Health Initiative Insomnia Rating Scale Research Articles

Abstract MP37: Insomnia is Associated With Fatty Acid and Oxylipin Inflammatory Biomarkers in the Hispanic Community Health Study/Study of Latinos

Introduction: Insomnia symptoms are prevalent in Hispanic/Latino adults, and insomnia is a risk factor for cardiometabolic disease, possibly through dysregulated inflammatory pathways. However, existing evidence has largely focused on non-specific and downstream inflammatory biomarkers. Informed by prior research, we hypothesized that insomnia promotes chronic low-grade inflammation by disrupting the physiological balance between upstream bioactive fatty acids and oxylipins. Objective: To evaluate associations between insomnia and 81 upstream bioactive fatty acid and oxylipin inflammatory biomarkers in the population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: After excluding night and rotating shift workers, participants were 14,439 HCHS/SOL adults (mean age: 46 y, 61% female, 62% with education ≥ high school degree). Insomnia was measured using the Women’s Health Initiative Insomnia Rating Scale (WHIIRS). We used the WHIIRS score as a continuous (range 0-20, with higher scores indicating greater severity) and categorical variable (WHIIRS ≥ 9, indicating clinically significant insomnia). The 81 oxylipins and fatty acids were profiled in fasting blood samples using non-targeted liquid chromatography-mass spectrometry and annotated based on mass-to-charge ratio, retention time, and spectra. Cross-sectional associations between rank normalized oxylipins and fatty acids with insomnia were assessed using survey-weighted multivariable linear regression adjusting for confounders (age, sex, center, Hispanic background group, education, smoking, alcohol use, the alternative healthy eating index, physical activity, and body mass index). We addressed multiple comparisons using a false discovery rate <0.05. Results: The mean WHIIRS score was 7.1 (standard deviation: 5.4) and 36% displayed clinically significant insomnia. The WHIIRS showed statistically significant positive associations with 7 fatty acids (nervonic, docosadienoic, palmitoleic, eicosanoic, docosaenoic, behenic, and lignoceric acid) and 4 oxylipins (HpODE, leukotriene/HpETE/DiHETE/prostaglandin, HOTrE/oxoODE, and an oxylipin with unknown biological pathway). Clinically significant insomnia defined categorically showed statistically significant positive associations with 3 fatty acids and 3 oxylipins, all of which were also identified in the continuous WHIIRS analysis (see above). Identified fatty acids and oxylipins included both putative pro-inflammatory (e.g., HpODE) and anti-inflammatory (e.g., nervonic acid) compounds. Conclusions: Insomnia, like cardiometabolic disease, is associated with low-grade inflammation. The directionality of these relationships and degree to which associations between chronic inflammation with cardiometabolic disease and insomnia reflects overlapping pathways warrants further investigation.

Sleep-wake behavioral characteristics associated with depression symptoms: findings from the Multi-Ethnic Study of Atherosclerosis.

To help prioritize target/groups for experimental intervention studies, we characterized cross-sectional associations between 24-hour sleep-wake measures and depression symptoms, and evaluated if similar sleep-wake-depression relationships existed in people with and without higher insomnia severity. Participants had ≥3 days of actigraphy data (n = 1884; mean age = 68.6/SD = 9.1; 54.1% female). We extracted 18 sleep, activity, timing, rhythmicity, and fragmentation measures from actigraphy. We used individual and multivariable regressions with the outcome of clinically significant depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16). We conducted sensitivity analyses in people with higher insomnia severity (top quartile of the Women's Health Initiative Insomnia Rating Scale total score). From separate models in the overall sample, the odds of having depression symptoms were higher with: later timing (e.g. activity onset time odds ratio [OR]/1 SD = 1.32; 95% confidence interval [CI]: 1.16 to 1.50), lower rhythmicity (e.g. pseudo-F OR/1 SD = 0.75; 95% CI: 0.66 to 0.85), less activity (e.g. amplitude OR/1 SD = 0.83; 95% CI: 0.72 to 0.95), and worse insomnia (OR/1 SD = 1.48, 95% CI: 1.31 to 1.68). In multivariable models conducted among people with lower insomnia severity, later timing, lower rhythmicity, and higher insomnia severity were independent correlates of depression. In people with higher insomnia symptom severity, measures of later timing were most strongly associated with depression symptoms. These correlative observations suggest that experimental studies are warranted to test if: broadly promoting 24-hour sleep-wake functioning reduces depression even in people without severe insomnia, and if advancing timing leads to depression symptom reductions in people with insomnia.

Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer

PurposeWe examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients.MethodsWomen with stage I–III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women’s Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms).ResultsAt baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time.ConclusionsInsomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.

The effect of nonrestorative sleep on incident hypertension 1–2 years later among middle-aged Hispanics/Latinos

BackgroundInsomnia is known to be a major risk factor for incident hypertension. Nonrestorative sleep (NRS), which refers to insufficiently rested sleep, has reported to associate with various diseases. This study aimed to investigate the longitudinal association between insomnia-related symptoms including NRS and incident hypertension 1–2 years later by age group (young, 18–39 years and middle-age, 40–64 years) using existing cohort data involving Hispanics/Latinos.MethodsThis study included 1100 subjects who had participated in both the Hispanic Community Health Study/Study of Latinos and its follow-up study, the Sueño Ancillary Study, and met additional eligibility criteria. Incident hypertension was assessed by self-reported history and/or the use of antihypertensives. The Women’s Health Initiative Insomnia Rating Scale (WHIIRS) was used to evaluate insomnia-related symptoms (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, difficulty returning to sleep, and NRS). Logistic regression analyses were conducted to assess the degree to which insomnia-related symptoms at baseline predicted incident hypertension.ResultsAmong the participants (64% middle-aged, 36% young adults), 140 (12.7%) developed hypertension during the follow-up period. Among the sleep-related symptoms, only NRS predicted incident hypertension after adjusting for sociodemographic factors and physical condition (odds ratio: 1.88, 95% confidence interval: 1.10–3.21, p = 0.022) in middle-aged adults. None of the insomnia-related symptoms were associated with incident hypertension in the young adults. No association was found between WHIIRS-defined insomnia (total score ≥ 9) and incident hypertension in middle-aged adults or young adults.ConclusionThe present findings suggest the importance of focusing on NRS to help prevent the development of hypertension in middle-aged adults.

0030 Insomnia is associated with lower serum antioxidants in the Hispanic Community Health Study/Study of Latinos

Abstract Introduction Insomnia is associated with neurodegenerative diseases. Concentration levels of some metabolites are associated with pathophysiologic changes, possibly in a sex-specific manner. Thus, serum metabolite levels are useful for understanding insomnia-related pathophysiological changes and how they potentially relate to neurodegenerative disease. Methods The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a longitudinal cohort study following self-reported Hispanic/Latino individuals in the U.S. At baseline, insomnia symptoms were captured using the Women Health Initiative Insomnia Rating Scale (WHIIRS), insomnia being defined as WHIIRS≥9. Metabolites were measured using blood serum from the baseline exam in independent discovery and replication datasets. In discovery, metabolite associations with WHIIRS and with insomnia were estimated in linear regression. Significant associations (FDR p-values&amp;lt; 0.05) were tested in the replication dataset and considered replicated if their p-value&amp;lt; 0.05 and the direction of association matched with the discovery analysis. Associations were further studied for gender interaction. All analyses were adjusted for age, self-reported gender, study center, and Hispanic/Latino background. Results 3,895 individuals participated in the discovery analysis, and 2,121 in replication analysis. Female individuals were aged 46.5 on average (SD 15.1) and 35% had insomnia, while male individuals were aged 44.8 (14.8) and 24% had insomnia. After quality control, 767 metabolites were tested for association. Six metabolites were associated with WHIIRS (FDR&amp;lt; 0.05) in the gender-combined analysis. Three were xenobiotics which were on the benzoate or salicylic acid metabolism pathway. Of the 6 metabolite associations, two replicated (p-value&amp;lt; 0.05): hydrocinnamate and indolepropionate. These two metabolites had spearman correlation of 0.44. Higher levels of both metabolites were associated with lower WHIIRS, showing stronger associations in females (interaction p-value =0.04 for hydrocinnamate and p-value=0.13 for indolepropionate). Associations remained essentially unchanged in a model further adjusting for hypertension and diabetes. When removing 534 individuals who self-reported using sleeping pills at least once a week, the associations attenuated slightly: from an effect estimates of -0.0075 to -0.0069 (hydrocinnamate) and from -0.0082 to -0.0068 (indolepropionate). Conclusion Among the HCHS/SOL target population, insomnia symptom severity is associated with a lower concentrations of some plasma metabolite levels which are important antioxidant needed in preventing oxidative stress and neurodegeneration. Support (if any) R01HL161012.

