Abstract MP76: The Association Between Sleep Health and Gestational Weight Gain

Background: Poor sleep health is associated with weight gain and obesity outside of pregnancy. Still, there is little research regarding the impact of sleep health on weight among pregnant populations, particularly using a multidimensional sleep-health framework. This study examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health, and gestational weight gain (GWG).

Methods: This was a secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n=745). Indicators of individual sleep health domains (i.e., regularity, nap duration, timing, efficiency, and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined “good” sleep health in each domain based on empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD), and high (>+1 SD).

Results: We identified four distinct sleep profiles (Figure 1). While indicators of individual sleep domains were not associated with GWG, multidimensional sleep health was associated with higher risk of low GWG. Compared to people with a good sleep profile (Class 1), people with a low efficiency and long sleep duration profile (Class 4) had a 1.88 (95% CI 1.04 to 3.39) higher risk of low GWG (vs. moderate GWG) in models adjusting for education, depressive symptoms, race, smoking status.

Discussion: Multidimensional sleep health was more strongly associated with GWG than were individual sleep domains. Future research should determine whether sleep health is a useful intervention target for optimizing GWG.

Figure 1- Probabilities of each sleep characteristic by sleep profile, derived from latent class analysis

The association between multidimensional sleep health and migraine burden among patients with episodic migraine

STUDY OBJECTIVES

Using the Sleep Regularity, Satisfaction, Alertness, Timing, Satisfaction, and Duration (Ru-SATED) sleep health framework, we examined the association between multidimensional sleep health and headache burden in a cohort of 98 adults with episodic migraine.

METHODS

Participants wore wrist actigraphs and completed twice-daily electronic diaries regarding sleep, headaches, and other health habits for 6 weeks. We calculated separate composite sleep health scores from diary and actigraphy assessed measures using the Ru-SATED framework. We used adjusted multivariable linear regression models to examine the association between composite sleep health scores and headache frequency, duration, and pain intensity.

RESULTS

Among 98 participants (mean age: 35 ± 12 years; 87.8% female), 83 had healthy ranges in ≥ 3 sleep dimensions. In models adjusted for age, sex, menopausal status, physical activity and alcohol intake, good sleep health was associated with fewer headache days/month (actigraphy: 3.1 fewer days; 95% confidence interval: 0.9, 5.7; diary: 4.0 fewer days; 95% confidence interval: 1.1, 6.9). Results did not change substantively with further adjustment for stress and depressive symptoms. We did not observe an association between sleep health and headache duration or intensity, respectively.

CONCLUSIONS

Among patients with episodic migraine, good multidimensional sleep health, but not the majority of singular dimensions of sleep, is associated with approximately 3-4 fewer headache days/month. In addition, there was no association with headache duration or intensity. These findings highlight the importance of assessing multiple dimensions of sleep and suggest that improving sleep health may be a potential clinical strategy to reduce headache frequency.

CITATION

Yoo A, Vgontzas A, Chung J, et al. The association between multidimensional sleep health and migraine burden among patients with episodic migraine. J Clin Sleep Med. 2023;19(2):309-317.

Multidimensional Sleep Health and Long-Term Cognitive Decline in Community-Dwelling Older Men

Specific sleep characteristics have been associated with cognitive decline, Alzheimer's disease, and related dementias; however, studies examining the association between multidimensional sleep (a more comprehensive integration of sleep parameters) and cognitive decline are lacking. Among 2,811 older men without dementia, those with none, 1-2, and 3-5 "poor" self-reported sleep health dimensions had an adjusted 10-year change score of global cognition (3MS) of 2.9, 4.0 and 3.5 points (p-trend = 0.05), and in executive function (Trails B) completion time of 36.7, 42.7, and 46.7 seconds (p-trend < 0.01), respectively. In conclusion, a multidimensional measure of sleep health was associated with greater cognitive decline.

MULTIDIMENSIONAL SLEEP HEALTH AND RECURRENT FALLS: THE OSTEOPOROTIC FRACTURES IN MEN STUDY (MROS)

Prospective studies have reported associations between individual dimensions of sleep and subsequent falls. Considering sleep as a multidimensional construct may provide a more comprehensive assessment. Using data from the MrOS Sleep study, we calculated a multidimensional index of sleep, operationalized as the number of disturbances in 5 dimensions of sleep (self-reported “poor”: satisfaction, duration, daytime sleepiness, latency and sleep midpoint) and categorized as: 0, 1-2, &gt;=3. A total of 3111 men, mean age 76.4 years, were studied. Logistic regression generalized estimating equations were used to model repeated measures of annually self-reported recurrent falls (≥2 falls) over 4 years of follow-up. Compared to men with no poor sleep dimensions, the Odds Ratio (OR) of recurrent falls in men with scores of 1 or 2 was 1.13 (95% Confidence Intervals, 0.96, 1.34), and in men with scores &gt;3, the OR was 1.46(1.15, 1.84). Worse multidimensional sleep health was associated with recurrent falls.

