Mean Total Sleep Time Research Articles

A sleep promotion program for insufficient sleep among adolescents: a pilot feasibility randomized controlled trial.

To examine the feasibility, acceptability, and impact of a Sleep Promotion Program (SPP). This pilot trial randomized adolescents (13-15y) with insufficient sleep duration and irregular sleep timing to SPP-continuation (n=24; SPP in month 1, continuation treatment in month 2) or monitoring-SPP (n=20; monitoring in month 1, SPP in month 2). SPP included one clinician session and at-home delivery of web-based reports of each youth's sleep diary data with accompanying intervention questions that prompt youth to engage in sleep behavior change. Attrition rate primarily measured feasibility. Program satisfaction measured acceptability. Total sleep time (TST), sleep timing, and sleep timing regularity were measured via sleep diary at baseline, follow-up 1, and follow-up 2 (each ∼1 month apart). Linear mixed effects models compared treatment arms on changes in sleep from baseline to follow-up 1 (month 1). We also compared changes in sleep during month 1 to changes in sleep during month 2 among SPP-continuation participants. Attrition rate was 8.5%. 96.5% participants rated the quality of care received as good or excellent. In month 1, SPP-continuation youth showed a significantly greater increase in mean TST than monitoring-SPP youth (0.57 vs. -0.38 hours; contrast=0.95; CI=0.14, 1.76, p=0.024). SPP-continuation participants showed an increase in TST during month 1 (0.51h) but a decrease during month 2 (-0.74 h; contrast=-1.24, CI=-2.06, -0.42, p=0.005). No other significant effects were observed. SPP is highly feasible, acceptable, and associated with a significant increase in TST early in treatment. Registry: ClinicalTrials.gov; Name: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents; Identifier: NCT04163003; URL: https://clinicaltrials.gov/ct2/show/NCT04163003.

Abstract P414: Association between postpartum sleep and blood pressure reduction in women with hypertensive disorders of pregnancy

Importance: It is anticipated that many women do not get enough sleep after delivery. However, it is unclear how poor sleep affects postpartum blood pressure. Objective: To investigate the relationship between postpartum blood pressure and sleep habits, we examined women who developed hypertensive disorders of pregnancy by using automated blood pressure monitors and accelerometers. Setting: The blood pressure, pulse rate, and sleep were monitored at home. Total sleep time, sleep efficiency, sleep fragmentation coefficient, and wake after sleep onset were measured. Participants completed a behavior chart including breastfeeding frequency. The 24-hour, awake time and sleep time mean blood pressures were calculated for each participant as well as the change in blood pressure between postpartum days 7 and 14. Participants: We recruited 11 women who delivered singletons and developed hypertensive disorders of pregnancy at the National Center for Child Health and Development from April to September 2021. Intervention or Exposure: None Main Outcomes: The relationship between the change in blood pressure and sleep measurements and frequency of breastfeeding were analyzed. Results: Seven participants were included in the final analysis. The mean total sleep time was 5.3 hours, and the mean breastfeeding frequency was 6.1 times per day. Mean systolic and diastolic blood pressure and pulse rate during sleep periods tended to be lower than those during awake periods (-8.5±4.5 mmHg, -8.8±2.7 mmHg, -8.7±2.7 bpm, respectively). Lower sleep time was significantly correlated with smaller 24h-systolic and diastolic blood pressure drop (correlation coefficient r=-0.823, p=0.023 and r=-0.812, p=0.026, respectively. No association was found between other sleep measurements and the change in 24h-blood pressure. The blood pressure and pulse rate values in six of the seven participants during the early sleep phase (≤30 min) were similar to those in later sleep phases (>30 min), showing that beneficial effects of sleep on blood pressure were apparent throughout the sleep phases. Conclusions and Relevance: Our results suggest that longer total sleep time, even if sleep is fragmented, is associated with a greater decrease in postpartum blood pressure among women who developed hypertensive disorders of pregnancy.

The Relationships of Specific Cognitive Control Abilities with Objective and Subjective Sleep Parameters in Mild Cognitive Impairment: Revealing the Association between Cognitive Planning and Sleep Duration.