A Longitudinal Study of Sleep Habits and Leukemia Incidence Among Postmenopausal Women.

We sought to assess the relationship between sleep duration, sleep disturbance, and leukemia incidence among postmenopausal women. This study included 130,343 postmenopausal women aged 50-79 years who were enrolled in the Women's Health Initiative (WHI) during 1993-1998. Information on self-reported typical sleep duration and sleep disturbance was obtained by questionnaire at baseline, and sleep disturbance level was defined according to the Women's Health Initiative Insomnia Rating Scale (WHIIRS). WHIIRS scores of 0-4, 5-8, and 9-20 comprised 37.0%, 32.6%, and 30.4% of all women, respectively. After an average of 16.4 years (2,135,109 cumulative person-years) of follow-up, 930 of the participants were identified as having incident leukemia. Compared with women with the lowest level of sleep disturbance (WHIIRS score 0-4), women with higher sleep disturbance levels (WHIIRS scores of 5-8 and 9-20) had 22% (95% confidence interval (CI): 1.04, 1.43) and 18% (95% CI: 1.00, 1.40) excess risks of leukemia, respectively, after multivariable adjustment. A significant dose-response trend was found for the association between sleep disturbance and leukemia risk (P for trend = 0.048). In addition, women with the highest level of sleep disturbance had a higher risk of myeloid leukemia (for WHIIRS score 9-20 vs. WHIIRS score 0-4, hazard ratio = 1.39, CI: 1.05, 1.83). Higher sleep disturbance level was associated with increased risk of leukemia, especially for myeloid leukemia among postmenopausal women.

The Burden of Survivorship: Survivor Guilt and Its Association with Psychiatric Sequelae in COVID-19 Patients.

COVID-19 survivors struggle with intense depressive and post-traumatic symptoms in sub-acute stages. Survivor guilt may affect post-acute psychopathology. Herein, we aim to unveil the potential affective mechanism underpinning post-COVID psychiatric implications by focusing on the association of survivor guilt with psychopathology and maladaptive attributional style. At one month after discharge, we evaluated symptoms of depression on The Zung Severity Rating Scale (ZSDS), post-traumatic distress on Impact of Event Scale-Revised (IES-R), and sleep disturbances on the Women's Health Initiative Insomnia Rating Scale (WHIIRS) in 195 COVID-19 survivors. Interpersonal Guilt Rating Scale (IGRS-15) rated survivor guilt. A discrepancy score between the burden of depression and post-traumatic distress symptoms was computed individually. Dysfunctional depressive attributions were assessed through the Cognition Questionnaire (CQ). Survivor guilt significantly predicts all evaluated psychopathological dimensions. Moreover, higher rates of survivor guilt were associated with an overlap between post-traumatic and depressive symptomatology, thus suggesting that survivor guilt equally sustains both psychiatric manifestations. Finally, survivor guilt fully mediated the relationship between dysfunctional depressive attributions and the discrepancy index. Our results confirm survivor guilt as a clinically relevant form of suffering related to psychopathological dimensions of post COVID-19 infection, gaining the status of a specific phenomenon and a promising treatment target.

Associations of Health-Related Quality of Life and Sleep Disturbance With Cardiovascular Disease Risk in Postmenopausal Breast Cancer Survivors.

Breast cancer (BC) survivors are at an increased risk of long-term cardiovascular disease (CVD), often attributed to cancer treatment. However, cancer treatment may also negatively impact health-related quality of life (HRQoL), a risk factor of CVD in the general population. We examined whether sleep disturbance, and physical or mental HRQoL were associated with CVD risk in BC survivors. We conducted a longitudinal analysis in the Women's Health Initiative of postmenopausal women given a diagnosis of invasive BC during follow-up through 2010 with no history of CVD before BC. The primary outcome was incident CVD, defined as physician-adjudicated coronary heart disease or stroke, after BC. Physical and mental HRQoL, measured by the Short-Form 36 Physical and Mental Component Summary scores, and sleep disturbance, measured by the Women's Health Initiative Insomnia Rating Scale, were recorded post BC. Time-dependent Cox proportional hazards models were used starting at BC diagnosis until 2010 or censoring and adjusted for relevant confounders. In 2884 BC survivors, 157 developed CVD during a median follow-up of 9.5 years. After adjustment, higher Physical Component Summary scores were significantly associated with a lower risk of CVD (hazard ratio, 0.90 [95% confidence interval, 0.81-0.99]; per 5-point increment in Physical Component Summary). No associations with CVD were found for Mental Component Summary or Insomnia Rating Scale. In BC survivors, poor physical HRQoL is a significant predictor of CVD. Our findings highlight the importance for nurses to assess and promote physical HRQoL as part of a holistic approach to mitigating the risk of CVD in BC survivors.