A Nationally Representative Survey Assessing Restorative Sleep in US Adults

Restorative sleep is a commonly used term but a poorly defined construct. Few studies have assessed restorative sleep in nationally representative samples. We convened a panel of 7 expert physicians and researchers to evaluate and enhance available measures of restorative sleep. We then developed the revised Restorative Sleep Questionnaire (REST-Q), which comprises 9 items assessing feelings resulting from the prior sleep episode, each with 5-point Likert response scales. Finally, we assessed the prevalence of high, somewhat, and low REST-Q scores in a nationally representative sample of US adults (n= 1,055) and examined the relationship of REST-Q scores with other sleep and demographic characteristics. Pairwise correlations were performed between the REST-Q scores and other self-reported sleep measures. Weighted logistic regression analyses were conducted to compare scores on the REST-Q with demographic variables. The prevalence of higher REST-Q scores (4 or 5 on the Likert scale) was 28.1% in the nationally representative sample. REST-Q scores positively correlated with sleep quality (r=0.61) and sleep duration (r=0.32), and negatively correlated with both difficulty falling asleep (r=-0.40) and falling back asleep after waking (r=-0.41). Higher restorative sleep scores (indicating more feelings of restoration upon waking) were more common among those who were: ≥60 years of age (OR=4.20, 95%CI: 1.92-9.17); widowed (OR=2.35, 95%CI:1.01-5.42), and retired (OR=2.02, 95%CI:1.30-3.14). Higher restorative sleep scores were less frequent among those who were not working (OR=0.36, 95%CI: 0.10-1.00) and living in a household with two or more persons (OR=0.51,95%CI:0.29-0.87). Our findings suggest that the REST-Q may be useful for assessing restorative sleep.

0316 Actigraphy-Derived Sleep Health Profiles and Mortality in Older Men and Women

Introduction

To identify actigraphy sleep health profiles in older men (Osteoporotic Fractures in Men Study; N=2,640) and women (Study of Osteoporotic Fractures; N=2.430), and to determine whether the identified profiles predict mortality.

Methods

We applied a novel and flexible clustering approach (Multiple Coalesced Generalized Hyperbolic mixture modeling) to identify sleep health profiles based on actigraphy midpoint timing, midpoint variability, sleep interval length, continuity, and napping/inactivity. Adjusted Cox models were used to determine whether profile membership predicts time to all-cause mortality.

Results

We identified similar profiles with different prevalences in men and women: High Sleep Propensity [HSP] (20% of women; 39% of men; high napping and high continuity); Adequate Sleep [AS] (74% of women; 31% of men; average actigraphy levels); and Abnormal Continuity/Timing [ACT] (6% of women; 30% of men; low continuity and late/variable midpoint). In women, ACT was associated with increased mortality risk (Hazard Ratio [HR]=1.59 for ACT vs. AS; 1.75 for IS vs. HSP). In men, ACT and AS were associated with increased mortality risk relative to HSP (1.19 for IS vs. HSP; 1.22 for AS vs. HSP).

Conclusion

These findings suggest several considerations for sleep-related interventions in older adults. For instance, interventions may be developed to target the combination of low continuity with late/variable midpoint. Findings also indicate that high napping/inactivity co-occurs with high sleep continuity in some older adults. Although high napping/inactivity is typically considered a risk factor for deleterious health outcomes, our findings suggest that it may not be inherently problematic when occurring in combination with high sleep continuity.

Support (If Any)

The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH grants U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, UL1 TR000128, R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Study of Osteoporotic Fractures (SOF) is supported by NIH grants R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. This study is also supported by NIH grants R01AG056331 and RF1AG056331 (PI: Wallace), R56AG065251 (PI: Lee), K01MH112683 (PI: Smagula), and R35HL135815 (PI: Redline).

0176 Comparing Sleep and Homeostatic Sleep Drive Between Retired Night Shift Workers and Retired Day Workers

Introduction

Retired night shift workers report poorer sleep quality compared to retired day workers, even after returning to a nocturnal sleep schedule, suggesting a potential “scarring” of night shift work on sleep. History of sleep deprivation and sleep at an unfavorable circadian phase may compromise sleep and homeostatic sleep regulation, potentially contributing to poor sleep quality in retired night shift workers. This study compared sleep efficiency and homeostatic sleep regulation in response to sleep deprivation (delta EEG power during NREM sleep, theta EEG power during wakefulness) between retired night shift workers and retired day workers.

Methods

Participants (N = 75, mean age: 68.3 +/-5.5 years, 51% females, 87% non-Hispanic White) were 35 retired night shift workers and 40 age-, sex-, and race-equated retired day workers. Participants completed a 60-hour laboratory study including one baseline night of sleep, followed by 36 hours of sleep deprivation, followed by one recovery night of sleep. Sleep efficiency and NREM delta EEG power were measured by polysomnography on both nights, and waking theta EEG power was measured every other hour during the 36-hour sleep deprivation period. We analyzed the effects of group (retired night shift workers vs. retired day workers), time (baseline vs. recovery night for sleep efficiency and delta EEG power, hour for theta EEG power), and their interaction on each outcome using linear mixed models.