This study aimed to examine the associations between specific sleep parameters and specific aspects of cognitive functioning in individuals diagnosed with mild cognitive impairment (MCI), compared with healthy controls (HCs) by using cognitive, subjective, and objective sleep measures. A total of 179 participants were enrolled, all aged ≥ 65 years (mean age = 70.23; SD = 4.74) and with a minimum of six years of education (mean = 12.35; SD = 3.22). The sample included 46 HCs (36 females), 75 individuals with amnestic MCI (aMCI) (51 females), and 58 individuals with non-amnestic MCI (naMCI) (39 females). Inhibition, cognitive flexibility as a combined application of inhibitory control and set shifting or task/rule switching, and planning were examined. The following D-KEFS subtests were administered for their evaluation: Verbal Fluency Test, Color-Word Interference Test, and Tower Test. Self-reported sleep questionnaires (Athens Insomnia Scale, Stop-Bang questionnaire, and Pittsburg Sleep Quality Index) were used for subjective sleep assessments. Actigraphy was used for objective sleep measurements. Mixed-measures ANOVA, MANOVA, and one-way ANOVA, as well as the Scheffe post hoc test, were applied to the data. The results showed that the three groups exhibited statistically significant differences in the Tower Test (total achievement score, total number of administered problems, and total rule violations). As regards objective sleep measurements, the total sleep time (TST) was measured using actigraphy, and indicated that there are significant differences, with the HC group having a significantly higher mean TST compared to the naMCI group. The relationships evaluated in the TST Tower Test were found to be statistically significant. The findings are discussed in the context of potential parameters that can support the connection between sleep duration, measured as TST, and cognitive planning, as measured using the Tower Test.

The effects of daylight duration on the multiple sleep latency test (MSLT) results: A pilot study

ObjectiveMSLT results are known to be affected by multiple factors including sleep time, frequency of nighttime arousals, and medications intake. Although being the main synchronizer of sleep and wakefulness, daylight duration effects on MSLT have not been examined. Burlington, Vermont, USA experiences great variations in daylight duration, ranging from 8 h 50 min to 15 h 33 min of daylight. The aim of this study was to test the hypothesis that there would be photoperiod duration effects on MSLTs performed during short daylight (short daylight studies, SDS) vs. long daylight (long daylight studies, LDS) from 2013 to 2023 in our sleep laboratory. methodsWe identified and analyzed 37 SDS (daylight 530–560 min) and 36 LDS (daylight 903–933 min) from our database. Groups of SDS and LDS results were compared using non-paired student T test, Chi-Square and non-parametric Mann Whitney U Test. ResultsAverage daylight duration was 15 h 18 ± 14.6 min for LDS and 8 h 57 ± 18 min for SDS. Two groups did not differ in terms of the age, gender, BMI and race of patients studied. Mean total sleep time and sleep efficiency during PSG preceding MSLT, and MSLT mean sleep onset latency did not significantly differ for the two groups. However, SDS MSLT naps had significantly more sleep onset REM periods (SOREMP), and distribution of the number of SOREMP captured during MSLT was different for SDS and LDS groups. Differences of SDS and LDS results did not relate to sleep architecture of the overnight PSG as analysis of sleep and REM latency and relative percentages of N1, N2, REM, and N3 was not significantly different between SDS and LDS. The two groups showed difference in arousal indexes during N1 and REM sleep. ConclusionsDaylight duration may impact MSLT results and should probably be accounted for in MSLT interpretation. Attention to photoperiod could be considered in MSLT guidelines, if our results are replicated in larger samples.

Evaluating Sleep Challenges in Hospitalized Youth.

To characterize sleep quality and sleep disruptions among youth hospitalized outside of the intensive care unit (ICU). Participants were eligible for the survey-based study if they were 8-17 years old, English-speaking, hospitalized for ≥3 days outside of the ICU, and developmentally able to understand surveys. Survey administration included a sleep diary, the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and a study-specific Inpatient Sleep Disruptors Questionnaire. The chart review provided additional clinical information. Descriptive and comparative statistics were performed to assess the association between overnight clinical monitoring and daytime sleepiness. Forty-five participants (mean age 13.4 years, 60% female), recruited between May and December 2022, were included in the study. Mean total sleep time (8.2 ± 1.7 hours) and ESS-CHAD score (8.6 ± 4.3) were normal with 79% reporting fair to good sleep the previous night.Participants rated alarms on equipment, vital signs, and noise as most disruptive to sleep. Participants with vital signs every four hours showed higher levels of daytime sleepiness compared with participants with vitals measured every shift (9.3 vs. 6.3; p=0.04). Most participants reported normal sleep, although there was wide variability with a portion with impaired sleep quality and elevated daytime sleepiness. Alarms on equipment, vital signs, and noise were most disruptive, and increased vital sign frequency was also associated with increased daytime sleepiness. In clinically stable pediatric patients, a reduction in vital sign monitoring overnight may be an important change to improve patient sleep.

Development of optic disc edema during 30 days of hypercapnic head-down tilt bed rest is associated with short sleep duration and blunted temperature amplitude.

