Sleep Measures Research Articles

Translation and validation of sleep questionnaires in Jordanian and Qatari athletes.

To translate two prominent sleep questionnaires, the Functional Outcomes of Sleep Questionnaire 10 (FOSQ-10) and the Sleep Hygiene Index (SHI), into Arabic. The translations adhered to the established international criteria and underwent subsequent validation among 130 Arabic-speaking athletes from Jordan and Qatar. The validation process involved comparison against existing Arabic sleep questionnaires to ensure linguistic and cultural appropriateness. Of the 130 participants, 70 completed the test-retest for FOSQ and 58 the test-retest for the SHI. The internal consistency reliability was excellent for the Arabic FOSQ-10 (0.824) and the Arabic SHI (0.892). The assessment of test-retest reliability of the total score for both measures showed that the Arabic FOSQ-10 had moderate reliability (ICC = 0.468, 95% CI = 0.263-0.633), whereas the Arabic SHI had excellent reliability (ICC = 0.952, 95% CI = 0.921-0.972). Both newly developed Arabic sleep measures had significant associations with almost all other established Arabic sleep questionnaires, indicating good validity. Exploratory factor analysis identified 5 factors for FOSQ and 3 factors for SHI, with significant loadings indicating distinct domains related to sleepiness, tiredness, discomfort, behavior, and sleep patterns. Confirmator factor analysuis confirmed these factors for both FOSQ and SHI, though the RMSEA values (0.132 for FOSQ and 0.171 for SHI). the Arabic FOSQ-10 and the Arabic SHI were established and showed satisfactory reliability and validity in athletes. Further studies are needed to validate those measures in Arabic clinical populations.

Wearable sensors for monitoring caregivers of people with dementia: a scoping review

Abstract Purpose Caregivers of people with dementia often face a demanding care burden that may lead to adverse physical and psychological outcomes. Wearable sensors are becoming a valuable tool for preventive care. We aimed to provide the first systematic map of the published evidence on the use of wearable sensors to monitor caregivers of people with dementia. Methods We developed a scoping review protocol following the PRISMA-ScR guidelines. The searches were conducted on PubMed, Scopus, Web of Science, PsycInfo, and IEEE. Results We identified 1394 articles and selected 37 reports. Sleep measures were the outcome most frequently evaluated (28/37). Among these reports, eight assessed the effectiveness of different interventions targeting both caregivers and care-receivers and found no improvement in caregivers’ sleep; three compared the sleep of caregivers of people with dementia with controls, with conflicting results; five focused on depressive symptoms; and four associated these symptoms with shorter sleep duration and greater sleep fragmentation and sleep latency. A single device was used in 33 reports and sensors were most commonly placed at the wrist (33/37). Most studies monitored caregivers for 1 or more weeks (27/37). Conclusion Wearable sensors were mainly used to monitor sleep in informal caregivers of people with dementia based on wrist accelerometry for 1 or more weeks, with conflicting results. There is a need for targeted studies with adequate control groups to identify factors associated with sleep alterations in informal and formal caregivers of people with dementia, leveraging multi-sensor setups with the inclusion of autonomic nervous system metrics.

The association between subjective sleep and stress in recreational athletes

Subjective sleep and stress are strongly associated, at multiple levels, and the current body of evidence highlights a bi-directional association. Previous research has highlighted that issues with sleep can impact on several stress responses. On the other side of this relationship, research has shown that stress-inducing factors can significantly impact sleep. The present study examined this association in a sample of recreational athletes, a population that has received little to no research focus to date Recreational athletes are defined as individuals who exercise >4 hours per week for health, fitness, or unofficial competitions. Recreational athletes (n = 34) completed online measures of subjective sleep, subjective stress, subjective anxiety/depression and training load (PSQI, PSS, HADS and DALDA). Pearson correlations were carried out to examine associations between variables. There was a significant positive correlation between subjective sleep quality and subjective stress. There was a significant positive correlation between subjective stress and training load. There was a significant positive correlation between subjective sleep quality and training load. The positive associations between sleep, stress and training load are consistent with previous research, but the present study adds to the literature by highlighting the associations in recreational athletes. Recreational athletes should proactively manage their sleep and stress, as due to the bi-directional relationship, improving sleep may benefit stress, and improving stress may benefit sleep quality. This is also likely to benefit overall mood and reduce the likelihood of overtraining in recreational athletes.

