Increased Sleep Efficiency Research Articles

0850 Association of Actigraphy-Assessed Sleep Parameters and Physical Functioning following Acute Hospitalization in Older Adults

Abstract Introduction Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Identifying factors, such as sleep continuity, that may be related to recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between actigraphy-assessed sleep parameters and physical functioning after an acute hospitalization in community dwelling older adults. Methods Participants (n=24; age 68.9±5.5y, 71% female, 96% white), were recruited during an acute hospitalization. Participants completed physical performance testing using the Short Physical Performance Battery (SPPB) during acute hospitalization (baseline) and at 4-weeks post-discharge (follow-up). At the time of discharge, participants were given Philips Actiwatch-2® device to record sleep continuity for four weeks following hospital discharge. Actigraphy parameters included total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL) and wake after sleep onset (WASO). We conducted multivariate regression analyses using Poisson distribution to determine whether actigraphy-derived sleep parameters predicted of physical function. Results Increase in actigraphy-derived SE was associated with greater SPPB Balance (0.05±0.02, p=0.04) at the 4-week follow-up assessment. Increased TST was associated with improvements in SPPB total score (0.004±0.002, p=0.05) change score from baseline to 4-week follow-up. SE (0.11±0.04, p=0.01) and TST (0.004±0.002, p=0.005) were positively associated, whereas WASO (0.03±0.01, p=0.05) and SOL (0.15±0.07, p=0.03) were inversely associated with improvement in SPPB Balance change score from baseline to 4-week follow-up. Conclusion Together, these results demonstrated that improvements in actigraphy-derived sleep parameters (increased sleep efficiency and total sleep time; and decreased wake after sleep onset and sleep onset latency) were associated with improvements in physical functioning from hospital to 4-week follow up. Improving sleep during hospitalization may reduce hospital deconditioning and improve functional recovery. Support (if any) This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi) Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).

0227 Impact of 5-night sleep restriction on actigraphy-estimated sleep in young adolescents: preliminary associations with ADHD traits

Abstract Introduction Prior research suggests that children with attention-deficit/hyperactivity-disorder (ADHD) may experience disrupted sleep. In typically developing children, short-term sleep restriction increases sleep pressure and efficiency; however, whether a similar homeostatic response occurs in children with ADHD is unknown. Here we explore the effects of 5 nights of experimental sleep restriction on actigraphy-estimated sleep of children with and without high ADHD characteristics. Methods Nineteen young adolescents (Mage=12.24yr, range 10.17-13.88yr; 10F/9M) participated in an at-home crossover protocol. After ≥5 nights of stabilization (10hr time-in-bed[TIB] set to habitual risetimes), participants had five nights of sleep optimization (SO; same stabilization schedule) or restriction (SR; 7.5hr TIB, sleep opportunity reduced by delaying bedtime and advancing risetime equally), a 2-3 night restabilization, and then the reverse schedule. Sleep was assessed via wrist-worn actigraphy (AMI Micro Motionlogger), sleep diaries, and twice-daily phone calls ensuring schedule adherence. Primary sleep variables included: total sleep time (TST; min), sleep period time (SPT; min), and sleep efficiency (TST/SPT*100). Children were grouped by parent-rated Conners 3 ADHD-Probability-Index: < 50% (low-ADHD; n=10, 8F) or >=50% (high-ADHD; n=9, 2F). Results Mixed-effects ANOVAs evaluating condition (SO vs. SR) and group (low- vs. high-ADHD) on schedule adherence indicated significant effects of condition; that is, SR reduced both SPT (M±SD SO=9.08[0.54]hr, SR=7.10[0.57]hr; F(1,17)=479.75, p<.001, ηp2=.97) and TST (M±SD SO=7.92[0.97]hr, SR=6.38[0.86]hr; F(1,17)=302.13, p<.001, ηp2=.95). No group or group-by-condition effects were significant (all ps>.21). For sleep efficiency, a group-x-condition interaction (F(1,17)=8.29, p=.01, ηp2=.33) revealed that SR significantly increased sleep efficiency in low-ADHD children (M±SD SO=85.08[9.95]%, SR=89.74[7.66]%, Bonferroni-p<.001) but not in high-ADHD children (M±SD SO=90.67[3.74]%, SR=91.21[3.19]%, Bonferroni-p=.61). Other between-group effects were not significant (all ps>.12). Conclusion These preliminary data indicate that our sleep restriction protocol successfully reduces sleep opportunity and sleep duration in peripubertal children, including those with high ADHD traits. Notably, sleep restriction improved sleep efficiency in low-ADHD children, whereas sleep efficiency was high and unchanging in our high-ADHD group. It is possible that high-ADHD children maintained higher sleep pressure even after stabilization. While data collection (matching groups on sex and age) continues, we are examining waking EEG markers to explore this possibility. Support (if any) R01HD103655, P20GM139743

Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta-analysis.

Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea-hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta-analysis of the AHI showed a decrease of 7.18 events/h [95% CI (-9.69, -4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (-0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by -3.21 events/hour [95% CI (-6.04, -0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%-21%) for postoperative AHI < 1 and 57% (95% CI, 51%-63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies.

0656 Evaluating the Interrelationship Between Insomnia, Sleep Apnea and Nightmares in Veterans With Posttraumatic Stress Disorder

Abstract Introduction Observational research demonstrates a strong association between nightmares, insomnia, and sleep apnea in veterans with posttraumatic stress disorder (PTSD), supportive of the notion of a “complex sleep disturbance”. Relations between sleep disturbances and PTSD are often bi-directional and disturbed sleep affects non-sleep PTSD outcomes. We aimed to examine relationships between nightmares, respiratory events, CPAP use, and insomnia in trauma-exposed veterans with frequent nightmares. Methods Three weeks of app-based daily sleep diaries and weekly insomnia severity index (ISI) reports were collected from 41 veterans with a history of trauma and frequent nightmares. Relationships between weekly nightmares (total number), CPAP use, sleep efficiency, and ISI scores were analyzed using linear regression with standard errors adjusted for clustering of weeks within participants. Of the 41 participants, a subset of 15 participants completed 6-9 nights of at-home objective sleep measurements (Sleep Profiler) to examine the relationship between apnea events and nightmare awakenings. Measurements involved EEG integrated with airflow, respiratory effort, oxygen saturation, and actigraphy with event marker for real-time reporting of nightmares preceding awakenings. Results 41 veterans (mean age 48 (SD=16), 30% female) participated. Higher prior week ISI score predicted reduced CPAP adherence (β=-.53, p=.005). In turn, increased frequency and duration of CPAP use was associated with a significant increase in sleep efficiency the same week (β=.53, p=.018 and β=.56, p=.026, respectively). Analysis of respiratory events indicates that 20 of the 64 nightmare awakenings (31%) were preceded (i.e., within seconds of awakening) by apnea or hypopnea events. Of these 20, 11 events were reported by participants with a diagnosis of OSA and a CPAP device. Amongst these 11 events, 7 (64%) occurred on nights during which the participant reported use of their CPAP. Conclusion Analyses demonstrated statistically significant and clinically meaningful relationships among insomnia, nightmares, respiratory events and CPAP adherence in our sample, highlighting their interrelationships in trauma subjects. These data support the hypothesis that OSA contributes to nightmare experiences by demonstrating an immediate temporal relationship between apnea/hypopnea events and nightmare awakenings, and they underscore the importance of detecting and adequately treating sleep apnea for the treatment of nightmares in veterans. Support (if any)

Electroencephalographic Changes in Sleep During Acute and Subacute Phases After Sports-Related Concussion.

