Sleep Measures Research Articles

Mendelian randomization analysis using GWAS and eQTL data to investigate the relationship between chronotype and neuropsychiatric disorders and their molecular basis.

Chronotype is a proxy sleep measure that has been associated with neuropsychiatric disorders. By investigating how chronotype influences risk for neuropsychiatric disorders and vice versa, we may identify modifiable risk factors for each phenotype. Here we used Mendelian randomization (MR), to explore causal effects by (1) studying the causal relationships between neuropsychiatric disorders and chronotype and (2) characterizing the genetic components of these phenotypes. Firstly, we investigated if a causal role exists between five neuropsychiatric disorders and chronotype using the largest genome-wide association studies (GWAS) available. Secondly, we integrated data from expression quantitative trait loci (eQTLs) to investigate the role of gene expression alterations on these phenotypes. Evening chronotype was causal for increased risk of schizophrenia and autism spectrum disorder and schizophrenia was causal for a tendency toward evening chronotype. We identified 12 eQTLs where gene expression changes in brain or blood were causal for one of the phenotypes, including two eQTLs for SNX19 in hippocampus and hypothalamus that were causal for schizophrenia. These findings provide important evidence for the complex, bidirectional relationship that exists between a sleep-based phenotype and neuropsychiatric disorders, and use gene expression data to identify causal roles for genes at associated loci.

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.

Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty: a prospective, double-blind, pilot, randomised controlled trial

BackgroundPostoperative sleep disturbance (PSD) is a common and serious postoperative complication and is associated with poor postoperative outcomes.AimsThis study aimed to investigate the effect of transcranial direct current stimulation (tDCS)...

Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study.

Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. DERR1-10.2196/52652.

Abstract P129: Risk of COVID-19 Hospitalization or Death by the AHA's Life’s Essential 8: The Collaborative Cohort of Cohorts for COVID-19 Research (C4R)

Background: It is unknown how cardiovascular health (CVH) relates to severe Covid-19 illness in adults without clinical cardiovascular disease (CVD). We hypothesized that more optimal Life’s Essential 8 (LE8)-quantified CVH is associated with lower risk of severe Covid-19 among US adults without clinical CVD. Methods: C4R is ascertaining Covid-19 events in 14 NIH cohorts via questionnaires, serosurvey, and medical record adjudication. We included cohorts with pre-pandemic LE8 measures of body mass index (BMI), blood pressure (BP), lipids, diet, glucose, physical activity, smoking, and sleep in participants without clinical CVD. Covid-19 was defined as severe (hospitalization, death) or non-severe (all other events). Fine-Gray sub-distribution hazard models compared incident Covid-19 by LE8 quartiles, with non-severe and severe Covid-19 as competing risks. Models were censored at first event, stratified by cohort, and adjusted for sociodemographics and vaccinations at time of Covid-19. Results: Among 21,300 participants in 7 cohorts (mean [SD] age 67 years [14], 61% female, 2% American Indian, 4% Asian, 16% Black, 33% White, 43% Hispanic), mean (SD) LE8 was 65 (14). In 3/2020-9/2022, there were 3,034 non-severe and 488 severe Covid-19 cases. The best CVH quartile (Q) 4 had more non-severe and fewer severe Covid-19 events. The Q4 vs. Q1 aHR was 1.08 (95% CI 0.98, 1.20) for non-severe Covid-19 and 0.59 (0.45, 0.77) for severe Covid-19. Examining LE8 components separately, better status on 5 LE8 components (BMI, BP, glucose, physical activity, smoking) was associated with significantly lower risk of severe Covid-19, whereas 3 were not associated (cholesterol, diet, sleep; data not shown). Conclusions: Better LE8-quantified CVH was associated with 41% lower risk of severe Covid-19 events in adults without clinical CVD. Further research is needed to elucidate mechanisms of Covid-19 resilience and the role of CVH-directed interventions to reduce risks of severe Covid-19.