Daily fluctuations in adolescents' sleep predict next-day attention, sleepiness, and fatigue: an ecological momentary assessment study over 28 days.

Current understanding of the associations between adolescents' daily sleep and daytime alertness and fatigue under naturalistically occurring restricted (school) and unrestricted (vacation) sleep opportunities is limited. A convenience sample of adolescents (n = 205; 54.1% females, Mage ± SD = 16.9 ± 0.87 years) completed daily measures of sleep, alertness, and fatigue over 28 days (2 weeks during school, and the subsequent 2-week vacation). Actigraphy and sleep diary total sleep time (TST) and sleep efficiency (SE) were measured. Participants self-reported sleepiness and fatigue every morning and afternoon, and completed a tablet-based, 3.2-min psychomotor vigilance task (PVT) every afternoon. Cross-lagged multilevel models tested daily TST and SE as predictors of next-day subjective sleepiness/fatigue and PVT performance. Between- (i.e., differences between individuals) and within-person associations (i.e., whether nights with higher-than-individual's-average TST/SE, predict next-day outcomes) were tested simultaneously. Covariates included previous-day outcome, day of the week, study day (1-28), school/vacation, chronotype, and sociodemographic variables. Within-persons, higher-than-average TST and SE (both actigraphy and diary) predicted better next-day PVT performance (all p ≤ .006), and lower subjective sleepiness and fatigue the following morning and afternoon (all p ≤ .032). Between-persons, adolescents with higher overall diary SE had lower morning subjective sleepiness (p < .001) and fewer PVT false starts in the afternoon (p = 0.02). Nights with longer- and higher-than-average sleep efficiency (both actigraphy and diary) predicted better daytime alertness and fatigue, both when examined objectively via sustained attention and via self-report. These findings are relevant for understanding the significance of sleep for adolescents' day-to-day alertness levels and fatigue, particularly in the context of classroom learning and road safety.

Sleep Fragmentation Despite Intact Rest-Activity Patterns in Premanifest Huntington's disease: An Actigraphy Study

ObjectiveSleep research in Huntington’s disease (HD) has primarily focused on manifest HD, with significantly less attention given to premanifest HD (Pre-HD). Therefore, we investigated sleep and rest-activity patterns in people with Pre-HD versus healthy controls (HC). MethodsWe conducted a cross-sectional study including 36 Pre-HD and 48 HC participants. Pre-HD participants were stratified into three groups according to their proximity to estimated diagnosis, using a cytosine-adenine-guanine (CAG) and current age-based predictive model: NEAR (<9 years to diagnosis), MID (9-15 years to diagnosis) and FAR (>15 years to diagnosis). Sleep and rest-activity patterns were assessed using wrist-worn actigraphy, a sleep diary, and sleep questionnaires. ResultsNEAR and MID groups experienced higher fragmentation index than HC and FAR groups. NEAR and MID groups also exhibited greater WASO than the FAR group. NEAR and MID groups showed lower intra-daily variability (IV) than HC and FAR groups, with the NEAR group also being more active in the most active 10 hours (M10). Groups did not differ on subjective sleep measures, inter-daily stability (IS), sleep regularity index, relative amplitude, or amount of activity in the least active five hours (L5). Considering all Pre-HD participants, fewer years to diagnosis, higher CAG-age-product (CAP) scores (a measure of cumulative exposure to the HD-causing gene mutation) and larger CAG repeat lengths correlated with higher WASO, fragmentation index, L5, IS, and lower sleep efficiency and IV. Higher CAP score correlated with higher M10. ConclusionsDespite intact rest-activity patterns and similar subjective sleep quality to HC, greater sleep fragmentation is a prominent and early feature in Pre-HD. Therefore, reducing sleep fragmentation may be a potential target for sleep intervention in HD. Longitudinal studies using larger samples are needed to assess sleep across the disease spectrum and its impact on clinical outcomes, like cognition.

