Increased Daytime Sleepiness Research Articles

Chronic sleep restriction triggers inadequate napping habits in adolescents: a population-based study

BackgroundThe prevalence of chronic sleep restriction during adolescence is a major public health issue. Napping has been adopted to alleviate sleep pressure complaints. However, it also has the potential to amplify sleep restriction due to a vicious cycle triggered by delayed sleep times. The aim of this study was to investigate sleep and napping habits in a sample of Brazilian adolescents. MethodsThis study enrolled 1554 high school students and included the evaluation of sleep times, daytime sleepiness, sleep quality, and circadian preference. The students were asked about their napping routine, ie its frequency and duration per week. ResultsThe adolescent sleep recommendation was achieved by only 27.6% of the sample. Napping habit was reported by 58.1%, with 36.2% of nappers informing naps in 1–2 times per week. Prolonged naps were reported by 44.9% of nappers. Nappers had later median bedtime (23:30) and reduced time in bed (TIB) (median = 07:00 h) compared to non-nappers. The frequency of nappers who did not achieve satisfactory TIB was higher than non-nappers. In addition, nappers reported increased daytime sleepiness and poor sleep quality. Later bedtimes and reduced TIB were associated with longer nap duration. Increased sleepiness and poor sleep quality were linked to a higher nap frequency. ConclusionsThis exploratory survey demonstrated a severe sleep restriction faced by Brazilian adolescents. Napping can be an efficient strategy to counteract sleep restriction, but it needs to be adopted with caution due to the detrimental effects of frequent and prolonged naps on nocturnal sleep.

Longitudinal association between daytime sleepiness and cognitive decline in dementia: A study protocol

IntroductionDementia is a major cause of disability worldwide. About 25%-40% of patients with mild to moderate dementia are affected by sleep-awake cycle disturbances, including increased daytime sleepiness and insomnia. However, little is known about the specific impact of excessive daytime sleepiness on the cognitive decline of dementia patients.ObjectivesTo evaluate the impact of daytime sleepiness on the cognitive decline of dementia patients. Additionally, longitudinal associations with functional impairment and neuropsychiatric symptoms will be explored.MethodsA longitudinal study will be conducted in a psychogeriatric consultation. Patients will be consecutively invited according to predefined eligibility criteria. Those aged ≥65 years, with dementia diagnosis or Mini-Mental State Examination (MMSE) <24, and with a knowledgeable caregiver, will be included. The exclusion criteria are: a caregiver <18 years, terminally ill, incapable to communicate or with a known diagnosis of insomnia, sleep related respiratory disorders, central hyperinsomnia, restless legs syndrome or sleep paralysis. Participants will undergo an assessment with a comprehensive protocol including: Montreal Cognitive Assessment (MoCA), Barthel and Lawton Index, Epworth Sleepiness Scale (ESS), Neuropsychiatric Inventory (NPI) and Global Deterioration Scale (GDS). Participants will be re-assessed 6 months after the initial evaluation. The Health Ethics Committee of Hospital Universitário de São João granted the study authorization (nº 260/2020).ResultsFindings will be disseminated via publication in peer-reviewed journals and presentations at national and international scientific conferences.ConclusionsThis study will address key questions on the relation of daytime sleepiness and dementia outcomes, in order to undertake corrective and preventive non-pharmacological and pharmacological approaches.

Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border

ABSTRACT Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration. Methods: Data were collected from N = 100 adults (age 18–60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for “cognitive restraint,” “uncontrolled eating,” and “emotional eating.” Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status. Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0–51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint. Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria

ABSTRACT Sleep impairment is highly prevalent in night shift workers, but evidence on the association of former night shift work (NSW) and its metrics (duration and frequency) in relation to sleep complaints is lacking. We evaluated the association of former and current NSW with chronic insomnia or circadian rhythm sleep disorder in a sample of the general worker (GW) population and in hospital workers (HW) in Austria. Information on sleep, NSW history, sociodemographic, and lifestyle factors was collected through an online cross-sectional survey in a representative sample of GW (N= 1,004) and a sample of HW (N= 799) between 2017 and 2019. Multi-variable adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for various measures of sleep (including chronic insomnia, daytime sleepiness, sleep duration, napping habits) and doctor-diagnosed chronic insomnia across NSW exposure (never night shift work; ever; ever/former; ever/current) and related metrics (cumulative duration, average frequency), compared to never NSW. Effect modification by chronotype and daytime napping was investigated. Former NSW was associated with higher odds of chronic insomnia in both samples (GW: OR = 2.28, 95% CI = 1.07–4.83; HW: OR = 1.17, 95% CI = 0.60–2.27). Chronic insomnia odds tended to increase among current night shift workers (HW: OR = 1.50, 95% CI = 0.79–2.83), compared to day workers. Higher NSW frequency (shifts/month) was associated with higher chronic insomnia odds in former night shift workers in both samples (GW: ORper shift/month = 1.06, 95% CI = 1.00–1.12; HW: ORper shift/month = 1.12, 95% CI = 1.00–1.25). Former NSW was also associated with increased daytime sleepiness among GW (OR = 2.26, 95% CI 1.28–3.99). Associations were more pronounced among early chronotypes and participants who reported no daytime naps. Our results suggest that NSW is associated with chronic insomnia even in the years after cessation of involvement in working it.

An Internet of Medical Things System to Increase Continuous Positive Airway Pressure Usage in Patients with Sleep-Disordered Breathing

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder associated with increased daytime sleepiness and cardiovascular risk. Continuous positive airway pressure (CPAP), requiring a pressure-generating device connected via tubing to a mask during sleep, is an effective treatment. However, patients’ adherence to CPAP is often suboptimal. Behavioral interventions are effective in improving adherence to CPAP. We aimed to provide proof of principle for the operation of a low-cost, self-standing, internet-based system to measure and promote adherence to CPAP. The system is composed of triaxial acceleration sensors attached to the CPAP mask and to the wrist, able to record CPAP usage information, and a mobile app that collects such information and, thorough a chatbot, feeds back to the patient to improve adherence to treatment. The mask subsystem identifies time periods when the mask is put on based on relatively high values of the ratio between acceleration spectral power at frequencies < 0.35 Hz vs. 0.35–2 Hz over 1-min windows. Accuracy in identification may be increased taking account of the surges in the standard deviation of wrist accelerations over 1-min windows that accompany putting on and taking off the mask. The whole system can represent a unique tool capable of monitoring and improving patients’ adherence to CPAP treatment. Its main strength lies in its simplicity, low cost, and independence from the specific CPAP device and mask employed.

Factor structure and psychometric properties of the Persian versions of the Pediatric Daytime Sleepiness Scale and Morningness-Eveningness Scale for Children.

BACKGROUND:The Pediatric Daytime Sleepiness Scale (PDSS) and the Morningness–Eveningness Scale for Children (MESC) are widely used to measure two important facets of sleep patterns, but neither have been adapted and validated for use in Iran. The purpose of this study was to examine the psychometric properties and factor structure of the Persian versions of the PDSS and the MESC in a sample of Iranian adolescents.MATERIALS AND METHODS:The Persian versions of PDSS and MESC were translated and administered to a representative sample (n = 407) of Iranian early adolescents, aged 9–15 years, who attended school in morning shifts. The factor structure of both scales, found in prior studies, was tested using Confirmatory Factor Analyses to assess their validity and reliability.RESULTS:The results revealed that the model fit indices of the one factor solution of the PDSS and the two factor solution of the MESC were acceptable to good. A high Pearson correlation was found between raw and latent factor scores for the PDSS and the two factors derived from the MESC (i.e., Morningness and Planning). Furthermore, the higher the PDSS score (more daytime sleepiness), the lower the MESC scores (more eveningness), indicating criterion validity of the scales showing the expected increase in daytime sleepiness in evening oriented adolescents who wake up early for attending school.CONCLUSION:The Persian versions of the PDSS and the MESC can be considered reliable and valid tools for evaluating, respectively, daytime sleepiness and morningness-eveningness in the adolescent population of Iran.

