1156 Polysomnographic Total Sleep Time: A Novel Biomarker For Dementia

Abstract Introduction Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined whether total sleep time (TST) derived from attended overnight polysomnography (PSG) studies is associated with an increased prevalence of dementia diagnosis and determined the optimal cut-point. Methods We identified 69,847 PSG sleep studies using CPT code 95810 from 2000-19 in the US Department of Veteran Affairs (VA) national database of patient care. We used natural language processing to verify PSG reports and extract TST values from the patient free-text notes. We examined a TST of 240-420 minutes in 10-minute increments using a run chart (time series) approach to determine the optimal cut-point for determining greater odds of dementia. Results Patients had a mean age of 55.4±13.8, 91.5% were male, and 64% were Caucasian. PSG studies revealed a mean TST of 310.6±79.5 minutes. The run chart time series analysis revealing < 360 minutes being the optimal cut-point for increased odds of dementia (OR: 1.64, 95% CI: 1.36-1.99, p<.05). Conclusion Lower TST predicted higher prevalence of dementia diagnosis. TST of 360 minutes may serve as the optimal cut-point to determine greater odds of dementia. This is an important study examining PSG sleep duration and the prevalence of dementia across 19 years in the largest integrated healthcare system in the US. TST may function as a potential biomarker for developing dementia. Support This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).

Download Full-text

1157 Comparison Of Polysomnography Total Sleep Time In Veterans With A Dementia Diagnosis, Incipient Dementia, And No Dementia

SLEEP ◽

10.1093/sleep/zsaa056.1151 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A441-A441

Author(s):

J Razjouyan ◽

S Nowakowski ◽

A D Naik ◽

A Sharafkhaneh ◽

M E Kunik

Keyword(s):

Sleep Duration ◽

Total Sleep Time ◽

Sleep Time ◽

National Database ◽

Free Text ◽

Dementia Diagnosis ◽

Veteran Affairs ◽

Department Of Veteran Affairs ◽

The Us ◽

Diagnosis Of Dementia

Abstract Introduction Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined the total sleep time derived from overnight polysomnography (PSG) studies in veterans with a current dementia diagnosis at the time of PSG study (dementia), future diagnosis of dementia following the PSG study (incipient dementia), and no diagnosis of dementia at any time point (no dementia) over a 19-year period. Methods We identified 69,847 PSG sleep studies using CPT code 95810 and all-cause dementia diagnosis using ICD 9/10 codes (e.g., F03.90) from 2000-19 in the US Department of Veteran Affairs (VA) national database. To be included patients must have ≥ 1 VA visits in 12 months leading up to PSG. Dementia diagnosis must be documented on two separate visits between 12 months prior to 6 months following PSG for current dementia group and anytime after the PSG for incipient dementia. We used natural language processing to extract TST values from the patient free-text notes. Analysis of variance was used to compare PSG TST of the three groups. Results Patients had a mean age of 55.4±13.8 at the time of PSG study, 91.5% were male, and 64% were Caucasian. TST of dementia patients (N=1,031) was m=257±110m (d=0.33, p<.05), incipient dementia (N=1,875) was m=253±116m (d=0.35, p<.05) versus no dementia (61,871) m=292±104mins. Conclusion Patients with a diagnosis of dementia at the time of PSG study and patients that went on to receive a diagnosis following their PSG study had a significantly lower total sleep time compared to patients that have never received a dementia diagnosis. This is an important study that compares sleep duration during overnight PSG studies and dementia diagnosis across 19 years in the largest integrated healthcare system in the US. Support This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).

Download Full-text

Personality Traits and Insomnia Symptoms in Shift Workers

Frontiers in Psychology ◽

10.3389/fpsyg.2021.689741 ◽

2021 ◽

Vol 12 ◽

Author(s):

Brigitte Holzinger ◽

Lucille Mayer ◽

Gerhard Klösch

Keyword(s):

