0617 Association Between Green, Blue, and Open Spaces and Sleep Health in a Black Population: An Analysis of the MetSO Dataset

Introduction

Blacks have a high burden of poor sleep health outcomes. Environmental determinants, such as green space or open environments, represent an underexplored contributor to sleep burden among Blacks. The extent these environmental factors affect sleep health outcomes within this population has not been adequately explored. To fill this gap in the literature, we investigated associations between environmental factors and sleep outcomes among Blacks in a large urban city. Objectives included (1) examine if zip-code derived open spaces (defined as proportion of open space in residential area,) green spaces (defined as open tree coverage of the ground) and blue spaces (proportion of water space) sleep apnea risk, and insomnia symptoms; (2) Examine if open, blue, and green spaces predict sleep outcomes independent of sex, age, and education level.

Methods

Our study used data from the Metabolic Syndrome Cohort Study (2009-2014), a studythat examined behavioral intervention methods to improve sleep apnea outcomes among Blacks. Sleep Apnea was assessed with the ARES (apnea risk) scale and insomnia status was collected through self-report (“Do you have difficulty staying/falling asleep or waking up?”) in a subset of 344 participants. Logistic regression analyses were performed to predict the effect green, blue, and open spaces had on sleep outcomes. To account for within zip-code correlation, mixed effects models (unadjusted and adjusted) account for sex, age, and education were considered.

Results

We found that none of the green, blue, or open space variables predicted sleep outcomes in the unadjusted model. In adjusted models, green space predicted sleep apnea risk scores, (OR=1.03, P<.05), but not insomnia.

Conclusion

Our study examined the extent which green, blue, and open spaces predicted insomnia and sleep apnea in urban blacks. We found that only green spaces were associated with sleep apnea, and none of our environmental variables predicted insomnia. Given the large amount of literature detailing a complex and multifactorial process on how environment affects sleep outcomes, our findings suggest that the link between urban environments, green spaces, and sleep outcomes may not be as definitive as they seem. Further research should explore the differential effect environment has on diverse populations’ sleep outcomes.

Support (If Any)

NIH R01HL142066, R01HL095799, RO1MD004113, R01HL152453

Predicting the number of COVID-19 infections and deaths in USA

Background

Uncertainties surrounding the 2019 novel coronavirus (COVID-19) remain a major global health challenge and requires attention. Researchers and medical experts have made remarkable efforts to reduce the number of cases and prevent future outbreaks through vaccines and other measures. However, there is little evidence on how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection entropy can be applied in predicting the possible number of infections and deaths. In addition, more studies on how the COVID-19 infection density contributes to the rise in infections are needed. This study demonstrates how the SARS-COV-2 daily infection entropy can be applied in predicting the number of infections within a given period. In addition, the infection density within a given population attributes to an increase in the number of COVID-19 cases and, consequently, the new variants.

Results

Using the COVID-19 initial data reported by Johns Hopkins University, World Health Organization (WHO) and Global Initiative on Sharing All Influenza Data (GISAID), the result shows that the original SAR-COV-2 strain has R₀<1 with an initial infection growth rate entropy of 9.11 bits for the United States (U.S.). At close proximity, the average infection time for an infected individual to infect others within a susceptible population is approximately 7 minutes. Assuming no vaccines were available, in the U.S., the number of infections could range between 41,220,199 and 82,440,398 in late March 2022 with approximately, 1,211,036 deaths. However, with the available vaccines, nearly 48 Million COVID-19 cases and 706, 437 deaths have been prevented.

Conclusion

The proposed technique will contribute to the ongoing investigation of the COVID-19 pandemic and a blueprint to address the uncertainties surrounding the pandemic.

Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border

Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration.Methods: Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status.Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint.Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Stress and Depression Are Associated With Life's Simple 7 Among African Americans With Hypertension: Findings From the Jackson Heart Study

BACKGROUND

The American Heart Association created the Life's Simple 7 (LS7) metrics to promote cardiovascular health (CVH) by achieving optimal levels of blood pressure, cholesterol, blood sugar, physical activity, diet, weight, and smoking status. The degree to which psychosocial factors such as stress and depression impact one's ability to achieve optimal CVH is unclear, particularly among hypertensive African Americans.

METHODS

Cross-sectional analyses included 1,819 African Americans with hypertension participating in the Jackson Heart Study (2000-2004). Outcomes were LS7 composite and individual component scores (defined as poor, intermediate, ideal). High perceived chronic stress was defined as the top quartile of Weekly Stress Inventory scores. High depressive symptoms were defined as Center for Epidemiologic Studies Depression scale scores of ≥16. We compared 4 groups: high stress alone; high depressive symptoms alone; high stress and high depressive symptoms; low stress and low depressive symptoms (reference) using linear regression for total LS7 scores and logistic regression for LS7 components.

RESULTS

Participants with both high stress and depressive symptoms had lower composite LS7 scores (B [95% confidence interval] = -0.34 [-0.65 to -0.02]) than those with low stress and depressive symptoms in unadjusted and age/sex-adjusted models. They also had poorer health status for smoking (odds ratio [95% confidence interval] = 0.52 [0.35-0.78]) and physical activity (odds ratio [95% confidence interval] = 0.71 [0.52-0.95]) after full covariate adjustment.

