Poor Sleep Health Research Articles

0284 Sleep Health in Latino Day Laborers: Occupational Health and Wellbeing

Abstract Introduction Little is known about the sleep health of Latin(x) day laborers. Existing research demonstrates that they experience precarious employment, low wages, and hazardous working conditions. Recent studies also show that periods of unemployment and psychosocial stressors, such as financial insecurity, have been associated with worsened mental health outcomes and poor sleep health. Our investigation brings these insights together in order to understand how sleep health impacts well-being in the workplace and how precarious work, such as day labor, impacts sleep, contributing to health disparities. Methods This was a mixed-methods study in which twenty participants were recruited using purposive sampling from a worker center run by the Austin Public Health Department and an informal hiring site. Participants were male, over 18 years of age, of Latin(x) ethnicity, who reported problems with sleep. All completed a semi-structured interview with validated sleep questionnaires. Interviews were audio-recorded, transcribed, and thematically coded. Results Most workers were between 30 - 44 years of age, of Mexican ethnicity, and worked in construction. Workers reported poor sleep quality with an average of 5.6 hours of sleep at night. Eighty-five percent (n=17) had problems with either clinically significant insomnia (Insomnia Severity Index ≥ 15), daytime sleepiness (Epworth Sleepiness Scale ≥ 10), or both. In addition, 50% reported either moderate or severe anxiety or depression. Most agreed (80%) that poor sleep affected their quality of life. Regarding work performance, 50% found themselves not concentrating enough on their work two or more times a week. Common themes included: (1) lack of routine and unpredictability of work schedule (2) poor sleep habits and coping mechanisms (3) negative impact of fatigue on work routine and relationships (4) belief that sleep would improve unaided and (5) willingness to seek behavioral health interventions for sleep concerns. Conclusion Our results indicate that study participants experience short sleep duration and insomnia in conjunction with high levels of anxiety and/or depression. Participants linked these with unpredictable work schedules, stress, and financial difficulties. However, many were interested in receiving a clinical behavioral intervention to improve their sleep. Support (if any) This work was supported in part by BSM PRIDE Institute SRP funding from NHLBI (R25HL105444).

0817 Associations between Sleep Health and Injuries among Adults in the US: Findings from the National Health Interview Survey

Abstract Introduction In 2020, 55.4 million Americans sought medical attention due to nonfatal, preventable injuries. Injury-related death rate was 15.7% higher than in 2019. Poor sleep health is associated with increased risk of injuries (e.g., falls, sports, and motor vehicle-related injuries). This study examined the associations between sleep health and injuries among adults (≥18 years). Methods This study utilized the 2020 National Health Interview Survey (n=31,568). The primary outcome encompassed sustained bodily injuries in the past 3 months. Secondary outcomes were fall-related, sports-related, and motor vehicle (MV)-related injuries. Sleep health in the past month was measured via 1) sleep quantity: very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours); 2) sleep quality: trouble falling asleep and trouble staying asleep; 3) feeling well-rested upon waking-up; and 4) sleep medications. Response categories included never, some days, most days, or every day. Adjusted multivariable logistic regression was used to examine associations between injuries and these four domains of sleep health. Results Overall, 9.1% of respondents sustained an injury. Among injured adults, 47.4% had fall-related injuries, 29.1% had sport-related injuries, and 6% had a MV-related injury. Adults with very short, short, and long sleep were 37%, 15%, and 22% more likely to be injured than adults with healthy sleep (p< 0.05). Adults with trouble staying asleep were 36% more likely to be injured than adults who never had trouble staying asleep (p< 0.01). Adults who woke up never rested or rested on some days were 49% and 36% more likely to be injured (p< 0.01) Adults who took medications for sleep on some days or every day were 24% and 36% more likely to be injured (p< 0.05; p< 0.001). Adults who had trouble staying asleep some days were 22% more likely to have a fall-related injury (p< 0.05). Respondents with long sleep were 43% less likely to have sports-related injuries (p< 0.05). Those who had trouble staying asleep were 3.5 times more likely to have experienced a MV-related injury (p< 0.01). Conclusion Sleep health is strongly associated with injuries among adults. Further studies are needed to determine causality in the observed associations. Support (if any)