Sleep and circadian temperature disturbances occur with spaceflight and may, in part, result from the chronically elevated carbon dioxide (CO2) levels on the international space station. Impaired sleep may contribute to decreased glymphatic clearance and, when combined with the chronic headward fluid shift during actual spaceflight or the spaceflight analog head-down tilt bed rest (HDTBR), may contribute to the development of optic disc edema. We determined if strict HDTBR combined with mildly elevated CO2 levels influenced sleep and core temperature and was associated with the development of optic disc edema. Healthy participants (5 females) aged 25-50 yr, underwent 30 days of strict 6° HDTBR with ambient Pco2 = 4 mmHg. Measures of sleep, 24-h core temperature, overnight transcutaneous CO2, and Frisén grade edema were made pre-HDTBR, on HDTBR days 4, 17, 28, and post-HDTBR days 4 and 10. During all HDTBR time points, sleep, core temperature, and overnight transcutaneous CO2 were not different than the pre-HDTBR measurements. However, independent of the HDTBR intervention, the odds ratios {mean [95% confidence interval (CI)]} for developing Frisén grade optic disc edema were statistically significant for each hour below the mean total sleep time (2.2 [1.1-4.4]) and stage 2 nonrapid eye movement (NREM) sleep (4.8 [1.3-18.6]), and above the mean for wake after sleep onset (3.6 [1.2-10.6]) and for each 0.1°C decrease in core temperature amplitude below the mean (4.0 [1.4-11.7]). These data suggest that optic disc edema occurring during HDTBR was more likely to occur in those with short sleep duration and/or blunted temperature amplitude.NEW & NOTEWORTHY We determined that sleep and 24-h core body temperature were unaltered by 30 days exposure to the spaceflight analog strict 6° head-down tilt bed rest (HDTBR) in a 0.5% CO2 environment. However, shorter sleep duration, greater wake after sleep onset, and lower core temperature amplitude present throughout the study were associated with the development of optic disc edema, a key finding of spaceflight-associated neuro-ocular syndrome.

Sleep and allergic diseases among young Chinese adults from the Singapore/Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES) cohort

Background and objectiveSleep disruption has been shown to affect immune function and thus influence allergic disease manifestation. The specific effects of sleep on allergic diseases, however, are less well-established; hence, in a unique population of young Chinese adults, we investigated the association between sleep and allergic disease.MethodsYoung Chinese adults recruited from Singapore in the Singapore/Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES) were analyzed. We used the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a skin prick test to determine atopic dermatitis (AD), allergic rhinitis (AR), and asthma status. Information regarding total sleep time (TST) and sleep quality (SQ) was also obtained.ResultsOf 1558 participants with a mean age of 25.0 years (SD = 7.6), 61.4% were female, and the mean total sleep time (TST) was 6.8 h (SD = 1.1). The proportions of AD, AR, and asthma were 24.5% (393/1542), 36.4% (987/1551), and 14.7% (227/1547), respectively. 59.8% (235/393) of AD cases suffered from AD-related sleep disturbances, 37.1% (209/564) of AR cases suffered from AR-related sleep disturbances, and 25.1% (57/227) of asthma cases suffered from asthma-related sleep disturbances. Only asthma cases showed a significantly lower mean TST than those without asthma (p = 0.015). Longer TST was significantly associated with lower odds of AR (OR = 0.905, 95% CI = 0.820–0.999) and asthma (OR = 0.852, 95% CI = 0.746–0.972). Linear regression analyses showed that lower TST was significantly associated with asthma (β = − 0.18, SE = 0.076, p-value = 0.017), and AR when adjusted for AR-related sleep disturbances (β = − 0.157, SE = 0.065, p-value = 0.016). Only sleep disturbances due to AR were significantly associated with a poorer SQ (OR = 1.962, 95% CI = 1.245–3.089).ConclusionsWe found that sleep quality, but not sleep duration was significantly poorer among AD cases, although the exact direction of influence could not be determined. In consideration of the literature coupled with our findings, we posit that TST influences allergic rhinitis rather than vice versa. Finally, the association between TST and asthma is likely mediated by asthma-related sleep disturbances, since mean TST was significantly lower among those with nighttime asthma symptoms. Future studies could consider using objective sleep measurements coupled with differential expression analysis to investigate the pathophysiology of sleep and allergic diseases.

Efficacy of auricular acupressure using semen vaccariae (Wang Bu Liu Xing) seeds on acupoints of nada protocol in treating primary insomnia: A pilot study

This pilot study first aimed to evaluate the safety and efficacy of this twenty-day auricular acupressure using Semen Vaccariae (Wang Bu Liu Xing) in improving the sleeping conditions of primary insomnia patients. The secondary aim was to evaluate the improvement of some other self-reported symptoms caused by insomnia. A clinical prospective pre–post study was designed, enrolling 60 primary insomnia patients. Each patient was administered the auricular acupressure on five acupoints of NADA protocol of both ears by applying the Vaccariae seeds and was instructed to gently press 1 minute/acupoint each time, four times a day for twenty consecutive days. After 20 days, the mean total sleep time increased significantly from 3.8 ± 1.0 to 5.4 ± 1.0 (hours) (p<0.05). The mean ISI score decreased from 19.3 ± 5.4 at D0 to 9.5 ± 4.7 (points). The sleep efficiency increased significantly from 52.7 ± 13.9 to 80.7 ± 10.0 (%) (p<0.05). The number of patients suffering from self-reported insomnia-related symptoms (including fatigue, decreased concentration, anxiety, decreased memory, dizziness) decreased significantly compared to those at baseline (p<0.05). Auricular acupressure using Semen Vaccariae ear seeds followed the NADA protocol showed both safety and potential efficacy in improving sleep quality and other insomnia-related symptoms.

