Prior Sleep Research Articles

Impact of Cumulative Unhealthy Sleep Practices in Adolescence on Substance Use in Young Adulthood Estimated Using Marginal Structural Modeling.

ObjectivesThe purpose of this study was to identify the impact of chronic, unhealthy sleep practices in adolescence on substance use in young adulthood. Unhealthy sleep practices in adolescent samples exhibit a bidirectional relationship with substance use. The relationship is further complicated if we consider that confounders such as depression vary over time and are often in response to adolescents’ prior poor sleep practice, which can be addressed by a counterfactual approach using a marginal structural model.MethodsData in this study are from the Taiwan Youth Project, a longitudinal study that started in 2000 and surveyed 2,690 7th grade students at age 13. Outcomes include frequency of cigarette smoking and alcohol drinking at age 21. Three unhealthy sleep practices were included in this study: short sleep, social jetlag, and sleep disturbance. We used a marginal structural model with stabilized inverse probability-of-treatment weights to address time-varying confounders in each wave and a total sample of 1,678 adolescents with complete information for this study.ResultsAccumulated waves of sleep disturbance and social jetlag in adolescence were significantly associated with cigarette use in young adulthood. Accumulated social jetlag but not sleep disturbance was also associated with alcohol use in adulthood. Accumulated waves of short sleep were not associated with later alcohol use, but were negatively correlated with cigarette use.ConclusionInterventions that aim to reduce the likelihood of substance use in young adulthood should consider confronting unhealthy sleep practices, in particular the discrepancy between bedtimes on school days and weekends and sleep disturbance.

Reported history of childhood trauma and stress-related vulnerability: Associations with emotion regulation, executive functioning, daily hassles and pre-sleep arousal.

Childhood trauma is associated with poor health outcomes in adulthood. Mechanisms for these associations are not well understood because past studies have focused predominantly on populations that have already developed physical and mental health problems. The present study examined the association between childhood trauma and stress-related vulnerability factors in a healthy adult sample (n = 79; 68% female, mean age = 27.5, SD = 6.5). Emotion regulation difficulties were examined as a potential mediator. Participants completed baseline laboratory assessments of reported childhood trauma, emotion regulation difficulties, prior month sleep quality, baseline impedance cardiography and behavioural tests of executive functioning (EF) and a three-day experience sampling assessment protocol that included sleep diary, reported and objective pre-sleep arousal, daily hassles and reported EF difficulties. Reported history of childhood abuse was significantly associated with difficulties in emotion regulation, self-report and objective pre-sleep arousal, diary-assessed sleep quality, daily hassles and reported EF difficulties. Reported history of childhood neglect was associated with greater pre-sleep arousal and poorer EF-behavioural control. Emotion regulation difficulties mediated the relationship between childhood abuse and reported pre-sleep arousal, daily hassles and reported EF difficulties. In conclusion, history of childhood trauma is associated with a variety of stress-related vulnerability factors in healthy adults that may be viable early intervention targets.

Repeated afternoon sleep recordings indicate first-night-effect-like adaptation process in family dogs.

The importance of dogs (Canis familiaris) in sleep research is primarily based on their comparability with humans. In spite of numerous differences, dogs' comparable sleep pattern, as well as several phenotypic similarities on both the behavioural and neural levels, make this species a most feasible model in many respects. Our aim was to investigate whether the so-called first-night effect, which in humans manifests as a marked macrostructure difference between the first and second sleep occasions, can be observed in family dogs. We used a non-invasive polysomnographic method to monitor and compare the characteristics of dogs' (N=24) 3-hr-long afternoon naps on three occasions at the same location. We analysed how sleep macrostructure variables differed between the first, second and third occasions, considering also the effects of potential confounding variables such as the dogs' age and sleeping habits. Our findings indicate that first-night effect is present in dogs' sleep architecture, although its specifics somewhat deviate from the pattern observed in humans. Sleep macrostructure differences were mostly found between occasions 1 and 3; dogs slept more, had less wake after the first drowsiness episode, and reached drowsiness sleep earlier on occasion 3. Dogs, which had been reported to sleep rarely not at home, had an earlier non-rapid eye movement sleep, a shorter rapid eye movementsleep latency, and spent more time in rapid eye movement sleepon occasion 3, compared with occasion 1. Extending prior dog sleep data, these results help increase the validity of further sleep electroencephalography investigations in dogs.

