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Taylor-Piliae R, Morrison H, Hsu CH, Grandner M. Changes in symptoms, sleep, oxidative stress, and inflammatory markers among community-dwelling stroke survivors after a tai chi exercise intervention. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Laurence B. Emmons Research Award
Background
Depression is prevalent among one-third to two-thirds of stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even 5-10 years post-stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms, thus we investigated the feasibility of Tai Chi, alongside conventional care, to manage post-stroke depression.
Purpose
Describe changes in symptoms of depression, anxiety and stress, sleep, oxidative stress, and inflammatory markers post-intervention among community-dwelling stroke survivors with depressive symptoms.
Methods
In this feasibility study, a single-group pre-post intervention design was used. Due to COVID-19, participants attended a 1-hour Tai Chi exercise class three times per week for 8 weeks, instead of the planned 12-weeks. Symptoms of depression, anxiety and stress were assessed using standardized questionnaires (Center for Epidemiological Studies Depression scale, CESD; Generalized Anxiety Disorder Assessment; Perceived Stress Scale), objective sleep was assessed via a research-grade triaxial accelerometer (ActiGraph GT9X), and blood samples were taken to assess oxidative stress (plasma superoxide dismutase, SOD) and inflammatory markers (serum tumor necrosis factor-alpha, interleukin-6, interleukin-10). Pre-post intervention changes were assessed using paired t-tests.
Results
Community-dwelling stroke survivors (N = 11) on average 69.7 ± 9.3 years old, mainly retired (73%, n = 8), married men (55%, n = 6) with >13 years education (91%, n = 10), reporting depression symptoms (CESD = 17.3 ± 11.4) and 55% taking anti-depressant medications, enrolled. The majority of participants reported having an ischemic stroke (82%, n = 9) with hemiparesis (55%, n = 6), but were able to walk 15 feet without assistance (91%, n = 10). After the Tai Chi intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, p = 0.01), anxiety (-2.2 ± 2.4, p = 0.01) and stress (-4.6 ± 4.8, p = 0.01); along with better sleep efficiency (+1.8 ± 1.8, p = 0.01), less wakefulness after sleep onset (-9.3 ± 11.6, p = 0.04), and less time awake (-9.3 ± 11.6, p = 0.04). In addition, there was a 36% decrease in SOD activity (p = 0.02) indicative of a decreased oxidative environment post-intervention; though no significant changes in any of the inflammatory markers were found (all p-values >0.05).
Conclusion
Symptoms of depression, anxiety and stress were observed in these community-dwelling stroke survivors along with sub-optimal sleep. Among community-dwelling stroke survivors, Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage post-stroke depression and may also aid in reducing symptoms of anxiety and stress, and improve sleep. Further research is needed with rigorous study designs and larger samples, before widespread recommendations can be made.
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Affiliation(s)
| | - H Morrison
- University of Arizona, Tucson, United States of America
| | - C-H Hsu
- University of Arizona, Tucson, United States of America
| | - M Grandner
- University of Arizona, Tucson, United States of America
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Patterson F, Brewer B, Hernandez Y, Mayberry S, Satti A, Zantah M, Gangemi A, Grandner M. DUAL SMOKING AND VAPING ASSOCIATED WITH GREATER SLEEP DISTURBANCES. Chest 2020. [DOI: 10.1016/j.chest.2020.05.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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3
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Patterson F, Brewer B, Blair R, Zantah M, Gangemi A, Grandner M, Satti A. INCREASED SLEEP EFFICIENCY ASSOCIATED WITH INCREASED LUNG FUNCTION IN AFRICAN AMERICAN LIGHT SMOKERS: RESULTS FROM A PROSPECTIVE COHORT EXAMINATION. Chest 2020. [DOI: 10.1016/j.chest.2020.05.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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4
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Hollimon L, Moore J, Richards S, Robbins R, Grandner M, Chung A, Chung D, Jean-Louis G, Seixas A. 1212 A Systematic Assessment Of Engagement, Functionality, Aesthetics, Information, And Recommendation Features In Sleep Mobile Applications. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Initial download and use of sleep tracking is very high, but prolonged use is very low. Poor prolonged use may be attributable to several factors such as engagement, functionality, aesthetics, information, and recommendation. We appraised these five factors in 16 consumer- and research/medical- grade digital sleep devices.
