Self-reported Insomnia Symptoms Research Articles

DOES A SINGLE DAY OF EXERCISE SNACKING IMPROVE INSOMNIA SEVERITY AND SLEEP ARCHITECTURE IN INDIVIDUALS WITH SELF-REPORTED INSOMNIA?

INTRODUCTION & AIMS Regular exercise may reduce an individual’s insomnia severity, but time constraints remain a significant barrier to participation. Exercise snacking, defined as short bouts of moderate-to-vigorous physical activity performed periodically during the day, shows potential to address time pressures for other chronic conditions. However, its effects on insomnia severity and sleep architecture are unknown. The aim of this study was to explore the impact of a single day of exercise snacking on insomnia severity and sleep architecture in individuals with self-reported insomnia symptoms. METHODS Adults self-reporting insomnia symptoms were recruited to participate in a single-arm study. Participants completed a single-day exercise snacking protocol that included three sessions of 3 x 20 second ‘all out’ stair climbing efforts, separated by 1-4 hours. Self-reported insomnia severity was assessed at baseline and at 24-hours using the Insomnia Severity Index (ISI). Sleep architecture (sleep stages, time, and efficiency) was quantified during the night before, and immediately after the exercise protocol, via the Withings Sleep Analyzer. RESULTS Fourteen adults aged (median [range]) 23 [19-34] years at baseline, including 64% females, with a body mass index of (mean ± SD) 24.4 ± 5.0 kg/m2, and an ISI score of 15.4 ± 3.2, were recruited. Twelve participants completed all testing timepoints. Adherence to the protocol was 93%. Compared to baseline, there was a significant reduction in the ISI at 24-hours (baseline mean: 15.2, 95% CI 12.8-17.7; 24-hours: 11.4, 95% CI 9.0-13.8; p = 0.001, Cohen’s d = -1.21). No significant changes were found for sleep architecture outcomes including sleep stages, time, or efficiency. CONCLUSION A single day of exercise snacking improves acute insomnia severity symptoms, but not objectively measured sleep architecture, in adults with self-reported insomnia symptoms. A randomised controlled trial with an extended follow-up period and wider age range of participants is required.

Do sleep and circadian characteristics predict alcohol use in adult drinkers?

While sleep and circadian rhythms are recognized contributors to the risk for alcohol use and related problems, few studies have examined whether objective sleep and circadian measures can predict future alcohol use in humans, and no such studies have been conducted in adults. This study examined whether any baseline sleep and/or circadian characteristics of otherwise healthy adults predicted their alcohol use over the subsequent 12 months. Participants (21-42 years) included 28 light and 50 heavy drinkers. At baseline, a comprehensive range of self-reported and objective sleep/circadian measures was assessed via questionnaires, wrist actigraphy, and measurement of dim light melatonin onset and circadian photoreceptor responsivity. Following this, the number of alcoholic drinks per week and binge drinking episodes per month were assessed quarterly over the subsequent 12 months. Anticipated effects of alcohol (stimulation, sedation, and rewarding aspects) were also assessed quarterly over the 12 months. Analyses included generalized linear mixed-effects models and causal mediation analysis. Across the range of measures, only self-reported insomnia symptoms and a longer total sleep time at baseline predicted more drinks per week and binges per month (ps <0.02). There was a trend for the anticipated alcohol effect of wanting more alcohol at the 6-month timepoint to mediate the relationship between insomnia symptoms at baseline and drinks per week at 12 months (p = 0.069). These results suggest that in otherwise healthy adults, insomnia symptoms, even if subclinical, are a significant predictor of future drinking, and appear to outweigh the influence of circadian factors on future drinking, at least in otherwise healthy adults. Insomnia symptoms may be a modifiable target for reducing the risk of alcohol misuse.