Linking inhibition and anxiety symptoms following sleep restriction: The moderating role of prior sleep efficiency

Although sleep loss increases state anxiety, the effects of partial sleep restriction on specific anxiety symptoms and mechanisms that may influence this relation remain unknown. It is also unknown whether prior sleep buffers the impact of sleep restriction on anxiety symptoms. Thus, the present study examined the relations between inhibition and repetitive negative thinking (RNT), obsessions, and other OCD symptoms following sleep restriction and the moderating role of prior night's sleep efficiency. Healthy sleeping adults (n = 73) completed measures of inhibition, anxiety symptoms, and sleep before and after one night of sleep restriction (4 h between 4:00am and 8:00am). Results indicate significant associations between decreased post-sleep restriction inhibition and increased post-sleep restriction RNT and obsessions. Prior night's subjective and objective sleep efficiency significantly moderated these relations, such that the highest post-sleep restriction anxiety symptoms were reported by those with the lowest post-sleep restriction inhibition and the lowest pre-sleep restriction sleep efficiency. These findings suggest decreased inhibition may be one mechanism by which sleep loss affects anxiety, and those with worse sleep prior to acute sleep loss may be particularly vulnerable. The implications for the prevention and treatment of anxiety-related disorders characterized by intrusive cognition are discussed.

Abstract TP347: Obstructive Sleep Apnea Frequency in Intracerebral Hemorrhage

Introduction: Obstructive sleep apnea (OSA) is a treatable condition and well-established risk factor for ischemic stroke, but the prevalence in ICH is unknown. We aim to characterize the frequency of OSA in spontaneous intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective observational study evaluating risk factors for ICH among whites, blacks, and Hispanics. OSA status was determined using two different strategies: (1) the Berlin Questionnaire, a validated screening tool to identify those with a high likelihood of OSA where “high risk” is defined as > 1 point in at least 2 of 3 categories assessing snoring, fatigue, and hypertension, and (2) self-reported history of diagnosed sleep apnea. Results: We evaluated 3000 ICH cases. Within this group, 2896 (96.5%) completed the Berlin questionnaire, with 2064 (71%) patients being high risk for OSA. Compared to patients with low risk of OSA, those at high risk were more likely to be male (61% versus 53%, p<0.001) with hypertension (93% versus 65%, p<0.001), diabetes (32% versus 20%, p<0.001), hyperlipidemia (49% versus 38%, p<0.001), and higher BMI (29.8 +/- 8.1 versus 26.8 +/- 6.5, p<0.001), and less likely to have lobar ICH location (29% versus 35%, p<0.001). Self-reported history of prior sleep apnea diagnosis was present in only 175 (9.5%) of ICH cases. Conclusions: OSA is highly prevalent and underdiagnosed in our cohort of ICH patients. Given the effective treatments available for OSA, which have been shown to improve morbidity and mortality in patients with ischemic stroke, further studies are needed to assess the role of OSA as both a determinant of both risk and outcome in ICH.

Behavioural Observation as a Means of Assessing Sleepiness Related Driving Impairment in Obstructive Sleep Apnea

This study compared the temporal pattern of collateral behaviours (actions not directly related to task performance) in obstructive sleep apnea (OSA) drivers under monotonous driving conditions following sleep restriction versus normal sleep. Seventeen patients with untreated severe OSA completed a 90-minute driving simulator task during mid-afternoon under two experimental conditions: prior normal habitual sleep (~8h) and prior sleep restriction (4h time in bed). Steering deviation and crash events were identified using a driving simulator. Collateral behaviours (self-centred gestures, non-verbal facial activities, postural adjustments, ludic activities and eye closures) were identified using video recording and a behavioural ethogram. Participants demonstrated increased steering deviation over the drive (p<0.001) and following sleep restriction (p<0.001). All collateral behaviours, except non-verbal facial activities, increased over the drive (all p<0.01). Compared to normal sleep condition, the incidence rate was 2.1 times higher for eye closures (95%CI 1.75-2.60) and 1.5 times higher for postural adjustments (95%CI 1.29-1.72) following sleep restriction, while ludic behaviours reduced by 50% (IRR 0.53, 95%CI 0.36-0.78), all p<0.01. In the 10 minute period prior to simulator crash events, eye closure frequency increased compared to equivalent periods without a crash event 2.1 (95%CI 1.4-3.8, p<0.01). Kaplain-Meier analyses showed a progressive cessation of non-verbal facial activities leading up to crash events (c²=6.2, p=0.013). Although eye-closure appears to be a more sensitive marker of poor vigilance, behavioural observation could provide a novel further method for assessing vigilance failure in OSA and could assist in the development of novel video-based in-car devices for detection of driver sleepiness/fatigue.