Methods
Three reviewers independently assessed 16 consumer- and medical-grade sleep digital devices using the Mobile Application Rating Scale (MARS) App quality ratings, which measures engagement (engagement, entertainment, interest, customization, interactivity, target group), functionality (functionality, performance, ease of use, navigation, gestural design), aesthetics (layout, graphics, visual appeal), information (Accuracy. Goals, Quality of information, Quantity of information, Visual information, Credibility, and Evidence base) and recommended on a Likert scale, with 1- Inadequate to 5 Excellent. Each subcategory is rated on a 1-5 Likert scale which is summed for each category: engagement (30), functionality (25), aesthetics (15), information (35) and recommended (yes or no).
Results
Devices that had the highest engagement score were Fitbit (27), Apple Watch (27), Garmin (27), and Dreem 2 headband (25.5). Apple Watch (30) had highest score; while Fitbit (13), Apple Watch (13), Garmin (13), Samsung Gear (13) had highest aesthetic score. While for information, ActiGraph (35), SOMNOwatch plus (35), CleveMed SleepView Monitor (35), CleveMed Sapphire PSG (35), SOMNOscreen plus (35), Nox T3 Sleep Monitor (35) and Nox A1 PSG System (35) had the highest ratings. The Dreem 2 headband has the potential induce prolong use among users with and without sleep disorders, based on high scores on engagement (25.5), Functionality (20.5), and Information (26.5).
Conclusion
Consumer- and research-grade digital devices that measure sleep have varying levels of engagement, functionality, aesthetics, information and recommendations to facilitate prolong use. Consumer grade devices had higher engagement, functionality and aesthetics scores, while research grade devices had higher information and recommendation scores. If consumer- and research-grade devices are to have prolonged use, standardization is needed across the five MARS components.
Support
K01HL135452, R01MD007716, R01HL142066, and K07AG052685
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Affiliation(s)
- L Hollimon
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - S Richards
- NYU Grossman School of Medicine, New York, NY
| | | | | | - A Chung
- NYU Grossman School of Medicine, New York, NY
| | - D Chung
- NYU Grossman School of Medicine, New York, NY
| | | | - A Seixas
- NYU Grossman School of Medicine, New York, NY
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Seixas A, Jin P, Liu M, Nunes J, Grandner M, Rogers A, McFarlane S, Jean-Louis G. 1062 The Role of Sleep in Sex and Racial/Ethnic Differences in 10-Year CVD Risk in the Sleep Heart Health Study: The Use of Machine-Learnt and Precision Insights to Understand Racial/Ethnic and Sex Differences in Sleep-CVD Disparity. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The current study investigated whether insufficient sleep (<7 hrs.) explains differences in 10-year CVD risk, using Framingham risk (FRS) and Reynolds risk (RRS) scores, between blacks and whites and characterized risk and protective CVD risk profiles.
Methods
Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (<5%), low-medium (5% to <10%), medium-high (10% to <20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles.
Results
Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups.
Conclusion
These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts.
Support
K01HL135452, R01MD007716, R01HL142066, K07AG052685
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Affiliation(s)
- A Seixas
- NYU Grossman School of Medicine, New York, NY
| | - P Jin
- NYU Grossman School of Medicine, New York, NY
| | - M Liu
- NYU Grossman School of Medicine, New York, NY
| | - J Nunes
- City University of New York School of Medicine, New York, NY
| | - M Grandner
- University of Arizona College of Medicine, Tuscon, AZ
| | - A Rogers
- St. John’s University, Queens, NY
| | - S McFarlane
- State University of New York, Downstate Health Science University, New York, NY
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6
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Vargas I, Drake C, Muench A, Boyle J, Morales K, Grandner M, Ellis J, Perlis M. 0456 Natural History of Insomnia: Sleep Reactivity Predicts New-Onset Acute Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Greater vulnerability to stress-related sleep disturbance (i.e., sleep reactivity) is a risk factor for chronic insomnia (CI). What has not been investigated is whether greater sleep reactivity, as assessed by the Ford Insomnia Response to Stress Test (FIRST), predicts the onset of acute insomnia (AI), and more, whether greater sleep reactivity predicts the transition from AI to CI.
