Wake After Sleep Onset Research Articles

Neuropsychological and Behavioral Profile in Sleep-Related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DOA): A Multimodal Analysis.

Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in cognitive functions. Controversial findings are raised about the cognitive profile in SHE; however, no studies have investigated the cognitive profile in DOA. This study aimed to assess whether sleep instability affects cognitive functions in patients with SHE or DOA. This study analyzed 11 patients with DOA, 11 patients with SHE, and 22 healthy controls (HC). They underwent full-night video polysomnography (vPSG) and comprehensive neuropsychological and behavioral evaluation. Differences in the variables of interest among the SHE group, DOA group, and their respective control groups were evaluated. The auto-contractive map (auto-CM) system was used to evaluate the strength of association across the collected data. The SHE group had reduced sleep efficiency and increased wake after sleep onset (WASO); both the SHE and DOA groups showed increased % of N2 and REM sleep compared to the HC group. Neuropsychological and behavioral evaluations showed a different cognitive profile in the SHE group with respect to the HC group. The auto-CM showed that Pittsburgh Sleep Quality Index (PSQI), Beck depression inventory (BDI), MWCST_PE, Epworth sleepiness scale (ESS), WASO, N1, and % REM were strictly correlated with SHE, whereas the SE and arousal index (AI) were strictly related to DOA. Patients with SHE and DOA present different cognitive and psychiatric profiles, with subtle and selective cognitive impairments only in those with SHE, supporting the discriminative power of cognitive and psychiatric assessment in these two conditions.

Theanine maintains sleep quality in healthy young women by suppressing the increase in caffeine-induced wakefulness after sleep onset.

Energy drinks take advantage of caffeine's effects on wakefulness and performance; however, excessive intake has a negative effect on sleep. Green tea is consumed worldwide and has both a stimulating effect from caffeine and a calming or relaxing effect from theanine. Theanine reduces the excitotoxicity of caffeine. This study evaluated whether theanine improves the sleep quality worsened by caffeine in healthy young women. Sleep latency, sleep time, wake after sleep onset (WASO) time, and the number of WASOs were measured. A crossover study was performed using four treatment groups: theanine (50 mg), caffeine (30 mg), combined theanine and caffeine (TC), and placebo. The sleep stage was determined using electroencephalograms, and cerebral blood flow was measured using near-infrared spectroscopy. The caffeine group showed a significant increase in the WASO time compared with the placebo group; no difference was observed between the theanine or TC group and the placebo group. There were no differences in the sleep-onset latency or number of WASOs between the theanine, caffeine, or TC groups and the placebo group. In combination with theanine, only the caffeine-induced increase in the WASO time was suppressed. Our results suggest that theanine can reduce caffeine's effects on sleep quality.

Interrupted lullabies: the association between menopausal symptoms and sleep variability in peri- and post-menopausal women

ABSTRACT Poor sleep is a reality for many midlife women experiencing menopause. Although much empirical attention has been allocated toward ameliorating vasomotor symptoms and related consequences, less focus has been given toward sleep, specifically sleep variability, in menopausal women. The present study aimed to determine the association between menopausal symptoms and night-to-night sleep variability among peri- and post-menopausal women. Participants were 220 menopausal women (42.3 percent peri-menopausal, 57.7 percent post-menopausal) aged 40 to 64 from the United States recruited via Prolific, and online platform. The current study conducted secondary analyses on data collected as part of a larger investigation on midlife women from the United States. A structural equation model assessed associations between a latent menopausal symptom construct, composed of several Women’s Health Questionnaire domains, and a latent sleep variability construct, composed of sleep diary indices. Menopausal symptoms were associated with latent sleep variability (β = 0.49, p < .05); greater experience of menopausal symptoms was associated with more night-to-night sleep variability (medium effect size). Waking after sleep onset (WASO) was the sole significant indicator of the latent sleep factor. The findings highlight the importance of menopausal symptoms for sleep variability, specifically wakefulness. As such, wakefulness may be an important target for sleep interventions for menopausal women. The findings further suggest a need for more research and interventions targeted toward understanding and ameliorating the impact of menopausal symptoms on night-to-night wakefulness overall.