Report on sadness/depression, nervousness/anxiety and sleep problems in the Brazilian adult population during the COVID-19 pandemic.

To analyze the frequency of sadness, nervousness, and sleep disorders during the COVID-19 pandemic in Brazil, identifying the most affected demographic segments. This was a cross-sectional study using an online questionnaire answered by adults and elderly people to collect information on living conditions, health and health-related behaviors. Prevalence rates and prevalence ratios adjusted for age and sex were estimated. The data on 45,161 Brazilian respondents showed that during the pandemic 40.4% (95%CI 39.0;41.8) frequently felt sad or depressed and 52.6% (95%CI 51.2;54.1) frequently felt anxious or nervous; 43.5% (95%CI 41.8;45.3) reported the onset of sleep problems and 48.0% (95%CI 45.6;50.5) had a prior sleep problem that had become worse. Frequent sadness and nervousness, as well as change in sleep patterns were higher in young adults, women and those with a history of depression. The high prevalence found indicates the need to guarantee the provision of services for mental health and quality of sleep that are adapted to the pandemic context.

Abnormal Sleep Signals Vulnerability to Chronic Social Defeat Stress

There is a tight association between mood and sleep as disrupted sleep is a core feature of many mood disorders. There is a paucity in available animal models for investigating the role of sleep in the etiopathogenesis of depression. Therefore, we aimed to assess whether prior sleep disturbances can predict susceptibility to future stress using the chronic social defeat (CSD) stress paradigm.Pre-CSD, mice susceptible to stress displayed increased fragmentation of Non-Rapid Eye Movement (NREM) sleep, due to increased switching between NREM and wake and a higher percentage of NREM bouts with short duration, relative to resilient mice. The pre-CSD sleep features from both phenotypes were separable enough to allow prediction of susceptibility to stress with >80% accuracy. Post-CSD, susceptible mice maintained the enhanced NREM fragmentation while resilient mice exhibited high NREM fragmentation, only in the dark.Our findings emphasized the putative role sleep plays in signaling vulnerability to stress.

Hypothetical Radiological Findings in Dogs and Cats Suffering from Insomnia

Sleep is a vital body function, regulating several biological phenomena. Deprivation studies are one of the ways used to examine the physiological functions and the regulation of the sleep. Sleep deprivation is a stressor, and its’ effects depend on an individual’s prior sleep deficit and distribution during the day. Sleep deprivation can be partial, total, acute, or chronic or specifically focused on one of the sleep phases. Sleep deprivation affects a large spectrum of vital systems such as thermoregulation, energy and mineral balance, and immunofunction. Based on the fact that sleep is a very important process for the normal development of many metabolic pathways, it is logical to think that insomnia has serious organism consequences. Functional irregularities of different organs are always reflected in structural changes that can be identified with imaging techniques. Imaging methods can also help identify problems of animals insomnia.

Safety profile and clinical course of patients with insomnia administered suvorexant by initial treatment status in a post-marketing survey

ABSTRACTObjectives: Suvorexant is a dual orexin receptor antagonist used for treating insomnia. The authors elucidated the safety profiles and clinical course of insomnia therapy with suvorexant under different initial treatment status seen in daily routine practice.Methods: Subgroup analysis of a post-marketing survey (PMS; 2015–2017) divided patients based on their initial treatment status with suvorexant into ‘hypnotic-naïve (Group N)’, ‘switching from a prior sleep medication (Group S),’ ‘add-on therapy (Group A),’ and ‘others (Group O).’Results: Among 3248 patients analyzed in the PMS, the number of patients in Groups N, S, A, and O was 1946 (59.9%), 703 (21.6%), 536 (16.5%), and 63 (1.9%), respectively. The incidence of insomnia-related adverse drug reactions (ADRs) in Group S (5.3%) tended to be higher than that in Groups N (0.46%) and A (1.5%). Discontinuation rate due to an inadequate effect at 6 months in Group S (14.9%) tended to be higher than that in Groups N (9.6%) and A (10.4%).Conclusion: The results suggest that initiating suvorexant treatment after switching from other insomnia medication must require careful monitoring of insomnia-related ADRs, which might be due to abrupt discontinuation of the prior insomnia medication use.

Effects of core temperature, skin temperature, and inter-beat interval on resting metabolic rate measurements in thermoneutral conditions.

