Self-reported Sleep Disturbance Research Articles

Associations between food insecurity and Sleep Duration, Quality, and Disturbance among older adults from six low- and middle-income countries.

Although food insecurity has been associated with poor sleep outcomes in young and middle-aged adults, few studies have examined this relationship in older adults. This study aimed to examine the relationship between food insecurity and sleep duration, quality, and disturbance among older adults in six low-income countries (LMICs). We analyzed nationally representative cross-sectional data from 33,460 adults (≥50 years) from the Study on global AGEing and adult health (SAGE). Food insecurity (FI) was assessed using two questions regarding the frequency of eating less and hunger caused by a lack of food. Sleep outcomes included self-reported sleep duration, sleep quality, and sleep disturbances (difficulty falling asleep, frequent sleep interruptions, and early awakening) assessed based on self-reports over two nights. Multivariable logistic regression was used to assess country-specific relationships between food insecurity and sleep outcomes, and random-effects models were used to estimate pooled associations. The prevalence of FI among older adults in the overall population was 16.2%. In pooled analyses, FI was significantly associated with long sleep duration ≥ 9 h (OR=1.58, 95% CI: 1.30 to 1.93; P=0.001). There were also significant pooled associations between FI and poor sleep quality (OR=1.34, 95% CI: 1.14 to 1.56; P < 0.001) and sleep disturbances (OR=1.44, 95% CI: 1.08 to 1.91; P = 0.014). In conclusion, the current study found that FI is adversely associated with sleep duration, quality and disturbances in older adults, with some heterogeneity by country. The findings suggest food policies and intervention programs are needed for vulnerable households.

Associations among early life adversity, sleep disturbances, and depressive symptoms in adolescent females and males: a longitudinal investigation.

Exposure to adversity early in life (ELA) has been associated with elevated risk for depression during adolescence, particularly for females; the mechanisms underlying this association, however, are poorly understood. One potential mechanism linking ELA and sex differences in depressive symptoms is sleep disturbances, which increase during adolescence and are more common in females. Here, we examined whether sleep disturbances mediate the association between ELA and increases in depressive symptoms during adolescence and whether this mediation differs by sex. 224 (N = 132 females) youth were recruited at age 9-13 years and assessed every 2 years across three timepoints. At the first timepoint, we conducted extensive interviews about stressful events participants experienced; participants provided subjective severity ratings of events and we objectively scored the severity of each event. Self-reported sleep disturbances and depressive symptoms were assessed at all timepoints. We conducted linear mixed models to estimate both initial levels and changes in sleep disturbances and depressive symptoms, and moderated mediation analyses to test whether initial levels and/or changes in sleep disturbances mediated the association of ELA (objective and subjective) with increases in depressive symptoms across adolescence and whether the mediations differed by sex. While higher initial levels and increases in sleep problems were uniquely associated with increases in depressive symptoms for males and females, they were related to ELA differently by sex. For females, greater ELA (both objectively and subjectively rated) was associated with higher initial levels of sleep problems, which in turn were associated with increases in depressive symptoms from early to late adolescence. In contrast, for males, ELA exposure was not associated with either initial levels of, or increases in, sleep problems. These findings highlight the role of sleep disturbances during the transition to adolescence in mediating sex differences in the effects of ELA on depressive symptoms.

