, oppression, drowning, failure, helplessness, natural disasters, anxiety, evil forces, war, domestic abuse, separation from loved ones, totalitarian regimes, being chased, dangerous animals, sickness, death, COVID-19, and apocalypse. Logistic regression analyses examined each nightmare content as outcome and increased stress, worse sleep, and more middle-of-the-night insomnia as predictors, adjusted for age, sex, and race/ethnicity.ResultsThose who reported greater general COVID-related stress were more likely to have nightmares about confinement (OR=1.66,p<0.03), failure (OR=1.64,p<0.005), helplessness (OR=2.89, 0<0.0005), anxiety (OR=2.37,p<0.0005), war (OR=3.42,p<0.0005), separation (OR=2.23,p<0.0005), totalitarianism (OR=3.78,p<0.003), sickness (OR=1.92,p<0.003), death (OR=1.66,p<0.01), COVID (OR=1.96,p<0.01), and apocalypse (OR=2.92,p<0.0005). Those who reported worsened sleep were more likely to have nightmares about confinement (OR=1.80,p<0.003), oppression (OR=2.99,p<0.0005), failure (OR=2.12,p<0.0005), helplessness (OR=1.67, 0<0.0005), disaster (OR=1.86,p<0.005), anxiety (OR=1.97,p<0.0005), evil forces (OR=1.56,p<0.02), war (OR=2.08,p<0.002), domestic abuse (OR=2.22,p<0.009), separation (OR=2.01,p<0.0005), totalitarianism (OR=3.39,p<0.0005), sickness (OR=1.74,p=0.003), death (OR=2.03,p<0.0005), COVID (OR=2.15,p<0.001), and apocalypse (OR=1.86,p<0.006). Those who reported worsened middle-of-the-night insomnia were more likely to have nightmares about confinement (OR=1.60,p<0.01), oppression (OR=1.97,p<0.002), failure (OR=2.00,p<0.0005), helplessness (OR=1.60,p<0.001), disaster (OR=1.52,p<0.04), anxiety (OR=2.27,p<0.0005), war (OR=2.10,p<0.001), domestic abuse (OR=1.74,p<0.04), separation (OR=1.86,p<0.0005), totalitarianism (OR=1.87,p<0.03), sickness (OR=1.80,p<0.001), death (OR=2.00,p<0.0005), COVID (OR=1.68,p<0.009), and apocalypse (OR=1.65,p<0.01).ConclusionThe results suggest that increased stress may induce negatively-toned dreams related to that stress. Future studies will have to determine whether (and when) this symptom indicates an emotional regulation mechanism at play or the failure of such a mechanism.Support (if any):

205 Changes in Sleep Due to COVID Pandemic Associated with Changes to Dietary Patterns

IntroductionThe COVID-19 pandemic has affected sleep and diet for many people. The present study sought to examine potential associations between changes to sleep and eating habits during the COVID-19 pandemic.MethodsA sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Questions for diet asked, “since quarantine: I’m eating healthier, eating more processed foods, home-cooked meals and more regularly,” “I’m enjoying food in quarantine and I’m struggling with overeating in quarantine.” Sleep questions asked “since quarantine: I have managed to keep a regular sleep-wake schedule, my sleep has improved, I’m struggling to fall asleep, I’m waking up more during the night, I’m more sleepy during the day and I’m taking more naps during the day.” Answers were reported on a 4-point scale ranging from “strongly disagree to strongly agree.” Ordinal logistic regressions were used, adjusted for age and sex and examined each dietary variable as ordinal outcome and each sleep variable as predictor.ResultsThose who report that they kept a more regular schedule were more likely to report eating healthier (oOR=3.13, p=0.007), eating more home-cooked meals (oOR=3.19, p=0.005), and less likely to be eating more processed foods (oOR=0.39, p=0.02), struggle with overeating (oOR=0.39, p=0.02) or undereating (oOR=0.30, p=0.004) or snacking (oOR=0.25, p=0.001). Those reporting more difficulty falling asleep were less likely to be eating healthier (oOR=0.25, p=0.002) and more likely to be eating more processed foods (oOR=3.07, p=0.009) and snacking (oOr=2.36, P=0.04). Those reporting more difficulty with awakenings were less likely to report eating healthier (oOR=0.34, p=0.03) and more likely to report eating more processed foods (oOR=4.52, p=0.001). Those with more sleepiness were less likely to report eating healthier (oOR=0.29, p=0.01) and more homecooked meals (oOR=0.40, p=0.046) and more likely to report eating more processed foods (oOR=6.42, p<0.0005), overeating (oOR=3.63, p=0.01) and snacking (oOR=5.81, p=0.001).ConclusionResearch studying psychological, behavioral and environmental factors that are contributing to changes in sleep and dietary patterns is especially important during a pandemic that has forced people into changes that they may not have been prepared for and which may result in long-term health outcomes.Support (if any)T32HL007249, R01MD011600, R01DA051321