Objective Sleep and Circadian Rest‐Activity Rhythms and Multiple Domains of Cognitive Function in Older Men and Women

AbstractBackgroundEmerging evidence from experimental and epidemiologic studies suggests that sleep and circadian rest‐activity rhythms (RAR) play a key role in dementia and Alzheimer Disease (AD) pathology. Studies with objective measures of sleep and RAR and multiple domains of cognition in older adults remain limited.MethodWe studied 820 older men and women enrolled in the Study of Muscle, Mobility, and Aging (SOMMA), a unique cohort designed to study the cellular biology of aging and related loss of mobility. In this initial cross‐sectional analysis, participants wore wrist actigraphs for a mean of 8.0 consecutive days; recordings were processed for traditional sleep‐wake measures including total sleep time (TST) and sleep efficiency (SE); as well as parametric (acrophase, pseudo‐F) and non‐parametric (interdaily stability [IS], intradaily variability [IV], and relative amplitude [RA]) 24‐hour RAR variables. Measures of cognitive function included global cognition (the Montreal Cognitive Assessment), executive function (Trails B test), memory (California Verbal Learning Test‐short form; and psychomotor performance (Digit‐Symbol Coding Test). In models adjusted for age, sex, clinic site and education, we examined adjusted mean cognitive test scores by quartiles or categories of sleep and RAR exposures.ResultMean age of the cohort was 76 years, 58% were female, and 15% were non‐white. Mean TST and SE were 6.9 hours and 85%, respectively. Higher RA, reflecting a more robust 24‐hour RAR, was associated with better cognition on all tests (p for trend <0.05). The association of higher pseudo‐F, a parametric measure or robustness of RAR, to cognition was limited to psychomotor performance (p<0.03). Better psychomotor performance was also related to higher IS (consistency of RAR across days); whereas those with delayed timing (acrophase) had worse psychomotor performance (p<.0006). Lower SE was related to worse cognitive function (psychomotor performance, global cognition, memory; p<.05). There were no associations between TST and any cognitive measures.ConclusionSE and RAR were variably associated with both global and specific domains of cognition in older men and women. The RA in particular was strongly related to multiple domains of cognition related to AD, and may be useful in identifying individuals at risk. Additional analyses will explore gender differences and longitudinal associations.

Comparison of efficacy and usability of custom mandibular advancement devices fabricated with the conventional method and digital workflow: A pilot clinical study.

To compare the effects of fabricating methods of custom monoblock mandibular advancement devices (MADs) on usability and efficacy in patients with mild and moderate obstructive sleep apnea (OSA). Digitally fabricated custom MADs (dMADs) were produced for 11 OSA participants who had previously used conventionally fabricated custom MADs (cMADs). The participants answered a modified usability questionnaire for both MADs, and the average scores that were given to the questionnaire were evaluated by age, sex, and body mass index (BMI), and the scores of cMADs and dMADs were compared. After 6 months of usage of each MAD, the apnea-hypopnea index (AHI), mean and lowest oxygen saturations, and total sleep time were measured for efficacy assessment. Data were analyzed with Cronbach's alpha, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, one-way repeated measures analyses of variance, and Bonferroni tests (α = 0.05). Cronbach's alpha was found at 0.834 and 0.722 for the conventional and digital questionnaires, respectively. The usability scores of the dMADs were significantly higher than those of cMADs (p = 0.013). There was no difference in usability scores in terms of sex or BMI (p>0.05). No statistically significant difference was found for cMAD (p = 0.113) among age groups; however, there was a significant difference for dMAD (p = 0.046). The AHI, mean, and lowest oxygen saturation values were significantly affected by MAD usage (p<0.001). However, total sleep time values did not differ after the MAD treatments (p>0.05). Significantly lower AHI and significantly higher lowest oxygen saturation values were observed with dMAD, while both appliances led to similar results for mean oxygen saturation and total sleep time values (p>0.05). Participant usability scores were higher for digitally manufactured MADs than conventionally manufactured MADs. However, both conventional and digital MADs were found effective in decreasing the AHI levels and increasing the mean and lowest oxygen saturation values of the participants.