It is important to identify potential underlying factors that can affect the variability of resting metabolic rate (RMR) measurements. The RMRs of 20 college-aged men were tested twice in stable environmental conditions, with each measurement separated by 40 min. Skin temperature, core temperature, and inter-beat interval were monitored throughout the study as identified factors that could affect RMR measurements. Since environmental conditions in a clinic or laboratory can vary, skin temperature and core temperature can be affected which may affect RMR. Similarly, prior physical activity, stress, sleep, and caffeine intake can affect inter-beat interval and may be a co-variable affecting RMR. Higher RMR measurements were compared to lower RMR measurements. RMR for the higher trial was 2068 ± 66 kcal/day, the lower trial was 1975 ± 65 kcal/day (t = 4.23; p < 0.01). Core temperature for higher trial was 37.1 ± 0.1 °C, the lower trial was 36.8 ± 0.1 °C (s = 105.00; p < 0.01). Skin temperature measurements were significantly different for the anterior bicep site (t = -2.52; p = 0.02), but not for any other site. Inter-beat interval for the higher measurement was 1038 ± 33 ms, the lower measurement was 998 ± 32 ms (t = 3.82; p < 0.01). However, regression analysis found that none of the variables were significant predictors for the higher RMR, lower RMR, or change in RMR. While the factors affecting RMR measurement variability remain unclear, the results suggest that typical fluctuations in core temperature, skin temperature, and inter-beat interval do not effectively predict changes in RMR in a thermoneutral environment.

Sleep inertia: current insights.

Sleep inertia, or the grogginess felt upon awakening, is associated with significant cognitive performance decrements that dissipate as time awake increases. This impairment in cognitive performance has been observed in both tightly controlled in-laboratory studies and in real-world scenarios. Further, these decrements in performance are exaggerated by prior sleep loss and the time of day in which a person awakens. This review will examine current insights into the causes of sleep inertia, factors that may positively or negatively influence the degree of sleep inertia, the consequences of sleep inertia both in the laboratory and in real-world settings, and lastly discuss potential countermeasures to lessen the impact of sleep inertia.

Predonation fears identify young donors at risk for vasovagal reactions.

Extending existing research on the relationship between predonation fear of having blood drawn and risk for vasovagal reactions among young donors, this study assessed the predictive power of specific donation-related fears. After the health screening, high school whole blood donors (59.5% female) were randomly assigned into one of three groups. Group 1 (n = 881) answered a control question about their prior night's sleep. Group 2 (n = 911) answered the sleep question and a question about fear of having blood drawn. Group 3 (n = 924) answered the sleep question, the fear of having blood drawn question, and four questions about specific donation-related fears (seeing blood, needles, pain, and fainting). The proportion of vasovagal reactions did not differ significantly among the groups, indicating that asking one or more fear questions before donation did not promote reactions. Fearful donors were more likely to have a vasovagal reaction, even after controlling for other important demographic and health predictors, with odds ratios ranging from 2.17 (95% confidence interval [CI], 1.44-3.27) for fear of fainting to 3.50 (95% CI, 2.34-5.23) for fear of seeing blood. Hours of sleep was not significantly related to vasovagal reaction risk. Predonation fear identifies donors who are more likely to experience a vasovagal reaction and does so without increasing the risk of such reactions. Accordingly, fear should be assessed during screening to identify those who could benefit from instruction in anxiety management and who might require greater attention to help prevent donor injury.

Shorter Sleep Duration Is Associated With Increased Sedentary Duration In Lean, But Not Overweight Or Obese, Individuals