CONCLUSIONS

The combination of high stress and high depressive symptoms was associated with poorer LS7 metrics in hypertensive African Americans. Psychosocial interventions may increase the likelihood of engaging in behaviors that promote optimal CVH.

COVID-19 instructional approaches (in-person, online, hybrid), school start times, and sleep in over 5,000 U.S. adolescents

Study Objectives

To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents.

Methods

Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6–12), recruited through social media outlets in October/November 2020. Participants reported on instructional approach (in-person, online/synchronous, online/asynchronous) for each weekday (past week), school start times (in-person or online/synchronous days), and bedtimes (BT) and wake times (WT) for each identified school type and weekends/no school days. Sleep opportunity was calculated as BT-to-WT interval. Night-to-night sleep variability was calculated with mean square successive differences.

Results

Respondents included 5,245 racially and geographically diverse students (~50% female). BT and WT were earliest for in-person instruction; followed by online/synchronous days. Sleep opportunity was longer on individual nights students did not have scheduled instruction (>1.5 h longer for online/asynchronous than in-person). More students obtained sufficient sleep with later school start times. However, even with the same start times, more students with online/synchronous instruction obtained sufficient sleep than in-person instruction. Significantly greater night-to-night variability in sleep-wake patterns was observed for students with in-person hybrid schedules versus students with online/synchronous + asynchronous schedules.

Conclusions

These findings provide important insights regarding the association between instructional approach and school start times on the timing, amount, and variability of sleep in U.S. adolescents. Given the public health consequences of short and variable sleep in adolescents, results may be useful for education and health policy decision-making for post-pandemic secondary schools.

Using a Digital Neuro Signature to measure longitudinal individual-level change in Alzheimer's disease: the Altoida large cohort study

Conventional neuropsychological assessments for Alzheimer's disease are burdensome and inaccurate at detecting mild cognitive impairment and predicting Alzheimer's disease risk. Altoida's Digital Neuro Signature (DNS), a longitudinal cognitive test consisting of two active digital biomarker metrics, alleviates these limitations. By comparison to conventional neuropsychological assessments, DNS results in faster evaluations (10 min vs 45-120 min), and generates higher test-retest in intraindividual assessment, as well as higher accuracy at detecting abnormal cognition. This study comparatively evaluates the performance of Altoida's DNS and conventional neuropsychological assessments in intraindividual assessments of cognition and function by means of two semi-naturalistic observational experiments with 525 participants in laboratory and clinical settings. The results show that DNS is consistently more sensitive than conventional neuropsychological assessments at capturing longitudinal individual-level change, both with respect to intraindividual variability and dispersion (intraindividual variability across multiple tests), across three participant groups: healthy controls, mild cognitive impairment, and Alzheimer's disease. Dispersion differences between DNS and conventional neuropsychological assessments were more pronounced with more advanced disease stages, and DNS-intraindividual variability was able to predict conversion from mild cognitive impairment to Alzheimer's disease. These findings are instrumental for patient monitoring and management, remote clinical trial assessment, and timely interventions, and will hopefully contribute to a better understanding of Alzheimer's disease.

Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review

BACKGROUND

The influence of social media among adolescent peer groups can be a powerful change agent.

OBJECTIVE

Our scoping review aimed to elucidate the ways in which social media use among adolescent peers influences eating behaviors.

METHODS

A scoping review of the literature of articles published from journal inception to 2019 was performed by searching PubMed (ie, MEDLINE), Embase, CINAHL, PsycINFO, Web of Science, and other databases. The review was conducted in three steps: (1) identification of the research question and clarification of criteria using the population, intervention, comparison, and outcome (PICO) framework; (2) selection of articles from the literature using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; and (3) charting and summarizing information from selected articles. PubMed's Medical Subject Headings (MeSH) and Embase's Emtree subject headings were reviewed along with specific keywords to construct a comprehensive search strategy. Subject headings and keywords were based on adolescent age groups, social media platforms, and eating behaviors. After screening 1387 peer-reviewed articles, 37 articles were assessed for eligibility. Participant age, gender, study location, social media channels utilized, user volume, and content themes related to findings were extracted from the articles.

RESULTS

Six articles met the final inclusion criteria. A final sample size of 1225 adolescents (aged 10 to 19 years) from the United States, the United Kingdom, Sweden, Norway, Denmark, Portugal, Brazil, and Australia were included in controlled and qualitative studies. Instagram and Facebook were among the most popular social media platforms that influenced healthful eating behaviors (ie, fruit and vegetable intake) as well as unhealthful eating behaviors related to fast food advertising. Online forums served as accessible channels for eating disorder relapse prevention among youth. Social media influence converged around four central themes: (1) visual appeal, (2) content dissemination, (3) socialized digital connections, and (4) adolescent marketer influencers.

CONCLUSIONS

Adolescent peer influence in social media environments spans the spectrum of healthy eating (ie, pathological) to eating disorders (ie, nonpathological). Strategic network-driven approaches should be considered for engaging adolescents in the promotion of positive dietary behaviors.

The development and psychometric evaluation of the Survey of Obstructive Sleep Apnea Functional Health Literacy

OBJECTIVE AND OBJECTIVE

Obstructive Sleep Apnea (OSA) is a highly prevalent disorder that disparately affects racial/ethnic minorities. OSA functional health literacy can contribute to health disparities. Documenting poor OSA functional health literacy is needed to inform research agendas, policy, and advocacy efforts. The objective of this study is to develop a scale for measuring OSA functional health literacy among diverse audiences and a variety of reading levels and to ascertain its reliability and validity.

