Subthreshold Insomnia Research Articles

A Prevention Program for Insomnia in At-risk Adolescents: A Randomized Controlled Study.

To prevent the future development of insomnia in at-risk adolescents. A randomized controlled trial comparing 4 weekly insomnia prevention program with a nonactive control group. Subjects were assessed at baseline, postintervention, and 6 and 12 months after intervention. Assessors were blinded to the randomization. Analyses were conducted on the basis of the intention-to-treat principles. A total of 242 adolescents with family history of insomnia and subthreshold insomnia symptoms were randomly assigned to an intervention group (n = 121; mean age = 14.7 ± 1.8; female: 51.2%) or control group (n = 121; mean age = 15.0 ± 1.7; female: 62.0%). There was a lower incidence rate of insomnia disorder (both acute and chronic) in the intervention group compared with the control group (5.8% vs 20.7%; P = .002; number needed to treat = 6.7; hazard ratio = 0.29; 95%confidenceinterval: 0.12-0.66;P= .003) over the 12-month follow-up. The intervention group had decreased insomnia symptoms (P = .03) and reduced vulnerability to stress-related insomnia (P = .03) at postintervention and throughout the 12-month follow-up. Decreased daytime sleepiness (P = .04), better sleep hygiene practices (P = .02), and increased total sleep time (P = .05) were observed at postintervention. The intervention group also reported fewer depressive symptoms at 12-month follow-up (P = .02) compared with the control group. A brief cognitive behavioral program is effective in preventing the onset of insomnia and improving the vulnerability factors and functioning outcomes.

Sleep disorders among nurses and other health care workers in Poland during the COVID-19 pandemic

BackgroundThe profession of nurses involves exposure to harmful agents. Despite numerous international studies on the occurrence of sleep disorders in nurses, most studies lacked an assessment of the dependence on the occurrence of the situation causing fear and anxiety which is a highly contagious. AimDetermining the relationship between the occurrence of sleep disorders and socio-demographic variables of medical personnel during the COVID-19 epidemic. DesignThis is a cross-sectional study conducted online involving 336 health professionals. ResultsInsomnia among staff was determined at the level of Subthreshold insomnia and Clinical insomnia (moderate severity). Suspicion or confirmed COVID-19 had an effect on the occurrence of sleep disorders in the study group of medical personnel. ConclusionTaking into account the statistical error of 6%, the sleep disorders concern about 40% of professionally active nurses and midwives in Poland. Worsening of insomnia was observed in people with the possibility of contact with a patient with COVID-19 in the workplace. Insomnia was more common in respondents over 25 years of age. Psychosocial interventions are needed to help healthcare staff better respond to COVID-19 and future epidemics.

Progressive gray matter hypertrophy with severity stages of insomnia disorder and its relevance for mood symptoms.

To investigate the gray matter (GM) alterations in patients with insomnia disorder (ID) at different severity stages and the relationship between GM alterations and sleep, mood, and cognitive measures. One hundred one ID patients and 63 healthy controls (HC) were included. Each patient underwent structural MRI and completed sleep-, mood-, and cognitive-related questionnaires. The ID patients were further grouped into subthreshold insomnia (SI) group and clinical insomnia (CI) group. We investigated changes in GM volumes in ID patients via diffeomorphic anatomical registration through exponentiated lie algebra voxel-based morphometry (DARTEL-VBM). We first compared voxel-wise differences in GM volumes between the HC group and the ID group. Analysis of variance was performed on individual GM maps in the SI, CI, and HC groups to further investigate the effects of different stages of ID severity on GM volumes. Multiple regression was used to model the relationship between altered GM volumes in SI and CI groups and clinical measures. GM hypertrophies in the left anterior and middle cingulate gyrus, right middle and inferior temporal gyrus, and right cerebellum Crus II were detected in ID. Increased GM volume in the right middle temporal gyrus was detected in the SI group, whereas all three regions in the CI group. Regression analysis showed that mood- and cognitive-related measures had a positive correlation with GM volumes, while sleep-related measures had a negative correlation with GM volumes in the CI group. Our findings of the progressively increased GM volumes in ID suggest that a hypertrophic cortical morphological mechanism may underlie the altered neuroanatomy induced by insomnia. • Insomnia-induced GM hypertrophies in the cingulate gyrus, temporal gyrus, and cerebellum Crus II. • The middle temporal gyrus was early detectable in the SI group. • The increased GM volumes in the CI group were correlated with clinical measures.