Abstract 23: Multidimensional Association of Sleep With Health Behaviors and Cardiometabolic Risk in Adolescents

Introduction: Insufficient sleep has been recognized by AHA as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). While sleep is a multidimensional phenomenon comprised of duration, efficiency, quality, timing, and regularity, prior epidemiological research in youth has predominantly focused on sleep duration. It is important to disentangle which sleep dimensions most associate with other health behaviors and biomarkers for CVD risk in adolescents. Hypothesis: We hypothesize that specific dimensions of insufficient, disturbed, and misaligned sleep will be differentially associated with nutrition, physical activity, and inflammation. Methods: We analyzed data from 421 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 5-night at-home actigraphy (ACT), 1-night in-lab 9-h polysomnography (PSG), self-reported insomnia symptoms, daytimes sleepiness, sleep schedule, circadian preference, and dietary assessment, as well as fasting blood draw assayed for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα). Linear regression models tested the independent association of each sleep dimension with caloric intake, ACT-derived sedentary behavior, and blood-based inflammatory biomarkers, while accounting for sex, age, race/ethnicity, and body mass index. Results: Higher ACT-measured night-to-night variability in sleep duration was most strongly associated with increased caloric intake, particularly carbohydrates (B=0.203, p&lt;0.001), while shorter PSG-measured sleep duration was also associated with carbohydrates but to a lesser extent (B=-0.150, p=0.002). Later bedtime on weekdays was most strongly associated with higher bouts of sedentary behavior (B=0.216, p&lt;0.001), while shorter ACT-measured sleep duration was most strongly associated with time spent sedentary (B=-0.226, p&lt;0.001). PSG-measured sleep apnea was most strongly associated with higher CRP (B=0.287, p&lt;0.001) and IL-6 levels (B=0.260, p&lt;0.001), while later bedtime on weekdays (B=0.136, p=0.025) and evening circadian preference (B=-0.124, p=0.017) were also associated with inflammation but to a lesser extent. Conclusions: The association of inadequate sleep with health behaviors and cardiometabolic risk in adolescents is in itself multidimensional. These data support that AHA guidelines should be updated to include insufficient, disturbed, and misaligned sleep as contributors to CVD risk.

Associations between immune biomarkers and symptoms of anxiety, depression, and insomnia in paediatric inflammatory bowel disease: A preliminary longitudinal analysis

Innate immunity may influence the onset of affective symptoms and alter sleep patterns in chronic inflammatory conditions. Here, we tested the prospective associations between baseline serum C-reactive protein (CRP), albumin, and CRP/albumin ratio (CAR, i.e., an emerging biomarker of disease activity), and self-reported symptoms of anxiety, depression, and insomnia at 1-year follow up in paediatric inflammatory bowel disease (n = 17). After controlling for baseline values, CAR (ρ = 0.591, p = 0.026) predicted anxiety symptoms, while albumin predicted both anxiety (ρ = -0.687, p = 0.007) and insomnia symptoms (ρ = -0.648, p = 0.012). Current findings preliminarily suggest that inflammation may influence anxiety and sleep disturbance in paediatric IBD.

Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms

IntroductionInsomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms. MethodsSeven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms. ResultsSedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = −0.002, t = −3.02, p = .003). ConclusionsSedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.

Sleep and Risk of Pancreatic Cancer in the UK Biobank.

Light at night, which may cause circadian disruption, is a potential pancreatic cancer risk factor. However, evidence from related exposures such as poor sleep health and shift work remains inconclusive and sparsely investigated. We evaluated associations between self-reported typical sleep duration, chronotype, shift work, insomnia symptoms, snoring, and daytime sleeping and pancreatic ductal adenocarcinomas (PDAC) incidence among 475,286 UK Biobank participants. We used Cox proportional hazards models to estimate HRs and 95% confidence intervals (CI) adjusting for age, sex, body mass index, smoking status, duration, and frequency, alcohol intake, diabetes status, race, and employment/shift work. Over 14 years of follow-up, 1,079 adults were diagnosed with PDAC. There were no associations observed between sleep characteristics, including sleep duration [<7 vs. 7-<9 hours; HR, 1.03; 95% CI, 0.90-1.19; ≥9 hours; HR, 1.00 (0.81-1.24), evening chronotype ("definitely" an evening person vs. "definitely" a morning person; HR, 0.99 (0.77-1.29)], shift work, insomnia symptoms, snoring, or daytime sleep and PDAC risk. Self-reported typical sleep characteristics and shift work were not associated with PDAC risk. Considering the role of light at night and shift work in circadian disruption and cancer risk, it is plausible that poor sleep health among a general population may be related to cancer risk through similar sleep and circadian disrupting processes. This work may suggest that typical sleep characteristics and shift work are not associated with PDAC, although additional work is needed to confirm these findings.