Results

Groups did not differ in sleep efficiency averaged across nights (F=1.48, p&gt;0.05) or from baseline to recovery nights (F=0.05, p&gt;0.05). Delta EEG responses to sleep deprivation did not differ by group (F=0.33, p&gt;0.05). Compared to retired day workers, retired night shift workers showed greater overall waking EEG theta power during sleep deprivation (F=13.20, p&lt;0.001). The group by time interaction was not significant (F=0.36, p&gt;0.05), suggesting that group differences in theta EEG power were not due to increased sleep deprivation.

Conclusion

Sleep efficiency and homeostatic sleep regulation appeared to be preserved in retired night shift workers. Theta EEG power findings suggested greater sleep propensity during wakefulness in retired night shift workers. Interventions to improve sleep quality in retired night shift workers may leverage intact homeostatic sleep regulation mechanisms.

Support (If Any)

R01AG047139, T32HL082610, T32HL07560, T32MH019986

0470 Pre-treatment Objective Short Sleep is Associated with Poor Treatment Response in Patients with Insomnia and Major Depression: A Report from the TRIAD Study

Introduction

Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral insomnia therapy insomnia (CBT-I) but such studies have not included patients with comorbid conditions. This study was conducted to determine whether pre-treatment sleep duration moderates the response of patients with major depression (MDD) and insomnia (ID) disorders to a combined CBT-I and antidepressant medication treatment.

Methods

This study involved a secondary analysis of data from the TRIAD trial that tested combined CBT-I/antidepressant medication treatment of patients with MDD and ID. Participants (N=99; 70 women; Mage = 47.7 +/-12.4 yrs.) completed pre-treatment polysomnography (PSG) and were randomly assigned to a 12-week treatment comprised of antidepressant medication combined with CBT-I or a sham quasi-desensitization therapy for insomnia (DTI). Short and longer sleepers were defined using PSG total sleep time cutoffs of &lt;5, &lt;6 and &lt;7 hours for short sleep. Insomnia and depression remission determined respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned.

Results

Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of &lt;5 hours of sleep was used to define “short sleep.” CBT-I recipients with &gt; 5 hours of sleep were significantly more likely to achieve insomnia remission than were either the DTI recipients with &gt; 5 hours of sleep (OR = 6.72; 95% CI = 2.03 – 22.26) or the CBT-I recipients with short sleep (OR = 18.92; 95% CI = 2.03 – 178.69). The longer sleeping CBT-I group was also more likely to achieve insomnia and/or depression remission than was either the longer sleeping DTI group (OR = 3.12 95% CI = 1.11 – 9.53) or the shorter sleeping CBT-I group (OR = 8.464; 95% CI = 1.40 – 51.12).

Conclusion

Sleeping &lt;5 hours may dispose patients with comorbid MDD/ID to a poor response to combined CBT-I/antidepressant medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted.

Support (If Any)

National Institutes of Health, Grant Numbers MH078924, MH078961, MH079256 and HL096492.

0044 Pre-Pandemic Circadian Phase Predicts Pandemic Sleep, Depression, and Alcohol Use Among Adolescents

Introduction

Growing evidence links later circadian timing during adolescence to worse sleep, more severe depression, and greater alcohol involvement, perhaps due to circadian misalignment and sleep restriction imposed by early school start times. School schedules initially shifted later during the COVID-19 pandemic, which hypothetically should reduce circadian misalignment and sleep restriction for adolescents with later circadian timing, and thus may mitigate any problems with sleep, depression, and alcohol. Here we used the pandemic as a natural experiment to test whether adolescent drinkers with later circadian timing, relative to those with earlier circadian timing, showed improved sleep, depressive symptoms, and alcohol involvement.

Methods

We studied 42 high school students reporting alcohol use (aged 16-18; 27 female participants), assessing circadian phase via the dim light melatonin onset (DLMO) during pre-pandemic conditions, and then following them over four remote assessments every 3 months during the pandemic. Sleep characteristics were assessed via the Munich Chronotype Questionnaire, depressive symptoms were assessed via the Quick Inventory of Depressive Symptomatology, and alcohol use was assessed via a 90-day Timeline Followback. Mixed-effect models focused on the pre-pandemic baseline, COVID baseline (Apr/May 2020), and COVID-9-mo (Jan/Feb 2021) timepoints, and covaried for age, time between pre-pandemic and COVID baselines, and current school/work status.

Results

In the pre-pandemic period, compared to those with earlier circadian timing, individuals with later circadian timing (later DLMO) got relatively less sleep (shorter total sleep time) on school nights. During the pandemic, earlier and later groups no longer differed on school night sleep. Over the course of the pandemic, compared to the earlier group, individuals with later circadian timing also reported larger increases in alcohol use (number of drinks, drinking days, and maximum drinks). Individuals with later circadian timing reported relatively greater depressive symptoms both pre-pandemic and 9-months into the pandemic.

Conclusion

While individuals with later circadian timing benefitted in terms of more school night sleep during the pandemic, this did not translate to mitigating depression or alcohol use. These findings suggest that later circadian timing may contribute to risk for depression and alcohol use over and above effects due to insufficient sleep.

