Sleep Measures Research Articles

Abstract 28: Social Dimensions of Sleep: An Exploration of Midlife Working-Class Women’s Experiences in Mexico

Sleep, one of Life’s Essential 8, is vital to midlife women’s cardiovascular health (CVH). However, achieving healthy sleep is complex. As a first step, it is important to understand the barriers and facilitators to achieve adequate and high-quality sleep among midlife women in a context-specific manner. To comprehensively address this issue, we employed a mixed-methods approach to provide a nuanced understanding of the ecologies and experiences surrounding sleep health among working-class midlife women from Mexico City. First, we utilized existing epidemiologic data on participants to describe sleep and its correlates in a study population (n=120) of women enrolled in a cohort study via objective and subjective standard sleep measures. Then, we used thematic analysis to analyze in-depth ethnographic interview data (n=30) to characterize self-described barriers and facilitators of sleep. Our findings revealed that a substantial proportion of midlife women experienced poor sleep quality, with 53% reporting short sleep duration and 43% experiencing insomnia-related difficulties over seven days. Epidemiologic data suggested poor sleep outcomes were driven by age, type of work/occupation, food insecurity, mental health issues, and diabetes status. Our ethnographic interviews demonstrated that study participants perceived their familial relationships and responsibilities as the prominent barrier to quality sleep, encompassing challenges such as insufficient sleep due to family obligations and sleep disturbances triggered by family-related stressors. Combining these methodological approaches underscored the strong social dimension of sleep, where good sleep hinged on completing household tasks and attending to family needs. In response to sleep deficits, women frequently turned to caffeine consumption and occasional napping as coping mechanisms and described using sleep facilitators, including remedies like teas or other “natural” products. This study highlights the intricate social drivers of sleep, termed the “Sociality of Sleep,” among Mexican midlife women and may demonstrate how sleep recommendations and hygiene principles are likely inadequate in relation to the complex social dynamics of sleep. These insights provide evidence for considering the social context when tailoring recommendations that promote healthy sleep within this demographic. Furthermore, the combined methodology employed in this research may serve as a model for future sleep health studies.

Abstract P522: Racial Differences in Sleep Health in Middle-Aged Adults

Introduction: Sleep health is comprised of many dimensions, including duration, quality and sleep disorders. Prior work found that Black adults have worse sleep health than White adults, but the underlying reasons are unknown. Our goal was to examine possible determinants of racial disparities in sleep health. We hypothesized that sleep health would be worse in Black participants, and this would be partly explained by clinical, psychosocial and lifestyle risk factors. Methods: We used cross-sectional data from the sleep ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) study. Several objective sleep measures were collected, including 7 days of wrist actigraphy and a home sleep test (Nox T3s). Sleep disordered breathing was classified by oxygen desaturation index (ODI)>=10 or apnea-hypopnea index (AHI) >=15. We used a series of regression models to calculate the percent reduction in the coefficient estimate for race in models for each sleep health metric after adjusting for clinical factors, psychosocial factors or lifestyle factors. Results: There were 565 Black and 741 White adults in this analysis (mean (SD) age 61 (3.6) years). Black adults had significantly worse sleep health based on all measures, including shorter sleep duration, lower sleep percentage, greater sleep fragmentation and higher prevalence of sleep disordered breathing compared to White adults. Clinical factors, psychosocial factors and lifestyle factors all explained a proportion of the racial differences in sleep fragmentation and sleep percentage and explained away the racial differences in sleep disordered breathing (Table). Conclusions: Racial disparities in sleep health may be partly explained by clinical factors, such as blood pressure and BMI, psychosocial factors, such as education and depression, and lifestyle factors, such as smoking, alcohol intake, and physical activity. These findings provide several potential intervention targets to improve sleep health, particularly in Black adults.

Abstract P231: Are Resiliency and Religiosity/Spirituality Associated With Better Sleep Outcomes in Midlife Latinas?