An Emerging 21st-Century Midlife Sleep Crisis? Cohort Differences in Sleeping Patterns Among Americans in Midlife and Older Adulthood.

To descriptively document birth cohort differences in sleeping patterns, self-reported age-specific sleep duration, and insomnia symptoms among adults aged 50+ from the National Health Interview Survey (NHIS) and the Health and Retirement Study (HRS). We analyzed respondents aged 50+ (born 1920-1969) from the 2006-2018 NHIS (n = 162,400) and HRS (n = 28,918). We fit multinomial models among the NHIS sample predicting age-specific optimal sleep duration (optimal for age vs short for age, and optimal for age vs long for age). For the HRS sample, we fit growth curve models predicting age-based insomnia symptom trajectories. The models for both samples adjusted for age, gender, race/ethnicity, and educational attainment. Results regarding sleep duration in the NHIS, suggested that cohorts born in the 1950s and 1960s had significantly higher odds of reporting short sleep duration than cohorts before them. Results from the HRS similarly illustrated that cohorts born in the 1950s and 1960s had significantly higher levels of insomnia symptoms than those born before them. The worsening sleep among cohorts entering midlife was consistent regardless of alternative cohort specification, when age groups or periods were analyzed, and when more extensive covariates were modeled. We observe a pronounced decline in healthy sleeping patterns among American cohorts in midlife, with consistent and striking results across data sets, methods, and measures. These findings have important implications for the well-being and longevity of Americans who have entered midlife in the 21st century.

Sleep Disorders and Cognitive Aging Among Cognitively Impaired Versus Unimpaired Older Adults.

Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). A total of 5,822 participants (Mage = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep.

The association between polluted fuel use and self-reported insomnia symptoms among middle-aged and elderly Indian adults: a cross-sectional study based on LASI, wave 1

BackgroundInsomnia predisposes the aging population to reduced quality of life and poor mental and physical health. Evidence of the association between polluted fuel use and insomnia symptoms is limited and is non-existent for the Indian population. Our study aimed to explore the link between polluted fuel use and insomnia symptoms in middle-aged and older (≥ 45 years) Indian populations.MethodsWe utilized data from nationally representative Longitudinal Aging Study in India (LASI) Wave 1. Participants with complete information on fuel use, insomnia symptoms, and covariates were included. Insomnia symptoms were indicated by the presence of at least one of three symptoms: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA), ≥ 5 times/week. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between polluted fuel use and insomnia symptoms. We also assessed the interaction of association in subgroups of age, gender, BMI, drinking, and smoking status.ResultsSixty thousand five hundred fifteen participants met the eligibility criteria. Twenty-eight thousand two hundred thirty-six (weighted percentage 48.04%) used polluted fuel and 5461 (weighted percentage 9.90%) reported insomnia symptoms. After full adjustment, polluted fuel use was associated with insomnia symptoms (OR 1.16; 95%CI 1.08–1.24) and was linked with DIS, DMS, and EMA (OR 1.14; 95%CI 1.05–1.24, OR 1.12; 95%CI 1.03–1.22, and OR 1.15; 95%CI 1.06–1.25, respectively). No significant interactions for polluted fuel use and insomnia symptoms were observed for analyses stratified by age, sex, BMI, drinking, or smoking.ConclusionsPolluted fuel use was positively related to insomnia symptoms among middle-aged and older Indians. Suggestions are offered within this article for further studies to confirm our results, to explore underlying mechanisms, and to inform intervention strategies.

