Frequent Sleep Disturbances Research Articles

Sleep disturbance in children with attention-deficit hyperactivity disorder: relationship with melatonin and behavior

ABSTRACT Aim To evaluate the prevalence and types of sleep problems and their correlations with melatonin content and behavior in Attention-Deficit Hyperactivity Disorder (ADHD) children. Method Sleep in ADHD children and typically developing children (TD) aged 6–14 was assessed by the Sleep Disorders Scale for Children (SDSC) and actigraphy, salivary melatonin quantified by ELISA, and behavior was analyzed using the Strengths and Difficulties Questionnaire. Results ADHD children showed a higher frequency of sleep disturbances, higher sleep latency, and lower sleep efficiency than in the TD group. The ADHD group presented lower melatonin nocturnal content compared to the TD group. Disorders of Initiating and Maintaining Sleep (DIMS) was moderately associated with nocturnal melatonin. The total behavior difficulties were correlated with Disorders of Initiating and Maintaining Sleep (DIMS), Sleep/Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), Sleep Hyperhidrosis (SHY) and Total SDSC Score. The behavior was the only determinant of the total SDSC score (R2 = 0.499; p < 0.002). Conclusion This study provides, for the first time, evidence that among the frequent sleep disturbances in ADHD, the disorders in initiating and maintaining sleep are associated with the low levels of melatonin found in this population. Additionally, these, along with other sleep disturbances, are linked to behavioral problems in ADHD.

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

BackgroundSleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China.MethodsThis study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support.ResultsAmong 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that anxiety symptoms (OR = 1.305, 95% CI: 1.269–1.342, P < 0.001) was risk factor for sleep disturbances, and significant other support (OR = 0.944, 95% CI: 0.896–0.994, P = 0.028) and good annual household income (OR = 0.616, 95% CI: 0.394–0.963, P = 0.034) were protective factors. Furthermore, multinomial logistic regression analysis showed that age, sex, and anxiety symptoms were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05).ConclusionsWe have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.

Comparison of sleep characteristics between Parkinson's disease with and without freezing of gait: A systematic review

Parkinson's disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Among the motor complaints, freezing of gait (FOG) is a common and disabling phenomenon that episodically hinders patients' ability to produce efficient steps. Concurrently, sleep disorders are prevalent in PD and significantly impact the quality of life of affected individuals. Numerous studies have suggested a bidirectional relationship between FOG and sleep disorders. Therefore, our objective was to systematically review the literature and compare sleep outcomes in PD patients with FOG (PD + FOG) and those without FOG (PD-FOG). By conducting a comprehensive search of the PubMed and Web of Science databases, we identified 20 eligible studies for inclusion in our analysis. Our review revealed that compared to PD-FOG, PD + FOG patients exhibited more severe symptoms of rapid eye movement sleep behavior disorder in nine studies, increased daytime sleepiness in eight studies, decreased sleep quality in four studies, and more frequent and severe sleep disturbances in four studies. These findings indicate that PD + FOG patients generally experience worse sleep quality, higher levels of daytime sleepiness, and more disruptive sleep disturbances compared to those without FOG (PD-FOG). The association between sleep disturbances and FOG highlights the importance of evaluating and monitoring these symptoms in PD patients and open the possibility for future studies to assess the impact of managing sleep disturbances on the severity and occurrence of FOG, and vice versa.

0176 Predictors of sleep duration among university students in Japan: Cross-cultural insights for developing sleep health interventions