METHODS

Development of the 18-item Survey of OSA Functional Health Literacy (SOFHL) was guided by literature review and input from experts. A convenience sample of persons enrolled in a clinical trial completed the survey (n=194). The psychometric evaluation was conducted using factor analysis to identify the number of dimensions in the SOFHL and their relationship to other domains that are relevant to OSA functional health literacy.

RESULTS

Internal consistency reliability (alpha) was estimated for the resulting scale and correlations with educational attainment and income completed. All respondents were Black and 29% reported average household income less than $10,000 USD. Confirmatory factor analysis provided support for two dimensions: OSA general knowledge (alpha=0.81) and self-efficacy for OSA self-management (alpha=0.71).

CONCLUSIONS

Higher educational attainment and socioeconomic status were associated with better OSA functional health literacy. These results provide preliminary support for the SOFHL, a measure that can be used to assess OSA functional health literacy.

Binge drinking and insomnia in students from health sciences at one university in Rio de Janeiro, Brazil

In spite of the many studies examining alcohol consumption, recent reviews have indicated that binge drinking has not been extensively studied. Furthermore, it is becoming increasingly clear that sleep is associated with many physiological functions and to drug addictions. The present study aimed to evaluate the relationship between alcohol binge drinking and insomnia in college students of health sciences. All first-year health sciences students (n=286) were evaluated in a cross-sectional study. Envelopes containing the Insomnia Severity Index (ISI), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and questions capturing sociodemographic data were distributed and collected in classes. It was found that most non-drinkers were female (70.6%), although there were no sex-related differences in the number of binge drinkers (more than 5 drinks on each occasion at least once a week), allowing statistical comparison. The Mann-Whitney U test indicated that the ISI scores were significantly greater in female than male binge drinkers (P=0.014). Moderate or severe insomnia was reported by 23% of the sample, with alcohol being the most frequently associated substance. A specialized intervention was suggested by ASSIST: brief for marijuana (19.2%) and tobacco (23.3%) use, and moderate (31.5%) or intensive (1.4%) for alcohol consumers. The data highlighted the need to pay attention to the habits of college students beyond obtaining scientific information. New data suggesting the influence of genetics on insomnia may be of importance when performing additional studies on the sex differences in alcohol binge drinking.

Ambient Stimuli Perpetuate Nighttime Sleep Disturbances in Hospital Patients With TBI

BACKGROUND AND OBJECTIVES

The effect of the ambient environment, sound, light, and movement, on the nighttime rest-activity of patients hospitalized with moderate-severe traumatic brain injury (TBI) is poorly understood. The purpose of this study was to examine how sound, light, and movement in these patients' hospital rooms may contribute to nighttime awakenings.

METHODS

An observational design was used with 18 adult participants on a neuroscience step-down unit diagnosed with moderate-severe TBI. For up to five consecutive nights, actigraphy was used to capture nighttime awakenings while a custom-made multisensory device captured sound, light, and movement exposures in the participant's room.

RESULTS

Participants were awake for 24% (or about 3 hr) of the time during the designated nighttime period of 8 pm to 8 am. Average nighttime exposures of sound was 52 dB, light was nine lumens, and movement, measured as a proportion, was 0.28% or 28%. With each stimuli exposure set at its average, there was a 20% probability of participant nighttime awakenings. Clinically meaningful reductions of movement in and out the participant's room and elevated sound significantly decreases the participant's probability of nighttime awakenings (p < .05), but reductions in light did not.

CONCLUSION

The ambient environment seems to impede restful sleep in immediate post-injury phase of patients with moderate-severe TBI.

201 COVID-19 Pandemic Sleep Disturbances Related to Stress Experiences at the US-Mexico Border

Introduction

The COVID-19 pandemic has impacted many individuals at the vulnerable US-Mexico border region in a variety of ways. Fear, worry, and stress have increased for many, as has poor sleep. The present study evaluated the degree to which worsened sleep due to the pandemic impacted stress experiences.

Methods

Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). They were asked the degree to which their sleep worsened due to the pandemic. They also reported the degree to which they agreed with statements regarding various pandemic-related stress experiences. These included infection-related stresses, stresses about community impact, personal psychosocial stresses, stresses about consequences of potential infection, media and society-related stresses, feelings of safety, and how the pandemic has impacted home life. Ordinal logistic regressions were used to determine whether changes in sleep were associated with agreement with statements about pandemic-related stress experiences, adjusted for age, sex, financial status, education, and mental health (PHQ4).

Results

Those who perceived that their sleep worsened were more likely to report greater endorsement of beliefs that they were infected (ordinal Odds Ratio [oOR]=2.82,p&lt;0.0005), they could possibly be infected (oOR=1.98,p=0.003), they feared testing (oOR=1.94,p=0.006), COVID-19 would impact their community (oOR=1.75,p=0.017) and would do so for a long time (oOR=1.90,p=0.006), they experience more general (oOR=4.10,p&lt;0.0005), financial (oOR=3.15,p&lt;0.0005), food-related (oOR=2.97,p&lt;0.0005), housing-related (oOR=2.14,p=0.002), family-related (oOR=2.53,p&lt;0.0005) and relationship (oOR=3.37,p&lt;0.0005) stress, their shopping was impacted by scarcity (oOR=1.76,p=0.014), and they are at high risk for COVID (oOR=1.87,p=0.008). Furthermore, media coverage of COVID-19 had increased their stress (oOR=2.46,p&lt;0.0005), there is too much panic about COVID-19 (oOR=1.67,p=0.032), and they themselves are scared of getting COVID-19 (oOR=1.95,p=0.005), worried about the future (oOR=1.71,p=0.022), feel less secure (oOR=0.59,p=0.028), are thriving less (oOR=0.40,p&lt;0.0005), and their mental health is not improving (oOR=0.46,p=0.002).