Eating behavior, sleep self-assessment and personality traits of students with extreme chronotypes

To identify the differences in eating behavior, sleep self-assessment and personality traits in students with extreme chronotypes. Students (n=350), aged 17 to 23 years, with extreme chronotypes (owls/larks) were studied. Eating behavior was assessed with the Three-Factor Eating Questionnaire (TFEQ-R18). Evaluation of the condition of the cycle sleep-wakefulness (sleep quality, sleep hygiene, daytime sleepiness) and psychophysiological differences (Eysenck Personality Questionnaire, Spielberger-Khanin anxiety inventory and the Taylor Manifest Anxiety Scale (TMAS); the Stress test) was performed. Higher neuroticism, psychoticism and anxiety, low resistance to stress, reduced quality and hygiene of sleep with increased daytime sleepiness are found in people with evening preferences in comparison with the morning chronotype. Eating behavior according to TFEQ-R18 is characterized by a lack of cognitive restraint. The results may indicate preclinical health disorders, which are affected by lifestyle factors. The number of alcohol consumers and smokers is two and more than three times higher, respectively, among students with evening chronotype. The changes identified in people with evening chronotype require additional attention to student's health.

Examination of Depression And Daytime Sleepiness Level In Associate Degree Students

Amaç: Önlisans öğrencilerinde depresyon ve gündüz uykululuk düzeyini belirlemek ve bunlara etki eden faktörleri ortaya koymak amaçlanmıştır.&#x0D; Materyal ve Metot: Araştırma sağlıkla ilgili programları içeren bir meslek yüksekokulunda 130 katılımcıyla yürütüldü. Veriler sosyo-demografik veri formu, Beck Depresyon Envanteri ve Epworth Uykululuk Ölçeği kullanılarak elde edildi. Veriler IBM SPSS Statistics 23,0 paket programı ile analiz edildi. Verilerin analizinde tanımlayıcı, parametrik ve nonparametrik testler ile korelasyon analizleri kullanıldı. &#x0D; Bulgular: Araştırmaya katılan öğrencilerin yaş ortalaması 20±1,57 ve %79,2’si kadındı. Öğrencilerin %35,4’ünde depresyon bulguları mevcutken, %30’unda artmış gündüz uykululuğa rastlandı. Hem depresyon hem de artmış gündüz uykululuk oranı kadın öğrencilerde, erkek öğrencilerden anlamlı derecede yüksekti(p

An Unidentified Monster in the Bed – Assessing Nocturnal Asthma in Children

Nocturnal asthma (NA) is increasing in prevalence, affecting millions of people worldwide. In addition to being associated with increased mortality, NA is associated with a decreased quality of life. NA associated sleep disturbances and increased daytime sleepiness are especially important in children due to the accompanying behavioral and developmental difficulties. As diurnal spirometry is not a practical tool for the diagnosis and monitoring of NA, self or parental reports are used. Children underreport and underestimate their NA symptoms and parents are not fully aware of their child's NA indicators. In addition, there is the lack of physician familiarity regarding the assessment and treatment of NA. Therefore, NA is chronically underreported. The development of a non-invasive, objective, home-based diagnostic tool is crucial in diagnosing and monitoring children with NA. The presence of wheeze during sleep has been successfully employed as a tool to measure NA in children. This review discusses the increasing prevalence of NA, current diagnostic tools and the consequences of undiagnosed NA in children. In conclusion, this paper suggests that an automated wheeze detective device is an objective and practical tool to aid the diagnosis and monitoring of NA.

Perfil da Qualidade de Sono de um grupo de estudantes de Medicina

Introdução: O ingresso numa universidade gera grandes impactos na vida dos estudantes de medicina, pois a mudança na rotina e o novo nível de cobrança, devido à responsabilidade da futura profissão, podem causar impactos na saúde e na qualidade do sono. Objetivo: Avaliar a quantidade e a qualidade de sono de estudantes de Medicina da Universidade Federal de Alfenas. Metodologia: Fizeram parte da amostra estudantes do curso de medicina que responderam a três instrumentos de coleta de dados: I) Questionário Sociodemográfico; II) Escala de Sonolência de Epworth; e III) Índice de Qualidade de Sono de Pittsburgh, que foram aplicados pelos pesquisadores tanto no início, quanto ao final do segundo e do terceiro períodos do curso, totalizando quatro inquéritos. Resultados: Observou-se um decréscimo do número de horas de sono por noite e um aumento da sonolência diurna durante o período de aulas, com intensificação do agravo nos questionários referentes ao final do semestre letivo. Conclusão: Os estudantes demonstraram pior qualidade e quantidade de sono quando comparado o início e o término dos semestres letivos.