Association between depression, anxiety, and insomnia with musculoskeletal pain source: a multi-center study

BackgroundMusculoskeletal pain syndrome (MPS) is one of the modern diseases. Musculoskeletal pain (MP) may develop at any age and impact physical and mental health. This study aimed to evaluate the association between anxiety, depression, and insomnia with musculoskeletal pain source. This cross-sectional study was conducted on 450 patients with musculoskeletal pain. Goldberg depression (GB), Beck Anxiety Inventory (BAI), and Morin Insomnia Severity Index (ISI) questionnaires were used to collect data. Participants have divided into two groups: individuals with unknown musculoskeletal pain sources and individuals with known musculoskeletal pain sources. Anxiety, depression, and insomnia scores were compared between the two groups. For statistical analysis of data mean (SD), frequency (%), Chi-square, Mann-Whitney test, and Logistic regression models were used. All analysis was performed using SPSS 26.ResultsIn this study, 39.4% of the participants were in severe depression, 31.1% in severe anxiety, 34.7% in the no clinically significant, and 32.9% in the sub-threshold insomnia group. There was a significant difference between the severity of anxiety and insomnia in the two groups with the known and unknown pain sources (p < 0.05). However, the score of depression (OR = 1.00, 95% CI 0.99–1.01), anxiety (OR = 1.00, 95% CI 0.99–1.02), and insomnia (OR = 1.01, 95% CI 0.98–1.03) was not related to the pain source.ConclusionThere was a statistically significant relationship between anxiety and insomnia severity with musculoskeletal pain source. According to the high prevalence of depression, anxiety, and depression in both groups with known and unknown musculoskeletal pain sources, the cooperation of orthopedists, rheumatologists, and physical therapists with psychiatrist can be useful in improving the condition of patients.

Weathering the Storm: Psychological Impact of COVID-19 Pandemic on Clinical and Nonclinical Healthcare Workers in India.

BackgroundCoronavirus disease-2019 (COVID-19) pandemic has exposed healthcare workers (HCWs) to a unique set of challenges and stressors. Our frontline workers are under tremendous psychological pressure because of the ever-rising crisis. This study was done to assess the magnitude of the psychological impact of the COVID-19 pandemic on clinical and nonclinical HCWs in India.Materials and methodsIt was a cross-sectional, online survey that was done from June 1, 2020, to July 4, 2020. A total of 313 clinical and nonclinical HCWs, who were directly or indirectly involved in patient care, participated in the study. The psychological impact was assessed in terms of four variables: insomnia, anxiety, depression, and stress. Insomnia was assessed by the Insomnia Severity Index (ISI). Anxiety and depression were assessed via the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2). Stress was assessed via the Perceived Stress Scale (PSS). We also compared the psychological impact of this pandemic between clinical and nonclinical HCWs.Results7.3% of HCWs were having moderate insomnia, 3.8% had severe insomnia, and 20.8% were having subthreshold insomnia. Severe anxiety and depression were found in 6.7% of respondents. 8.0 and 32.3% of the respondents had moderate and mild anxiety–depression, respectively. 6.4% had high perceived stress. 47.6 and 46.0% of the respondents had moderate and low stress, respectively. There was a statistically significant difference in severe insomnia between clinical and nonclinical HCWs, whereas no significant difference in anxiety, depression, and stress between clinical and nonclinical HCWs.ConclusionThis study suggests that psychological morbidity is prevalent among both clinical and nonclinical HCWs and both males and females. Early intervention may be beneficial to prevent this issue.How to cite this articleSunil R, Bhatt MT, Bhumika TV, Thomas N, Puranik A, Chaudhuri S, et al. Weathering the Storm: Psychological Impact of COVID-19 Pandemic on Clinical and Nonclinical Healthcare Workers in India. Indian J Crit Care Med 2021;25(1):16–20.