Conclusion

Worse sleep due to the COVID-19 pandemic was associated with increased reports of stresses across a wide range of domains. Perhaps sleep health interventions could improve social and emotional health in these domains and reduce stress experiences and better cope with the pandemic. Alternatively, mental health interventions should perhaps be targeted to this population.

Support (if any)

R01MD011600, R01DA051321

238 Adolescent Sleep Variability, Social Jetlag, and Mental Health during COVID-19: Findings from a Large Nationwide Study

Introduction

Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health.

Methods

Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) for each instructional format and for weekends/no school days. Sleep opportunity (SlpOpp) was calculated from BT and WT. Weekday night-to-night SlpOpp variability was calculated with mean square successive differences. SJL was calculated as the difference between the average sleep midpoint on free days (O/A, no school, weekends) versus scheduled days (IP, O/S). Participants also completed the PROMIS Pediatric Anxiety and Depressive Symptoms Short Form. Data were analyzed with hierarchical linear regressions controlling for average SlpOpp, gender, and school-level (middle vs high school).

Results

Mean reported symptoms of anxiety (60.0 ±9.1; 14%≧70) and depression (63.4 ±10.2; 22%≧70) fell in the at-risk range. Shorter average SlpOpp (mean=8.3±1.2hrs) was correlated with higher anxiety (r=-.10) and depression (r=-.11; p’s<.001) T-scores. Greater SlpOpp variability was associated with higher anxiety (B=.71 [95%CI=.41-1.01, p<.001) and depression (B=.67 [.33-1.00], p<.001) T-scores. Greater SJL (mean=1.8±1.2hrs; 94% showed a delay in midpoint) was associated with higher anxiety (B=.36 [.12-.60], p<.001) and depression (B=.77 [.50-1.03], p<.001) T-scores.

Conclusion

In the context of system-wide education changes during COVID-19, students on average reported at-risk levels of anxiety and depression symptoms which were associated with greater variability in sleep opportunity across school days and greater social jetlag. Our findings suggest educators and policymakers should consider these sleep-mental health associations when developing instructional formats and school schedules during and post-pandemic.

Support (if any)

T32MH019927(P.W.)

694 Insufficient sleep linked with higher COVID-19 infection cases and deaths in the United States

Introduction

Causes of COVID-19 burden in urban, suburban, and rural counties are unclear, as early studies provide mixed results implicating high prevalence of pre-existing health risks and chronic diseases. However, poor sleep health that has been linked to infection-based pandemics may provide additional insight for place-based burden. To address this gap, we investigated the relationship between habitual insufficient sleep (sleep <7 hrs./24 hr. period) and COVID-19 cases and deaths across urban, suburban, and rural counties in the US.

Methods

County-level variables were obtained from the 2014–2018 American community survey five-year estimates and the Center for Disease Control and Prevention. These included percent with insufficient sleep, percent uninsured, percent obese, and social vulnerability index. County level COVID-19 infection and death data through September 12, 2020 were obtained from USA Facts. Cumulative COVID-19 infections and deaths for urban (n=68), suburban (n=740), and rural (n=2331) counties were modeled using separate negative binomial mixed effects regression models with logarithmic link and random state-level intercepts. Zero-inflated models were considered for deaths among suburban and rural counties to account for excess zeros.

Results

Multivariate regression models indicated positive associations between cumulative COVID-19 infection rates and insufficient sleep in urban, suburban and rural counties. The incidence rate ratio (IRR) for urban counties was 1.03 (95% CI: 1.01 – 1.05), 1.04 (95% CI: 1.02 – 1.05) for suburban, and 1.02 (95% CI: 1.00 – 1.03) rural counties.. Similar positive associations were observed with county-level COVID-19 death rates, IRR = 1.11 (95% CI: 1.07 – 1.16) for urban counties, IRR = 1.04 (95% CI: 1.01 – 1.06) for suburban counties, and IRR = 1.03 (95% CI: 1.01 – 1.05) for rural counties. Level of urbanicity moderated the association between insufficient sleep and COVID deaths, but not for the association between insufficient sleep and COVID infection rates.

Conclusion

Insufficient sleep was associated with COVID-19 infection cases and mortality rates in urban, suburban and rural counties. Level of urbanicity only moderated the relationship between insufficient sleep and COVID death rates. Future studies should investigate individual-level analysis to understand the role of sleep mitigating COVID-19 infection and death rates.