Background: The disproportionate cardiovascular disease (CVD) burden among Latinas is not completely explained. An important health behavior in CVD prevention is sleep. In the United States (U.S.), Latinas experience unique sociocultural stressors that may impact sleep, particularly in midlife. Yet, little is known about protective factors such as resiliency and religiosity/spirituality among midlife Latinas. Aims: To assess the relation of resiliency and religiosity/spirituality with sleep disturbances in midlife Latinas. Methods: We conducted a cross-sectional analysis using baseline data from 49 participants in a pilot study to reduce CVD risk in midlife Latinas. Participants were Latinas aged 40-60 years who were perimenopausal or early postmenopausal, free of CVD, with no menopause hormone therapy use in the prior three months. Women were recruited from community settings. The frequency of sleep disturbances (trouble falling asleep, waking early, or nocturnal awakenings) over the past two weeks was assessed, and a sum score was created (0-16). The 6-item Brief Resilience Scale was used to assess the perceived ability to “bounce back” or recover from hardship. Religiosity/spirituality was determined by self-report (how important is religion/spirituality to you). Multivariable linear regression models were performed at p<0.15, adjusting for sociodemographic. Results: Participants were on average aged 47.1±4.5 years, 47% had less than a high school education, and 98% were born outside of the continental U.S. Sixty-nine percent of women experienced trouble falling asleep. The mean sleep score was 6.9±4.6. In adjusted models, we found an inverse relationship between resiliency and sleep (ß[SE]= -0.33[0.13],p=0.01). Religiosity/spirituality was not related to sleep disturbances (ß[SE]= 1.15[1.60],p=0.48). Conclusions: In this analysis of midlife Latinas, higher resiliency was associated with poorer sleep. Findings suggest that the ability to “bounce back” after hardship and religiosity/spirituality may not buffer the negative impact of stress on sleep. Further research is necessary with objective sleep measures to identify protective factors for sleep disturbances that may subsequently improve CVD risk in midlife Latinas.

Abstract MP40: Associations Between Meal Timing and Sleep in Older Adults

Introduction: Poor sleep health has been associated with increased risk and worse outcomes for a number of diseases such as cognitive dysfunction, dementia and Alzheimer’s disease. An emerging area of research has highlighted the association between dietary factors and sleep. Meal timing is one aspect of diet that has unclear effects on sleep. Few studies have examined this relationship in older adults, an important distinction because sleep architecture and dietary habits change significantly across the lifespan. By identifying the involvement of meal timing in sleep health, specific behavioral interventions can be developed for older adults with sleep-related morbidity. Hypotheses: We tested the hypothesis that a longer time duration between the last meal of the day and bedtime is associated with positive changes in sleep quality Methods: Forty-six healthy older adults (72% (33 of 46) female, 13% (6 of 46) Black, mean age=70.1 years) recruited from the community in Chicago were included in the analysis. Participants underwent sleep assessment with 7 days of sleep actigraphy, one night of sleep profiler, and sleep questionnaires. Two 24-hour diet recalls within 1 week were administered with the ASA24 tool to evaluate meal timing. The data was analyzed with linear regression models adjusting for age, sex, educational attainment, and BMI. Results: For every 1-hour increase in time from last meal to bedtime, sleep onset latency (SOL) increased by 7.4 minutes (SE=3.0, p=0.019), total sleep time (measured from actigraphy) decreased by 10.6 minutes (SE=4.4, p=0.022), and sleep midpoint was delayed by 17.5 minutes (SE=0.09, p=0.002). Other sleep measures showed no significant associations with time from last meal to bedtime. Conclusions: Meals consumed closer to bedtime were associated with shorter SOL, longer total sleep time, and delayed sleep midpoint in older adults. These findings suggest that meal timing may correlate with sleep, however further investigation with larger sample sizes should be done to clarify this link.

Night-to-night variability of objective sleep outcomes in youth Middle Eastern football players

ObjectiveTo describe components of night-to-night variation in objective measures of sleep. MethodsWe conducted a secondary data analysis of consecutive and chronologically ordered actigraphy-based measurements for time in bed (min), time asleep (min), and wake-after-sleep onset (min). This investigation examined 575 individual night-based measures available for a sub-sample of fifty-two, male youth Middle Eastern football players tracked over a 14-day surveillance period (chronological age range: 12.1 to 16 years). Distinct multivariable-adjusted generalized additive models included each objective sleep outcome measure as dependent variable and disaggregated components of variation for night measurement-by-sleep period interaction, week part (weekday or weekend), and study participant random effects from within-subject night-to-night sleep variation. ResultsThe within-subject standard deviation (SD) of ±98 min (95% confidence interval [CI], 92 to 104 min) for time in bed, ±87 min (95%CI, 82 to 93 min) for time asleep, and ±23 min (95%CI, 22 to 25 min) for wake-after-sleep-onset overwhelmed other sources of variability and accounted for ∼44% to 53% of the overall night-to-night variation. The night measurement-by-fragmented sleep period interaction SD was ±83 min (95%CI, 44 to 156 min) for time in bed, ±67 min (95%CI, 34 to 131 min) for time asleep, and ±15 min (95%CI, 7 to 32 min) for wake-after-sleep-onset that accounted for ∼22% to 32% of each sleep outcome measure overall variability. ConclusionsSubstantial random night-to-night within-subject variability poses additional challenges for strategies aiming to mitigate problems of insufficient and inconsistent sleep that are detrimental to school learning and youth athlete development processes.