Actigraphy-derived multidimensional sleep health among breast cancer survivors and controls: Pink SWAN.

To compare breast cancer survivors (BCS) to women without breast cancer (controls) on sleep health risk factors and actigraphy-derived dimensions of sleep (duration, maintenance, timing, and regularity) and examine whether the effect of breast cancer on sleep differs by time since diagnosis. Analyses included data from 68 BCS and 1042 controls who participated in actigraphy and Pink SWAN sub-studies within the Study of Women's Health Across the Nation. BCS and control characteristics were compared using chi-square, Fisher's exact, and Wilcoxon rank sum tests. Sleep measures were regressed onto breast cancer status using binomial logistic and linear regression. The interaction between BCS status and years since diagnosis (< 5; ≥ 5) was tested in these models before and after covariate adjustment. There were no overall sleep differences between BCS and controls; both groups experienced poor sleep health on average across multiple dimensions. Physical inactivity, sleep apnea, and vasomotor and depressive symptoms were associated with worse sleep in both groups. Total sleep time was lower among BCS than controls within 5years of diagnosis (6.13 vs. 6.57h; p = .03) but did not differ at > 5years post-diagnosis (6.59 vs. 6.45h; p = .32). BCS reported greater use of exogenous hormones (p < .0001) and were twice as likely to have initiated anxiolytic use post-diagnosis (p = .03). BCS within 5years of diagnosis experienced shorter sleep duration than controls but did not differ on other sleep parameters. Both groups experienced poor sleep health. BCS and similarly-aged women experience poor sleep health requiring assessment and treatment.

Project G-SPACE: protocol for exploring the influence of green space on sleep and mental health among children

BackgroundThe prevention of pediatric mental health disorders is a growing health priority in the United States. While exposure to green space, such as outdoor vegetation, has been linked with improved mental health outcomes in children, little is known about the impact of green space on children’s sleep. Sleep has many benefits, but the factors affecting both sleep and mental health as they relate to green space exposure are not well understood in children. This study aims to investigate how green space can affect sleep in children and contribute to the promotion of mental health and wellbeing.MethodsProject Green Space, Sleep, and Mental Health (G-SPACE) aims to recruit 250 elementary school-children from first, second, and third grade in Rhode Island to examine the influence of green space exposure on sleep, physical activity, and mental health over a five-year period. Objective measures of sleep, physical activity, and daily activity space will be assessed using an actigraph and a GPS (Global Positioning System) unit. Subjective measures of sleep duration, sleep quality, and mental health will be assessed using daily sleep diaries from parents, in addition to a range of survey items, including PROMIS® (Patient Reported Outcome Measurement Information System) pediatric scales, and the Children’s Sleep Habits questionnaire, among others. Green space exposure will be based on measures of green space from the normalized difference vegetation index (NDVI) aligned with the daily activity trajectory of children. Additionally, saliva and DNA samples will be collected to examine epigenetic mechanisms linking green space to sleep and mental health. A subset of participants (n = 50) will be followed longitudinally to evaluate the long-term impact of green space on sleep and mental health among children. Multi-level models will be used to assess the association between green space exposure, sleep behaviors, and mental health.DiscussionProject G-SPACE will evaluate whether green space utilization influences sleep and mental health in early elementary school children, and the possible mechanistic pathways through which these associations emerge.