Support (if any)

NIH (K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

712 COVID-19 Risk Perception, Sleep Health and Peritraumatic Distress Among New Yorkers: The NYU COVID-19 Mental Health Study

Introduction

Long-term exposure to pandemics like COVID-19 may increase psychological distress (e.g., peri-traumatic and post-traumatic distress) and sleep problems. Little is known about the effects of COVID-19 on peritraumatic distress, a well-documented risk factor for post-traumatic stress disorders (PTSD). The aim of this study was to investigate the association between COVID-19 risk perception and peritraumatic distress, and whether this relationship is moderated by sleep quality among individuals located in NY.

Methods

We examined data from 541 individuals (69% were female, mean age (SD) = 40.9 (15.3)] recruited online during summer and fall 2020 in New York for the NYU-COVID-19 Mental Health Study. Data were gathered on sociodemographic, COVID-19 risk perception (yes or no items), peri-traumatic distress measured by Peritraumatic Distress Inventory (PDI), and sleep quality measured by the Pittsburg Sleep Quality Index (PSQI). Descriptive, regression analysis and interaction terms were conducted using SPSS v. 25 to examine associations between COVID-19 risk perception with symptoms of peritraumatic distress and sleep quality.

Results

Of the 541 participants, 311(57.5%) reported they felt at risk for contracting COVID-19. PSQI was positively correlated with PDI (r =.38, p =0.01). An independent sample t student test indicated, on average, that the symptoms of PDI [(mean (SD)=27.3 (7.63), t = 7.07, n =307)] and PSQI [mean(SD)=10.62(3.57), t=4.31 n=311)] of our participants who felt at risk for contracting the COVID-19 significantly exceeded those who did not [(PDI mean(SD)=22.7(7.13), n =228); PSQI (mean(SD) =9.25(3.72), n=229]. Results of multiple linear regression analysis shown that COVID-19 risk perception was the strongest predictor of PDI [B(t) = −.630(12.7); p &lt; .001]. Furthermore, the interaction effect of PSQI scores and COVID-19 risk perception revealed that sleep quality significantly reduced the association between COVID-19 risk perception and PDI [B(t) = .319(5.71); p &lt;.001], such that poorer sleep and feeling at risk of contracting COVID-19 resulted in more severe PDI scores.

Conclusion

COVID-19 risk perception was associated with peritraumatic distress and poorer sleep quality, and sleep quality attenuated this relationship.

Support (if any)

NIH (T32HL129953, K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453)

202 COVID-19 Pandemic Sleep Disturbances Related To Dietary Behavior at the US-Mexico Border

Introduction

The COVID-19 pandemic has disrupted life at the US-Mexico border in many ways, including sleep and dietary behavior. Given the potential long-term impact of worsening sleep and metabolic health due to the pandemic, the present study examines whether changes to dietary behavior were associated with changes to sleep.

Methods

Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and were contacted about completing a COVID-19 sub-study (95% Hispanic/Latino). Participants reported the degree to which they experienced pandemic-related changes to sleep, including a more regular schedule, overall improvement, overall worsening, more initial insomnia, more middle-of-the-night insomnia, more daytime sleepiness, and more napping. They were also asked whether as a result of the pandemic they consumed an overall healthier diet, more homecooked meals, more processed meals, more regular meals, whether they enjoyed food more, and degree of overeating. Ordinal regressions with diet change as outcome and sleep change as predictor were adjusted for age, sex, education, and socioeconomics.

Results

Those who reported more regular sleep were more likely to report a healthier overall diet (oOR=3.12,p<0.0005), more homecooked meals (oOR=2.18,p=0.001), more enjoyment of food (oOR=1.71,p=0.028), and less likelihood of overeating (oOR=0.59,p=0.033). Similarly, those who reported more “improved” sleep reported healthier overall diet (oOR=7.42,p<0.0005), more homecooked meals (oOR=2.59,p=0.001), more regular diet (oOR=2.15,p=0.006), more enjoyment of food (oOR=2.92,p<0.0005), less consumption of processed foods (oOR=0.54,p=0.039), and less overeating (0.33,p<0.0005). Those whose sleep worsened reported eating more processed foods (oOR=1.78,p=0.030) and overeating (oOR=3.90,p<0.0005). Those who reported more initial insomnia reported eating more processed foods (oOR=1.93,p=0.016), more regular diet (oOR=1.65,p=0.042), and overeating more often (oOR=4.11,p<0.0005). More middle-of-the-night insomnia was associated with eating more processed foods (oOR=2.45,p=0.001), more regular diet (oOR=1.66,p=0.031), and overeating more often (oOR=3.68, <0.0005). Those with more daytime sleepiness also reported eating more processed foods (oOR=2.36,p=0.003), more regular diet (oOR=1.79, =0.019), and overeating more often (oOR=3.28,p<0.0005). More napping was associated with a more regular diet (oOR=1.90,p=0.011) and more overeating (oOR=3.53,p<0.0005).

Conclusion

Overall, worse sleep led to worse dietary behavior, especially eating more processed food and overeating.

Support (if any)

Supported by T32HL007249, R01MD011600, R01DA051321

200 COVID-19 Pandemic Sleep Changes Related to Social and Financial Impacts at the US-Mexico Border

Introduction

The COVID-19 pandemic has caused major impacts to social and financial status for many people, including those living in the vulnerable US-Mexico border region. This study examined relationships between changes in sleep and perceived impacts to social and financial stability due to the pandemic.