PURPOSE: Sedentary behavior and insufficient sleep both can independently increase the risk for chronic diseases such as obesity and cardiovascular disease. However, whether or not prior nocturnal sleep duration influences daytime sedentary behavior is not well understood. We hypothesized that total sleep duration at night will be inversely associated with the subsequent day’s total sedentary time. We also explored if this relationship is different in lean compared to non-lean individuals. METHODS: 27 adults (10 lean, 50 ± 2 years) chose a self-selected 8-h sleep opportunity for 5-14 days (μ = 11). Adherence to the self-selected sleep period was verified using a sleep diary and phone calls to a time stamped mailbox at bedtime and upon awakening. Sleep duration was manually scored from wrist actigraphy (wGT3X-BT); and activity levels and sedentary duration were scored using ‘Freedson Adult’ algorithm'. To test whether total sleep duration (TSD) influenced subsequent sedentary duration (SD), a mixed model analysis was conducted with TSD as the independent variable, and subject as random factor. We further tested the associations between TSD and SD separately in lean and non-lean individuals. Finally, independent sample t-tests were used to determine whether TSD and SD differed between lean and non-lean individuals. RESULTS: TSD was negatively associated with the subsequent day’s SD [F (1, 289) = 4.8; p=0.03]. SD was significantly higher in non-lean as compared to lean individuals [mean 386 minutes vs 302 minutes per day; t (25) = 2.9; p = 0.02). TSD was not different between groups; p = 0.64. When lean and non-lean groups were analyzed separately, there was a significant inverse relationship between TST and subsequent ST in lean [F (1, 117) = 9.69, p = 0.002] but not in non-lean individuals (p>0.05). CONCLUSIONS: We discovered that shorter sleep duration during an 8h scheduled sleep opportunity is associated with increased SD during the subsequent day. This relationship was only found in lean individuals, possibly due to the higher ST in non-lean compared to lean individuals. Experimental studies investigating the bidirectional effects of sedentary behavior and sleep and the subsequent effect on cardiometabolic physiology are recommended to better understand the effect of these behaviors on the risk for chronic disease.

Solriamfetol for Excessive Sleepiness in Obstructive Sleep Apnea (TONES 3). A Randomized Controlled Trial.

Rationale: Primary treatment of obstructive sleep apnea can be accompanied by a persistence of excessive sleepiness despite adherence. Furthermore, effectiveness of sleep apnea treatment is limited by poor adherence. Currently available pharmacologic options for the treatment of sleepiness in this population are limited. Objectives: To evaluate the efficacy and safety of solriamfetol (JZP-110), a selective dopamine and norepinephrine reuptake inhibitor with robust wake-promoting effects, for the treatment of excessive sleepiness in participants with obstructive sleep apnea with current or prior sleep apnea treatment. Methods: This was a double-blind, randomized, placebo-controlled, parallel-group, 12-week trial comparing solriamfetol, 37.5, 75, 150, and 300 mg, with placebo. Measurements and Main Results: Of 476 randomized participants, 459 were included in the prespecified efficacy analyses. Coprimary endpoints (Maintenance of Wakefulness Test sleep latency and Epworth Sleepiness Scale score) were met at all solriamfetol doses (P < 0.05), with dose-dependent effects observed at Week 1 maintained over the study duration. All doses except 37.5 mg resulted in higher percentages of participants reporting improvement on Patient Global Impression of Change (key secondary endpoint; P < 0.05). Adverse events were reported in 47.9% of placebo- and 67.9% of solriamfetol-treated participants; five participants experienced serious adverse events (two [1.7%] placebo, three [0.8%] solriamfetol); none were deemed related to study drug. The most common adverse events with solriamfetol were headache (10.1%), nausea (7.9%), decreased appetite (7.6%), anxiety (7.0%), and nasopharyngitis (5.1%). Conclusions: Solriamfetol significantly increased wakefulness and reduced sleepiness in participants with obstructive sleep apnea and excessive sleepiness; most adverse events were mild or moderate in severity. Clinical trial registered with www.clinicaltrials.gov (NCT02348606) and www.eudract.ema.europa.eu (EudraCT 2014-005514-31).

The Effects of Sleep Loss on Military Physical Performance.

As part of both training and active service, military members can be exposed to prolonged periods of sleep loss. Given the extent of physical and cognitive performances viewed as critical to successful military performance, such sleep disruption may present risk to health and performance. The primary aim of this narrative review was to investigate evidence on the effect of inadequate sleep on measures of aerobic capacity, anaerobic capacity, muscular strength and muscular endurance in military personnel. Sleep loss appears to have the greatest negative impact on aerobic capacity, muscular endurance and military-specific performance in military populations. The findings showed varied results for handgrip strength and anaerobic capacity, with sleep loss inducing a decrease in mean power of the upper body. In comparison to other measures of performance, lower-body muscular strength appeared to be resilient to sleep restriction. However, due to the limited evidence and inter-individual variability in results there is no clear consensus on the specific volume of sleep loss that induces significant or meaningful performance decrements. The difficulties of conducting well-designed and -controlled interventions in military populations are appreciated. However, due to the low quality of reporting and lack of control for confounders (i.e. physical activity, load carriage, prior sleep debt, motivation and energy intake) in the majority of studies, it is difficult to establish the relationship between sleep loss and physical performance in military populations.

