Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome

OBJECTIVE

Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS.

METHODS

Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms.

RESULTS

The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04).

CONCLUSIONS

Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

Day-to-day associations of intersectional minority stressors with sleep health in sexual and gender minority people of color

OBJECTIVE

To determine the day-to-day associations between minority stressors (i.e., anticipated and experienced discrimination) and sleep health outcomes (i.e., total sleep time (TST), sleep disturbances, and sleep-related impairment) among sexual and gender minority (SGM) people of color.

METHOD

An online sample of SGM people of color living in the United States participated in a 30-day daily diary study. Daily anticipated and experienced discrimination as well as subjective sleep outcomes were assessed via electronic diaries using validated measures. Wrist-worn actigraphy was used to objectively assess TST. Multilevel linear models (MLMs) were used to estimate the independent associations of daily intersectional minority stressors with subsequent sleep outcomes, adjusted for demographic factors and lifetime discrimination.

RESULTS

The sample included 43 SGM people of color with a mean age of 27.0 years (± 7.7) of which 84% were Latinx, 47% were multiracial, and 37% were bisexual. Results of MLMs indicated that greater report of daily experienced discrimination was positively associated with same-night sleep disturbances, B (SE) = 0.45 (0.10), p < .001. Daily anticipated discrimination was positively associated with sleep-related impairment on the following day, B (SE) = 0.77 (0.17), p < .001. However, daily anticipated and experienced discrimination were not associated with same-night TST.

CONCLUSIONS

Findings highlight the importance of considering the differential effects of daily intersectional minority stressors on the sleep health of SGM people of color. Further research is needed to identify factors driving the link between daily minority stressors and sleep outcomes to inform sleep health interventions tailored to this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study

OBJECTIVES

This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress.

METHODS

Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary.

RESULTS

Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (β -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05).

CONCLUSIONS

These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

Rest-Activity Rhythms Are Associated With Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults

BACKGROUND

Rest-activity rhythms (RARs), a measure of circadian rhythmicity in the free-living setting, are related to mortality risk, but evidence is limited on associations with cardiovascular disease (CVD) and its risk factors.

METHODS AND RESULTS

Participants included 4521 adults from the 2013 to 2014 National Health and Nutrition Examination Survey physical activity monitoring examination. Wrist-worn ActiGraph GT3X+ data were used to estimate RARs. Multivariable logistic models evaluated associations of RARs with prevalent CVD, hypertension, obesity, and central adiposity. Participants (mean age, 49 years) in the highest versus lowest tertile of relative amplitude (greater circadian rhythmicity) had 39% to 62% lower odds of prevalent CVD, hypertension, obesity, and central adiposity. A more active wake period was associated with 19% to 72% lower CVD, hypertension, obesity, and central adiposity odds. Higher interdaily stability (regular sleep-wake and rest-activity patterns) was related to 52% and 23% lower CVD and obesity odds, respectively. In contrast, participants in the highest versus lowest tertile of intradaily variability (fragmented RAR and inefficient sleep) had >3-fold and 24% higher CVD and obesity odds, respectively. A later and less restful sleep period was associated with 36% to 2-fold higher CVD, hypertension, obesity, and central adiposity odds. A statistically significant linear trend was observed for all associations (P-trend<0.05).

CONCLUSIONS

A robust, stable, and less fragmented RAR, an active wake period, and an earlier and more restful sleep period are associated with lower prevalent CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The magnitude, timing, and regularity of sleep-wake and rest-activity patterns may be important targets for reducing cardiovascular risk.

Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study

OBJECTIVE

Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization.

METHOD

In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device.

RESULTS

Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients.

CONCLUSIONS

Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.

The relationship of shift work disorder with symptoms of depression, anxiety, and stress

Shift workers commonly suffer from disturbed sleep, which is known to affect mental health in other populations. Shift work disorder (SWD) is characterized by complaints of insomnia and/or excessive daytime sleepiness temporally associated with working non-standard schedules that occur during the usual time for sleep. Few studies have explored the extent to which workers with vs. without SWD experience worse mental health. We administered the Shift Work Disorder Screening Questionnaire to 60 adults engaged in various shift work schedules to categorize workers as being at high or low risk for SWD. Mental health outcomes were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Linear regression was performed for each DASS-21 subscale, adjusting for age, sex, shift type, sleep duration, and frequency of alcohol use. Most participants (55 %) were at high risk for SWD. High-risk participants had higher depressive symptoms than low-risk participants, B = 3.59, 95 % CI [0.54, 6.65], p = .02. The estimated value for those at high risk for SWD corresponded to clinically significant mild depressive symptoms, (M = 13.43), compared to those at low risk, (M = 9.84). High risk for SWD was marginally associated with increased stress symptoms, B = 2.48, 95 % CI [-0.06,5.02], p = .06. Our findings add to the body of evidence that SWD is associated with poor mental health outcomes. Providing interventions specific to the sleep impacts of SWD, including tailored cognitive behavioral therapy for insomnia, may improve shift workers' mental health.

Sleep Disturbance and Burnout in Emergency Department Health Care Workers

This cross-sectional study examines the association of sleep disturbances with burnout among emergency medicine health care workers.

A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials

BACKGROUND

Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Although using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin are unknown. Using the National Institutes of Health Stage Model for Behavioral Intervention Development, a stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions.

OBJECTIVE

This trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for remote delivery of melatonin dose (3 and 0.5 mg) versus placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing remote N-of-1 randomized controlled trials to improve poor sleep.

METHODS

Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg of melatonin, 0.5 mg of melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. The feasibility and acceptability of the personalized trial approach will be determined with participants' ratings of usability and satisfaction with the remote, personalized intervention delivery system. The effectiveness of the intervention will be measured using participants' self-reported sleep quality and duration and Fitbit tracker-measured sleep duration and efficiency. Additional measures will include ecological momentary assessment measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection.

RESULTS

As of the submission of this protocol, recruitment for this National Institutes of Health stage IB personalized trial series is approximately 78.3% complete (47/60). We expect recruitment and data collection to be finalized by June 2023.

CONCLUSIONS

Evaluating the feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer term aim of this program of research-is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT (Consolidated Standards of Reporting Trials) extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health institutional review board.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05349188; https://www.clinicaltrials.gov/study/NCT05349188.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45313.

A First Look at Childhood Abuse in Women with Obstructive Sleep Apnea

Study objectives. Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. control, with possible mediation by obesity. Methods . We studied 21 women with OSA (age mean±s.d. 59±12 years, body mass index (BMI) 33±8 kg/m 2 , respiratory event index [REI] 25±16 events/hour, Epworth Sleepiness Scale [ESS] 8±5) and 21 women without OSA (age 53±9 years, BMI 25±5 kg/m 2 , REI (in 7/21 women) 1±1 events/hour, ESS 5±3). We evaluated four categories of trauma (general trauma, physical, emotional, and sexual abuse) with the early trauma inventory self-report-short form (ETISR-SF). We assessed group differences in trauma scores with independent samples t-tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women. Results. Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA ( p =0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator ( p =0.02) in predicting OSA in women who experienced childhood physical abuse. Conclusions. Childhood sexual abuse was more common in a group of women with OSA than those without OSA. Additionally, BMI was a mediator for OSA of childhood physical but not sexual abuse. There may be physiological impacts of childhood trauma in women that predispose them to OSA.