210 Changes in Dream Recall During the COVID-19 Pandemic: Associations with Sleep, Stress and Dream Content

IntroductionDuring the COVID-19 pandemic, individuals have faced unprecedented events, which are often stressful. Stress has an important impact on dreams, and stress-induced sleep difficulties may also impact dream recall. The present study evaluated associations between sleep, stress and dream content on dream recall during the pandemic.MethodsA sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked if they remember more, fewer or about the same amount of dreams as before the pandemic. They were also asked whether the pandemic was associated with more stress, a more regular schedule, improved sleep, worse sleep, more early insomnia, more middle-of-the-night insomnia, more sleepiness, and more naps. They also completed the Insomnia Severity Index, Fatigue Severity Scale, Epworth Sleepiness Scale, Brief Index of Sleep Control, Assessment of Sleep Environment, GAD-7 anxiety scale, and PHQ9 depression scale. Multinomial logistic regressions examined correlates of increased or decreased recall (versus same), adjusted for age, sex, and race/ethnicity.ResultsThose who experienced greater schedule regularity were less likely to report decreased recall (RRR=0.50,p<0.0005), as were those who reported sleep improvement (RRR=0.48,p=0.006). Those whose sleep worsened were more likely to report both increased (RRR=1.64,p=0.003) and decreased (RRR=2.16,p<0.0005) recall. Those suffering maintenance insomnia were more likely to report both increased (RRR=1.70,p=0.001) and decreased (RRR=2.68,p<0.0005) recall, as did those who reported more daytime sleepiness (Increased RRR=1.57,p=0.006; Decreased RRR=1.94,p=0.001). Those whose dream content was more negative were more likely to report both increased (RRR=4.05,p<0.005) and decreased (RRR=3.35,p<0.0005) recall, as did those who reported less negative content (Increased RRR=4.20,p<0.0005; Decreased RRR=5.05,p<0.0005). Similarly, those who reported more positive dream content reported both increased (RRR=17.37,p<0.0005) and decreased (RRR=7.14,p=0.02) recall, as did those who reported less positive content (Increased RRR=4.49,p<0.0005; Decreased RRR=5.59,p<0.0005). Less recall was associated with greater insomnia severity (RRR=1.08,p=0.001), fatigue (RRR=1.04,p=0.001), sleepiness (RRR=1.09,p=0.01), COVID stress (RRR=1.67,p=0.03), anxiety (RRR=1.08,p=0.01), and depression (RRR=1.06,p=0.007), worse sleep environment (RRR=1.06,p=0.005), and less sleep control (RRR=0.56,p=0.001).ConclusionThe results of this survey suggest that a sudden decrease in dream recall in reaction to a new stress could be considered as a pejorative indicator regarding sleep quality and mental health.Support (if any)R01MD011600, R01DA051321

767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis

Abstract Introduction During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables. Methods Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies. Results 10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p&amp;lt;.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p&amp;lt;.001) and wake after sleep onset (z=13.50, p&amp;lt;.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p&amp;lt;.001) and subjective sleep satisfaction (z=3.50, p&amp;lt;.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p&amp;lt;.001), daytime sleepiness (z=26.68, p&amp;lt;.001) and sleep disturbances (z=8.00, p&amp;lt;.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included. Conclusion In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD. Support (if any):