Correlates of daytime sleepiness and insomnia among adults in Samoa

To describe daytime sleepiness and insomnia among adults in Samoa and identify modifiable factors associated with these measures. Cross-sectional analysis of data from the Soifua Manuia ("Good Health") study (n = 519, 55.1% female); Upolu island, Samoa. Daytime sleepiness and insomnia were assessed with the Epworth Sleepiness Scale (ESS) and the Women's Health Initiative Insomnia Rating Scale (WHIIRS), respectively. Detailed physical, sociodemographic, and behavioral factors were collected. Sleep measures were characterized using multiple linear regression with backwards elimination and a bootstrap stability investigation. Excessive daytime sleepiness (ESS>10) and insomnia (WHIIRS>10) were reported by 20% and 6.3% of the sample, respectively. ESS scores were higher in individuals reporting more physical activity (Estimate=1.88; 95% CI=1.12 to 2.75), higher material wealth (0.18; 0.09 to 0.28), and asthma (2.85; 1.25 to 4.51). ESS scores were lower in individuals residing in periurban versus urban regions (-1.43; -2.39 to -0.41), reporting no work versus day shift work (-2.26; -3.07 to -1.41), and reporting greater perceived stress (-0.14; -0.23 to -0.06). WHIIRS scores were lower in individuals reporting "other" shift work (split/irregular/on-call/rotating) versus day shift work (-1.96; -2.89 to -1.14) and those who perceived their village's wealth to be poor/average versus wealthy (-0.94; -1.50 to -0.34). Participants had a generally higher prevalence of excessive daytime sleepiness, but lower prevalence of insomnia, compared with individuals from high-income countries. Factors associated with sleep health differed compared with prior studies, emphasizing potential cultural/environmental differences and the need for targeted interventions to improve sleep health in this setting.

Effects of health education and progressive muscle relaxation on vasomotor symptoms and insomnia in perimenopausal women: A randomized controlled trial

ObjectivesThis study aims to determine the effects of health education (HE) and progressive muscle relaxation (PMR), individually or combined, on vasomotor symptoms and insomnia in perimenopausal women. MethodsThis study is a single-center, pretest-posttest, randomized controlled trial with a factorial design. The research sample consists of 108 women who were randomly divided into three groups: HE + PMR group (n = 36), PMR group (n = 36) and control group (n = 36). 90 women completed the study. The data were collected in three steps by using instruments of Personal Information Form, Visual Analog Scale and a diary for vasomotor symptoms, Women’s Health Initiative Insomnia Rating Scale. ResultsHot flash and night sweats frequency and severity scores/24 h, the VAS scores for hot flashes and night sweats, and the WHIIRS scores significantly improved more in the intervention groups compared to the control group (p < 0,05). Compared to the group PMR, the group PMR + HE had a greater improvement with larger effect size in all measurements. ConclusionsPMR and HE counseling by nurses benefit perimenopausal women who suffer from insomnia and vasomotor symptoms. Practice implicationsPMR combined with HE or PMR alone is effective in managing vasomotor symptoms and insomnia; therefore, they can easily be integrated into clinical practice.