Abstract P205: Poor Sleep Quality and Daytime Sleepiness Associated With Lower Quality Diet in an Israeli Cohort

Introduction: Sleep health and diet quality are bidirectionally linked. Poor sleep can impair metabolic function and alter eating behavior, while a poor quality diet may negatively impact sleep and daytime function through multiple pathways (i.e. inflammation, obesity, daytime fatigue). Methods: In a 2017 Israeli Bureau of Statistics population-based survey of households, 7,230 Israeli individuals reported habitual sleep and diet quality. Sleep variables included sleep duration (≤5, 6, 7, 8, or ≥9 hours per night), sleep disturbances (0, ≤1, 2-3, or 4+ nights per week), and daytime sleepiness (categorized as either “None”, “Not Much”, “Somewhat”, or “Greatly”). Diet variables were categorized as 0, 1, 2, 3, or 4+ daily servings of vegetables, fruits, and whole grains, and 0, 1, 2, 3, or 4+ weekly servings of legumes, red meat, and fish. Covariates included age, sex, BMI, financial status, and ethnicity. Results: Individuals who slept ≤5 hours were less likely to eat daily vegetables (oOR=0.863, p&lt;0.05). Individuals who slept ≤7 hours were less likely to eat daily fruits (oOR=0.858, p&lt;0.02), and whole grains (oOR=0.0.772, p&lt;0.0005). Individuals who slept ≥9 hours were less likely to eat daily vegetables (oOR=0.803, p=0.038), fruits (oOR=0.783, p=0.025), or wholegrains (oOR=0.783, p=0.027), as well as weekly legumes (oOR=0.788, p=0.025), and fish (oOR=0.779, p=0.028). Those with severe sleep disturbances (4+ per week) were less likely to eat daily vegetables (oOR=0.675, p&lt;0.0005), fruits (oOR=0.765, p&lt;0.0005), and whole grains (oOR=0.840, p=0.011), or weekly legumes (oOR=0.806), p=0.001). Mild daytime sleepiness was associated with fewer daily vegetables (oOR=0.834, p=0.007), while “great” daytime sleepiness was associated with fewer vegetables (oOR=0.558, p&lt;0.0005), fruits (oOR=0.689, p&lt;&gt;0.0005), wholegrains (oOR=0.751, p&lt;0.0005), and legumes (oOR=0.734, p&lt;0.0005). In a stepwise model adjusting for all sleep variables, many measures of poor sleep were independently associated with fewer daily vegetables, fruits, and wholegrains, fewer weekly legumes, and more weekly red meat. Conclusions: While the relationship between sleep and diet is complex, these data suggest that multiple independent pathways link poor sleep with an objectively unhealthier diet. The interaction between diet and daytime function, in particular, warrants further attention. Interventions targeting healthier sleep and diet must consider all aspects of sleep quality, including nocturnal sleep itself and daytime sleepiness.

Abstract P464: Performance of an Automated Sleep Scoring Approach for Actigraphy Data in Children and Adolescents

Background: Actigraphy has advanced the measurement of sleep for cardiometabolic research in childhood. However, actigraphy methods lack standardization, limiting rigor and reproducibility. GGIR, an open-source R package, facilitates raw accelerometer data processing to generate sleep data in a standardized manner. This tool has been validated and applied to adult data, but less is known about the suitability of this tool for generating sleep estimates among children. We aimed to (1) determine the validity of multiple sleep scoring settings available within GGIR in children, and (2) evaluate how this tool automatically generates sleep data in community-based pediatric studies. Method: The validation study included 30 children (14 female, 8-16y) referred for in-lab overnight polysomnography at Children’s Hospital of Philadelphia. Participants wore a GENEActiv during polysomnography that captured data at 50 Hz, which were aligned into 30-second epochs against the sleep stages from polysomnography scored by a sleep medicine physician. Balanced accuracy was the primary validation metric, which is the average of sensitivity and specificity. For community-based testing, three pediatric cohorts were used: Study 1 (Philadelphia; 12-16y; GENEActiv, N=251), Study 2 (Mexico City, 9-18y; ActiGraph GT3X-BT; N=543), and Study 3 (Houston; 5-8y; ActiGraph GT3X+, N=226). We processed raw accelerometry data with the Cole-Kripke (CK), Sadeh (S), and Van Hees (VH) algorithm settings. Result: For in-lab validation, 271.5 hours of polysomnography data were collected with 80% of the epochs scored as sleep; sleep duration averaged 7.3 hours (SD = 1.3). In rank order, average balanced accuracies were 0.81 (SD = 0.08) for GGIR-CK, 0.77 (SD = 0.09) for GGIR-VH, and 0.68 (SD = 0.11) for GGIR-S. The GGIR-S algorithm had the poorest detection of night awakenings (specificity: 0.38 [SD = 0.21]). For community-based data, without manually altering the data, the average sleep duration was highest when using the Sadeh algorithm in each study (8.3 [SD = 1.6], 8.0 [SD = 1.9], and 5.2 [SD = 4.4] hours for studies 1-3) and lower when using the GGIR-CK algorithm (7.1 [SD = 1.4], 6.9 [SD = 1.7], 4.3 [SD = 3.7] hours for studies 1-3). Approximately 2% of the data were affected by obvious errors (e.g., negative wake after sleep onset), with almost all such errors detected with the Sadeh algorithm. Conclusion: In a controlled setting, GGIR-CK had the optimal balanced accuracy performance for estimating sleep duration in children. In keeping with the lab-based finding of poorer detection of night awakenings, sleep duration was highest in the community samples when using GGIR-S. When applied to community-based data the automated GGIR approach generated sleep data that included errors, necessitating additional data cleaning. Incorporating standardized data cleaning steps within GGIR would improve rigor and reproducibility.