Sleep Quality ◽

Personality Traits ◽

Sleep Duration ◽

Total Sleep Time ◽

Sleep Time ◽

Work Schedule ◽

Shift Workers ◽

Time In Bed ◽

Shift Schedules ◽

Insomnia Symptoms

The discrepancy between natural sleep-wake rhythm and actual sleep times in shift workers can cause sleep loss and negative daytime consequences. Irregular shift schedules do not follow a fixed structure and change frequently, which makes them particularly harmful and makes affected individuals more susceptible to insomnia. The present study compares insomnia symptoms of non-shift workers, regular shift workers, and irregular shift workers and takes into account the moderating role of the Big Five personality traits and levels of perfectionism. Employees of an Austrian railway company completed an online survey assessing shift schedules, sleep quality and duration, daytime sleepiness, and personality traits. A total of 305 participants, of whom 111 were non-shift workers, 60 regular shift workers, and 134 irregular shift workers, made up the final sample. Irregular shift workers achieved significantly worse scores than one or both of the other groups in time in bed, total sleep time, sleep efficiency, sleep duration, sleep quality, sleep latency, and the number of awakenings. However, the values of the irregular shifts workers are still in the average range and do not indicate clinical insomnia. Participants working regular shifts reported the best sleep quality and longest sleep duration and showed the least nocturnal awakenings, possibly due to higher conscientiousness- and lower neuroticism scores in this group. Agreeableness increased the effect of work schedule on total sleep time while decreasing its effect on the amount of sleep medication taken. Perfectionism increased the effect of work schedule on time in bed and total sleep time. Generalization of results is limited due to the high percentage of males in the sample and using self-report measures only.

Download Full-text

1092 Attention-deficit/hyperactivity Disorder Symptoms And Sleep Characteristics Within A Seasonal Affective Disorder Spectrum

SLEEP ◽

10.1093/sleep/zsaa056.1087 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A415-A416

Author(s):

K N Kim ◽

D L Wescott ◽

P L Franzen ◽

B P Hasler ◽

K A Roecklein

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Adhd Symptom ◽

Symptom Severity ◽

Daytime Sleepiness ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Onset Latency ◽

Adhd Symptoms ◽

Depression Severity

Abstract Introduction Seasonal affective disorder (SAD) increases risk for attention-deficit/hyperactivity disorder (ADHD), although the mechanism linking SAD and ADHD is unknown. Prior research has identified insomnia and delayed sleep phase in both ADHD and SAD. We hypothesized that sleep duration and timing in SAD would be associated with the severity of ADHD symptoms. Methods Adults with SAD (n = 45) and subsyndromal SAD (S-SAD; n = 18) aged 19-66 years from Pittsburgh, PA., were assessed for ADHD symptoms, self-report sleep quality, depression severity, and daytime sleepiness in the Winter. Participants wore an Actiwatch for 4-14 days, from which we calculated sleep-onset latency, total sleep time, sleep midpoint, and sleep efficiency. We conducted a hierarchical multivariate linear regression to determine if sleep characteristics predict ADHD symptom severity in our sample while controlling for depressive symptoms. Age and gender were added in Step 1, seasonal depression severity in Step 2, actigraphy-based total sleep time, sleep onset latency, midpoint, and efficiency in Step 3, and self-reported sleep quality and daytime sleepiness in Step 4. Results Participants mostly scored in the “likely” or “highly likely” ADHD range (87.30%, n=55), higher than the national prevalence rate (4.4%). When controlling for age, gender, and depression severity, only shorter actigraphy-based total sleep time was associated with higher ADHD symptom severity (β=-0.30, p<0.05). However, when self-reported sleep quality and daytime sleepiness were added as predictors, total sleep time was no longer a statistically-significant predictor of ADHD symptom severity and only daytime sleepiness predicted ADHD symptom severity (β=0.31, p<0.05). Conclusion Our results suggest that individuals with SAD who experience daytime sleepiness and/or possibly shorter actigraphy-based sleep duration experience higher ADHD symptom severity. Treatments like Trans-C or CBT-I to improve daytime sleepiness and sleep duration may be indicated for SAD patients who present with comorbid ADHD symptoms. Support NIMH K.A.R. MH103303

Download Full-text

0409 The Efficacy of Afternoon-Evening Sleep Following Night Shifts on Sleep and Alertness in Nurses with Rotating Shift Work Schedule: Real World Data

SLEEP ◽

10.1093/sleep/zsaa056.406 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A156-A157

Author(s):

J Kim ◽

S Han ◽

S Kim ◽

J Duffy

Keyword(s):