App-Supported Sleep Coaching: Implications for Sleep Duration and Sleep Quality.

The present study evaluated whether completers of a 12-week app-based, personalized text supported sleep coaching program demonstrated improvements in sleep continuity, sleep duration, and reduced use of sleep aids. Data were obtained from Sleep Reset, a 12-week consumer product that offers app-based sleep education and monitoring, along with personalized text-based sleep coaching provided by live coaches. 564 completers were included in the study. Pre-post changes for sleep latency (SL), wake after sleep onset (WASO), number of awakenings (NWAK), total sleep time (TST), sleep efficiency (SE%) and use of "sleep aids" were evaluated. To evaluate whether the program produced meaningful results, the proportion of participants who demonstrated reductions in SL, WASO, and NWAK, and increases in TST and SE% were examined. Mean SL was reduced by 11 minutes, mean WASO was reduced by 28 minutes, mean SE% increased by 6.6%, and mean TST increased by about 44 minutes. Of those who reported using "sleep aids" during Week 1, 41% no longer used them by week 12. Those with low SE% at baseline demonstrated greater improvements in SL (16.2 vs 5.7mins), WASO (47.3 vs 7.2mins), SE% (11.2% vs 1.6%), and TST (65.3 vs 31.2mins). Those with ≤6 hours of sleep at baseline demonstrated greater improvements in WASO (36.8 vs 22.3mins), SE% (10.1% vs 4.3%), and TST (85.1 vs 25.5mins). Participants that completed the app-based, personalized text supported coaching intervention reported subjective improvements in sleep duration and quality that suggest more beneficial effects particularly in those with lower sleep efficiency or sleep duration at baseline. An effective sleep coaching program that utilizes trained sleep coaches with access to board-certified providers, may provide a valuable resource for subclinical populations.

#4268 RELATIONSHIP BETWEEN MEASURED SLEEP QUALITY AND CLINICAL PARAMETERS IN DIALYSIS PATIENTS

Abstract Background and Aims Poor sleep quality in dialysis patients has been well reported and has deleterious effects on quality of life. Factors affecting the sleep quality in these patients have not been very well explored. Actigraphy using wearable devices with 3D accelerometers is a well-recognised method of analysing the sleep quality. We set out to determine the relationship of sleep quality parameters measured using actigraphy with dialysis related factors in patients on dialysis. Method We conducted a prospective analysis of 95 patients, involving 75 In Centre Haemodialysis (ICHD), 15 Home Haemodialysis (HHD) and 8 Peritoneal dialysis (PD) patients. Sleep data was collected using Actigraph wrist device. Participants were instructed to wear the device 24 hours a day for consecutive 7 days. Sleep data analysis was conducted with Actilife software using Cole-Kripke sleep-wake algorithm. Sleep quality parameters used for assessment included Sleep Efficiency, Average Total sleep time (TST), Wake after sleep onset (WASO), Number of Awakenings, Sleep Fragmentation index. All of these are well recognised sleep quality parameters. Demographic and clinical information was collected prospectively from medical records. Results Our study cohort was well representative of general dialysis population. Median Age was 65 years, with 65.6% Males and 34.4% Females. All sleep quality parameters were considerably poor compared to age matched general population. Mean Sleep Efficiency was 77.5% (Normal for age matched general population is 83.2%), Mean TST was 318 minutes (Normal 372 minutes), Mean WASO was 83 minutes (Normal 64 minutes), Mean Sleep Fragmentation index was 43. None of the sleep quality parameters had significant difference in different dialysis modalities in our study. Amongst the predictors of sleep quality, serum phosphate had significant association with increased WASO (p = 0.002). Mean WASO was 99 minutes for patients with serum Phosphate &amp;gt; 1.8 mmol/L compared to 74 minutes for those with serum phosphate of &amp;lt; 1.8 mmol/L. Serum phosphate had a borderline significant positive correlation with Number of Awakenings (p = 0.06) and borderline significant negative correlation with Sleep Efficiency (p = 0.06). Renal urea clearance (KRU) had statistically significant positive correlation with sleep efficiency (p = 0.013) but didn’t reach statistical significance in relation to the other sleep quality parameters. Urine volume also had positive correlation with sleep efficiency nearly reaching statistical significance (p = 0.055). Other factors analysed during the study didn’t appear to have any significant associations with sleep quality. Conclusion Actigraphy is non-invasive, less cumbersome, and reliable method of sleep assessment in dialysis patients. Compared to the age matched general population, dialysis patients have objectively measured poor sleep quality. Serum phosphate has significant negative impact on sleep quality possibly secondary to hyperphosphatemia-related side effects. Residual kidney function has positive association with sleep efficiency. This study highlights the potential importance of preserving residual kidney functions and treating hyperphosphatemia in dialysis patients which warrants further research.

Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study.

This cross-sectional study was conducted with 1029 children and adolescents aged 6-15 years attending elementary and secondary schools in Damascus, Syria. The questions involved 19 sleep problems items using the children sleep habits questionnaire, and 4 sleep disorder items (loud snoring, having snorts or gasps, breathing pauses, daytime sleepiness). Total sleep time (TST) was determined by sleep habits. Severe possible OSAS (p-OSAS) was addressed as having all OSA symptoms "frequently", and mild p-OSAS was defined as having any of the symptoms "sometimes". Severe and mild daytime sleepiness were rated as being very sleepy during the day "frequently", and "sometimes", respectively. Logistic regression was applied to predict risk factors of severe and mild daytime sleepiness. The prevalence of p-OSAS was 22.2%, of them 15.8% were mild, and 6.3% were severe. p-OSAS was more recognized in males 15.2% children (P<0.05). Most p-OSAS children sleep less than 6h of TST; however; the mean TST was significantly lower at the secondary school level (P≤0.001). Predicted risk factors for severe and mild daytime sleepiness were students' grade level (P<0.05), severe and mild p-OSAS (P≤0.001), and TST less than 6h (P≤0.001). A significant number of children have p-OSAS, affecting daytime sleepiness in school age. Physicians should consider loud snoring, and breathing pauses as marked symptoms of severe daytime sleepiness. Moreover, raising parents awareness about OSAS and daytime sleepiness is essential to ensure early access to primary care.

0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity

Abstract Introduction The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures. Methods We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported. Results The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p&amp;lt; 0.05) and identifying as non-Hispanic white (r=-0.14, p&amp;lt; 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p&amp;lt; 0.01), less disturbed sleep (r=-0.28, p&amp;lt; 0.01) and higher arousal (r=-0.21, p&amp;lt; 0.01) scores were associated with higher MSH scores. Conclusion Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents. Support (if any) NIH (R01HL136587,UL1TR000127)

0673 Sleep in PTSD: A Subjective Concern

Abstract Introduction Sleep complaints are a hallmark of posttraumatic stress disorder (PTSD). Prior studies examining sleep abnormalities in PTSD are inconsistent, with some reporting objective sleep changes including associated obstructive sleep apnea (OSA), possibly due to moderating variables including advancing age, traumatic brain injury (TBI), and medications. We sought to compare sleep disorders and objective and subjective sleep metrics in service members with and without PTSD while controlling for these potential confounders. Methods Case-controlled observational cohort study performed at an academic military sleep center. Detailed sleep history, sleep-related questionnaires, trauma history, and video-polysomnography was performed. Patients with a history of TBI, abnormal neuroimaging, or psychoactive medication use (antidepressants, antipsychotics, anxiolytics) were excluded. Results Patients (N=169, 124 males) were active duty service members (median age 37.1 years) reporting a sleep complaint. Of these, 43 (25.4%) had PTSD vs 126 (74.6%) without PTSD. In patients with PTSD vs no PTSD, there was no significant difference in the rate of OSA, mean total sleep time, sleep efficiency, mean apnea-hypopnea index, sleep stage percentage, or any other polysomnogram (PSG) variable. Stage N3 sleep was non-significantly increased in patients with PTSD (18% vs 14%, p=0.078). Subjective sleepiness was similar between those with and without PTSD (Epworth Sleepiness Score 12.9 vs 11.9, p=0.35). However, subjective insomnia symptoms (Insomnia Severity Index 20.4 vs 15.2, p&amp;lt; 0.0001) and perceived sleep quality (Pittsburgh Sleep Quality Index 15.4 vs 11.1, p&amp;lt; 0.0001) were worse in those with PTSD vs no PTSD. Conclusion In a relatively young active duty cohort with no history of psychoactive medication use or TBI, patients with PTSD had more subjective sleep complaints than those without PTSD but objective sleep parameters, including PSG variables and OSA rate, did not differ significantly. The higher stage N3 (slow wave) sleep percentage, though not statistically significant, suggests that PTSD patients sleep better in a monitored sleep lab than in their habitual sleeping environment. Support (if any)