SLEEP DISTURBANCES IN RACIAL/ETHNIC DIVERSE MIDDLE-AGED AND OLDER ADULTS: FACTORS RELATED TO SLEEP DISTURBANCES

Abstract Complaints of poor sleep health is a prevailing U.S. public health issue. Although complaints of sleep disturbances is common in U.S. adults, prior research has indicated rates of sleep disturbances tend to vary across racial/ethnic groups. These cross-racial/ethnic comparison approaches may be limited, however, in identifying specific and unique sociodemographic and health factors related to sleep disturbances within racial/ethnic groups. The current study explored two specific aims. The first aim was to explore racial differences in self-reported sleep disturbances. The second aim was to explore sociodemographic and health factors related to sleep disturbances within racial/ethnic groups. A sample of U.S. adults (N=521; age range=40-92) were surveyed via Qualtrics Software (December 2022). Sleep disturbances was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Surveys were also collected on sociodemographic (e.g., age, monthly household income, education years, food insecurity, income changes due to COVID-19) and health (e.g., cognitive function, depressive symptoms, well-being, physical functioning, bodily pain, physical health conditions, and loneliness) factors. A univariate analysis of variance revealed non-significant racial/ethnic group differences in sleep disturbances (p &amp;gt; .05). However, bivariate correlations stratified by racial/ethnic groups suggested unique sociodemographic and health factors related to sleep disturbances within each racial/ethnic group. These findings contradict prior research of significant racial/ethnic group differences in sleep disturbances. Conversely, the findings support further investigating unique biopsychosocial factors associated with sleep health within racial/ethnic groups, which may provide meaningful information that may not be detected with cross-racial/ethnic comparison approaches.

Sleep disturbances and progression of mobility disability: Longitudinal findings from the Nurses’ Health Study

ObjectiveTo examine longitudinal associations between self-reported sleep disturbances and mobility disability progression among women, including subgroups with multiple sclerosis (MS), diabetes, and osteoarthritis (OA). MethodsProspective cohort study using data from Nurses’ Health Study long-form questionnaires (2008, 2012, 2014, 2016). Logistic regression was used to quantify associations between sleep-related variables at baseline and subsequent increase in mobility disability. ResultsOf 70,303 women (mean age 73), 392 had MS, 7,302 had diabetes, and 24,099 had OA. Between 2008–2016, mobility disability increased by 16.9 % overall, 27.8 % in the MS subgroup, 27.0 % in the diabetes subgroup, and 23.7 % in the OA subgroup. Known/suspected obstructive sleep apnea was significantly associated with an increase in mobility disability between 2008 and 2016, overall (OR:1.4, 95 %CI:1.2,1.5), and in 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 in 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 overall, but not in disease subgroups. Perception of adequate sleep was 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 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). ConclusionsPrevalent sleep disturbances could increase disability progression among women. Chronic disease populations may be uniquely vulnerable. Informed by these data, future research could offer new insight into sleep-based strategies to ameliorate mobility decline.

Sleep and Pain in Veterans with Chronic Pain: Effects of Psychological Pain Treatment and Temporal Associations.

Chronic pain is highly prevalent in US military Veterans. Non-opioid and non-pharmacologic treatments are recommended when clinically appropriate, but research on the mechanisms underlying benefits of these treatments is lacking. Here, we examined the role of sleep in the effects of three non-pharmacologic pain treatments in Veterans. Specifically, we investigated whether treatment effects on sleep predicted treatment effects on pain occurring later, or vice versa. Veterans enrolled in a randomized controlled trial were invited to participate in this supplementary sleep study. A total of 174 Veterans were randomized to one of three 8-session, in-person, group-based pain treatments: hypnosis, mindfulness meditation, or education control. Measurements included self-reported sleep disturbance, pain intensity, and pain catastrophizing; sleep duration was assessed with actigraphy. Sleep and pain measurements were obtained at baseline, posttreatment, and 3-month posttreatment follow-up. At baseline, average pain intensity was moderate (mean ± SD: 5.7 ± 1.7 on the 0-10 Numeric Rating Scale), pain catastrophizing was just below the clinically relevant threshold (mean ± SD: 28.6 ± 12.2 on the Pain Catastrophizing Scale), and subjective sleep disturbance exceeded the US population average (mean ± SD: 58.5 ± 8.1 on the Patient Reported Outcomes Measurement Information System Sleep Disturbance - Short Form). By contrast, objective sleep duration was consistent with the recommended daily sleep amount of 7-8 h for adults (mean ± SD: 8.3 ± 1.4 h). Across treatment conditions, pain intensity, pain catastrophizing, and subjective sleep disturbance were significantly less at posttreatment and 3-month follow-up than at baseline (p < 0.001). Actigraphic sleep duration did not differ significantly as a function of time. There was a high degree of covariation among the measures of pain intensity, pain catastrophizing, and sleep disturbance (p < 0.05). However, self-reported sleep disturbance was not significantly correlated with actigraphic sleep duration (|r| <= 0.13, p > 0.05). Sleep and pain variables observed at prior assessments predicted these same variables at subsequent assessments. There was no significant evidence that changes in pain preceded changes in sleep or that changes in sleep preceded changes in pain (all p > 0.05). For this study's Veterans, treatment-related changes in sleep and pain appeared to occur in parallel. The concomitant changes in sleep and pain suggest that therapies improving pain in Veterans may yield attendant benefits for the treatment of sleep, and possibly vice versa.