Post-stroke sleep disturbance and recurrent cardiovascular and cerebrovascular events: A systematic review and meta-analysis

Despite improvements in survival rates, risk of recurrent events following stroke remains high. Identifying intervention targets to reduce secondary cardiovascular risk in stroke survivors is a priority. The relationship between sleep and stroke is complex: sleep disturbances are likely both a contributor to, and consequence of, stroke. The current aim was to examine the association between sleep disturbance and recurrent major acute coronary events or all-cause mortality in the post-stroke population. Thirty-two studies were identified, including 22 observational studies and 10 randomized clinical trials (RCTs). Identified studies included the following as predictors of post-stroke recurrent events: obstructive sleep apnea (OSA, n = 15 studies), treatment of OSA with positive airway pressure (PAP, n = 13 studies), sleep quality and/or insomnia (n = 3 studies), sleep duration (n = 1 study), polysomnographic sleep/sleep architecture metrics (n = 1 study), and restless legs syndrome (n = 1 study). A positive relationship of OSA and/or OSA severity with recurrent events/mortality was seen. Findings on PAP treatment for OSA were mixed. Positive findings indicating a benefit of PAP for post-stroke risk came largely from observational studies (pooled RR [95% CI] for association between PAP and recurrent cardiovascular event: 0.37 [0.17-0.79], I2 = 0%). Negative findings came largely from RCTs (RR [95% CI] for association between PAP and recurrent cardiovascular event + death: 0.70 [0.43-1.13], I2 = 30%). From the limited number of studies conducted to date, insomnia symptoms/poor sleep quality and long sleep duration were associated with increased risk. Sleep, a modifiable behavior, may be a secondary prevention target to reduce the risk of recurrent event and death following stroke. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021266558.

Assessing sleep health dimensions in frontline registered nurses during the COVID-19 pandemic: implications for psychological health and wellbeing

The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross sectional survey was distributed across three hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100 000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, and compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of the participants reported burnout (64%), depression, (67%), and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI ≤ 5) had over five times the odds of no burnout (OR: 5.65, 95% CI: 2.60, 12.27); increased odds of screening negative for depression (OR: 6.91, 95% CI: 3.24, 14.72), anxiety (OR: 10.75, 95% CI: 4.22, 27.42), and compassion fatigue (OR: 7.88, 95% CI: 1.97, 31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR: 2.21, 95% CI: 1.41, 3.48) but sleep duration subcomponent was not (OR: 0.84, 95% CI: 0.59, 1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.

Sleep and Circadian Disturbance in Cardiovascular Risk

PURPOSE OF REVIEW

We discuss the relationship between sleep and circadian factors with cardiovascular disease (CVD) risk, including physiologic, behavioral, and psychological mechanisms along this pathway.

RECENT FINDINGS

The relationship between short and long sleep duration, as well as insomnia, with CVD risk is well-established. Recent work has highlighted how other sleep factors, such as sleep regularity (i.e., consistency of sleep timing), multidimensional sleep health, and circadian factors like chronotype and social jetlag, relate to CVD risk. Sleep-focused interventions (e.g., cognitive behavioral therapy for insomnia and sleep extension) may be effective to reduce CVD risk and disease burden. Sleep is increasingly recognized as an integral component of cardiovascular health. This was underscored by the recent inclusion of sleep duration as a health behavior in the American Heart Association's Life's Essential 8 for defining optimal cardiovascular health.

COVID-19 and the amplification of cardiovascular risk by psychological distress

The COVID-19 pandemic has unleashed a tidal wave of psychological distress. Here, we discuss the biobehavioral mechanisms through which psychological distress amplifyies the adverse effects of SARS-CoV-2-infection on cardiovascular outcomes. We also examine how the stress of caring for patients with COVID-19 increases cardiovascular risk in healthcare workers.

The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity

STUDY OBJECTIVES

This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status.

METHODS

In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality.

RESULTS

Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings.

CONCLUSIONS

If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.

0560 Rest-Activity Rhythms are Associated with Prevalent Cardiovascular Disease, Hypertension, Obesity, and Central Adiposity in a Nationally Representative Sample of US Adults

Introduction

Prior studies have linked rest-activity rhythms (RAR), a measure of circadian rhythmicity in the free-living setting, to morbidity and mortality. However, evidence is limited on the associations of RAR with adiposity, hypertension, and cardiovascular disease (CVD) in a nationally representative sample of US adults.

Methods

Participants were 4,822 adults (age:≥20y) from the 2013-2014 National Health and Nutrition Examination Survey, who participated in the physical activity monitoring examination. Data from a wrist-worn ActiGraph GT3X+ accelerometer were used to estimate non-parametric 24-h RAR variables. Logistic models adjusted for age, sex, race/ethnicity, education, marital status, smoking, and alcohol use were used to evaluate associations of RARs with prevalent CVD (self-reported), hypertension (blood pressure≥130/80mmHg or medication use), obesity (BMI≥30kg/m2), and central adiposity (waist circumference&gt;102cm for men and &gt;88cm for women).

Results

Participants (mean age: 48y, 53% female, 33% racial/ethnic minority) in the highest vs. lowest tertile of relative amplitude, indicative of more robust RAR, had lower odds of prevalent CVD (OR(95%CI):0.47(0.25-0.87)), hypertension (OR(95%CI):0.63(0.40-0.99)), obesity (OR(95%CI):0.50(0.36-0.69)), and central adiposity (OR(95%CI):0.50(0.36-0.69)). Those in the highest vs. lowest tertile of M10 counts, indicating a more active wake period, had 66%, 54%, and 39% lower odds of CVD, obesity, and central adiposity, respectively. In contrast, participants in the highest vs. lowest tertile of intradaily variability, indicative of more fragmented RARs, had &gt;2-fold (OR(95%CI):2.40(1.23-4.70)) and 40% (OR(95%CI):1.40(95%CI:1.04-1.88)) higher CVD and obesity odds, respectively. Further, those in the highest vs. lowest tertile of L5 midpoint, indicative of a later sleep period, had 68% and 41% higher odds for CVD and hypertension, while those with higher L5 counts, indicative of less efficient sleep, had 72%, 57%, and 79% higher hypertension, obesity, and central adiposity odds, respectively. A statistically significant linear trend was observed across RAR tertiles for all associations (p-trend&lt;0.05).

Conclusion

Robust RAR, an active wake period, and an earlier and more efficient sleep period are associated with lower odds for CVD, hypertension, obesity, and central adiposity, with evidence of a dose-response relationship. The timing, regularity, and periodicity of sleep-wake and rest-activity patterns may represent an important target for reducing cardiovascular risk in adults.

Support (If Any)

NHLBI R00-HL148511; AHA grant #855050

0653 Poor sleep quality is associated with burnout in emergency medicine healthcare workers

Introduction

Prolonged exposure to stressful environments is associated with adverse psychological outcomes, including sleep disturbance and burnout. Burnout rates have increased substantially during the unprecedented challenges faced by healthcare workers (HCWs) during the COVID-19 pandemic. Since burnout has been associated with significant health risk and adverse organizational outcomes, it is important to identify factors that inform preventive or therapeutic approaches to mitigate adverse outcomes in HCWs.