Sleep Duration ◽

Shift Work ◽

Total Sleep Time ◽

Sleep Time ◽

Hospital Nurses ◽

Sleep Timing ◽

Time In Bed ◽

Shift Schedules ◽

Sleep Schedule ◽

Night Shifts

Abstract Introduction The aim of this study was to investigate the efficacy of changing sleep timing to afternoon-evening following nightshifts in hospital nurses with three rapid rotating shift schedules. Methods Hospital nurses with three rotating shift schedules were enrolled for a 1-month pre-intervention and a 1-month intervention study. During the Intervention, sleep timing following nightshifts was directed to afternoon-evening sleep for 8h time-in-bed (TIB) after 1 PM, and ad-lib sleep schedule for other shifts. Baseline and follow-up evaluation included sleep schedule, sleep duration, Epworth sleepiness scale (ESS), insomnia severity index (ISI) for each shift, Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Sleep was assessed by sleep diary and actigraphy. Alertness during the night shift was evaluated using the Karolinska sleepiness scale (KSS) in the beginning and at the end of the shift by texts sent to their cell phones. The participants were asked to give feedback and a willingness to continue this intervention. Results A total of 26 subjects (30.7±8.5years, 25 female) finished the study among 29 nurses who participated in the study. The shift work was 6.5±8.0years. The mean morningness-eveningness scale was 42.1±8.0(31-62). TIB following nightshifts were 379.9±91.2 and 478.4±48.7 min for preintervention and intervention, respectively (p=0.001). Total sleep time (TST) was 328.0±91.0 vs. 361.0±70.4min, respectively following nightshifts (p=0.187, Cohen’s drm = 0.467). BDI, BAI, ESS, and ISI were significantly improved after the intervention. 60.7% and 49% of the participants reported improved alertness, and work efficiency during the nightshift. 17.9% and 42.9% of the participants reported increased sleep duration, and improved sleep quality after nightshift, respectively. Only eight participants were willing to continue the afternoon-evening sleep schedule following night shifts. KSS was not different between pre-intervention and intervention. Conclusion The afternoon-evening sleep schedule modestly increased total sleep time following nightshift. The overall mood, sleepiness and insomnia scale improved after the intervention although the alertness assessed by KSS failed to show the difference. The individual difference should be considered for applying afternoon-evening sleep for rapid rotating shift schedules. Support 2018 Research award grants from the Korean sleep research society and NRF-2019R1A2C1090643 funded by the Korean national research foundation

Download Full-text

652 Association Between Poor Sleep and Lymphocyte Subsets In Chronic HIV Infection

SLEEP ◽

10.1093/sleep/zsab072.650 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A255-A255

Author(s):

Priya Borker ◽

Bernard Macatangay ◽

Naresh Punjabi ◽

Charles Rinaldo ◽

Steven Wolinsky ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Sleep Duration ◽

T Lymphocyte ◽

Lymphocyte Subsets ◽

Total Sleep Time ◽

Sleep Time ◽

Poor Sleep ◽

People Living With Hiv ◽

Hiv Seropositive

Abstract Introduction Low CD4+ T lymphocyte counts and CD4+/CD8+ lymphocyte ratios predict mortality and cardiovascular risk among people living with HIV (PLWH). Whether polysomnographic (PSG) sleep measures impact T lymphocyte subset counts among PLWH is unknown. We sought to evaluate the association between lymphocyte subsets and PSG-derived sleep measures in a cohort with HIV seropositive men. Methods We analyzed data from HIV seropositive men who have sex with men participating in the Multicenter AIDS Cohort Study on antiretroviral therapy for >1 year with undetectable (<500 copies/mL) plasma HIV-1 RNA who underwent a sleep evaluation with home polysomnography. The following seven sleep parameters were examined: total sleep time (TST), sleep efficiency, sleep stage (N1, N2, N3, and REM) duration, and apnea-hypopnea index. Multivariable linear regression models adjusted for age and body mass index were used to assess whether sleep measures were associated with CD4+ T cell count, CD8+ T cell count, or CD4+/CD8+ ratio. Results Participants (n= 286) had a mean age of 55.2 ± 11.3 years, 52.8% had sleep apnea and mean CD4+ count was 728 ± 306 cells/mm3. None of the sleep measures were associated with CD4+ counts but longer TST and REM duration were associated with lower CD8+ counts and higher CD4+/CD8+ ratio. In adjusted analyses, every one hour increase in TST was associated with a 35 ± 18 cells/mm3 lower CD8+ count (p=0.049) and 6.3% elevation in CD4+/CD8+ ratio (p=0.006) while every hour increase in REM was associated with 123 ± 50 cells/mm3 lower CD8+ count (p=0.01) and 20% elevation in CD4+/CD8+ ratio (p=0.003). Conclusion In PLWH, longer total sleep time and REM sleep duration are associated with protective CD4+/CD8+ ratios due to lower CD8+ cell count. Further research is needed to assess if longer sleep duration is associated with decreased inflammatory markers. Support (if any) American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship

Download Full-text

PAX8/PAX8-AS1 DNA methylation levels are associated with objective sleep duration in persons with unexplained hypersomnolence using a deep phenotyping approach

SLEEP ◽

10.1093/sleep/zsab108 ◽

2021 ◽

Author(s):

David T Plante ◽

Ligia A Papale ◽

Andy Madrid ◽

Jesse D Cook ◽

Michael L Prairie ◽

...

Keyword(s):

Dna Methylation ◽

Sleep Duration ◽

Total Sleep Time ◽

Sleep Time ◽

The Body ◽

P Value ◽

Cpg Sites ◽

Infrared Pupillometry ◽

Pax8 Gene ◽

Ad Libitum

Abstract Study Objectives Patients with unexplained hypersomnolence have significant impairment related to daytime sleepiness and excessive sleep duration, the biological bases of which are poorly understood. This investigation sought to examine relationships between objectively measured hypersomnolence phenotypes and epigenetic modification of candidate hypersomnolence genes to advance this line of inquiry. Methods Twenty-eight unmedicated clinical patients with unexplained hypersomnolence were evaluated using overnight ad libitum polysomnography, multiple sleep latency testing, infrared pupillometry, and the psychomotor vigilance task. DNA methylation levels on CpG sites annotated to 11 a priori hypersomnolence candidate genes were assessed for statistical association with hypersomnolence measures using independent regression models with adjusted local index of significance (aLIS) P-value threshold of 0.05. Results Nine CpG sites exhibited significant associations between DNA methylation levels and total sleep time measured using ad libitum polysomnography (aLIS p-value < .05). All nine differentially methylated CpG sites were annotated to the paired box 8 (PAX8) gene and its related antisense gene (PAX8-AS1). Among these nine differentially methylated positions was a cluster of five CpG sites located in the body of the PAX8 gene and promoter of PAX8-AS1. Conclusions This study demonstrates that PAX8/PAX8-AS1 DNA methylation levels are associated with total sleep time in persons with unexplained hypersomnolence. Given prior investigations that have implicated single nucleotide polymorphisms in PAX8/PAX8-AS1 with habitual sleep duration, further research that clarifies the role of DNA methylation levels on these genes in the phenotypic expression of total sleep time is warranted.

Download Full-text

Sex Moderates Relationships Among School Night Sleep Duration, Social Jetlag, and Depressive Symptoms in Adolescents

Journal of Biological Rhythms ◽

10.1177/0748730419828102 ◽

2019 ◽

Vol 34 (2) ◽

pp. 205-217 ◽

Cited By ~ 4

Author(s):

Gina Marie Mathew ◽

Lauren Hale ◽

Anne-Marie Chang

Keyword(s):

Depressive Symptoms ◽

Sleep Duration ◽

Total Sleep Time ◽

Emotional Health ◽

Depression Scale ◽

Sleep Time ◽

Epidemiologic Studies ◽

Female Adolescents ◽

Sleep Timing ◽

Social Jetlag

Social jetlag, a misalignment between sleep timing on the weekend and during the work week, is associated with depressive symptoms among adults across both sexes. A previous study found that later sleep timing was associated with depressive symptoms in women but not men. To date, however, no research has investigated whether the association between social jetlag and depression varies by sex among adolescents. The current study assessed self-reported sleep, depressive symptoms, and demographic information from 3058 adolescents (48% female, mean [SD] age 15.59 [0.77] years) from the age 15 wave of the Fragile Families and Child Wellbeing Study (FFCWS). Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Depressive symptoms were measured through a modified 5-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). We assessed whether the associations among sleep duration on school nights, social jetlag, and depressive symptoms were similar between male and female adolescents using multiple linear regression. In fully adjusted models, sex moderated the association between school night total sleep time and depressive symptoms ( p < 0.001) and between social jetlag and depressive symptoms ( p = 0.037). In females, but not in males, school night total sleep time was negatively associated with depressive symptoms ( p < 0.001), whereas social jetlag ( p < 0.001) was positively and independently associated with depressive symptoms. The results indicate the importance of regular sleep timing across the week and adequate sleep duration for the maintenance of optimal emotional health among female adolescents.

Download Full-text

1161 Tasimelteon Shows Persistence Of Efficacy In Improving Sleep Disturbances In Patients With Smith-Magenis Syndrome (SMS) In Open-Label Extension Study

SLEEP ◽

10.1093/sleep/zsaa056.1155 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A442-A444

Author(s):

J Brooks ◽

M Gibson ◽

K Kite ◽

E Czeisler ◽

M Fisher ◽

...

Keyword(s):

Sleep Quality ◽

Crossover Study ◽

Sleep Duration ◽

Total Sleep Time ◽

Neurodevelopmental Disorder ◽

Daily Diary ◽

Sleep Time ◽

Open Label ◽

Open Label Extension ◽

Nighttime Sleep

Abstract Introduction Smith-Magenis Syndrome (SMS) is a rare (1/15,000 - 25,000 births) neurodevelopmental disorder resulting from an interstitial deletion of chromosome 17p11.2, or from a point mutation in the RAI1 gene. Severe sleep disorder is almost universal in patients with SMS and poses a significant challenge to patients and their families. Tasimelteon improved sleep symptoms in a randomized, double-blind, two-period, crossover study; and here we show that this effect persists for up to four years in an open-label extension. To our knowledge, this is the largest interventional study of SMS patients to date. Methods Following the 4-week crossover study, all eligible participants had the option to enroll in an open-label extension. 31/39 (79.4%) of all individuals who participated in the efficacy study have continued on tasimelteon treatment. Participants in the open-label extension provided daily diary sleep quality (DDSQ), and daily diary total sleep time (DDTST) measures via parental post sleep questionnaire and characterized behavior using the Aberrant Behavior Checklist (ABC). Results In the open-label extension, tasimelteon continued to show improvement in the primary endpoints of 50% worst sleep quality (mean = 0.7, SD = 0.94) and 50% worst total nighttime sleep duration (mean = 53.3, SD = 59.01) when compared to baseline. Tasimelteon also improved overall sleep quality (mean=0.7, SD=0.83) and overall total nighttime sleep duration (mean = 51.9, SD=53.03). ABC scores also improved with tasimelteon (mean= -16.3, SD = 15.82). Conclusion Tasimelteon continues to demonstrate persistence in efficacy (longest approximately 4 years) with similar magnitudes observed in the 4-week crossover study for sleep quality and total sleep time. Interestingly, daytime behavior also demonstrates long-term improvement in patients with SMS treated with tasimelteon. These results further confirm tasimelteon as a novel therapy for the treatment of sleep disorders in patients with SMS and may provide benefit for behavioral symptoms. Support This work was supported by Vanda Pharmaceuticals Inc.

Download Full-text

0758 Quantification of Late REM Periods in Patients With Prolonged Sleep Duration

SLEEP ◽

10.1093/sleep/zsaa056.754 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A288-A288

Author(s):

M S Blattner ◽

J August ◽

S Chopra ◽

L Dalal ◽

S Luthra ◽

...

Keyword(s):

Sleep Duration ◽

Rem Sleep ◽

Sleep Latency ◽

Total Sleep Time ◽

Sleep Onset ◽

Onset Time ◽

Sleep Time ◽

Sleep Studies ◽

Long Sleep ◽

Idiopathic Hypersomnia

Abstract Introduction Evaluation of hypersomnia includes polysomnography followed by mean sleep latency testing (MSLT). As consistent with guidelines as applied in most centers, the overnight portion of the study will be terminated to begin sleep latency testing. For patients with prolonged sleep duration, this interruption could result in REM sleep on nap testing that reflects continuation of their biological night, rather than abnormalities in REM sleep pressure/regulation. Methods We reviewed 42 consecutive extended (unrestricted) sleep studies for patients with a total sleep time greater than 600 minutes. For studies with sleep onset before midnight, we evaluated for REM period onset after 6AM, the number of REM periods after 6AM and 8AM, and the time of the final REM period onset. Results 42 hypnograms were reviewed for patients undergoing evaluation of hypersomnia, median age 32 years (range 19-92) with a median total sleep time of 663 minutes (range 602-832), of these 28/42 (67%) had sleep onset before midnight (12 AM) and were included in the analysis. 27/28 (96%) of hypnograms reviewed had REM sleep after 6 AM, 24/28 (86%) had REM sleep after 8 AM, with the onset of the final REM period ranging from 4:46 AM-12:30 PM for patients with sleep onset time before midnight (12 AM). Conclusion These data suggest that termination of overnight polysomnography to complete mean sleep latency testing, as is standard in most sleep labs, may influence the presence of REM sleep on MSLT for patients with prolonged total sleep duration. These results may have implications for the interpretation of MSLT for patients with long sleep duration, and may explain why a given individual may test as type II narcolepsy or idiopathic hypersomnia unpredictably on repeat testing. Support Sleep Medicine Fellowship at BIDMC

Download Full-text