A - 73 The Impact of Posttraumatic Stress Disorder on Cognitive Health in 9/11 Responders: the Role of Sleep Disturbances.

PTSD is known to have a long-term impact on cognitive health, specifically executive dysfunction. However, most studies have not tested possible mechanisms underpinning this association. Sleep disturbances have emerged as a potential pathway between PTSD and cognitive functioning. This study aimed to investigate whether sleep disturbances account for the association between PTSD and executive dysfunction in trauma-exposed first responders. Participants consisted of 9/11 WTC responders (N = 452, mean age = 55.22, SD = 8.73, 89% male, 90% White). Data collection occurred across 3 time points, each 1year apart. Measures included self-reported PTSD and insomnia symptoms, two weeks of Ecological Momentary Assessment of sleep duration and sleep quality, and the Trail Making Test part B. Due to high stability across 3years, the present study focused on mean, trait-like variables. Analyses adjusted for demographics, BMI, and trauma exposure severity. PTSD was associated with Trail Making Test part B (r = 0.10, p = 0.03), as well as insomnia (r = 0.63, p < 0.00) and sleep quality (r = -0.45, p < 0.00), but not sleep duration. Mediation analyses revealed that sleep quality fully accounts for the significant association between PTSD and executive functioning (indirect effect β= 0.056, p = 0.041, 95% CI [0.009, 0.108]). The current results highlight the important role that disturbances in sleep may have on cognitive health outcomes. Improving sleep, in the context of PTSD, could attenuate cognitive symptoms, and possibly protect against further decline. Future research conducted in the acute phase of trauma-exposure and PTSD is needed to clarify the directionality of these relationships, with longitudinal analyses that will allow form modeling cognitive decline.

Internet-delivered cognitive behavioral therapy for adolescents with insomnia: Feasibility and preliminary efficacy.

Insomnia is common in adolescents. This study evaluated feasibility and preliminary efficacy of a six-week internet-delivered cognitive-behavioral therapy for insomnia (ICBT-I) in adolescents. In this uncontrolled pilot study, participants (n = 27, 78% female) completed assessments pre- and post intervention. Data on recruitment, adherence to treatment, treatment activity, satisfaction and credibility was collected to assess feasibility. Self-reported insomnia symptoms, sleep parameters as well as depression, anxiety and daytime function were also assessed. Participants showed good adherence to treatment and found the intervention overall credible and satisfactory. From pre- to post-assessment, statistically significant improvements were found for insomnia symptoms (p < .001; d = 1.02), sleep onset latency (p < .001; d = .39), wake after sleep onset (p = .001; d = .34), sleep efficiency (p < .001; d = .5) and depression (p = .01, d = .37). Changes in scores of total sleep time, generalized anxiety, daytime sleepiness and functional disability were not significant. The present study indicates that ICBT-I is well accepted by adolescents, that insomnia symptoms and sleep parameters can improve following the intervention, and that co-morbid symptoms of depression can be reduced. Due to the limited sample size and the uncontrolled design, the suggested results need to be replicated in well-powered controlled clinical trials.

Sleep-wake timing and chronotype in perinatal periods: longitudinal changes and associations with insomnia symptoms, sleep-related impairment, and mood from pregnancy to 2 years postpartum.

Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.

Impact of the early months of the COVID-19 pandemic on the sleep patterns of a Brazilian population sample

ABSTRACT Humanitarian and health crisis have drastic effects on the physical and mental well-being of people. The COVID-19 pandemic forced many countries to impose containment measures on its population to halt the spread of the new coronavirus (SARS-CoV-2). This aim of this study was to explore self-reported sleep quality and insomnia symptoms in a sample of the Brazilian population before and during the COVID-19 quarantine period. Our data was collected through online questionnaires, including the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Index. The final sample comprised 1,109 volunteers. Generalized estimating equations (GEE) revealed that during the initial months of the COVID-19 pandemic, alterations in self-reported sleep parameters were observed in the participants. Sleep efficiency and sleep duration increased, but there was a worsening in sleep quality and an increase in symptoms related to insomnia.