Methods
A national cohort of 1,222 good sleeper subjects (68% female; mean age=53.2 years) were prospectively assessed to estimate the incidence of AI and CI. The FIRST was completed at baseline and sleep diaries were completed on a daily basis for a period of one year. Subjects were categorized based on their FIRST scores (high, FIRST>16; low, FIRST≤16). Subjects were also grouped based on whether they developed AI (two consecutive weeks with a frequency of ≥ 3 nights per week of sleep initiation or maintenance problems) or maintained good sleep (GS; n=896). For those subjects that transitioned to AI (n=326), they were also grouped based on whether or not they developed CI (insomnia ≥ 3 nights/week for at least three months; n=23). Chi-square analyses were performed to determine if higher FIRST scores at baseline predicted the incidence of AI or CI.
Results
32.5% of subjects in the high FIRST group met criteria for AI at some point during the one-year interval, whereas 22.5% of subjects in the low FIRST group experienced AI (χ 2=15.2, p<.001). In contrast, FIRST did not predict CI status (low FIRST, 8.5% CI, high FIRST, 5.6% CI; χ 2=1.1, p=.30).
Conclusion
Greater sleep reactivity predicted incident AI but not the onset of CI. While these findings suggest that sleep reactivity may be a predisposing factor for AI, data are not consistent with previous findings showing FIRST scores are predictive of the development of CI. It’s possible that the present study was underpowered to detect these differences, given that the incidence of CI was low (less than 2% of the total sample). Additional analyses are ongoing to evaluate the temporal association between stressful life events and AI in subjects with high and low FIRST scores.
Support
Perlis: NIH R01AG041783, K24AG055602
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Affiliation(s)
- I Vargas
- University of Arkansas, Fayetteville, AR
| | - C Drake
- Henry Ford Hospital, Novi, MI
| | - A Muench
- University of Pennsylvania, Philadelphia, PA
| | - J Boyle
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - K Morales
- University of Pennsylvania, Philadelphia, PA
| | | | - J Ellis
- Northumbria University, Newcastle, UNITED KINGDOM
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
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7
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Klingman KJ, Morse A, Williams N, Grandner M, Perlis ML. 1175 Sleep Disorders Screening in Primary Care: Prevalence of Diagnosis and Treatment in the EMR. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Undetected and untreated sleep disorders likely precipitate or exacerbate medical and/or psychiatric illnesses. Given this, primary care is an ideal point for managing sleep disorders, yet prior research shows that PCPs diagnose and/or treat sleep disorders at rates far below population prevalences. The purpose of this study was to determine the current rate of detection and treatment of sleep disorders within primary care settings.
Methods
EMR data from two health care systems was analyzed. The proportion of PCPs diagnosing and treating one or more sleep disorders was calculated (per year) for 5 years (2014-2018). Also calculated was the percent of PCP caseload diagnosed and/or treated for sleep disorders.
Results
The two systems comprised n=1021 PCPs. From 2014-2018, the proportion of PCPs diagnosing patients with sleep disorders fluctuated between 58-89%. The proportion treating sleep disorders fluctuated between 50-91%. Non-parametric one-sample run tests (SPSS) indicate these are random distributions (p>0.05). PCPs’ use of medications to treat sleep disorders is trending downward over time within one system (per linear regression, p=0.03, R-squared=0.8). Other temporal trends were not evidenced. The average percentage of diagnosed and treated patients per PCP was around 2.5% of their caseloads. Between-system differences were observed.
Conclusion
There is a profound mismatch between percentage of PCPs identifying patients with sleep disorders (60-90%) and the percentage of patient caseload diagnosed and/or treated for sleep disorders (2.5%). This suggests that the majority of PCPs are willing to assess for sleep health but do so in only a small minority of patients. These data, along with our survey data (elsewhere in this volume) suggest that the intention-action gap could be closed if PCPs were appropriately resourced.