Little is known about sleep after a concussion, a form of mild traumatic brain injury. Given the importance of sleep for both maintaining brain health and recovery from injury, we sought to examine sleep acutely and subacutely after concussion. Athletes who experienced a sports-related concussion were invited to participate. Participants underwent overnight sleep studies within 7 days of the concussion (acute phase), and again eight-weeks after the concussion (subacute phase). Changes in sleep from both the acute and subacute phases were compared to population normative values. Additionally, changes in sleep from acute to subacute phase were analysed. When compared to normative data, the acute and subacute phases of concussion showed longer total sleep time (p < 0.005) and fewer arousals (p < 0.005). The acute phase showed longer rapid eye movement sleep latency (p = 0.014). The subacute phase showed greater total sleep spent in Stage N3% (p = 0.046), increased sleep efficiency (p < 0.001), shorter sleep onset latency (p = 0.013), and reduced wake after sleep onset (p = 0.013). Compared to the acute phase, the subacute phase experienced improved sleep efficiency (p = 0.003), reduced wake after sleep onset (p = 0.02), and reduced latencies for both stage N3 sleep (p = 0.014) and rapid eye movement sleep (p = 0.006). This study indicated sleep during both the acute and subacute phases of SRC was characterised by longer and less disrupted sleep, along with improvements in sleep from the acute to subacute phases of SRC.

Effectiveness of non-pharmacological interventions for sleep disturbances in people living with dementia: A systematic review and meta-analysis

We summarize the evidence on non-pharmacological interventions for sleep disturbances in people living with dementia(PlwD). A literature search was performed using PubMed, Embase, Cochrane library, Web of Science, PsycINFO, CINAHL, and clinicaltrials.gov. Up to August 20, 2022. Six studies met our eligibility criteria. Light therapy, the therapeutic pet-type robotic seal(PRAO), and slow-stroke back massage(SSBM) are non-pharmacological interventions for sleep disturbances in PlwD.PARO increased night-time sleep duration (p < 0.05). The benefit of SSBM for sleep disturbances in PlwD is unclear (p > 0.05). Although there is a lack of evidence for the effect of light therapy on sleep disturbances in PlwD (p > 0.05), light therapy reduced sleep disturbance (SMD = -0.38; 95% CI:1.25, 0.48), increased sleep efficiency (MD = 3.77; 95% CI:-0.23, 7.78), and also reduced depression (MD = -2.49; 95% CI: -2.92, -2.06). More large-scale randomized controlled trials are needed and consider combining multiple non-pharmacological measures for sleep interventions in PlwD.

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance.

Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.

Intensified Olympic Preparation: Sleep and Training-Related Hormonal and Immune Responses in Water Polo.

To investigate whether sleeping activity, hormonal responses, and wellness are altered in elite water polo players during their preparation toward the Tokyo Olympics. Eight elite-level water polo players participated in 3 consecutive training phases: (1)before the commencement of a residential-based conditioning camp (PRE-CAMP; 3d), (2)residential-based conditioning camp (5d), and (3)a congested period of training and competition (POST-CAMP; 8d). Nocturnal sleep was monitored for 14 consecutive days in PRE-CAMP (2d), CAMP (5d), and POST-CAMP (7d). Postawakening salivary cortisol, immunoglobulin-A, and subjective wellness were measured during PRE-CAMP, CAMP, and POST-CAMP, and internal training/match load (ITL) was calculated daily. The averaged values for dependent variables were compared among training phases and analyzed using linear mixed models. At CAMP compared with PRE-CAMP, ITL was higher (P < .01), and sleep onset and offset were earlier (P < .01). At this period, sleep interruptions and salivary cortisol were higher (P < .01, d = 1.6, d = 1.9, respectively), and subjective wellness was worsened (P < .01, d = 1.3). At POST-CAMP, the reduction of workload was followed by increased sleep efficiency, reduced sleep interruptions, and moderately affected salivary cortisol, yet overall wellness remained unaltered. In POST-CAMP, 2 of the players demonstrated severe symptoms of illness. At the highest level of the sport and prior to the Olympics, large increments in workload during a training campinduced meaningful sleep interruptions and salivary cortisol increases, both of which were reversed at POST-CAMP. We suggest that the increased workload alongside the inadequate recovery affects sleep patterns and may increase the risk of infection.

Non-pharmacological interventions for sleep disturbances in people with dementia.

Non-pharmacological interventions for sleep disturbances in people with dementia.