Abstract 24: Actigraphy-Measured Sleep Irregularity Increases the Risk of Incident Cardiovascular Disease and Cardiovascular Mortality in Older Women

Background: Cardiovascular disease (CVD) is the leading cause of death for U.S. women. Our understanding of how poor sleep health contributes to CVD is limited by reliance on cross-sectional studies, self-reported sleep measures, and predominately non-Hispanic white samples. Our objective was to prospectively investigate actigraphy-measured sleep health and incident CVD and CVD mortality in a cohort of older multiethnic women. Methods: Women (n=3,992; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in May 2012-April 2014 and were followed through February 2022 for physician-adjudicated incident CVD (definition in Table footnote) and CVD mortality. Sleep duration, timing, efficiency, irregularity, and continuity were derived from accelerometers (definition in Table footnote). Women with prior CVD at baseline were excluded from analyses. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Minimally adjusted models included age, race and ethnicity. Models were additionally adjusted for education, smoking, alcohol consumption, comorbid conditions, self-rated health, and CVD risk factors. Results: Over a median of 8.3 years of follow-up, 636 incident CVD cases occurred, including 395 CVD deaths. In minimally adjusted models, longer sleep duration, greater sleep irregularity, and more wake after sleep onset were associated with increased CVD risk (Table 1). In models further adjusted for CVD risk factors, the HR (95% CI) for a 60-minute increase in sleep irregularity was 1.18 (1.01-1.37) for incident CVD and 1.30 (1.07-1.58) for CVD mortality. Conclusions: Greater sleep irregularity was associated with higher risk of incident CVD and CVD mortality in a diverse cohort of older women. These results support the importance of maintaining regular sleep for cardiovascular health.

Abstract 28: Social Dimensions of Sleep: An Exploration of Midlife Working-Class Women’s Experiences in Mexico

Sleep, one of Life’s Essential 8, is vital to midlife women’s cardiovascular health (CVH). However, achieving healthy sleep is complex. As a first step, it is important to understand the barriers and facilitators to achieve adequate and high-quality sleep among midlife women in a context-specific manner. To comprehensively address this issue, we employed a mixed-methods approach to provide a nuanced understanding of the ecologies and experiences surrounding sleep health among working-class midlife women from Mexico City. First, we utilized existing epidemiologic data on participants to describe sleep and its correlates in a study population (n=120) of women enrolled in a cohort study via objective and subjective standard sleep measures. Then, we used thematic analysis to analyze in-depth ethnographic interview data (n=30) to characterize self-described barriers and facilitators of sleep. Our findings revealed that a substantial proportion of midlife women experienced poor sleep quality, with 53% reporting short sleep duration and 43% experiencing insomnia-related difficulties over seven days. Epidemiologic data suggested poor sleep outcomes were driven by age, type of work/occupation, food insecurity, mental health issues, and diabetes status. Our ethnographic interviews demonstrated that study participants perceived their familial relationships and responsibilities as the prominent barrier to quality sleep, encompassing challenges such as insufficient sleep due to family obligations and sleep disturbances triggered by family-related stressors. Combining these methodological approaches underscored the strong social dimension of sleep, where good sleep hinged on completing household tasks and attending to family needs. In response to sleep deficits, women frequently turned to caffeine consumption and occasional napping as coping mechanisms and described using sleep facilitators, including remedies like teas or other “natural” products. This study highlights the intricate social drivers of sleep, termed the “Sociality of Sleep,” among Mexican midlife women and may demonstrate how sleep recommendations and hygiene principles are likely inadequate in relation to the complex social dynamics of sleep. These insights provide evidence for considering the social context when tailoring recommendations that promote healthy sleep within this demographic. Furthermore, the combined methodology employed in this research may serve as a model for future sleep health studies.