Methods

Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). Participants were asked if the COVID-19 pandemic was causing them to feel more socially isolated, negatively impacting their finances, causing increased worry about finances, affecting their primary job, causing a job loss, and impacting their belief life will one day return to normal. In addition, they were asked to report the degree to which they experienced pandemic-related changes to sleep, including a regularity, overall improvement/worsening, initial and middle-of-the-night insomnia, daytime sleepiness, and napping. Logistic regression analyses were adjusted for age, sex, socioeconomics, and mental health (PHQ4).

Results

Those who kept a more regular schedule had lower odds of endorsing isolation (OR=0.32,p<0.0005) and higher odds of believing things will return to normal (OR=1.67,p=0.041). Those whose sleep improved also had lower odds of feeling isolated (OR=0.40,p=0.005). Those with worsened sleep had increased odds of feeling isolated (OR=2.14,p=0.023), experiencing a financial impact (OR=1.85,p=0.016) and increased financial worry (OR=1.71,p=0.033), and lower odds of believing things will return to normal (OR=0.53,p=0.012). More initial insomnia was associated with isolation (OR=3.62,p=0.001), financial impact, (OR=1.89,p=0.015), financial worry (OR=1.87,p=0.016) and job impact (OR=1.95,p=0.010). More middle-of-the-night insomnia was associated with financial worry (OR=1.82,p=0.016) and job impact (OR=1.93,p=0.009). More sleepiness was associated with job loss (OR=1.84,p=0.043). More napping was associated with financial impact (OR=1.89,p=0.017) and worry (OR=1.88,p=0.017), impact to job (OR=1.89,p=0.016) or lost job (OR=1.81,p=0.041), and decreased likelihood of believing things will return to normal (OR=0.45,p=0.003).

Conclusion

Pandemic-related stress was linked with sleep disturbances. Worse sleep was indicative of increased social isolation, greater financial fears, more job-related impacts and less of a general sense that things would return to normal.

Support (if any)

Supported by T32HL007249, R01MD011600, R01DA051321

685 Sleep Latency, Pre and Peri-COVID-19 Experiences and PTSD Symptoms: Results from the NYU COVID-19 Mental Health Study

Introduction

An effective response to the COVID-19 pandemic has been the decision to subject individuals residing in New York City to quarantine rules in order to reduce the spread of the virus. As might have been expected, restriction of usual daily activities would affect individuals’ sleep-wake patterns. It is also known that exposure to traumatic experiences can also engender sleep disturbances, most notably in their ability to initiate sleep. This study investigated the associations between sleep onset latency (SOL), pre and peri-COVID-19 exposure and symptoms of posttraumatic stress disorder (PTSD) among New Yorkers.

Methods

541 individuals (female = 373(69%); mean age=40.9) were recruited during the summer and fall of 2020 in New York City to participate in the NYU-COVID-19 Mental Health Study. Participants provided sociodemographic data and were also asked to respond to the COVID-19 quarantine experiences, comprised of seven binary questions, the PTSD Checklist-PCL-5, and the Pittsburg Sleep Quality Index. Descriptive and linear regression analysis were performed to explore associations of scores on the COVID-19 quarantine experience with PTSD and sleep data. All analyses were performed using SPSS 25.0

Results

Regression analyses revealed that SOL emerged as the strongest independent predictor of PTSD symptoms [B(t) = −.630(12.7); p < .001]; factors adjusted in the model included pre and peri-covid-19 factors such as age, sex, job type, and quarantine experience. Analyses assessing potential interaction effect revealed that quarantine experience did not affect the relationship between SOL and PTSD [B(t) = .086(.831); p = >.005]. The other sleep factors in the model did not yield significance. sleep duration had a weak correlation with quarantine, it was not found to be a predictor of PTSD.

Conclusion

We observed that SOL was the most important determinant of PTSD symptoms among individuals exposed to COVID-19. This is consistent with other findings suggesting that a sizable proportion of individuals exposed to pandemics are likely to experience sleep disturbances. It is plausible that quarantine might lead to increased daytime naps, which may impact SOL. Further research is needed to better understand the association of SOL and PTSD as a result of Covid-19.

Support (if any)

K07AG052685, R01MD007716, R01HL142066, T32HL129953, K01HL135452, R01HL152453

237 Sleep disturbances, online instruction, and learning during COVID-19: evidence from 4148 adolescents in the NESTED study

Introduction

COVID-19 fundamentally altered education in the United States. A variety of in-person, hybrid, and online instruction formats took hold in Fall 2020 as schools reopened. The Nationwide Education and School in TEens During COVID (NESTED) study assessed how these changes impacted sleep. Here we examined how instruction format was associated with sleep disruption and learning outcomes.

Methods

Data from 4148 grade 6-12 students were included in the current analyses (61% non-male; 34% non-white; 13% middle-school). Each student’s instructional format was categorized as: (i) in-person; (ii) hybrid [≥1 day/week in-person]; (iii) online/synchronous (scheduled classes); (iv) online/asynchronous (unscheduled classes); (v) online-mixed; or (vi) no-school. Sleep disturbances (i.e., difficulty falling/staying asleep) were measured with validated PROMIS t-scores. A bootstrapped structural equation model examined how instructional format and sleep disturbances predict school/learning success (SLS), a latent variable loading onto 3 outcomes: (i) school engagement (ii) likert-rated school stress; and (iii) cognitive function (PROMIS t-scores). The model covaried for gender, race-ethnicity, and school-level

