0526 Objective Total Sleep Duration Do Not Predicting the Effectiveness of Cognitive-Behavioral Therapy for Insomnia (CBT-I)

Abstract Introduction Several studies investigated the role of objective sleep markers, in particular of Total Sleep Time (TST) in identifying different subtypes of Insomnia Disorder (ID) and in evaluating the efficacy of treatments. Based on objective TST two phenotypes of ID are usually distinguished in the literature: normal sleepers (objective sleep duration ≥ 6 hours) and short sleepers (objective sleep duration < 6 hours). Aim of our study was to evaluate in normal and short sleepers (objective sleep duration was assessed by both Polysomnography and Actigraphy) possible different response to Cognitive-Behavioral Therapy for Insomnia (CBT-I). Methods 53 ID patients (females = 50.9%; mean age = 56.53±11.43) were divided into “Short Sleep duration” and “Normal Sleep duration” groups. All patients underwent 7-sessions group CBT-I. Main clinical outcome was Insomnia Severity Index questionnaire (ISI); secondary outcomes were Sleep Efficacy (SE), Sleep Latency (SL), Wake After Sleep Onset (WASO), Number of Awakenings (N°awk) according to sleep diaries. Results All ID patients showed significant improvements after treatment for all clinical outcomes. Non-significant effects of CBT-I between “Short Sleep duration” and “Normal Sleep duration” measured by patients were found in terms of ISI, SE, SL, WASO and N°awk, neither using Polysomnography nor Actigraphy. Furthermore, no accordance between these two objective measurements was found for the identification of the two subgroups. Conclusion Our findings suggest that the use of objective TST (both by Actigraphy and Polysomnography) is not a consistent predictor for CBT-I effectiveness. Moreover, only a small percentage of patients were classified as short or normal sleepers according both to Polysomnography and Actigraphy. These findings underline the instability and poor reliability of using objective TST in subtyping insomniacs. Support No

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0373 Trazodone vs. Cognitive Behavioral Therapy in Insomnia with Short Sleep Duration: Effects on Total Sleep Time and Cortisol Levels

SLEEP ◽

10.1093/sleep/zsy061.372 ◽

2018 ◽

Vol 41 (suppl_1) ◽

pp. A142-A143 ◽

Cited By ~ 1

Author(s):

A N Vgontzas ◽

J Fernandez-Mendoza ◽

J H Baker ◽

V Krishnamurthy ◽

J Gaines ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Duration ◽

Total Sleep Time ◽

Behavioral Therapy ◽

Sleep Time ◽

Cognitive Behavioral ◽

Short Sleep Duration ◽

Short Sleep ◽

Cortisol Levels

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Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8740 ◽

2020 ◽

Vol 16 (12) ◽

pp. 2009-2019

Author(s):

Alexandros N. Vgontzas ◽

Kristina Puzino ◽

Julio Fernandez-Mendoza ◽

Venkatesh Basappa Krishnamurthy ◽

Maria Basta ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Duration ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Short Sleep Duration ◽

Short Sleep ◽

Preliminary Study

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Insomnia Patients With Objective Short Sleep Duration Have a Blunted Response to Cognitive Behavioral Therapy for Insomnia

SLEEP ◽

10.1093/sleep/zsw012 ◽

2016 ◽

Cited By ~ 5

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Duration ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Short Sleep Duration ◽

Short Sleep

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Insomnia and sleep state misperception: Clinical features, diagnosis, management and implications

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1696 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s853-s853

Author(s):

J. Isaac ◽

C. Santos ◽

A. Matos Pires

Keyword(s):

Sleep Duration ◽

Clinical Features ◽

Mental Disease ◽

Sleep Time ◽

Sleep State ◽

Short Sleep Duration ◽

Short Sleep ◽

Psychological Therapies ◽

Normal Sleep ◽

Competing Interest

BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.ObjectivesDescribe the main differences between primary insomnia WSM and wSM regarding:– clinical features;– diagnosis;– management;– implications.MethodsWe conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.ResultsThe prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.ConclusionsThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Abstract 2455: Short Sleep Duration is an Independent Predictor of Cardiovascular Events in Hypertensive Patients

Circulation ◽

10.1161/circ.118.suppl_18.s_728-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Kazuo Eguchi ◽

Thomas G Pickering ◽

Joseph E Schwartz ◽

Satoshi Hoshide ◽

Joji Ishikawa ◽

...