Characterising the inconsistency between perceived and actual sleep and its impact upon cognition and mood

Sleep profoundly influences human behaviour across cognition, affect, and daily experience. This study evaluated how subjective reports and objective measures of sleep capture the interaction between sleep quality and quantity on cognition and affect. We collected subjective sleep reports using the Pittsburgh Sleep Quality Index and objective seven-day actigraphy recordings from 83 participants. A test battery, including the Stop Signal, Digit Span, and Emotional Bias Tasks, measured response inhibition, working memory, and affect. Mood was evaluated using the Positive and Negative Affect Schedule, State-Trait Anxiety Inventory, and Beck’s Anxiety Inventory. We reveal that subjective sleep reports do not predict objectively measured sleep duration or quality. We demonstrate that objective measures predict cognitive performance on executive function and memory tasks for the upper and lower sleep quartiles, while subjective reports do not. Moreover, we demonstrate that subjective reports, but not objective measures, are strongly predicted by emotional state. These findings suggest that while subjective measures do not accurately index actual sleep, they are a reliable proxy for emotional well-being. We propose that combined subjective and objective measures are required to characterise the multifaceted interaction between sleep, cognition and emotion. We discuss the implications of these findings for understanding the cause-effect relationship of sleep-disturbance in neurological and psychiatric disorders.

Explanatory variables of objectively measured physical activity, sedentary behaviour and sleep in adults with type 1 diabetes: A systematic review.

This systematic review aimed to summarize knowledge on explanatory variables of PA, SB and sleep in adults with T1D to support the development of healthy lifestyle interventions. A systematic search of four databases (PubMed, Web of Science, Scopus and Embase) was performed. Only objective measurements of PA, SB and sleep were included and all explanatory variables were classified according to the socio-ecological model (i.e. intrapersonal, interpersonal, environmental and policy level). Risk of bias (ROB) (Joanna Briggs Institute appraisal checklists) and level of evidence (Evidence-Based Guideline Development) were assessed. Twenty-one studies were included (66.7% low ROB). Most explanatory variables were situated at the intrapersonal level. A favourable body composition was associated with more time spent in total PA and moderate-to-vigorous PA (MVPA). Men with T1D spent more time in MVPA than women and a younger age was associated with increased MVPA. Barriers to PA were indeterminately associated with MVPA and HbA1c showed an indeterminate association with sleep. Explanatory variables of SB and light PA were not studied in at least two independent studies. This review underscores the focus on the individual level to identify explanatory variables of movement behaviours in adults with T1D, despite the necessity for a socio-ecological approach to develop effective interventions. More evidence on psychological, interpersonal and environmental variables is needed as these are modifiable.

The Influence of Neck Pain and Sleep Quantity on Headache Burden in Service Members With and Without Mild Traumatic Brain Injury: An Observational Study.

Headache is the most overwhelmingly reported symptom following mild traumatic brain injury (mTBI). The upper cervical spine has been implicated in headache etiology, and cervical dysfunction may result in neck pain that influences the experience of headache. Sleep problem is the second most reported symptom following mTBI. We explored the contribution of neck pain (as a potential proxy for cervical dysfunction) on headache burden along with the contribution of sleep quantity following mTBI. Retrospective data from a repository consisting of service members recruited from primary care, with (N = 493) and without a history of mTBI (N = 63), was used for analysis. Portions of the Neurobehavioral Symptom Inventory, Pittsburgh Sleep Quality Index, and Orebro Musculoskeletal Pain Questionnaire were used for headache, sleep, and neck pain measures. Demographic and military characteristics that differed between groups were treated as covariates in analyses. Group comparisons revealed significant differences in the expected direction on all measures: mTBI > controls on headache and neck pain; controls > mTBI on sleep quantity. Regression revealed that neck pain accounted for the most variance in headache score, followed by group membership and sleep quantity. When analyzing groups separately, no difference in the pattern of results was revealed in the mTBI group. In the control group, variance in headache score was only significantly related to neck pain. Amongst service members who sought service from primary care, neck pain explains more variance in headache burden than mTBI history or sleep quantity, supporting that cervical dysfunction may be a salient factor associated with headache. Neck functioning may be a potential area of intervention in the management of headaches.