0132 The role of stress in the association between neighborhood environment and sleep

Abstract Introduction Adverse neighborhood characteristics have been associated with poor sleep health. However, the mechanisms through which the neighborhood environment influences sleep are not completely understood. We examined the role of perceived stress in the association between neighborhood environment and sleep. Methods Between 2010 and 2013, 2,001 Multi-Ethnic Study of Atherosclerosis (MESA) participants completed the Neighborhood and Sleep Ancillary studies. Neighborhood aesthetic quality and neighborhood social environment were measured among MESA participants and an independent sample of individuals living in the same neighborhood (defined as census tracts) using survey-based methods and geographic information systems at the census tract level. Responses from MESA participants and neighborhood informants were aggregated at the neighborhood level using empirical Bayes estimation to improve reliability and precision. MESA participants completed 1-week wrist actigraphy, yielding measures of average sleep duration and sleep efficiency. Stress was measured using the 4-item Perceived Stress Scale. Multi-level linear regression models were fit to examine associations between neighborhood aesthetic quality or social environment, perceived stress, and sleep duration or efficiency. Results The average age of the study population was 68.5 years (standard deviation [SD]=9.10), and 54% were women. The average sleep duration and sleep efficiency were 388.9 minutes (SD=80.8) and 89.8% (SD=3.7), respectively. A SD increase in neighborhood aesthetic quality or social environment was associated with 6.02 (95% CI 1.89, 10.14) and 6.96 (95% CI 2.92, 11.00) minutes longer sleep duration, respectively, after adjusting for age, gender, race/ethnicity, study site, and socioeconomic and behavioral factors. Further adjustment for perceived stress attenuated the associations by 2.9-3.6% (neighborhood aesthetic quality: 5.80, 95% CI 1.68, 9.92; neighborhood social environment: 6.76, 95% CI 2.72, 10.80). Neighborhood environment and perceived stress were not associated with sleep efficiency. Conclusion Perceived stress had a modest 2.9-3.6% reduction in the association of neighborhood environment and sleep duration, thus suggesting a partial mediation. Future longitudinal studies with formal mediation analysis are needed to confirm these findings. Support (if any) Support for MESA is provided by the National Heart, Lung, and Blood Institute and contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881, and DK06349. MESA Sleep exam was supported by grant HL098433.

0367 Urban Stress and Sleep Health by Proximal Neighborhood Groups in Washington, DC

Abstract Introduction African Americans are disproportionately affected by environmental factors that increase the risk for negative health outcomes. Analyses from National Health Interview Survey (NHIS) data estimated 15 to 75 percent of the disparities between Black and White respondents being accounted for by residential context. Poor sleep health, particularly short sleep duration, has been linked to metabolic and cardiovascular disease. A population study indicated that sleep duration of less than 6 hours was more common among African Americans compared with other racial groups in the United States and this association was accounted for by African Americans living in high density urban environments. Threats of violence may engender feelings of vulnerability when sleeping and be an important determinant of sleep health though this relationship has not been adequately studied. The aim of this study is to determine how an individual’s sleep health relates to violent crime rates in their neighborhood of residence as well as indicators of neighborhood stress endorsed in a self-reported survey. Methods African- American men and women between the ages of 18-35 filled out the insomnia severity index (ISI) and city stress inventory (CSI). Sleep duration and sleep efficiency were obtained through home-based actigraphy. Participants were categorized as poor sleepers if two out of three criteria were met: sleep duration of less than six hours, ISI greater than 10, and sleep efficiency below 85%. Participants addresses were linked to one of the 51 proximal neighborhood groups (PNG) defined by the DC Department of Health and Office of Planning using MAR geocoder and QGIS mapping software. Violent death rates and other social health determinants are indicated by PNG in the DC DOH’s Health Equity Report (2019). Results Sleep measures were not correlated with neighborhood violent death rates (Pearson r’s: .05 - .17; all NS). SE and TST were weakly correlated with CSI scores (both r’s = -.22, NS). Conclusion The negative findings may be related to sample size, the presence of threat and crime in all of the locations, and the importance of individual coping. Support (if any) NIHLB grant R01HL136626 to Dr. Thomas A. Mellman and NCATS grant for a Clinical Translational Science Award UL1-TR001409.