Methods

Participants were HCWs (physicians, nurses, advanced practice providers, technicians etc.) from 4 emergency departments in New York City who completed a cross-sectional electronic survey (completed at study enrollment between November 2020-October 2021). The Pittsburgh Sleep Quality Index (PSQI) assessed global sleep quality. The Maslach Burnout Inventory (MBI) assessed 3 burnout dimensions: emotional exhaustion (EE; feelings of being emotionally overextended and exhausted by one's work); Feelings of depersonalization (DP; unfeeling and impersonal response towards patients); and reduced personal accomplishment (PA; feelings of competence and successful achievement in one's work). Descriptive statistics were calculated and separate binary logistic regressions were used to predict poor global sleep quality (PSQI >5) from individual MBI subscales (dimensions of burnout), while controlling for age, race, ethnicity, and gender.

Results

Ninety-one participants, studied to date, were included in the analysis (51% non-Hispanic/Latino White, 63% female, mean age: 40 [SD: 9.6] y). Poor global sleep quality was reported by 68%. High EE (score >9), DP (score >6) and reduced PA (score <9) were reported by 44%, 27%, and 18% of participants, respectively. Poor global sleep quality was significantly associated with presence of elevated EE (OR: 3.04, 95% CI: 1.07-8.63, p=0.037), but not with elevated DP (OR: 1.35, 95% CI: 0.44-4.10, p=0.603) or reduced PA (OR: 3.29, 95% CI: 0.65-16.44, p=0.146).

Conclusion

During the COVID-19 pandemic, poor sleep quality was reported by the majority of participants and associated with increased burnout in HCWs. Poor global sleep appears to have the most influence on the burnout dimension EE, thus suggesting new evidence about associations between sleep and emotional regulation in HCW during the pandemic. Future trials should test whether existing (or novel) interventions can improve sleep and thereby support HCWs in high stress periods.

Support (If Any)

R01HL146911

0144 Identification of sleep factors related to blood pressure in emergency medicine healthcare workers

Introduction

Emergency Department (ED) healthcare workers (HCWs) may be at elevated risk for the development of cardiovascular disease (CVD), due in part to sleep and/or circadian disturbances. This study aimed to evaluate the relationship of sleep factors with blood pressure, a primary marker of CVD risk, in ED HCWs.

Methods

Participants were HCWs (physicians, nurses, advanced practice providers, technicians, etc.) from 4 EDs in New York City who completed study procedures between November 2020-October 2021. Participants completed a 2-week data burst, which included sleep/activity (Fitbit Inspire) and home blood pressure monitoring (Omron 5 Series BP7250; preceding and following their main daily sleep episode). Linear regression models, adjusted for age, gender, and race/ethnicity, were conducted predicting blood pressure from sleep factors.

Results

The sample included n=74 ED HCWs (mean [SD] age=38.4 [8.7] years). Most were female (62.2%) and non-Hispanic/Latino White (55.6%). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 116.1 (12.5) mmHg and 75.1 (7.6) mmHg, respectively. Actigraphy-derived sleep factor means for the data burst period were: a) Total sleep time (TST): 6.8 (1.0) hours; b) Sleep efficiency (SE): 94.5 (2.2)%; c) Percentage of main sleep episodes throughout the burst with TST &lt;6 hours: 25.9 (20.8)%; d) Sleep start time: 24:06 (01:24); and e) Within-subject inter-daily bedtime variability (i.e., SD of sleep start times): 2.4 (1.8) hours. Higher TST was associated with lower SBP (B [SE] =-0.50 [0.30] mmHg/10 min, p=.04) and DBP (B [SE] =-0.50 [0.20] mmHg/10 min, p=.01). Greater SE was associated with lower SBP (B [SE] =-1.23 [0.55], mmHg/%, p=.03) and DBP (B [SE] =-1.05 [0.39], mmHg/%, p=.01). A higher proportion of nights with TST &lt;6 hours was associated with higher DBP (B [SE] =1.4 [0.40], mmHg/10%, p&lt;0.01) but not SBP. Sleep start time and bedtime variability were not associated with BP.

Conclusion

These findings provide support for the relationship between sleep and blood pressure. Of note, data were collected during the COVID-19 pandemic, which may impact observed relationships. Because this is a cross-sectional analysis, the causal direction of the association may be (at least partially) reversed. Further research should examine psychological and work-related factors in ED HCWs that may modify these relationships, e.g., stress/anxiety, burnout, and job strain, and include assessments of the circadian system.

Support (If Any)

R01HL146911

The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic

BACKGROUND

Healthcare workers (HCWs) treating patients with COVID-19 report psychological distress. We examined whether disturbed sleep was associated with psychological distress in New York City (NYC) HCWs during the initial peak of the COVID-19 pandemic (April-May 2020).

METHODS

HCWs completed a survey screening for acute stress (4-item Primary Care PTSD screen), depressive (Patient Health Questionaire-2), and anxiety (2-item Generalized Anxiety Disorder scale) symptoms. Insomnia symptoms (modified item from the Insomnia Severity Index) and short sleep (SS, sleep duration <6 h/day) were assessed. Poisson regression analyses predicting psychological distress from SS and insomnia symptoms, adjusting for demographics, clinical role/setting, redeployment status, shifts worked, and multiple comparisons were performed.

RESULTS

Among 813 HCWs (80.6% female, 59.0% white) mean sleep duration was 5.8 ± 1.2 h/night. Prevalence of SS, insomnia, acute stress, depressive, and anxiety symptoms were 38.8%, 72.8%, 57.9%, 33.8%, and 48.2%, respectively. Insomnia symptoms was associated with acute stress (adjusted prevalence ratio [PR]: 1.51, 95% CI: 1.35, 1.69), depressive (PR: 2.04, 95% CI: 1.78, 2.33), and anxiety (PR: 1.74, 95% CI: 1.55, 1.94) symptoms. SS was also associated with acute stress (PR: 1.17, 95% CI: 1.07, 1.29), depressive (PR: 1.36, 95% CI: 1.233, 1.51), and anxiety (PR: 1.38, 95% CI: 1.26, 1.50) symptoms.

LIMITATIONS

Our cross-sectional analysis may preclude the identification of temporal associations and limit causal claims.

CONCLUSIONS

In our study, SS and insomnia were associated with psychological distress symptoms in NYC HCWs during the COVID-19 pandemic. Sleep may be a target for interventions to decrease psychological distress among HCWs.

The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath

After hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients' partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (yes/no), spouse hospitalized ≥ two times (yes/no), and spouse spent ≥ eight nights in-hospital (yes/no). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one's own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one's own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients' partners.

Sleep and circadian rhythms: pillars of health-a Keystone Symposia report

The human circadian system consists of the master clock in the suprachiasmatic nuclei of the hypothalamus as well as in peripheral molecular clocks located in organs throughout the body. This system plays a major role in the temporal organization of biological and physiological processes, such as body temperature, blood pressure, hormone secretion, gene expression, and immune functions, which all manifest consistent diurnal patterns. Many facets of modern life, such as work schedules, travel, and social activities, can lead to sleep/wake and eating schedules that are misaligned relative to the biological clock. This misalignment can disrupt and impair physiological and psychological parameters that may ultimately put people at higher risk for chronic diseases like cancer, cardiovascular disease, and other metabolic disorders. Understanding the mechanisms that regulate sleep circadian rhythms may ultimately lead to insights on behavioral interventions that can lower the risk of these diseases. On February 25, 2021, experts in sleep, circadian rhythms, and chronobiology met virtually for the Keystone eSymposium "Sleep & Circadian Rhythms: Pillars of Health" to discuss the latest research for understanding the bidirectional relationships between sleep, circadian rhythms, and health and disease.