Insomnia symptoms in adulthood. Prevalence and incidence over 25 years

Objective/backgroundDespite its high prevalence, little information is available about the course of insomnia symptoms over the life span. In this study, we analyzed the self-reported insomnia symptoms of the general population over more than 20 years, covering young up to middle adulthood. Patients/methodsData from waves 12 to 32 of the Saxon Longitudinal Study (1996–2021), were analyzed. Based on data from the 12th wave, n = 115 adults (48 men (41.7%), 67 women (58.3%), Mage = 23.59, SD = 0.59) completed the G-Score Item #3 in the following 18 waves, thus forming the basis for our analyses. The G-Score Item #3 reads “In the last 12 months, have you had the following complaints? Please indicate how often they occurred – Insomnia”. The G-Score Item #3 was dichotomized using a cut-off score of 2, and prevalence and incidence rates were calculated by gender. ResultsThe minimum prevalence rate was 23.48% (Mage = 32.11, SD = 0.40), and the maximum was 47.83% (Mage = 48.43, SD = 0.64), indicating an increase in insomnia symptoms with age. In most cases, no evidence was found for gender differences in prevalence rates. The incidence rates were 10.43% for the 1st year of follow-up and 8.7% for the 5th year and 6th year of follow-up, respectively. ConclusionsThis study provides further evidence for the high prevalence rates of insomnia symptoms in the general population. As this study is the first epidemiological study of insomnia symptoms based on a single-item (screening) instrument, it should be rather seen as an extension than a replication of previous study findings.

0749 Adolescents’ Self-Reported Insomnia, Subjective Experiences And Objective Sleep Measures During The COVID-19 Pandemic

Abstract Introduction Studies examining adolescents’ sleep during the COVID-19 pandemic yielded inconsistent results, with some studies finding a significant increase in insomnia symptoms but others finding no change. A majority of these studies used retrospective or concurrent reports of insomnia symptoms and did not include objective sleep measures, making it impossible to know the extent to which the reported symptoms were associated with actual sleep patterns. In addition, these studies did not account for factors that might have biased adolescents’ subjective reporting of insomnia such as negative emotions or high levels of pre-bedtime cognitive arousal. The goal of the present study was to examine the associations of self-reported symptoms of insomnia among typically developing adolescents with their emotional experiences, cognitive arousal at bedtime, and objective sleep measures during the COVID-19 pandemic. Methods Participants. Seventy-six adolescents (33 female, M(SD) age = 13.74(0.87) years). Procedure. Each participant’s sleep pattern was assessed in the home environment using actigraphy and a sleep log for seven consecutive nights in 2021. Adolescents provided information regarding their experiences during the COVID-19 pandemic using the COVID-19 Adolescent Symptom &amp; Psychological Experience (CASPE) questionnaire; information regarding their arousal at bedtime using the Pre-Sleep Arousal Scale and information regarding the insomnia symptoms using the Insomnia Severity Index. Results Principal-component analysis produced a three-factor solution for the CASPE labeled as Negative-Anxious, Negative-Angry and Positive Emotions. Hierarchical regression analysis was conducted to examine the cross-sectional associations among adolescents’ emotional responses and subjective and objective sleep measures during the COVID-19 pandemic. Being a girl, reporting high level of pre-bedtime cognitive arousal and high Negative-Anxious emotions accounted the explained variance in adolescents’ self-reported insomnia symptoms. Actigraphy measured sleep efficiency, latency or duration did not increase significantly the explained variance. Conclusion These findings suggest that documentation of adolescents’ insomnia during the COVID-19 pandemic might have captured adolescents’ negative emotions rather than their objective sleep patterns. Limitations The cross-sectional design of this study limits the ability to determine causality. Support (if any) CIHR, SSHRC