The importance of specialized sleep investigations in children with a suprasellar tumor

PurposeDisruption of sleep has great impact on quality of life. In children with a suprasellar tumor and hypothalamic-pituitary dysfunction, the circadian rhythm may be disturbed causing sleep problems. However, also other factors may influence sleep. Awareness of these different etiologies and careful history taking with appropriate additional diagnostics will aid in restoring sleep quality.MethodsWe present the workup of 4 cases with a suprasellar tumor and disturbances of sleep initiation, sleep maintenance, and daytime sleepiness. In parallel, we developed a flowchart, to aid clinicians in the diagnostics of sleep problems in children after treatment for a (supra) sellar brain tumor.ResultsAll four patients, known with hypopituitarism, presented with sleep complaints and increased daytime sleepiness. In all four, the cause of sleep problems showed to be different. In the first case, sleep evaluation revealed a severe obstructive sleep apnea, whereupon nocturnal ventilation was started. The second case revealed poor sleep hygiene in combination with an obsessive compulsive disorder. Sleep hygiene was addressed and psychiatric consultation was offered. Dexamphetamine treatment was started to reduce her obsessive compulsive complaints. The third case showed a delayed sleep phase syndrome, which improved by educational support. The fourth case revealed a secondary organic hypersomnia for which modafinil treatment was started.ConclusionSleep disturbances in children with hypopituitarism due to a (supra) sellar tumor can have different entities which require specific therapy. Awareness of these different entities is important to enable appropriate counseling. Referral to an expertise sleep center may be advised, if standard educational support is insufficient.

Motor and cognitive decline of healthy elderly and elderly with parkinson’s disease - a cross-sectional study

Background: Parkinson’s disease (PD) was initially described as a movement disorder, however there is now recognition that its clinical features also include non-motor symptoms such as cognitive impairment and dementia, which are frequent even in the early stages of the disease and, especially in the advanced stages. Cognitive deficits in PD include impairments in executive functions, attention, memory, and visuospatial skills. Cognitive impairment may manifest as mild cognitive impairment (MCI) or dementia, in which MCI refers to the stage between normal cognitive functioning and dementia. Factors associated with cognitive dysfunction in PD include advanced age, low schooling, worse motor scores, stiffness, postural instability and increased daytime sleepiness. Objective: To track cognitive decline and to correlate measurement instruments in subjects with PD by comparing them to healthy subjects. Methods: Study conducted at the Faculty of Health Sciences of Trairi / UFRN. The sample consisted of 20 old people (10 healthy elderlies and 10 elderlies with PD). It was applied the socio-demographic record, Unified Parkinson’s Disease Rating Scale (UPDRS II and III), Hoehn &amp; Yahr Scale, Mini Mental State Examination, Leganés Cognitive Test (LCT) and Montreal Cognitive Assessment (MoCA). Results: It was observed cognitive decline in both groups by MoCA (90% of the PD group and 80% of the healthy group), with no statistically significant difference (p=0.10). It was also verified association between UPDRS II and LCT (r= -0.69, p=0.03) and between UPDRS III and LCT (r=-0.66, p=0.04). Conclusion: We found a cognitive deficit in the elderly group with PD, with no significant difference when compared to the healthy elderly. There was an association between motor and cognitive function in subjects with PD. MoCA was more sensitive in the screening of cognitive deficit in subjects with PD.

Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports.

Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS. Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months. 470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60-98; 71% women). Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support). Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = -0.006, 95% CI: -0.013 to -0.0001, p = 0.045) and higher number of depressive symptoms (effect size = -0.002, 95% CI: -0.004 to -0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time. Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

Daytime sleepiness, depression and obesity in patients with type 2 diabetes mellitus of different sexes as a drug target