Abstract 3226: Sleep disruption among prostate cancer survivors by metastatic disease status

Abstract Introduction: Advances in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors, many of whom experience persistent cancer-related side effects. Multiple studies have found that cancer survivors report poorer sleep than the general population. More than 3 million men in the US are prostate cancer survivors, yet few existing studies have focused on sleep in this population, especially among men with metastatic disease. Thus, a better understanding of sleep problems among prostate cancer survivors could help characterize how sleep affects the quality of life among men with prostate cancer. Aim: To describe sleep behaviors and problems among prostate cancer survivors overall and specifically among those with metastatic disease. Methods: Self-reported sleep data, including sleep disruption, sleep apnea, and insomnia, were obtained from the 2018 Prostate Cancer Follow-up Survey (PCFS) administered to participants of the Health Professionals Follow-Up Study with a diagnosis of prostate cancer. We evaluated each item individually and calculated a score for clinical insomnia using the validated Women’s Health Initiative Insomnia Rating Scale (range 1-20; score &amp;gt;10 indicative of clinically relevant insomnia). Descriptive analyses on sleep measures were conducted overall and stratified by metastatic disease. We utilized multivariable linear regression models to compare metastatic disease status and insomnia score, adjusting for age, race, body mass index, physical activity, smoking, and other health information. Results: Of 2,431 men (median age: 83 years) who completed the 2018 survey, 87 had metastatic disease, de novo or men who progressed after diagnosis. Sleep disturbances were relatively common in this population. Among all men with prostate cancer, 33% (n=290) reported waking up several times a night five or more times a week, 14% (n=337) rated their sleep quality as restless, and 15% (n=368) reported a clinical diagnosis with sleep apnea. The Insomnia Rating Scale scores were relatively high among all prostate cancer survivors with a mean score of 9.0 (95% CI 6.0-12.0). Scores significantly differed by metastatic disease status and men with metastatic disease had scores that were 1.30 (95% CI 0.19-2.41) points higher than men without metastatic disease. Conclusion: The growing global number of prostate cancer survivors with metastatic disease and the potentially high prevalence of negative cancer-related quality of life effects pose pressing challenges to health systems. Our findings suggest that sleep disturbances are common among prostate cancer survivors. Men with metastatic disease had poorer sleep overall and higher rates of clinical insomnia than men without metastatic disease. These results could highlight the importance of sleep among men with prostate cancer and could increase the clinical treatment of sleep problems. Citation Format: Alaina H. Shreves, Lorelei Mucci, Unnur Valdimarsdottir, Sarah Markt, Kathryn Penney. Sleep disruption among prostate cancer survivors by metastatic disease status [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3226.

Cardiovascular correlates of sleep apnea phenotypes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BackgroundIdentifying Obstructive Sleep Apnea (OSA) phenotypes among middle-aged and older Hispanics/Latinos can facilitate personalized care, better inform treatment decisions, and could lead to improved clinical outcomes.MethodsWe focused on middle-aged and older adults (ages ≥45–74 years at baseline) with an apnea-hypopnea index (AHI) ≥5 from the HCHS/SOL (2008–2011) (unweighted n = 3,545). We used latent class analyses (LCA) to identify empirical and clinically meaningful OSA phenotypes. Sleep variables included AHI, percent sleep time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS) score, self-reported average sleep duration, restless legs symptoms, napping frequency, and self-reported sleep quality. We used survey logistic and Poisson regression to test the associations between our OSA phenotypes and prevalent and incident cardiovascular measures (cardiovascular disease, heart failure, Stroke/TIA, hypertension, diabetes, and the Framingham Cardiovascular Risk Score).ResultsAverage AHI, ESS, WHIIRS, and sleep duration were 18.1±19.5, 6.3±6.1, 7.4±6.6, and 7.8±1.7 hours, respectively, and 2.9% had zero percent time SpO2 <90%. We identified a three-class solution that clustered individuals into (1) insomnia OSA (44.3%), (2) asymptomatic mild OSA, (36.2%) and (3) symptomatic OSA (19.5%). Elevated WHIIRS and AHI scores primarily drove classification into groups one and three, respectively. In covariate adjusted models, OSA phenotypes were differentially associated with prevalence (baseline and seven years later) and incidence of cardiovascular measures.ConclusionsOSA subtypes in diverse U.S. Hispanic/Latino adults have different cardiovascular complications. More targeted research, that takes these variations into account, could help ameliorate Hispanic/Latino sleep and cardiovascular health disparities.