Conscious entry into sleep: Yoga Nidra and accessing subtler states of consciousness.

Human sleep is a dynamic and complex process comprising sleep stages with REM and NREM sleep characteristics that come in cycles. During sleep, there is a loss of responsiveness or a perceptual loss of conscious awareness with increasing thresholds for wakefulness as sleep progresses. There are brief bursts of wakefulness or Wake After Sleep Onset (WASO) throughout a nocturnal sleep. Conscious experience during nocturnal sleep is known to occur during lucid dreaming when one is aware during dreams when the dream is occurring. Most cultures have known lucid dreaming since antiquity. However, conscious experience during dreamless sleep is relatively lesser known. Nevertheless, selected Indo-Tibetan meditation literature has documented it since antiquity. Minimal Phenomenal Experience (MPE) research describes lucid dreamless sleep as its target phenomenology. "Conscious entry into sleep" posits tonic alertness is maintained post sleep onset through the sleep stages for sustained durations of time until an eventual loss of conscious awareness. Entering sleep consciously and being aware during dreamless sleep, including Slow Wave Activity, is plausibly to be in the state of "Yoga Nidra" or Yogic sleep. An attentive sleepful state provides access to subtler states of consciousness and significantly deepens the levels of silence. It is phenomenologically distinct from hypnagogic hallucinations and lucid dreaming. Unfortunately, sleep studies validating this phenomenology are yet to be done. Therefore, an experimental methodology akin to those used in lucid dreaming experiments is described.

Habitual Subjective Sleep Continuity is Not Associated With Fluid Intelligence: An Exploratory Study

The link between sleep and cognition is well-established, but the link between subjective sleep and fluid intelligence is poorly understood. The aim of this exploratory study was to examine the relationship between habitual subjective sleep continuity and fluid intelligence. In this study, a total of 56 healthy sleepers (M&lt;sub&gt;age&lt;/sub&gt; = 30.91 years; SD&lt;sub&gt;age&lt;/sub&gt; = 12.93 years) completed two fluid intelligence (abstract reasoning and two-dimensional mental rotation) tasks after completing seven consecutive days of sleep diaries. Relationships between subjective sleep continuity (total sleep time [TST]; sleep efficiency [SE%]); wake after sleep onset (WASO) and sleep onset latency (SOL), and task accuracy and speed were assessed using Pearson correlations. Overall, there were no associations between subjective sleep continuity (TST, SE%, WASO, SOL) and either task accuracy or speed (adjusted p-values &gt; 0.0125). Overall, habitual subjective sleep continuity and fluid intelligence may not be associated. These results should be replicated in larger samples.

Objective multi-night sleep monitoring at home: variability of sleep parameters between nights and implications for the reliability of sleep assessment in clinical trials.

In-laboratory polysomnography is the current gold standard for objective sleep measurements in clinical trials, but this does not capture night-to-night variability in sleep parameters. This study analyzed variability in sleep parameters recorded over multiple nights of sleep in an ecological setting using a portable sleep monitor and then estimated the minimum sample sizes required to reliably account for inter- and intra-individual variability in sleep parameters. Participants were males who self-reported the absence of sleep disorders, and used a sleep monitoring device (Dreem Headband, Dreem, France) over multiple nights of sleep. Night-to-night variability of sleep parameters was determined over five consecutive weeknights using coefficients of variation (CV), and the minimal number of individuals and nights needed to reliably determine each sleep parameter was assessed. Night-to-night variability for the whole group (n = 94; 470 nights) was high (CV 0.44-0.58) for N2, N3, sleep onset and persistent sleep latencies, and wake after sleep onset (WASO), medium (CV 0.22-0.28) for N1 and N3 percentage, awakenings and REM latency, and low (CV 0.04-0.19) for sleep efficiency, N2 and REM percentages, total sleep time (TST) and micro-arousal index. Minimum sample sizes for reliable assessment of TST and WASO were 2 nights with 10 participants and 4 nights with 50 participants, respectively. Night-to-night variability of sleep parameters is underestimated and under-recognized. These data on variability in commonly used sleep parameters will facilitate better estimation of sample sizes and number of nights required in clinical trials based on the outcomes of interest.