Persian version of brief infant sleep questionnaire (BISQ): a psychometric evaluation

BackgroundThe high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population.Methods and materialsThis study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated.ResultsThe CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant’s sleep. All BISQ items were significantly different among the two levels of maternal view about the infant’s sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (rs ranged from 0.59 to 0.72). In addition, the associations of mothers’ and infants’ demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99).ConclusionThe Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants’ sleep problems.

Neurobehavioral Phenotype of Children With Congenital Myotonic Dystrophy.

To describe the neurobehavioral phenotype of congenital myotonic dystrophy. Congenital myotonic dystrophy (CDM) is the most severe form of myotonic dystrophy, characterized by symptom presentation at birth and later, cognitive impairment, autistic features, and disordered sleep. The neurobehavioral phenotype was assessed in this cross-sectional study by a neuropsychological battery consisting of the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Weschler Intelligence Scale for Children, Fourth Edition, Vineland Adaptive Behavior Scale, Second Edition (Vineland-II), Behavior Rating Inventory of Executive Function including preschool and teacher reports, Autism Spectrum Screening Questionnaire, Social Communication Scale, and Repetitive Behavior Scale-Revised. Sleep quality was evaluated with the Pediatric Sleep Questionnaire and Pediatric Daytime Sleepiness Scale. Fifty-five children with CDM, ages 5 weeks to 14 years, were enrolled. The mean age and (CTG)n repeats (±SD) were 6.4 ± 3.8 years and 1,263 ± 432, respectively. The mean IQ was 64.1 ± 14.9 on the Weschler scales with 65.6% of participants falling in the extremely low range for IQ. Adaptive functioning was significantly low for 57.1% of participants (n = 20). Caregiver report of executive functioning indicated 23.1% (9/39) of participants had clinically elevated levels of dysfunction, though teacher report was discrepant and indicated 53.3% of participants with CDM fell in this range (8/15). Spearman correlations were strongly positive (p ≤ 0.05) for estimated full scale IQ, overall adaptive functioning and with daily living and socialization domain standard scores on the Vineland-II ranging from r = 0.719 to r = 0.849 for all ages. Aspects of executive function were directly related to features of autism and sleep quality. Social communication was inversely related to all aspects of daily functioning, except communication, and directly related to aspects of autism behavior. Depressed IQ, adaptive skills, and executive functioning, poor sleep quality, and features of autism and altered social functioning individually describe different aspects of the neurobehavioral phenotype in CDM. These neurobehavioral and sleep measures could help quantitatively measure and assess the burden of cognitive impairment in CDM.

Pain Care at Home to Amplify Function: Protocol Article.

Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.

Tryptophan-kynurenine metabolic pathway and daytime dysfunction in women with HIV.

Sleep disturbances are prevalent in women with HIV (WWH). Tryptophan-kynurenine (T-K) pathway metabolites are associated with alterations in actigraphy derived sleep measures in WWH, although may not always correlate with functional impairment. We investigated the relationship between T-K pathway metabolites and self-reported daytime dysfunction in WWH and women without HIV (WWoH). 141 WWH on stable antiretroviral therapy and 140 demographically similar WWoH enrolled in the IDOze Study had targeted plasma T-K metabolites measured using liquid chromatography-tandem mass spectrometry. We utilized the daytime dysfunction component of the Pittsburgh Sleep Quality Index (PSQI) to assess functional impairment across HIV-serostatus. Lower levels of 5-hydroxytryptophan and serotonin were associated with greater daytime dysfunction in all women. In WWH, daytime dysfunction was associated with increased kynurenic acid (R = 0.26, p < 0.05), and kynurenic acid-tryptophan (KA-T) ratio (R = 0.28, p < 0.01). WWH with daytime dysfunction had a 0.7 log fold increase in kynurenic acid compared to WWH without daytime dysfunction. Kynurenic acid levels and the KA-T ratio were associated with daytime dysfunction in WWH but not in WWoH. Longitudinal studies are needed to establish a causal relationship and directionality between T-K metabolic changes and sleep impairment in WWH.