Abstract Introduction Inadequate sleep among university students, especially in Japan, contributes to low academic performance and mental health challenges. Sleep health, including adequate sleep duration and quality, may serve a protective role in promoting performance and full participation in daily life. We sought to identify factors explaining sleep duration in Japanese college students as potential targets for culturally sensitive sleep health promoting intervention. Methods Cross-sectional descriptive study of university students in Japan in 2021; N = 362 completed validated Japanese versions of the Pittsburg Sleep Quality Index (PSQI), Morningness and Eveningness Questionnaire, Sleep Hygiene Practice Scale, and Dysfunctional Beliefs and Attitudes about Sleep. Indicators of sleep and PSQI subscales (except sleep duration), personality, depression, anxiety, time use, and participation quality were included in multivariate logistic regression modeling to explain less healthy (6 hours or less) versus healthier (more than 6 hours) sleep duration. Results Students were 20.0 (SD = 1.3) years, 86.4% female with a mean sleep duration of 400 (SD = 67) minutes. The mean PSQI score was 4.8 (SD = 2.5) indicating good sleep quality, though 41.4% of the sample reported sleeping 6 hours or less and these persons had lower sleep quality (PSQI; d = 1.20) compared to longer sleepers. Logistic regression explained category assignment (Chi-square = 68.978, df = 8, p &amp;lt;.001; Nagelkerke R-squared = .234). Longer sleepers were more likely to report greater sleep efficiency, less frequent sleep disturbances, lesser daytime dysfunction, shorter commuting times, a morning-like chronotype, greater participation quality, and a less agreeable personality type. Interestingly, longer sleepers reported less effective sleep hygiene practices. Conclusion Short sleep was common and associated with poor sleep quality. Longer sleepers were more likely to report optimal sleep health indicators and greater participation quality (i.e. engagement in meaningful activities). Counter-intuitive sleep hygiene findings indicate potential cultural variation in sleep timing, pre-sleep arousal, and environment regulation as targets for intervention. Sleep health promotion intervention should consider personality, chronotype preference and time use (e.g. meaningful activities, commuting) as factors promoting or inhibiting sufficient sleep duration and quality in university students. Support (if any) Fulbright U.S. Scholar Award to Japan

0765 Enlarged perivascular spaces in infancy: associations with autism diagnosis, cerebrospinal fluid volume, and later sleep problems

Abstract Introduction Since the re-discovery of the glymphatic system, there has been an increased interest in perivascular spaces (PVS) and cerebrospinal fluid (CSF) characteristics in relation to sleep. Enlarged PVS (ePVS) are associated with neurological disorders and sleep problems, and excessive extra-axial CSF (EA-CSF) volume is associated with autism spectrum disorder (ASD). However, ePVS has not been studied in infancy in relation to autism, EA-CSF volume, or sleep problems. The objectives of this study, therefore, are to examine whether ePVS is 1) more prevalent in infants who later develop ASD, 2) related to EA-CSF volume, and 3) associated with later sleep problems. Methods The study was conducted on a prospective, longitudinal cohort from the Infant Brain Imaging Study (IBIS). Participants underwent neuroimaging at 6-, 12-, and 24-months of age, and parent-reported Children’s Sleep Habits Questionnaires (CSHQ) were collected at a follow-up visit at school age (age range = 7-12 years, M = 10.0). A total of 311 participants were included: 47 infants at high familial likelihood for ASD who were later diagnosed with ASD (HL+), 180 high likelihood infants not diagnosed with ASD (HL-), and 84 low likelihood control infants (LL-). The CSHQ was available on a subset of 109 participants. Results Significant group differences in ePVS rates were found at 24 months of age (p=0.041), with 44.7% of the HL+ group having ePVS, compared to 26.7% in the HL- group (p=0.017) and 26.2% in the LL- group (p=0.031). ePVS at 24 months was associated with greater EA-CSF volume from 6-24 months (p=0.002) and greater sleep disturbances at school-age (p=0.006), regardless of ASD diagnosis. Conclusion The presence of ePVS during infancy was associated with ASD diagnosis, elevated EA-CSF volume, and more frequent sleep disturbances. Results suggest that infants with ePVS should be monitored for early signs of ASD and potential long-term sleep problems, particularly sleep disturbances. Further examination is needed to establish whether early ePVS is ASD-specific or an indication of early glymphatic system dysfunction that can put infants and children at risk for atypical brain development and later sleep problems. Support (if any)

Generalized Anxiety Disorder among Adult patients attending psychiatric clinic at Baghdad Teaching Hospital