Results

Our model fit well (RMSEA=.041). Examining total effects (direct + indirect), online and hybrid instruction were associated with lower SLS (b’s:-.06 to -.26; p’s<.01). The three online groups had the strongest effects (synchronous: b=-.15; 95%CI: [-.20, -.11]; asynchronous: b=-.17; [-.23, -.11]; mixed: b=-.14; [-.19, -.098]; p’s<.001). Sleep disturbance was also negatively associated with SLS (b=-.02; [-.02, -.02], p<.001). Monte-carlo simulations confirmed sleep disturbance mediated online instruction’s influence on SLS. The strongest effect was found for asynchronous instruction, with sleep disturbance mediating 24% of its effect (b = -.042; [-0.065, -.019]; p<.001). This sleep-mediated influence of asynchronous instruction propagated down to each SLS measure (p’s<.001), including a near 3-point difference on PROMIS cognitive scores (b = -2.86; [-3.73, -2.00]).

Conclusion

These analyses from the NESTED study indicate that sleep disruption may be one mechanism through which online instruction impacted learning during the pandemic. Sleep disturbances were unexpectedly influential for unscheduled instruction (i.e., asynchronous). Future analyses will examine specific sleep parameters (e.g., timing) and whether sleep’s influence differs in teens who self-report learning/behavior problems (e.g., ADHD). These nationwide data further underscore the importance of considering sleep as educators and policy makers determine school schedules.

Support (if any):

232 COVID stress and sleep disturbance among a racially/ethnically diverse sample of adolescents: Analysis from the NESTED study

Introduction

Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance.

Methods

Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors.

Results

Sleep disturbance was prevalent among adolescents (89% above average, T-score &gt;50); about two-thirds (64.4%) reported greater stress due to the pandemic. Compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents. Chi-square analysis indicated that both race/ethnicity (□2 = 14.96, p&lt;.05) and SVI (□2 = 8.34, p&lt;.05) had an effect on sleep disturbance. HBLR analysis indicated that compared to pre-pandemic, adolescents reporting “little stress” (OR=.70, 95% CI= .49-.99, p=.04) or “the “same amount of stress” (OR=.64, 95% CI= .47-.89, p=.007) had lower odds of sleep disturbance. Higher depression (OR=1.06, 95% CI=1.04-1.07, p&lt;.001) and anxiety (OR=1.05, 95% CI=1.04-1.07, p&lt;.001) symptoms increased odds of sleep disturbance, while male gender lowered odds of sleep disturbance (OR=.11, 95% CI=.015-.86, p&lt;.05). Overall, race/ethnicity (p=.44) and SVI (p=.45) did not independently predict sleep disturbance. Race/ethnicity stratified analyses indicated that for Black and Hispanic adolescents, being in grades 11/ 12 and depression predicted sleep disturbance; and for Asian adolescents SVI and anxiety predicted sleep disturbance.

Conclusion

COVID-related stress and symptoms of depression and anxiety are associated with sleep disturbance. We observed differences in sleep disturbance across racial/ethnic groups and neighborhood social vulnerability strata, for specific racial/ethnic groups.

Support (if any)

AS was supported by funding from the NIH (K01HL135452, R01HL152453)

638 Sleep and circadian markers of BMI in a diverse sample of 9-year old children from the Fragile Families Child and Wellbeing Study

Introduction

Hispanic and Black school-age children from low-income communities experience disproportionate rates of obesity (26% Hispanic, 22% Black) compared to their White counterparts (14%). Sleep patterns and circadian regulation of biological markers are associated with BMI status. However, little is known about racial and ethnic disparities in circadian regulation among children of color. These suggest that it is important to investigate biological markers that could help delineate associations between sleep-circadian regulation and obesity among children of color. Serotonin transporter gene, a neurotransmitter associated with circadian rhythm regulation, has emerged as an important biological variable. In this study, we investigated whether this factor could serve as a proxy for studying associations of circadian rhythm regulation with weight status in this diverse sample.

Methods

Statistical analysis included descriptive and linear regression analysis of the wave 5, Year 9 cohort of the Fragile Families Child and Wellbeing Study dataset. Interviews were conducted with the participant child around their ninth birthday for data collection on home routines and other parent relationship and school connectedness variables. Biological variables were derived from saliva samples at Year 9 to assess telomere length and DNA methylation levels and changes. Variables of interest included sleep duration, sleep timing, and biological variables 5httlpr (insomnia and sleep quality), skin 2 (serotonin transporter), telomere length (stress) and rs9939609 (fat mass and obesity), with BMI as the outcome.

Results

The final sample of 466 children comprised 52% male were 9 years old. Participants’ race was: 35% White, 46% Black, 20% Hispanic, 4% Asian and 5% other. Median family income was $42,500. Sleep duration obtained from these children was negatively associated with BMI (β = -0.245 with p=0.022). We found that gk5stin212 (serotonin transporter gene) was positively associated with BMI (β = 0.991, p = 0.009), while no significant associations was found for genetic variable gk5stin210.

Conclusion

Circadian rhythm dysregulation may serve as a biological mechanism driving overweight or obesity among minority children. Lifestyle and behavioral interventions aimed at the family unit may be needed to modify household and environmental factors that affect circadian regulation among children.