Associations of nonrestorative sleep and insomnia symptoms with incident depressive symptoms over 1–2 years: Longitudinal results from the Hispanic Community Health Study/Study of Latinos and Sueño Ancillary Study

Nonrestorative sleep (NRS), defined as insufficiently rested or refreshed sleep, is considered to play an important role in the development of depression. The aim of this study is to investigate the predictive ability of insomnia-related symptoms, including NRS, for incident depressive symptoms (DEPs) in a longitudinal manner. We used data of 1196 samples aged 18-64 years who participated in both the Hispanic Community Health Study/Study of Latinosconducted in 2008-2010 and the follow-up study (Sueño Ancillary Study) conducted in 2010-2013. DEPs and insomnia-related symptoms (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], early morning awakening [EMA], difficulty returning to sleep [DRS], and NRS) were evaluated by the 10-item Center for Epidemiologic Studies Depression Scale and the Women's Health Initiative Insomnia Rating Scale, respectively. A logistic regression analysis was used to evaluate the predictive ability of each insomnia-related symptom at baseline for incident DEPs in couple-years. In the univariate logistic regression analysis, all insomnia-related symptoms had significant associations with incident DEPs (DIS, odds ratio [OR] = 1.6; DMS, OR = 1.6; EMA, OR = 1.5; DRS, OR = 1.9; NRS, OR = 2.5). After adjusting for sociodemographic factors and the confounding effects of other insomnia-related symptoms, only NRS (OR = 2.2, 95% confidence interval = 1.4-3.5, p = .001) was significantly associated with incident DEPs. NRS was a risk factor for incident DEPs, which includes a predictive ability for other insomnia-related symptoms. Our results suggest that focusing on NRS is an effective strategy for preventing depression in public health promotions.

The association of hypnotics with incident cardiovascular disease and mortality in older women with sleep disturbances

Background/ObjectiveInsomnia is common in older women and is associated with higher cardiovascular disease (CVD) risk. Nonbenzodiazepine GABA agonists (Z-drugs) are the most commonly prescribed sleep aids. The study objective was to determine whether the use of Z-drugs is associated with the risk of developing CVD and mortality in older women with sleep disturbances. Patients/MethodsThe study cohort included post-menopausal women who, at baseline, scored ≥9 with the Women's Health Initiative Insomnia Rating Scale (N = 40,728). Members of the cohort were categorized as users of Z-drugs, users of other prescription hypnotics, or non-users. Outcomes were composite CVD (congestive heart failure, stroke, and fatal/non-fatal myocardial infarction) and mortality. Hazard ratios were estimated from Cox proportional hazards regression models adjusted for demographics, medical history, and sleep measures. To address potential confounding by indication, we also adjusted for propensity to be prescribed hypnotics. ResultsThe mean age of our cohort was 63.57 years (SD = 7.23) and mean follow-up time after the initial follow-up visit was 14.0 years (SD = 6.3). Z-drug use was significantly associated with an increased risk of composite CVD (HR = 1.35, 95%CI: 1.02–1.79) and all-cause mortality (HR = 1.38, 95%CI: 1.13–1.69). When groups were divided by heavy and casual use, only heavy users (≥3 times per week) had an increased risk of mortality. ConclusionsZ-drugs use was associated with an increased risk for death and CVD in post-menopausal women being treated for sleep disturbances. Additional research is needed to evaluate both frequency and duration of Z-drug use.

Personality and insomnia symptoms in older adults: the Baltimore Longitudinal Study of Aging.

To examine associations of personality dimensions and facets with insomnia symptoms in a community sample of older adults. We studied 1049 participants aged 60-97 years in the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R), and insomnia symptom severity was measured by the Women's Health Initiative Insomnia Rating Scale (WHIIRS). Adjusting for demographic characteristics, higher neuroticism, lower conscientiousness, and lower extraversion were associated with greater insomnia symptom severity. These associations remained significant for neuroticism and conscientiousness when further adjusting for depressive symptoms and comorbidities. Higher scores on neuroticism facets Anxiety, Angry Hostility, and Depression, and lower scores on conscientiousness facets Competence, Order, and Achievement Striving and on agreeableness facet Altruism were associated with greater insomnia symptom severity in fully adjusted models. Results were similar among cognitively normal older adults (N = 966), except higher scores on extraversion facets Warmth and Assertiveness associated with lower insomnia symptom severity, and agreeableness facet Altruism was unassociated. Among older adults, insomnia symptoms appear partially related to personality, with persons higher in neuroticism experiencing greater insomnia symptom severity, and those higher in conscientiousness experiencing lower insomnia symptom severity. Exploring facets of the Big-Five dimensions may provide additional insight regarding the etiology and resolution of sleep disturbance, and some of these associations may differ based on cognitive status. Future studies should investigate the hypothesis that sleep impairment mediates part of the association between specific personality traits and health-related outcomes.