Support (If Any)

Supported by grants from NIH (R01AA025626; P50DA046346).

0247 Sleep Disturbance is Associated with Dysregulation of Positive and Negative Affect Systems

Introduction

Sleep disturbance is a risk factor for the development of mood disorders and up to 90% of mood disorder patients report sleep problems. However, the neural mechanisms by which poor sleep contributes to mood disorders are not well understood. We investigated whether sleep disturbance was associated with dysregulation of positive and negative affect systems, including passive reactivity and active emotion regulation.

Methods

Participants (n=55, Mage=24.4 years, 53% female) selected for high, medium, and low scores on the PROMIS Sleep Disturbance scale completed a cognitive reappraisal task in an fMRI scanner. Participants were presented with International Affective Picture Stimuli (30 positive, 30 negative, 15 neutral) and were instructed to either passively view or actively up- or down-regulate their emotional experience. We tested five conditions: view-positive, upregulate-positive, view-negative, downregulate-negative, view-neutral. Participants also completed objective (i.e., 7-day actigraphy) and self-report (i.e., Insomnia Severity Index [ISI]) measures of sleep prior to the scan. Analyses in AFNI were constrained within an emotion regulation network, identified using a Neurosynth mask, and treated as a single region of interest. Voxelwise (puncorr&lt;.005) and clusterwise thresholds (p&lt;.05) were used to correct for multiple comparisons.

Results

Actigraphy-assessed sleep duration was associated with supplementary motor area (SMA) activity when upregulating positive affect relative to passively viewing positive images (k=44 voxels, clusterwise p=.04); participants who slept less showed greater SMA activity. ISI score was marginally associated with dorsolateral prefrontal cortex (dlPFC) activity when downregulating negative affect relative to an implicit baseline (k=30 voxels, clusterwise p=.10); individuals with greater insomnia severity showed more dlPFC activity. PROMIS Sleep Disturbance showed no significant associations.

Conclusion

Markers of poor sleep (i.e., lower sleep duration, greater insomnia severity) were associated with heightened SMA and dlPFC activity during cognitive reappraisal. This may suggest inefficiency in modulating positive affect via verbal and motor processes (i.e., SMA) and negative affect via cognitive control (i.e., dlPFC). Alternatively, individuals with poor sleep may have greater emotional reactivity to modulate. Mood disorders are commonly associated with increased negative affect and blunted positive affect. Our findings suggest a plausible neural substrate for how sleep disturbance contributes to dysregulation of these systems.

Support (If Any)

NIMH R21 MH102412.

0210 Social rhythm regularity: Associations with sleep, circadian, mental health, and alcohol use outcomes in adolescents

Introduction

Circadian rhythms and sleep regularity relate to a range of negative health outcomes, such as mental illness and substance abuse including binge drinking. According to the social zeitgeber hypothesis, the timing of key modifiable daily behaviors serves as time cues that entrain circadian rhythms, ostensibly stabilizing them and thereby improving health. The cross-day stability in timing of these behaviors (i.e., social rhythm regularity) is measured by SRM5; however, studies have not tested whether SRM5 correlates with circadian rhythm regularity based on physiological measures, such as dim light melatonin onset (DLMO). The current study examined whether SRM5 was associated with: (1) the regularity of circadian rhythms and/or sleep regularity metrics, and (2) sleep quality, depression, and binge drinking.

Methods

Late adolescents aged 18 to 22 years old who drink alcohol (n = 36; 61.1% female, Mage = 21.26) completed a self-reported sleep diary (including SRM5 items for first contact, start work, and dinner time), wore a wrist actigraph for 14 days, and completed 2 overnight visits to assess DLMO. We used the self-reported data to calculate SRM5 and standard deviation (StDev); actigraphy data to calculate composite phase deviation (CPD), social jet lag (SJL), and interdaily stability (IS); and DLMO data to calculate the stability of the circadian phase (Sunday minus Thursday). Participants also completed surveys that assessed global sleep quality, depressive symptoms, and frequency of binge drinking. Correlational analysis and hierarchical linear regression modeling were used.

Results

Higher SRM5 scores (i.e., higher social rhythm regularity) were associated with higher regularities of mid-sleep timing (r = –.48, p &lt; .001) and total sleep duration (r = –.41, p = .01) based on StDev metrics but were not associated with IS (r = 13, p = .45), CPD (r = –.19, p = .28), SJL (r = –.07, p = .68), and stability of DLMO (r = –.003, p = .99). A post-hoc analysis found that higher stability of the “out of bed” item of SRM5 was related to higher stability of DLMO (b = –.11, se = .05, p = .03, r2 = .33). Higher SRM5 scores were associated with better sleep quality (b = –.73, se = .30, p = .02, r2 = .21), but were not with depressive symptoms or binge drinking

Conclusion

In contrast with the social zeitgeber hypothesis, SRM5 was not associated with circadian rhythm regularity measured by DLMO. However, social rhythm regularity is an important factor in predicting better sleep quality. This study provides a foundation for future research with better power to determine the extent to which social rhythms influence circadian stability and to better understand why social rhythm regularity relates to sleep quality.