Introduction. Patients with type 2 diabetes are more likely to have concomitant depression. In addition, there are some studies that have alluded to a direct relationship between overweight and diabetes and daytime drowsiness.The aim of this study was to study the relationship of metabolic disorders, anthropometric data with daytime sleepiness and depression in patients with type 2 diabetes.Material and methods. A general clinical study consisted in interviewing the patient (complaints, medical history), obtaining physical data (anthropometry) – height (cm), weight (kg), neck circumference (cm), waist circumference (cm), hip circumference (cm). The object of the study was the whole blood and blood plasma of patients in order to determine the level of fasting plasma glucose, glycosylated hemoglobin and other blood biochemical parameters. To verify violations in the emotional-volitional sphere, the Beck Depression Inventory and the Epworth Sleepiness Scale were used.Results. All patients had visceral obesity, the waist circumference is significantly higher than normal, both in men and women. In accordance with the Epworth drowsiness scale, on average, borderline insomnia was recorded in the examined patients with type 2 diabetes. Drowsiness rate correlated with waist circumference (r = 0,65) and hips (0,67), age (0.34) only in male patients. The level of depression correlated with age in female patients (r = 0.37, p &lt; 0,05) and male (r = 0,6, p &lt; 0,05) and did not correlate with drowsiness in both groups. The level of depression was 16, which corresponds to mild to moderate depression. However, the rate of depression is negligible, but higher among female patients (14.00 [6.00; 18.00] versus 19.00 [10.50; 20.00], p = 0,047).Conclusions. Increased daytime sleepiness and depression accompany patients with type 2 diabetes, regardless of gender. The dependence between the severity of decreased daily activity and increased anthropometric indicators and age can be seen in male patients, which may illustrative of increasing androgen deficiency in men and its contribution to the development of metabolic disorders, including obesity. Depressive states have deeper manifestations in female patients with type 2 diabetes compared to male patients, which may indicate both emotional instability of female patients and a more pronouncedeffect of the disease itself on the psychoemotional background in women.

Drosophila as a Model to Study the Relationship Between Sleep, Plasticity, and Memory.

Humans spend nearly a third of their life sleeping, yet, despite decades of research the function of sleep still remains a mystery. Sleep has been linked with various biological systems and functions, including metabolism, immunity, the cardiovascular system, and cognitive functions. Importantly, sleep appears to be present throughout the animal kingdom suggesting that it must provide an evolutionary advantage. Among the many possible functions of sleep, the relationship between sleep, and cognition has received a lot of support. We have all experienced the negative cognitive effects associated with a night of sleep deprivation. These can include increased emotional reactivity, poor judgment, deficit in attention, impairment in learning and memory, and obviously increase in daytime sleepiness. Furthermore, many neurological diseases like Alzheimer’s disease often have a sleep disorder component. In some cases, the sleep disorder can exacerbate the progression of the neurological disease. Thus, it is clear that sleep plays an important role for many brain functions. In particular, sleep has been shown to play a positive role in the consolidation of long-term memory while sleep deprivation negatively impacts learning and memory. Importantly, sleep is a behavior that is adapted to an individual’s need and influenced by many external and internal stimuli. In addition to being an adaptive behavior, sleep can also modulate plasticity in the brain at the level of synaptic connections between neurons and neuronal plasticity influences sleep. Understanding how sleep is modulated by internal and external stimuli and how sleep can modulate memory and plasticity is a key question in neuroscience. In order to address this question, several animal models have been developed. Among them, the fruit fly Drosophila melanogaster with its unparalleled genetics has proved to be extremely valuable. In addition to sleep, Drosophila has been shown to be an excellent model to study many complex behaviors, including learning, and memory. This review describes our current knowledge of the relationship between sleep, plasticity, and memory using the fly model.

0394 Differential Role of Sleep Problems on Depression and Suicide in Community Adolescents

Abstract Introduction Sleep changes during adolescence, including “eveningness” or a preference for staying up late, decreased sleep hours, increased daytime sleepiness and irregular sleep patterns, can contribute to adolescent sleep disturbances, such as insomnia, daytime fatigue, and other sleep problems. The goals of the study were; 1) to examine the proportion of adolescents who experienced each type of sleep disturbances based on six sleep problems; and 2) to examine the association between six types of sleep disturbances and concurrent depression, suicide ideation, and suicide attempt at 12th grade. Methods Using the data from the Developmental Pathways Project (DPP), a community-based study in adolescence, total 425 students were included. Sequential logistic regression analyses were performed to examine the association between each sleep item and depression, suicide ideation, and lifetime history of suicide attempt. Results The most frequently reported sleep problems were ‘overtired without good reason (49.9%)’, ‘sleeps less than most kids (46.8%)’, and ‘sleep more than most kids (46.7%)’. After adjusting for depressive symptoms at baseline, 12th grade reports of ‘overtired without good reason’ (OR = 1.63, 95% CI = 1.22 - 2.17), ‘sleep less’ (OR = 2.03, 95% CI = 1.51 - 2.74), ‘trouble sleeping’ (OR = 1.50 95% CI = 1.10-2.06, p &amp;lt; .05), ‘nightmare’ (OR = 1.51, 95% CI = 1.12-2.02, p &amp;lt; .01) were significantly associated with depression. For suicide ideation (SI) and suicide attempt, ‘nightmare’ (OR = 1.68, 95% CI = 1.15 - 2.48; OR = 2.43 95% CI = 1.30 - 4.53, respectively) was significantly and positively associated with SI and having history of suicide attempt. Conclusion ‘Nightmare’ has the strongest association with depression, suicide ideation, and suicide attempt. To disentangle the mechanism of the association between nightmares and mental health issues, longitudinal studies examining causal or bidirectional relationships of the mechanism are warranted. Support National Institutes of Mental Health and Drug Abuse, Nesholm Family Foundation, Seattle Children’s Hospital Outcomes Research Steering Committee, Loeb Family Foundation, Seattle Children’s Research Institute, University of Washington Office of the Provost, AETNA Foundation.

0014 Reduced Cortical Thickness as a Biomarker of Daytime Sleepiness in Mild Traumatic Brain Injury

Abstract Introduction Sleep disruptions, including the increase of daytime sleepiness, are reported in roughly 70% of all individuals who have suffered a mild traumatic brain injury (mTBI). Prior research using magnetic resonance imaging (MRI) has identified associations between functional brain changes and daytime sleepiness following mTBI. In the present study, we aimed to identify whether structural differences in cortical thickness are associated with increased daytime sleepiness in adults with mTBI. Methods A total of 58 adults between 18 and 45 years of age (M=23.58±5.31) participated in the study, including 19 healthy controls and 39 individuals with a documented mTBI. Individuals with mTBI were further divided based on time-since-injury into a sub-acute (n=22) or chronic (n=17) group. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) and cortical thickness was measured using high-resolution T1-weighted structural MRI. Whole-brain vertex-wise estimations of cortical thickness were calculated using FreeSurfer (v.6.0) and entered into a GLM to identify between-group differences in cortical thickness and the association with ESS. Results Significant differences in cortical thickness were found between the two mTBI groups (cluster-forming threshold p&amp;lt;.01; cluster-wise threshold p&amp;lt;.05; two-tailed; FWE-corrected). Specifically, lower cortical thickness in the left hemisphere was found in the inferior parietal lobule (p=.01), precuneus (p=.03), and pars triangularis (p=.04) for the sub-acute, compared to chronic group. Furthermore, a significant negative correlation was found between ESS and cortical thickness in the inferior parietal lobule (r=-.55, p=.009) for the sub-acute mTBI group. Conclusion More daytime sleepiness was associated with reduced inferior parietal cortical thickness in those 2 to 12-weeks post-injury, an association not observed in those 6 to 12-months post-injury or healthy controls. The inferior parietal lobule is part of the frontoparietal attention network and has been associated with vulnerability to sleep loss. Our findings suggest structural damage to the attention network following mTBI may be one factor affecting daytime sleepiness in mTBI. These findings may reflect a potential biomarker of sleep disturbances in mTBI. Support USAMRMC grant (W81XWH-12–0386).

0938 Sleep, Perfectionism and Cognitive Anxiety in Sports: An Exploratory Study

Abstract Introduction Perfectionism has been related to cognitive anxiety in sports. The bidirectional association between sleep and anxiety has also been well studied. However, the relationship between sleep habits, anxiety and perfectionism in physically active young individuals hasn’t been documented yet. This was the objective of the present study. Methods 150 young, physically active participants (10 to 18 years old; 47% boys, 51% girls) completed an online survey comprised of questions extracted from the Sport Multidimensional Perfectionism Scale-2, the Competitive State Anxiety Inventory-2R and the Adolescent Sleep Habits Survey. First, independent t-tests were conducted to compare sleep habits, personal standards (PS), perceived parental pressure (PPP) and perceived coach pressure (PCP) of more anxious (ANX) to less anxious (NOANX) participants. Then, stepwise multiple linear regression analyses were computed to examine the significant sleep habits and perfectionism variables associations with competitive cognitive anxiety. Results Results show that ANX participants have higher PS (t(148)=3.19, p=0.002), less total sleep time on weekend (TST; t(148)=-2.94, p=0.004), longer sleep onset latency (SOL) on weeknights (t(128.09)=2.28, p=0.03) and report more daytime sleepiness (t(148)=3.06, p=0.003) compared to NOANX participants. The significant sleep variables and PS collectively explained 17.7% of competitive cognitive anxiety variance (p=0.00). PS was the largest predictor (β=0.27, p=0.00), followed by daytime sleepiness (β=0.21, p=0.007), weekend TST (β=-0.17, p=0.023) and weeknight SOL (β=0.16, p=.038). Conclusion These results suggest that, even though PS is associated with cognitive anxiety, sleep seem to be an important factor to consider. Specifically, increased daytime sleepiness accompanied by difficulties falling asleep during school nights and no recovery sleep during weekends significantly contribute to competitive cognitive anxiety. These results could have important implications when addressing competitive anxiety issues in young athletes. Support N/A

1256 Narcolepsy Type 2 in a Pediatric Patient with Auto-Immune Disease

Abstract Introduction We present a case of Narcolepsy Type 2 in the setting of concomitant auto-immune disease. Report of Case At 9 years of age, an African-American female was referred to a sleep center for fatigue, excessive daytime sleepiness (EDS), and snoring. Polysomnogram (PSG) at an outside facility recorded a total sleep time (TST) of 408 minutes, 92% sleep efficiency (SE), sleep onset latency (SOL) 22 minutes, REM latency 70 minutes, and apnea-hypopnea index (AHI) of 0.3. Multiple Sleep Latency Test (MSLT) was not done at that time. Due to her daytime sleepiness, methylphenidate was initiated empirically twice daily with improvement in daytime sleepiness and sleep maintenance. Over time, methylphenidate was steadily increased due to increasing daytime sleepiness. Between 14 to 15 years of age, she developed increased fatigue, skin changes, arthralgias, myalgias, and presented to our hospital in respiratory distress secondary to severe pulmonary hypertension. Clinical exam and workup indicated scleroderma. Methylphenidate was discontinued due to pulmonary hypertension. At 17 years of age (after receiving treatment for scleroderma and pulmonary hypertension), she had an overnight PSG followed by MSLT. PSG recorded TST 309 minutes, 67% SE, SOL 1.5 minutes, REM latency 48 minutes, AHI 0.2. The MSLT recorded a mean SOL of 2.4 minutes with 2 out of 4 sleep onset REM periods - diagnostic of narcolepsy. She does not endorse cataplexy, hallucinations or sleep paralysis. Conclusion While the link between Narcolepsy Type 1 and an auto-mediated process is more supported given consistent human leukocyte antigen findings, the link between Narcolepsy Type 2 and auto-immune mediated process is less clear. Patients with autoimmune disease may have symptoms of narcolepsy; therefore, they may benefit from screening for EDS.

0992 Prevalence Of Insufficient Sleep Duration And Consequences On Daytime Sleepiness, Mood And Academic Performance In Thai Adolescents

Abstract Introduction Insufficient sleep duration in adolescents is key public health concerns in many societies. This study aims to assess the prevalence of insufficient sleep duration and the association between short sleep with daytime sleepiness, depressive symptoms, and anxiety among Thai adolescents. Methods Thai adolescents aged 11 -18 years completed a self-administered questionnaire including Phramongkutklao Hospital Sleep disorders center Questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), The Children depress Inventory (CDI) scale and Child Anxiety Related Emotional Disorder (SCARED). Results 232 adolescents with the mean age of 14.58 (range 11-18) years participated in this survey. The average total sleep time was 7.44 hours. The overall prevalence of insufficient sleep duration (sleep duration &amp;lt;8 hours) was 37.5% and the small difference was found between males (42.0%) and females (32.7%). Compared with those who had a sleep length of 8 hours and more, insufficient sleep duration group exhibited higher in BMI and less in Grade Point Average (GPA). Subjective sleep insufficiency among Thai adolescent also had higher percentage of subjects with ESS ≥10 (43.2% vs 21.3%, P &amp;lt;0.001), depressive symptoms (56.3% vs 39.3%, P 0.012) and anxiety (54.0% vs 38.6%, P 0.022) compare to those with adequate sleep duration. Conclusion High amount of Thai adolescents with poor sleep duration were observed in the study, consistency with prior surveys. Insufficiency sleep duration group had significantly increased daytime sleepiness, mood and anxiety problems among Thai adolescents. These findings emphasized the development of interventions to improve sleep duration in Thai adolescents and more sample size should be achieved in the future. Support None