Cardio-COVID clinic – a one-center experience

Background

Persistent symptoms affect a relatively large portion of coronavirus disease (COVID) survivors. Hence, specific clinics had been established in order to better characterize and manage this emerging entity of Post-COVID, among them our Cardio-COVID Clinic, which is dedicated to the cardiovascular (CV) aspects of the phenomenon.

Aim

To present the experience of our Cardio-COVID Clinic.

Methods

Included in this report are 76 adult patients seen at the clinic between June 2020 and March 2021, who have recovered from a polymerase chain reaction (PCR)-confirmed COVID, and who were suspected by their referring physicians to experience ongoing cardiac sequelae. All participants underwent a structured assessment by a single cardiologist, which consisted of history taking, physical examination (PE), electrocardiogram (ECG), trans-thoracic echocardiogram (TTE), and further tests as deemed appropriate, including any combination of Holter, ischemic provocation test, cardiopulmonary exercise test (CPET), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT).

Results

Initial visits occurred within a median of 131 days after diagnosis. Most participants (83%) were referred from our general Long-COVID Clinic. About half were males, and the mean age was 53 years. 18% of participants had prior CV conditions, and the majority (72%) had at least one CV risk factor, mostly dyslipidemia. Nearly all participants experienced a symptomatic acute illness, which was graded according to the National Institutes of Health (NIH) criteria as severe in 23% of the study cohort. As for Post-COVID, late symptoms were present in 97% of patients, the most common being dyspnea (57%). While PE was unremarkable in all but 3 patients who exhibited murmurs, ECG findings were revealed in 45% – mostly non-specific ST-T changes (31%) and conduction abnormalities (14%) – and TTE aberrations were discovered in 28% – including pericardial effusion (24%), reduced left ventricular ejection fraction (LVEF) (5%), grade 2 diastolic dysfunction (3%), moderate and up valvular dysfunction (1%), and systolic pulmonary hypertension (1%); right ventricular function was universally normal. Upon conclusion of the work-up, CV diagnoses were made in 8 (11%) patients – including myocarditis (4), myopericarditis (1), inappropriate sinus tachycardia (1), chronotropic incompetence (1), and an aberrant coronary (1). Of note, CPET and CMR had the highest diagnostic yield, in light of 57% positive results on each – followed by CCT, Holter, and provocation test. Interesting as well, among those with abnormal CMR findings, 40% had normal ECG's and TTE's. Also, none of the CV restraints on CPET translated to provocation test anomalies.

Conclusion

CV symptoms of Post-COVID are highly prevalent, but signify actual CV disease only in a minority of patients. Further research is needed that will help identify predictors for CV morbidity and define optimal clinical pathways.

Funding Acknowledgement

Type of funding sources: None.

Severe aortic stenosis echocardiographic thresholds revisited

Background

In view of inconsistencies in threshold values of severe aortic stenosis (AS) hemodynamic indices, it is unclear what is the relative contribution of each variable in a binary classification of AS based on aortic valve replacement (AVR) indication.

Purpose

Assess relative discriminative value and optimal threshold of each constituent hemodynamic parameter for this classification and confirm additional prognostic value.

Methods

Echocardiography studies of 168 patients with ≥ moderate AS were included. AS types were dichotomized based on intervention implication into two groups: Group-A, comprising moderate and Normal-Flow Low-Gradient (NFLG), and Group-B, comprising High-Gradient (HG), Low Ejection Fraction Low-Flow Low-Gradient (Low EF-LFLG), and Paradoxical Low-Flow Low-Gradient (PLFLG) AS. Aortic valve area (AVA), Doppler velocity index (DVI), peak aortic velocity, mean gradient and stroke volume index were assessed for A/B Group discrimination value and optimal thresholds were determined. Dichotomized values were assessed for predictive value for AVR or death.

Results

C-statistic values for binary AS classification was 0.74–0.9 for the tested variables. AVA and DVI featured the highest score, and SVI the lowest one. AVA≤0.81 cm2 and DVI≤0.249 had 87.6% and 86% respective sensitivity for Group B patients, and a similar specificity of 80.9%. During a mean follow-up of 9.1±10.1 months, each of the tested dichotomized variables except for SVI predicted AVR or death on multivariate analysis.

Conclusion

An AVA value ≤0.81 cm2 or a DVI ≤0.249 threshold carry the highest discriminative value for severe AS in patients with aortic stenosis, translating into an independent prognostic value, and should be considered in clinical decisions.

Funding Acknowledgement

Type of funding sources: None. Echo variables correlation with Group BSurvival curves for individual AS types

Temporal trends in the characteristics, treatment and clinical outcomes of conservatively managed patients with non-ST elevation acute coronary syndrome: ACSIS registry 2000–2016

Background

Despite advances in percutaneous coronary interventions (PCI), a sub group of acute coronary syndrome (ACS) patients are still managed medically by a conservative approach. We sought to characterize a contemporary, large-scale, real-world cohort of ACS patients treated conservatively via pharmacological management, without PCI.

Methods

Data from the ACS Israeli Survey (ACSIS) accrued between 2000–2016, encompassing all consecutive patients admitted to cardiology wards with an ACS diagnosis. Examined were 3543 conservatively managed patients with non-ST elevation ACS (NSTE-ACS). Patients with ST elevation MI or those referred to bypass surgery were excluded. Primary endpoints were 30-day major adverse cardiovascular events (MACE) and 1-year mortality. The study cohort was divided to 4 time-periods.

Results

Over 2 decades, medically managed NSTE-ACS patients remained of similar age (67±13y, p=0.78), but had more atherosclerotic risk-factors and comorbidities. During time, patients were more often referred to diagnostic angiography and treated with statins, ACE-I/ARBs, and P2Y12 inhibitors (p&lt;0.001 for each). Over time, there were less in-hospital complications such as kidney injury and heart failure. The rate of 30-day MACE decreased (from 20.7% to 10.3%, earliest to latest period, p&lt;0.001). Compared with the earliest period, the latest period was associated with a reduction in 1-year mortality (14.7% to 11.6%; adjusted HR 0.65, 95% CI 0.47–0.90).

Conclusions

Over two decades, in medically managed NSTE-ACS patients, short term prognosis has significantly improved while 1-year mortality demonstrated improvement only recently, likely due to incremental benefits of medical management. Further studies are needed to examine treatment modalities in these unique ACS patients.

Funding Acknowledgement

Type of funding sources: None. Kaplan Meier survival curvesTrends in management and Angiographies

The association of transmission concerns and social distance from loved ones with distress in medical professionals providing care during the COVID-19 pandemic in New York City

BACKGROUND

Health care workers (HCWs) during the COVID-19 pandemic report high levels of psychological distress. We examined whether concerns regarding transmission of COVID-19 to loved ones and social distancing from loved ones were associated with HCWs' distress. We tested whether living with others modified these associations.

METHOD

HCWs at a New York City academic medical center (N = 767; 80.7% female, 58.5% White) enrolled in the COVID-19 Health Care Provider Study and completed a web-based survey between April 9, 2020 and May 11, 2020.

RESULTS

Controlling for demographics, distress regarding potential transmission to loved ones and social distancing from loved ones were each significantly associated with higher odds of a positive screen for acute stress, depression, and anxiety (ORs = 1.29-1.59, all ps < .01). Living with others was associated with lower odds of a positive screen for depression and anxiety, though the protective effect for anxiety was evident only for HCWs with no distress regarding transmission concerns.