Background: Generalized anxiety disorder is characterized by chronic and persistent worry, which is multifocal, excessive, and difficult to control, and accompanied by nonspecific psychological and physical symptoms. The objective of the study is to determine the proportion of GAD, evaluate clinical symptoms with socio-demographic data and determine whether such patients have co-morbid mental illnesses. Method and patient: This cross sectional study was conducted at Baghdad teaching hospital, 263 patients included, the study took 17 weeks starting in June 2021 till mid-October 2021. Result: 6% of patients (7 patients from 263) found to have GAD, men and women were almost equally affected, most of the patients were employed and married, had secondary school achievements and all of them were from urban areas. Restlessness and irritability were the most frequent symptoms and sleep disturbance was the least among other symptoms. Depression was the most frequent comorbid illness; other anxiety disorders and personality disorder were the least comorbidities. Conclusions: The proportion of GAD is slightly lesser than other studies, higher proportion seen in older adults than the younger patients, common symptoms of GAD are also seen in other psychiatric disorders leading to under-diagnosing of the illness, and mental health comorbidities are high among patients with GAD, mainly depression.

Sleep quality and its associated factors among patients with tuberculosis: A cross-sectional study.

Tuberculosis (TB) patients commonly suffer from sleep issues owing to various adverse drug reactions (ADRs), disease symptoms, and the contagious nature of their disease. These sleep issues negatively affect the treatment outcome and quality of life. However, the prevalence of sleep disturbance and its associated factors among TB patients have rarely been reported. A total of 497 inpatients with TB from three hospitals in China were enrolled in this cross-sectional study to investigate their sleep quality using the Pittsburgh sleep quality index (PSQI). Clinical data, including demographic information, TB-related stigma, perceived stress, and nutrition- and immunity-related indicators, were also collected to explore the factors associated with sleep disturbance among the recruited patients. Approximately 70% of the recruited patients reported a sleep disturbance to varying degrees, presenting poorer global and subjective sleep qualities, longer sleep latency, shorter sleep duration, lower sleep efficiency, more frequent sleep disturbances, greater use of sleeping medication, and more severe daytime dysfunction. Furthermore, the body mass index (BMI), hemoglobin levels, albumin levels, and T lymphocyte count of the patients in the poor sleep quality group were significantly lower than those in the good sleep quality group (p < 0.05). Increasing age, higher income, drug resistance, higher stigma or stress perception, lower albumin levels, and lower CD4 levels were significantly associated with sleep disturbance among TB patients (p < 0.05). Three-quarters of the participants were found to suffer from a probable sleep disturbance. And sleep problems are linked to biological traits that interact with psychological, cultural, and social factors in complex ways. It is therefore important to pay attention to the sleep quality of TB patients, especially those with the identified risk factors. Besides, taking care of these risk factors may prove to be an effective sleep management strategy.

Sleep problems in adolescents with epilepsy and their caregivers: associations with behavioural difficulties.

The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

Eczema among adolescents in Kuwait: Prevalence, severity, sleep disturbance, antihistamine use, and risk factors

BackgroundEczema (atopic dermatitis) is a common inflammatory skin disease that is more prevalent in children and adolescents than adults. In Kuwait, there is a lack of empirical knowledge on eczema epidemiology among adolescents. Therefore, this study aimed to estimate the prevalence of eczema symptoms and severity, assess the frequency of eczema-related nocturnal sleep disturbance and its relation to antihistamine use, and determine factors that are associated with eczema prevalence and eczema-related nocturnal sleep disturbance. MethodsA school-based cross-sectional study enrolled adolescents (n = 3864) aged 11–14 years across Kuwait. Information on eczema symptoms and clinical history, use of antihistamines, parental history of eczema, mode of delivery, and childhood life-style factors and exposures were reported by parents. Current eczema was defined as chronic or chronically relapsing itchy dermatitis with characteristic morphology and distribution in the past 12 months. Among subjects reporting current itchy rash, frequency of nocturnal sleep disturbance due to itchy rash in the past 12 months was reported as: never, <1 night per week, and ≥1 nights per week. Associations were assessed by applying a modified Poisson regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). ResultsThe prevalence estimate of current (past 12 months) itchy rash was 20.5% (735/3593) and current eczema was 10.2% (388/3791), with 19.5% (736/3775) reporting history of ever doctor-diagnosed eczema. Among subjects with current itchy rash, nocturnal sleep disturbance due to itchy rash affected 21.7% (157/724) of participants for <1 night per week and affected 12.7% (92/724) of participants for ≥1 nights per week. Antihistamine use at least once per month increased as the frequency of nocturnal sleep disturbance due to itchy rash increased (Ptrend <0.001). Factors that demonstrated association with current eczema prevalence included underweight body mass index (aPR = 1.71, 95% CI: 1.16–2.53), Cesarean section delivery (1.29, 1.01–1.65), and maternal (1.72, 1.35–2.19) and paternal (1.83, 1.44–2.32) history of eczema. Frequent (≥1 nights per week) nocturnal sleep disturbance was associated with Cesarean section delivery (1.98, 1.37–2.85), exposure to household tobacco smoke (1.70, 1.18–2.47), and dog-keeping (1.93, 1.06–3.52). ConclusionsEczema symptoms are common among adolescents in Kuwait, with similar epidemiological patterns as those observed in western countries. A large proportion of affected adolescents reported nocturnal sleep disturbance due to itchy rash. Modifiable risk factors were associated increased prevalence of eczema and night awakenings.