Support (if any)

NIH (T32HL129953), K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

684 Contribution of Pulmonary Diseases to COVID-19 Mortality in a Diverse Community of New York City

Introduction

New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID-19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID-19-related mortality independent of other medical conditions, health risks, and sociodemographic factors.

Methods

We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white; cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease); pulmonary disease (e.g., COPD, sleep apnea, or asthma); autoimmune disease; and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses.

Results

Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05; 95%CI:1.04–1.05), ethnic minority (HR=1.26; 95%CI:1.10–1.44), low household income (HR=1.29; 95%CI:1.11, 1.49), and male sex (HR=0.85; 95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27; 95%CI:1.02–1.58), obesity (HR=1.19; 95%CI:1.04–1.37) and peripheral artery disease (HR=1.33; 95%CI:1.05–1.69). We observed a significantly higher rate of COVID-19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01).

Conclusion

Patients with COPD had the highest odds of COVID-19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

Support (if any)

K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

205 Changes in Sleep Due to COVID Pandemic Associated with Changes to Dietary Patterns

Introduction

The COVID-19 pandemic has affected sleep and diet for many people. The present study sought to examine potential associations between changes to sleep and eating habits during the COVID-19 pandemic.

Methods

A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Questions for diet asked, “since quarantine: I’m eating healthier, eating more processed foods, home-cooked meals and more regularly,” “I’m enjoying food in quarantine and I’m struggling with overeating in quarantine.” Sleep questions asked “since quarantine: I have managed to keep a regular sleep-wake schedule, my sleep has improved, I’m struggling to fall asleep, I’m waking up more during the night, I’m more sleepy during the day and I’m taking more naps during the day.” Answers were reported on a 4-point scale ranging from “strongly disagree to strongly agree.” Ordinal logistic regressions were used, adjusted for age and sex and examined each dietary variable as ordinal outcome and each sleep variable as predictor.

Results

Those who report that they kept a more regular schedule were more likely to report eating healthier (oOR=3.13, p=0.007), eating more home-cooked meals (oOR=3.19, p=0.005), and less likely to be eating more processed foods (oOR=0.39, p=0.02), struggle with overeating (oOR=0.39, p=0.02) or undereating (oOR=0.30, p=0.004) or snacking (oOR=0.25, p=0.001). Those reporting more difficulty falling asleep were less likely to be eating healthier (oOR=0.25, p=0.002) and more likely to be eating more processed foods (oOR=3.07, p=0.009) and snacking (oOr=2.36, P=0.04). Those reporting more difficulty with awakenings were less likely to report eating healthier (oOR=0.34, p=0.03) and more likely to report eating more processed foods (oOR=4.52, p=0.001). Those with more sleepiness were less likely to report eating healthier (oOR=0.29, p=0.01) and more homecooked meals (oOR=0.40, p=0.046) and more likely to report eating more processed foods (oOR=6.42, p<0.0005), overeating (oOR=3.63, p=0.01) and snacking (oOR=5.81, p=0.001).

Conclusion

Research studying psychological, behavioral and environmental factors that are contributing to changes in sleep and dietary patterns is especially important during a pandemic that has forced people into changes that they may not have been prepared for and which may result in long-term health outcomes.

Support (if any)

T32HL007249, R01MD011600, R01DA051321

211 Pandemic-Related Sleep Changes Associated with COVID-Related General, Financial, Food, Housing, Family and Relationship Stress

Introduction

The COVID-19 pandemic has caused widespread disruption and stress for people of all ages and circumstances around the world. This study investigates the relationship between general and specific stressors and various dimensions of sleep health.

Methods

A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked whether they experienced increased general, financial, food, housing, family and relationship stress due to the COVID-19 pandemic. They were also asked whether they experienced a more regular schedule, improved sleep, worsened sleep, more early insomnia, more middle-of-the-night insomnia, more daytime sleepiness, and more naps due to the COVID-19 pandemic. Ordinal logistic regressions with sleep change as outcome and stress variable as predictor were adjusted for age, sex, and race/ethnicity.

Results

COVID-19-related general, financial, food, housing, family, and relationship stress were all associated with a decreased likelihood of maintaining a more regular schedule (oOR=0.52-0.67, all p&lt;0.001) and improved sleep (oOR=0.56-0.67, all p&lt;0.001). They were also all associated with a greater likelihood of worsened sleep (oOR=1.48-2.41, all p&lt;0.001), early insomnia (oOR=1.63-1.85, all p&lt;0.001), middle-of-the-night insomnia (oOR=1.40-2.00, all p&lt;0.001), and daytime sleepiness (oOR=1.58-2.07, all p&lt;0.001). Increased napping was also associated with more COVID-related financial, food, and housing stress (oOR=1.33-1.55, all p&lt;0.005).

Conclusion

Regular sleep schedules can be disrupted by stressors directly, or by the anxiety that so often accompanies stress. Stressed individuals may experience increased difficulty falling asleep, or more nighttime arousals, or find themselves waking up earlier than usual, all as a result of ruminating thoughts, stress-induced nightmares, or outside disturbances. Disruption to sleep at night often results in increased daytime sleepiness and fatigue, with a higher chance of napping. This study reports the significant association of some of these with COVID-19 pandemic-related stress. More individuals now find themselves working from home with greater flexibility in their schedules, but this has not necessarily led to better sleep. The impact of the pandemic on various health outcomes as a result of stress is still to be revealed.

Support (if any):