Effect of mini-dose dexmedetomidine supplemented intravenous analgesia on sleep structure in older patients after major noncardiac surgery: A randomized trial

Study objectivesIn previous studies, low-dose dexmedetomidine supplemented opioid analgesia improved sleep architecture but increased sedation level. Herein we tested the hypothesis that mini-dose dexmedetomidine supplemented analgesia improves sleep structure without increasing sedation. MethodsIn this randomized trial, 118 older patients (≥65 years) following major noncardiac surgery were randomized to receive patient-controlled intravenous analgesia supplemented with either placebo or dexmedetomidine (median 0.02 μg kg−1 h−1) for up to 3 days. Polysomnogram was monitored from 9:00 p.m. on the day of surgery until 6:00 a.m. on the first day after surgery. Our primary outcome was the percentage of non-rapid eye movement stage 2 (N2) sleep. Secondary outcomes included other sleep structure parameters during the night of surgery and the sedation score during the first five postoperative days. ResultsAll 118 patients completed the study; of these, 85 were included in sleep structure analysis. Dexmedetomidine supplemented analgesia increased the percentage of N2 sleep (median difference, 10%; 95% CI, 1%–20%; P = 0.03). It also prolonged total sleep time (median difference, 78 min; 95% CI, 21 to 143; P = 0.01), increased sleep efficiency (median difference, 14%; 95% CI, 4%–26%; P = 0.01), decreased percentage of N1 sleep (median difference, −10%; 95% CI, −20% to −1%; P = 0.04), and lowered sleep fragmentation index (median difference, −1.6 times⋅h−1; 95% CI, −3.7 to 0.1; P = 0.04). Sedation score within 5 days did not differ between the two groups. ConclusionsSupplementing intravenous analgesia with mini-dose dexmedetomidine improved sleep structure without increasing sedation in older patients recovering from major surgery. Clinical trialswww.clinicaltrials.gov (NCT03117790), registered 2 April 2017.

Cognitive Behavioral Therapy for Chronic Insomnia in Outpatients with Major Depression-A Randomised Controlled Trial.

The aim of this randomised controlled assessor-blinded trial was to examine the effect of cognitive behavioural therapy for insomnia on sleep variables and depressive symptomatology in outpatients with comorbid insomnia and moderate to severe depression. Forty-seven participants were randomized to receive one weekly session in 6 weeks of cognitive behavioural therapy for insomnia or treatment as usual. The intervention was a hybrid between individual and group treatment. Sleep scheduling could be especially challenging in a group format as patients with depression may need more support to adhere to the treatment recommendations. The primary outcome measure was the Insomnia Severity Index. Secondary measures were sleep diary data, the Dysfunctional Beliefs and Attitudes about Sleep Questionnaire, the Hamilton Depression Rating Scale, and the World Health Organization Questionnaire for Quality of Life and polysomnography. Compared to treatment as usual, cognitive behavioural therapy significantly reduced the insomnia severity index (mean ISI 20.6 to 12.1, p = 0.001) and wake after sleep onset (mean 54.7 min to 19.0 min, p = 0.003) and increased sleep efficiency (mean SE 71.6 to 83.4, p = 0.006). Total sleep time and sleep onset latency were not significantly changed. The results were supported by analyses of the other rating scales and symptom dimensions. In conclusion, cognitive behavioural therapy for insomnia as add-on to treatment as usual was effective for treating insomnia and depressive symptoms in a small sample of outpatients with insomnia and major depression. ClinicalTrials.gov Identifier: NCT02678702.

Nutritional Modulation of Sleep Latency, Duration, and Efficiency: A Randomized, Repeated-Measures, Double-Blind Deception Study.