Evaluation of Sleep Habits and Disturbances Among US Adults, 2017-2020

Unhealthy sleep behaviors and sleep disturbances are associated with higher risk of multiple diseases and mortality. The current profiles of sleep habits and disturbances, particularly the differences between workdays and free days, are unknown in the contemporary US. To comprehensively evaluate sleep habits on workdays and free days and the prevalence of sleep disturbances among US adults. This study is a cross-sectional analysis of US nationally representative data from the National Health and Nutrition Examination Survey (2017-2020) among adults aged 20 years or older. Data analysis was performed from February to May 2022. The main outcomes were means and/or distributions of sleep habits, including sleep duration and sleep-wake timing on workdays and free days, sleep debt (ie, the difference between sleep duration on free days and mean weekly sleep duration), and social jet lag (ie, the difference between the midpoint between sleep and wake time on workdays and free days). Prevalence of trouble sleeping (ie, participants told a doctor or other health professional that they have trouble sleeping) and daytime sleepiness (ie, self-reported feeling of being overly sleepy during the day ≥5 times per month) were also determined. A total of 9004 individuals (mean [SE] age, 48.3 [0.53] years; 4635 women [51.9%]; 3158 non-Hispanic White [62.8%]) were included in the current study. The mean sleep duration was 7.59 hours (95% CI, 7.54 to 7.64 hours) on workdays and 8.24 hours (95% CI, 8.17 to 8.31 hours) on free days (difference, 0.65 hour). The mean sleep and wake times were at 11:02 pm (95% CI, 10:57 pm to 11:17 pm) and 6:41 am (95% CI, 6:36 am to 6:45 am), respectively, on workdays and 11:25 pm (95% CI, 11:21 pm to 11:35 pm) and 7:41 am (95% CI, 7:37 am to 7:46 am), respectively, on free days (differences, 0.23 hour for sleep time and 1.00 hour for wake time). On workdays, 23.1% (95% CI, 21.3% to 24.9%) of adults slept less than 7 hours and 25.4% (95% CI, 24.1% to 26.6%) went to sleep at midnight or later; the corresponding percentages changed to 12.9% (95% CI, 11.6% to 14.1%) and 40.9% (95% CI, 38.4% to 43.5%), respectively, on free days. Furthermore, the mean sleep debt was 0.73 hours (95% CI, 0.68 to 0.77 hours), and mean social jet lag was 1.10 hours (95% CI, 1.05 to 1.15 hours); 30.5% (95% CI, 26.8% to 33.3%) of adults experienced 1 hour or more of sleep debt, and 46.5% (95% CI, 42.6% to 50.3%) experienced 1 hour or more of social jet lag. The prevalence of trouble sleeping was 29.8% (95% CI, 28.2% to 31.5%), and that of daytime sleepiness was 27.2% (95% CI, 25.0% to 29.5%). In 2017 to 2020, US adults showed variability in sleep habits between workdays and free days, with longer sleep duration and later sleep-wake phases on free days, and high percentages of US adults experienced long-term sleep deprivation, chronic social jet lag, and frequent sleep disturbances. These findings provide evidence to further investigate potential approaches to optimize overall US sleep health.