0293 Sleep Health in America: Update from the National Sleep Foundation’s 2022 Sleep Health Index®

Abstract Introduction Sleep is a crucial measure of health and wellbeing. Individuals with good sleep health tend to have better physical, emotional, cognitive, and social functioning than individuals with poor sleep health. The National Sleep Foundation developed the Sleep Health Index® (SHI) in 2016 as a means to monitor the sleep health of the general population. Since its inception, the National Sleep Foundation has administered the SHI annually to a representative sample of the US population. This study reports on the 2022 SHI and examines US population trends in sleep health from 2019 through 2022. Methods The SHI is a valid, reliable measure consisting of 16 questions related to the three discrete constructs of sleep duration, sleep quality, and disordered sleep. In 2022, the SHI was administered to a nationally representative, random sample of 1,042 Americans via the probability-based Ipsos KnowledgePanel®, in which panelists complete surveys online in English or Spanish. Results have a margin of sampling error of 3.2 points. We examined sleep health trends from 2019 through 2022 and examined whether sleep health in 2022 differed from previous years. Group differences in sleep health were also investigated. Results Americans’ average SHI score in 2022 was 75 (on a 0–100 scale), which is consistent with SHI scores observed in previous years. The SHI total score was statistically highest among college graduates, Hispanic adults, and people with household incomes of $100,000+ a year and statistically lowest among those with household incomes less than $50,000. Despite stable SHI total scores, there were statistically significant declines in both average weekday sleep scores (76 in 2021 to 71 in 2022) and in sleep deficit scores (86 in 2021 to 82 in 2022), which are based on the difference between weekday sleep and the amount of sleep respondents say they need to be well-rested and feel their best. Conclusion While overall sleep health remained stable, weekday sleep duration and sleep deficit worsened considerably as pandemic-related restrictions came to an end. The sociocultural and political contexts in which sleep health occurs, as well as associated features, like mental and physical health, deserve further consideration. Support (if any)

0288 Multidimensional Sleep Health and Cognitive Function in Retired Night Shift Workers and Retired Day Workers

Abstract Introduction Night shift work is associated with compromised cognitive function, and with chronic exposure, may place shift workers at elevated risk for dementia. Given that former night shift workers experienced prior long-term sleep and circadian rhythm disruption, their sleep in retirement—after returning to a daytime schedule—may be particularly salient for cognitive function. This study examined associations between multidimensional sleep health and neurocognitive function among retired night shift workers and retired day workers. Methods Participants (N = 61; mean age: 67.9 +/- 4.7 years; 61% females; 13% non-Hispanic White) were 31 RDW and 30 RNSW equated on age, sex, race/ethnicity, premorbid IQ, and years in retirement. Multidimensional sleep health was quantified using wrist actigraphy measures of sleep efficiency, timing, duration, and regularity, and diary measures of alertness and satisfaction. Each component was dichotomized and summed to create a composite score (0-6); higher values indicated better sleep health. Participants completed a neurocognitive battery assessing six cognitive domains (language, visuospatial ability, attention, immediate and delayed memory, executive function) and self-reported cognitive function. Linear regression models tested associations of multidimensional sleep health and its individual components with cognitive domains in each group, adjusting for age, sex, and education. Results Retired night shift workers and retired day workers did not differ on multidimensional sleep health or its individual components. Among retired night shift workers, poorer multidimensional sleep health was associated with poorer self-reported global cognitive function (beta = 0.51, p = .018), and more irregular sleep timing was associated with poorer self-reported memory (beta = 0.41, p = .054). Multidimensional sleep health and its individual components were unrelated to cognitive function in retired day workers. Conclusion Retired night shift workers may be cognitively vulnerable to poor sleep health in retirement, possibly due to a history of long-term sleep and circadian rhythm disruption while working. Given that self-reported cognitive difficulties often precede more objective cognitive changes, future research should determine whether associations of sleep health with cognitive function are found in more objective cognitive measures as retired night shift workers age. Support (if any) R01AG047139, R01AG047139-S1, K01AG075171