0001 Effect of Time-Restricted Eating on Actigraphy-Derived Sleep Parameters

Abstract Introduction Time-restricted eating (TRE) is an emerging dietary intervention for weight loss. Sleep can be influenced by timing of food intake. Nevertheless, the impact of TRE on sleep patterns remains under-explored. The Time-Restricted Intake of Meals (TRIM) study was a parallel-arm, controlled feeding trial in 41 adults with obesity and prediabetes or untreated diabetes, randomized to TRE (8am-6pm) or usual eating pattern (UEP; 8am-12am) for 12 weeks, where the primary outcome was weight change. We hypothesized that TRE would cause changes in sleep/wake patterns. Methods This was a post-hoc analysis of TRIM using wrist actigraphy data obtained at baseline and week-12. We applied an objective process to determine sleep parameters after sleep estimation (Cole-Kripke) from actigraphy data. We analyzed 6 days/nights of recordings for each participant at each timepoint. Outcomes were sleep duration defined by mean total sleep time per 24-hour period (TST), sleep timing measured by mid-sleep time, sleep onset/offset, and sleep continuity. We used paired t-tests or Wilcoxon signed rank tests to compare data between baseline and week-12 within intervention arms and Mann-Whitney U tests or Wilcoxon signed rank tests to compare changes between intervention arms. Results 38 participants (20 UEP; 18 TRE) with adequate actigraphy data (mean age 60 years, 92% female, and 92% Black) were analyzed. Baseline TST (mean□SD) was 394□90 minutes and 386□81 minutes for UEP and TRE, respectively. Week-12 TST was 397□92 minutes and 444□95 minutes for UEP and TRE, respectively. Compared to UEP, TRE increased TST by 55 minutes (p=0.03). TRE shifted mid-sleep time to 44 minutes earlier, from 3:24am to 2:40am (p=0.01), while UEP maintained the same mid-sleep time at 3:15am. Sleep onset shifted from a median of 12:22am to 11:52pm in TRE (p=0.03) while it remained stable in UEP (p=0.97). There were no differences in sleep offset and sleep continuity within and between intervention arms. Conclusion Sleep behaviors were different by treatment arm with increased total sleep time and earlier sleep onset in TRE participants. TRE may have ancillary consequences on sleep, which could have clinical implications for sleep regulation. Support (if any) AHA SFRN 17SFRN33590069 K23DK133690

0120 Interactions between Temperament and Parent-Child Relationship Quality in Early Childhood and Sleep in Middle Childhood

Abstract Introduction Effects of child temperament on biopsychosocial outcomes, including sleep, are known to differ based on parent-child relationship quality (PCRQ). However, previous studies have primarily focused solely on early childhood, relied on subjective reports of PCRQ and sleep, and have neglected to examine variability in sleep, which is an important dimension of sleep health. We examined whether there were interactions between temperament and objectively measured PCRQ during early childhood in association with actigraphy measured sleep (average and variability) in middle childhood. Methods Participants included 90 preschoolers (mean age=4.24 years, SD=0.81) who were 47% female; 37% White, 17% Black, 47% other racial groups; and 46% Hispanic. Thirty-four percent experienced moderate to severe maltreatment. PCRQ was coded from a video-recorded free-play task between each child and their primary caregiver. Child temperament dimensions including Activity Level, Anger, Social Fear, Inhibitory Control, and Appropriate Attentional Allocation were measured with the parent-report Toddler Behavior Assessment Questionnaire. Child Mean and SDs of total sleep time (TST) and sleep efficiency (SE) were generated from actigraphy data collected for two weeks during a follow-up study when participants were ages 8-11. Results There were no direct effects of any of the temperament variables or PCRQ on sleep. In models adjusted for demographic characteristics and number of adversities experienced, greater attentional allocation was associated with greater average TST only among those children high in PCRQ (estimate = 20.59, 95% CI = 5.19, 35.99). For every one unit increase in attentional allocation score (possible range 1:7), there is a more than 20 min increase in mean TST. In contrast, greater activity levels were associated with better average sleep efficiency, only among those low in PCRQ (estimate = 2.35, 95% CI = 0.46, 4.24). For each unit increase in activity level score, there was a 2% increase in sleep efficiency. Conclusion Findings extend cross-sectional research in early childhood and provide support for models showing that children have differing susceptibility to the effects of temperament on sleep, depending on PCRQ. Support (if any) NIMH R01 MH083704, NICHD R01 HD086487, NICHD, R01 HD095837, SRCD Small Grant for Early Career Scholars, T32HD101392, NIGMS P20 GM139767.