Support
There was no funding for this study.
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Affiliation(s)
- K J Klingman
- Upstate Medical University, The State University of New York, Syracuse, NY
| | - A Morse
- Geisinger Medical Center, Danville, PA
| | - N Williams
- NYU Langone Health, Department of Population Health, New York, NY
| | | | - M L Perlis
- Department of Psychiatry, Director of Behavioral Sleep Medicine Program, Philadelphia, PA
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Boyle JT, Rosenfield B, DiTomasso RA, Vargas I, Grandner M, Perlis ML. 0351 Sleep Continuity, Sleep-Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
It is well documented that sleep continuity (i.e., SC [ability to initiate and/or maintain sleep]) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, an analysis was undertaken to assess whether initial, middle, and/or late insomnia all exhibit age related change and whether problem endorsement and/or daytime dysfunction show comparable age-related changes.
Methods
The study utilized a cross-sectional group design in an archival/community dataset (www.sleeplessinphilly.com). This dataset (N=932) was comprised of adults between 18 and 89 years of age with self-reported sleep complaints. Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Age Adults (45-64 years); and Older Adults (65-89 years). Age groups were matched to the Older Adults group (n=233) by sex, race, and BMI. ANOVAs with Bonferroni corrections (alpha = .001), and contingency analyses were performed to assess for age group differences.
Results
It was found that, as expected, SC worsens with age but that this was limited to middle and late insomnia. Further, problem endorsement increased with age (except for SL) but sleep-related daytime dysfunction did not (except for concentration issues).
Conclusion
These results have several implications. Methodologically speaking, when evaluating the effects and/or correlates of SC, it may be wise to concomitantly assay “is this a problem for you” and “does this affect your daytime function”, as SC can occur without perceived daytime consequences, especially in older adults. Conceptually speaking, the observed discordance requires further exploration. In the past, it has been argued that sleep need is reduced in older adults. While this is a reasonable hypothesis (no need, no functional consequence), it remains to be demonstrated that older adults require less sleep.
Support
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Affiliation(s)
- J T Boyle
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine School of Professional and Applied Psychology, Philadelphia, PA
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - B Rosenfield
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine School of Professional and Applied Psychology, Philadelphia, PA
| | - R A DiTomasso
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine School of Professional and Applied Psychology, Philadelphia, PA
| | - I Vargas
- Department of Psychological Sciences, University of Arkansas, Fayetteville, AR
- Sleep and Stress Research Laboratory, University of Arkansas, Fayetteville, AR
| | - M Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - M L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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Bullock A, Burns A, Alkozei A, Taylor E, Grandner M, Killgore W. 1083 Nightmares Are Negatively Associated With Immediate Memory And Visuospatial Performance In Individuals With Ptsd. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Disturbing dreams and nightmares are common in individuals with post-traumatic stress disorder (PTSD). At present, little research has investigated the associations between nightmares and cognition in these individuals. However, a robust body of research has shown memory and attention impairments among those with PTSD. The present study sought to investigate the potential relationships between cognitive performance and nightmares in this population.
Methods
Seventy-five individuals (49 female; Mage=31.8, SDage=8.8) were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the PTSD Checklist for the DSM-5 (PCL-5), the Insomnia Severity Index (ISI), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Clinician-Administered PTSD Scale (CAPS), and the Disturbing Dreams and Nightmares Index (DDNSI). Five linear regressions were conducted with index scores on the RBANS subscales (immediate memory, visuospatial/constructional, language, attention, and delayed memory) as the dependent variables and PCL-5, ISI, FOSQ, CAPS symptom class subscales (intrusion, avoidance, cognition, and arousal), and DDNSI scores entered stepwise.
Results
A linear regression revealed that nightmares predicted 15% of the variance in RBANS immediate memory scores (R2 change=.152, β=-.390, p=.003). A second linear regression revealed that nightmares predicted 9.6% of the variance in RBANS visual memory scores (R2 change=.096, β=-.310, p=.019). No other independent variables added to either model. None of the independent variables predicted any variance in language, attention, or delayed memory scores.