0239 Perceptions of Sleep Health among Black Americans: Recommendations for Improving Sleep

Abstract Introduction Despite African Americans having a high prevalence of poor sleep health, the determinants remain understudied. Sleep disparities research mainly examines quantitative data, with little attention to qualitative data, which can inform targeted interventions. We aimed to qualitatively identify 1) perceptions of sleep; 2) facilitators/barriers to healthy sleep; and 3) preferences for receiving sleep recommendations in a socioeconomically diverse sample of African Americans. Methods Participants (N=36 individuals divided into 11 groups) attended online focus groups and discussed the following topics: attitudes and beliefs about sleep, facilitators and barriers to sleep, and knowledge and attitudes about sleep recommendations. Self-reported sleep was measured via the Pittsburgh Sleep Quality Index. The focus group data were analyzed using a rapid analytic approach. Results The sample had a mean age of 34 (13.1), and 64% identified as female. The overall prevalence of poor sleep quality, short sleep duration, and long sleep duration was 39%, 24%, and 15%, respectively. Participants defined healthy sleep as a matter of quality over quantity and waking up feeling well-rested. Women, men, and gender non-conforming individuals reported average sleep durations of 6.3 hours, 5.9 hours, and 8 hours, respectively. Women, but not men or gender non-confirming individuals reported disturbed mood because of poor sleep. Regardless of gender, participants reported anxiety, stress, and daily responsibilities such as work, taking care of family, and sudden changes in plans as barriers to healthy sleep. A subset of respondents (25.5%) reported screen time and feeling unsafe as barriers. Men and women reported listening to music, aromatherapy, relaxing, and limiting phone use before bedtime as facilitators to healthy sleep. Men preferred information on how to achieve and maintain deep/quality sleep, whereas women preferred more personalized information on sleep and the sleep-mental/physical health relation. Social media was generally the preferred avenue for receiving sleep recommendations. Conclusion Mood, stress, screen time and lack of safety were identified barriers to healthy sleep patterns. Participants were interested in strategies for improving sleep health. Future studies should consider targeting relaxing bedtime routines and enhanced safety as sleep interventions. Support (if any) National Institutes of Health, National Institute for Heart Lung and Blood 1R01HL157954 and K01HL138211.

0079 Subjective-Objective Sleep Discrepancy in Older Adults: Does Cognitive Functioning Matter?

Abstract Introduction Differences between subjective and objective sleep [subjective-objective sleep discrepancy (SOSD)] is prevalent in insomnia and older adults. Despite associations between cognition and sleep parameters, the impact of cognitive functioning on SOSD is unclear. We examined associations between various cognitive domains and SOSD in older adults and whether insomnia status moderates these associations. Methods Older adults with (N=47, Mage=68.85, 66% women) and without (N=32, Mage=67.41, 78% women) insomnia [met DSM-5 criteria plus reported >30 mins sleep onset latency (SOL) and/or wake time after sleep onset (WASO) on 3+nights/7] completed measures of subjective sleep (7-days of sleep diaries), objective sleep (one-night polysomnography, PSG), and objective cognitive tasks: Dimensional Change Card Sort (executive functioning, EF), List Sorting (working memory, WM), Auditory Verbal Learning Test (episodic memory), Flanker (inhibitory control), Pattern Comparison (processing speed). SOSD direction (average sleep diary variable – PSG variable) was computed. Moderated regressions determined independent and interactive (with insomnia status) associations between cognitive performance and SOSD for SOL, WASO, total sleep time (TST) and sleep efficiency, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Results For insomnia, longer self-reported than PSG TST was associated with better WM (b=27.90, SE=9.05, p=.003, episodic memory (b=12.83, SE=2.77, p=.01), processing speed (b=9.50, SE=2.00, p<.01), and inhibitory control (b=118.40, SE=54.09, p=.03). Similarly for insomnia, better self-reported than PSG sleep efficiency was associated with better WM (b=5.58, SE=2.12, p=.01), episodic memory (b=2.66, SE=1.08, p=.02), and processing speed (b=2.11, SE=0.47, p<.01). For non-insomnia, reports of SOSD were not associated with cognitive functioning (ps>.05). Conclusion Better diffuse cognitive functioning may be a contributing SOSD mechanism in older adults with insomnia. We speculate that better cognitive functioning may suppress cognitive arousal symptoms that are prevalent in insomnia patients, leading to better self-reported sleep relative to what is objectively measured. Prospective studies examining independent and interactive associations between cognition functioning and arousal, and insomnia on SOSD may inform underlying mechanisms of poor sleep health and the temporal impact on cognition. Support (if any) This research project was made possible by awards (PI: Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.