0598 Patient-Reported Sleep Quality in People With Narcolepsy Transitioning From Sodium Oxybate to Lower-Sodium Oxybate

Abstract Introduction Lower-sodium oxybate (LXB; Xywav®), which contains the same active moiety as higher-sodium oxybate (SXB; Xyrem®) but with 92% less sodium, is approved by the US Food and Drug Administration (FDA) for treating cataplexy or excessive daytime sleepiness in patients ≥7 years of age with narcolepsy. LXB is recognized as clinically superior to SXB in narcolepsy by the US FDA due to lower chronic sodium exposure. Real-world data related to sleep quality following transition from SXB to LXB are lacking. Methods Transition Experience of persons with Narcolepsy taking Oxybate in the Real-world (TENOR; NCT04803786) was a patient-centric, prospective, observational, noninterventional, virtual-format study of US adults with narcolepsy (type 1 or 2) transitioning from SXB to LXB within the previous/upcoming 7 days. Longitudinal data collected during transition and for 21 weeks thereafter were based on daily and weekly questionnaires and sleep diaries instructing participants to rate the quality of their sleep and how refreshed they felt upon waking, and to record their sleep latency, wake after sleep onset (WASO), time in bed (TIB), and total sleep time (TST). Results The mean (standard deviation [SD]) age of the 85 participants (narcolepsy type 1, n=45; narcolepsy type 2, n=40) was 40.3 (13.0) years; most were female (73%) and White (87%). Almost all participants took SXB (82/85, 96%) twice nightly prior to transition and LXB (82/84, 98%) twice nightly after transition. Most participants rated their sleep quality as “good” or “very good” at baseline (45/84, 54%) and end of study (38/71, 54%), while 24/84 (29%) and 30/71 (42%) reported feeling “well-rested” or “very well-rested” at baseline and end of study, respectively. At end of study, changes (n=71) in mean (SD) sleep latency, WASO, TIB, and TST were −10.5 (16.2), −14.8 (56.6), 7.6 (67.7), and 33.0 (93.8) minutes, respectively. Conclusion Although participant-reported sleep quality was generally unchanged during the study, a greater percentage of participants reported feeling refreshed at end of study (on LXB) than at baseline (on SXB); however, there was no non-transitioning arm for comparison. Small changes were noted at end of study in sleep parameters, including sleep latency, WASO, and TST. Support (if any) Jazz Pharmaceuticals

0274 Comparing Sleep Architecture in Apple Watch Series 7 with SleepImage Rings

Abstract Introduction The awareness of the importance of healthy sleep is increasing in the community, hence many devices were developed in the last decade to help recognize sleep architecture. Studies that assessed the matching between sleep rings and iOS systems in apple watches are limited. We aimed to show that the Apple watch can be a useful tool in evaluating sleep architecture for many sleep disorders by comparing it with sleepimage rings. Methods We conducted home sleep studies on 1 participant for 7 nights using SleepImage rings and Apple Watch Series 7 with sleep health simultaneously. The participant is a healthy 32 year old male. N1, N2 and N3 stages of sleep were clumped together as NREM in the apple watch for comparative data. Data collected included total sleep time (TST), time in bed (TIB), time in REM, and time in NREM. Data was analyzed with IBM SPSS v. 29.0.0 using descriptive statistics. Mann Whitney test for comparison with p&amp;lt; 0.05 considered significant. Results Data in minutes included mean TST with watch 408.7, standard deviation (SD) 44.3 and with ring 404.57, SD 47.1 (p=0.902). Total NREM sleep with watch 330.1, SD 32.8 and with ring 337.8, SD 42.3 (p=0.620). Total REM with watch 72.7 SD 19.5 and with ring 66.7 SD 13.1 (p=0.535). Total TIB with watch 475.3 SD 20.8 and with ring 421.4 SD 52.8 (p= 0.017). Conclusion We found no statistically significant difference between the sleep ring and apple watch in estimating TST, REM-sleep and non-REM sleep. The only measurement that was significantly different is the time in bed. This report suggests that Apple Watch can be used as an adjunctive tool for sleep architecture for treating sleep disorders. Support (if any)

From early birds to night owls: a longitudinal study of actigraphy-assessed sleep trajectories during the transition from pre- to early adolescence.

Pre- and early adolescence are believed to constitute periods of important age-related changes in sleep. However, much of the research on these presumed developmental changes has used cross-sectional data or subjective measures of sleep, limiting the quality of the evidence. In addition, little is known about the development of certain features of the sleep-wake cycle pertaining to regularity (e.g. weekend-weekday differences and intra-individual variability) or circadian rhythms (e.g. sleep midpoint). This study examined the sleep trajectories of 128 typically developing youth (69 girls) from ages 8 to 12 years on four sleep characteristics: sleep onset, sleep offset, total sleep time (TST), and sleep midpoint. For each of these characteristics, actigraphy-derived estimates of typical (i.e. mean) sleep and sleep regularity were obtained at each time point. Multilevel growth curves were modeled. Overall, the sleep-wake cycle significantly changed between 8 and 12 years. Mean sleep onset, offset and midpoint exhibited an ascending curvilinear growth pattern that shifted later with age, while mean TST decreased linearly. Weekend-weekday differences (social jetlag) for sleep offset and midpoint became more pronounced each year. Weekday TST was longer than weekend TST, though this difference became smaller over time. Finally, intra-individual variability increased over time for all sleep characteristics, with variability in TST ascending curvilinearly. Important between-person and sex differences were also observed. This study reveals the marked changes that occur in the sleep of typically developing pre- and early adolescents. We discuss the potential implications of these trajectories.