Conclusion
Our analysis revealed a unique contribution of nightmares to immediate memory and visuospatial performance in individuals with PTSD. This finding was not better explained by variation in PTSD severity or sleep. Because sleep and dreams are implicated in memory consolidation, one explanation for our finding is that highly distressing trauma-related dreams (i.e. nightmares) may lack the same memory-improving qualities as ordinary dreams. Additionally, given that immediate memory and visuospatial functioning utilize working memory, perhaps nightmares and deficits in working memory share similar mechanisms.
Support
W81XWH-14-1-0570
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Affiliation(s)
| | - A Burns
- University of Arizona, Tucson, AZ
| | | | - E Taylor
- University of Arizona, Tucson, AZ
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10
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Bullock A, Burns A, Taylor E, Grandner M, Miller M, Alkozei A, Killgore W. 1076 Self-referential Language In Trauma Narratives Predicts Shorter Sleep Duration In Women With Ptsd. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The use of self-referential language, defined as first-person singular pronouns (e.g. I, me, my), in trauma narratives has been found to predict post-traumatic stress disorder (PTSD) severity. Additionally, taking a self-immersed perspective correlates with higher blood pressure reactivity than a self-distanced perspective. Given this relationship between self-immersed perspectives and physiological processes, we investigated the relationship between self-referential language and sleep in people with PTSD, as dysfunctional sleep is a major treatment target in this disorder.
Methods
Seventy-five participants (49 females; Mage=31.8, SDage=8.8) meeting DSM-5 criteria for PTSD were administered the PTSD Checklist for the DSM-5 (PCL-5) and the Pittsburg Sleep Quality Index (PSQI). Sleep duration was assessed with the PSQI. Participants provided typed descriptions of their traumatic event, which were then analyzed using the Linguistic Inquiry and Word Count 2015 software to count instances of first-person singular pronouns (“I” words). Linear regression, with PCL-5 scores and “I” words entered stepwise, was used to predict scores on the PSQI sleep duration subscale. Use of “I” words between the sexes was also compared.
Results
For females but not males, PTSD severity significantly predicted sleep duration (R2=.207, p=.001). Additionally, the number of “I” words in the trauma narratives predicted an additional 8% of the variance in sleep duration for females (R2 change=.083, β=.288, p=.029) but not males. Females used significantly more self-referential language in their narratives (M=11.84, SD=8.42) compared to males (M=5.25, SD=6.10, p=.001).
Conclusion
After controlling for PTSD severity, self-referential language in trauma narratives significantly predicted shorter sleep duration in females. While speculative, this finding suggests that treatment approaches for PTSD may benefit from a focus on targeting self-referential processes to improve sleep and PTSD in females but not males. As dysfunctional sleep is a hallmark of PTSD, further investigation into this relationship may illuminate a new treatment avenue for this disorder.
Support
W81XWH-14-1-0570
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Affiliation(s)
| | - A Burns
- University of Arizona, Tucson, AZ
| | - E Taylor
- University of Arizona, Tucson, AZ
| | | | - M Miller
- University of Arizona, Tucson, AZ
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11
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Benca R, Ferziger R, Wickwire EM, Bertisch S, Biddle J, Boustani M, Culpepper L, Gooneratne N, Lett J, Manderscheid R, Mehra R, Reynolds C, Grandner M. 1185 Developing A Care Pathway For Insomnia In Older Adults And Adults With Dementia: Results Of A Consensus Meeting. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Insomnia among older adults and dementia patients carries a high public health burden. Yet, treatment is inconsistent or absent. Standardized, programmatic carepaths can be implemented in clinics/systems/communities to address this after tailoring to local environments. To determine what elements should be included, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building among diverse stakeholders.
