Sleep Insomnia Research Articles

0331 Intersectional discrimination and sleep health among women veterans: a pilot study

Abstract Introduction Structural inequalities perpetuate poor health outcomes. Sleep inequality, which is the disproportionate burden of sleep problems among marginalized groups compared to historically advantaged groups, is poorly understood. While racial discrimination is associated with chronic health outcomes, few studies have examined the health impact of discrimination stemming from multiple social vulnerabilities. The current study assessed women veterans’ experiences of intersectional discrimination, specifically the combined impact of gender and racial/ethnic discrimination on sleep health. Methods Data were from the WISE (Women Improving Sleep through Education) study. Participants were women veterans with a previous diagnosis of sleep apnea or 1 or more risk factors for sleep disordered breathing (n=39). Data collection was from 3/2021–11/2021. The 9-item Major Discrimination Scale (MDS) and 10-item Everyday Discrimination Scale (EDS) were employed. The MDS included items such as “have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?” and the EDS, “how often on a day-to-day basis are you treated with less courtesy than other people?”. Items were adapted to assess discrimination related to respondents' gender and race/ethnicity separately. Major intersectional discrimination (MDS-gender + MDS-race/ethnicity) and everyday intersectional discrimination (EDS-gender + EDS-race/ethnicity) were computed. Sleep health was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Descriptive statistics and correlational analyses were performed. Results Racial/ethnic minority women veterans comprised 54% of the study sample. Prevalence of major intersectional discrimination was 67% and everyday intersectional discrimination, 92%. Compared to other racial/ethnic groups, the proportion of Black women veterans reporting major intersectional discrimination was highest (78%). Major intersectional discrimination was positively correlated with ISI (p=0.04) and PSQI (p=0.01). Everyday intersectional discrimination was not correlated with sleep health (p>0.05). Conclusion Pilot study findings highlight the potential role of discrimination on sleep health, particularly multiple forms of discrimination. High prevelence of intersectional discrimination related to women veterans' gender and racial/ethnic identities was observed. Major intersectional discrimination, not everyday intersectional discrimination, was associated with higher insomnia severity and poorer sleep quality. Support (If Any) LIP VA HSRD IIR16-244, RCSA20-191, LIP65-177, NIH/NHLBI K24HL143055, VAGLAHS GRECC, VAGLAHS CSHIIP, RCS 21-135, CIN 13-417, RCS 05-195

Sleep Quality and Related Clinical Manifestations in Huntington Disease.

(1) Background: Sleep patterns are frequently disrupted in neurodegenerative disorders such as Huntington disease (HD); however, they are still poorly understood, especially their association with clinic features. Our study aimed to explore potential correlations between sleep features and motor, cognitive, behavioural and functional changes in manifest HD subjects. (2) Methods: We enrolled 42 patients who were assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires; clinical features were evaluated by the validated ENROLL-HD platform assay, including the Unified Huntington’s Disease Rating Scale (UHDRS) and the Problem Behaviours Assessment Short Form (PBA-s). (3) Results: We found a significant association between the patients’ perception of sleep abnormalities and scores of impaired independence, cognitive and motor performances. Specifically, sleep efficiency (PSQI—C4 subscores) and the use of sleep medications (PSQI—C6 subscores) seem to be more frequently associated with the severity of the disease progression. (4) Conclusion: sleep abnormalities represent an important part of the HD clinical profile and can impair patients’ quality of life by affecting their level of independence, cognition performance and mental well-being.

Periocular Skin Warming Promotes Sleep Onset Through Heat Dissipation From Distal Skin in Patients With Insomnia Disorder.

Study ObjectivesPeriocular skin warming before bedtime has been demonstrated to improve subjective sleep initiation in healthy adults with sleep difficulties scored six or higher in the Pittsburgh Sleep Questionnaire Index. This study aimed to investigate the effects of periocular skin warming on sleep initiation and thermoregulation processes in patients with insomnia disorder.MethodsParticipants included those with sleep difficulty (n = 22) and those with insomnia disorder (n = 16). Individuals from both groups were assessed at baseline (habitual sleep-wake schedule) and after two intervention conditions (use of a warming eye mask or a sham eye mask before habitual bedtime). The subjective and electroencephalographic sleep onset latency, along with proximal and distal skin temperature after periocular skin warming, were evaluated.ResultsPeriocular skin warming reduced objective sleep onset latency in independently of the group. Foot temperature and foot-proximal temperature gradient after getting into bed increased with periocular skin warming in independently of the group. However, the increase in hand temperature was observed only in the insomnia disorder group. Periocular skin warming also increased the normalized high frequency component of heart rate variability in independently of the group. The reduction of objective sleep onset latency was strongly associated with heat dissipation from the foot skin region.ConclusionThese results suggest that periocular skin warming promotes sleep initiation by enhancing heat dissipation from the distal skin regions in individuals with sleep difficulty and insomnia disorder. Periocular skin warming could thus be a novel non-pharmacological therapy for insomnia disorder.