Mental Health Outcomes Amongst Health Care Workers During COVID 19 Pandemic in Saudi Arabia.

Objectives: The study aimed to assess the mental health outcomes and associated factors among health care workers during COVID 19 in Saudi Arabia.Design, Setting, and Participants: We conducted a cross-sectional survey of health care workers from tertiary care and ministry of health Centers across the Central, Eastern, and Western regions of Saudi Arabia. There were 1,130 participants in the survey, and we collected demographic and mental health measurements from the participants.Primary Outcomes and Measures: The magnitude of symptoms of depression, anxiety, and insomnia was measured using the original version of 9-item patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder scale (GAD-7), and 7-item insomnia severity index (ISI). We use the multiple logistic regression analysis to identify the associated risk factors of individual outcomes.Results: The scores on the PHQ-9 showed that the largest proportion of health care workers (76.93%) experienced only normal to mild depression (50.83 and 26.1%, respectively). The scores on the GAD-7 showed that the largest proportion of health care workers (78.88%) experienced minimal to mild anxiety (50.41 and 28.47%, respectively). The scores on the ISI showed that the largest proportion of health care workers (85.83%) experienced absence to subthreshold insomnia (57.08 and 28.75%, respectively). The risk factors for depression in health care workers were Saudi, living with family, working from an isolated room at home and frontline worker. For anxiety, being female was risk factor and for insomnia, being frontline worker was risk factor.Conclusion: It was observed that the symptoms of depression, anxiety, and insomnia were reported in a lower proportion of health care workers in our study. The participants who were female, frontline workers, Saudi, living with family, and working from home in isolated rooms were predisposed to developing psychological disorders.

Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity.

Background: Alternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep, remains unknown. Objective: This study examined the effect an ADF-LC diet on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period. Results: Reductions in body weight (−5 ± 1 kg, p < 0.001) and fat mass (−4 ± 1 kg, p < 0.01) were noted during the weight loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The percent of subjects with high risk of obstructive sleep apnea at baseline was 45%, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. Conclusion: The ADF-LC diet does not impact sleep quality, duration, insomnia severity or the risk of obstructive sleep apnea in adults with obesity.

Insomnia is associated with worry, cognitive avoidance and low academic engagement in Argentinian university students during the COVID-19 social isolation

ABSTRACT An increment in mental health problems related to social isolation strategies was evinced in several populations, however few investigations address this problem in students. This study aimed to analyze the relationship between insomnia, worry, coping strategies, and academic engagement in subjects pursuing a university degree in Argentina during the first month of compulsory social isolation against the COVID-19 pandemic. Self-report online questionnaires were administered to 584 participants: Insomnia Severity Index, Penn State Worry Questionnaire, Coping Responses Inventory, Utrecht Work Engagement Scale for Students. Demographic data was recorded. Statistics included bivariate and multivariate techniques. Prevalences of 45% for subthreshold insomnia, 23% for moderate insomnia, and 4% for severe insomnia were found. The severe insomnia group presented higher levels of worry and cognitive avoidance strategies. Insomnia was also associated with daytime concerns. The group without insomnia was more vigorous in their academic engagement. Being physically active was associated with lower sleep problems. Insomnia prevalence is high in socially isolated university students. Cognitive avoidance coping strategies are associated with worry, which leads to an alert state that makes sleep difficult. These findings should be taken into account by academic institutions to define their pedagogic strategies.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States.