0501 Manganese and sleep health outcomes in U.S. adults: analysis of the NHANES 2017-2020

Abstract Introduction Manganese (Mn) is an essential trace mineral required for normal growth and physiological processes. However, inadequate or excess Mn can have a detrimental impact on human health. Despite the essentiality, little is known about the relationship between Mn and sleep. The objective of this study is to examine the relationships between blood Mn levels and sleep patterns (duration, midpoint of sleep, obstructive sleep apnea [OSA] symptoms, and trouble sleeping) in U.S. adults. Methods Data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) was used for the analysis. Adults aged 18 or older with both blood Mn levels and sleep parameters were included (n=8356). Self-reported fall asleep time and wake up time in the past week were used to calculate sleep duration and midpoint. Trouble sleeping and symptoms of OSA were also collected. Blood Mn levels were divided into quintiles for analysis. Multivariable logistic regressions that accounted for complex study design were used. Results The mean (SE) blood Mn concentration was 9.7 (0.1) µg/L, and was higher among participants who were younger, female, identified as non-Hispanic Asian, had lower income, were non-smokers, and had lower iron levels (P< 0.05, for all). About 25% of adults had short sleep duration (< 7 hours) on weekdays. OSA symptoms were noted in 49% of adults. In men, the odds of short sleep duration on weekdays were higher among those with the lowest Mn level (Q1: < 7.0 µg/L) than the reference group (Q3: 8.5-10.0 µg/L) after adjusting for age, race, income, smoking, and iron (OR: 1.5, 95% CI: 1.1-2.1, P=0.03). Among women, Q2 (7.0-8.4 µg/L) was the related to the lowest odds of OSA symptoms compared to all other groups after adjusting for covariates (P=0.049). Conclusion Lower or higher Mn levels in blood were related to poor sleep health in U.S. adults, which suggests that inadequate or excessive Mn intake might be harmful to sleep. Future studies on the mechanisms of these relationships are needed. Support (if any) This work was supported by National Institutes of Health R01DK123022, R21NS112974 to YAS, and K01HL151673 to ECJ.

Sleep Disparities Across Pregnancy: A Michigan Cohort Study.

Poor sleep health during pregnancy is related to adverse pregnancy outcomes. This study aims to identify sociodemographic characteristics associated with sleep health during pregnancy and to examine how they relate to changes in sleep during pregnancy. Participants (n = 458) were from the Michigan Archive for Research on Child Health, which is a prospective pregnancy cohort. Sociodemographic characteristics and self-reported sleep timing and quality were collected in phone interviews. This longitudinal study collected sleep parameters once during the early trimesters and once during the third trimester. Fall asleep and wake-up times were used to calculate sleep duration and sleep midpoint. Compared to the third trimester, sleep duration was 12 minutes longer (p = 0.02), fall asleep time was 21 minutes earlier (p < 0.001), and the midpoint of sleep was 12 minutes earlier (p = 0.01) in early trimesters. Shorter sleep duration was noted in younger women. Sleep midpoint was later in those who were younger, overweight, or obese, racial minorities, unmarried, and with lower educational levels or socioeconomic status, and who smoked before pregnancy after adjusting for covariates. After controlling for confounders, women who were not working for pay had higher likelihood of reduced sleep duration, and women who were unmarried were more likely to have a delayed sleep midpoint in the third trimester compared to the early trimesters. This study suggests that sleep parameters changed during pregnancy and sleep health differed by sociodemographic characteristics. Understanding sleep disparities could help with early detection of at-risk populations during prenatal care.

0933 Sleep Specialists in Federally Qualified Health Centers: A Gap in Sleep Health Care Potentially Contributing to Sleep Disparities

Abstract Introduction Poor sleep is associated with adverse cardiometabolic health outcomes and increased risk of mortality. Although primary care providers recognize the importance of sleep, they report low comfort levels in diagnosing, treating, and managing sleep disorders; lack of clinical knowledge and skills is the most common barrier to recognizing insomnia in family practice. Furthermore, minoritized racial/ethnic groups are disproportionately affected by poor sleep health, likely due in part to structural and other forms of racism that result in limited access to sleep healthcare. Health Resources &amp; Services Administration (HRSA) has a variety of awards that support scholarships and loan repayment programs at colleges and universities to meet critical workforce shortages and diversify the health professions. We assessed the distribution of sleep specialists among clinicians who participated in a HRSA grant program because they tend to work for health care organizations that serve persons from lower socioeconomic and diverse racial-ethnic backgrounds. Methods Publicly available data were obtained from the HRSA data warehouse. Data were available for 44,199 clinicians (49% MD/DO and 16% Nurse Practitioner) who participated in a HRSA grant program between 2011 and 2021. We report data for those clinicians who endorsed sleep medicine as their subspecialty. Results Of the 44,199 clinicians, 27 (0.06%) physicians trained in a medical subspecialty of sleep medicine, and the majority (52%) were in Michigan. The remainder of sleep medicine specialists completed their program in Pennsylvania (33%), Ohio (7%), Minnesota (4%), and California (4%). Only the participants in the Children's Hospital Graduate Medical Education program designated their subspecialty as sleep medicine. None of the sleep medicine specialists currently practice in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas/Populations (MUA/P), and 1 physician currently practices in a rural area. Conclusion A marked paucity of trained sleep specialists in HRSA grant programs and an absence of such practitioners in HSPAs underscores the disparities in access to sleep specialty care. Initiatives are needed to incentivize sleep specialists to serve in under-resourced communities as well as to implement programs training primary care practitioners working in these areas to deliver sleep health care, supported by sleep specialists. Support (if any) Divisions of Intramural Research: NIMHD/NIEHS, NIH