Abstract P522: Racial Differences in Sleep Health in Middle-Aged Adults

Introduction: Sleep health is comprised of many dimensions, including duration, quality and sleep disorders. Prior work found that Black adults have worse sleep health than White adults, but the underlying reasons are unknown. Our goal was to examine possible determinants of racial disparities in sleep health. We hypothesized that sleep health would be worse in Black participants, and this would be partly explained by clinical, psychosocial and lifestyle risk factors. Methods: We used cross-sectional data from the sleep ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) study. Several objective sleep measures were collected, including 7 days of wrist actigraphy and a home sleep test (Nox T3s). Sleep disordered breathing was classified by oxygen desaturation index (ODI)&gt;=10 or apnea-hypopnea index (AHI) &gt;=15. We used a series of regression models to calculate the percent reduction in the coefficient estimate for race in models for each sleep health metric after adjusting for clinical factors, psychosocial factors or lifestyle factors. Results: There were 565 Black and 741 White adults in this analysis (mean (SD) age 61 (3.6) years). Black adults had significantly worse sleep health based on all measures, including shorter sleep duration, lower sleep percentage, greater sleep fragmentation and higher prevalence of sleep disordered breathing compared to White adults. Clinical factors, psychosocial factors and lifestyle factors all explained a proportion of the racial differences in sleep fragmentation and sleep percentage and explained away the racial differences in sleep disordered breathing (Table). Conclusions: Racial disparities in sleep health may be partly explained by clinical factors, such as blood pressure and BMI, psychosocial factors, such as education and depression, and lifestyle factors, such as smoking, alcohol intake, and physical activity. These findings provide several potential intervention targets to improve sleep health, particularly in Black adults.

Abstract P231: Are Resiliency and Religiosity/Spirituality Associated With Better Sleep Outcomes in Midlife Latinas?

Background: The disproportionate cardiovascular disease (CVD) burden among Latinas is not completely explained. An important health behavior in CVD prevention is sleep. In the United States (U.S.), Latinas experience unique sociocultural stressors that may impact sleep, particularly in midlife. Yet, little is known about protective factors such as resiliency and religiosity/spirituality among midlife Latinas. Aims: To assess the relation of resiliency and religiosity/spirituality with sleep disturbances in midlife Latinas. Methods: We conducted a cross-sectional analysis using baseline data from 49 participants in a pilot study to reduce CVD risk in midlife Latinas. Participants were Latinas aged 40-60 years who were perimenopausal or early postmenopausal, free of CVD, with no menopause hormone therapy use in the prior three months. Women were recruited from community settings. The frequency of sleep disturbances (trouble falling asleep, waking early, or nocturnal awakenings) over the past two weeks was assessed, and a sum score was created (0-16). The 6-item Brief Resilience Scale was used to assess the perceived ability to “bounce back” or recover from hardship. Religiosity/spirituality was determined by self-report (how important is religion/spirituality to you). Multivariable linear regression models were performed at p&lt;0.15, adjusting for sociodemographic. Results: Participants were on average aged 47.1±4.5 years, 47% had less than a high school education, and 98% were born outside of the continental U.S. Sixty-nine percent of women experienced trouble falling asleep. The mean sleep score was 6.9±4.6. In adjusted models, we found an inverse relationship between resiliency and sleep (ß[SE]= -0.33[0.13],p=0.01). Religiosity/spirituality was not related to sleep disturbances (ß[SE]= 1.15[1.60],p=0.48). Conclusions: In this analysis of midlife Latinas, higher resiliency was associated with poorer sleep. Findings suggest that the ability to “bounce back” after hardship and religiosity/spirituality may not buffer the negative impact of stress on sleep. Further research is necessary with objective sleep measures to identify protective factors for sleep disturbances that may subsequently improve CVD risk in midlife Latinas.