Long-Term Caregiving Impact and Self-Care Strategies in Family Caregivers of People with Neuropsychiatric Disorders: A Mixed-Method Study.

Family caregivers of people with neuropsychiatric conditions are at risk of caregiver burden and declining health. The aims of this study were to identify the impact of caring on long-term family caregivers and their unmet needs and to explore their self-care strategies for achieving a successful caregiving experience. A mixed-method study was conducted using semi-structured interviews and a questionnaire in which standardized, self-reported measures of burden, health behaviors, sleep, and mental well-being were administered. Participants were family caregivers of people with neuropsychiatric disorders. Convenience sampling of 28 caregivers: 13 of people with mental health disorders (schizophrenia and bipolar disorder) and 15 with Alzheimer's disease. Based on the analysis of the semi-structured interviews, data saturation was reached. Analysis of self-reported measures indicated that 32.1% of long-term caregivers had high caregiver burden, 64.3% had reduced quality of life, 39.3% had low sleep quality, 21.4% had low adherence to the Mediterranean diet, 50.0% had a physical activity below the recommendation, 42.9% had high anxiety symptoms, 35.7% had high depressive symptoms, and 71.4% had reduced self-care agency. Content analysis and statistical analysis were conducted. Two themes were identified: (1) the impact of long-term caregiving and unmet needs and (2) successful self-care strategies. Caregivers of people with Alzheimer's disease spent less time doing physical activity, had higher caregiver burden, and poorer health-related quality of life. The negative impact of caregiving could be prevented/managed by assessing the individual's circumstances for the development of cross-sectional self-care strategies involving physical, emotional, and social spheres.

OGC O02 - Measurement of functional, psychosocial, and quality of life impacts of Robotic versus Hybrid Oesophago-gastrectomy

Abstract Background Since the introduction of Robotic-Assisted Minimally-Invasive Oesophago-gastrectomy (RAMIO), comparisons to other surgical approaches have focussed primarily on peri-operative and oncological outcomes. Few studies have focused on quality-of-life measures once the patient has been discharged home. We sought to compare physical, psychosocial, sleep, pain and employment related measures at six weeks following discharge in patients undergoing RAMIO versus Hybrid Oesophago-gastrectomy. Method We performed a prospective cohort study comparing RAMIO and Hybrid Oesophago-gastrectomy. Twenty-five consecutive patients on a curative surgical pathway were recruited to each group. Participants were contacted via telephone pre-operatively and six weeks post-operatively. Parameters studied were: physical activity, social activity, sleep, pain control, and employment. Psychological wellbeing was measured using the Hospital Anxiety and Depression Scale, and quality of life with the European Organisation for Research and Treatment of Cancer questionnaires C30 (all cancer patients) and OG25 (patients undergoing oesophago-gastric cancer treatment). Results were analysed using Chi Square and Mann-Whitney-U statistical tests. Results There were no differences in age, ASA, or anaerobic threshold between study groups. At six weeks the RAMIO group was more likely than Hybrid to have returned to pre-operative physical and social activity (physical 7/25 vs. 1/25, p=0.04, social 13/25 vs. 5/25, p=0.03). The RAMIO group stopped regular analgesia earlier, and required fewer opiates. Patients were more likely to return to work in the RAMIO group (7/15 vs. 1/12,p=0.04). The RAMIO group had fewer cases of depression (2 vs. 9, p=0.03), lower QLQ C30 and OG25 scores, and reported higher overall health and quality of life scores (p=0.001). Conclusion We have demonstrated an improvement in physical and social activity, a faster return to work, a reduction in analgesia requirements, lower rates of depression and improved health and quality of life, six weeks post-operatively when comparing RAMIO to hybrid oesophago-gastrectomy. This study has highlighted additional considerations for the selection of surgical modality in oesophago-gastrectomy beyond peri-operative outcomes. Further investigation across a larger sample size and longer time frame to quantify the full spectrum of potential benefits of robotic oesophago-gastric surgery is warranted.