Aims and objectivesTo describe the levels of insomnia, fatigue and intershift recovery, and psychological well‐being (burnout, post‐traumatic stress and psychological distress), and to examine differences in these measures based on work‐related characteristics among nursing staff during COVID‐19 pandemic in the United States.BackgroundThe COVID‐19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic.DesignCross‐sectional study.MethodsHospital nurses and nursing assistants (N = 587) were recruited online between May–June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery‐15), burnout (Maslach Burnout Inventory‐Human Services Survey), post‐traumatic stress (Short Post‐Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire‐4), and questions on work and demographics. The STROBE checklist was followed for reporting.ResultsThe sample had subthreshold insomnia, moderate‐to‐high chronic fatigue, high acute fatigue and low‐to‐moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post‐traumatic stress. Nurses who cared for COVID‐19 patients had significantly scored worse on almost all measures than their co‐workers. Certain factors such as working hours per week and the frequency of 30‐min breaks were significant.ConclusionNursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID‐19 pandemic. Moreover, staff who were involved in the care of COVID‐19 patients, worked more than 40 h per week and skipped 30‐min breaks showed generally worse self‐reported outcomes.Relevance to clinical practiceNursing administration is recommended to monitor for fatigue and distress on nursing units, re‐visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front‐line nursing groups.

A Comparative Study on the Use of Alprazolam and Melatonin for Sleep Disturbances in Hemodialysis Patients.

Background and objectivesSleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis.Materials and methodsWe conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS).ResultsA total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062).ConclusionAs melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.

Sleep Disorders and Fatigue among Health Care Providers Working at University Hospitals

Background and Objective: Sleep disorder and fatigue are common among health care workers (HCWs) and negative-ly affect their quality of life and caregiving to the patients. Early diagnosis and rapid modification of causative factors might prevent the potential disastrous results of these problems on personal and population health. This study aimed to evaluate the state of sleep and fatigue among HCWs of hospitals affiliated to Mazandaran University of Medical Sci-ences, Iran, and their related factors. Materials and Methods: This cross-sectional study was conducted from September 2014 to December 2014 among HCWs at hospitals of Mazandaran University of Medical Sciences. Demographic data, medical history, and occupation-al shift information were recorded. Sleep quality was assessed by the valid and reliable Persian versions of Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). Fatigue was evaluated by valid and reliable Persian version of Fatigue Severity Scale (FSS). Statistical analysis was performed using SPSS software. Results: 595 HCWs participated in the study. According to ISI, 48.4% of HCWs experienced subthreshold insomnia, 25.4% were affected by moderate, and 5.0% by severe clinical insomnia. PSQI indicated poor sleep quality in 79.8% of the participants. 71.6% of HCWs had FSS of 4 or more, which was correlated to gender, age, and sleep quality. Correla-tion of sleep quality components with participants’ shift characteristics was also investigated. Conclusion: Sleep disorders and fatigue are common in HCWs of university hospitals. Correction of certain modifiable factors can reduce negative consequences of sleep disorders and fatigue in HCWs.

Psychological impact of COVID-19 pandemic on health-care professionals in India – A multicentric cross-sectional study

Objectives:The world is grappling with an ongoing COVID-19 pandemic that has shaken the mankind to the core and disrupted the lives of everyone. The aim of the study was to assess the presence of psychological distress, depression, anxiety, stress, and insomnia experienced by the Indian healthcare workers.Material and Methods:A cross-sectional study was conducted in India among 777 doctors to evaluate the mental health of doctors working in Corona wards from April 2020 to May 2020 using a pre-designed, pre-tested validated, semi-structured DASS-21 questionnaire, and the Insomnia Severity Index. Continuous variables between the groups were measured using the Mann–Whitney U-test and the Kruskal–Wallis H test.Results:Among the doctors working for the pandemic, around 55% of medical officers in the study reported having moderate levels of depression. With respect to anxiety, it was found that among men as many as 52% reported experiencing severe anxiety and 24% had moderate levels of anxiety whereas females reported as high as 68% and 48% of moderate and severe anxiety, respectively. In our study, around 30% and 44% of male doctors reported mild and moderate levels of stress, respectively, whereas 70% and 56% of female doctors reported mild and moderate levels of stress, respectively. It was also observed that among female doctors the rates of moderate insomnia were especially high (65%), whereas a high level of male participants reported sub-threshold insomnia (52%).Conclusion:Early screening targeting the medical workforce and the implementation of psychological interventions is essential for protecting and maintaining the functionality of the health-care system.