This study aimed to test the hypothesis that a novel nutritional blend composed of tryptophan, glycine, magnesium, tart cherry powder, and l -theanine enhances subjective and objective measures of sleep during free living conditions. In a randomized, repeated-measures crossover and double-blind deception design, participants ( n = 9 males and 7 females, age = 24 ± 3 yr, body mass = 69.8 ± 11.6 kg, stature = 170.8 ± 9.1 cm) completed a 3-d familiarization period, followed by 3-d intervention and placebo trials. Subjective Pittsburgh Quality Sleep Index, Core Consensus Sleep Diary, and Karolinska Sleepiness Scale survey tools, alongside objective actigraphy measures of sleep, were assessed, with daily nutritional intake, activity, and light exposure standardized between trials. Participants provided daily urine samples for assessment of targeted and untargeted metabolomes. The intervention trial reduced sleep onset latency (-24 ± 25 min; P = 0.002), increased total sleep time (22 ± 32 min; P = 0.01), and increased sleep efficiency (2.4% ± 3.9%; P = 0.03), while also reducing morning sleepiness ( P = 0.02). Throughout the study, 75% of participants remained blinded to sleep assessment as a primary outcome measure, with 56% subjectively indicating improved sleep during the intervention trial. Metabolomic analysis highlighted several significantly altered metabolomes related to sleep regulation between trials, inclusive of 6-sulfatoxymelatonin, d -serine, and l -glutamic acid. Data demonstrate that using the proposed blend of novel nutritional ingredients during free living conditions reduced sleep onset latency, increased total sleep duration, and increased sleep efficiency, leading to reduced perceptions of morning sleepiness. These effects may be mediated by the upregulation of key metabolites involved in the neurophysiological modulation of the sleep/wake cycle.

Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis.

The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD]=-4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD=-12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD=-16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD=7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD=-2.75 points, 95%CI: -4.28 to -1.21), SOL (MD=-13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD=-6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.

Mother-child interactions and child anger proneness as antecedents of changes in sleep during the preschool period.

Age-related developments in sleep during the preschool years are normative and consequential. Yet, very few studies have examined the antecedents of individual differences in such developments, and most have used parental reports of child sleep. This study aimed to investigate the roles of mutual responsiveness in mother-child interactions and child temperamental anger proneness in the prediction of changes in sleep during the preschool period. The sample was comprised of 94 children (44 girls, 50 boys) of mostly White (93%) and college-educated (85%) mothers. Mother-child mutual responsiveness and child anger proneness were assessed at 2 years, and sleep was assessed using actigraphy at the ages of 2, 3, and 4 years. Multilevel growth models revealed that higher temperamental anger proneness was concurrently associated with lower sleep efficiency and shorter nighttime sleep duration at 2 years. In regard to changes in sleep, nighttime sleep duration decreased between 2 and 4 years among children exposed to lower mutual responsiveness in interactions with their mothers. High anger proneness was related to an increase in sleep efficiency from 2 to 4 years, whereas low anger proneness was associated with a decrease in nighttime duration during the same period. No interactive effect was found between anger proneness and mother-child mutual responsiveness. These results suggest that mother-child relationships and child temperament may play different roles, not only in children's concurrent sleep patterns but also in changes in sleep across the preschool period. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: a randomised controlled trial

ABSTRACT Insomnia is a significant difficulty and is reported by large proportion of people with tinnitus. Although cognitive behavioural therapy for insomnia (CBTi) might be an effective treatment, no controlled studies had been conducted to date. This randomised controlled trial evaluated the benefits of CBTi on a sample of 102 people with tinnitus-related insomnia. Participants were randomised to 1) CBTi, 2) Audiology-Based Care (ABC) or 3) Sleep Support Group (SSG). Primary outcomes included insomnia, sleep efficiency and total sleep time. Secondary outcomes measured sleep onset latency, sleep quality, tinnitus distress, psychological distress, functioning and quality of life. CBTi was superior at reducing insomnia and increasing sleep efficiency compared to ABC post-intervention and at 6-month follow-up. ABC was superior at reducing insomnia and increasing sleep efficiency compared to SSG. Both CBTi and ABC reported increased total sleep time compared to SSG at 6-month follow. More than 80% of participants in the CBTi group reported clinically meaningful improvements compared to 47% in ABC and 20% for those receiving social support. CBTi was more effective in reducing tinnitus distress and improving sleep quality, functioning and some aspects of mental health. CBTi and ABC offer effective treatments for tinnitus-related sleep disorder but CBTi offers a sizeable benefit.