CONCLUSIONS

Transmission concerns and social distancing from loved ones were associated with greater odds of psychological distress, whereas living with others was associated with lower odds of distress. Interventions should consider ways to facilitate the ability of HCWs to receive social support from loved ones, while simultaneously protecting their family's health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors Associated with Insomnia Symptoms in a Longitudinal Study among New York City Healthcare Workers during the COVID-19 Pandemic

Background: Few studies have examined the longer-term psychological impact of COVID-19 in healthcare workers (HCWs). Purpose: We examined the 10-week trajectory of insomnia symptoms in HCWs during the COVID-19 pandemic. Methods: HCWs completed a web-based survey at baseline (9 April–11 May 2020) and every 2 weeks for 10 weeks. The main outcome was the severity of insomnia symptoms in the past week. Multivariable-adjusted generalized estimating equation analyses examined factors associated with insomnia symptoms. Results: n = 230 completed surveys at baseline. n = 155, n = 130, n = 118, n = 95, and n = 89 completed follow-ups at weeks 2, 4, 6, 8, and 10, respectively. Prevalence of insomnia symptoms of at least moderate severity was 72.6% at baseline, and 63.2%, 44.6%, 40.7%, 34.7%, and 39.3% at weeks 2, 4, 6, 8, and 10, respectively. In multivariable analyses, factors significantly associated with increased odds of insomnia symptoms were younger age (OR: 0.98, 95% CI: 0.96–1.00), working in a COVID-facing environment (OR: 1.75, 95% CI: 1.15–2.67) and hours worked (OR: 1.16, 95% CI: 1.06–1.27). Conclusions: The initial high rates of insomnia symptoms improved as time passed from the peak of local COVID-19 cases but four out of ten HCWs still had moderate-to-severe insomnia symptoms ten weeks after baseline.

Digital phenotyping of sleep patterns among heterogenous samples of Latinx adults using unsupervised learning

OBJECTIVE

This study aimed to identify sleep disturbance subtypes ("phenotypes") among Latinx adults based on objective sleep data using a flexible unsupervised machine learning technique.

METHODS

This study was an analysis of sleep data from three cross-sectional studies of the Precision in Symptom Self-Management Center at Columbia University. All studies focused on sleep health in Latinx adults at increased risk for sleep disturbance. Data on total sleep time (TST), time in bed (TIB), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings (NOA) and the mean length of nightly awakenings were collected using wrist-mounted accelerometers. Cluster analysis of the sleep data was conducted using an unsupervised machine learning approach that relies on mixtures of multivariate generalized linear mixed models.

RESULTS

The analytic sample included 494 days of data from 118 adults (Ages 19-77). A 3-cluster model provided the best fit based on deviance indices (ie, DΔ∼ -75 and -17 from 1- and 2- to 3-cluster models, respectively) and likelihood ratio (P_diff ∼ 0.93). Phenotype 1 (n = 64) was associated with greater likelihood of overall adequate SE and less variability in SE and WASO. Phenotype 2 (n = 11) was characterized by higher NOAs, and greater WASO and TIB than the other phenotypes. Phenotype 3 (n = 43) was characterized by greater variability in SE, bed times and awakening times.

CONCLUSION

Robust digital data-driven modeling approaches can be useful for detecting sleep phenotypes from heterogenous patient populations, and have implications for designing precision sleep health strategies for management and early detection of sleep problems.

Effects Of Exogenous Melatonin On Sleep And Circadian Rhythms In Women With Premenstrual Dysphoric Disorder

We previously found normal polysomnographic (PSG) sleep efficiency, increased slow wave sleep (SWS) and a blunted melatonin secretion in women with premenstrual dysphoric disorder (PMDD) compared to controls. Here, we investigated the effects of exogenous melatonin in five patients previously studied. They took 2 mg of slow-release melatonin 1 hour before bedtime during their luteal phase (LP) for three menstrual cycles. At baseline, patients spent every third night throughout one menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual Symptoms (PRISM), and ovarian hormones. Participants also underwent two 24-hour intensive physiological monitoring (during the follicular phase and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration. In the intervention condition compared to baseline, we found increased urinary aMt6 (p<0.001), reduced objective SOL (p=0.01), reduced SWS (p<0.001) and increased Stage 2 sleep (p<0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p<0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p<0.001). These findings support a role for disturbed melatonergic system in PMDD that can be partially corrected by exogenous melatonin.

691 Associations of Sleep Quality and Burnout in Clinicians during the COVID-19 Pandemic

Introduction

Clinicians have faced unprecedented challenges in care delivery during the COVID-19 pandemic due to increases in patient volume/acuity, alongside fears of COVID-19 exposure. Increased burnout rates are associated with chronic health condition risk and adverse organizational outcomes. It remains unclear whether sleep is associated to burnout in clinicians treating COVID-19 patients.

Methods

A cross-sectional electronic survey was distributed via email across 3 hospital listserves from September to November, 2020. Clinicians delivering direct care to COVID-19 patients were eligible. Clinician burnout was measured using a single item from AHRQ’s Mini-Z survey. We assessed sleep using the Pittsburgh Sleep Quality Index (PSQI). Binary logistic regressions were used to determine the relationship between PSQI global score (global sleep quality) and burnout, controlling for age, race/ethnicity, gender, length of time employed, whether clinical role changed during COVID-19, and anxiety. In a separate model, we investigated the association between burnout and independent PSQI subcomponents: 1) sleep duration (“Hours of sleep per night”), and 2) subjective sleep quality (“How would you rate your sleep quality overall”) entered together, with the above covariates.

Results

The final sample included 315 clinicians, predominantly nurses (57% White, 15% Hispanic/Latino, 89% female). Burnout symptoms were reported by 61.6%, and poor global sleep quality (PSQI global score >5) in 84.4% of participants. Poor global sleep quality (PSQI global score >5 vs. ≤5) was significantly associated with the presence of burnout symptoms (OR: 2.52, 95% CI: 1.20–5.28, p=0.015). In the secondary model, self-reported sleep quality (rating of fairly or very bad vs. rating of fairly or very good) was significantly associated with burnout (OR: 4.13, 95% CI: 2.33–7.32, p<0.05), whereas short sleep duration (<6 h vs. ≥6 h) was not (OR: 0.726, 95% CI: 0.41–1.30, p=0.28).

Conclusion

Poor sleep quality is common and associated with increased burnout in clinicians delivering care to COVID-19 patients. Interestingly, sleep quality appears to be more strongly related to burnout than sleep duration. Increased evidence about the negative implications of poor sleep and burnout are emerging. Interdisciplinary efforts aimed at promoting effective sleep quality in clinicians during this pandemic may lead to improvements in long-term clinician physical and psychological health.

Support (if any):

650 The Association between Sleep and Psychological Distress among New York Healthcare Workers During the COVID-19 Pandemic

Introduction

Healthcare workers (HCWs) treating patients with COVID-19 report high rates of acute stress, depressive and anxiety symptoms. We examined whether sleep disturbances were associated with psychological distress in New York City (NYC) HCWs during the initial peak of COVID-19 in-patient admissions (April 9 - May 11, 2020).