Association between Gait Variability and Gait-Ability Decline in Elderly Women with Subthreshold Insomnia Stage.

This study investigates the gait characteristics of elderly women, aged more than 65 years, with subthreshold insomnia stage at various walking speeds. A total of 392 participants (insomnia: 202 and controls: 190) wearing shoe-type inertial measurement units completed walking tests on a treadmill for a duration of 1 min at slower, preferred, and faster speeds. The insomnia group indicated lower pace parameters (range of Cohen’s d: 0.283–0.499) and the single support phase (Cohen’s d: 0.237), greater gait variability (range of Cohen’s d: 0.217–0.506), and bilateral coordination (range of Cohen’s d: 0.254–0.319), compared with their age-matched controls; the coefficient of variance (CV) of the stance phase at the faster speed condition was a crucial variable for distinguishing between insomnia and control groups. In addition, the insomnia group demonstrated insufficient gait adaptation at the slower and preferred speeds, as indicated by the CVs of the stride length, stride time, and step time. In particular, participants with worsened insomnia symptoms or sleep problems showed that these worse gait patterns may increase the potential risk of falling in elderly women. Thus, elderly women with subthreshold insomnia stage need to improve their sleep quality to enhance their physical functions.

Insomnia is a risk factor for spreading of chronic pain: A Swedish longitudinal population study (SwePain).

Recent evidence suggests that insomnia negatively influences the occurrence of generalized pain. This study examined whether insomnia is a risk factor for the transition from local pain (LP) to generalized pain (i.e. spreading of pain). This longitudinal study, with a follow-up of 24months, included 959 participants (mean age: 55.8years; SD: 13.9) with local or regional pain at baseline. Participants were grouped by insomnia symptoms as measured by the Insomnia Severity Index. Spreading of pain was measured by body manikins based on the spatial distribution of pain on the body. We defined two outcome categories; one with relatively localized pain (i.e. LP and moderate regional pain [MRP]), and one with relatively generalized pain (i.e. substantial regional pain and widespread pain [WSP]). Baseline age, sex, education, depressive symptoms, anxiety symptoms, catastrophizing, pain intensity and spread of pain were also included in the Generalized Linear Model analysis. The unadjusted model showed that the risk of spreading of pain increased with an increase in insomnia symptoms (no insomnia: 55.4%; subthreshold insomnia: 25.4% moderate insomnia: 16.5% and severe insomnia: 2.7%). The risk increased in a dose-dependent manner; moderate insomnia risk ratio (RR) 2.34 (95% confidence interval [CI]: 1.34-4.09) and severe insomnia RR 4.13 (95% CI: 1.56-10.92). The results were maintained in the fully adjusted model although MRP was the strongest predictor RR 6.95 (95% CI: 3.11-15.54). Our findings show a strong prospective relationship between insomnia symptoms and the transition from relatively localized to generalized pain. This study shows that people with LP conditions are at much higher risk of developing WSP if they also have significant insomnia symptoms. The elevated risk is evident after 24months and increases in a dose-dependent manner regarding the degree of exposure to insomnia symptoms. Local pain conditions are quite common in primary care, and an evaluation of the insomnia symptoms is highly recommended since the most common sleep problems can be treated effectively if detected.