Keyword(s):

Sleep Duration ◽

Short Duration ◽

Cardiovascular Events ◽

Sleep Time ◽

Cvd Risk ◽

Short Sleep Duration ◽

Hypertensive Patients ◽

Short Sleep ◽

Multivariable Analyses ◽

Normal Sleep

We aimed this study to test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD) in hypertensive patients. We performed ambulatory BP monitoring (ABPM) in 1255 subjects with hypertension (mean age: 70.4 ± 9.9 years) and they were followed for an average of 50 ± 23 months. Short sleep duration was defined as <7.5 hrs (20 th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio (HR) and 95% CI for short sleep duration. A riser pattern was defined when average nighttime SBP exceeded daytime SBP. The end point was cardiovascular events: stroke, fatal or non-fatal myocardial infarction (MI), and sudden cardiac death. In multivariable analyses, short duration of sleep (<7.5 hrs) was associated with incident CVD (HR=1.68; 1.06 –2.66, P=.03). A synergistic interaction was observed between short sleep duration and the riser pattern (P=.089). When subjects were categorized on the basis of their sleep time and riser/non-riser patterns, the shorter sleep+riser group had a highest incidence of CVD among the 4 groups ( Figure ), and substantially and significantly higher incidence of CVD than the predominant normal sleep+non-riser group (HR=4.43; 2.09 –9.39, P<0.001), independent of covariates. Short duration of sleep is associated with incident CVD risk, and the combination of riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of hypertensive patients.

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Associations between fecal short-chain fatty acids and sleep continuity in older adults with insomnia symptoms

Scientific Reports ◽

10.1038/s41598-021-83389-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Faiga Magzal ◽

Carmel Even ◽

Iris Haimov ◽

Maayan Agmon ◽

Kfir Asraf ◽

...

Keyword(s):

Older Adults ◽

Fatty Acids ◽

Sleep Duration ◽

Sleep Onset ◽

Short Chain Fatty Acids ◽

Short Sleep Duration ◽

Short Sleep ◽

Sleep Continuity ◽

Normal Sleep ◽

Insomnia Symptoms

AbstractInsomnia is a disorder characterized by difficulty falling asleep and poor sleep continuity and is associated with increased risks for physical and cognitive decline. Insomnia with short sleep duration is considered the most biologically severe phenotype of the disorder. Evidence suggests that short-chain fatty acids (SCFAs), the main byproducts of fiber fermentation in the gut, may affect sleep via gut–brain communications. This study explores associations between SCFAs and sleep continuity and compares SCFA concentrations in short vs. normal sleep insomnia phenotypes in older adults. Fifty-nine participants with insomnia symptoms (≥ 65 years), completed 2 weeks of objective sleep monitoring (actigraphy), and were divided into short and normal sleep duration phenotypes via cluster analysis. Sleep measures included total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). Stool samples were collected and fecal SCFA concentrations were determined by gas-chromatography-mass-spectrometry (GCMS). Higher concentrations of acetate, butyrate, and propionate, and total SCFAs, were associated with lower SE and longer SOL after controlling for Body Mass Index (BMI). Concentrations were higher in the short sleep duration phenotype. Age, BMI, TST, and SOL explained 40.7% of the variance in total SCFAs. Findings contribute to understanding pathways along the gut–brain axis and may lead to the use of SCFAs as biomarkers of insomnia phenotypes.

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361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽

10.1093/sleep/zsab072.360 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A144-A144

Author(s):

Kathleen O’Hora ◽

Beatriz Hernandez ◽

Laura Lazzeroni ◽

Jamie Zeitzer ◽

Leah Friedman ◽

...

Keyword(s):

Older Adults ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Sleep Onset ◽

Post Treatment ◽

Cognitive Behavioral ◽

Sleep Onset Latency ◽

Significant Group ◽

Time Interaction ◽

Insomnia Symptoms

Abstract Introduction The prevalence of insomnia complaints in older adults is 30–48%, compared to 10–15% in the general population. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, non-pharmacological sleep treatment for Insomnia. However, the relative impact of Behavioral (BT) and Cognitive (CT) components compared to that of CBT-I in older adults is unknown. Methods 128 older adults with insomnia were randomized to receive CBT-I, BT, or CT. Sleep diaries and the Insomnia Severity Index (ISI) were collected pre- and post-treatment and at a 6-month follow-up. We conducted split-plot linear mixed models with age and sex as covariates to assess within and between subject changes to test effects of group, time, and their interaction on ISI, sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and percent of treatment responders (ISI decrease>7) and remitters (ISI<8). Effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results All treatments lead to a significant improvement across outcome measures at post-treatment (p’s<0.001) and 6-months (p’s<0.01), with the exception of TIB, response, and remission. For TIB, there was a significant Group x Time interaction (p<0.001): while all treatments significantly reduced TIB post-treatment relative to baseline, CBT-I (p<0.001,d=-2.26) and BT (p<0.001,d=-1.59) performed significantly better than CT (p=0.003, d=-0.68). In contrast, at 6-months CBT-I (p<0.001,d=-1.16) performed significantly better at reducing TIB than CT (p=0.195,d=-0.24) or BT (p=0.023,d=-0.61) relative to baseline. There was also a non-significant trend for a Group x Time interaction for remission status (p=0.062). Whereas, the percentage of remitters within all groups post-treatment did not differ from chance (p>0.234), at 6 months, the percentage of remitters was significantly higher than chance in CBT-I (73.63%,p=0.026) and BT (78.08%,p=0.012), but not CT (47.85%,p=0.826). There were no other significant time or interaction effects (all p>0.05). Conclusion CBT-I and its components are effective in improving subjective insomnia symptoms in older adults. Evidence suggests CBT-I may be superior to either CT or BT alone in improving TIB in older adults. Support (if any) NIMHR01MH101468; MIRECC at VAPAHCS

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

SLEEP ◽

10.1093/sleep/zsab072.373 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A149-A149

Author(s):

Andrew Kubala ◽

Mara Egeler ◽

Daniel Buysse ◽

Martica Hall ◽

Emma Barinas-Mitchell ◽

...

Keyword(s):

Sleep Duration ◽

Behavioral Therapy ◽

Exercise Program ◽

Short Sleep Duration ◽

Post Intervention ◽

Short Sleep ◽

Supervised Exercise ◽

Daytime Function ◽

Supervised Exercise Program ◽

Insomnia Severity

Abstract 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 <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<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

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Abstract P545: Insufficient Sleep and Nitric Oxide-Mediated Endothelium-Dependent Vasodilation in Adults With Elevated Blood Pressure

Circulation ◽

10.1161/circ.141.suppl_1.p545 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Kelly A Stockelman ◽

Anthony R Bain ◽

Dana M Withrow ◽

Tracey A Larson ◽

Elizabeth M Boland ◽

...

Keyword(s):

Oxidative Stress ◽

Nitric Oxide ◽

Blood Pressure ◽

Sleep Duration ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Short Sleep Duration ◽