The Influence of Scent on Sleep Quality

The use of scents in sleep medicine is gaining increasing attention since they have been shown to improve sleep quality. This randomized double-blinded crossover trial measured the extent to which a continuous nightly presentation of a synthetic jasmine scent combined with lavender oil and passionflower herb improves subjective and objective sleep quality. Thirty sensitive sleepers (ISI 7-14) who suffer from delayed sleep-onset and frequent sleep disturbances (2-3 per week) were monitored under four conditions in the sleep laboratory over four nights. The first night was for acclimation (baseline), and the other nights were randomized in a counterbalanced order (placebo rose scent, a high-dose of jasmine scent, or a low-dose relative to the essential oils). Alongside this, subjects were given standardized questionnaires to complete in the morning and evening. There was a significant improvement in sleep quality and total sleep time when using scents compared to baseline. Furthermore, both variants of jasmine decreased wake after sleep onset. The results also indicated that the application of scent on the T-shirt was well tolerated by all subjects. Overall, it was shown that the jasmine scent may positively affect sleep parameters, and moderators such as dosage, application method, and duration of the scent should be further investigated.

Abstract P098: Association Between Postpartum Sleep Characteristics And Twenty-four Hour Blood Pressure Patterns In Women With And Without A History Of Preeclampsia

Introduction: Women with a history of preeclampsia (hxPE), a hypertensive pregnancy disorder, are at a four-fold elevated risk of chronic hypertension postpartum compared with healthy pregnancy. The postpartum period is particularly vulnerable to adverse sleep characteristics such as poor sleep quality and frequent sleep disturbances, which are associated with hypertension risk. However, the relation between postpartum sleep characteristics, nighttime blood pressure (BP) and diurnal BP variation assessed by twenty-four hour ambulatory BP monitoring is not well-studied. Methods: Women with a hxPE (N=13, age 37 ± 5 years) and healthy pregnancy controls (N=12, 36 ± 3 years) without history of sleep disorders were enrolled between 1-5 years postpartum (2.9 ± 1.3 years). Subjective sleep characteristics were reported using the Pittsburgh Sleep Quality Index (PSQI). Ambulatory BP monitoring was conducted to measure 24-hour, day and night BP as well as nocturnal BP dipping and morning BP surge quantified by sleep-trough surge. Results: Women with a hxPE tended to report poorer global sleep quality (7 ± 3 vs 5 ± 3 PSQI score, P=0.09) related to more frequent sleep disturbance (8 ± 4 vs 5 ± 3 score, P=0.053) without differences in habitual sleep duration (7 ± 1 vs 7 ± 1 hours, P=0.37) or sleep latency (18 ± 11 vs 17 ± 9 min, P=0.89). In the entire group, frequency of sleep disturbance was associated with greater 24-hour BP (systolic: r = 0.42, P=0.046; diastolic: r = 0.43, P=0.04) but not night BP (systolic: r = 0.19, P=0.40; diastolic: r = 0.19, P=0.40). Only sleep latency was related to blunted nocturnal BP dipping % (r = -0.38, P=0.08), and no sleep characteristics were associated with augmented morning BP surge. Conclusions: Women with a hxPE reported poorer overall sleep quality compared with healthy pregnancy controls 1-5 years postpartum, particularly frequent sleep disturbances. Frequency of sleep disturbance was associated with elevated 24-hour BP, but not higher nighttime BP or attenuated nocturnal BP dipping, indicating that the impact of postpartum sleep characteristics on BP is not attributable to diurnal BP variation.