Assessment of glymphatic function in narcolepsy using DTI-ALPS index

IntroductionSleep is a modulator of glymphatic activity which is altered in various sleep disorders. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness (EDS), rapid onset of rapid eye movement (REM) sleep, cataplexy, disturbed night sleep with fragmentation. It is categorized into two types, type 1 (NT1) and type 2 (NT2) depending on the presence of cataplexy and/or absence of orexin. We sought for alterations in glymphatic activity in narcoleptic patients using diffusion tensor imaging (DTI) along perivascular space (ALPS) index on magnetic resonance imaging (MRI). Material and methodsAdult patients diagnosed with NT1 or NT2 who had polysomnography (PSG) and MRI with DTI were included in the study. Sleep recording included Epworth Sleepiness Scale (ESS) score, sleep latency during multiple sleep latency test (MSLT), sleep efficiency during night PSG, wake after sleep onset (WASO), REM sleep latency during PSG, percentage of non-REM (NREM), REM sleep and wakefulness during night PSG. DTI-ALPS index was calculated for each patient and age-sex matched healthy control(HC)s. ResultsThe study group was composed of 25 patients [F/M = 15/10, median age = 34 (29.5–44.5)], 14 with NT1 and 11 with NT2 disease. ESS, WASO and percentage of wakefulness were significantly higher in NT1 patients (p < 0.05). Mean DTI-ALPS was not significantly different neither between narcoleptic patients and HCs, nor between NT1 and NT2 patients (all, p > 0.05). However, DTI-ALPS was negatively correlated with WASO (r = −0.745, p = 0.013) and percentage of wakefulness (r = −0.837, p = 0.005) in NT1 patients. DTI-ALPS correlated negatively with percentage of N1 sleep (r = −0.781, p = 0.005) but positively with REM percentage (r = 0.618, p = 0.043) in NT2 patients. ConclusionIn this study, DTI-ALPS was not significantly different in narcoleptic patients than the HCs. However, the glymphatic index as assessed by DTI-ALPS correlated with PSG parameters; negatively with WASO, percentage of wakefulness in NT1, percentage of N1 sleep in NT2, and positively with REM sleep in NT2. A tendency for a reduction in DTI-ALPS in NT1 patients compared to both NT2 patients and HCs was also found. These findings might show the first evidence of an alteration of glymphatic activity, especially in NT1 patients, thus warrant further prospective studies in larger size of narcoleptic patient cohorts.

Validity of Two Consumer Multisport Activity Tracker and One Accelerometer against Polysomnography for Measuring Sleep Parameters and Vital Data in a Laboratory Setting in Sleep Patients.