Support (If Any)

This research was supported by the NIH NIAAA (R21AA023209-02 ), NHLBI (T32HL082610), and NIMH (T32MH019986)

0612 Does Coping Strategy Protect Sleep Quality During COVID-19? An Examination of Racial, Ethnic, Cultural Differences

Introduction

Little has been done to examine within/between group predictors and mediators of race/ethnic differences in sleep health outcomes, due to COVID-19 exposure. We evaluated the effect of COVID-19 exposure on sleep quality in a multiracial/ethnic sample of New York residents.

Methods

We conducted a cross-sectional study among adults exposed to COVID-19 across New York State from September to November of 2020. Comparisons of participant characteristics e.g., mean scores by race/ethnicity status were made using one-way ANOVA for continuous variables, and chi-square tests for categorical variables. Associations between social determinants of health (employment, location), Trauma Coping Self-Efficacy (CES-T), and sleep quality (Pittsburgh Sleep Quality Index-PSQI) were examined using multilinear regression analysis stratified by race/ethnicity.

Results

Of the 541 participants, 373 (68.9%) were female; mean age was 40.9 years (SD=15), 198 (36.6%) identified as Whites, 111 (20.5%) as Black, 97 (17.9%) as Hispanics, and 135(25%) identified as either Asians, Native-Americans, Pacific-Islanders. Sex was the strongest predictor [β = 1.335; p < .05] of sleep quality, but only among Whites. Trauma Coping Self-Efficacy was negatively associated with sleep quality among Asian, Native-American, or Pacific-Islander participants [β = -.114; p < .05 ]; Black [β = -.099; p < .05] and White participants [β = -0.79; p < .05] but not among Latinos/as [β = -.058; p = 0.71].

Conclusion

Coping Self-Efficacy moderated the effect of COVID-19 on sleep quality among some, but not all, racial/ethnic groups. While CSE-T scores during the first wave of COVID-19 acted as a protective factor for sleep quality among Asians, Native-Americans, and Pacific-Islanders, White and Black participants, this was not the case for Latinos/as/Hispanics residing in New York. Clinical interventions that are tailored for racial/ethnic, community and cultural needs may help to mitigate sleep problems associated with COVID-19 exposure.

Support (If Any)

T32HL129953; 7R01HL142066-04; 1R01HL152453-01

0315 Quantifying the Temporal Relationship Between Self-report Sleep Quality and Cognition in Older Adults

Introduction

Poor sleep is a promising modifiable risk factor for impaired cognition in older adults. However, the relationship between sleep and cognition is likely bi-directional, and few studies have examined these temporal associations. We seek to investigate the temporal relationships between self-report sleep quality and global cognition.

Methods

Our analytic sample includes 1,610 participants from the Memory and Aging Project and Minority Aging Research Study without cognitive impairment at the initial visit (41% black, 77% female, mean[min,max] age = 77[54,100] years). Participants have cognition and sleep quality measured at an initial visit and up to 14 years of annual follow-up (median 6 years). Sleep quality was measured using a modified 10-item Pittsburgh Sleep Quality Index score (higher scores indicating worse quality) and standardized; global cognition was a composite z-score computed from an average of 19 cognitive tests. We used linear mixed effects models to quantify the concurrent and prospective (1-year) relationships of sleep quality and global cognition. Quadratic terms were also tested to allow for a potentially U-shaped relationship.

Results

When examining same-year associations with cognition as the outcome, sleep quality and cognition exhibit a negative quadratic association (linear term BL[p] = 0.01[0.021]; quadratic term BQ[p] = -0.01[0.051]), indicating that both better- and worse-than-average sleep quality are associated with lower cognition. Regarding 1-year associations, both better- and worse-than average sleep quality predict worse next-year global cognition (BL[p] = 0.01[0.008], BQ[p] = -0.01[0.033]). In contrast, better-than-average cognition predicts worse next-year sleep quality (B L[p] = 0.05[p=0.005]; BQ[p] = -0.01[0.650]) with a stronger association in this direction.

Conclusion

Understanding the temporal association between sleep and cognition has important implications for screening and development of novel treatments and interventions. The finding that both better and worse sleep quality are associated with worse cognition may reflect an underreporting of poor sleep symptoms in older adults with worsened cognition. Future work will examine these associations considering specific domains of self-report sleep (e.g., timing, efficiency, duration) and cognitive function (memory and perception), consider mechanisms relating sleep and cognition, and use objective measures of sleep (e.g., actigraphy).

Support (If Any)

RF1AG056331 (PI: Wallace), R01AG17917, R01AG22018

649 Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic

Introduction

The COVID-19 pandemic is an enormous stressor that can impact various dimensions of health, including sleep health. Older adults may be particularly vulnerable. Coping strategies to manage stress can also impact health outcomes by modifying the relationships between perceived stress and health outcomes. This study examined concurrent and longitudinal associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether coping strategies moderate these associations.