Methods
Participants represented a wide range of stakeholders and specialties, including academic research, clinical care, industry, government, payors, sleep medicine, primary care, geriatrics, psychiatry, neurology, nursing, pharmacy, quality, and implementation science. 27 statements regarding key components of carepaths for insomnia in elderly and dementia populations were presented and discussed. These represented items addressing identification of patients, screening and assessment, deciding treatment modality and delivery, providing behavioral treatment, providing pharmacotherapy, addressing combined therapy, addressing comorbidities, and incorporating outcome evaluation. All N=20 participants voted individually whether they agreed or disagreed with each statement. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree.
Results
Despite diversity among attendees, median rate of agreement was 95% (IQR=85-95%). Mean score was 0.69 (SD=0.31). 95%CIs were computed for each proportion and compared to the mean. The following elements were significantly different from the mean (p<0.05): medication decision trees (M=0.25), accounting for comorbidities (M=0.26), include outcome evaluation (M=0.30), utilization of EMR (M=0.40), incorporate caregiver (M=0.42), and differ across parts of the system (M=1.79).
Conclusion
Insomnia carepaths for older adults should address identification, screening and assessment, treatment decisions, treatment type and delivery, and evaluation. Organizations should consider these elements when designing carepaths for insomnia among older adults and dementia patients. Consensus-building should begin during the process of prioritizing care path components.
Support
Merck Research Labs provided support
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Affiliation(s)
- R Benca
- University of California, Irvine, Irvine, CA
| | - R Ferziger
- Merck Research Laboratories, Upper Gwynedd, PA
| | | | | | - J Biddle
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - J Lett
- Avar Consulting, Rockville, MD
| | - R Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC
| | - R Mehra
- Cleveland Clinic, Cleveland, OH
| | - C Reynolds
- University of Pittsburgh, Pittsburgh, PA
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12
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Madhavaram S, Seixas A, Williams N, Kalinowskisi J, Rogers A, Williams S, Grandner M, Jean-Louis G. 0879 Associations Between Self-Reported Sleep Duration and the new AHA/ACC High Blood Pressure Guidelines: Results from the National Health and Nutrition Examination Survey. Sleep 2018. [DOI: 10.1093/sleep/zsy061.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Madhavaram
- New York University School of Medicine, New York, NY
| | - A Seixas
- New York University School of Medicine, New York, NY
| | - N Williams
- New York University School of Medicine, New York, NY
| | | | - A Rogers
- New York University School of Medicine, New York, NY
| | - S Williams
- New York University School of Medicine, New York, NY
| | - M Grandner
- Department of Psychiatry and Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - G Jean-Louis
- New York University School of Medicine, New York, NY
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13
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Sandino M, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0082 Sleep Duration and Perceived Cognitive Decline. Sleep 2018. [DOI: 10.1093/sleep/zsy061.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Yang R, Hale L, Branas C, Perlis M, Gallagher R, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0189 Work Productivity Loss Associated with Sleep Duration, Insomnia Severity, Sleepiness, and Snoring. Sleep 2018. [DOI: 10.1093/sleep/zsy061.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Yang
- University of Arizona, Tucson, AZ
| | - L Hale
- Stony Brook University, Stony Brook, NY
| | - C Branas
- Columbia University, New York, NY
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | - R Gallagher
- University of Pennsylvania, Philadelphia, PA
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15
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Killgore WD, Alkozei A, Knight S, Miller M, Grandner M, Weber M. 1027 Daily Morning Blue Light Exposure Enhances Executive Functioning in Individuals with Mild Traumatic Brain Injury. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - S Knight
- University of Arizona, Tucson, AZ
| | - M Miller
- University of Arizona, Tucson, AZ
| | | | - M Weber
- University of Arizona, Tucson, AZ
- University of Arizona, Tucson, AZ
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16
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Haghighi A, Athey A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0979 Insufficient Sleep Duration and Insomnia Symptoms Independently Predict Suicide Ideation in Student Athletes and Non-Athletes. Sleep 2018. [DOI: 10.1093/sleep/zsy061.978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Athey
- University of Arizona, Tucson, AZ