0744 Self-reported Sleep Quality and Insomnia Symptoms Mediate the Association between Depression and Physical Activity in Older Adults

Abstract Introduction Lack of physical activity (PA) is prevalent and leads to multiple chronic conditions in older adults. Understanding factors contributing to low PA may help develop effective and sustainable PA interventions and promote health in older adults. Depressive symptoms and poor sleep quality have been linked with low PA in older adults. Depression can lead to sleep disturbances. In this study, we tested the association between depression and physical activity in community-dwelling older adults and the possible mediating role of sleep quality in the association. Methods We used baseline data collected from an ongoing randomized clinical trial that aims to improve cognitive health in community-dwelling older adults. Participants’ depressive symptoms and level of PA were assessed using the Geriatric Depression Scale Short Form (GDS) and Physical Activity Scale for the Elderly (PASE). Sleep quality and insomnia symptoms were measured by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), respectively. Multiple regression models were used to test the associations between the variables. Baron and Kenny’s approach and the Sobel test were used to examine the mediation effects of participants’ self-reported sleep quality and insomnia symptoms on the association of depression and PA. Results The study sample (n=143) had a mean age of 70 years (SD=6), most were female (n=117, 82%), White (n=77, 54%), and had multiple comorbidities (n=98, 69%). After adjusting for covariates (age, sex, education, income, race, and Body Mass Index [BMI]), higher GDS score was associated with lower PASE (β=-3.58, 95% Confidence Interval [CI]: -7.08, -0.79). Mediation analyses showed that both sleep quality (indirect effect: B=-1.98, CI: -3.80, -0.15) and insomnia symptoms (indirect effect: B=-1.97, CI: -3.94, 0.00) significantly mediated the relationship between depression and PA. Conclusion Depressive symptoms were associated with reduced PA among older adults. Self-reported sleep significantly mediated this association. Older adults with more depressive symptoms had worse sleep quality and more insomnia symptoms, which were associated with decreased PA. Our findings suggest we pay more attention to sleep health in older adults, and people with depression may benefit from sleep-focused interventions to promote PA and health. Support (if any) R00NR016484

0377 Sleep Health Disparities Among U.S. Military Personnel and Veterans Registered on the Burn Pit Registry

Abstract Introduction Disparities are underrecognized factors for sleep health. Additionally, there are concerns about sleep health among Veterens with exposure to burn pit smoke. This study aimed to examine the association between sex, race, and ethnicity and self-reported insomnia and sleep apnea symptoms in Veterans and active duty personnel. Methods Using items from the online health questionnaire of the VA/DoD Airborne Hazards and Open Burn Pit Registry administered between April 2014 and August 2022 to 320,231 Veterans and active duty personnel (age 40.1±9.2 y, 11% female, 75% white), we examined the association between sociodemographic variables (sex, race, and ethnicity) and self-reported sleep complaints (insomnia, sleep duration, sleep apnea events and snoring) in separate logistic regression models. Results Female sex predicted higher odds of insomnia (OR 1.3), where as male sex predicted higher odds of sleep apnea events (OR 2.6) and snoring (OR 2.4), p’s&amp;lt;.0001. African American race predicted higher odds of sleep apnea events, snoring, insomnia and shorter sleep duration (ORs1.5-3.2, p’s&amp;lt;.0001). Hispanic ethnicity predicted higher odds of sleep apnea events, snoring, insomnia and shorter sleep duration (ORs 1.2-1.6, p’s&amp;lt;.0001). Conclusion We observed a higher prevalence of self-reported sleep complaints among Black and Hispanic compared to White Veterans and active duty personnel who completed the burn pit registry. We also found a higher prevalence of insomnia in females compared to males, while snoring and sleep apnea events were more common in males compared to females. Future research will focus on sleep health dispartities of objective sleep data extracted from polysomnography reports in the Veteran Affairs electronic medical records in Veterans on the burn pit registry. Support (if any) This work is supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); Michael E DeBakey VAMC Bridge Grant (PI: Nowakowski); and VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).

Identifying the potential causal role of insomnia symptoms on 11,409 health-related outcomes: a phenome-wide Mendelian randomisation analysis in UK Biobank

BackgroundInsomnia symptoms are widespread in the population and might have effects on many chronic conditions and their risk factors but previous research has focused on select hypothesised associations/effects rather than taking a systematic hypothesis-free approach across many health outcomes.MethodsWe performed a Mendelian randomisation (MR) phenome-wide association study (PheWAS) in 336,975 unrelated white-British UK Biobank participants. Self-reported insomnia symptoms were instrumented by a genetic risk score (GRS) created from 129 single-nucleotide polymorphisms (SNPs). A total of 11,409 outcomes from UK Biobank were extracted and processed by an automated pipeline (PHESANT) for the MR-PheWAS. Potential causal effects (those passing a Bonferroni-corrected significance threshold) were followed up with two-sample MR in MR-Base, where possible.ResultsFour hundred thirty-seven potential causal effects of insomnia symptoms were observed for a diverse range of outcomes, including anxiety, depression, pain, body composition, respiratory, musculoskeletal and cardiovascular traits. We were able to undertake two-sample MR for 71 of these 437 and found evidence of causal effects (with directionally concordant effect estimates across main and sensitivity analyses) for 30 of these. These included novel findings (by which we mean not extensively explored in conventional observational studies and not previously explored using MR based on a systematic search) of an adverse effect on risk of spondylosis (OR [95%CI] = 1.55 [1.33, 1.81]) and bronchitis (OR [95%CI] = 1.12 [1.03, 1.22]), among others.ConclusionsInsomnia symptoms potentially cause a wide range of adverse health-related outcomes and behaviours. This has implications for developing interventions to prevent and treat a number of diseases in order to reduce multimorbidity and associated polypharmacy.

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.

Self-reported insomnia symptoms, sleep duration, chronotype and the risk of acute myocardial infarction (AMI): a prospective study in the UK Biobank and the HUNT Study

Insomnia and short/long sleep duration increase the risk of AMI, but their interaction with each other or with chronotype is not well known. We investigated the prospective joint associations of any two of these sleep traits on risk of AMI. We included 302 456 and 31 091 participants without past AMI episodes from UK Biobank (UKBB; 2006–10) and the Trøndelag Health Study (HUNT2; 1995–97), respectively. A total of 6 833 and 2 540 incident AMIs were identified during an average 11.7 and 21.0 years follow-up, in UKBB and HUNT2, respectively. Compared to those who reported normal sleep duration (7–8 h) without insomnia symptoms, the Cox proportional hazard ratios (HRs) for incident AMI in UKBB among participants who reported normal, short and long sleep duration with insomnia symptoms were 1.07 (95% CI 0.99, 1.15), 1.16 (95% CI 1.07, 1.25) and 1.40 (95% CI 1.21, 1.63), respectively. The corresponding HRs in HUNT2 were 1.09 (95% CI 0.95, 1.25), 1.17 (95% CI 0.87, 1.58) and 1.02 (95% CI 0.85, 1.23). The HRs for incident AMI in UKBB among evening chronotypes were 1.19 (95% CI 1.10, 1.29) for those who had insomnia symptoms, 1.18 (95% CI 1.08, 1.29) for those with short sleep duration, and 1.21 (95% CI 1.07, 1.37) for those with long sleep duration, compared to morning chronotypes without another sleep symptom. The relative excess risk for incident AMI in UKBB due to interaction between insomnia symptoms and long sleep duration was 0.25 (95% CI 0.01, 0.48). Insomnia symptoms with long sleep duration may contribute more than just an additive effect of these sleep traits on the risk of AMI.