MO121: The Relationship between Perceived Stress with Anxiety, Depression, Sleep Quality, Insomnia and Drug Adherence in Patients with Systemic Lupus Erythematosus during the COVID-19 Pandemic

BACKGROUND AND AIMSSleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE.METHODThis was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HAD-A and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher.RESULTSThe mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245–1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026–1.487), P = .026].CONCLUSIONSLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up.Table 1.Comparison of baseline characteristics and clinical data of SLE patients according to Perceived Stress Scale (PSS) scoreVariableHigh PSS(n:59)Low PSS(n:101) P valueAge, years41.14 ± 12.4543.07 ± 13.83.379Female gender, n (%)52 (88.1%)90 (89.1%)1.000Smoking, n (%)6 (10.2%)14 (13.9%).623Alcohol, n (%)0 (0.0%)2 (2.0%).532Marital status, married, n (%)54 (91.5%)81 (80.2%).071History of Covid-19, n (%)16 (27.1%)15 (14.9%).065Hospitalization, n (%)5 (8.5%)2 (2.0%).102HAD-D score8.32 ± 3.054.01 ± 2.45<.001HAD-A score8.27 ± 2.525.31 ± 2.48<.001PSQI score8.27 ± 3.825.17 ± 2.96<.001ISI score9.88 ± 4.935.01 ± 4.06<.001MARS-5 score22.80 ± 2.4222.90 ± 2.11.772Presence of depression, n (%)37 (62.7%)8 (7.9%)<.001Presence of anxiety, n (%)12 (20.3%)4 (4.0%).001Poor sleep quality, n (%)45 (76.3%)32 (31.7%)<.001Insomnia, n (%)41 (69.5%)21 (20.8%)<.001

Effectiveness of emotional freedom techniques (EFT) vs sleep hygiene education group therapy (SHE) in management of sleep disorders among elderly

Sleep disorders are common among elderly persons, with deleterious effects on their physical and mental health. Many approaches are used to manage such disorders. To compare the Emotional Freedom Techniques–Insomnia (EFT-I) and Sleep Hygiene Education (SHE) group therapy as two treatments for insomnia in a geriatric population when delivered, and their effects on sleep quality, depression, and life satisfaction. This open-label randomized controlled trial study was conducted at El-Abbasia Mental Hospital and Osana family wellness elderly nursing home at Maadi, Cairo. It included 60 elderly patients suffering insomnia sleep problems randomized into two equal groups: one group received a Sleep Hygiene Education (SHE) intervention, the other had a form of Emotional Freedom Techniques (EFT) adapted for use with insomnia (EFT-I). A self-administered questionnaire with tools for sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression, and life satisfaction was used to collect data. The fieldwork was from January to March 2021. The two groups had equal median age (70 years), and almost similar gender and place of residence distribution. After the intervention, 73.3% of the EFT group had good sleep quality, compared to 100.0% in the SHE group (P = 0.005); the median score of depression (3.00) was higher in the EFT group compared with 0.00 in the SHE group (P < 0.001); as for life satisfaction, the difference was not statistically significant. The multivariate analyses identified the study intervention as the main statistically significant negative predictor of PSQI and depression scores, and a positive predictor of life satisfaction. Being in the SHE group was a negative predictor of PSQI and depression scores. Both SHE and EFT approaches are beneficial for elderly patients’ sleep quality, with SHE being more effective in ameliorating sleep. Further replication of this study is needed on a large probability sample from different geographical areas to help for the generalization of the results.

Combining cardiac monitoring with actigraphy aids nocturnal arousal detection during ambulatory sleep assessment in insomnia.

Study ObjectivesThe objective assessment of insomnia has remained difficult. Multisensory devices collecting heart rate (HR) and motion are regarded as the future of ambulatory sleep monitoring. Unfortunately, reports on altered average HR or heart rate variability (HRV) during sleep in insomnia are equivocal. Here, we evaluated whether the objective quantification of insomnia improves by assessing state-related changes in cardiac measures.MethodsWe recorded electrocardiography, posture, and actigraphy in 33 people without sleep complaints and 158 patients with mild to severe insomnia over 4 d in their home environment. At the microscale, we investigated whether HR changed with proximity to gross (body) and small (wrist) movements at nighttime. At the macroscale, we calculated day-night differences in HR and HRV measures. For both timescales, we tested whether outcome measures were related to insomnia diagnosis and severity.ResultsAt the microscale, an increase in HR was often detectable already 60 s prior to as well as following a nocturnal chest, but not wrist, movement. This increase was slightly steeper in insomnia and was associated with insomnia severity, but future EEG recordings are necessary to elucidate whether these changes occur prior to or simultaneously with PSG-indicators of wakefulness. At the macroscale, we found an attenuated cardiac response to sleep in insomnia: patients consistently showed smaller day-night differences in HR and HRV.ConclusionsIncorporating state-related changes in cardiac features in the ambulatory monitoring of sleep might provide a more sensitive biomarker of insomnia than the use of cardiac activity averages or actigraphy alone.

Associations between Dietary Patterns and Sleep Problems in Adolescent Girls: A Descriptive Cross-Sectional Study

Background: Adolescence may be accompanied by abnormalities in menstrual cycles that result in a higher incidence of sleep problems and related psychological disorders. Dietary factors can intensify or improve sleep problems. This study aimed to evaluate the association between sleep problems and habitual dietary patterns among Iranian adolescent girls. Methods: This study was conducted in cities of Mashhad and Sabzevar, northeastern Iran. A total of 752 adolescent girls aged 12-18 years were recruited from several schools by using a random cluster sampling method. A valid and reliable food frequency questionnaire (FFQ) was used to obtain the dietary intakes of the girls. Validated Iranian versions of the questionnaires were used to assess insomnia and daytime sleepiness prevalences. Results: Three major dietary patterns were identified based on the principal component analysis (PCA), including healthy, western, and traditional dietary patterns. No significant associations were found between the quartiles of healthy (OR: 1; 95% CI 0.62-1.59, P trend = 0.75), western (OR: 1.3; 95% CI 0.8-2.10, Ptrend = 0.16) or traditional (OR: 0.62; 95% CI 0.69-1.82, Ptrend = 0.64) dietary patterns and sleep insomnia. In addition, there were no significant relationships between the quartiles of healthy (OR: 0.85; 95% CI 0.54-1.69, P trend = 0.84), western (OR: 0.81; 95% CI 0.49-1.32, Ptrend = 0.55) or traditional (OR: 1.07; 95% CI 0.66-1.74, Ptrend = 0.9) dietary patterns and daytime sleepiness. Conclusions: No significant association was observed between dietary patterns and insomnia or daytime sleepiness among adolescent girl participants.

Effectiveness of Cognitive-Behavioral Therapy for Improving Sleep Quality and Reducing Insomnia Severity in Afflicted Patients

Background: Based on the proven role of sleep quality in promoting health, the treatment of insomnia should be premised on identification of characteristics and severity of insomnia symptoms. This study aimed to investigate the effectiveness of Cognitive-Behavioral Therapy for Insomnia (CBT-I) in improving sleep quality and reducing insomnia severity among the afflicted patients. Methods: This was a semi-experimental study with a pre-test, post-test, and follow-up design and control group. The statistical population included all patients visiting the Sleep Disorder Clinic of Rasoul Akram Hospital and two private psychiatric clinics, selected using convenience sampling in Tehran in 2020. Twenty out of 60 patients with insomnia disorder, diagnosed based on the Diagnostic and Statistical Manual for Insomnia, were randomly selected using a lottery method. The participants were divided into the experimental and control groups. In the cognitive-behavioral group, each participant individually received a 6-week treatment intervention. All participants in both groups were evaluated at the beginning of the treatment, at the end of the treatment, and one month after the treatment. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used for data collection. Results: The results showed a significant between-group difference in the scores of sleep quality and insomnia severity at post-test stage (p&lt;0.05). Moreover, the follow-up test results suggested the stability of the effect of treatment interventions on sleep quality and insomnia severity among the experimental and control groups relative to their pre-test scores (p&lt;0.05). Conclusion: The results indicated that CBT-I could improve sleep quality and insomnia severity in afflicted patients.

The Association Between Perceived Stress with Sleep Quality and Insomnia in Hemodialysis Patients During the COVID-19 Pandemic

The Association Between Perceived Stress with Sleep Quality and Insomnia in Hemodialysis Patients During the COVID-19 Pandemic

Gender-specific predictors of poor sleep quality and insomnia among caregivers of persons living with dementia

While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient. Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support. Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving. For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life. Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life. Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States. Chi square tests were used for bivariate analyses and a logistic regression model was used to predict meaning in life based on caregiving status. After accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-caregivers (OR=1.501, CI= 1.493-1.510). This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.

Stress, Cognition, and Minority Health

This symposium examines the many factors influencing cognition and health among ethnically and racially diverse groups. Kindratt et al. use representative, national data to examine cognitive limitations and diabetes among foreign born Non-Hispanic Whites, Blacks, Hispanics, Asians and Arab Americans. Results indicate that prevalence of cognitive limitations was highest among non-Hispanic Whites and Arab-Americans, lowest among Blacks and Asians. Diminich et al. investigate the association of stressors and metabolic risk factors with cognitive/emotional functioning in a population of Hispanic/Latina(o) immigrants. They find a link between components of metabolic syndrome that are associated with domain specific deficits in cognition. These impairments are linked to posttraumatic stress, immigration related trauma and emotional health and wellbeing. Arevalo et al. examine cross-sectional and prospective associations of sleep duration and insomnia symptoms with measures of cognitive functioning among older Latinos from Puerto Rican ancestry with a longitudinal sample of older adults from the Boston Puerto Rican Health Study. Findings indicate that hours of sleep and insomnia symptoms are significantly associated with a number of global and specific cognitive factors. Finally, Munoz and colleagues, using a regional racially and ethnically diverse sample of people living in a large northeastern city, identified four stress profiles. These profiles (which focus on different types of stress) were differentially associated with working memory performance. In sum, these four papers document the experiences of stress and their association with cognitive functioning in diverse minority groups each of whom are disproportionately at risk for ADRD/RD. Gerald, from NIA, will serve as discussant.

Sleep and Cognition: Results From a Longitudinal Cohort of Older Puerto Rican Adults

We examined cross-sectional and prospective associations of sleep duration and insomnia symptoms with measures of cognitive function among older adults aged 45-75 y from the Boston Puerto Rican Health Study, a longitudinal cohort of 1500 participants of Puerto Rican ancestry. We found, statistically significant cross-sectional associations of sleep duration (hours) and an executive function domain before (F=6.20; Prob>F=0.0001) and after (F=2.33; Prob>F=0.05) controlling for covariates (age, sex, education, smoking, drinking, mental and health conditions and medication use); between sleep duration and global cognition before (F=5.38; Prob>F=0.0003) and a trend after controlling for covariates (F=2.20; Prob>F=0.0669). In longitudinal associations, sleep duration (time2) was significantly associated with global condition at time3 (F=2.42; Prob>F=0.0475) after controlling for time2 global cognition. In conclusion, we found hours of sleep and insomnia symptoms significantly associated with various cognitive factors. A public health focus on sleep hygiene may improve cognitive health outcomes in older Puerto Rican adults.

Sleep Disorders Among Commercial Airline Pilots.

BACKGROUND: Over the next 20 yr, international market expansion will necessitate the production of new commercial airplanes and the recruitment of additional crewmembers and technicians. Research has proven that fatigue and lack of sleep are risk factors for impaired cognitive performance and human error. Pilots frequently report fatigue to their employers, which may be related to sleep disturbance. Airline pilots, in particular, often experience circadian desynchronization and other types of sleep disorders. Shift workers have been observed to be at higher risk of fatigue that affects their performance and alertness. In Saudi Arabia, sleep disorders among airline pilots are understudied and underreported. The primary objective of this study was to screen for and determine the risk of sleep disorders, fatigue, and depression among pilots.METHODS: A cross-sectional epidemiological study with national commercial pilots was conducted from March 2019 to March 2020 using validated questionnaires to screen for the risk of sleep disorders, fatigue, and depression.RESULTS: In total, 344 pilots participated in the study. Half the sample was at risk for insomnia and fatigue. Older and more experienced pilots were less likely to suffer impaired sleep quality, insomnia, sleepiness, fatigue, and depression. In total, 59 (17.2%) pilots were at high risk for sleep apnea.CONCLUSION: The current study found that pilots were at risk of developing sleep disorders. A more robust and objective assessment is warranted for screening.Alzehairi A, Alhejaili F, Wali S, Al Qassas I, Balkhyour M, Pandi-Perumal SR. Sleep disorders among commercial airline pilots. Aerosp Med Hum Perform. 2021; 92(12):937-944.

Evaluation of habitual sleep and factors influencing it in patients awaiting acute or planned abdominal surgery

Background and aims: This study aimed to clarify the incidence and severity of habitual sleep disturbances in patients undergoing surgery. Methods: A survey was conducted to collect data in a cohort of patients awaiting abdominal surgery. The Insomnia Severity Index score was used as primary measurement, while the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index scores were used as secondary measurements. Findings: Overall, 119 patients were included in the analysis. The habitual sleep in the study cohort revealed high incidence of sleep difficulties and insomnia. Female sex and incidence of anxiety and depression were significantly related to all three scores, while age and employment were associated with Epworth Sleepiness Scale and Insomnia Severity Index scores, respectively. Conclusions: Female sex, experiencing depression or anxiety had severe negative impact on sleep in patients scheduled for elective or planned surgery. The prevalence of sleep problems in patients should be considered for optimising sleep to improve rehabilitation and reduce stress associated with surgery.

Towards a Consensus on Alzheimer's Disease Comorbidity?

Alzheimer’s disease (AD) is often comorbid with other pathologies. First, we review shortly the diseases most associated with AD in the clinic. Then we query PubMed citations for the co-occurrence of AD with other diseases, using a list of 400 common pathologies. Significantly, AD is found to be associated with schizophrenia and psychosis, sleep insomnia and apnea, type 2 diabetes, atherosclerosis, hypertension, cardiovascular diseases, obesity, fibrillation, osteoporosis, arthritis, glaucoma, metabolic syndrome, pain, herpes, HIV, alcoholism, heart failure, migraine, pneumonia, dyslipidemia, COPD and asthma, hearing loss, and tobacco smoking. Trivially, AD is also found to be associated with several neurodegenerative diseases, which are disregarded. Notably, our predicted results are consistent with the previously published clinical data and correlate nicely with individual publications. Our results emphasize risk factors and promulgate diseases often associated with AD. Interestingly, the comorbid diseases are often degenerative diseases exacerbated by reactive oxygen species, thus underlining the potential role of antioxidants in the treatment of AD and comorbid diseases.

Novel genetic variants associated with brain functional networks in 18,445 adults from the UK Biobank

Here, we investigated the genetics of weighted functional brain network graph theory measures from 18,445 participants of the UK Biobank (44–80 years). The eighteen measures studied showed low heritability (mean h2SNP = 0.12) and were highly genetically correlated. One genome-wide significant locus was associated with strength of somatomotor and limbic networks. These intergenic variants were located near the PAX8 gene on chromosome 2. Gene-based analyses identified five significantly associated genes for five of the network measures, which have been implicated in sleep duration, neuronal differentiation/development, cancer, and susceptibility to neurodegenerative diseases. Further analysis found that somatomotor network strength was phenotypically associated with sleep duration and insomnia. Single nucleotide polymorphism (SNP) and gene level associations with functional network measures were identified, which may help uncover novel biological pathways relevant to human brain functional network integrity and related disorders that affect it.

Temperament, sleep quality, and insomnia severity in university students: Examining the mediating and moderating role of sleep hygiene.

University students commonly experience sleep problems which have implications for daily functioning and academic achievement. For this reason, research is needed to identify modifiable individual difference variables that may contribute to better sleep in this population. Temperament and sleep hygiene may be two such factors. As part of a larger study, 167 university students (61.7% female) completed online questionnaires that inquired about temperament (the Adult Temperament Questionnaire; ATQ), sleep hygiene behavior (the Sleep Hygiene Index; SHI), global sleep quality (the Pittsburgh Sleep Quality Index; PSQI), and insomnia severity (the Insomnia Severity Index; ISI). Correlations amongst the included measures were in the predicted direction: effortful control was negatively associated with the SHI composite, PSQI global scores, and ISI scores; extraversion was negatively related to PSQI global scores; and negative affect was positively associated with the SHI composite and ISI scores. In addition, the SHI composite mediated the association between effortful control and the PSQI global scores as well as the association between negative affect and PSQI global scores; similar patterns of mediation were found when considering ISI scores, although the direct effects differed. That is, negative affect was directly associated with ISI scores but not PSQI global scores. These findings suggest that interventions designed enhance effortful control, reduce negative affect, and improve sleep hygiene may contribute to better global sleep quality and decrease insomnia in university students.

Why cardiac nurses need good sleep health literacy

A holistic view of patient health recognises sleep as an important pillar of wellbeing. There is increasing evidence that sleep disorders are associated with both the cause and consequences of a patient's cardiac conditions. It follows, therefore, that recognition and treatment of these disorders may be of particular importance in the secondary prevention of coronary heart disease. The purpose of this commentary is to outline how two major sleep disorders (obstructive sleep apnoea and insomnia) are associated with poor sleep quality, psychological health and cardiac health. It is hoped that health professionals, including cardiac nurses, can obtain a basic understanding of these associations so that they may better explain the importance of screening and treatment for sleep disorders to their patients.

Abstract 848: Sleep behaviors and risk of lung cancer in the UK Biobank

Abstract Background. Lung cancer is the second most common malignancy and the leading causes of cancer death in both men and women in the United States. Cross-sectional studies on sleep disorders showed that sleep apnea and nocturnal hypoxemia are associated with an increased risk of lung cancer. Studies on sleep patterns are largely limited to sleep duration, snoring, insomnia and narcolepsy, in which short or long sleep duration, insomnia and narcolepsy are associated with an increased lung cancer risk. However, the association with other sleep patterns such as chronotype has not yet been investigated and the joint collective impact of sleep behaviors on lung cancer risk remains undetermined. In this study, we examined the association of six sleep behaviors with risk of lung cancer overall and among subgroups defined by smoking status and sex. Methods. A total of 410,252 UK Biobank participants free of lung cancer aged 37-73 years recruited in 2006-2010 were included. Lung cancer cases were identified from cancer registry or death records up to September 2020. Self-reported sleep behaviors (chronotype, duration, daytime nap, snoring, insomnia, and narcolepsy) were collected at study baseline. Multivariable Cox proportional hazard regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CIs) for each sleep behavior and risk of lung cancer. A composite unhealthy sleep score (0-3) was further developed by summing the individual score of three unhealthy sleep behaviors: evening chronotype, sleep &amp;lt;7 or &amp;gt;8 h/day, and usual daytime nap, with higher scores indicating a higher-risk sleep pattern. Stratified analyses jointly by smoking status (never vs. ever) and sex were conducted. Results. During up to 13.6 years of follow up with 4,693,213 person-years, a total of 2,897 lung cancer cases were documented. Compared with individuals with morning chronotype, participants with evening chronotype had an 11% increased risk of lung cancer (HR: 1.11, 95%CI: 0.98-1.26). Those who slept &amp;lt;7 or &amp;gt;8 h/day had 9-25% increased risk compared with individuals who slept 7-8 hours. Compared with those who never took daytime nap, participants with usual nap had an 14% increased lung cancer risk (HR: 1.14, 95%CI: 1.00-1.30). Snoring, insomnia and narcolepsy were not associated with lung cancer risk. Compared with participants without any of high-risk sleep behavior (evening chronotype, sleep &amp;lt;7 or &amp;gt;8 h/day, and usual daytime nap), those with 1 high-risk behavior had 12% (HR: 1.12, 95%CI: 1.04-1.21) increased risk of lung cancer, and individuals with 2 or 3 high-risk sleep behaviors had a 30% (HR: 1.30, 95%CI: 1.15-1.47) increased risk of lung cancer (Ptrend &amp;lt; 0.001). Such association was similarly observed among male and female smokers, but was slightly stronger in male never smokers compared to females. Conclusion. Unhealthy sleep behaviors including evening chronotype, sleep &amp;lt;7 or &amp;gt;8 hours per day, and usual daytime nap was associated with increased risk of lung cancer. Citation Format: Xiaoyan Wang, Xiaoyu Zong, Na Li, Ramaswamy Govindan, Graham Colditz, Yin Cao. Sleep behaviors and risk of lung cancer in the UK Biobank [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 848.

Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer\xa0patients

ObjectiveThe objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems.MethodsA sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined.ResultsThe reliability of the ISI was very good (Cronbach’s alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15).Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs).ConclusionsThe ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.