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17
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Grandner M, Perlis M, Parthasarathy S, Pack A. 0877 Systematic Sleep Time Extension: A Novel Approach to Extending Sleep in Habitual Short Sleepers. Sleep 2018. [DOI: 10.1093/sleep/zsy061.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - A Pack
- University of Pennsylvania, Philadelphia, PA
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18
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Khader W, Morales K, Grandner M, Ellis J, Zandberg L, Kloss J, Perlis M. 0362 Does Time in Bed Differentiate Between Good Sleepers and Subjects that Develop Acute Insomnia, Recover from Acute Insomnia, and/or Develop Chronic Insomnia? Sleep 2018. [DOI: 10.1093/sleep/zsy061.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W Khader
- University of Pennsylvania, Philadelphia, PA
| | - K Morales
- Department of Biostatistics and Epidemiology, University of Pennsylvania, University of Pennsylvania, PA
| | - M Grandner
- Sleep & Health Research Program College of Medicine, University of Arizona, Tucson, AZ
| | - J Ellis
- Northumbria Center for Sleep Research, Northumbria University, Newcastle, UNITED KINGDOM
| | - L Zandberg
- Behavioral Sleep Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - J Kloss
- Behavioral Sleep Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - M Perlis
- Behavioral Sleep Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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19
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Tang R, Athey A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0186 Drowsy Driving In Student Athletes: Impact of Insomnia, Sleepiness, and Mood. Sleep 2018. [DOI: 10.1093/sleep/zsy061.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Tang
- University of Arizona, Tucson, AZ
| | - A Athey
- University of Arizona, Tucson, AZ
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20
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JI XW, Grandner M, Petrov M. 0894 The Role of Age, Sex, Race/ethnicity, Education, and Marital Status in the Relationship of Chronic Health Conditions and Habitual Sleep Duration. Sleep 2018. [DOI: 10.1093/sleep/zsy061.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X W JI
- Laval University, Quebec city, QC, CANADA
| | | | - M Petrov
- Arizona state university, Phoenix, AZ
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21
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Bliznak V, Athey A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 1030 History of Concussion In Student Athletes: A Risk Factor for Short Sleep Duration and Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - A Athey
- University of Arizona, Tucson, AZ
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22
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Gilles A, Grandner M. 0872 Sleep Duration and Cardiometabolic Disease Risk in Native Hawaiians. Sleep 2018. [DOI: 10.1093/sleep/zsy061.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Gilles
- University of Hawaii West Oahu, Kapolei, HI
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23
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Okuagu A, Athey A, Prichard R, Williams N, Jean-Louis G, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 1058 Racial/Ethnic Sleep Disparities Among College Students Are Different in Majority-White vs Majority-Minority Institutions. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Okuagu
- University of Arizona, Tucson, AZ
| | - A Athey
- University of Arizona, Tucson, AZ
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24
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Bremer E, Moreales K, Vargas I, Grandner M, Ellis J, Perlis M. 0415 Does Time In Bed Vary with the Use of Hypnotics? Sleep 2018. [DOI: 10.1093/sleep/zsy061.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Bremer
- Sleep Center, School of Nursing, Emory University, Atlanta, GA
| | - K Moreales
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - I Vargas
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - M Grandner
- Sleep and Health Reserach Program, College of Medicine, University of Arizona, Tucson, AZ
| | - J Ellis
- Northumbria Center for Sleep Research, Northumbria University, New Castle, UNITED KINGDOM
| | - M Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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25
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Tubbs A, Perlis M, Chakravorty S, Basner M, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0988 Seasonal Changes in Nocturnal Suicide Risk. Sleep 2018. [DOI: 10.1093/sleep/zsy061.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tubbs
- University of Arizona, Tucson, AZ
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - M Basner
- University of Pennsylvania, Philadelphia, PA
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26