Personality and Insomnia Symptoms in Older Adults: The Baltimore Longitudinal Study of Aging

Personality and disturbed sleep are tied to medical morbidity in older adults. We examined associations of personality dimensions and facets from the five-factor model with reports of insomnia symptoms in 1,069 well-functioning older adults 60-97 (SD=8.64) years (51% women) from the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory, and insomnia symptoms measured by the Women’s Health Initiative Insomnia Rating Scale. Adjusting for demographics and depressive symptoms, higher neuroticism (B=0.05, SE=-0.01, p<.001) and lower conscientiousness (B=-0.03, SE=-0.01, p<.05) were associated with greater insomnia severity. Although openness, extraversion and agreeableness were not associated with insomnia, a facet of each was. Higher scores on the “positive emotions” facet of extraversion (B =-0.03, SE=-0.01, p<.05) “ideas” facet of openness (B=-0.03, SE=-0.01, p<.05) and altruism facet of agreeableness (B=-0.03, SE=-0.01, p<.05) were associated with lower insomnia severity. Sleep disturbances may partially mediate personality’s influence on health. Part of a symposium sponsored by the Sleep, Circadian Rhythms and Aging Interest Group.

Disrupted Sleep Architecture Is Associated With Incident Bone Loss in Indian Postmenopausal Women: A Prospective Study.

Inadequate sleep has been shown to be detrimental to several body systems, including the bone. We proposed to study the impact of insomnia on bone health in Indian postmenopausal women. In a 2-year prospective study, ambulant community-dwelling postmenopausal women aged >50 years were recruited through simple random sampling. Sleep duration was recorded based on self-reported sleep duration and sleep quality using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). Anthropometry, bone biochemistry including bone turnover markers (C-terminal telopeptide of type 1 collagen [CTX], N-terminal telopeptide of type 1 pro-collagen [P1NP]), bone mineral density (BMD), and trabecular bone score (TBS) were assessed at baseline and at the end of 2 years. Among 190 postmenopausal women with mean (SD) age of 58.2 (6.9) years, 65/190 (34.2%) had insomnia (WHIIRS ≥ 9) and 20/190 (10.5%) developed osteoporosis at any site on follow-up. The percentage decline over 2 years in BMD in women with insomnia was significantly (p < 0.001) higher at femoral neck (2.9 [1.6] versus 1.2 [1.2]%) and lumbar spine (4.5 [2.0] versus 1.6 [1.1]%). The decrement in TBS was also significantly higher (p < 0.001) in women with suboptimal sleep (1.5 [2.1] versus 0.5 [1.0] %) when compared with those with adequate sleep. The increment in CTX (46.4 [32.2] versus 18.9 [26.4]) and decrement in P1NP (35.4 [9.1] versus 16.7 [18.9]), respectively, were also greater (p < 0.001) in women with insomnia compared with those without. On multivariate analysis, insomnia was the sole factor that was predictive (adjusted odds ratio [OR]= 9.3; 95% confidence interval [CI] 2.9-29.6; p < 0.001) of incident osteoporosis. In conclusion, poor sleep quality was associated with incident osteoporosis in Indian postmenopausal women. Optimal sleep may help to retard ongoing bone loss that results from sleep deprivation and requires further research. © 2022 American Society for Bone and Mineral Research (ASBMR).