Abstract MP40: Associations Between Meal Timing and Sleep in Older Adults

Introduction: Poor sleep health has been associated with increased risk and worse outcomes for a number of diseases such as cognitive dysfunction, dementia and Alzheimer’s disease. An emerging area of research has highlighted the association between dietary factors and sleep. Meal timing is one aspect of diet that has unclear effects on sleep. Few studies have examined this relationship in older adults, an important distinction because sleep architecture and dietary habits change significantly across the lifespan. By identifying the involvement of meal timing in sleep health, specific behavioral interventions can be developed for older adults with sleep-related morbidity. Hypotheses: We tested the hypothesis that a longer time duration between the last meal of the day and bedtime is associated with positive changes in sleep quality Methods: Forty-six healthy older adults (72% (33 of 46) female, 13% (6 of 46) Black, mean age=70.1 years) recruited from the community in Chicago were included in the analysis. Participants underwent sleep assessment with 7 days of sleep actigraphy, one night of sleep profiler, and sleep questionnaires. Two 24-hour diet recalls within 1 week were administered with the ASA24 tool to evaluate meal timing. The data was analyzed with linear regression models adjusting for age, sex, educational attainment, and BMI. Results: For every 1-hour increase in time from last meal to bedtime, sleep onset latency (SOL) increased by 7.4 minutes (SE=3.0, p=0.019), total sleep time (measured from actigraphy) decreased by 10.6 minutes (SE=4.4, p=0.022), and sleep midpoint was delayed by 17.5 minutes (SE=0.09, p=0.002). Other sleep measures showed no significant associations with time from last meal to bedtime. Conclusions: Meals consumed closer to bedtime were associated with shorter SOL, longer total sleep time, and delayed sleep midpoint in older adults. These findings suggest that meal timing may correlate with sleep, however further investigation with larger sample sizes should be done to clarify this link.

Night-to-night variability of objective sleep outcomes in youth Middle Eastern football players

ObjectiveTo describe components of night-to-night variation in objective measures of sleep. MethodsWe conducted a secondary data analysis of consecutive and chronologically ordered actigraphy-based measurements for time in bed (min), time asleep (min), and wake-after-sleep onset (min). This investigation examined 575 individual night-based measures available for a sub-sample of fifty-two, male youth Middle Eastern football players tracked over a 14-day surveillance period (chronological age range: 12.1 to 16 years). Distinct multivariable-adjusted generalized additive models included each objective sleep outcome measure as dependent variable and disaggregated components of variation for night measurement-by-sleep period interaction, week part (weekday or weekend), and study participant random effects from within-subject night-to-night sleep variation. ResultsThe within-subject standard deviation (SD) of ±98 min (95% confidence interval [CI], 92 to 104 min) for time in bed, ±87 min (95%CI, 82 to 93 min) for time asleep, and ±23 min (95%CI, 22 to 25 min) for wake-after-sleep-onset overwhelmed other sources of variability and accounted for ∼44% to 53% of the overall night-to-night variation. The night measurement-by-fragmented sleep period interaction SD was ±83 min (95%CI, 44 to 156 min) for time in bed, ±67 min (95%CI, 34 to 131 min) for time asleep, and ±15 min (95%CI, 7 to 32 min) for wake-after-sleep-onset that accounted for ∼22% to 32% of each sleep outcome measure overall variability. ConclusionsSubstantial random night-to-night within-subject variability poses additional challenges for strategies aiming to mitigate problems of insufficient and inconsistent sleep that are detrimental to school learning and youth athlete development processes.

Effects of Smart Goggles Used Before Bed on Objectively Measured Sleep and Self-Reported Anxiety, Stress, and Relaxation: A Pilot Study.

Insufficient sleep is a problem affecting millions. Poor sleep can instigate or worsen anxiety and, conversely, anxiety can lead to or exacerbate poor sleep. Advances in innovative consumer products designed to promote relaxation and support healthy sleep are emerging and their effectiveness can be evaluated accurately using sleep measurement technologies in the home environment. This pilot study examined the effects of smart goggles used before bed to deliver gentle, slow vibration to the eyes and temples. The hypothesis was that objective sleep, perceived sleep, and self-reported stress, anxiety, relaxation, and sleepiness would improve after using the smart goggles. A within-subjects, pre-post design was implemented. Healthy adults with subclinical threshold sleep problems (N=20) tracked their sleep nightly using a PSG-validated non-contact biomotion device and completed daily questionnaires (3 weeks baseline, 3 weeks intervention). During the baseline period, participants slept at home as usual. During the intervention period, participants used Therabody SmartGoggles in Sleep mode before bed. This mode, designed for relaxation, delivers gentle eye and temple massage through the inflation of internal compartments to create a kneading sensation and vibrating motors. At night, participants completed questionnaires assessing relaxation, stress, anxiety, and sleepiness immediately before and after goggle use. Daily questionnaires assessed perceived sleep each morning, complementing the objective sleep measurement. Multilevel regression analysis of 676 nights of objective data showed improvements during nights when using the goggles, relative to baseline, in sleep duration (+12 minutes, P=.014); deep sleep, measured in duration (+6 minutes, P=.002), proportion of the night (7% relative increase, P=.020), and BodyScore, an age- and gender-normalized measure of deep sleep (4% increase, P=.002); number of nighttime awakenings (7% decrease, P=.021); total time awake at night after sleep onset (-6 minutes, P=.047); and SleepScore, a measure of overall sleep quality (3% increase, P=.020). Questionnaire data showed that, compared to baseline, participants felt they had better sleep quality (P<.001) and felt more well-rested upon waking (P<.001). Furthermore, immediately after using the goggles each night, compared to immediately before, participants reported feeling sleepier, less stressed, less anxious, and more relaxed (all Ps<.05). A standardized inventory administered before and after the 3-week intervention period indicated reduced anxiety, confirming the nightly analysis (P=.03). Objectively measured sleep quality and duration, as well as perceived sleep, improved when using the goggles before bed compared to baseline. Participants also reported increased feelings of relaxation along with reduced stress and anxiety. Future research expanding on this pilot study is warranted to confirm the preliminary evidence presented in this brief report.

Persian version of brief infant sleep questionnaire (BISQ): a psychometric evaluation

BackgroundThe high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population.Methods and materialsThis study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated.ResultsThe CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant’s sleep. All BISQ items were significantly different among the two levels of maternal view about the infant’s sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (rs ranged from 0.59 to 0.72). In addition, the associations of mothers’ and infants’ demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99).ConclusionThe Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants’ sleep problems.

Neurobehavioral Phenotype of Children With Congenital Myotonic Dystrophy.

To describe the neurobehavioral phenotype of congenital myotonic dystrophy. Congenital myotonic dystrophy (CDM) is the most severe form of myotonic dystrophy, characterized by symptom presentation at birth and later, cognitive impairment, autistic features, and disordered sleep. The neurobehavioral phenotype was assessed in this cross-sectional study by a neuropsychological battery consisting of the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Weschler Intelligence Scale for Children, Fourth Edition, Vineland Adaptive Behavior Scale, Second Edition (Vineland-II), Behavior Rating Inventory of Executive Function including preschool and teacher reports, Autism Spectrum Screening Questionnaire, Social Communication Scale, and Repetitive Behavior Scale-Revised. Sleep quality was evaluated with the Pediatric Sleep Questionnaire and Pediatric Daytime Sleepiness Scale. Fifty-five children with CDM, ages 5 weeks to 14 years, were enrolled. The mean age and (CTG)n repeats (±SD) were 6.4 ± 3.8 years and 1,263 ± 432, respectively. The mean IQ was 64.1 ± 14.9 on the Weschler scales with 65.6% of participants falling in the extremely low range for IQ. Adaptive functioning was significantly low for 57.1% of participants (n = 20). Caregiver report of executive functioning indicated 23.1% (9/39) of participants had clinically elevated levels of dysfunction, though teacher report was discrepant and indicated 53.3% of participants with CDM fell in this range (8/15). Spearman correlations were strongly positive (p ≤ 0.05) for estimated full scale IQ, overall adaptive functioning and with daily living and socialization domain standard scores on the Vineland-II ranging from r = 0.719 to r = 0.849 for all ages. Aspects of executive function were directly related to features of autism and sleep quality. Social communication was inversely related to all aspects of daily functioning, except communication, and directly related to aspects of autism behavior. Depressed IQ, adaptive skills, and executive functioning, poor sleep quality, and features of autism and altered social functioning individually describe different aspects of the neurobehavioral phenotype in CDM. These neurobehavioral and sleep measures could help quantitatively measure and assess the burden of cognitive impairment in CDM.

Pain Care at Home to Amplify Function: Protocol Article.

Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.

Tryptophan-kynurenine metabolic pathway and daytime dysfunction in women with HIV.

Sleep disturbances are prevalent in women with HIV (WWH). Tryptophan-kynurenine (T-K) pathway metabolites are associated with alterations in actigraphy derived sleep measures in WWH, although may not always correlate with functional impairment. We investigated the relationship between T-K pathway metabolites and self-reported daytime dysfunction in WWH and women without HIV (WWoH). 141 WWH on stable antiretroviral therapy and 140 demographically similar WWoH enrolled in the IDOze Study had targeted plasma T-K metabolites measured using liquid chromatography-tandem mass spectrometry. We utilized the daytime dysfunction component of the Pittsburgh Sleep Quality Index (PSQI) to assess functional impairment across HIV-serostatus. Lower levels of 5-hydroxytryptophan and serotonin were associated with greater daytime dysfunction in all women. In WWH, daytime dysfunction was associated with increased kynurenic acid (R = 0.26, p < 0.05), and kynurenic acid-tryptophan (KA-T) ratio (R = 0.28, p < 0.01). WWH with daytime dysfunction had a 0.7 log fold increase in kynurenic acid compared to WWH without daytime dysfunction. Kynurenic acid levels and the KA-T ratio were associated with daytime dysfunction in WWH but not in WWoH. Longitudinal studies are needed to establish a causal relationship and directionality between T-K metabolic changes and sleep impairment in WWH.

The effects of physical activity on sleep architecture and mood in naturalistic environments

Physical activity has been found to alter sleep architecture, but these effects have been studied predominantly in the laboratory and the generalizability of these findings to naturalistic environments and longer time intervals, as well as their psychological effects, have not been evaluated. Recent technological advancements in wearable devices have made it possible to capture detailed measures of sleep outside the lab, including timing of specific sleep stages. In the current study, we utilized photoplethysmography coupled with accelerometers and smartphone ambulatory assessment to collect daily measurements of sleep, physical activity and mood in a sample of N = 82 over multi-month data collection intervals. We found a robust inverse relationship between sedentary behavior and physical activity and sleep architecture: both low-intensity and moderate-to-vigorous physical activity were associated with increased NREM sleep and decreased REM sleep, as well as a longer REM latency, while higher levels of sedentary behavior showed the opposite pattern. A decreased REM/NREM ratio and increased REM latency were in turn associated with improved wellbeing, including increased energy, reduced stress and enhanced perceived restfulness of sleep. Our results suggest that physical activity and sleep account for unique variance in a person’s mood, suggesting that these effects are at least partially independent.

Habitual Short Sleep Duration, Diet, and Development of Type 2 Diabetes in Adults

Understanding the interplay between sleep duration, dietary habits, and the risk of developing type 2 diabetes (T2D) is crucial for public health and diabetes prevention strategies. To investigate the associations of type of diet and duration of sleep with the development of T2D. Data derived from the UK Biobank baseline investigation (2006-2010) were analyzed for this cohort study between May 1 and September 30, 2023. The association between sleep duration and healthy dietary patterns with the risk of T2D was investigated during a median (IQR) follow-up of 12.5 (11.8-13.2) years (end of follow-up, September 30, 2021). For the analysis, 247 867 participants were categorized into 4 sleep duration groups: normal (7-8 hours per day), mild short (6 hours per day), moderate short (5 hours per day), and extreme short (3-4 hours per day). Their dietary habits were evaluated based on population-specific consumption of red meat, processed meat, fruits, vegetables, and fish, resulting in a healthy diet score ranging from 0 (unhealthiest) to 5 (healthiest). Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) and 95% CIs for the development of T2D across various sleep duration groups and healthy diet scores. The cohort comprised 247 867 participants with a mean [SD] age of 55.9 [8.1] years, of whom 52.3% were female. During the follow-up, 3.2% of participants were diagnosed with T2D based on hospital registry data. Cox regression analysis, adjusted for confounding variables, indicated a significant increase in the risk of T2D among participants with 5 hours or less of daily sleep. Individuals sleeping 5 hours per day exhibited a 1.16 adjusted HR (95% CI, 1.05-1.28), and individuals sleeping 3 to 4 hours per day exhibited a 1.41 adjusted HR (95% CI, 1.19-1.68) compared with individuals with normal sleep duration. Furthermore, individuals with the healthiest dietary patterns had a reduced risk of T2D (HR, 0.75 [95% CI, 0.63-0.88]). The association between short sleep duration and increased risk of T2D persisted even for individuals following a healthy diet, but there was no multiplicative interaction between sleep duration and healthy diet score. In this cohort study involving UK residents, habitual short sleep duration was associated with increased risk of developing T2D. This association persisted even among participants who maintained a healthy diet. To validate these findings, further longitudinal studies are needed, incorporating repeated measures of sleep (including objective assessments) and dietary habits.