Methods

HCWs (physicians, nurses, and advanced practice providers) completed a web-based survey which screened for acute stress (4-item Primary Care PTSD screen), depressive symptoms (Patient Health Questionnaire-2), and anxiety (2-item Generalized Anxiety Disorder scale). Past week insomnia symptoms were assessed with a modified item from the Insomnia Severity Index (5-point Likert Scale: none, mild, moderate, severe, very severe). Insomnia was defined as having “moderate, severe, or very severe” symptoms. Short sleep (SS) was defined as self-reported sleep duration &lt;6 hours per day. Poisson regression analyses predicting psychological distress from SS and, separately insomnia. adjusting for age, gender, race/ethnicity, clinical setting (COVID-focused or not COVID-focused), physician vs. non-physician status, and redeployment status, were performed.

Results

Data included 813 HCWs (80.6% female, 59.0% White, 75.6% worked in a COVID-focused setting). Mean sleep duration was 5.79 ± 1.22 hours/night. The prevalence of SS and insomnia were 38.8% and 72.8%; the prevalence of acute stress, depressive symptoms, and anxiety were 57.9%, 33.8% and 48.2%, respectively. Having SS, vs. not was associated with acute stress (adjusted prevalence ratio [PR]: 1.21, 95% CI: 1.07, 1.31), depressive symptoms (PR: 1.65, 95% CI: 1.35, 2.02), and anxiety (PR: 1.51, 95% CI: 1.30, 1.74). Presence of insomnia symptoms vs. “none or mild” was associated with acute stress (PR: 1.92, 95% CI: 1.57, 2.34), depressive symptoms (PR: 3.13, 95% CI: 2.16, 4.52), and anxiety (PR: 2.40, 95% CI: 1.86, 3.11).

Conclusion

Among NYC HCWs, sleep disturbances, including SS and insomnia symptoms during COVID-19 are common. In our study, SS and insomnia were associated with acute stress, depressive symptoms, and anxiety in HCWs, however further research on whether a bidirectional relationship exists between sleep and psychological distress during the COVID19 pandemic are still needed.

Support (if any):

738 Effects of exogenous melatonin on sleep, circadian rhythms, and mood in women with premenstrual dysphoric disorder

Introduction

Most women with premenstrual dysphoric disorder (PMDD) report sleep disturbances. Our group found normal polysomnographic (PSG) sleep efficiency and increased slow wave sleep (SWS) across the menstrual cycle in women with PMDD and insomnia compared to controls. Reduced melatonin levels were found in PMDD women compared to controls, with reduced secretion during their luteal phase (LP) compared to follicular phase (FP). Here, we investigated the effects of exogenous melatonin in the patients we previously studied.

Methods

Five patients (age, mean: 33.6, SD: 2.7) diagnosed prospectively with PMDD and insomnia participated in the study. Following a baseline assessment, patients took 2 mg of slow-release melatonin 1h before bedtime during their LP for three consecutive menstrual cycles. At baseline (treatment-free condition), patients spent every third night of their menstrual cycle sleeping in the laboratory. Measures included morning urinary 6-sulfatoxymelatonin (aMt6), PSG sleep, nocturnal core body temperature (CBT), visual analogue scale for mood (VAS-Mood), Prospective Record of the Impact and Severity of Menstrual symptoms (PRISM), subjective sleep and ovarian hormones (estrogen and progesterone). Participants also underwent two 24-hour intensive physiological monitoring (during the FP and LP) in time-isolation/constant conditions to determine 24-hour plasma melatonin and CBT rhythms. The same measures were repeated during their third menstrual cycle of melatonin administration.

Results

In the intervention condition compared to baseline, we found increased urinary aMt6 (p&lt;0.001), reduced objective SOL (p=0.01), SWS (p&lt;0.001) and increased Stage 2 sleep (p&lt;0.001). Increased urinary aMt6 was associated with reduced SWS (r=-0.51, p&lt;0.001). Circadian parameters derived from 24-hour plasma melatonin and CBT did not differ between conditions, except for an increased melatonin mesor in the intervention condition (p=0.01). Ovarian hormones were comparable between the conditions (p≥0.28). Symptoms improved in the intervention condition, as measured by the VAS-Mood (p=0.02) and the PRISM (p&lt;0.001).

Conclusion

We have shown normalization of SWS and reduction in self-reported mood and somatic symptoms after administrating exogenous melatonin in women with PMDD. These findings support a role for disturbed melatoninergic system in PMDD that can be partially corrected by exogenous melatonin.

Support (if any)

This study was supported by the Canadian Institutes of Health Research (CIHR)

Objective short sleep duration and 24-hour blood pressure

Background

Short sleep duration is a contributor to cardiovascular disease (CVD) events and mortality. Short sleep duration is associated with an increased risk of high clinic blood pressure (BP). BP measured outside the clinic using 24-h ambulatory blood pressure monitoring (ABPM) is a better predictor of an individual's CVD risk. We examined the association between objectively-assessed sleep duration and 24-h ambulatory blood pressure (ABP).

Methods

A total of 893 working adults underwent sleep and ABPM. Participants were fitted with an ABPM device, and measures were taken at 28-30 min intervals. Objective sleep duration, and times of wakefulness and sleep during the 24-h ABPM period were derived from wrist-worn actigraphy. Linear regression, adjusted for age, sex, race/ethnicity, body mass index, smoking status, and diabetes were conducted on the relationship between sleep duration and the ABP measures.

Results

Mean age of participants (final n = 729, 59.5% female, 11.9% Hispanic) was 45.2 ± 10.4 y. Mean actigraphy-derived sleep duration was 6.8 ± 1.2 h. Sleep duration <6 h was associated with a 1.73 mmHg higher 24-h systolic BP (p = 0.031) and 2.17 mmHg higher 24-h diastolic BP (p < 0.001). Shorter sleep duration was not associated with mean awake or asleep systolic BP (p = 0.89 and p = 0.92) or mean awake or asleep diastolic BP (p = 0.30 and p = 0.74).

Conclusions

To our knowledge, this is the largest study conducted which assessed sleep duration objectively while measuring 24-h ABP. Shorter sleep duration is associated with higher 24-h BP and potentially cardiovascular risk.

Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease

Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.

U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines

INTRODUCTION

Physical inactivity, high screen time, and short sleep are targets of public health initiatives for children. However, few data exist on how many U.S. children meet guidelines for these behaviors-data vital to inform which needs greater targeting. This study describes national prevalence estimates of U.S. children who meet physical activity, screen time, and sleep guidelines alone or in combination across each childhood year.

METHODS

This analysis (completed in 2019) used cross-sectional data from the 2016-2017 National Survey of Children's Health, a nationally representative sample of U.S. children. Child physical activity (days per week with ≥60 minutes), recreational screen time (hours per day of TV viewing and electronic device use), and sleep duration (hours per day) were assessed through parental report. Guidelines recommend ≥60 minutes per day of physical activity, ≤2 hours per day of screen time, and 9-12 hours per day of sleep for individuals aged 6-12 years (8-10 hours for those aged 13-17 years).

RESULTS

Only 8.8% (95% CI=8.2%, 9.5%) of U.S. children meet all the 3 guidelines combined. Majority of children/adolescents attain the sleep guideline (86.0%, 95% CI=85.2%, 86.7%), but a lower proportion meet physical activity (23.0%, 95% CI=22.1%, 23.9%) or screen time (32.9%, 95% CI=31.9%, 33.8%) guidelines. A substantial age effect was identified, with prevalence of meeting each distinct guideline and all the 3 declining with age (p<0.001).

CONCLUSIONS

Few U.S. children meet all the 3 movement guidelines, with prevalence rates of children meeting guidelines declining with age. Although many meet sleep guidelines, few meet physical activity or screen time guidelines. Initiatives targeting physical activity and screen time, especially for adolescents, should be pursued.