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Grandner M, Mullington J, Hashmi S, Redeker N, Watson N, Morgenthaler T. 0867 Sleep Duration and Hypertension among >700,000 Adults by Age and Sex: A Report of the National Healthy Sleep Awareness Project. Sleep 2018. [DOI: 10.1093/sleep/zsy061.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - S Hashmi
- American Academy of Sleep Medicine, Darien, IL
| | | | - N Watson
- University of Washington, Seattle, WA
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27
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Sanchez C, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0127 Nighttime Snacking: Prevalence And Associations With Poor Sleep, Health, Obesity, And Diabetes. Sleep 2018. [DOI: 10.1093/sleep/zsy061.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Knowlden A, Petrov M, Nowakowski S, Grandner M. 0278 Gender Differences in the Relationship between Short Sleep and Obesity Depend on Age. Sleep 2018. [DOI: 10.1093/sleep/zsy061.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Knowlden
- The University of Alabama, Tuscaloosa, AL
| | - M Petrov
- Arizona State University, Phoenix, AZ
| | - S Nowakowski
- University of Texas Medical Branch, Galveston, TX
| | - M Grandner
- University of Arizona College of Medicine, Tucson, AZ
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29
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Liang O, Seixas A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0888 Sleep Duration And Diabetes In The Us For 2007–2015: Moderation By Age, Sex, Race/ethnicity, And Body Mass Index. Sleep 2018. [DOI: 10.1093/sleep/zsy061.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Liang
- University of Arizona, Tucson, AZ
| | - A Seixas
- New York University, New York, NY
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30
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Grandner M, Olivier K, Killgore W, Gehrels J, Alfonso-Miller P. 0954 Domestic Violence as a Risk Factor for Insomnia and Short Sleep Duration, and the Role of Depressed Mood and Anxiety Symptoms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Sanchez C, Hale L, Branas C, Gallagher R, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0185 Relationships between Dietary Supplement Intake and Sleep Duration, Insomnia, and Fatigue. Sleep 2018. [DOI: 10.1093/sleep/zsy061.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - L Hale
- Stony Brook University, Stony Brook, NY
| | - C Branas
- Columbia University, New York, NY
| | - R Gallagher
- University of Pennsylvania, Philadelphia, PA
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32
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Tubbs A, Perlis M, Chakravorty S, Basner M, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0978 Does Increased Risk of Suicide at Night Favor One Method of Suicide Over Another? Sleep 2018. [DOI: 10.1093/sleep/zsy061.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tubbs
- University of Arizona, Tucson, AZ
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - M Basner
- University of Pennsylvania, Philadelphia, PA
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33
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Meridew C, Athey A, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0190 Academic Performance Associated with Sleep Duration among Student Athletes: Impact of Insomnia, Fatigue, and Depression. Sleep 2018. [DOI: 10.1093/sleep/zsy061.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Athey
- University of Arizona, Tucson, AZ
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34
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Bastien C, Ellis J, Athey A, Chakravorty S, Robbins R, Knowlden A, Charest J, Grandner M. Driving after alcohol consumption is associated with insufficient sleep and insomnia among student athletes and non-athletes. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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Vanuk JR, Shane BR, Bajaj S, Millan M, Grandner M, Killgore WD. 1171 SHORT-WAVELENGTH LIGHT THERAPY AS A WAY OF IMPROVING SLEEP, COGNITION, AND FUNCTIONAL CONNECTIVITY FOLLOWING A MILD TRAUMATIC BRAIN INJURY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Robbins R, Jean-Louis G, Sundarajan A, Hale L, Gallagher RA, Barrett M, Gooneratne N, Branas C, Alfonso-Miller P, Perlis M, Grandner M. 0809 SOCIAL CAPITAL AND SOCIAL CONNECTEDNESS RELATED TO SLEEP DURATION, INSOMNIA SYMPTOMS, AND DAYTIME SLEEPINESS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Richards S, Seixas A, Chung D, Nunes J, Grandner M, Zizi F, Tan N, Jean-Louis G. 1150 SLEEP IMPACTS QUALITY OF LIFE AND NEUROCOGNITIVE CHARACTERISTICS OF BLACK AND HISPANIC STROKE SURVIVORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Seixas A, Li Y, Pagan J, Mcfarlane S, Grandner M, Youngstedt S, Zizi F, Jean-Louis G. 1064 THE ROLE OF SLEEP AND PHYSICAL ACTIVITY IN REDUCING THE PREVALENCE OF DIABETES IN THE UNITED STATES: AN AGENT-BASED SIMULATION MODEL APPROACH. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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