Two commercial multisport activity trackers (Garmin Forerunner 945 and Polar Ignite) and the accelerometer ActiGraph GT9X were evaluated in measuring vital data, sleep stages and sleep/wake patterns against polysomnography (PSG). Forty-nine adult patients with suspected sleep disorders (30 males/19 females) completed a one-night PSG sleep examination followed by a multiple sleep latency test (MSLT). Sleep parameters, time in bed (TIB), total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), awake time (WASO + SOL), sleep stages (light, deep, REM sleep) and the number of sleep cycles were compared. Both commercial trackers showed high accuracy in measuring vital data (HR, HRV, SpO2, respiratory rate), r > 0.92. For TIB and TST, all three trackers showed medium to high correlation, r > 0.42. Garmin had significant overestimation of TST, with MAE of 84.63 min and MAPE of 25.32%. Polar also had an overestimation of TST, with MAE of 45.08 min and MAPE of 13.80%. ActiGraph GT9X results were inconspicuous. The trackers significantly underestimated awake times (WASO + SOL) with weak correlation, r = 0.11−0.57. The highest MAE was 50.35 min and the highest MAPE was 83.02% for WASO for Garmin and ActiGraph GT9X; Polar had the highest MAE of 21.17 min and the highest MAPE of 141.61% for SOL. Garmin showed significant deviations for sleep stages (p < 0.045), while Polar only showed significant deviations for sleep cycle (p = 0.000), r < 0.50. Garmin and Polar overestimated light sleep and underestimated deep sleep, Garmin significantly, with MAE up to 64.94 min and MAPE up to 116.50%. Both commercial trackers Garmin and Polar did not detect any daytime sleep at all during the MSLT test. The use of the multisport activity trackers for sleep analysis can only be recommended for general daily use and for research purposes. If precise data on sleep stages and parameters are required, their use is limited. The accuracy of the vital data measurement was adequate. Further studies are needed to evaluate their use for medical purposes, inside and outside of the sleep laboratory. The accelerometer ActiGraph GT9X showed overall suitable accuracy in detecting sleep/wake patterns.

Insomnia symptoms and markers of preclinical Alzheimer’s disease in the community

AbstractBackgroundAmyloid production increases during wakefulness before being cleared during sleep. Insomnia is one of the commonest sleep disorders, yet its relationship to core markers of preclinical Alzheimer’s disease remains unknown. We investigated the cross‐sectional relationship between insomnia symptom severity, APOE e4 carriage, and cerebrospinal spinal fluid (CSF) concentrations of Alzheimer’s disease biomarkers in a non‐demented community‐sample aged 43‐67 years.Method66 participants from the Healthy Brain Project Biomarker Sub‐study (age = 58±6 years; MMSE = 29±7; 68% women) completed a lumbar puncture, two weeks of actigraphy to measure sleep and wake patterns, and the Insomnia Severity Index (ISI) to measure insomnia symptom severity over the past two weeks. The ISI was split into two groups (normal vs. high [&gt;7]) based on established cut‐off values (42% of the sample were high). Two core insomnia features were captured: Difficulty initiating sleep (prolonged sleep onset latency) and difficulty maintaining sleep (high wake after sleep onset (WASO) duration and number of awakenings), with each variable classified as the top 25th percentile versus the remainder of the sample. Analysis of covariance was used to compare CSF amyloid‐beta 42 (Aβ42), phosphorylated tau 181 (p‐tau181), total‐tau, and neurofilament light chain protein (NfL) across each of the sleep groups, adjusting for age and sex.ResultPersons with high insomnia symptom severity had higher CSF Aβ42 levels (p=0.033, d=0.58). Difficulty maintaining sleep (both high WASO and number of awakenings) was also associated with higher Aβ42 levels (p=0.023, d=0.77 for WASO; p=0.013, d=0.92 for awakenings), whereas difficulty initiating sleep was not (p= 0.776, d=0.08). The sleep variables were not associated with p‐tau181, total‐tau, or NfL levels (p&gt;0.05). APOE e4 modified the association between WASO and Aβ42. The strength of the relationship between higher WASO (versus normal) and Aβ42 was stronger in e4 carriers, compared to non‐carriers (F(df) = 6.94 (1, 44), p=0.012).ConclusionIn this relatively young sample, symptoms and features of insomnia were associated with higher CSF Aβ42 levels. These findings may reflect increased amyloid production due to acute sleep disruption. Longitudinal studies are needed to determine whether sustained sleep disruption associates with amyloid accumulation over time.

Real‐world sleep in Parkinson’s disease predicts cognitive dysfunction.