0525 Subtypes of Efficacy of Cognitive-Behavioral Therapy for Insomnia

Abstract Introduction Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment for Insomnia disorder (ID). We aimed to identify ID patients’ subtypes based on clinical features and their response to CBT-I. Methods 294 chronic insomnia patients (61.6% female, mean age 40.7 ± 12.3 yrs) underwent 7-sessions group CBT-I. By use of latent class analysis (LCA) we identified insomnia disorder subtypes according to baseline (BL) evaluation of non-sleep indices and the response to CBT-I (Delta score of Insomnia Severity Index ISI between BL and end-of-treatment (ET). Moreover, we assessed ISI in 123 out of 294 insomnia patients (82 females (66.7%), mean age 40.59 ± 11.89 years) who completed a follow-up evaluation (FU) within a range of 4-10 years. Results We chose 3 latent classes as most parsimonious model. We identified Class 1 (insomnia+anxiety+depression+stress) (n=62), Class 2 (insomnia+anxiety+depression) (n=153) and Class 3 (only-insomnia) (n=79). The effect of CBT-I was maintained up to 10 years after the ET in the three classes but with significant difference between classes (p&amp;lt;0.05). At the ET, the largest percentage of responders (ISI decrease ≥ 8) was found in Class 1 (63.5%). Results of overall CBT-I effectiveness: in Class 3, 98.6% had subthreshold insomnia (ISI score=0-14) at the ET, and 97.2% at the FU; in Class 2, 89.0% at the ET, and 78.2% at the FU; in Class 1, 80.7% at ET and 51.8% at the FU. Conclusion Our analysis identified three different subtypes of insomniacs on the basis of clinical outcomes. The presence of anxiety and depression did not diminish the effect of CBT-I both short and long term. However, ID patients characterized by the presence of stress (Class 1) were the best responders at the ET but this was not maintained at the FU evaluation. We can speculate that stress could be considered a risk factor that plays an important role in the long-term outcome of CBT-I. Support No

0645 The Association of Hypoglossal Nerve Stimulator Adherence and Insomnia

Abstract Introduction The gold standard for treatment of Obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, CPAP adherence is less than 50%. An alternative treatment is the hypoglossal nerve stimulator (HNS) which displaces the tongue anteriorly to treat upper airway obstruction. Difficulties tolerating HNS are related to stimulation discomfort. In this study, we investigated insomnia as a barrier to adherence. Methods Patients implanted and activated with HNS at The Ohio State University Wexner Medical Center between 2015 and 2019 were eligible. Patient usage data from the previous six months was obtained and subjects were asked to complete an Insomnia Severity Index (ISI). Participants were divided into adherent (defined as use ≥28 hours/week) and non-adherent (use &amp;lt;28 hours/week). Results 32 subjects were enrolled, 22 in the adherent group and 10 in the non-adherent group. There was a significant decrease in mean treatment AHI in both groups: 36.25 to 11.14 in the adherent group and 36.30 to 15.69 in the non-adherent group (p&amp;lt;0.0001). The mean ISI score in the adherent group was 6.84 which is consistent with no clinically significant insomnia and 8.67 in the non-adherent group consistent with subthreshold insomnia. However, there was not a statistically significant difference between the two groups (p=0.441). There was a statistically significant higher score for the question “Do you worry about your sleep problems?” in the non-adherent group (1.78, SD1.39 vs 0.74. SD 0.81) (p =0.018). Conclusion This study suggests that patients who have difficulty with sleep may have more difficulty with HNS adherence than those who do not. In particular the question stating “Do you worry about your sleep problems” had a statistically higher score in the non-adherent group. Prospective studies are needed to further explore a possible relationship between insomnia and HNS adherence. Support N/A

Frequency of sleep disturbance with chronic low back pain: a cross sectional study.

To determine the frequency of sleep disturbance among individual with chronic low back pain, and to explore the association between the two. The cross-sectional study was conducted from January to March, 2017, at the Physiotherapy Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, and comprised patients of either gender aged 18-40 years with at least a three-month history of chronic low back pain. . Data was collected using insomnia severity index for sleep disturbance and Rolland Morris questionnaire for disability due to chronic low back pain. Data was analysed using SPSS 21. Of the 110, patients 68(62%) were males. The overall mean age of the sample was 31.79±6.18 years. Mean functional disability score was 13.66+2.44, while 84(76.4%) had sleep disorder; 78(70.9%) having sub-threshold insomnia, and 6(5.5%) with clinical insomnia of moderate severity. There was a positive intermediate correlation between sleep disorder and functional disability (p<0.05). Frequency of sleep disturbance was high in patients with chronic low back pain. There was an intermediate positive correlation between the two.

Prevalence of insomnia and daytime sleepiness in poststroke patients

Background The relationship between sleep disorders and stroke has been well-documented through multiple direct or indirect mechanisms. Participants and methods This was a cross-sectional (comparative case–control study) study. A total of 75 poststroke patients attending the neurology and internal medicine outpatient clinics at Al Zahraa University Hospital were selected, along with 75 matching individuals as a control group. All poststroke patients had a modified Ranken Scale less than or equal to 3 and interval was 8–12 weeks after stroke. All participants were subjected to complete neuropsychiatric history and medical history, the Pittsburg sleep quality index, insomnia severity index, and Epworth sleepiness scale. Strokes were divided into right and left cerebral hemispheres and the localization of stroke to cortical, subcortical, basal ganglion, or brain stem. Results Comparison between poststroke patients and the control group regarding Pittsburg sleep quality index shows statistically significant difference regarding all components of the scale except the use of sleep medication. Regarding insomnia severity index, poststroke patients scored more than the control group, denoting more insomnia ranging from subthreshold insomnia (30.67%) to moderately severe (32%) and severe (30.6%) insomnia. Epworth sleepiness scale shows a statistically significant difference between both groups, denoting more daytime sleepiness. It was more in right-sided hemispheric lesions and subcortical infarctions. Conclusion Increasing awareness about poststroke sleep disorders is mandatory among physicians to improve the prognosis and quality of life of these patients.

The effect of water loading for acute weight loss following fluid restriction on sleep quality and quantity in combat sports athletes

Introduction: Combat sport athletes commonly engage in established and novel acute weight-loss strategies to achieve weight division targets. The effect of such practices on sleep is unknown. Methods: Twenty-two combat sports athletes wore wrist actigraphy devices for nine nights during a training camp and completed questionnaires assessing daytime sleepiness, insomnia, sleep apnoea and chronotype. Athletes were assigned to a control (CG) or water loading group (WLG). Both followed a low residue diet for 96h, and restricted fluid for 24h before weigh-in. Prior to restriction, the CG consumed 40ml/kg and WLG consumed 100ml/kg fluid daily. Results: Four athletes responded positively for the potential prevalence of sleep apnoea (2 CG/WLG), reporting subthreshold insomnia 8±4, athletes were assessed as having an “intermediate chronotype”. Sleep latency estimates in CG were longer on days 4/6 relative to 3 (p<0.05). There was a between-group difference for sleep latency on day 6, with CG taking 35 mins longer (95% CI 5-64mins, p=0.022) to fall asleep. Conclusion: Acute weight loss by means of a low residue diet, both with and without water loading before the fluid restriction is a safe and effective means of manipulating body mass to in the context of sleep.

Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT

Objective/BackgroundMany patients find cognitive behavioral therapy for insomnia (CBT-I) useful. However, it is currently unknown if those with sub-threshold insomnia also benefit. Here we assessed whether CBT-I is both feasible and acceptable in participants with sub-threshold insomnia. The primary aims were to evaluate participation rates and treatment acceptability, and to establish an effect size for symptom improvement. Patients/MethodsA total of 199 female participants (Mage 20 ± 5 years) took part. Following baseline assessments, participants were randomly allocated to either a six-week digital CBT-I intervention or a six-week control group receiving puzzles. Additional assessments were performed three-weeks, six-weeks, and six-months later. ResultsParticipation rates at each survey assessment wave did not differ between the groups (ps > 0.140), though adherence to completing each weekly task was lower in the CBT-I group, p = 0.02. Treatment acceptability was high (M (SD) = 33.61 (4.82), theoretical range 6–42). The CBT-I group showed greater improvement in insomnia symptoms at the end of the intervention compared to the control group (p = 0.013, d = 0.42), with significant variation in outcome (M = 4.69, SD = 5.41). Sub-threshold participants showed a similar pattern of results, whilst those meeting insomnia criteria showed a smaller between-group difference. CBT-I led to improvements in anxiety, paranoia and perceived stress between baseline and end of intervention. Changes in insomnia symptoms were mediated by cognitions about sleep and somatic pre-sleep arousal. ConclusionsCBT-I provides a benefit even in sub-threshold insomnia. CBT-I may be useful to tackle insomnia symptoms even when they are sub-threshold.