Sleep Disturbances, Changes in Sleep, and Cognitive Function in Low-Income African Americans.

Sleep problems may contribute to the disproportionate burden of Alzheimer's disease and related dementias (ADRD) among African Americans (AAs). To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. This study (n = 216, 78.8% female; mean age = 67.7 years) examined associations between 1) the level (i.e., measured in 2018) and 2) change over time (from 2013 to 2018; n = 168) in actigraphy-assessed sleep with domain-specific cognitive function and clinically adjudicated cognitive impairment (2018) in a community-dwelling, predominantly AA (96.9%) sample. A comprehensive cognitive battery assessed global cognitive function (3MS) and domain-specific cognitive function (attention, visuo-spatial ability, language, delayed recall, immediate recall, and executive function) in 2018. Sleep was measured in 2013 and 2018 via actigraphy. Higher sleep efficiency and less wakefulness after sleep onset (WASO; measured in 2018) were associated with greater attention, executive function, and visuospatial ability. Increases in sleep efficiency between 2013 and 2018 were associated with better executive function, language, immediate recall, and visuospatial ability, whereas increases in WASO (2013-2018) were associated with poorer attention, executive function, and visuospatial ability. Level or change in sleep duration were not associated with domain-specific cognitive function, nor were any sleep measures associated with clinically adjudicated cognitive impairment. In a predominantly AA sample of older adults, both the level and change (i.e., worsening) of sleep efficiency and WASO were associated with poorer cognitive function. Improving sleep health may support ADRD prevention and reduce health disparities.

0087 Feasibility of examining component-specific effects of yogic breathing on self-report sleep metrics: A three-arm pilot RCT

Abstract Introduction Mind-body interventions (MBIs) continue to receive widespread interest for improving sleep disturbances. This study investigated the feasibility of using an automated electronic survey system in REDCap in the context of a fully remote clinical trial study to produce detailed measures of participant adherence, daily sleep quality, and associations with physiological outcomes captured by wearable devices. Methods Eighteen healthy participants (age 18-30 yrs, 12 female) were randomized to one of three 8-week long interventions: slow-paced breathing (SPB, N=5, 24.6 ± 2.1 years, 4 female), mindfulness (M, N=6, 23.7 ± 3.7 years, 4 female), or yogic breathing (SPB+M, N=7, 24.3 ± 3.1 years). Participants completed two weeks of daily sleep logs along with the Pittsburgh Sleep Quality Index (PSQI) prior to a virtual laboratory visit, which consisted of a 60-min intervention-specific training, including a 20-min guided practice, and subsequent tasks including experimental stress induction. Participants were then instructed to repeat their assigned intervention practice daily, selecting either the same or a similar guided audio as their initial training. After an initial video check-in appointment, participants received regular visual feedback of their data and completed weekly check-ins with the study team to improve adherence. At the end of the intervention period, participants again completed daily sleep logs and the PSQI, in addition to other outcome measures and a virtual laboratory visit. Data were analyzed using linear mixed models. Results Sleep log adherence was over 90% in all three groups. The groups were successfully distinguishable based on HRV-derived breathing and mindfulness ratings. For the SBP+M group only, there was a trend of reduced sleep onset latency (SOL, p=.093) and a significant increase in sleep efficiency (SE, p=.025). There were no significant changes in PSQI or other sleep log measures. More detailed analysis of timecourse across these measures is ongoing. Conclusion These findings support feasibility for a fully remote, semi-automated clinical trial study assessing component-specific effects of these MBIs on sleep in generally healthy young adults. Research evaluating MBIs for sleep in both clinical and nonclinical populations would benefit from similar study designs to examine intervention-specific components while increasing both scalability and quality control. Support (If Any) Pilot Research Grant, Osher Center for Integrative Medicine of Harvard Medical School and Brigham &amp; Women’s Hospital; National Institutes of Health (5T32HL007901-22)

0473 The impact on treatment adherence of adding a bedpartner to CBT-I: preliminary findings from a randomised controlled trial (Project REST)