The effects of physical activity on sleep architecture and mood in naturalistic environments

Physical activity has been found to alter sleep architecture, but these effects have been studied predominantly in the laboratory and the generalizability of these findings to naturalistic environments and longer time intervals, as well as their psychological effects, have not been evaluated. Recent technological advancements in wearable devices have made it possible to capture detailed measures of sleep outside the lab, including timing of specific sleep stages. In the current study, we utilized photoplethysmography coupled with accelerometers and smartphone ambulatory assessment to collect daily measurements of sleep, physical activity and mood in a sample of N = 82 over multi-month data collection intervals. We found a robust inverse relationship between sedentary behavior and physical activity and sleep architecture: both low-intensity and moderate-to-vigorous physical activity were associated with increased NREM sleep and decreased REM sleep, as well as a longer REM latency, while higher levels of sedentary behavior showed the opposite pattern. A decreased REM/NREM ratio and increased REM latency were in turn associated with improved wellbeing, including increased energy, reduced stress and enhanced perceived restfulness of sleep. Our results suggest that physical activity and sleep account for unique variance in a person’s mood, suggesting that these effects are at least partially independent.

Habitual Short Sleep Duration, Diet, and Development of Type 2 Diabetes in Adults

Understanding the interplay between sleep duration, dietary habits, and the risk of developing type 2 diabetes (T2D) is crucial for public health and diabetes prevention strategies. To investigate the associations of type of diet and duration of sleep with the development of T2D. Data derived from the UK Biobank baseline investigation (2006-2010) were analyzed for this cohort study between May 1 and September 30, 2023. The association between sleep duration and healthy dietary patterns with the risk of T2D was investigated during a median (IQR) follow-up of 12.5 (11.8-13.2) years (end of follow-up, September 30, 2021). For the analysis, 247 867 participants were categorized into 4 sleep duration groups: normal (7-8 hours per day), mild short (6 hours per day), moderate short (5 hours per day), and extreme short (3-4 hours per day). Their dietary habits were evaluated based on population-specific consumption of red meat, processed meat, fruits, vegetables, and fish, resulting in a healthy diet score ranging from 0 (unhealthiest) to 5 (healthiest). Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) and 95% CIs for the development of T2D across various sleep duration groups and healthy diet scores. The cohort comprised 247 867 participants with a mean [SD] age of 55.9 [8.1] years, of whom 52.3% were female. During the follow-up, 3.2% of participants were diagnosed with T2D based on hospital registry data. Cox regression analysis, adjusted for confounding variables, indicated a significant increase in the risk of T2D among participants with 5 hours or less of daily sleep. Individuals sleeping 5 hours per day exhibited a 1.16 adjusted HR (95% CI, 1.05-1.28), and individuals sleeping 3 to 4 hours per day exhibited a 1.41 adjusted HR (95% CI, 1.19-1.68) compared with individuals with normal sleep duration. Furthermore, individuals with the healthiest dietary patterns had a reduced risk of T2D (HR, 0.75 [95% CI, 0.63-0.88]). The association between short sleep duration and increased risk of T2D persisted even for individuals following a healthy diet, but there was no multiplicative interaction between sleep duration and healthy diet score. In this cohort study involving UK residents, habitual short sleep duration was associated with increased risk of developing T2D. This association persisted even among participants who maintained a healthy diet. To validate these findings, further longitudinal studies are needed, incorporating repeated measures of sleep (including objective assessments) and dietary habits.

Actigraphic sleep dimensions and associations with academic functioning among adolescents.