AbstractBackgroundSleep dysfunction is signature of Alzheimer’s disease and Parkinson’s disease (PD), and can signify incipient disease, disease risk, and worsen symptoms over time. How real‐world sleep dysfunction relates to patient self‐report of sleep and clinical cognitive dysfunction is poorly understood, partly because self ‐report is impaired in patients with cognitive decline. We monitored real‐world sleep with wearable actigraphy devices in patients with PD to test the hypothesis that objective patterns of sleep dysfunction are associated with worse cognitive performance.MethodTwenty‐nine participants with idiopathic PD (age = 67.44 ± 5.79, 20 males) completed the Montreal Cognitive Assessment (MoCA) and Epworth Sleepiness Scale (ESS) to capture clinical cognitive decline and self‐reported daytime sleepiness. Sleep was monitored for 4‐weeks using wrist‐worn ActiGraphs. Sub‐scores and total scores of MoCA were compared with Total Sleep Time (TST), Sleep Efficiency (SE), Wakefulness After Sleep Onset (WASO), and Sleep Fragmentation Index (SFI) measured by actigraphy, as well as ESS total using a Pearson correlation.ResultWorse sleep fragmentation (SFI), the percentage of awakenings and movements during sleep, predicted worse cognitive impairment overall (MoCA score: r = ‐0.38, p &lt; .05) and delayed recall (r = ‐0.44, p &lt; .05). Reduced sleep time (TST) and worse sleep quality (SE, WASO) did not worsen patient cognitive impairment. Patient self‐report of sleepiness (ESS) did not associate with worse cognitive outcomes.ConclusionThis pilot analysis identifies sleep fragmentation as a key risk factor for cognitive dysfunction in PD. Patient self‐report of sleep may not reliably reflect chronic sleep disruption and related cognitive dysfunction. Results underscore that objective measures of real‐world dysfunction can help inform clinical care and intervention for patients at risk for cognitive decline and dementia.

Applicability of Actigraphy for Assessing Sleep Behaviour in Children with Palliative Care Needs Benchmarked against the Gold Standard Polysomnography

In children with life-limiting conditions and severe neurological impairment receiving pediatric palliative care (PPC), the degree to which actigraphy generates meaningful sleep data is uncertain. Benchmarked against the gold standard polysomnography (PSG), the applicability of actigraphy in this complex population was to be assessed. An actigraph was placed on N = 8 PPC patients during one-night polysomnography measurement in a pediatric tertiary care hospital's sleep laboratory. Patient characteristics, sleep phase data, and respiratory abnormalities are presented descriptively. Bland-Altman plots evaluated actigraphy's validity regarding sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency compared to PSG. PSG revealed that children spent most of their time in sleep stage 2 (46.6%) and most frequently showed central apnea (28.7%) and irregular hypopnea (14.5%). Bland-Altman plots showed that actigraphy and PSG gave similar findings for sleep onset, sleep offset, wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency. Actigraphy slightly overestimated TST and sleep efficiency while underestimating all other parameters. Generally, the Actiwatch 2 low and medium sensitivity levels showed the best approximation to the PSG values. Actigraphy seems to be a promising method for detecting sleep problems in severely ill children.

Sound reasons for unsound sleep: Comparative support for the sentinel hypothesis in industrial and nonindustrial groups.

Sleep is a vulnerable state in which individuals are more susceptible to threat, which may have led to evolved mechanisms for increasing safety. The sentinel hypothesis proposes that brief awakenings during sleep may be a strategy for detecting and responding to environmental threats. Observations of sleep segmentation and group sentinelization in hunter-gatherer and small-scale communities support this hypothesis, but to date it has not been tested in comparisons with industrial populations characterized by more secure sleep environments. Here, we compare wake after sleep onset (WASO), a quantitative measure of nighttime awakenings, between two nonindustrial and two industrial populations: Hadza hunter-gatherers (n = 33), Malagasy small-scale agriculturalists (n = 38), and Hispanic (n = 1,531) and non-Hispanic White (NHW) (n = 347) Americans. We compared nighttime awakenings between these groups using actigraphically-measured sleep data. We fit linear models to assess whether WASO varies across groups, controlling for sex and age. We found that WASO varies significantly by group membership and is highest in Hadza (2.44 h) and Malagasy (1.93 h) and lowest in non-Hispanic Whites (0.69 h). Hispanics demonstrate intermediate WASO (0.86 h), which is significantly more than NHW participants. After performing supplementary analysis within the Hispanic sample, we found that WASO is significantly and positively associated with increased perception of neighborhood violence. Consistent with principles central to evolutionary medicine, we propose that evolved mechanisms to increase vigilance during sleep may now be mismatched with relatively safer environments, and in part responsible for driving poor sleep health.