Abstract Introduction Cognitive Behavioural Therapy for Insomnia (CBT-I) includes often difficult-to-implement behavioural change, and this can result in poor adherence to treatment recommendations. In other CBTs, adding a significant other to “individual” therapy increases adherence. Here, we report preliminary findings from a randomised controlled trial (RCT) of a newly developed partner-assisted CBT-I. Methods 117 adults with DSM-5 Insomnia Disorder (age M±SD=47.9±15.3yrs; 73F) and their live-in partners participated in a single-blind parallel RCT. They were assigned 1:1:1 to 7wk individual CBT-I (Ind-CBTI), partner-assisted CBT-I (PA-CBTI), or sleep management control (CTRL) conditions. Participants completed daily sleep diary throughout the intervention. Adherence in CBT-I conditions was assessed for Sleep Restriction Therapy (deviation from bed and wake times, naps) and Stimulus Control Therapy (wake time-in-bed during daytime, overnight, and after final morning awakening). Intention-to-treat, mixed effects models examined differences in adherence for “Build” (initial phase to build sleep debt) and “Maintain” (starting the first week when sleep opportunity was titrated upwards) stages of therapy. Results All conditions showed significant increase in sleep efficiency (p&amp;lt;.001), with significantly faster increase in Ind-CBTI and PA-CBTI compared to CTRL (ps&amp;lt;.001). Sleep Restriction Therapy: Build stage (vs Maintain) had greater adherence to prescribed wake time (p=.045); Condition by Stage interaction (p=.010) showed PA-CBTI (vs Ind-CBTI) adhered better in avoiding naps during Build (vs Maintain). Stimulus Control Therapy: PA-CBTI (vs Ind-CBTI) adhered better to avoiding daytime wake time-in-bed (p=.017), especially during Build (interaction p=.071); Condition by Stage interaction (p=.017) showed PA-CBTI (vs Ind-CBTI) adhered better to avoiding overnight wake time-in-bed during Maintain (vs Build). Both conditions had better adherence to avoiding daytime and wake time-in-bed after final awakening during Maintain (vs Build) Stage (ps&amp;lt;.001). Conclusion Adherence to CBT-I includes multiple indicators showing distinct features as the intervention progresses across different stages. Aspects of adherence appear modifiable, and adding bedpartners to CBT-I improved adherence to specific aspects of the intervention (i.e., avoiding naps, daytime wake time-in-bed, overnight wake time-in-bed). The Build and Maintain stages of treatment appear to be associated with better adherence to different aspects of the intervention (Sleep Restriction Therapy and Stimulus Control Therapy, respectively). Support (If Any) NHMRC grant APP1105458 (SPAD,DHB,PJN), APP1140299 (BB)Trial registration: ACTRN12616000586415

High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults.

Aging is associated with changes in sleep, and improving sleep may have important consequences for the health, cognition, and quality of life of older adults. Many prescription sleep aids increase the risk of nighttime falls, have adverse effects on next-day cognition, and are associated with increased mortality. Melatonin, a hormone secreted at night, increases sleep duration in young adults but only when administered during the day when endogenous levels are low. In a month-long cross-over study, we randomized 24 healthy older (age >55, mean 64.2 ± 6.3 years) participants to receive 2 weeks of placebo and 2 weeks of either a low (0.3 mg) or high (5.0 mg) dose of melatonin 30 min before lights out. Sleep was polysomnographically recorded and was scheduled during both the biological day and night using a forced desynchrony design. Although0.3 mg melatonin had a trend towards increasing sleep efficiency (SE) overall, this was due to its effects on sleep during the biological day. In contrast, 5 mg melatonin significantly increased SE during both biological day and night, mainly by increasing the duration of Stage 2 non-rapid eye movement sleepand slightly shortening awakenings. Melatonin should be further explored as a sleep aid for older adults.

Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study.

BackgroundSleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies.ObjectiveThis mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL.MethodsThe quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social).ResultsOf the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants’ scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β=1.11, 95% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF.ConclusionsOptimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA.