Sleep Medication Research Articles

0223 Associations of Pain Frequency and Severity with Excessive and Insufficient Sleep Duration in U.S. Adults

Abstract Introduction Pain and inadequate sleep duration are prevalent among adults in the United States. Both pain and inadequate sleep have been related to poorer quality of life and adverse health outcomes. However, the relationships of pain frequency and severity, modeled as predictors, to sleep duration have rarely been studied at the population level, particularly in the U.S. We aimed to investigate the relationships of both pain frequency and pain severity to sleep duration in a representative, population-based U.S. sample. Methods 2018 National Health Interview Survey data were analyzed. Self-reported sleep duration (on average) was categorized as short (6 hours or less), normal (7-9 hours), and long (10+ hours). Self-reported pain frequency (in the last three months) and pain severity (most recent event) were each categorized as “higher” and “lower or no”. Potential confounders/adjustment variables examined included age, sex, weight, chronic health conditions, race/ethnicity, depression, anxiety, and sleep medication use. For adjusted analyses, a multinomial logistic regression was fitted using stepwise selection using a sample of 10,173 U.S. adults. We estimated odds ratios (OR) and 95 percent (%) confidence intervals (CI) for three categories of sleep duration with regard to both pain frequency and severity in an adjusted multinomial model. Results In a multinomial model adjusted for age, anxiety, depression, and race/ethnicity, higher pain frequency, versus lower/no, was found to be associated with increased odds of short (OR=1.52, 95% CI, 1.38-1.66) and long (OR=1.85, 95% CI, 1.50-2.28) sleep duration versus normal sleep. In the same adjusted model, higher pain severity, versus lower/none, was found to be associated with an increased odds of short (OR=1.49, 95% CI, 1.33-1.68) and long (OR=1.77, 95% CI, 1.40-2.22) sleep duration versus normal sleep duration. Conclusion Higher pain frequency and higher pain severity, versus low or none, were both associated with an increased odds of insufficient (by 1.5-fold) and excessive (by 1.9 and 1.8-fold, respectively) sleep duration (vs. normal) in a large population-based U.S. sample. Results suggest that the prevention of pain, both its frequency and severity, should be considered to improve unhealthy sleep duration among US adults. Support (if any) None

0740 Factor Structure of Sleep in Older Adults Differs when Nearing End-of-Life

Abstract Introduction Adults aged 65 and older in the last year of life are at risk for experiencing non-beneficial hospitalizations, adversely effecting their quality-of-life. Reasons for undesired hospitalizations include the need to manage symptoms of progressing chronic illnesses, many of which are exacerbated by poor sleep. Given the complexity of sleep, especially as end-of-life (EOL) nears, it is imperative to understand if the myriad of variables traditionally used to describe sleep can be simplified. Insight gained by such knowledge could be used to guide assessment of sleep at EOL and identification of sleep-related interventions to improve EOL care. Methods Exploratory factor analyses (EFAs) were performed using data from rounds of the National Health and Aging Trends Study (NHATS) that included in-depth sleep modules. One EFA was performed for individuals who died before the next round, and another for those who did not. Ten variables were considered for each EFA, and comprised sleep disorders symptoms, sleep quality, and daytime consequences. Results There were three unique constructs each for the died and not-died groups. Among NHATS participants who had died, sleep experience (>30 mins falling asleep, try falling back asleep, time falling back asleep, sleep hours, and quality of sleep), tiredness (difficulty staying awake, how often nap), and EOL symptoms (sleep meds, breathing, and pain) explained 47.5% of the variability in sleep (n=122). Among NHATS participants who had not died, sleep disorder symptoms (>30 mins falling asleep, try falling back asleep, time falling back asleep, sleep hours, breathing, and quality of sleep), discomfort (pain, difficulty staying awake, how often nap), and sleep medication explained 40.9% of the variability in sleep (n=124). Conclusion Older adults nearing the EOL have different factor structures describing their sleep than those who are not near EOL. Napping and daytime sleepiness as well as pain, medication, and breathing for sleep have important implications for those nearing EOL that could be addressed by palliative care interventions. Support (if any) No support was provided for this study. Dr. Klingman is funded, in part, by NINR Award Number R01 NR018979. Dr. Sullivan is funded, in part, NIA Award Number R03 AG067159.

0721 Power Nap or Cognitive Trap? Role of Age in Associations Between Napping and Cognition

Abstract Introduction How napping is associated with cognition is currently unclear with past work indicating napping benefits cognition for young adults and inconsistent findings regarding cognition in older adults. The present study improved upon previous literature by examining how age moderates associations between napping behaviors across a full week and both subjective and objective cognition across the adult lifespan. Methods Cognitively healthy adults aged 18-82 (N=134, Mage=41.43, SD=22.14, 115 females) completed assessments of napping habits across 7 days (naps per week, duration), and subjective cognition [Cognitive Failures Questionnaire (CFQ) total, sub-scores of CFQ-memory, CFQ-distractibility, and CFQ-blunders]. A sub-set of participants (N=105) also completed objective cognitive tasks: Stroop (inhibition, attention, processing speed), Posner Cueing (attentional orienting), Sternberg (working memory), and Wisconsin Card Sorting (executive function). Multiple regression and Johnson-Neyman analyses evaluated the moderating impact of age on associations between napping and cognition, controlling for sex, anxiety and depression symptoms, and sleep and pain medication usage. Results Age moderated the relationship between nap duration and CFQ-total (R2-change=.02, p=.04), CFQ-memory (R2-change=.04, p=.01), and CFQ-blunders (R2-change=.06, p=.01). Specifically, longer nap duration was associated with fewer global cognitive complaints at age 20 and below (B=-.08, SE=.04, p=.049), more memory complaints at age 69 and above (B=.08, SE=.04, p=.05), as well as more blunder complaints at age 47 and above (B=.05, SE=.02, p=.048). Conclusion Findings suggest longer naps are associated with worse subjective cognition in older adults and better subjective cognition in younger adults. Similar patterns were not observed in middle-aged adults or for objective cognition. More work is needed to understand how the potential cognitive restorative impact of napping in younger adults may be disrupted in older adults. Given known associations between subjective cognition and future cognitive impairment, prospective studies should determine if napping is a key indicator of potential future cognitive decline in aging adults and explore underlying age-related mechanisms in this relationship such as systemic inflammation and changes in Support (if any) This work was supported by the American Academy of Sleep Medicine Foundation (NCT0282642; AASM Award #: 212-FP-19 PI: Curtis, a foundation of the American Academy of Sleep Medicine).

0932 Sleep Difficulties: Prevalence, relationship with psychological outcomes, and interindividual differences in student-athletes

Abstract Introduction Mental health issues are a leading cause of decreased academic and athletic performances when left untreated. Recently, the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) have highlighted the fundamental importance of mental health among young athletes. Sleep represents a core feature of mental health, and student-athletes represent a vulnerable population for sleep restriction and disruption due to the demands of their courseload and training schedule. This investigation was performed to identify differences in sleep and mental health across gender, race/ethnicity, and sport type. Methods Data were obtained throughout the academic semester from Canadian institutions, with student-athletes completing the Athlete Sleep Screening Questionnaire (ASSQ), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire (PHQ-9). ASSQ captured sleep and circadian health, while GAD-7 and PHQ-9 assessed anxiety and depressive symptoms, respectively. Linear regression determined gender, race/ethnicity, and sport type differences across ASSQ sleep problems score, ASSQ sleep items, GAD-7 score, PHQ-9 score, and PHQ-9 item #9 (suicidal ideation). Results Final sample (N=559) was 53.0% female, 79.1% white, comprised of young individual (Mean Age = 18.9 ± 3.21), and included student-athletes from basketball, field-hockey, football, ice-hockey, soccer, volleyball, track & field and swimming. Females reported more overall sleep difficulties (p=0.01), medication use (p=0.04) and WASO (p=0.001) compared to males. Females also reported higher anxiety (p < 0.0001), depression (p< 0.0001), and suicidal ideation (p=0.03). Significant variance in total sleep time (TST) (p=0.001) and sleep satisfaction (p=0.04) was observed across race/ethnicity, with student-athletes identifying as Black or African American reporting the lowest TST, while Asian or Pacific Islander student-athletes reported the lowest sleep satisfaction. Significant variance in sleep difficulties score (p< 0.0001), TST (p < 0.0001), and satisfaction (p< 0.0001), as well as anxiety (p < 0.0001) and depression (p< 0.0001) was observed across sport type. Football student-athletes reported the highest sleep difficulties score, and lowest TST satisfaction. Field-hockey student-athletes reported the highest anxiety and depression. Conclusion Results suggest that sleep and mental health challenges present differently across gender, race/ethnicity, and sport type. Clarifying these unique and specific challenges to student-athlete sleep and mental health is necessary to enhance and personalize interventions. Support (if any) Mitacs #IT23469

0376 Long-Term Effectiveness of Cognitive-Behavioral Therapy for Insomnia: A Patient-Reported Outcomes Post-Treatment Study

Abstract Introduction Insomnia is the most prevalent sleep disorder, with 10% of adults meeting criteria for a chronic insomnia disorder (CID). Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line recommended treatment given the strong evidence supporting its efficacy in the short-term and mid-term. Less is known about the effectiveness of CBT-I in routine clinical practice on patient-reported outcomes beyond 3y post-treatment. Methods Participants included 68 adults (48±15 years old, 63% female, and 11% minority) who received CBT-I for CID at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center3 to 7y prior to the present study. Participants completed Insomnia Severity Index (ISI) and Flinders Fatigue Scale (FFS) at baseline and follow up. Results After a median of 5y follow-up, 50% of patients didn’t meet insomnia case definition (ISI< 11), and 60% had experienced a meaningful improvement in insomnia severity (change in ISI score of -6 points or more). Only 35% of patients continued to experience moderate-to-severe insomnia (ISI>14) at follow-up. These effects were similar in patients who had a history of a medical (n=42) or psychiatric (n=38) disorder at pre-treatment when compared to those without prior medical or psychiatric disorders (p=0.380 and p=0.467 for insomnia caseness, respectively). The percent of patients absent of clinically significant daytime fatigue (FFS< 13) increased from 29% to 50 after the same period of long-term follow-up, and those with moderate-to-severe daytime fatigue (FFS>15) fell from 62% to 38%. Hypnotic use (i.e., prescription or over-the-counter) decreased from 66% at baseline, though this varied by insomnia status at follow-up: while 56% of insomnia cases (n=34) at follow-up reported still taking medications at bedtime, only 17% of remitted cases (n=34) did (p< 0.001). Conclusion This long-term evidence is consistent with prior clinical trials, national trends, and further supports that insomnia is a disorder, not a symptom, comorbid with medical and psychiatric conditions that should be treated independently. The effectiveness outcomes show improved sleep, daytime functioning, and discontinuation of sleep medications, a goal of clinical practice guidelines. Importantly, treatment gains remained after the onset of the COVID-19 pandemic. Support (if any) Penn State Health Department of Psychiatry Trainee Award

0692 Relationships Between Sleep and Social Cognitive Biases in Schizophrenia-Spectrum and Bipolar Disorders

Abstract Introduction People with schizophrenia-spectrum disorders (SSDs) and bipolar disorders (BDs) experience difficulty with social cognition, or the mental processes that underlie social interactions, but determinants of social cognitive impairment are still under investigation. Research suggests that poor sleep quality is related to reduced social cognitive ability in BDs, but it is unclear if sleep quality is related to social cognition in SSDs and if sleep may be related to different types of social cognition (e.g., emotion recognition, biases) in different ways. This study aimed to examine relationships between sleep and different types of social cognition in SSDs and BDs. Given known relationships between blaming and untrustworthiness biases and paranoia in these populations, paranoia was also examined as potential mediator of these relationships. Methods Participants (SSDs n=91; BDs with psychotic features n=87) completed tasks of social cognitive ability (e.g., facial and multi-modal emotion recognition, attributional bias, untrustworthiness bias). Participants self-reported their sleep quality. Paranoia was assessed via clinical interview. Results In the BD group, poor sleep quality (r=-.23, p=.04) and shorter sleep duration (r=-.25, p=.02) were associated with a bias towards untrustworthiness. For those with SSDs, increased use of sleep medication was associated with poorer multi-modal emotion recognition (r=-.22, p=.04). Additionally, poor sleep quality and overall poor sleep were associated with increased blaming (r=.22, p=.03; r=.21, p=.04) and untrustworthiness biases (r=-.24, p=.03; r=-.24, p=.03) in this group. Higher daytime tiredness was also associated with untrustworthiness bias (r=-.23, p=.03) in SSDs. Regarding mediation results, paranoia did serve as a mediator in the relationships between sleep and blaming and untrustworthiness biases across the sample. Conclusion Results suggest that poor sleep quality is linked to increased attributional and untrustworthiness biases, and that these relationships may be at least partially explained by paranoia symptoms. Of note, however, is that indirect effect sizes in mediation models were small. Contrary to expectations, poor sleep quality was not consistently associated with reduced social cognitive ability in the current sample. Findings from the current study require further exploration and replication. Support (if any) This work was supported by the National Institute of Mental Health (grant number R01 MH116902-04 awarded to C.A.D).

0694 Sleep Disorders and Serious Mental Illnesses: Comorbidity, Treatment, & Demographic Factors in VA Health Record Data

Abstract Introduction People diagnosed with serious mental illnesses (SMI), including schizophrenia-spectrum disorders, bipolar disorders, and major depression with psychosis, report high rates of clinically significant sleep disturbance. Yet, examination of how demographic- and health-related factors impact diagnosis and treatment in this group is scarce. We aimed to fill this gap by examining medical records of Veterans receiving treatment in VA VISN 4 healthcare facilities. Methods We used VA health record data to examine comorbidity between SMI and sleep diagnoses and receipt of sleep treatment from 2011-2019 (total N=573,974). A combination of descriptive and statistical techniques were used to investigate prevalence of sleep disorders, receipt of sleep treatment, and associations with demographic- and health-related factors. Results In 2019, 21.8% of Veterans with SMI were diagnosed with sleep disorder(s) in the medical record. White Veterans with SMI were more likely to have a sleep disorder than Veterans identifying as racial minorities. Veterans with SMI and sleep disorders were also younger, had higher BMIs, and had more medical comorbidities. Veterans with SMI were more likely to receive sleep treatment than Veterans without SMI, primarily driven by higher rates of sleep medication. Importantly, in contrast to findings regarding sleep disorder comorbidity, Veterans identifying as racial minorities received sleep treatment at a higher rate than White Veterans, and Veterans with higher BMIs received sleep treatment at a lower rate. Demographic factors including sex, age, and rurality were also associated in varying ways with rates of sleep treatment. Conclusion Our findings suggest that Veterans with SMI are being treated for sleep disorders at higher rates than Veterans without SMI. However, diagnosis and treatment are differentially impacted by demographic and health-related factors. Work is needed to better understand drivers of demographic differences and to examine any potential inequities in diagnosis or treatment of sleep disorders in Veterans with SMI. Support (if any) This work was funded by the Veterans Health Foundation (Co-PIs: Bonfils & Longenecker). Additional support was provided by pilot project funds (PI: Bramoweth) from the Department of Veterans Affairs VISN 4 Mental Illness Research, Education and Clinical Center and the Mississippi Center for Clinical & Translational Research (U54GM115428).

0382 Age at Onset in Adults with Insomnia: A Latent Profile Analysis

Abstract Introduction Research has sought to understand insomnia through identification of subtypes, yet age at onset (AAO) has received limited empirical attention. Across psychiatric disorders, early AAO is associated with higher clinical severity and burden, more persistent course, and greater familiality, whereas late AAO is associated with comorbid psychiatric and physical illness. We sought to detect clinically distinct AAO subgroups in adults with insomnia utilizing latent profile analysis (LPA). Methods Participants were 618 adults aged 18 to 71 years (M=28.94, SD=11.06) with insomnia, recruited through Prolific Academic. Participants completed an internet survey of demographics, medical/psychiatric history, family history, insomnia onset acuity, and course, causal attributions surrounding insomnia onset, and current insomnia severity and sleep-related impairment. LPA was performed on AAO of clinically significant insomnia (i.e., causing distress or daytime impairment and occurring 3 days per week for at least 3 months). Independent samples t-test and chi-squared test of independence were performed to compare resulting AAO subgroups on clinical outcomes. Results A two-class model (Class 1: n=547, 88.5%, Monset=19.2 years; Class 2: n=71, 11.5%, Monset=43.5 years) was optimal for forming insomnia AAO subgroups. The late onset group had higher relative insomnia severity, t=-2.78, p=.006, and sleep-related impairment, t=-3.75, p<.001. There were no group differences in lifetime prescription sleep medication, p=.569, lifetime diagnosis of psychiatric disorder(s), p=.189, family history of insomnia, p=.159, or insomnia onset acuity (i.e., sudden vs. gradual), p=.140. Late onset was associated with higher relative endorsement of hormonal factors, Χ2=12.81, p<.001, bodily arousal, Χ2=8.57, p=.003, scheduling, Χ2=9.08, p=.003, and childhood experiences and traumatic events, Χ2=5.67, p=.017). There were group differences in insomnia course, Χ2=16.35, p<.001, such that early onset was associated with higher relative endorsement of persistent insomnia and late onset was associated with higher relative endorsement of seasonal insomnia. Conclusion Findings suggest the presence of an early onset group with higher persistence, but not increased severity and impairment as anticipated, and a late onset group with more seasonal course, numerous causal attributions, and higher insomnia severity and impairment. Future replication is needed to determine the validity and treatment applications of these subgroups. Support (if any) NIMH K23MH113884

0079 Subjective-Objective Sleep Discrepancy in Older Adults: Does Cognitive Functioning Matter?

Abstract Introduction Differences between subjective and objective sleep [subjective-objective sleep discrepancy (SOSD)] is prevalent in insomnia and older adults. Despite associations between cognition and sleep parameters, the impact of cognitive functioning on SOSD is unclear. We examined associations between various cognitive domains and SOSD in older adults and whether insomnia status moderates these associations. Methods Older adults with (N=47, Mage=68.85, 66% women) and without (N=32, Mage=67.41, 78% women) insomnia [met DSM-5 criteria plus reported >30 mins sleep onset latency (SOL) and/or wake time after sleep onset (WASO) on 3+nights/7] completed measures of subjective sleep (7-days of sleep diaries), objective sleep (one-night polysomnography, PSG), and objective cognitive tasks: Dimensional Change Card Sort (executive functioning, EF), List Sorting (working memory, WM), Auditory Verbal Learning Test (episodic memory), Flanker (inhibitory control), Pattern Comparison (processing speed). SOSD direction (average sleep diary variable – PSG variable) was computed. Moderated regressions determined independent and interactive (with insomnia status) associations between cognitive performance and SOSD for SOL, WASO, total sleep time (TST) and sleep efficiency, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Results For insomnia, longer self-reported than PSG TST was associated with better WM (b=27.90, SE=9.05, p=.003, episodic memory (b=12.83, SE=2.77, p=.01), processing speed (b=9.50, SE=2.00, p<.01), and inhibitory control (b=118.40, SE=54.09, p=.03). Similarly for insomnia, better self-reported than PSG sleep efficiency was associated with better WM (b=5.58, SE=2.12, p=.01), episodic memory (b=2.66, SE=1.08, p=.02), and processing speed (b=2.11, SE=0.47, p<.01). For non-insomnia, reports of SOSD were not associated with cognitive functioning (ps>.05). Conclusion Better diffuse cognitive functioning may be a contributing SOSD mechanism in older adults with insomnia. We speculate that better cognitive functioning may suppress cognitive arousal symptoms that are prevalent in insomnia patients, leading to better self-reported sleep relative to what is objectively measured. Prospective studies examining independent and interactive associations between cognition functioning and arousal, and insomnia on SOSD may inform underlying mechanisms of poor sleep health and the temporal impact on cognition. Support (if any) This research project was made possible by awards (PI: Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.

0362 Sleep Medication Use in Hospitalized Geriatric Patients and Associated Outcomes

Abstract Introduction Disturbances in the diurnal sleep-wake cycles are prevalent within the geriatric population, consequently increasing the development of insomnia. Although insomnia is commonly treated in the inpatient setting, many pharmacologic interventions are classified as potentially inappropriate medications for the geriatric population, as defined through the Beers Criteria; potentially increasing the risk for adverse events (AEs) in this population. Methods A retrospective review and comparative analysis of medications used for the treatment of insomnia (diphenhydramine [DPH], hydroxyzine [HDX], trazodone [TZD]) in 121 hospitalized geriatric patients (≥65 years old) in our facility during the month of October 2021 was conducted. Multiple regression analysis was used to identify associations between selected medication use and AEs including inpatient falls, new or worsening delirium, and new onset urinary retention. Comparative analysis using individual T-testing between groups, and Kruskal-Wallis Testing for total comparison was used to identify significance between group outcomes. Results Patients treated with DPH or HDX showed significantly higher rates of AEs compared to patients treated with TZD (p< 0.001); but showed no significant difference in frequency of AEs between themselves (p=0.816). 54.8% of patients treated with DPH and 57.7% of patients treated with HDX had at least one recorded AE during their hospital stay. The most common AE in all treatment groups was new or worsening delirium at 31.0%, 38.5%, and 15.6% in DPH, HDX, and TZD groups respectively. Both DPH and HDX groups showed AEs of falls (4.8% and 11.5%) and new onset urinary retention (14.3% and 7.7%) respectively, whereas the TZD group showed neither of these AEs. Analysis yielded secondary outcomes with AE of new onset constipation occurring only within the DPH group at 11.9%. Further, secondary analysis showed treatment with DPH had a significant increase in hospital length of stay (HLOS) compared to TZD use (p< 0.01), but not compared to HDX use (p=0.755). Conclusion Treatment of insomnia in hospitalized geriatric patients is complex. Use of anticholinergic medications (DPH/HDX) substantially increases the risk for AEs within this population. Further, the use of DPH showed significant increased HLOS, possibly as a direct result of AEs incurred with the use of these medications. Support (if any)

0054 Does the Early Bird Get the Worm? Associations of Waketime Variability and Metacognition in College Students

Abstract Introduction Deviation in sleep patterns have been associated with cognitive functioning in college students, but little research has examined how deviation in bed and waketime impact next-day metacognition. Given college students have high daily variability with their bedtime and waketime, these are understudied parameter of interest in this population. Considering metacognition has been associated with academic outcomes (e.g., GPA), it is important to understand how daily bedtime and waketime patterns might impact metacognition. The present study examined how daily deviation from bedtime and waketime are associated with metacognitive ratings in college students. Methods College students (N=81, Mage=18.8, SD = 1.1, 64 females) completed seven days of sleep diaries reporting bedtime, sleep duration, and waketime. Students also provided morning metacognitive ratings regarding the perceived quality of mental functioning from very poor (0) to very good (100). Multilevel modeling analyses tested whether intraindividual patterns of associations between daily bedtime and daily waketime and daily morning metacognitive ratings, after controlling for intraindividual daily anxiety severity, interindividual levels of bed/wake time variability and sleep duration, as well as age, sex, and daily sleep medication usage. Results Daily waketime was associated with same morning metacognitive ratings (B=.02, p=0.03), in that those who woke up earlier than their typical average reported worse cognitive function. Findings did not reveal an association between bedtime variability and metacognition. Conclusion Findings suggest that regardless of how long one has slept, waking up earlier than typical may negatively impact perceptions of cognitive functioning in college students. Similar patterns are not observed at the average/interindividual level. Given younger adults typically have a delayed circadian preference, findings may reflect acute circadian disruption and associated “brain fog” in college students when waking up earlier than typical. Future studies should examine associations between daily waketime and objective cognition to better understand how regularity impacts daytime functioning. Similar to findings in adolescent populations, such evaluations could inform recommendations regarding college class start times. Support (if any)

0271 Patterned Planar Bed Surface Vibration Is Effective in Shortening Time to Onset of Sleep (As Good as a Sleeping Pill?)

Abstract Introduction 70 million Americans suffer from poor sleep, 42 million have a chronic sleep disorder, and an estimated 64% report regularly taking a pharmacological sleep aid regularly with well-known risks. A link between vibration and sleep was first observed during investigations of highway hypnosis. We developed a prototype bed producing sub-audible, tactilely perceptible traveling-wave vibration where noninvasive sleep monitors could objectively measure sleep. Methods A bed was outfitted with low-frequency effectors (LFEs) and phasers to create infrasonic, low-frequency vibration that traversed the mattress in patterns. Amplitude was adjusted to comfort using a bedside dial. Sleep was monitored over four sequential weeks in a single 22-year-old healthy male subject with 3 devices each employing a unique mechanism: the OuraRing (actigraphy), Google NestHub (GHz radar chip), and SleepScore (ultrasound). No vibration was used during weeks 1 and 4 to establish a baseline/return to baseline. Week 2 vibration was a highly periodic waveform (25 Hz, migrating at 1 Hz), while week 3 vibration was an irregular, chaotic waveform. Objective data was collected from the 3 devices to plot total sleep duration and latency of onset. Results 1. Strong agreement was seen among the 3 different sensors 2. Patterned, highly periodic, low-frequency vibration shortened sleep latency by nearly 50% consistently for one week (from 15 to 8 minutes) 3. Chaotic, irregular vibration of week 3 also shortened latency, but less so (from 15 to 12 minutes) 4. Baseline and repeat baseline were statistically nearly identical 5. Sleep duration was not impacted by vibration (mean 7 hours 45 minutes) Conclusion The primary mechanism of improved latency with vibration may be somatic/mental distraction. The subject reported that vibration diverted away from pre-occupying thoughts and was highly pleasant. These observations were reflected in nearly 50% reduction of latency in week 2 and more modest reduction in week 3. Patterned planar vibration appears as effective as prescribed sleep medications, suggesting it may be a useful non-pharmacologic sleep adjunct. Support (if any) Jacob Bentley is the recipient of scholarship support for this research from the American Medical Association and AASM.

Self-Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation.

Sleep disturbances are common and may impact fracture risk directly by influencing bone turnover or indirectly through shared risk factors or mediators. To investigate the association between self-reported sleep disturbances across the menopausal transition (MT) and fractures, we prospectively studied 3101 women enrolled in the Study of Women's Health Across the Nation (SWAN). At each of 14 study visits spaced approximately 18 months apart, a standardized validated scale ascertained trouble falling asleep, waking up several times during the night, and waking up earlier than planned. Two time-varying exposures were modeled: presence of any of the three disturbances at least three times per week and waking up several times during the night at least three times per week. Base models adjusted for fixed (race/ethnicity, study site) and time-varying characteristics (age, body mass index, and MT stage). Fully adjusted models also included time-varying bone beneficial and detrimental medications, smoking, alcohol, physical activity, diabetes, depression and sleep medications, and depressive symptoms. Women who experienced a fracture were more likely to report a greater frequency of having trouble falling asleep, waking up several times, and/or waking up earlier: 35% versus 30% at baseline, p = 0.02. In the base models, women who had any of the three sleep disturbances at least three times per week had a higher risk of any fracture, odds ratio (OR) = 1.23 (95% confidence intervals, 1.02, 1.48) and nontraumatic fracture, OR = 1.36 (1.03, 1.80). These associations were largely attenuated to nonsignificance in the fully adjusted model. Sensitivity analyses limiting our sample to 2315 SWAN women enrolled in the bone mineral density (BMD) centers yielded similar results. Additional adjustment for femoral neck BMD had no effect on our results. In conclusion, self-reported sleep disturbances were associated with an increased risk of fractures, but these associations likely reflect shared risk factors or factors in the causal pathway. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Sleep quality and sleep disorders in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Sleep disorders have been considered risk factors for cardiovascular diseases, and poor sleep quality has become a common complaint in patients with coronary artery disease. Despite being a very common problem in these patients, it is not yet routinary studied and reflected in the clinical practice guidelines. Purpose To study the prevalence and type of sleep disorders in patients with acute coronary syndrome (ACS). Methods This study was a quantitative, descriptive, cross-sectional investigation. We included patients admitted for ACS (unstable angina, STEMI, NSTEMI, MINOCA,...) during the period from June to October 2022. The patients were interviewed, collecting the following information: Demographic variables (age, sex, marital status), classic cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia), presence or absence of a diagnosis of Obstructive Sleep Apnoea (OSA), as well as treatment or not with CPAP, toxic habits (tobacco, alcohol, other drugs), need for sleep medication and sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which is a validated self-rated questionnaire that assesses sleep quality and sleeps disturbance over the past month. Results We included 46 patients in our study. The mean age was 68,85 years (SD 11,88), 69,56% were male and 60,87% were married. The main reason for admission was NSTEMI. The distribution of risk factors was: High blood pressure 78,26%, Diabetes Mellitus 36,96%, dyslipidemia 63,04%, smoking 21,74%, drinking alcohol habitually 19,57%, and other drugs abuse 4,35%. The prevalence of OSA was 17,39%. Overall, the mean PSQI score of all participants was 8,98 (SD 4,73). The most affected sleep component was ‘Sleep disturbance’ (mean score 1,76/3), followed by ‘Sleep latency’ (1,5/3) and ‘Sleep duration’ (1,48/3). 34,78 % referred use of sleep medication and 41,30% had daytime dysfunction. Table 1 shows the results in PSQI related to the reason for hospitalization. Conclusions Sleep disorders and poor sleep quality are remarkably prevalent in our cohort of ACS patients, which could be considered as a possible added cardiovascular risk factor or risk modifier. We consider the proactive investigation of sleep disorders useful in clinical practice as we can develop strategies to improve sleep and reduce residual cardiovascular risk and quality of life.

Clinical characteristics and prescriptions associated with a 2-year course of rapid cycling and euthymia in bipolar disorder: a multicenter treatment survey for bipolar disorder in psychiatric clinics.

In patients with bipolar disorder (BD), rapid cycling (RC) presents a risk for a more severe illness, while euthymia (EUT) has a better prognosis. This study focused on the progression of RC and EUT, which are contrasting phenomenology, and aimed to clarify the influence of patient backgrounds and prescription patterns on these different progressions, using a large sample from the first and second iterations of a multicenter treatment survey for BD in psychiatric clinics (MUSUBI). In the cross-sectional study (MUSUBI), a questionnaire based on a retrospective medical record survey of consecutive BD cases (N = 2,650) was distributed. The first survey was conducted in 2016, and the second one in 2017. The questionnaire collected information on patient backgrounds, current episodes, and clinical and prescribing characteristics. In the first survey, 10.6% of the participants had RC and 3.6% had RC for two consecutive years, which correlated with BP I (Bipolar disorder type I), suicidal ideation, duration of illness, and the use of lithium carbonate and antipsychotic medications. Possible risk factors for switching to RC were comorbid developmental disorders and the prescription of anxiolytics and sleep medication. Moreover, 16.4% of the participants presented EUT in the first survey, and 11.0% presented EUT for two consecutive years. Possible factors for achieving EUT included older age; employment; fewer psychotic symptoms and comorbid personality disorders; fewer antidepressants, antipsychotics, and anxiolytics, and more lithium prescriptions. RC and EUT generally exhibit conflicting characteristics, and the conflicting social backgrounds and factors contributing to their outcomes were distinctive. Understanding these clinical characteristics may be helpful in clinical practice for management of patients with BD.

A randomized trial to evaluate the effects of a supervised exercise program on insomnia in patients with non-metastatic breast cancer undergoing chemotherapy: design of the FATSOMCAN study

BackgroundUp to 70% of breast cancer patients report symptoms of insomnia during and after treatment. Despite the ubiquity of insomnia symptoms, they are under-screened, under-diagnosed and poorly managed in breast cancer patients. Sleep medications treat symptoms but are ineffective to cure insomnia. Other approaches such as cognitive behavioral therapy for insomnia, relaxation through yoga and mindfulness are often not available for patients and are complex to implement. An aerobic exercise program could be a promising treatment and a feasible option for insomnia management in breast cancer patients, but few studies have investigated the effects of such a program on insomnia.MethodsThis multicenter, randomized clinical trial evaluate the effectiveness of a moderate to high intensity physical activity program (45 min, 3 times per week), lasting 12 weeks, in minimizing insomnia, sleep disturbances, anxiety/depression, fatigue, and pain, and in enhancing cardiorespiratory fitness. Patients with breast cancer be recruited from six hospitals in France and randomly allocated to either the “training” or the “control” group. Baseline assessments include questionnaires [Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression Scale (HADS), Epworth Sleepiness Scale (ESS)], home polysomnography (PSG), and 7-day actigraphy coupled with completion of a sleep diary. Assessments are repeated at the end of training program and at six-month follow-up.DiscussionThis clinical trial will provide additional evidence regarding the effectiveness of physical exercise in minimizing insomnia during and after chemotherapy. If shown to be effective, exercise intervention programs will be welcome addition to the standard program of care offered to patients with breast cancer receiving chemotherapy.Trial registration: National Clinical Trials Number (NCT04867096).

Use of Sleep Aids in Insomnia: The Role of Time Monitoring Behavior.

Objective: Over-the-counter (OTC) and prescription sleep medications are frequently used as treatments for chronic insomnia, despite risks and limited long-term efficacy. Investigating mechanisms underlying this predilection for pharmacotherapy may uncover strategies to decrease reliance on sleep aids. The objective of this study was to determine how time monitoring behavior (TMB; clock-watching) and associated frustration may interact with insomnia symptoms to drive the use of sleep aids.Methods: Patients (N = 4,886) presenting for care at a community-based, private sleep medical center between May 2003 and October 2013 completed the Insomnia Severity Index (ISI) and Time Monitoring Behavior-10 (TMB-10) and reported their frequency of sleep medication use (OTC and prescription, separately). Mediation analyses examined how clock-watching and related frustration could be associated with insomnia symptoms and medication use.Results: The relationship between TMB and sleep medication use was significantly explained by ISI (P < .05), in that TMB (especially related frustration) appears to aggravate insomnia, which in turn leads to sleep aid use. Similarly, but to a lesser extent, the relationship between ISI and sleep medication use was explained by TMB, in that ISI may lead to increased TMB, which may in turn lead to sleep aid use.Conclusions: TMB and the associated frustration it engenders may perpetuate a negative cycle of insomnia and sleep aid use. Future longitudinal and interventional research is necessary to examine the developmental course of these clinical symptoms and behaviors and to test whether decreasing frustration by limiting TMB reduces the proclivity for pharmacotherapy.

Hypnotic Drugs

Insomnia is one of the most frequently encountered diseases in clinical practice, and about half of the patients have a long-term course. Therefore, proactive prevention against chronicity is required, using a non-pharmacological approach for insomnia (sleep hygiene). Pharmacological treatment, needs to decrease the risk of appearance of rebound insomnia, the risk of the patient falling, drug dependence, and cognitive dysfunctions caused by hypnotics. In view of this, it is recommended to use novel sleep medications such as orexin receptor antagonists and melatonin receptor agonists.

Genetic analysis of probable sleep bruxism and its associations with clinical and behavioral traits.

Sleep bruxism (SB) can cause damage on teeth, headache and severe pain affecting both sleep and daily functioning. Yet despite the growing interest into bruxism, the underlying clinically relevant biological mechanisms remain unresolved. The aim of our study was to understand biological mechanisms and clinical correlates of SB including previously reported disease associations. We used data from the FinnGen release R9 (N = 377 277 individuals) that are linked with Finnish hospital and primary care registries. We identified 12 297 (3.26%) individuals with International Classification of Diseases (ICD)-10 codes used for SB. In addition, we used logistic regression to examine the association between probable SB and its clinically diagnosed risk factors and comorbidities using ICD-10 codes. Furthermore, we examined medication purchases using prescription registry. Finally, we performed the first genome-wide association analysis for probable SB and computed genetic correlations using questionnaire, lifestyle, and clinical traits. The genome-wide association analysis revealed one significant association: rs10193179 intronic to Myosin IIIB (MYO3B) gene. In addition, we observed phenotypic associations and high genetic correlations with pain diagnoses, sleep apnea, reflux disease, upper respiratory diseases, psychiatric traits, and also their related medications such as antidepressants and sleep medication (p < 1e-4 for each trait). Our study provides a large-scale genetic framework to understand risk factors for SB and suggests potential biological mechanisms. Furthermore, our work strengthens the important earlier work that highlights SB as a trait that is associated with multiple axes of health. As part of this study, we provide genome-wide summary statistics that we hope will be useful for the scientific community studying SB.

Melatonin for Huntington Disease (HD) Gene Carriers with HD-Related Sleep Disturbance - a Pilot Study (P1-11.013)

<h3>Objective:</h3> To evaluate the efficacy of exogenous melatonin in improving sleep quality in Huntington disease (HD) gene carriers. <h3>Background:</h3> Various sleep disorders have been identified in HD. Low melatonin levels might explain disrupted circadian behavior in HD [1]. There is evidence of improvement in sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) in individuals receiving melatonin [2]. This is the first study evaluating the efficacy of melatonin in HD. <h3>Design/Methods:</h3> Randomized, double-blind, placebo-controlled, crossover, proof of concept study. HD gene carriers with a PSQI ≥5 and stable medications for the past 2 months were recruited from the UTHealth, Houston HDSA Center of Excellence. The PSQI, HD Sleep Questionnaire, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Clinical Global Impression (CGI) scale, and UHDRSc were administered. Wilcoxon signed-rank test was used to analyze the data. <h3>Results:</h3> We enrolled 15 patients (mean age 47.5 years, 46% female), 73% white, 13% African American, and 13% Hispanic. As expected, both melatonin and placebo groups showed significant differences in the PSQI-6 since they were taking medications for sleep. Interestingly, compared to baseline the melatonin group had significantly improved scores in the HD Sleep Questionnaire, and increased scores in the improvement component of the CGI. No differences were noted in the HADS or ESS. <h3>Conclusions:</h3> This pilot study in HD gene carriers demonstrates a potential benefit of melatonin for sleep disturbances. Consistent with previous data in other neurodegenerative diseases, melatonin can positively impact sleep quality. Analysis of other variables including changes in BMI, subcomponents of the UHDRS, and measures of quality of life will be forthcoming. Future studies that use objective assessments such as polysomnogram or actigraphy, a larger sample size, and differentiating between disease stages might provide valuable information regarding the utility of melatonin in HD. <b>Disclosure:</b> Dr. Patino Murillas has nothing to disclose. Dr. Zadegan has nothing to disclose. Natalia Pessoa Rocha has nothing to disclose. An immediate family member of Dr. Karagas has received personal compensation for serving as an employee of Thirty Madison. An immediate family member of Dr. Karagas has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for Thirty Madison. An immediate family member of Dr. Karagas has stock in Thirty Madison. Mr. Tanigaki has nothing to disclose. Mrs. Duncan has nothing to disclose. Dr. Furr-Stimming has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Pharmaceuticals. Dr. Furr-Stimming has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Michael J. Fox Foundation. Dr. Furr-Stimming has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva Pharmaceuticals. The institution of Dr. Furr-Stimming has received research support from Cures within Reach. The institution of Dr. Furr-Stimming has received research support from Huntington’s Disease Society of America. The institution of Dr. Furr-Stimming has received research support from Roche/Genetech. The institution of Dr. Furr-Stimming has received research support from Uniqure. The institution of Dr. Furr-Stimming has received research support from CHDI. The institution of Dr. Furr-Stimming has received research support from Huntington Study Group/Neurocrine. The institution of Dr. Furr-Stimming has received research support from NIH/University of Iowa. The institution of Dr. Furr-Stimming has received research support from Sage Therapeutics. Dr. Furr-Stimming has received publishing royalties from a publication relating to health care.