0272 Decreased Risk of 2-Year Incidence of Alzheimer’s Disease Among Older Adults Who Report Sleep Symptoms

Abstract Introduction Those with dementia or Alzheimer’s Disease report an elevated amount of sleep difficulties compared to age-matched controls. Sleep-based interventions may be especially useful for this group, such as cognitive behavioral therapy for insomnia or pharmacological interventions. Therefore, it is important to expand the current understanding of the nature of sleep difficulties in those with Alzheimer’s Disease. Methods Data from the 2018 Health and Retirement Survey was collected from 17,146 older adults. Poisson regression analyses were used to explore the relationship between Alzheimer’s Disease as diagnosed by a doctor and sleep difficulties. Individuals who reported no Alzheimer’s Disease in the previous wave (N=16,751) were asked if they had since become diagnosed. N=101 individuals reported incident Alzheimer’s Disease in the 2-year gap between assessments. Sleep difficulties were assessed by asking participants if they had difficulties initiating or maintaining sleep, waking up too early, and how rested they felt upon awakening. All 4 of these symptoms were coded as “never,” “sometimes,” or “often.” Results Unexpectedly, there was a significant decreased risk of developing Alzheimer’s Disease among those who reported difficulties maintaining sleep (IRR=0.9962; 95%CI[0.9936,0.9988]; p=0.004), and early morning awakenings (IRR=0.9961; 95%CI[0.9938,0.9984]; p=0.001) “sometimes”. When the model was adjusted for sex, race, ethnicity, age, and depression, a similar finding of decreased risk for Alzheimer’s Disease for those who reported difficulties maintaining sleep (IRR=0.9953; 95%CI[0.9927,0.9980]; p&amp;lt;0.001), and early morning awakenings (IRR=0.9954; 95%CI[0.9930,0.9978]; p=0.001), “sometimes” were maintained. Conclusion Although previous studies have shown that poor sleep may lead to increased risk of Alzheimer’s and related dementias, the present study, which examined longitudinal data from a large, national sample of older adults, found that there was no association between frequent sleep disturbances and 2-year incidence of Alzheimer’s Disease, and a small association between more mild symptoms and decreased risk. It is possible that the 2-year observation window was insufficient to detect effects. Also, there is a risk of measurement error in collecting self-reported data on sleep and Alzheimer’s diagnoses. Support (If Any) The HRS (Health and Retirement Study) is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan.

0748 Proteomic Biomarkers of Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by recurrent, partial or complete obstructive respiratory events accompanied by interruptions in sleep with frequent arousals, deoxygenation, and/or sleep disturbance. The present study profiled the largest array of plasma proteins, to date, to contribute to the identification of proteomic biomarkers associated with the presence and severity of OSA. Methods The SomaScan highly multiplexed aptamer assay was used to profile 5,000 proteins in 24–48-hour old EDTA plasma samples from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. The apnea-hypopnea index (AHI) was derived from overnight polysomnography and all participants provided a blood sample. OSA severity was classified as moderate-to-severe (AHI&amp;gt;15) and controls/mild OSA (AHI&amp;lt;15). Univariate linear regression analyses included log2-normalized relative protein expression as the dependent variable, AHI/OSA as the independent variable, and important covariates such as age, gender, BMI, BMI2, age x gender x BMI, sample storage time, and blood draw period. False discovery rate (FDR) to control for multiple testing was applied with an a-priori p-value of 0.05 for identifying significance. Results Univariate analyses identified 101 (65 upregulated, 36 downregulated) differentially expressed proteins (DEPs) between moderate-to-severe OSA and controls/mild OSA and 120 proteins (69 positive, 51 negative) associated with AHI as a continuous outcome with 70 proteins consistent in both models. Upregulated proteins involved pathways related to complement and coagulation cascades and metabolic processes and downregulated proteins involved pathways related to regulation of insulin-like growth factor, fibrin clot formation, and MAPK signaling. An OSA machine learning classifier (AHI&amp;gt;15 vs AHI&amp;lt;15) trained on relative protein expression performed robustly, achieving 72% accuracy in a validation dataset. Significant contributing features of the classifier included age, BMI, and 134 proteins, including 22 DEPs identified in univariate analyses for OSA categories. Conclusion The present study identified differential protein expression patters associated with OSA and AHI, thereby supporting the potential of proteomic biomarkers in OSA and providing new insight into the mechanisms underlying OSA. Support (If Any) This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952] and the Klarman Family Foundation.

Associations between sleep disturbances, diabetes and mortality in the UK Biobank cohort: A prospective population-based study.