Sleep problems and impact of obstructive hydrocephalus in newly diagnosed pediatric brain tumor patients

BackgroundPediatric brain tumor patients are at risk of developing sleep problems. Previous studies were conducted in longer-term survivors or without comprehensive sleep evaluations, therefore it remains unclear whether and when problems arise. Insights can facilitate timely interventions. The aim is to examine sleep problems and contributing factors shortly after diagnosis. MethodsChildren 6–16 years with a primary brain tumor (diagnosed ≤3 months) were recruited for a prospective study. Sleep was measured at home using wrist-worn actigraphy and questionnaires (PROMIS Sleep Disturbance and Sleep Related Impairment, self- and parent-reports). Mean PROMIS scores, prevalence of sleep problems (established by cut-off scores) and actigraphic outcomes were compared to norms (t-test, chi-square, linear regression). Risk factors were explored with multivariable linear regression models. ResultsSixty-nine children (68% male, mean age 11.6 ± 2.8 years, 53 ± 28 days after diagnosis) participated. Parents reported more child sleep disturbances (mean T = 53.7, P < .01) compared to norms. Rates of self- and parent-reported severe sleep disturbances were elevated (11% versus 5% in norms, P < .04). Parents also reported higher rates of moderate child sleep disturbance (31%) and sleep related impairment (42%) than norms (25%, P < .03). Actigraphy was comparable to healthy controls. Obstructive hydrocephalus was associated with longer sleep times (B=41.04, 95%CI 11.41;70.68) and shorter time since diagnosis with self-reported sleep disturbances (B=−.11, 95%CI −0.19;−0.03). ConclusionSleep problems are more frequently reported shortly after pediatric brain tumor diagnosis, compared to healthy controls. Attention for sleep around brain tumor diagnosis and impact of obstructive hydrocephalus is important, as sleep is vital for recovery and health-related quality of life.

Effects of Aircraft Noise on Sleep: Federal Aviation Administration National Sleep Study Protocol.

Aircraft noise can disrupt sleep and impair recuperation. The last U.S. investigation into the effects of aircraft noise on sleep dates back more than 20 years. Since then, traffic patterns and the noise levels produced by single aircraft have changed substantially. It is therefore important to acquire current data on sleep disturbance relative to varying degrees of aircraft noise exposure in the U.S. that can be used to check and potentially update the existing noise policy. This manuscript describes the design, procedures, and analytical approaches of the FAA's National Sleep Study. Seventy-seven U.S. airports with relevant nighttime air traffic from 39 states are included in the sampling frame. Based on simulation-based power calculations, the field study aims to recruit 400 participants from four noise strata and record an electrocardiogram (ECG), body movement, and sound pressure levels in the bedroom for five consecutive nights. The primary outcome of the study is an exposure-response function between the instantaneous, maximum A-weighted sound pressure levels (dBA) of individual aircraft measured in the bedroom and awakening probability inferred from changes in heart rate and body movement. Self-reported sleep disturbance due to aircraft noise is the secondary outcome that will be associated with long-term average noise exposure metrics such as the Day-Night Average Sound Level (DNL) and the Nighttime Equivalent Sound Level (Lnight). The effect of aircraft noise on several other physiological and self-report outcomes will also be investigated. This study will provide key insights into the effects of aircraft noise on objectively and subjectively assessed sleep disturbance.