Methods

Older adults (n = 115; Mage = 68.62, 58.3% female) reported perceived stress (PSS), coping strategies (Brief COPE), global sleep quality (PSQI global sleep quality score and dichotomous good/poor sleep quality), depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12) before and during the COVID-19 pandemic.

Results

The number of individuals with poor sleep quality was greater during the COVID-19 pandemic than before (50% vs. 36.5%). Participants also reported poorer physical health during the COVID-19 pandemic than before. Hierarchical linear regression and hierarchical logistic regression revealed that higher perceived stress was cross-sectionally associated with poorer sleep (e.g., higher total PSQI score and dichotomous sleep quality category). Higher perceived stress was associated with worse depressive symptoms and global mental health concurrently and longitudinally. Coping strategies moderated the relationships between perceived stress and physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health for those who have lower problem-focused coping—but not for those with higher problem-focused coping—both concurrently and longitudinally.

Conclusion

Perceived stress influences cross-sectional and longitudinal measures of sleep health and general health among older adults during the COVID-19 pandemic. Coping strategies can moderate the effects of perceived stress on health outcomes. Older adults may benefit from prevention and intervention strategies targeting stress management and problem-focused coping strategies.

Support (if any)

This research was supported by the National Institute of Aging (R01AG047139), the National Heart, Lung, and Blood Institute (T32HL007560; T32HL082610), and the National Institute of Mental Health (T32MH019986)

540 Age Trends in Sleep Across the Lifespan: Findings from the Pittsburgh Lifespan Sleep Databank

Introduction

Sleep continuously changes over the human lifespan and it does so across multiple dimensions, including duration, timing, efficiency, and variability. Although studies focused on specific developmental periods have shown age-related changes in sleep, methodological differences make it difficult to synthesize information across studies to fully understand precisely when these sleep changes occur. Our goal was to use individual-level actigraphy and self-report sleep data from a single site to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human lifespan. To accomplish this goal, we developed the Pittsburgh Lifespan Sleep Databank (PLSD), a large aggregate databank of participants from sleep research studies conducted at the University of Pittsburgh.

Methods

In the present analysis, we included N=1,070 PLSD participants from 21 studies without a major psychiatric, sleep, or medical condition. We used Generalized Additive Models to examine flexible, potentially non-linear relationships between age and sleep dimensions (actigraphy and self-report duration, efficiency, and timing; actigraphy variability) from ages 10 to 87. We also examined whether these sleep characteristics differed by sex across the lifespan.

Results

The most dramatic age-related trends were observed in sleep timing. Actigraphy and self-report sleep onset time shifted later between ages 10–18 and then shifted earlier again during the 20s. Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s. Self-report duration became shorter from approximately ages 10–20. Self-report sleep efficiency and actigraphy variability both decreased over the entire lifespan. Relative to males, females tended to have earlier self-report sleep onset, higher actigraphy sleep efficiency, and longer actigraphy duration.

Conclusion

By focusing on lifespan sleep rather than specific age segments of the samples, we can provide a unified assessment of age-related changes and sex differences from childhood through older adulthood. An understanding of age trends and sex differences in sleep in healthy individuals – and explicating the timing and nature of these difference – can be used to identify periods of sleep-related risk or resilience and guide intervention efforts.

Support (if any)

University of Pittsburgh Clinical and Translational Science Institute (UL1TR001857).

374 Cognitive Behavioral Therapy with Exercise in Adults with Insomnia and Short Sleep: Daytime Function Outcomes from a Pilot Study

Introduction

Cognitive behavioral therapy for insomnia (CBT-I) is efficacious, but there is mixed evidence as to whether improvement is blunted in adults with insomnia and short sleep duration. Exercise training can reduce physiologic hyperarousal and may increase homeostatic sleep drive, which could potentiate CBT-I treatment effects. This pilot study explored changes in self-reported outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and objective short sleep duration.

Methods

Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (mean actigraphic TST &lt;6.5 hr) completed a 12-week single-arm trial. Participants self-administered the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program with additional staff guidance while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 days/wk of strength training). Participants completed assessments of self-reported sleep and daytime function pre- and post-intervention, including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), Ford Insomnia Response to Stress Test (FIRST), Perceived Stress Scale (PSS), and Epworth Sleepiness Scale (ESS). Differences between timepoints were analyzed using paired t-tests and Cohen’s d effect size calculations.

Results

Insomnia severity significantly decreased after the intervention (ISI: p&lt;0.001, d=2.99), with 75% reporting post-intervention ISI ≤ 7. Likewise, fatigue significantly decreased after the intervention (FFS: p=0.032, d=0.95). Symptoms of stress-related sleep reactivity and stress were also reduced (FIRST: p=0.012, d=1.19; PSS: p=0.014, d=1.14). Though nonsignificant, large reductions in sleepiness were additionally observed (ESS: p=0.058, d=0.80).

Conclusion

In this pilot trial among patients with insomnia and short sleep duration, online CBT-I plus a supervised exercise program resulted in a significant reduction in insomnia severity. The intervention also produced large and meaningful reductions in fatigue and stress, which are common daytime impairments in patients with insomnia. Future research should attempt to disentangle the independent contributions of CBT-I and exercise on outcomes in this population.

Support (if any)

NIH: K23HL118318

221 Social Integration and Sleep Quality during the COVID-19 Pandemic: Prospective Evidence from a Study of Retired Older Adults

Introduction

Growing evidence has documented the adverse impact of the global coronavirus pandemic on sleep quality. Older adults may be especially susceptible to declines in sleep quality for multiple reasons, including their elevated risk of social isolation and loneliness during the pandemic. Given the adverse health consequences of poor sleep, there is a need to identify resilience factors that help protect older adults against decreased sleep quality. Social integration is a plausible resilience factor because involvement in a broad range of social relationships is thought to promote psychological well-being (e.g., meaning, purpose in life), as well as reduce the intensity and duration of negative psychological states. Social integration may also assume increased importance during the coronavirus pandemic because of normative declines in overall social contact. This prospective study assessed the impact of the coronavirus pandemic on older adults’ sleep quality and tested whether social integration moderated the impact of the pandemic on sleep quality.

Methods

A sample of 115 retired older adults (mean age = 68.6, 58% female, 89% white) completed self-report assessments of their social integration (number of roles on Cohen’s Social Network Index) and sleep quality (global score on Pittsburgh Sleep Quality Index) before and after the onset of the coronavirus pandemic (mean duration of follow-up = 2.3 years).

Results

Multilevel analyses indicated that social integration moderated the impact of the coronavirus pandemic on sleep quality; there was no main effect of time. Older adults with low social integration had reduced sleep quality from Time 1 to Time 2 (b=.94, p=.02), whereas older adults with high social integration showed no changes in sleep quality over time (b=-.38, p=.37).

Conclusion

Broader social networks confer resilience against pandemic-related declines in sleep quality among older adults. The level of social integration should be addressed when studying or treating sleep complaints during the coronavirus pandemic. Additional research is warranted to determine whether psychosocial interventions targeted towards older adults with low social integration can reduce observed differences in sleep quality.

Support (if any)

This research was supported by R01AG047139, T32HL007560, T32HL082610, T32MH019986.

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4–5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt “whole-person health and performance” models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.

Multidimensional Sleep Health and Physical Functioning in Older Adults

Prior studies link specific sleep parameters to physical functioning in older adults. Recent work suggests the utility of examining sleep health from a multidimensional perspective, enabling consideration of an individual’s experience across multiple different sleep parameters (e.g., quality, duration, timing). We examined the associations of multidimensional sleep health with objective, performance-based measures of physical functioning in older adults. We conducted a secondary analysis of 158 adults (Mage=71.8 years; 51.9% female) who participated in the Midlife in the United States (MIDUS) 2 and MIDUS Refresher studies. We used data from daily diaries, wrist actigraphy, and self-report measures to derive a composite multidimensional sleep health score ranging from 0-6, with higher scores indicating better sleep health. Physical function was assessed using gait speed during a 50-foot timed walk, lower extremity strength as measured by a chair stand test, and grip strength assessed with dynamometers. We used hierarchical regression to examine the associations between sleep health and gait speed, lower extremity strength, and grip strength. Age, sex, race, education, depression symptoms, medical comorbidity, and body mass index were covariates in each model. In adjusted analyses, better multidimensional sleep health was significantly associated with faster gait speed (B=.03, p=.01). Multidimensional sleep health was not significantly associated with lower limb strength (B=-.12, p=.89) or grip strength (B=.45, p=.40). Gait speed is a key indicator of functional capacity as well as morbidity and mortality in older adults. Multidimensional sleep health may be a therapeutic target for improving physical functioning and health in older adults.

Do Sleep and Psychological Distress Mediate the Association Between Neighborhood Factors and Pain?

OBJECTIVE

Pain affects millions of American adults. However, individuals from socioeconomically disadvantaged groups experience higher rates of pain, and individuals from racial/ethnic minorities report greater pain severity and pain-related disability. Some studies find an association between neighborhood socioeconomic status and pain. The present study aimed to further understand the association between neighborhood disadvantage and pain, including the role of objective (e.g., crime rates) and subjective neighborhood characteristics (e.g., perceived safety, neighborhood satisfaction), and to examine sleep and psychological distress as potential mediators of these associations.

METHODS

The sample included 820 participants from two predominantly African American socioeconomically disadvantaged neighborhoods. Trained data collectors interviewed participants on a number of self-report measures, and objective neighborhood characteristics were obtained from city crime data and street segment audits.

RESULTS

Subjective characteristics, specifically perceived infrastructure and perceived safety, were associated with pain. Based on bootstrapped regression models, sleep efficiency and psychological distress were tested as mediators of the association between these neighborhood factors and pain. Results of mediation testing indicated that psychological distress served as a significant mediator. Though sleep efficiency was not a mediator, it had a significant independent association with pain.

CONCLUSIONS

Understanding the contribution of sleep problems and psychological distress to pain among at-risk individuals living in disadvantaged neighborhoods is important to identifying ways that individual- and neighborhood-level interventions may be leveraged to reduce pain-related disparities.

Joint analysis of cognitive and circadian variation in Schizophrenia and Bipolar I Disorder

BACKGROUND

Impairment in cognitive variables and alterations in circadian function have been documented among patients with schizophrenia (SZ) and bipolar I disorder (BP1), but it is not known whether joint analysis of these variables can define clinically relevant sub-groups in either disorder.

OBJECTIVES

To evaluate the pattern and relationship of cognitive and circadian function in SZ and BP1 patients with respect to diagnosis and indices of clinical severity.

METHODS

Among patients with SZ and BP1, cognitive function was evaluated using the Penn Computerized Neurocognitive Battery and circadian function was assessed using the Composite Scale of Morningness/ Eveningness (CSM). Clinical severity was estimated using the Global Assessment of Function (GAF) scale, and age at onset of illness (AAO). The patients were compared with community based non-psychotic control individuals and non-psychotic first degree relatives of the SZ patients. The cluster distributions of cognitive function, circadian function and clinical severity were investigated and identified clusters compared across diagnostic groups.

RESULTS

Across participants, the cognitive domains could be separated into two clusters. Cluster 1 included the majority of control individuals and non-psychotic relatives, while SZ patients predominated in Cluster 2. BP1 patients were distributed across both clusters. The clusters could be differentiated by GAF scores, but not AAO. CSM scores were not significantly correlated with individual cognitive domains or with the clusters.

CONCLUSIONS

Clusters based on levels of cognitive function can discriminate SZ patients from control individuals, but not BP1 patients. CSM scores do not contribute to such discrimination.

Stress Reactivity in Insomnia

This study examined whether individuals with primary insomnia (PI) are more reactive to stress than good sleepers (GS). PI and GS (n = 20 per group), matched on gender and age, completed three nights of polysomnography. On the stress night, participants received a mild electric shock and were told they could receive additional shocks during the night. Saliva samples were obtained for analysis of cortisol and alpha amylase along with self-report and visual analog scales (VAS). There was very little evidence of increased stress on the stress night, compared to the baseline night. There was also no evidence of greater stress reactivity in the PI group for any sleep or for salivary measures. In the GS group, stress reactivity measured by VAS scales was positively associated with an increase in sleep latency in the experimental night on exploratory analyses. Individuals with PI did not show greater stress reactivity compared to GS.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

ABSTRACT

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.

Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety

BACKGROUND

Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women.

METHODS

This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.

RESULTS

Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23).

DISCUSSION

Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.

Sleep spindle deficits in antipsychotic-naïve early course schizophrenia and in non-psychotic first-degree relatives

INTRODUCTION

Chronic medicated patients with schizophrenia have marked reductions in sleep spindle activity and a correlated deficit in sleep-dependent memory consolidation. Using archival data, we investigated whether antipsychotic-naïve early course patients with schizophrenia and young non-psychotic first-degree relatives of patients with schizophrenia also show reduced sleep spindle activity and whether spindle activity correlates with cognitive function and symptoms.

METHOD

Sleep spindles during Stage 2 sleep were compared in antipsychotic-naïve adults newly diagnosed with psychosis, young non-psychotic first-degree relatives of schizophrenia patients and two samples of healthy controls matched to the patients and relatives. The relations of spindle parameters with cognitive measures and symptom ratings were examined.

RESULTS

Early course schizophrenia patients showed significantly reduced spindle activity relative to healthy controls and to early course patients with other psychotic disorders. Relatives of schizophrenia patients also showed reduced spindle activity compared with controls. Reduced spindle activity correlated with measures of executive function in early course patients, positive symptoms in schizophrenia and IQ estimates across groups.

CONCLUSIONS

Like chronic medicated schizophrenia patients, antipsychotic-naïve early course schizophrenia patients and young non-psychotic relatives of individuals with schizophrenia have reduced sleep spindle activity. These findings indicate that the spindle deficit is not an antipsychotic side-effect or a general feature of psychosis. Instead, the spindle deficit may predate the onset of schizophrenia, persist throughout its course and be an endophenotype that contributes to cognitive dysfunction.

The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008

OBJECTIVES

Patient-reported outcomes (PROs) are essential when evaluating many new treatments in health care; yet, current measures have been limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The Patient-Reported Outcomes Measurement Information System (PROMIS) provides item banks that offer the potential for efficient (minimizes item number without compromising reliability), flexible (enables optional use of interchangeable items), and precise (has minimal error in estimate) measurement of commonly studied PROs. We report results from the first large-scale testing of PROMIS items.

STUDY DESIGN AND SETTING

Fourteen item pools were tested in the U.S. general population and clinical groups using an online panel and clinic recruitment. A scale-setting subsample was created reflecting demographics proportional to the 2000 U.S. census.

RESULTS

Using item-response theory (graded response model), 11 item banks were calibrated on a sample of 21,133, measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Short forms from each bank were developed and compared with the overall bank and with other well-validated and widely accepted ("legacy") measures. All item banks demonstrated good reliability across most of the score distributions. Construct validity was supported by moderate to strong correlations with legacy measures.

CONCLUSION

PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. Further testing will continue to validate and test PROMIS items and banks in diverse clinical populations.