Non‐communicable diseases, including diabetes, are partly responsible for the deceleration of improvements of life expectancy in many countries. Diabetes is also associated with sleep disturbances. Our aim was to determine whether sleep disturbances, particularly in people with diabetes, were associated with increased mortality risk. Data from the UK Biobank were analysed (n = 487,728, mean follow‐up time = 8.9 years). The primary exposure was sleep disturbances, assessed through the question: Do you have trouble falling asleep at night or do you wake up in the middle of the night? The primary outcome was mortality. We also dichotomized sleep disturbances into “never/sometimes” versus “usually” (frequently), and combined with the presence/absence of diabetes: 24.2% of participants reported “never/rarely” experiencing sleep disturbances, 47.8% “sometimes” and 28.0% “usually”. In age‐ and sex‐adjusted models, frequent sleep disturbances were associated with an increased risk of all‐cause mortality (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.26–1.37), which remained significant in the fully adjusted model (HR 1.13, 95% CI 1.09–1.18). The presence of both diabetes and frequent sleep disturbances was associated with greater risk of all‐cause mortality than either condition alone. In the fully adjusted model, the hazard ratio for all‐cause mortality was 1.11 (95% CI, 1.07–1.15) for frequent sleep disturbances alone, 1.67 (95% CI, 1.57–1.76) for diabetes alone and 1.87 for both (95% CI, 1.75–2.01). Frequent sleep disturbances (experienced by more than one quarter of the sample) were associated with increased risk of all‐cause mortality. Mortality risk was highest in those with both diabetes and frequent sleep disturbances. Complaints of difficulty falling or staying asleep merit attention by physicians.

Abstract MP45: Social Jetlag, Independent Of Other Sleep Characteristics, Is Associated With Obesity-related Outcomes In 9-11-year-old Girls

Introduction: Though short sleep has been identified as a predictor of childhood obesity, few have explored the importance of sleep characteristics beyond duration. Literature in adolescents examining the influence of social jetlag, the difference in hours between the midpoint of sleep during weekdays (school) and weekend days (free), has suggested a potential sex-specific relationship with obesity-related indices. However, little is known about the potential sex-specific relationships between social jetlag or other sleep characteristics and obesity-related outcomes earlier in youth. Objective: To examine the relationships between sleep duration, disturbances, and social jetlag with obesity-related outcomes during childhood, with an emphasis on sex-specific relationships. Methods: This cross-sectional study included 381 children from Dunedin, New Zealand (9-11 years, 49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry, measured over 8 consecutive days. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire, with higher scores (range 1-3) denoting more frequent sleep disturbances. Obesity-related outcomes included age-specific body mass index z-scores (zBMI) calculated using the World Health Organization method, relative (% fat) and absolute (kg) adiposity and fat mass index (kg/m 2 ) assessed via bioelectrical impedance analysis, and waist-to-height ratio (WHtR). Linear mixed models that nested children within schools, with a random intercept and fixed slope were used to identify relationships among sleep variables and obesity-related outcomes. Multivariable analyses included all sleep variables (unadjusted) and known covariates (adjusted). Cross-level interactions assessed the presence of sex-specific relationships. Results: Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Associations between sleep duration and sleep disturbances with body composition variables were non-significant. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI ( B =0.23, 95%CI: 0.03, 0.43, p =0.025), though not with any other obesity-related outcome. Furthermore, cross-level interactions were present for social jetlag with zBMI ( B =-0.40, 95%CI: -0.80, -0.00, p =0.051) and LnWHtR ( B =-0.01, 95%CI: -0.03, -0.00, p=0.042), with simple slopes suggesting positive associations in girls but not boys (girls B =0.43 and 0.01, respectively, both p &lt;0.05 ). Conclusions: Social jetlag may be an important target for youth obesity prevention efforts, given its association with obesity-related outcomes. Importantly, these associations were seen in girls but not boys, suggesting that a targeted approach to prevention may be needed.