Dimdazenil for the treatment of insomnia: a systematic review and narrative synthesis.

Insomnia is a common sleep disorder affecting approximately 10-20% of adults worldwide. Despite various available treatment modalities, significant gaps remain in improving sleep maintenance and reducing functional impairments. To systematically review and synthesize studies on the efficacy and safety of Dimdazenil for the treatment of insomnia. A comprehensive search of multiple databases and websites was conducted to identify published and unpublished trials from inception to July 19, 2024. Due to the limited number of studies available, quantitative data were synthesized narratively. This synthesis included four randomized controlled trials. The primary efficacy endpoints of these studies met the predetermined criteria for superiority. Dimdazenil significantly improved certain objective and subjective sleep measures in patients with insomnia, including reduced sleep latency and longer total sleep duration. Importantly, these outcomes were achieved without causing significant excessive daytime drowsiness or impairing daytime functionality. Furthermore, Dimdazenil demonstrated a generally acceptable safety profile and was well tolerated. Most evaluation indicators related to withdrawal symptoms, drug residues, and rebound effects did not show significant statistical differences. The number of included studies and sample sizes were small, and there is a lack of data on the long-term efficacy and safety of Dimdazenil. Dimdazenil offers significant benefits in improving sleep onset and maintenance in patients with insomnia. It presents a favorable safety and tolerability profile while preserving daytime functioning. Future studies should extend the duration and scale to assess the long-term efficacy and safety of Dimdazenil across diverse populations.

Abstract 4144503: Association of Granular Sleep Health Metrics with Arterial Stiffness in the Community

Introduction: Poor sleep is a risk factor for cardiovascular disease and all-cause mortality; however, the mechanisms underlying this relationship remain poorly understood. Since sleep health is a complex construct extending beyond mere sleep duration, we aimed to examine the relationship between granular sleep health indicators and arterial stiffness. Methods: We analyzed Framingham Offspring cohort (Exam 9) and OMNI cohort 1 (Exam 4) participants with sleep study and applanation tonometry data (n= 847, 56.6% females). Participants wore an M1 device to obtain ECG-derived sleep spectrograms to assess sleep quality and the Nonin WristOx device for oximetry data over two consecutive nights. Sleep variables of interest included total sleep time, duration of stable and unstable NREM, duration of elevated low-frequency coupling (e-LFC), and duration and number of nocturnal hypoxia events. Measures of aortic stiffness and pressure pulsatility included carotid-femoral pulse wave velocity (PWV), and central pulse pressure (CPP). Results: Characteristics of the sample are presented in Table 1. Several sleep measures were associated with PWV in univariable analysis, but significance attenuated after age/sex adjustment (Table 2). After adjusting for cardiovascular risk factors and sociodemographics, duration of e-LFCnb remained associated with CPP (β = 0.036, p = 0.02) Conclusion: Sleep measures associated with aortic stiffness are closely tied to age and sex. Longer duration of e-LFCnb, a hallmark of carotid body-driven elevated sympathetic tone and periodic breathing, is associated with greater pressure pulsatility. Longitudinal studies are needed to fully elucidate the role of e-LFCnb in vascular health

Abstract 4122679: Associations Between Recent and Cumulative Lifetime Cannabis Use and Sleep Health in Middle-Aged Adults: 35-Year Insights from the Coronary Artery Risk Development in Young Adults (CARDIA) and CARDIA Sleep Studies

Background: Cannabis use has become common, but its effects on sleep health—an important contributor to cardiovascular health—remain poorly understood. We investigated associations between recent and cumulative lifetime cannabis use and objective and subjective sleep measures in middle-aged adults. Method: We assessed recent cannabis use (last 30 days) repeatedly from young adulthood (age 18-30 at baseline in 1985-86) to middle age (after 35 years) in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study. Cumulative lifetime cannabis use (1 year = 365 days of use) was estimated by summing days of use during follow-up. At Year 35 (Y35), we obtained objective sleep measures (duration, efficiency, fragmentation, wake after sleep onset [WASO]) via 7-day wrist actigraphy from CARDIA Sleep Ancillary Study II. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Robust regression models adjusted for Y35 age, sex, race, education, cumulative cigarette smoking, alcohol use, other substance use, physical activity, body mass index, sleep medication, and comorbidities. We also examined race, sex, and cigarette smoking status differences in associations. Result: Of 571 participants, mean age was 61.9 years; 65% were female, and 35% Black. Means (SD) for sleep duration, efficiency, fragmentation, WASO, and PSQI were 6.9 (1.1) hours, 90.5 (4.2)%, 20.6 (7.6)%, 43.5 (20.9) minutes, and 6.1 (3.6) scores, respectively. At Y35, 13.8% reported recent cannabis use, 56% reported former use, mean (SD) cumulative use was 1.6 (4.4) years. With adjustment, recent cannabis use was associated with longer sleep duration, lower efficiency, and higher WASO; former cannabis use was associated with longer sleep duration (Table). Compared to those with cumulative cannabis exposure years in the first quartile, fourth quartile users had longer sleep duration, lower efficiency, and higher WASO (β/p-value: 0.3/0.01, -1.2/0.01, and 8.9/&lt;.001, respectively). PSQI was not associated with recent or cumulative cannabis use. Associations were similar across race, sex, and cigarette smoking status. Conclusion: Recent and cumulative lifetime cannabis use is associated with longer sleep duration and poorer sleep quality in objective, but not subjective, measures. Further longitudinal studies are needed to identify interventions aimed at improving sleep health and promoting cardiovascular health in cannabis users.

Abstract 4128919: A Study Using Team Based Hypertension Care Focused on Black Patients to Inform a Future Randomized Trial

Background: Current telemedicine programs to manage hypertension are less effective in Black patients perhaps due to insufficient support for self-care skills and social needs. We describe a tailored program for Black patients emphasizing self-management support and social needs to inform future studies. Method: We piloted a 12-week telemedicine intervention comprising home blood pressure (BP) guided pharmacotherapy, frequent self-management support and social support using pharmacist, nurses, community health workers (CHW) and social workers (SW) among 20 patients in 2 clinics. At enrollment, we trained patients to use a BP monitor and a telemonitoring app that transmits BP real-time via a smartphone and provided a pill box to facilitate medication adherence. We asked patients to measure BP at least once daily and used 6 weeks average to guide pharmacotherapy. Trained nurses helped patients achieve self-care goals and provided 8-12 self-management support calls discussing hypertension, medication adherence, diet, physical activity, weight management, sleep, and BP measurement techniques. SWs and CHWs provided social support to address social needs such as food, transportation, and housing, and also offered home visits. Result: Eighteen patients completed the study of which 15 were Black, 2 White, and 1 Korean (9 were women). Mean age was 61.7 ± 11.8 years. Patients measured BP 10 ± 8.6 times/week and completed 8.3 ± 2.5 self-management calls. Over 12 weeks, SBP/DBP decreased by 16.5 ± 26.2/10.2 ± 18.5 mmHg without safety events (Table). There were 1.1 ± 0.8 (range 0-3) medication adjustments (dose or medication changes) per patient. Patients had 8 minor technical difficulties that were promptly resolved. 17 patients used pill boxes to improve medication adherence. Conclusion: Our tailored telemedicine program to manage hypertension is feasible among Black patients and offer valuable insights for future research.

Abstract 4128698: Mental Health and Sleep Quality as Determinants of Physical Activity Levels in Depressed Rural Patients with Coronary Heart Disease

Background: Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined. Purpose: The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD. Methods: A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress. Results: Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p &lt; .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity. Conclusions: Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.