0722 Sleep disturbances and subsequent mobility disability in chronic disease: Findings from the Nurses’ Health Study

Abstract Introduction Impaired mobility is the leading cause of disability in the U.S. Across chronic neurological, metabolic, and musculoskeletal conditions, mobility reductions are observed beyond expected effects of aging. Poor sleep health may be one common factor that drives accelerated reduction in mobility among people with chronic conditions. This study compared longitudinal associations between self-reported sleep disturbances and mobility disability progression among women with and without multiple sclerosis (MS), diabetes, and osteoarthritis (OA). Methods This prospective cohort study used data from four waves of the Nurses’ Health Study (2008, 2012, 2014, 2016). Logistic regression and the Kaplan-Meier method were used to quantify associations between baseline sleep-related variables and subsequent increase in mobility disability. Results Of 70,303 women (mean age 73), 392 had MS, 7,302 had diabetes, and 24,099 had OA. Between 2008-2016, mobility disability increased in 16.9% of the sample overall, 27.8% in the MS subgroup, 27.0% in the diabetes subgroup, and 23.7% in the OA subgroup. Between 2008-2016, known/suspected OSA was significantly associated with increased mobility disability in the overall sample (OR:1.4, 95%CI:1.2,1.5), and within the diabetes (OR:1.5, 95%CI:1.2,1.9) and OA subgroups (OR:1.2, 95%CI:1.0,1.4), but not the MS subgroup (OR:2.3, 95%CI:0.6,8.9); however, across 2012-2016, this association was significant for MS (OR:4.0, 95%CI:1.0,16.1). Suboptimal sleep duration was significantly associated with increased odds of mobility disability progression in the overall sample, but not within disease subgroups. Conversely, perception of adequate sleep was significantly associated with lower odds of mobility disability progression overall (OR:0.82, 95%CI:0.78,0.87) and for the OA subgroup (OR:0.83, 95%CI:0.76,0.91). Excessive daytime sleepiness was significantly associated with mobility disability progression overall (OR:1.2, 95%CI:1.1,1.4) and for the OA subgroup (OR:1.2, 95%CI:1.0,1.4). Conclusion Prevalent sleep disturbances could increase risk of disability progression among women, particularly in common chronic disease populations. Informed by these data, future research could offer new insight into sleep-based strategies to ameliorate mobility decline. Support (if any) This work was supported in part by a Michigan Institute for Clinical and Health Research Pilot Grant (UL1TR002240). Dr. Shieu was supported by a T32 grant from National Heart, Lung, and Blood Institute (T32HL110952).

0016 Influence of Circadian Preference on Sleep, Depression, and Anxiety in Canadian Student-Athletes

Abstract Introduction Student-athletes face unique demands that heighten vulnerability to both sleep and mental health problems. Circadian preference (CP) describes an individuals’ preferred timing for sleep and wake activity, with this conceived as a continuum between the extremes of morningness and eveningness. CP has been shown to influence both sleep and mental health, with greater eveningness preference generally associating with worse outcomes. However, these relationships are understudied in student-athletes. Thus, this investigation was designed to assess the influence of CP on sleep, depression, and anxiety in Canadian student-athletes. Methods Data were obtained throughout the academic semester from Canadian institutions, with student-athletes completing the Athlete Sleep Screening Questionnaire (ASSQ), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire (PHQ-9). ASSQ captured sleep health characteristics and CP, while GAD-7 and PHQ-9 assessed anxiety and depressive symptoms, respectively. ASSQ CP response options were Definitely-Morning, Morning, Evening, or Definitely-Evening as response options, and was coded on a 0-3 scale, with higher values representing increasing eveningness preference. Linear regression estimated associations of CP with sleep, depression, and anxiety. Adjusted regressions controlled for age, gender, race/ethnicity, and sport type. Results Sample included 559 Canadian student-athletes (Average Age = 18.9 ± 3.21 years; Percentage Women = 53%; Percentage White = 79.1%) from eight different sports. Regarding CP, 11.4% reported Definitely-Morning, 27.0% reported Morning, 41.8% reported Evening, and 19.8% reported Definitely-Evening. Greater eveningness preference significantly associated with worse overall sleep difficulties (padjusted &amp;lt; 0.0001), longer sleep latency (padjusted &amp;lt; 0.0001), reduced sleep satisfaction (padjusted &amp;lt; 0.0001), more prolonged sleep inertia (padjusted &amp;lt; 0.0001), more daytime naps (padjusted = 0.01), and more severe depressive symptomatology (padjusted = 0.0006). Conclusion Greater eveningness in a sample of Canadian student-athletes associated with worse sleep and psychological characteristics, including overall sleep difficulty, sleep latency, sleep satisfaction, sleep inertia, daytime napping, and depressive symptom severity. The results of this study provide compelling evidence that eveningness CP may predict poor mental and sleep health outcomes in student-athletes. Thus, further attention to circadian characteristics of student-athletes is warranted. Additionally, modifications to training schedules and team routines could be considered as preventative strategies for mental and sleep health problems. Support (if any) Mitacs #IT23469