0135 Self-Reported Sleep and Gut Microbiome Composition and Diversity: Associations in Well-Functioning Older Adults

Abstract Introduction The gut microbiome is believed to play an important role in health and disease, yet little is known about the link between sleep and the gut microbiome in humans. We investigated the association of self-reported sleep with gut microbiome composition and diversity in a cohort of well-functioning older adults. Methods We studied 791 participants (mean age = 71.5±12.0 years, 55% women) in the Baltimore Longitudinal Study of Aging with self-report sleep measures and whole-genome DNA sequencing of stool samples. Predictors (modeled as continuous variables) included insomnia symptoms from the Women’s Health Initiative Insomnia Rating Scale (WHIIRS), sleep duration (&amp;lt;5, 5–6, 6–7, &amp;gt;7 hours), and frequency of excessive daytime sleepiness (EDS). We tested their association with gut microbiome diversity (Shannon index) and relative abundance of individual taxa using Kendall Tau Correlation. Next, we assessed whether these sleep variables were associated with overall microbiome structure (Bray-Curtis), adjusting for age, sex, race, education, BMI, depressive symptoms, and number of comorbidities. Results Sleep duration was associated with overall microbiome composition (p&amp;lt;0.01), with longer sleep duration associated with lower biodiversity of microbes in the gut (p&amp;lt;0.05). In phylum-level analyses, higher WHIIRS total (i.e., more severe insomnia) was associated with lower relative abundance of Actinobacteria, while more frequent EDS was associated with lower relative abundance of Fusobacteria. More frequent trouble falling asleep, staying asleep, early waking, poorer sleep quality and higher WHIIRS total were associated with lower abundance of Synergistetes (all p&amp;lt;0.05). Conclusion In well-functioning older adults, self-reported sleep duration, symptoms of insomnia, and EDS were associated with microbiome diversity and composition. The phylum Synergistetes, which has been associated with protective humoral immune response in prior literature, may be an important correlate of insomnia symptoms in older adults. Future investigations are needed to examine the gut microbiome as a driver or mediator of sleep-health associations. Support This study was supported in part by National Institute on Aging (NIA) grant R01AG050507, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.

0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract Introduction Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias). Methods Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2&amp;lt;90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality. Results Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 &amp;lt;90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2&amp;lt;90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds. Conclusion We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities. Support 5R01AG048642-05; R21AG056952; R21HL140437.

Abstract MP27: The Association Between Psychosocial Factors and Sleep Among African-American Men and Women, the Jackson Heart Sleep Study

Background: Emerging evidence suggests that sleep traits and disorders are strong predictors of cardiovascular disease (CVD), particularly among African-Americans. Identifying determinants of insufficient sleep among African-Americans may help to target interventions and potentially reduce CVD burden. Psychosocial factors may be particularly relevant to sleep health among African-Americans; however, more research is needed using objective and well-validated sleep assessments. We investigated associations of individual and aggregate psychosocial factors (e.g. stress, depression, anxiety) with objectively-measured sleep traits and insomnia; and examined differences by sex among African-Americans. Methods: Between 2012 and 2016, Jackson Heart Sleep Study (JHSS) participants (N=913) underwent 7-day wrist actigraphy, had a clinic visit and completed questionnaires. Actigraphy-based measures included short sleep duration (&lt;6 hours), low sleep efficiency (&lt; 85%), and wake after sleep onset (WASO). Insomnia was assessed by the Women’s Health Initiative Insomnia Rating Scale (WHIIRS ≥10). A composite psychosocial factors variable was created based on the number of high-level factors that the participant reported: top quintile of stress (Perceived Stress Scale ≥ 18), high depressive symptoms (Center for Epidemiologic Studies Depression Scale-20, excluding restless sleep, ≥ 16), and top quintile of anxiety (State-Trait Anxiety Inventory score ≥ 38). Linear and logistic regression models were fit to test associations between psychosocial factors and sleep outcomes, adjusted for demographics, socioeconomic status, body mass index (BMI), and physical activity. Psychosocial factors and sex interactions were tested in adjusted models. Results: JHSS participants had a mean age of 63.4 years (standard deviation: 10.7), 33.6% were male, 53.6% had a college degree and the mean BMI was 31.9 kg/m 2 (6.9). Short sleep and low sleep efficiency were common, 26.1% and 30.0%, respectively. The average WASO was 54.5 (23.5) minutes. Psychosocial factors (composite and individually) were associated with insomnia. Adverse psychosocial factors were associated with a higher odds of insomnia, adjusted odds ratio (aOR)=1.65 (95% confidence interval: 1.39, 1.95). High anxiety, but not stress or depressive symptoms were associated with a short sleep duration, aOR=2.00 (1.34, 2.98). There was no evidence of associations between psychosocial factors and sleep efficiency or WASO in the overall sample. However, in males only, high anxiety and stress were associated with lower sleep efficiency, P ≤0.05 for all. Conclusion: Stress and negative emotional state, anxiety and depressive symptoms were associated with insomnia. Short sleep duration was specifically associated with anxiety. Psychosocial factors may be a point of intervention for improving sleep health, particularly among men.