0099 The Effects Of Prior At-home Sleep Duration On Reversal-learning During A "Shoot/No-Shoot" Task

0099 The Effects Of Prior At-home Sleep Duration On Reversal-learning During A "Shoot/No-Shoot" Task

Trait-like characteristics of sleep EEG power spectra in adolescents across sleep opportunity manipulations.

The electroencephalographic power spectra of non‐rapid eye movement sleep in adults demonstrate trait‐like consistency within participants across multiple nights, even when prior sleep deprivation is present. Here, we examined the extent to which this finding applies to adolescents who are habitually sleep restricted on school‐days and sleep longer on weekends. We evaluated 78 adolescents across three sleep restriction groups who underwent different permutations of adequate sleep (9 hr time‐in‐bed), sleep restriction (5 hr time‐in‐bed), afternoon naps (1 hr afternoon) and recovery sleep (9 hr time‐in‐bed) that simulate behaviour on school‐days and weekends. The control group comprised a further 22 adolescents who had 9 hr of sleep opportunity each night. Intra‐class correlation coefficients showed moderate to almost perfect within‐subject stability in electroencephalographic power spectra across multiple nights in both sleep restriction and control groups, even when changes to sleep macrostructure were observed. While nocturnal intra‐class correlation metrics were lower in the low‐frequency and spindle frequency bins in the sleep restriction compared with the control group, hierarchical clustering measures could still identify multi‐night electroencephalographic spectra as originating from the same individual. The trait‐like characteristics of electroencephalographic spectra from an adolescent remain identifiable despite the disruptive effects of multi‐night sleep restriction to sleep architecture.

Remembering in the Context of Internal States: The Role of Sleep for Infant Memory

AbstractResearch with adults has shown that a person's internal context, or state, influences how memory functions. This factor is rarely considered in research on infant memory, in part because of the practical and ethical difficulties of manipulating these variables in infants. In this article, we argue that models of infant memory will remain limited in scope and accuracy if the internal context of participants is not considered. As a case in point, we present emerging literature on sleep‐dependent memory. Our review shows that for infants, timely sleep after a learning experience helps them retain and further process new memories. Studies need to explore the role of prior sleep for encoding, and to tease apart the contributions to infant memory of different types, features, and stages of sleep. We conclude that considering internal states, such as sleep, is necessary for developing a deeper understanding of early human memory.

Insomnia symptoms in primary care: A prospective study focusing on prevalence of undiagnosed co-morbid sleep disordered breathing

ObjectiveTo determine prevalence of comorbid undiagnosed sleep disordered breathing (SDB) in chronic insomnia patients, using two complementary methods, one standard and one novel. MethodsUsing prospective design, adult patients diagnosed with chronic insomnia, treated with prescription pharmacological agents for >3 months without prior objective sleep evaluation or diagnosis of SDB were invited to participate. All patients recorded their sleep for two consecutive nights using level 3 home-sleep-apnea-test (HSAT) device to derive Respiratory Event Index (REI) for OSA diagnosis. The electrocardiogram-signal (ECG) recorded by the same device was analyzed using FDA cleared medical software, Cardiopulmonary Coupling (CPC) to quantify sleep time and identify sleep-quality and pathology. ResultsOf 110 chronic insomnia patients who volunteered between May 2017 and June 2018, 88% were women. Prevalence of moderate-severe SDB (REI > 15) was 25% based on REI-scoring. Surrogate markers of moderate-severe SDB detected by the novel method identified prevalence of 33%, with negative predictive value 96%, reclassifying 10 individuals that HSAT diagnosed with mild SDB with more advanced disease state. Agreement between the methods is 88%. ConclusionHigh prevalence and overlap in symptoms between insomnia and SDB warrants objective testing when evaluating sleep complaints before therapy is initiated. Diagnostic caution is even more importantly warranted for female patients presenting insomnia sleep complaints, as SDB may not be initially considered as a biological symptom driver. CPC-analysis can complement standard HSAT or serve as a standalone option to evaluate sleep complaints in individuals presenting insomnia symptoms before therapy is initiated. Clinical trial registry name and numberPilot study: Co-occurrence of Insomnia and Sleep Disordered Breathing (SDB) symptoms: Prospective study focusing on chronic insomnia patients treated with pharmacological agents. Approved by the Bioethics Committee on March 7th, 2017.VSNb: 17- 047- S1/ ST - GRA - 17029 – PDX – SH http://vsn.is/is/content/17-047