Reliability and responsiveness of virtual portion size creation tasks: Influences of context, foods, and a bariatric surgical procedure

Food portion size influences energy intake and sustained high-energy intake often leads to obesity. Virtual portion creation tasks (VPCTs), in which a participant creates portions of food on a computer screen, predict intake in healthy individuals. The objective of this study was to determine whether portions created in VPCTs are stable over time (test-retest reliability) and responsive to factors known to influence food intake, such as eating contexts and food types, and to determine if virtual portions can predict weight loss. Patients with obesity scheduled for bariatric surgery (n = 29), and individuals with a normal BMI (18.5-24.9 kg/m2, controls, n = 29), were instructed to create virtual portions of eight snack foods, which varied in energy density (low and high) and taste (sweet and salty). Portions were created in response to the following eating situations, or "contexts": What they would a) eat to stay healthy (healthy), b) typically eat (typical), c) eat to feel comfortably satisfied (satisfied), d) consider the most that they could tolerate eating (maximum), and e) eat if nothing was limiting them (desired). Tasks were completed before, and 3 months after, surgery in patients, and at two visits, 3 months apart, in controls. Body weight (kg) was recorded at both visits. Virtual portions differed significantly across groups, visits, eating contexts, energy densities (low vs. high), and tastes (sweet vs. salty). Portions created by controls did not change over time, while portions created by patients decreased significantly after surgery, for all contexts except healthy. For patients, desired and healthy portions predicted 3-month weight loss. VPCTs are replicable, responsive to foods and eating contexts, and predict surgical weight loss. These tasks could be useful for individual assessment of expectations of amounts that are eaten in health and disease and for prediction of weight loss.

Interventions to reduce short-wavelength ("blue") light exposure at night and their effects on sleep: A systematic review and meta-analysis

The sleep-wake and circadian cycles are influenced by light, particularly in the short-wavelength portion of the visible spectrum. Most personal light-emitting electronic devices are enriched in this so-called "blue" light. Exposure to these devices in the evening can disturb sleep. Interventions to reduce short-wavelength light exposure before bedtime may reduce adverse effects on sleep. We conducted a systematic review and meta-analysis to examine the effect of wearing color-tinted lenses (e.g. orange or amber) in frames to filter short-wavelength light exposure to the eye before nocturnal sleep. Outcomes were self-reported or objective measures of nocturnal sleep. Relatively few (k = 12) studies have been done. Study findings were inconsistent, with some showing benefit and others showing no effect of intervention. Meta-analyses yielded a small-to-medium magnitude combined effect size for sleep efficiency (Hedge's g = 0.31; 95% CI: -0.05, 0.66; I2 = 38.16%; k = 7), and a small-to-medium combined effect size for total sleep time (Hedge's g = 0.32; 95% CI: 0.01, 0.63; I2 = 12.07%; k = 6). For self-report measures, meta-analysis yielded a large magnitude combined effects size for Pittsburgh Sleep Quality Index ratings (Hedge's g = -1.25; 95% CI: -2.39, -0.11; I2 = 36.35%; k = 3) and a medium combined effect size for total sleep time (Hedge's g = 0.51; 95% CI: 0.18, 0.84; I2 = 0%; k = 3), Overall, there is some, albeit mixed, evidence that this approach can improve sleep, particularly in individuals with insomnia, bipolar disorder, delayed sleep phase syndrome, or attention-deficit hyperactive disorder. Considering the ubiquitousness of short-wavelength-enriched light sources, future controlled studies to examine the efficacy of this approach to improve sleep are warranted. Systematic review registration: PROSPERO 2018 CRD42018105854.

0172 Blue-Light Blockers and Sleep: A Meta-Analysis of Intervention Studies

Introduction

Sleep and circadian physiology are influenced by external light, particularly within the short-wavelength portion of the visible spectrum (~450–480 nm). Most personal light-emitting electronic devices (e.g., tablets, smartphones, computers) are enriched in this so-called “blue” light. Interventions to reduce short-wavelength light exposure to the eyes before bedtime may help mitigate adverse effects of light-emitting electronic devices on sleep.

Methods

We conducted a meta-analysis of intervention studies on the effects of wearing color-tinted lenses (e.g., orange or amber) in frames in the evening before sleep to selectively filter short-wavelength light exposure to the eyes. Outcomes were self-reported or objective (wrist-accelerometer) measures of nocturnal sleep. Databases (MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, AMED) were searched from inception to November 2019. PROSPERO Registration: CRD42018105854.

Results

Ten studies were identified (7 randomized controlled trials; 3 before-after studies). Findings of individual studies were inconsistent, with some showing benefit and others showing no effect of intervention. For objective sleep onset latency, there was a significant modest-sized combined effect (Hedge’s g=-0.52, 95% CI: -1.27-0.24, Z=-2.94, p=0.003, I2=16.6%, k=3). There was a minor but non-statistically significant combined effect for objective sleep efficiency (Hedge’s g=0.24, 95% CI: -0.16–0.64, Z=1.69, p=0.09, I2=23.7%, k=5). There were no significant combined effects for objective measures of total sleep time and wake after sleep onset. For self-reported total sleep time, there was a statistically significant medium-sized combined effect (Hedge’s g=0.61, 95% CI: 0.14–1.09, Z=5.56, p&lt;0.01, I2=0%, k=3).

Conclusion

There is mixed evidence that this approach can improve sleep. Relatively few studies have been conducted, and most did not assess light levels or melatonin. The “blue-blocker” intervention may be particularly useful in individuals with insomnia, delayed sleep phase syndrome, or attention-deficit hyperactive disorder. Considering the ubiquitousness of short wavelength-enriched light sources and the potential for widespread sleep disturbance, future controlled studies examining the efficacy of this approach to improve sleep are warranted.

Support

N/A

0253 Eating Behaviors, Physical Activity, and Sleep in Shift Workers: Results from a Combined Field and Laboratory Study

Introduction

In shift workers, short sleep duration combined with circadian misalignment may affect behaviors that impact regulation of energy balance and metabolism. We conducted a combined field-and-laboratory study to determine how real-life shift work affects diet, physical activity, and sleep via objective and self-report measures.

Methods

Participants were day (n=12) and night (n=12) shift workers from an urban hospital setting (nurses and technicians, all female). During the field portion of the study, participants wore a wrist-mounted accelerometer to track sleep and physical activity during their series of shifts, and completed a computer-assisted 24-hour dietary recall. After awakening from the sleep episode following the final work shift, participants entered the laboratory in the fasted state and underwent an ad libitum 14-item test-meal buffet to objectively quantify food choice and intake.

Results

Sleep duration was significantly shorter and worse quality in night vs. day workers. Physical activity levels were not different between groups. Based on 24-h dietary recall, night vs. day workers consumed less protein (65.9 ± 39.0 vs. 87.2 ± 40.7 g, p=0.01) and fiber (12.5 ± 6.0 vs. 16.9 ± 6.2 g, p=0.01), but did not differ in daily intakes of calories, fat, or carbohydrate. Night vs. day workers reported a longer daily window of eating duration (14.2 ± 3.8 vs. 12.0 ± 1.5 h, p=0.02). In the lab test-meal, there were no group differences in total calories consumed. When expressed as percent of calories consumed, night vs. day workers had lower protein intake (11.82 ± 4.05 vs. 16.03 ± 5.69 %; p=0.05).

Conclusion

To our knowledge, this was the first study to include a laboratory-based behavioral assessment of food choice/intake in real-life night and day shift workers using objective measures. We did not assess measures of circadian phase so can only assume that circadian misalignment, in addition to the disturbances in sleep duration and quality, contributes to findings. Changes to dietary patterns in night vs. day workers (namely, reduced protein intake which may affect satiety, and prolonged daily eating duration window) may present potential pathways by which night shift work contributes to risk for overweight and obesity.

Support

UL1TR000040

1154 Self-reported Sleep Duration And Quality Are Associated With Post-traumatic Stress Disorder Following Stroke

Introduction

Up to one in eight patients may experience post-traumatic stress disorder (PTSD) within the year following a stroke or transient ischemic attack (TIA). Sleep disturbance is a chief complaint in PTSD and is common following stroke. We therefore examined whether sleep was associated with post-stroke PTSD.

Methods

The Reactions to Acute Care and Hospitalization (REACH)-Stroke study is an observational cohort study examining factors related to long-term health outcomes following stroke/TIA. Typical sleep duration (self-report) and quality (1: very good to 4: very bad) over the month following hospital discharge was assessed at 1-month follow-up. At 1 month, patients also completed the PTSD checklist for DSM-5 (PCL-5 cued to the stroke/TIA event). Binary logistic regression was conducted, producing odds ratios (OR) on the association between sleep within the month following discharge and PTSD symptoms at 1 month post-stroke, controlling for age, sex, and race/ethnicity.

Results

Analyses included 459 patients (age: 61.1 ± 15.6 y, 53.2% female). Short sleep (&lt;7 h/night) and poor sleep quality (fairly/very bad) was reported in 49.2% and 25.5% of patients, respectively. Elevated PTSD symptoms (PCL-5 score ≥30) at 1 month were reported in 10.9% of patients. Sleep was significantly shorter and worse quality in those with PTSD vs. without (p-values&lt;0.001). Short sleep duration vs. not short duration throughout the month following discharge was significantly associated with elevated PTSD symptoms at 1-month (OR=3.34, 95% CI: 1.51-7.38, p=0.003). Poor sleep quality (fairly or very bad rating) vs. good sleep (fairly or very good rating) was also significantly associated with elevated PTSD symptoms at 1-month (OR=2.23, 95% CI: 1.13-4.41, p=0.021).

Conclusion

Patients with short duration and poor quality sleep in the month following stroke are at an increased risk of having elevated PTSD symptoms. Understanding factors related to the development of post-stroke PTSD is important since PTSD in stroke survivors can reduce quality of life, contribute to non-adherence to prescribed medications, and increase risk of recurrent stroke and/or cardiovascular events. Future studies should be conducted to determine whether sleep is a modifiable determinant of PTSD symptoms after stroke.

Support

R01HL141494, R01HL132347

Short Sleep Duration After Hospital Evaluation for Acute Coronary Syndrome Is Associated With Increased Risk of 6-Month Readmission

OBJECTIVE

Hospital readmission after acute coronary syndrome (ACS) is associated with worsened patient outcomes and financial burden. Short sleep duration is a risk factor for cardiovascular events and may therefore represent a behavioral factor that increases risk of adverse posthospitalization outcomes. This study examined whether short sleep duration in the month after hospital evaluation for ACS is associated with 6-month all-cause emergency department (ED) and hospital readmission.

METHODS

The current analyses entail a secondary analysis of a larger prospective observational cohort study. Sleep duration during the month after hospital evaluation for ACS was assessed subjectively and dichotomized as short (<6 hours) or not short (≥6 hours). A Cox proportional hazards model was used to assess the association between short sleep duration during the month after ACS hospital evaluation and 6-month all-cause ED/hospital readmission.

RESULTS

A total of 576 participants with complete data were included in analyses. Approximately 34% of participants reported short sleep duration during the month after ACS evaluation. Short sleep duration was significantly associated with 6-month all-cause ED/hospital readmission (hazard ratio = 2.03; 95% confidence interval = 1.12-3.66) in the model adjusted for age, sex, race/ethnicity, clinical severity, cardiac and renal markers, depression, acute stress, and including a sleep duration by ACS status interaction.

CONCLUSIONS

Short sleep duration after ACS hospital evaluation is prevalent and is associated with increased risk of all-cause readmission within 6 months of discharge. Current findings suggest that short sleep duration is an important modifiable behavioral factor to consider after hospital evaluation for ACS.

Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic

OBJECTIVE

The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic.

METHODS

This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657).

RESULTS

Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest.

CONCLUSIONS

NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.

Free-Living Sleep, Food Intake, and Physical Activity in Night and Morning Shift Workers

Objective: Shift work is associated with risk for adverse health outcomes including cardiovascular disease, type 2 diabetes, cancer, and obesity. Short sleep duration combined with disruptions to the circadian system may alter factors involved with the behavioral regulation of energy intake and expenditure. We aimed to determine how shift work affects sleep, food intake, and physical activity.Methods: This was a field-based observational study using objective assessments of sleep and physical activity and a 24-hour dietary recall in shift workers. Day (n = 12) and night (n = 12) hospital shift workers (nurses and technicians) who were women had their free-living sleep and physical activity tracked via accelerometry, and completed a computer-assisted 24-hour food recall, during a series of work shifts.Results: Compared to day workers, night workers had significantly shorter sleep duration and reported more premature awakenings and feeling less refreshed upon awakening. Daily self-reported energy and macronutrient intakes were not different between groups, although the night shift workers reported a significantly longer total daily eating duration window than day workers. Objectively recorded physical activity levels were not different between groups.Conclusions: The present findings confirm that sleep is disturbed in women night workers, while there are relatively less effects on objectively recorded physical activity and self-reported food intake. We also observed a prolonged daily eating duration in night vs. day workers. These observations can help inform the design of novel behavioral interventions, including, potentially, time restricted feeding approaches (e.g., by limiting daily eating episodes to within a 10-12 h window), to optimize weight management in shift workers.

Effects of Continuous Positive Airway Pressure on Body Composition in Individuals with Obstructive Sleep Apnea: A Non-Randomized, Matched Before-After Study

A reciprocal relationship between obesity and obstructive sleep apnea (OSA) likely exists, wherein obesity contributes to OSA, and OSA-related sleep disturbances promote weight gain. It remains unclear whether continuous positive airway pressure (CPAP) affects body composition. We conducted an open-label, parallel-arm, non-randomized, matched before-after study in individuals with OSA who were starting CPAP use (n = 12) and who were not (n = 12) to examine the effects of CPAP on total body composition (via air displacement plethysmography) including fat and fat-free mass. CPAP users (n = 12) were studied at baseline and after 8 weeks of CPAP use, and 12 age- and sex-matched non-CPAP OSA controls were studied at baseline and after an 8 week period. Statistically significant group x time interactions were seen for body weight, fat-free mass, and fat-mass, such that body weight and fat-free mass were increased, and fat mass decreased, at 8-week follow-up in the CPAP group compared to baseline. Body weight and body composition measures were unchanged in the non-CPAP control group. These findings are consistent with prior studies showing CPAP-induced weight gain, and suggest that weight gain observed following CPAP may be driven primarily by increases in fat-free mass. An increase in lean mass (and decrease in fat mass), despite an overall increase in body weight, can be considered a favorable metabolic outcome in response to CPAP use.