Agreement between actigraphy and sleep diaries: A 28-day real-time monitoring study among suicidal adolescents following acute psychiatric care

ObjectiveTo examine the agreement between, and adherence to, wrist actigraphy and digital sleep diaries as methods for sleep assessment among high-risk adolescents in the 28 days following discharge from acute psychiatric care. Sleep parameters included: number of nighttime awakenings (NWAK), sleep efficiency (SE), sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO). MethodsFifty-three adolescents (12–18 years) were recruited following discharge from acute psychiatric care for suicide risk. Adolescents completed a baseline assessment followed by a 28-day monitoring period with daily sleep diaries and continuous wrist actigraphy. Bland-Altman and multi-level models examined agreement. ResultsAdherence to actigraphy was high, but lower for sleep diaries; a similar pattern of adherence emerged on weekdays vs. weekends. Bland-Altman analyses revealed no clinically meaningful bias for sleep parameters (except NWAK), but the limits of agreement make interpretation ambiguous. Our base model indicated strong agreement between actigraphy and sleep diaries for TST (r = 0.850), moderate for SOL (r = 0.325) and SE (r = 0.322), and weak for WASO (r = −0.049) and NWAK (r = 0.114). A similar pattern emerged with the insomnia severity models with baseline insomnia influencing agreement on all parameters. There were significant weekday-weekend differences for WASO and NWAK, but not for SOL, SE, and TST. ConclusionResults suggest that it may be beneficial to find a modeling approach to account for the concordant and discordant information and relevant time-level variables.

Associations between Sleep and Body Composition in Older Women and the Potential Role of Physical Function.

The relationship between sleep and adiposity in older women remains unclear partly due to the reliance of body mass index as a measure of adiposity. The purpose of this study was to investigate associations between objectively measured sleep characteristics and body composition measured by dual energy x-ray absorptiometry (DXA) in older women. A secondary purpose was to examine if physical function mediates this relationship. Non-obese older women (ages 60-75 years, n=102) were included in the study. Total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and wake after sleep onset (WASO) were determined by actigraphy. A battery of tests was used to assess physical function. With adjustment for age, there was a negative association between TST and TIB with lean mass. Both grip strength and dominant leg extension were associated with TST, TIB, and lean mass; the associations between TST and TIB with lean mass were lost after adjusting for grip strength or leg extension strength. Additionally, SE was negatively associated with total, gynoid, and trunk lean mass, and there was a positive association between TST and percent trunk fat, and WASO and gynoid lean mass, with age adjusted. Sleep characteristics, TST, TIB, SE, and WASO, were associated body composition measures in this sample of older women. The relationship between TST and TIB with body composition was mediated, in part, by grip strength and leg extension strength.

O029 Sleep architecture differs for individuals manifesting excessive daytime sleepiness with and without obstructive sleep apnea