Efficacy of elobixibat as bowel preparation agent for colonoscopy: Prospective, randomized, multi‐center study

Background and AimElobixibat is a novel ileal bile acid transporter inhibitor. This study aimed to compare the efficacy, tolerability, and safety of the combination of elobixibat and 1 L of polyethylene glycol formulation containing ascorbic acid (PEG‐Asc) solution versus the combination of sodium picosulfate and 1‐L PEG‐Asc solution as bowel preparation for colonoscopy.MethodsThis multi‐center, randomized, observer‐blinded, non‐inferiority study recruited 210 outpatients who were assigned to either the elobixibat plus 1‐L PEG‐Asc group (group A) or the sodium picosulfate plus 1‐L PEG‐Asc group (group B). The quality of the bowel cleansing level was assessed by the Boston Bowel Preparation Scale (BBPS) and compared the bowel cleansing level between the groups. Data regarding bowel preparation time, patients’ tolerability, and adverse events were also analyzed.ResultsData for 196 patients (99 in group A and 97 in group B) were analyzed finally. BBPS was comparable between group A and B (8.3 ± 0.9 vs. 8.3 ± 0.7; P = 0.88). Consequently, the adequate bowel preparation rate in groups A and B was 95.0% and 99.0%, respectively (−4.0%, 95% CI −9.3 to 1.5). Bowel preparation time in group A was similar to that in group B (348.2 ± 79.8 min vs. 330.8 ± 82.5 min; P = 0.13), whereas, sleep disturbance was significantly less frequent in group A than in group B (10.2% vs. 22.7%; P = 0.02).ConclusionsThe combination of elobixibat and 1‐L PEG‐Asc can be considered an alternative bowel preparation for colonoscopy considering the equivalent bowel cleansing effect and less frequent sleep disturbance. The Japan Registry of Clinical Trials (jRCTs41180026).

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0-10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207days (SD=154). At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i)pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BackgroundNausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.MethodsWomen attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011–2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.ResultsAccording to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79–8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20–9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .ConclusionsMore severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

ПРОБЛЕМЫ ПСИХИЧЕСКОГО ЗДОРОВЬЯ И ОБРАЩЕНИЕ ЗА ПОМОЩЬЮ СРЕДИ ПОДРОСТКОВ

The mental health problems among adolescents have long-lasting effects throughout life. However, research evidence indicates that only 10–30% of adolescents who needed mental health care had received specialized help. The present study reports the prevalence of mental health problems and help-seeking among adolescents, taking into account gender and age differences. The sample included 1752 adolescents (47 % boys,) aged 12-17 years. Data were collected on in two Siberian cities (Novosibirsk and Krasnoyarsk) using an international self-report questionnaire developed for the school-based Eurasian Child Mental Health Study. Participants were recruited from 18 schools, students completed questionnaires anonymously during school lessons. Statistical analysis included analysis of variance (ANOVA), multiple regression analysis, and crosstabs using a chi-squared test. The level of emotional and behavioral problems in Siberian adolescents was slightly higher than that found in European and Asian countries. Twenty three percent of adolescents reported frequent headaches (at least once a week), 11 % reported frequent abdominal pain and 14% suffered from frequent sleep disturbances (3–5 times a week or more). Girls reported a significantly higher level of problems than boys, with the largest gender differences for emotional problems, recurrent pains and sleep disturbances. Weekly consumption of alcohol and daily use of nicotine among boys was more common than among girls (3 % and 6 %, respectively), whereas less frequent use of alcohol and nicotine was commoner in girls (16 %) than in boys (10 %); 7 % of boys and girls had tried drugs at least once. Suicidal thoughts were reported by 22 % of adolescents, 6 % reported suicide attempts and 6 % reported repeated self-harm. One third of adolescents considered seeking outside help and 9 % had actually done so. Girls reported more help-seeking than boys; older girls sought help more often than younger and middle-aged ones. Around one third of adolescents sought help from their relatives; 26 % from friends, the Internet or other non-professional sources; 5 % reported seeking help from a doctor or nurse, and 3 % from a psychologist. The most important independent predictors of seeking help were emotional symptoms, suicidal ideation and hyperactivity/inattention. The results suggest a need for future investigation of the factors associated with help-seeking behavior among adolescents. It is also necessary to develop mental health promotion programs for adolescents, interventions to improve mental health literacy and access to mental health care.