Daily Sleep, Well-Being, and Adult Day Services Use Among Dementia Care Dyads

Sleep is critical for health and well-being among both persons with dementia (PwD) and their family caregivers (CG). This study described sleep characteristics for dementia family care dyads, then examined the associations with sleep quality, daytime functioning, and mood in the context of Adult Day Services (ADS) use. Caregivers (n = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons with dementia across 8 consecutive days (N = 1,359), where PwD attended ADS at least 2 days of the week. They also reported their own fatigue and affect and PwD’s daytime and nighttime sleep and behavior problems on each day. Findings from multilevel models suggested that bedtime was earlier and total time in bed was shorter before an ADS day for the dyad, and also on an ADS day for PwD; wake time was earlier for the dyad on and following an ADS day. Using ADS related to better prior night sleep quality for PwD; it also weakened the association between nighttime sleep problems and higher daytime negative affect for CG. Yesterday’s ADS use buffered the negative impact of shorter total time in bed on CG daytime fatigue; it also buffered the association between nighttime sleep problems and lowered CG daytime positive affect. Regular ADS use may protect against the adverse impact of sleep disturbances on daytime functioning and well-being for dementia care dyads.

Sleep problems and daytime functioning in adolescents with ASD

Sleep problems commonly occur in adolescents with an autism spectrum disorder diagnosis (ASD). However, the knowledge of how sleep problems affect those adolescents’ lives is fragmentised. This review focuses on the question: What is the relationship between sleep and daytime functioning in adolescents with ASD. An electronic database (PsycINFO, Cochrane, ERIC, PubMed, WOS) and hand search (INSAR congress archive and included studies reference lists) was performed in September 2020 resulting in 2561 studies. Studies were included if they contained autistic participants aged between 10 and 19 without intellectual disability, related sleep to daytime functioning, were available in English, and used original data. Nine studies were included (Nparticipants = 674). The most prominent finding was the association of all sleep parameters with internalizing problems. Furthermore, most significant associations with daytime functioning were found for sleep problems in general and for sleep efficiency. The results provide input for tailored sleep interventions. However, more research is needed to get a clearer picture of the relationship between specific sleep parameters and daytime functioning to ensure that this knowledge will provide better input for sleep interventions. It is important to focus on limited age ranges, larger samples sizes, multiple measurement methods, and longitudinal approaches.

P166 Measures of overnight sleep stability in patients with hypersomnolence

Introduction Hypersomnolence causes significant impairment of daytime functioning. The multiple sleep latency test (MSLT) measures objective hypersomnolence (OH). Patients with hypersomnolence with a normal MSLT are said to have subjective hypersomnolence (SH). The mechanisms of hypersomnolence in such patients is uncertain. This study describes differences in measures of sleep stability derived from the overnight polysomnography (PSG) in patients with OH and SH. Methods A retrospective analysis of 100 patients undergoing PSG/MSLT for investigation of hypersomnolence was performed. Patients were classified as OH (MSLT≤8 min) or SH (MSLT>8min). Sleep stage distribution and PSG-derived markers of sleep stability including cardiopulmonary coupling (CPC), cyclic alternating pattern (CAP) and sleep stage shifts were compared between the two groups. Results When compared to OH patients (N=50), SH patients (N=50) had significantly more sleep stage shifts, more shifts to stage N1 and longer PSG sleep latency. Small but significantly lower sleep efficiency, higher stage N1 and N3 proportions were also observed in SH patients. OH patients had a small but significantly higher CAP rate and CAP index compared to SH patients. There were no significant differences in CPC metrics between the two groups. Conclusion Several PSG-derived markers of sleep stability indicated that patients with SH experienced more unstable sleep than OH patients. This may provide insight into the underlying pathophysiological mechanisms which differentiate these patient groups and may serve as a future therapeutic target.

P106 Evaluating the correlation between objective daytime sleepiness, daytime functioning and subjective sleepiness

Introduction Daytime sleepiness is typically assessed in clinical settings with the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). However, these tests do not necessarily assess daytime functioning. This study aimed to assess the correlation between a 10-min Psychomotor Vigilance Test (PVT), as a measure of daytime functioning, and excessive daytime sleepiness as measured with the MSLT or MWT. Methods Patients attending the sleep clinic for assessments of daytime sleepiness underwent overnight polysomnography (PSG) and completed the Epworth Sleepiness Scale (ESS). The following day, patients completed four test sessions every 2h starting 1.5h after waking. Testing sessions included the Stanford Sleepiness Scale (SSS), PVT, MWT or MSLT. PVT lapses (reaction time >500ms), SSS score and sleep latencies (MSLT and MWT) were averaged within participants across sessions and regression analyses performed to assess the relationship between PVT lapses and sleepiness measures. Results A total of 41 patients (BMI: 33.7±8.7kg/m²; aged 44.8±17.8 years) completed the study. Of these, 22 (19 F) underwent the MSLT and 19 (2 F) underwent the MWT. PVT lapses correlated with MWT mean sleep latency (r²=0.62; p<0.001), ESS (r²= 0.19; p<0.01) and SSS (r²= 0.12; p<0.05) but not MSLT mean sleep latency (r²= 0.02; p = 0.50). Discussion In clinical practice, MWT and ESS are often used in conjunction to assess daytime functioning. Results suggest that the PVT could be used alongside MWT to aid clinical judgments around an individuals’ daytime functioning.

O009 The Good Sleeper Scale-13 Items: a standardised questionnaire for the assessment of good sleepers

Introduction Good sleep is not merely the absence of sleep disorder symptoms, yet this criterion is commonly applied in research studies. We developed the Good Sleeper Scale-13 (GSS-13) to standardise identification of good sleepers. Methods We conducted a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N = 2,044, aged 18–90 years). Possible GSS-13 items were chosen collaboratively with co-authors. Exploratory factor analysis (EFA) was conducted on 10% of the dataset chosen at random (N = 191) for factor identification and item reduction. Confirmatory factor analysis (CFA) on the remaining 90% (N = 1,853) tested model fit. Associations with sleep concerns, health, and daytime functioning tested validity of the final version. Results From EFA, six factors were identified: Adequate Sleep; Insomnia; Regularity; Timing; Sleep Duration; Perceived Sleep Problem. On CFA, model fit was comparable to other sleep instruments, X² (67) = 387.34, p < .001, CFI = .95, TLI = .92, RMSEA = .05. Cronbach’s alpha was largely acceptable (≥.7) across subscales. Consistent correlations were found between GSS-13 global scores and outcomes, including “a good night’s sleep” (r = .65, p < .001), feeling un-refreshed (r = -.53, p < .001), and general health rating (r = .44, p < .001). Classification accuracy for insomnia symptoms was also high (AUC = .84). Conclusions The GSS-13 is psychometrically sound, correlated well with sleep, health, and daytime functioning, and can be used to identify good sleepers for research. Future work will test relationships with other sleep measures.

How Sleep Affects Daytime Functioning: The Latest Insights from Different Patient and Age Groups

Sleep problems can have a major impact on daytime functioning across all domains (i.e.., cognitive, affective and physical) [...]

Nonclinical pharmacology of daridorexant: a new dual orexin receptor antagonist for the treatment of insomnia

Dual orexin receptor antagonists (DORAs) represent a novel type of sleep medication that provide an alternative to the traditionally used positive allosteric gamma-aminobutyric acid (GABA)-A receptor modulators. Daridorexant is a new DORA that exhibited in phase 3 trials in insomnia not only a beneficial effect on sleep variables, measured objectively and assessed subjectively, but also an improvement in daytime functioning. Daridorexant was discovered through a tailored research program aimed at identifying an optimized sleep-promoting molecule with pharmacokinetic properties appropriate for covering the whole night while avoiding next-morning residual activity at efficacious doses. By specific binding to both orexin receptors, daridorexant inhibits the actions of the wake-promoting orexin (also called hypocretin) neuropeptides. This mechanism avoids a more widespread inhibition of neuronal pathways and associated side effects that are intrinsic to positive allosteric GABA-A receptor modulators. Here, we review the general pharmacology of daridorexant, based on nonclinical pharmacology studies of daridorexant, unpublished or already described, or based on work with other DORAs. Some unique features of daridorexant will be highlighted, such as the promotion of natural and surmountable sleep, the preservation of memory and cognition, the absence of tolerance development or risk of physical dependence, and how it can benefit daytime functioning.

Chronotype and self-reported sleep, alertness, and mental health in U.S. sailors

Service members are at risk for sleep and psychological conditions affecting their readiness. Chronotype (“morningness” or “eveningness”) is strongly associated with sleep, health and performance. The objective of this study was to examine associations between validated measures of chronotype and sleep quality, daytime functioning, alertness, and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) in US service members (n = 298). Although predominantly young males (who skew toward eveningness in civilian populations), these Sailors skewed toward morningness (35.6% morning, 51.3% intermediate). Eveningness was associated with symptoms of depression and post-traumatic stress disorder (PTSD) (P < 0.01), less time in bed (P < 0.05), more sleep disruption (P < 0.01), and poorer daytime functioning and alertness (P < 0.05). Evening types were less likely to consider sleep important for performance (P < 0.05). To maximize service member readiness, schedules should be aligned with endogenous rhythms, whenever possible, and evening chronotypes may benefit from targeted interventions. Chronotype should be examined alongside health and readiness in service members.