Insufficient Sleep ◽

Short Sleep ◽

Normal Sleep

Elevated blood pressure (BP ≥130/80 mmHg) is associated with increased risk for myocardial infarction, heart failure, stroke and vascular disease. Insufficient nightly sleep (<7 h/night) has been linked not only to the etiology of elevated blood pressure but is a prevalent, often ignored, comorbidity. Indeed, short sleep duration is now considered to be a plausible risk factor for elevated blood pressure and a harbinger of increased cardiovascular risk. A high prevalence of insufficient nightly sleep has been reported in adults with elevated blood pressure. The influence of insufficient sleep on endothelial vasodilator function in adults with elevated blood pressure is unknown. We tested the hypotheses that chronic insufficient sleep is associated with diminished nitric oxide (NO)-mediated endothelium-dependent vasodilation in adults with elevated blood pressure. Moreover, the insufficient sleep-related reduction in endothelial vasodilator function is due, at least in part to increased oxidative stress. Thirty-five middle-aged and older adults with elevated blood pressure were studied: 15 with normal nightly sleep duration (11M/4F; age: 58±2 yr; BP: 136/82±1/2 mmHg; sleep: 7.6±0.2 h/night) and 20 with short nightly sleep duration (14M/6F; 58±1 yr; BP: 138/84±1/1 mmHg; sleep: 6.0±0.1 h/night). Forearm blood flow (FBF) responses to intra-arterial infusion of acetylcholine (ACh), in the absence and presence of the endothelial NO synthase inhibitor N G -monomethyl-L-arginine (L-NMMA) and the antioxidant vitamin C were determined by venous occlusion plethysmography. The FBF response to ACh was significantly lower (~20%) in the short sleep (from 3.8±0.2 to 11.0±0.6 ml/100 ml tissue/min) compared with the normal sleep duration group (from 4.2±0.2 to 13.6±0.6 ml/100 ml tissue/min). L-NMMA significantly reduced (~25%) the FBF response to ACh in the normal sleep but not the short sleep group. Vitamin C markedly increased (~35%; P<0.05) the vasodilator response to ACh in short sleepers only. In summary, habitual short sleep duration worsens NO-mediated endothelium-dependent vasodilation in adults with elevated blood pressure. Furthermore, the sleep-related diminishment in endothelial vasodilator function is due, in part, to increased oxidative stress.

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0927 Variations in Sleep and Glucose in Adolescents with Type 1 Diabetes

SLEEP ◽

10.1093/sleep/zsaa056.923 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A352-A353

Author(s):

S Griggs ◽

N S Redeker ◽

S Jeon ◽

M Grey

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Sleep Duration ◽

Sleep Onset ◽

Glucose Variability ◽

Poor Sleep ◽

Short Sleep Duration ◽

High Blood Glucose ◽

Short Sleep

Abstract Introduction The association between short sleep duration and poorer glycemic control in adolescents ages 10-16 with type 1 diabetes (T1D) is well established. Researchers have used cross-sectional, between-subjects’ methods, with limited focus on the potential intraindividual variation among these variables. The purpose of this analysis was to examine the within person associations between glucose variability indices (J index, low/high blood glucose index, time in range) and sleep characteristics (bedtime, waketime, total sleep time, sleep efficiency, wake after sleep onset [WASO], awakenings, and sleep fragmentation index) in adolescents with T1D. Methods Adolescents monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and either their own continuous glucose monitor (CGM) or a provided blinded CGM. General linear mixed models (GLMM) were used to determine within-person and day level associations. Results The sample included 38 adolescents (M age 13.4±1.8; 37.8% male; M A1C 8.2±1.2%). Average glucose levels were controlled in all GLMMs. Adolescents had earlier waketimes on days when more time was spent in hypoglycemia <70mg/dL (β=-0.15, p<0.001). At the person level, adolescents had greater WASO with more % time spent in severe hypoglycemia <54mg/dL with more severe low blood glucose indices (β=0.35, p<0.01 and β=0.34, p<0.01 respectively). At the daily level, adolescents had greater WASO (β=0.20, p=0.01) and more awakenings (β=0.16, p=0.04) on the days they had more overall glucose variability (J index) and more severe high blood glucose indices (β=0.17, p=0.04), but were less likely to have more % time in hypoglycemia (β=-0.15, p=0.02). Conclusion Glucose variability was positively associated with poor sleep (e.g., WASO and awakenings) in adolescents with T1D both at the daily and intraindividual level. Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person associations between habitual short sleep duration and glucose variability. Support NINR T32NR0008346 & P20NR014126, Medtronic MiniMed provided CGMs at a discounted rate for the study.

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