There is mixed evidence regarding associations of sleep duration with academic functioning in adolescents and a lack of research on other sleep dimensions, particularly using objective sleep measures. We examined associations of multiple actigraphic sleep dimensions with academic functioning among adolescents. Data were from the sleep sub-study of the age 15 wave of the Future of Families and Child Wellbeing Study (n = 774-782; 52% female), a national, diverse sample of teens. Adolescents wore wrist-actigraphs for ~1 week and completed a survey reporting academic performance and school-related behavioral problems. Regression models assessed whether average sleep duration, timing, maintenance efficiency, and SD-variability were associated with self-reported academic functioning in cross-sectional analyses adjusted for demographic characteristics, depressive symptoms, and anxious symptoms. Later sleep timing (hours) and greater sleep variability (SD-hours) were associated with poorer academic outcomes, including sleep onset variability with higher odds of receiving a D or lower (OR = 1.29), sleep onset (β = -.07), sleep offset (β = -.08), and sleep duration variability (β = -.08) with fewer A grades, sleep offset with lower GPA (β = -.07), sleep offset (OR = 1.11), sleep duration variability (OR = 1.31), and sleep onset variability (OR = 1.42) with higher odds of being suspended or expelled in the past 2 years, and sleep duration variability with greater trouble at school (β = .13). Sleep duration, sleep maintenance efficiency, and sleep regularity index were not associated with academic functioning. Later sleep timing and greater sleep variability are risk factors for certain academic problems among adolescents. Promoting sufficient, regular sleep timing across the week may improve adolescent academic functioning.

Abstract A032: Preliminary evaluation of sleep-related patient-reported outcomes (pros), morningness-eveningness chronotype, &amp; objective sleep measures using smart wearables in a primary brain tumor patient population

Abstract Introduction: Sleep is vitally important for the improvement of cancer outcomes, but evaluation of sleep in the primary brain tumor (PBT) population is limited. This analysis aims to provide preliminary data on the consistency/reliability of sleep-related patient-reported outcomes (PROs) and to assess sleep symptom severity with both PROs and objective sleep measurements. Methods: PBT patients ³ 18 years wore a Fitbit smart-wearable device for 4 weeks, which captured objective sleep measures (total sleep time, sleep latency, nap odds/number/duration, and wake after sleep onset (WASO)). The Morningness-Eveningness Questionnaire (MEQ) was completed at baseline, PROMIS Sleep-Related Impairment (SRI) and Sleep Disturbance (SD) Short-Forms were completed at baseline and at the end of the study, and daily sleep diaries were done during the final week. Descriptive statistics were used to describe patient demographics/clinical characteristics, Cronbach’s alpha to test consistency, McNemar’s tests for change in PRO severity, and Pearson’s correlations for relationships between PROs and objective sleep measures at week 1 and week 4. Results: 54 patients (median 46 years (24-71), 56% male, 85% white non-Hispanic, 81% KPS ≥ 90) completed the study. Most had anaplastic astrocytoma (20%) or glioblastoma (17%), had received radiation therapy (83%), had prior tumor recurrence (32%), and were not on active treatment (80%) during the study. PROMIS SRI/SD and MEQ were all consistent and reliable (Cronbach’s alpha 0.74-0.92). Fifty-six percent of patients had an intermediate sleep chronotype, 35% moderate-morning, 4% definite-morning, and only 6% moderate-evening (0% definite-evening). Moderate-severe SD and SRI were reported in 13% and 17% at baseline, and 4% (p=0.06) and 13% (p=0.69) at study exit. Co-occurrence of SD and SRI decreased from 11% to 2% (p=0.06). Fitbit-recorded measures showed a correlation at week 4 between WASO and SD (r=0.35, p=0.009), and a trend with SRI (r=0.24, p=0.08). Conclusions: This investigation shows initial evidence that sleep-related PROs are consistent and reliable in PBT patients, &amp;gt;10% of participants had significant SD and SRI, and the majority had intermediate and morningness chronotypes. Surprisingly, significant improvement in SD was reported during the study, which may be related to increased awareness of sleep patterns by the participants. Lack of sleep improvement (high SD/SRI) was associated with increased WASO, suggesting greater sleep fragmentation and potentially greater circadian vs. homeostatic sleep drive dysregulation in this population, warranting further investigation. Citation Format: Maeve M. Pascoe, Elizabeth Vera, Hope Miller, Alex Wollet, Dorela Shuboni-Mulligan, Amanda L. King, Terri S. Armstrong. Preliminary evaluation of sleep-related patient-reported outcomes (pros), morningness-eveningness chronotype, &amp; objective sleep measures using smart wearables in a primary brain tumor patient population [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A032.