Abstract Introduction The mechanism underlying the development of excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) remains unclear. Thus, we characterised the association between sleep architecture and EDS in individuals with and without OSA. Methods 1876 suspected OSA patients reporting daytime sleepiness underwent in-lab polysomnography and next-day multiple sleep latency test (MSLT). We investigated sleep architecture characteristics in OSA (apnea-hypopnea index [AHI]≥5, n=1508) and non-OSA (AHI&amp;lt;5, n=368) patients with and without EDS (MSLT≤10-minutes and MSLT&amp;gt;10-minutes). Sleep architecture was quantified by N1, N2, N3, REM, total sleep time (TST), and wake after sleep onset (WASO). Results OSA patients with EDS had less N1 (median: 10.0 vs 12.0-minutes, p&amp;lt;0.05) and N3 (60.2 vs 71.5-minutes, p&amp;lt;0.05) sleep, less WASO (43.0 vs 51.0-minutes, p&amp;lt;0.05), more N2 (210.5 vs 189.0-minutes, p&amp;lt;0.05) sleep, and higher TST (365.0 vs 351.5-minutes, p&amp;lt;0.05) than non-EDS patients. No difference was observed in the amount of REM (70.0 vs 67.5-minutes, p=0.46) sleep. Non-OSA patients with EDS had less WASO (31.5 vs 40.0-minutes, p&amp;lt;0.05), more N2 (188.5 vs 177.5-minutes, p&amp;lt;0.05) sleep, and higher TST (374.5 vs 359.0-minutes, p&amp;lt;0.05) and the amount of REM sleep (76.5 vs 68.5-minutes, p&amp;lt;0.05) than non-EDS patients. Discussion While EDS was associated with less WASO and greater TST and N2 in both OSA and non-OSA groups, there was also characteristic differences. Non-OSA patients with EDS have greater REM sleep duration, while OSA patients with EDS have less N3 sleep. There is likely a complex bi-directional relationship between sleep architecture and EDS reflecting acute/chronic sleep disruption and compensatory mechanisms.

O006 Acute effects of combined cannabidiol (CBD) and ∆9-tetrahydrocannabinol (THC) in insomnia disorder: A randomised, placebo-controlled trial using high-density EEG

Abstract Introduction Medicinal cannabis is often cited as a popular alternative to common sleep aids; however, there are limited studies using complex sleep EEG methods examining its’ effects in insomnia disorder. Methods Twenty patients (16 female; median [IQR] age, 47 [13.8] years) with insomnia disorder (mean ISI=20.8) completed two 24-hour in-laboratory visits during which they received a single oral dose of ‘CBD/THC’ containing 200 mg cannabidiol (CBD) and 10 mg delta9-tetrahydrocannabinol (THC) or placebo. Co-primary outcomes were total sleep time (TST) and wake after sleep onset (WASO). Secondary outcomes included next-day neurobehavioural function and sleep microarchitecture metrics determined using overnight polysomnography with 256-channel high-density EEG. Results Compared to placebo, CBD/THC significantly decreased TST (-24.5 min, p=0.047) with no significant change to WASO (+10.7 min, p=0.422). CBD/THC significantly decreased time spent in REM sleep (-33.9min, p&amp;lt;0.001) and increased REM sleep latency (+65.6 min, p=0.008). Preliminary high-density EEG analysis revealed increased alpha activity during REM sleep overlying the parietal cortex (p&amp;lt;0.05). CBD/THC did not impair next-day (+12 h post-treatment) cognitive performance, alertness or simulated driving performance (all p’s&amp;gt;0.05). Eighty-five mild, non-serious, adverse events were reported (55 during CBD/THC; most common dry mouth, drowsiness, and fatigue). Conclusions An acute dose of 200 mg CBD and 10 mg THC reduced TST and the time spent in REM sleep. Analysis of all high-density EEG outcomes is ongoing. CBD/THC did not affect next-day performance. Further research is required to determine the impact of chronic cannabinoid dosing on REM sleep and other objective sleep outcomes in insomnia disorder.