A sleepy cannabis constituent: cannabinol and its active metabolite influence sleep architecture in rats.

Medicinal cannabis is being used worldwide and there is increasing use of novel cannabis products in the community. Cannabis contains the major cannabinoids, Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), but also an array of minor cannabinoids that have undergone much less pharmacological characterization. Cannabinol (CBN) is a minor cannabinoid used in the community in "isolate' products and is claimed to have pro-sleep effects comparable to conventional sleep medications. However, no study has yet examined whether it impacts sleep architecture using objective sleep measures. The effects of CBN on sleep in rats using polysomnography were therefore examined. CBN increased total sleep time, although there was evidence of biphasic effects with initial sleep suppression before a dramatic increase in sleep. CBN increased both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. The magnitude of the effect of CBN on NREM was comparable to the sleep aid zolpidem, although, unlike CBN, zolpidem did not influence REM sleep. Following CBN dosing, 11-hydroxy-CBN, a primary metabolite of CBN surprisingly attained equivalently high brain concentrations to CBN. 11-hydroxy-CBN was active at cannabinoid CB1 receptors with comparable potency and efficacy to Δ9-THC, however, CBN had much lower activity. We then discovered that the metabolite 11-hydroxy-CBN also influenced sleep architecture, albeit with some subtle differences from CBN itself. This study shows CBN affects sleep using objective sleep measures and suggests an active metabolite may contribute to its hypnotic action.

IntelliSleepScorer, a Software Package with a Graphic User Interface for Mice Automated Sleep Stage Scoring.

Sleep stage scoring in rodents is the process of identifying the three stages: nonrapid eye movement sleep (NREM), rapid eye movement sleep (REM), and wake. Sleep stage scoring is crucial for studying sleep stage-specific measures and effects. Sleep patterns in rodents differ from those in humans, characterized by shorter episodes of NREM and REM interspaced by waking, and traditional manual sleep stage scoring by human experts is time-consuming. To address this issue, previous studies have used machine learning-based approaches to develop algorithms to automatically categorize sleep stages, but high-performing models with great generalizability are often not publicly available/cost-free nor user-friendly for non-trained sleep researchers. Therefore, we developed a machine learning-based LightGBM algorithm trained with a large dataset. To make the model available to sleep researchers without coding experience, a software tool named IntelliSleepScorer (v1.2- newest version) was developed based on the model, which features an easy-to-use graphic user interface. In this manuscript, we present step-by-step instructions for using the software to demonstrate a convenient and effective automatic sleep stage scoring tool in mice for sleep researchers.

The behavioral and physiological correlates of affective mood switching in premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD), a more severe manifestation of premenstrual syndrome (PMS), is characterized by emotional, behavioral, and physical symptoms that begin in the mid-to-late luteal phase of the menstrual cycle, when estradiol and progesterone levels precipitously decline, and remit after the onset of menses. Remotely monitoring physiologic variables associated with PMDD depression symptoms, such as heart rate variability (HRV), sleep, and physical activity, holds promise for developing an affective state prediction model. Switching into and out of depressive states is associated with an increased risk of suicide, and therefore, monitoring periods of affective switching may help mitigate risk. Management of other chronic health conditions, including cardiovascular disease and diabetes, has benefited from remote digital monitoring paradigms that enable patients and physicians to monitor symptoms in real-time and make behavioral and medication adjustments. PMDD is a chronic condition that may benefit from real-time, remote monitoring. However, clinical practice has not advanced to monitoring affective states in real-time. Identifying remote monitoring paradigms that can detect within-person affective state change may help facilitate later research on timely and efficacious interventions for individuals with PMDD. This narrative review synthesizes the current literature on behavioral and physiological correlates of PMDD suitable for remote monitoring during the menstrual cycle. The reliable measurement of heart rate variability (HRV), sleep, and physical activity, with existing wearable technology, suggests the potential of a remote monitoring paradigm in PMDD and other depressive disorders.