The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review.

Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.

Assessing changes in sleep across four weeks among adolescents randomized to incentivized cannabis abstinence

BackgroundWithdrawal from cannabis use is associated with sleep disturbances, often leading to resumption of use. Less is known about the impact of abstinence on sleep in adolescence, a developmental window associated with high rates of sleep disturbance. This study investigated effects of sustained abstinence on self-reported sleep quality and disturbance in adolescents reporting frequent cannabis use. MethodsNon-treatment seeking adolescents, recruited from school screening surveys and the community, with frequent cannabis use (MAge=17.8, SDAge=1.7, 47% female, 45% non-white) were randomized to four weeks of biochemically-verified abstinence, motivated via contingency management (CB-Abst, n=53), or monitoring without an abstinence requirement (CB-Mon, n=63). A mixed-effects model was used to predict change in Pittsburgh Sleep Quality Index (PSQI) scores. ResultsParticipants in CB-Abst reported higher overall PSQI scores than those in CB-Mon (M=1.06, p=0.01) indicating worse sleep during the four-week trial. Sleep disruptions in CB-Abst increased during Week 1 of abstinence (d=0.34, p=0.04), decreased during Week 2 (d=0.36, p=0.04), and remained constant for the rest of the trial. At Week 4, sleep was comparable to baseline levels for those in CB-Abst (p=0.87). Withdrawal-associated sleep disruption in the CB-Abst group was circumscribed to increases in sleep latency (b=0.35; p=0.05). ConclusionsCannabis abstinence in adolescents was associated with transient delayed onset of sleep initiation falling asleep during the first week of abstinence. Findings highlight withdrawal-associated changes in sleep latency as an intervention target for supporting adolescents attempting abstinence. Future research should use objective measures of sleep and focus on elucidating mechanisms underlying sleep disturbances with cannabis use and withdrawal.

A - 159 The Influence of Sleep Duration on Reported Post-Concussion Symptoms Following Cognitive Exertion.

To investigate the influence of self-reported sleep disturbance on post-concussion symptom clusters after completing the ImPACT concussion screening tool in collegiate athletes. Participants (N&#3f215) were selected from a deidentified sports medicine ImPACT database. Participants were stratified into groups based on self-reported sleep disturbance: intact sleep duration (n = 150, Mage = 19.2, Medu = 11.8,64.7% female) and hyposomnia (n = 65, Mage = 22.5, Medu = 13.8,72.3% female). Data were included from the first post-injury follow-up session. Groups did not differ in gender, age, or years of education. ANCOVAs were used to test for differences in cognitive, physical, and neuropsychiatric symptom clusters post-ImPACT while controlling for pre-ImPACT symptoms and previous concussions. ANCOVA indicated a significant effect of sleep duration on cognitive (F(1,192) = 13.01,p < 0.001,ηp2 = 0.063), physical (F(1,154) = 7.29,p = 0.008,ηp2 = 0.045), and neuropsychiatric (F(1,192) = 6.24,p = 0.013,ηp2 = 0.031) symptoms reported after completing the ImPACT screening assessment. Mean comparisons revealed that the hyposomnia group reported symptom scores 1.5 points greater on cognitive (SE = 0.42), 1.4 points greater on physical (SE = 0.52), and 0.78 points greater on neuropsychiatric (SE = 0.31) symptom clusters. Results indicated that athletes who endorsed sleeping less during concussion recovery reported greater symptom scores after completing cognitive screening when controlling for pre-screening symptoms. These findings align with previous research suggesting that sleep dysfunction may negatively impact the recovery process. Our findings suggest that reduced sleep duration may lead to worsened symptoms following cognitive exertion, thereby exacerbating deficits and potentially lengthening the recovery trajectory. As a result, these athletes may benefit from interventions targeting sleep and a gradual return to sport.

Early life stress, sleep disturbances, and depressive symptoms during adolescence: The role of the cingulum bundle

Adolescence is often characterized by sleep disturbances that can affect the development of white matter tracts implicated in affective and cognitive regulation, including the cingulate portion of the cingulum bundle (CGC) and the uncinate fasciculus (UF). These effects may be exacerbated in adolescents exposed to early life adversity (ELA). We examined the longitudinal relations between sleep problems and CGC and UF microstructure during adolescence and their relation to depressive symptoms as a function of exposure to ELA. We assessed self-reported sleep disturbances and depressive symptoms and acquired diffusion-weighted MRI scans twice: in early adolescence (9–13 years) and four years later (13–17 years) (N = 72 complete cases). Independent of ELA, higher initial levels and increases in sleep problems were related to increases in depressive symptoms. Further, increases in right CGC fractional anisotropy (FA) mediated the association between sleep problems and depressive symptoms for youth who experienced lower, but not higher, levels of ELA. In youth with higher ELA, higher initial levels of and steeper decreases in sleep problems were associated with greater decreases in right UF FA, but were unrelated to depressive symptoms. Our findings highlight the importance of sleep quality in shaping fronto-cingulate-limbic tract development and depressive symptoms during adolescence.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States.

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Relationship of Sleep Health and Endoscopic Disease Activity in Inflammatory Bowel Disease: Endoscopic Disease Activity and Sleep.

Among adults with inflammatory bowel disease (IBD), self-reported sleep disturbances are associated with active symptoms, but the association between sleep measures and endoscopic disease activity is unknown. This study aimed to (1) compare sleep-wake behaviors among IBD patients based on endoscopic and clinical disease activity and (2) describe associations between actigraphy, self-reported sleep measures, and symptoms of fatigue, anxiety, and depression. Participants wore a wrist actigraph for 10 consecutive days and completed self-reported sleep questionnaires (Pittsburgh Sleep Quality Index [PSQI] and Patient-Reported Outcome Measures System [PROMIS] Sleep Disturbance and Sleep Interference questionnaires). Clinical and endoscopic disease activity were assessed. Based on actigraphic recordings ( n = 26), average total nighttime sleep was 437 minutes and sleep efficiency was 84%. Objective sleep measures did not differ based on endoscopic or clinical disease activity. Individuals with active clinical disease had higher PROMIS Sleep Disturbance (57.3 vs. 49.7, d = 1.28) and PROMIS Sleep-Related Impairment (58.1 vs. 52.8, d = 0.51) compared with those with inactive clinical disease. Self-reported sleep was significantly associated with anxiety, depression, and fatigue. Further research is needed to better characterize the relationship between sleep and endoscopic disease activity, and determine underlying mechanisms related to poor sleep in the IBD population.

The relationship between subjective sleep disturbance and attenuated psychotic symptoms after accounting for anxiety and depressive symptoms.

Sleep disturbances are increasingly recognized as cooccurring with psychotic symptoms. The potential importance of this relationship is complicated when considering the effects of anxiety and depressive symptoms which commonly present in early-stage illness states. This study aimed to investigate the relationship between self-reported sleep disturbance on the development of attenuated psychotic symptoms (APS) cross-sectionally and longitudinally while adjusting for roles of anxiety and depressive symptoms. Eight-hundred and two help-seeking young people aged 12 to 25years who engaged with our Australian early intervention services were included in the study (the "Transitions" cohort). Cross sectional mediation and cross-lagged longitudinal (12-month) mediation models were developed with outcomes being different APS domains. Only baseline excessive daytime sleepiness predicted later APS when accounting for previous APS, anxiety and depressive symptomatology. Cross sectionally, self-reported sleep disturbance showed both direct and indirect predictive relationships with all APS domains. Partial mediation through anxiety and depression was shown for unusual thought content, perceptual abnormalities, and disorganised speech, while full mediation through depression was shown for non-bizarre ideas. The specificity of the relationship between self-reported sleep disturbance on APS highlights the potential for different roles in mechanistic models of psychotic symptom expression. This further indicates the need for further experimental research to illuminate potential causal pathways. Future research should continue to use continuous, symptom level approaches across a range of timeframes to more accurately model the complex dynamics present in the sleep-psychosis relationship.

Social support and psychosocial well-being among older adults in Europe during the COVID-19 pandemic: a cross-sectional study

The objective of the study was to identify the association between social support and psychosocial well-being among men and women aged over 65 years in Europe during the COVID-19 pandemic.MethodsCross-sectional...

Perceived Neighborhood Characteristics and Sleep in Australian Adults.

Poor sleep can contribute to poorer health and socioemotional outcomes. Sleep health can be influenced by a range of individual and other socioecological factors. Perceptions of neighborhood physical and social characteristics reflect broader social-level factors that may influence sleep, which have not been well studied in the Australian context. This study examined the association between perceived neighborhood characteristics and sleep in a large sample of Australians. Data were from 9,792 people aged 16 years or older, from Waves 16 and 17 of the nationally representative Household, Income and Labour Dynamics in Australia Survey. Associations between perceived neighborhood characteristics (neighborly interaction and support, environmental noise, physical condition, and insecurity) and self-reported sleep duration, sleep disturbance, and napping were examined using multiple logistic regression models. "Neighborhood interaction and support" and "neighborhood physical condition" were not significantly associated with any sleep outcomes after adjusting for relevant covariates. However, "environmental noise" and "neighborhood insecurity" remained significantly associated with sleep duration and sleep disturbance. None of the neighborhood characteristics were associated with napping. Furthermore, associations did not significantly vary by gender. This study highlights the potential benefit of public health policies to address noise and safety in neighborhoods to improve sleep.

The Effect ofConcussion Mechanism ofInjury onSleep Problems inActive Duty Service Members Following Deployment.

Sleep disruption is pervasive in the military and is generally exacerbated during deployment, partially due to increases in operational tempo and exposure to stressors and/or trauma. In particular, sleep disruption is a commonly reported symptom following deployment-related traumatic brain injury (TBI), though less is known about the prevalence of sleep disturbance as a function of whether the TBI was induced by high-level blast (HLB) or direct impact to the head. TBI assessment, treatment, and prognosis are further complicated by comorbidity with posttraumatic stress disorder (PTSD), depression, and alcohol misuse. Here, we examine whether concussion mechanism of injury is associated with differences in the prevalence of self-reported sleep disturbance following deployment in a large sample of U.S. Marines while accounting for probable PTSD, depression, and alcohol misuse. This was a retrospective cohort study of active duty enlisted Marines with a probable concussion (N = 5757) who completed the Post-Deployment Health Assessment between 2008 and 2012. Probable concussion was defined as endorsement of a potentially concussive event with corresponding loss or alteration of consciousness. The presence of concussion-related sleep problems was assessed with a dichotomous item. Probable PTSD, depression, and alcohol misuse were assessed using the Primary Care PTSD Screen, the Patient Health Questionnaire-2, and the Alcohol Use Identification Test-Concise, respectively. Logistic regression models investigated the effects of mechanism of injury (HLB vs. impact), PTSD, depression, and alcohol misuse on the presence of sleep problems, adjusting for sex and pay grade. The study was approved by the Naval Health Research Center Institutional Review Board. Approximately 41% of individuals with a probable deployment-related concussion reported sleep problems following the event; 79% of concussed individuals reporting both HLB and probable PTSD reported sleep problems. All main effects were significantly associated with sleep disturbance in adjusted models. PTSD showed the strongest association with sleep disturbance (adjusted odds ratio [AOR] = 2.84), followed by depression (AOR = 2.43), HLB exposure (AOR = 2.00), female sex (AOR = 1.63), alcohol misuse (AOR = 1.14), and pay grade (AOR = 1.10). A significant HLB × PTSD interaction emerged (AOR = 1.58), which suggests that sleep disturbance was elevated among those with both HLB-induced (vs. impact-induced) concussions and presence (vs. absence) of PTSD. No other significant interactions emerged. To our knowledge, this is the first study to examine the prevalence of concussion-related sleep complaints following deployment as a function of the mechanism of injury in individuals with and without probable PTSD and depression. Individuals with HLB-induced concussion were twice as likely to report sleep problems as those with an impact-induced concussion. Future work should examine these effects longitudinally with validated measures that assess greater precision of exposure and outcome assessment (e.g., blast intensity and type of sleep disturbance).

A prospective study evaluating the association of patient-reported outcomes with activity level and sleep patterns in sarcoma survivors.

12085 Background: Sarcomas are a rare heterogeneous malignancy group affecting both sexes and all ages. Treatment is often intensive, resulting in long-term toxicities. Given the rarity of sarcoma, there is a paucity of data defining physical and emotional outcomes. The Cohort to Augment the Understanding of Sarcoma Survivorship Across the Lifespan (CAUSAL) was constructed at Vanderbilt University Medical Center (VUMC) to evaluate health-related outcomes. Methods: Sarcoma patients treated at VUMC from 2012 – present are enrolled into CAUSAL. Patient demographics, tumor and treatment data are abstracted from the electronic medical record. Participants complete surveys including PROMIS-57 consisting of seven domains including physical function, sleep disturbance, fatigue, and satisfaction with participation in social roles, which are reported here. Participants who have completed treatment are given a FitBit to track activity level and sleep over 12 weeks. Data are synced to an online platform, Fitabase. Body mass index (BMI) is assessed at study entry. For each participant, FitBit data were summarized using medians. To estimate the association between PROMIS-57 scores and activity and sleep data (FitBit), linear regression models were fit controlling for age, sex, and BMI of participants. Results: Of 306 CAUSAL participants who completed the PROMIS-57, 193 were post completion of sarcoma therapy. Of these, 76 also had FitBit data and are included in this analysis. Median step count was 5826 (quartiles: 3668, 7967), which was lower than average Fit Bit step count data for the US population (8170). Median daily active minutes was 252 minutes (quartiles: 174, 307). Median duration of sleep was 447 minutes (quartiles:381, 474) which was greater than the average reported by FitBit for the general US population (436 min). Step count was correlated with higher physical function score (p &lt; 0.001). A 10-point increase in physical function led to an average increase of 1291 (95% CI: 609,1973) steps when adjusting for age and sex. Compared with participants receiving treatment within 30 days prior to CAUSAL enrollment, participants not receiving treatment had 4.50 (95% CI: 1.53, 7.47) higher physical function score and 6.26 (95% CI: 1.87, 10.65) higher satisfaction in their social roles. There was no correlation between minutes of sleep recorded by FitBit and PROMIS responses. Conclusions: Using PROMIS-57, and FitBits, we demonstrated an association between higher step counts and self-reported higher physical function but did not find a correlation between FitBit recorded activity level/sleep and self-reported sleep disturbance or fatigue scores. Further, our data suggests patients with sarcoma sleep more and walk less than the general US population. As enrollment continues in CAUSAL, we will focus on PROMIS scores over time and their association with activity level and sleep.

0665 Ibogaine treatment in combat Veterans significantly improves sleep, beyond alleviating Posttraumatic Stress Disorder symptoms

Abstract Introduction Ibogaine is an indole alkaloid traditionally used in spiritual and healing rites in some African cultures. Ibogaine is primarily studied in the context of substance dependence, but indications suggest it may enhance recovery from trauma. Here, we investigated the effects of ibogaine treatment for multisystem effects of exposure to repeated blasts and combat on self-reported sleep disturbance, insomnia severity, and trauma-related symptoms. Methods Participants were Special Operations Veterans who independently and voluntarily underwent ibogaine treatment at a specialized clinic outside the USA. After meeting rigorous screening requirements, 30 participants were enrolled, all endorsing histories of repeated combat and blast exposure and traumatic brain injury. Participants were seen in person for baseline, immediate post-treatment, and 1-month post-treatment assessments, including the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for DSM-5 (CAPS-5), the Pittsburgh Sleep Quality Index (PSQI), and the Pittsburgh Insomnia Rating Scale (PIRS). Twenty-six participants completed sleep measures at baseline and 1-month post-treatment. Results Two-tailed paired samples t-tests revealed significant effects of time, with post-treatment improvements in CAPS (ΔM = -26.8±11.1, t(25) = 12.283, p &amp;lt; .001), PSQI (ΔM = -6.5±5.6, t(25) = 5.920, p &amp;lt; .001), and PIRS (ΔM = -23.8±15.5, t(24) = 7.690, p &amp;lt; .001). However, pre-post changes in PTSD symptom severity were not a significant predictor of improvements in PSQI (R² = .229, b = .354, p = .074) or PIRS (R² = .232, b = .339, p = .090) after controlling for age (p = .206 and p = .165, respectively). Conclusion To our knowledge, this is the first study examining the effects of ibogaine use on sleep in humans. Results indicated that while sleep and PTSD symptom severity improve 1-month post-treatment, they might be impacted by different mechanisms targeted by ibogaine. Even though a small sample size may have hindered the ability to reach desired probability values, the variance explained by the improvement in PTSD symptoms was still relatively modest (up to 23%). These promising findings demonstrate ibogaine’s therapeutic potential for disturbed sleep in the context of traumatic brain injury and trauma. Potential explanations are discussed. Support (if any) This study was supported by a private fund.

0386 Brief cognitive-behavioral therapy for insomnia among Japanese university students with sleep disturbances

Abstract Introduction Sleep disturbances among Japanese university students negatively affect their academic performance and mental health. Student habits, such as naps and using smartphones in bed, may lead to sleep problems. We hypothesized the Sleep Health through University Student Habits (SHUSH) program, a four-week cognitive-behavioral therapy for insomnia intervention, would improve sleep disturbances in university students. Methods We used a pretest-posttest, single arm pilot study design and evaluated the feasibility and preliminary efficacy of SHUSH. Occupational therapy and physical therapy students (N = 18) in a university with self-reported sleep disturbances (Insomnia Severity Index; ISI score ≥ 9) were offered 90-minutes of sleep education (e.g., two-process model of sleep regulation, stimulus control, and sleep hygiene) then prescribed personalized sleep restriction therapy (SRT) and stimulus control therapy (SCT) goals based upon 10-days of sleep diary data. This was followed by weekly 15-minute individualized meetings for three consecutive weeks; SRT and SCT goals were titrated based upon sleep diaries, and occupational therapists supported treatment adherence. Assessments included validated Japanese versions of sleep-related (e.g., sleep disturbance), mental health-related (e.g., depression) and sleep diary (e.g., sleep efficiency) variables. Dependent t-tests (d) and Wilcoxon rank sum tests (r) were used to test differences between baseline and posttest assessments. Results There were 15 students who completed SHUSH with a mean age of 19.7 years; 9 were women. Improvements were found in sleep disturbance (r = 0.843), sleep quality (r = 0.851), daytime sleepiness (d = 0.762), sleep hygiene practice (d = 1.216) and change from an eveningness towards a morningness circadian preference (d = 0.990). Anxiety (d = 0.604) and depression (d = 0.729) improved. Sleep onset latency (r = 0.851), nighttime awakening (r = 0.514), and sleep efficiency (r = 0.880) also improved. Participants were satisfied with the SHUSH group-based education, one-on-one therapist meetings, and program brevity; there were no adverse events. Conclusion SHUSH is a feasible and preliminarily effective sleep improvement program for reducing sleep disturbances among Japanese university students. Improved sleep was associated with improved mental health and sleep-promoting behaviors. A randomized controlled trial of SHUSH is recommended. Support (if any) Fulbright U.S. Scholar Award to Japan