0098 Prenatal Maternal Sleep Quality Predicts Neonatal White Matter Microstructure and Infant Negative Emotionality

Abstract Introduction Poor prenatal sleep health is a pervasive reproductive health concern that informs the health of the mother and fetal development. Despite the almost ubiquitous nature of sleep disturbances across pregnancy, sleep health within pregnant populations, and its effects on the next generation, remain poorly studied. We recently showed that prenatal maternal sleep quality predicts newborn hippocampal volume. However, the relation between prenatal sleep quality and neonatal neural circuit development remains unknown. Changes in neonatal white matter microstructure presage compromised socioemotional and cognitive health, including the development of psychopathology and neurocognitive disorders, making it a plausible neurobiological pathway linking prenatal maternal sleep and offspring socioemotional health. This study first examined the relations between trajectories of prenatal maternal sleep quality and subsequent neonatal white matter integrity. We next evaluated whether neonatal white matter integrity partially mediates associations between prenatal sleep and infant negative emotionality. Methods Pregnant participants (n = 116) provided prospective and longitudinal data of prenatal maternal sleep quality at 16, 29, and 35 gestational weeks using the Pittsburgh Sleep Quality Index. Neonatal (53% female) white matter integrity was assessed via diffusion weighed images using magnetic resonance imaging (MRI). Infant negative emotionality was collected at 6 postpartum months using the Infant Behavior Questionnaire. Results Trajectories of prenatal maternal sleep quality predicted higher bilateral neonatal fractional anisotropy (FA) in the uncinate fasciculus (e.g., right: b = 0.15, p = .023). Further, higher uncinate FA predicted more infant negative emotionality (e.g., right: b = 0.25, p = .011) and uncinate FA partially mediated the association between prenatal maternal sleep and infant negative emotionality (right: indirect effect = 0.014, CI = [.0001, .0323], p &amp;lt; .05). Associations remained after covarying for infant postconceptional age at MRI, motion in MRI scan, sex, and income-to-needs ratio. Conclusion These findings highlight prenatal maternal sleep health as a prenatal signal with intergenerational connections to offspring neurobiology and negative emotionality, both of which have been previously implicated in the development of psychopathology. Pregnancy is a sensitive period in which interventions may inform the health of two generations. Support (if any) NIMH R01MH109662, NHLBI R01HL155744, and diversity training supplement for 1st author; F32MH125572 for 2nd author.

0092 Barriers and facilitators of sleep health in family caregivers of persons living with dementia: A qualitative study

Abstract Introduction Family caregivers of persons with dementia (PLwD) commonly report poor sleep health. Existing effects of sleep interventions are mixed and may not have addressed unique issues experienced by caregivers of PLwD. Understanding the barriers and facilitators to get a good night's sleep for these caregivers is imperative for developing acceptable and effective interventions to improve sleep health in this population. Methods This was a secondary data analysis that used a qualitative descriptive design and aimed to explore sleep characteristics and experiences in family caregivers of PLwD. The current study used the same study design to explore barriers and facilitators of good sleep. Using a semi-structured interview, 19 family caregivers of PLwD who provided unpaid caregiving &amp;gt; 4 hours a day with insomnia symptoms (Insomnia Severity Index &amp;gt; 5) participated in this study. Interviews were audio-recorded and transcribed verbatim. Codes and themes were identified. Results Caregivers, on average, were 64 years old and primarily female (57.9%), Caucasian (68.4%), and spouses (78.9%). In general, caregivers of PLwD reported that the caregiving role negatively influenced and changed their sleep. Themes associated with barriers to good sleep included 1) PLwD’s sleep problems, including a need for increased vigilance for the PLwD, 2) stress associated with balancing work and family responsibilities with caregiving, and 3) caregiver's sleep problems, such as the use of CPAP, having a history of sleep problems before the caregiving role, and changes of sleep patterns with aging. Participating in regular exercise and practicing mindfulness activities (e.g., breathing, meditation or yoga) were themes associated with facilitators of good sleep. Maintaining good sleep hygiene habits (e.g., no caffeine and no daytime naps) and avoiding bad sleep hygiene habits (e.g., watching TV in the bedroom or using an electronic device in bed) were also identified as facilitators of good sleep. Conclusion Caregivers of PLwD reported poor sleep but identified multiple modifiable factors that could be used for interventions to improve sleep. These interventions can be at individual, dyadic, or family levels to best impact caregivers’ sleep. Support (if any) This study was supported by a research supplement to support diversity in health-related research awarded to Glenna Brewster (R01AG054079, PIs: Hepburn/Griffiths)