Abstract 11891: Adverse Childhood Experiences are Associated With Elevated Blood Pressure and Disturbed Sleep in the First Trimester of Pregnancy in Apparently Healthy, Young Adult Women

Introduction: Adverse childhood experiences (ACEs) are potentially traumatic psychosocial stressors that occur in early life, such as abuse, neglect, and household dysfunction. We hypothesize that ACEs are an underlying risk factor for disturbed sleep and hypertension in pregnancy, which is a major cause of maternal-fetal morbidity and mortality. Hypothesis: In young adult women, ACE exposure will be positively associated with first trimester systolic (SBP), diastolic blood pressure (DBP), and wakefulness after sleep onset (WASO), and inversely associated with sleep efficiency (SE). Further, ACE exposure will be associated with greater odds of first trimester elevated or stage 1 hypertension (ES1H). Methods: Data were obtained at 10-12 weeks of gestation from 142 pregnant women who were enrolled in an ongoing, clinical cohort study in Iowa City and Pittsburgh. Participants were 18-45 y of age, had a BMI &lt;40 kg/m 2 , and could not be taking medications or receiving treatment for sleep or cardiometabolic disorders such as chronic hypertension or diabetes. BP was assessed in accordance with AHA recommendations. Actigraphy was used to assess WASO and SE over ≥5 nights. ACE scores were log transformed and correlations were used to examine associations between ACE exposure and SBP, DBP, WASO and SE. Logistic regression was used to examine the association of ACE exposure with the probability of ES1H in an unadjusted model (model 1) and a model adjusted for age, race, ethnicity, BMI, and depressive symptoms (model 2). Results: 56% reported exposure to ≥1 ACE, and 28% reported exposure to ≥3. ACE exposure was positively related to SBP (r = 0.17, p = 0.04), DBP (r = 0.21, p = 0.01), and WASO (ρ = 0.21, p = 0.01), and negatively associated with SE (ρ = -0.22, p = 0.009). ACE exposure was associated with greater odds of first trimester ES1H in model 1 (OR = 2.73, 95% CI = 1.36 - 5.50; p = 0.005) and model 2 (OR = 2.44, 95% CI = 1.07 - 5.56; p = 0.03). Conclusions: ACEs represent an important risk factor for elevated BP and disturbed sleep in pregnancy. Large cohort studies are needed to understand the links among ACE exposure, sleep, resilience factors and hypertensive risk in pregnancy to provide information for developing targeted interventions to improve maternal-fetal cardiovascular health.

Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study

Introduction: Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension. Methods: We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274). Results: Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (&gt; 30 minutes), low SE (&lt;85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation. Conclusions: Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.

Sleep in hospitalized pediatric and adult patients – A systematic review and meta-analysis

BackgroundSleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing. ObjectiveThe objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors. MethodsA systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep’ and 'hospitalization’. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines. ResultsOut of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6–1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep. ConclusionOf all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7–3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3–3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.

Actigraphy-Based Assessment of Sleep Parameters in Intensive Care Unit Patients Receiving Respiratory Support Therapy

Purpose : This study aimed to investigate sleep parameters and to identify differences according to respiratory support therapy, sedation, and pain medication in intensive care unit (ICU) patients.Methods : In this observational study, sleep parameters were measured using actigraphy. We observed 45 sleep events in 30 ICU patients receiving respiratory support therapy. We measured the sleep parameters, time, efficiency, and wakefulness after sleep onset (WASO). The differences in sleep parameters according to the respiratory support therapy were analyzed using the Mann-Whitney U test.Results : The average daily sleep time of the participants was 776.66±276.71 minutes, of which more than 60% accounted for daytime sleep. During night sleep, the duration of WASO was 156.93±107.91 minutes, and the frequency of WASO was 26.02±25.82 times. The high flow nasal cannula (HFNC) group had a significantly shorter night sleep time (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=7.86, &lt;i&gt;p&lt;/i&gt; =.049), a greater number of WASO (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=5.69, &lt;i&gt;p&lt;/i&gt; =.128), and a longer WASO duration (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=8.75, &lt;i&gt;p&lt;/i&gt; =.033) than groups of other respiratory therapies.Conclusion : ICU patients on respiratory support therapy experienced sleep disturbances such as disrupted circadian rhythm and sleep fragmentation. Among respiratory support regimens, HFNC was associated with poor sleep parameters, which appears to be associated with the insufficient use of analgesics. The results of this study warrant the development of interventions that can improve sleep in ICU patients receiving respiratory support, including HFNC.