Perinatal anxiety disorders screening study: a study protocol

BackgroundThe anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD.MethodsA large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks’ gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive–compulsive disorder, and posttraumatic stress disorder.DiscussionThis research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.

Reducing crash risk for young drivers: Protocol for a pragmatic randomised controlled trial to improve young driver sleep

BackgroundRoad trauma is a leading cause of death and disability for young Australians (15–24 years). Young adults are overrepresented in crashes due to sleepiness, with two-thirds of their fatal crashes attributed to sleepy driving. This trial aims to examine the effectiveness of a sleep extension and education program for improved road safety in young adults. MethodsYoung adults aged 18–24 years (n = 210) will be recruited for a pragmatic randomised controlled trial employing a placebo-controlled, parallel-groups design. The intervention group will undergo sleep extension and receive education on sleep, whereas the placebo control group will be provided with information about diet and nutrition. The primary outcomes of habitual sleep and on-road driving performance will be assessed via actigraphy and in-vehicle accelerometery. A range of secondary outcomes including driving behaviours (driving simulator), sleep (diaries and questionnaire) and socio-emotional measures will be assessed. DiscussionSleep is a modifiable factor that may reduce the risk of sleepiness-related crashes. Modifying sleep behaviour could potentially help to reduce the risk of young driver sleepiness-related crashes. This randomised control trial will objectively assess the efficacy of implementing sleep behaviour manipulation and education on reducing crash risk in young adult drivers.

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

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

Comparison of actigraphy with a sleep protocol maintained by professional caregivers and questionnaire-based parental judgment in children and adolescents with life-limiting conditions

BackgroundActigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics.MethodsIn this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures’ concordance.ResultsDescriptively, and except for the number of waking episodes, the different measures’ estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02).ConclusionAgreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.

Bidirectional Associations Between Loneliness, Emotional Support, and Sleep in Daily Life.

Evidence suggests a link between positive social relationship perceptions and improved sleep (e.g., quality, efficiency) across the life span. Less work has probed the directionality of these relationships. Here, we report findings from the first study to examine bidirectional between- and within-person associations between loneliness and emotional support with daily life measures of sleep. Participants were 389 healthy adults aged 40 to 64 years (61% female) who completed hourly surveys assessing loneliness and perceptions of emotional support over the course of 4 days. Measures of actigraphy-assessed sleep and nightly sleep quality were also assessed for 7 to 10 days. Individuals with lower average daily loneliness showed higher sleep quality and efficiency than individuals with higher loneliness (r = -0.19, p < .001; r = -0.14, p = .008, respectively), and greater average emotional support was likewise linked with better sleep quality (r = 0.18, p < .001). Controlling for neuroticism attenuated the effects of average loneliness on sleep. Within-person analyses showed unexpected bidirectional effects. Specifically, days in which people felt relatively lonelier were followed by nights with greater sleep efficiency (γ = 1.08, p = .015), and nights when people reported relatively poorer sleep quality were followed by days with greater emotional support (γ = -0.04, p = .013). These unexpected findings are probed in exploratory analyses. Individuals with higher loneliness and lower emotional support report poorer sleep quality and efficiency, on average. Day-to-day fluctuations in perceptions of social relationships may affect the following night's sleep, and vice versa.

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.

Effects of Auriculo-Acupuncture on Sleep and Emotional Stress in Hispanic Immigrants: A Small Randomized Clinical Trial.

Objectives: To investigate whether Hispanic immigrants with sleep disturbance showed improvements with auriculo-acupuncture mediated by emotional stress. Design: Single-blind randomized clinical trial. Settings/Location: Community. Subjects: Sixteen Hispanic male (N = 4) and female (N = 12) volunteers. Interventions: Bi-weekly intervention for eight total treatments of National Acupuncture Detoxification Association (NADA) auriculo-acupuncture or sham. Outcome Measures: Emotional distress and sleep measures were completed Baseline, Mid- (four treatments), and Follow-up (eight treatments). Comparisons between Groups and within sessions using Mixed-Model ANOVA; linear regression assessed emotional stress and sleep association. Results: Significant within-subjects effect of Session (p's <.05) with significant differences Baseline/Mid-Way and Baseline/Final (p's <.05). Linear Regression showed significant positive associations at Baseline. Conclusions: Community auriculo-acupuncture may improve sleep and emotional stress in Hispanic immigrants.