Respiratory Health, Sleep Dysfunction, and Mental Health in Children and Adolescents With a Neuromuscular Disorder: A Descriptive Qualitative Study

Objectives: To explore how respiratory health and sleep problems affect mental health in children and adolescents with neuromuscular disorders (NMDs).Methods: A qualitative descriptive study was carried out with content analysis of in-depth interviews conducted with children with NMDs and their parents. Data were collected during semi-structured interviews with children with NMDs and their parents. A total of 14 families were recruited (17 parents and 7 children and adolescents with NMD aged 5–17 years). Each interview was conducted with 1–3 family member(s).Results: Engagement in community activities, meaningful relationships, feeling well, and achieving independence each contributed positively to children’s mental health. Additional challenges to mental health during periods of poor respiratory and/or sleep health included: 1) challenges to behavioral regulation, 2) changes to mood, and 3) challenges to thinking. Parents and children reported nurturing and coping self-management strategies when their physical and mental health were dually challenged in addition to medical management strategies such as non-invasive ventilation (NIV).Conclusions: This study supports the notion that changes in mental health may indicate poor physical health in children with NMDs. Treating respiratory and sleep problems, such as by early NIV implementation, may improve the mental health of children with NMDs and thus support their overall wellbeing and health outcomes.

Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States.

Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth. This study analyzed data of 32,212U.S. youth (6-17years) whose primary caregiver participated in the 2017-2018 National Survey of Children's Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators. Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males. Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed.

Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study.

To examine the association between light at night (LAN) and multiple sleep health dimensions. Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity. Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women. Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.

Sleep health dimensions and shift work as longitudinal predictors of cognitive performance in the UK Biobank cohort.

The long-term effects of sleep health and shift work on cognitive performance are unclear. In addition, research has been limited by small sample sizes and short follow-up periods. We conducted one of the largest examinations of the longitudinal influence of sleep health dimensions and shift work on cognitive performance in people of middle and old age using data from the UK Biobank. The hypothesis was that poor sleep health and shift work would predict lower cognitive performance. Self-reported sleep duration, daytime sleepiness, insomnia symptoms, chronotype and shift work status were assessed as predictors at baseline. Cognitive performance was operationalised by a touchscreen test battery at follow-up between 7.4 ± 2.2 and 9.0 ± 0.9 years after baseline assessment, depending on the specific task. Models were performed for each cognitive domain including relevant confounders (e.g., depression). The alpha level was set at p<0.01 for all analyses. The study sample comprised 9,394 participants for the reasoning task, 30,072 for the reaction time task, 30,236 for the visual memory task, 2,019 for the numeric memory task and 9,476 for the prospective memory task. Shift work without night shifts (ß= -2.0x10- 1 ± 6.5x10- 2, p=0.002) and with night shifts (ß= -1.9x10- 1 ± 7.2x10- 2, p=0.010) predicted a significantly reduced performance in the reasoning task. Short sleep duration (ß= -2.4x10- 1 ± 7.9x10- 2, p=0.003) and shift work without night shifts (ß= -3.9x10- 1 ± 1.2x10- 1, p=0.002) predicted a significantly lower performance in the task probing prospective memory. Our results suggest that, after controlling for confounding variables, shift work and short sleep duration are important predictors for cognitive performance in people of middle and old age. Further work is required to examine causal mechanisms of the observed associations.

Social-ecological considerations informing a universal screening strategy for sleep health in the community.

"Poor sleep health" (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a "medical" and a merged "social emotional wellbeing framework" and combine them utilizing the concept of "ecologies." The first framework proposes the incorporation of "sleep" in the interpretation of "vigilance" and "inappropriate" labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for "social emotional wellbeing" in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our "transcultural, transdisciplinary and transdiagnostic screening framework" may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts.