Sympathoadrenal activity and sleep: in the search for a marker of hyperarousal in insomnia

Objective. To assess subjective and objective sleep characteristics and urinary metanephrine levels in patients with insomnia. Design and methods. We included patients with insomnia complaints and those without sleep– related complaints (control group) 18–75 years old. Subjective evaluation of the main sleep characteristics during the last month was assessed by the Pittsburgh Sleep Quality questionnaire, daytime sleepiness — by the Epworth Sleepiness Scale. For objective sleep evaluation we performed one-night polysomnography (PSG). Within 1 week after the PSG, daily urine was collected to determine the level of metaepinephrine. Results. The groups did not differ by age, mean sleep duration over the past month, number of night awakenings by the Pittsburgh Questionnaire, and level of daytime sleepiness. Sleep latency in insomnia group was 15 minutes longer than in the control group. PSG showed higher apnea-hypopnea and desaturation indices in the control group. There were no differences in daily urinary metanephrine excretion in the main and control groups. Correlation analysis showed no significant association between the metanephrine levels and the severity of somnolence and the index of periodic limb movements. Conclusions. Our analysis showed no significant differences in the daily urine metanephrine levels and the main PSG sleep characteristics among subjects with and without insomnia. Further work is required to clarify markers of insomnia and their negative health effects.

Quality of life and subjective sleep-related measures in bipolar disorder and major depressive disorder

Purpose Diminished quality of life (QoL) has been reported in patients with mood disorders. QoL has also been shown to be decreased by sleep disturbances. Since sleep disorders are common in mood disorders, the aim of this study was to determine whether sleep characteristics are associated to QoL among patients with Bipolar Disorder (BD) and unipolar Major Depressive Disorders (MDD). Methods QoL was assessed in 170 patients with mood disorders (61 BD and 109 MDD), who also completed questionnaires measuring the severity of insomnia, sleepiness, chronotype preference and obstructive sleep apnea (OSA) probability index. Results Analyses showed that BD and MDD groups had similar QoL and sleep measures but the MDD group had higher OSA scores. In BD, correlations indicated a relationship between QoL and insomnia complaints and sleepiness, whereas in MDD, correlations indicated an association between QoL and insomnia complaints and OSA score. In both groups, QoL was related to depressive symptomatology. Linear regressions showed that, in BD, QoL was related to insomnia complaints and sleepiness even in the euthymic state, whereas in MDD, QoL was related to insomnia complaints but not in euthymic patients. Conclusion QoL is related to sleep differently in BD and MDD. The results suggest that insomnia and sleepiness are particularly high in BD even when patients are euthymic. These findings suggest that focusing on insomnia and sleepiness during different mood states of BD could increase QoL.

162 Age, sex, and sleep continuity disturbance: Does binary sex impact sleep continuity while co-varying for age across the lifespan?

Introduction It is well-documented that insomnia symptoms can worsen with age and that women have a greater predisposition to insomnia symptoms than men. Additionally, it has been found that women are more likely to report insomnia symptoms across the lifespan (i.e., increased prevalence of insomnia regardless of age). The aim of the present study was to 1) confirm the finding that women are more likely to endorse having insomnia problems (specifically as they pertain to SL, WASO, and EMA) and 2) evaluate if there are binary sex differences with respect to sleep continuity disturbance (SCD) while accounting for age. Methods Sleep continuity (SL, WASO, EMA) duration (in minutes) and problem endorsement data was collected from individuals with insomnia complaints in an archival/community-based sample (n=1837;56.9% female; ages 18-87) (www.sleeplessinphilly.com). A multivariate analysis of covariance was conducted to determine a significant difference between sex (male, female) on SL, WASO, and EMA in minutes while controlling for age. Pearson correlations were run to determine relationships between age and SL, WASO, and EMA. Chi-Square tests were run to determine if there were sex differences in problem endorsement of SL, WASO, and EMA. Results Significant sex differences were observed in reports of SCDs as problematic, where more women endorsed SL (58.5%;p<.001), WASO (58.1%;p<.001), and EMA (56.9%;p<.001) as a problem than men. There were no significant effects of binary sex on sleep continuity disturbances when controlling for age. Age was significantly negatively related to SL(p<.001) and significantly positively related to WASO(p<.001) and EMA(p<.001). Conclusion These results confirm that women are more likely to report SCDs as a problem and that men and women experience similar levels of insomnia severity with respect to SL, WASO, and EMA. Clinically speaking, it may be important to evaluate insomnia with explicit questions about specific measures of SCD, followed by an inquiry regarding whether each SCD symptom “is a problem.” Future studies should consider gender identification as a relevant factor when evaluating for sleep continuity disturbances across the lifespan. Support (if any):

Short, But Highly Concentrated, Direct Inhalations of Essential Oil Molecules Improve Poor Sleep Quality: A Natural History Controlled, Within Group, Self-Administration Field Pilot Study

Background: Essential oils are among the preferred alternative remedies for treating sleep disturbance, but empirical evidence for their effectiveness is varied. According to a new line of research, an inhaler designed to deliver high concentrations of essential oil molecules directly into the nose effectively influences the hypothalamic-pituitaryadrenal axis and the autonomous nervous system. Objective: This study was run to investigate whether insomnia complaints were reduced upon use of the inhaler AromaStick® ‘Relax’. Methods: A documentation field study involving thirty individuals with a recorded history of non-specific insomnia complaints was conducted to determine the inhaler’s specific effects. Results: Upon the nightly use for one week, the odor inhaler strongly improved sleep quality and reduced symptoms associated with poor sleep. Depending on the dimensions tested, effect sizes ranged between 0.8 < d < 2.6. Strongest effects were found for ‘difficulty maintaining sleep’, ‘difficulty initiating sleep’ and ‘feeling recovered after sleeping’. Conclusion: The inhaler proved to be useful in mitigating sleep impairment. The effects were strongest in individuals reporting low sleep quality.

Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study

Background The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. Conclusions These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.

Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study (Preprint)

BACKGROUND The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. OBJECTIVE Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. METHODS The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score &gt;14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. RESULTS Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score &gt;14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; <i>P</i>&lt;.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; <i>P</i>&lt;.001). Users that were most severely affected (ISI score &gt;21) did not respond to either intervention. CONCLUSIONS These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.

Sleep Quality and Psychological Status in a Group of Italian Prisoners

Prison could be considered a prolonged stressful situation that can trigger not only a dysregulation of sleep patterns but can also bring out psychiatric illness, such as anxiety and depression symptoms. Our study is aimed at exploring sleep quality and sleep habits in an Italian prison ward with three different security levels, and to attempt to clarify how anxiety state and the total time spent in prison can moderate insomnia complaints. There were 129 participants divided into three groups who enrolled in this study: 50 were in the medium-security prison ward (Group 1), 58 were in the high-security prison ward (Group 2) and 21 were in the medium-security following a protocol of detention with reduced custodial measures (Group 3). All participants filled in a set of questionnaires that included the Beck Depression Inventory (BDI-2), the State-Trait Anxiety Inventory (STAI), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Based on their responses, we observed that all participants showed poor sleep quality and insomnia, mild to moderate depressive symptoms that tended to a higher severity in Groups 1 and 3, and the presence of clinically significant anxiety symptoms, mainly in Groups 1 and 3. Our study shows that increased anxiety state-level and the presence of mood alteration corresponds to an increase in both poor sleep quality and, more specifically, insomnia complaints. Finally, we propose that TiP (total time in prison) could have an interesting and stabilizing paradox-function on anxiety state and insomnia.

0836 Self-Reported Difficulty Initiating Sleep and Early Morning Awakenings are Associated With Nocturnal Diastolic Non-Dipping in Older Men

Introduction Aging increases the risk of insomnia and elevated blood pressure (BP). Here, we examined in older men whether reports of difficulty falling asleep (DIS) and early morning awakenings (EMA) are associated with 24-h BP and heart rate. Methods We utilized variables from 995 men (mean age: 71 years) who participated in the Uppsala Longitudinal Study of Adult Men (ULSAM). BP and heart rate were measured over 24 hours. Results Non-dippers (night-to-day BP ratio &gt; 0.90) had a higher risk of hypertension than dippers (systolic non-dippers vs. systolic dippers, OR [95%CI]: 1.64 [1.21, 2.21], P=0.001; diastolic non-dippers vs. diastolic dippers, 1.50 [1.10, 2.04], P=0.01). Compared to men without DIS, men who reported DIS (10% of the cohort) had a higher risk of diastolic non-dipping (1.85 [1.19, 2.87], P=0.006). Similarly, men who reported EMA (19% of the cohort) had a higher risk of diastolic non-dipping than those without EMA (1.59 [1.12, 2.24], P=0.009). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+1.4 mmHg, P=0.035), no other differences in BP and heart rate were found between men with and those without insomnia complaints. Conclusion Our findings uncover a link between disruption in nocturnal dipping of diastolic BP and insomnia symptoms related to difficulty initiating sleep and early morning awakening in older men. Support Authors’ work is funded by the Novo Nordisk Foundation (C.B., NNF19OC0056777), Swedish Brain Research Foundation (C.B., FO2019-0028), Swedish Research Council (C.B., 2015-03100), Åke Wiberg Foundation (X.T., M18-0169, M19-0266), Fredrik and Ingrid Thuring Foundation (X.T., 2018-00365), and the Swedish Medical Research Society (X.T., P18-0084).

0377 A Strengths-Based Approach to Examine Obstructive Sleep Apnea in Black and White Patients

Introduction The majority of studies on race/ethnic disparities in OSA are derived from a deficit-based perspective (i.e. &gt;BMI, non-adherence to PAP). It would prove useful to identify which aspects are protective to inform potential treatment approaches. We focused on two potential factors: resilience and social support, in patients newly diagnosed with OSA. Given the high prevalence of insomnia complaints in patients with OSA, insomnia was our outcome of interest. Methods 91 patients newly diagnosed with OSA provided demographic and socioeconomic status, sleep measures (Epworth, DBAS), resilience (Connor Davidson Resiliency Scale), social support (MOS Social Support Scale) and completed the Insomnia Severity Index. The cross-sectional associations between ISI, race/ethnicity, resilience, social support and their interaction effects were examined using linear regression models with covariate adjustment for participant age, sex and BMI. We ascertained total ISI score and individual items. Results The sample was 34.1% black (n=31), mean age of 57.6 years, SD=13.6, 64.8% male (n=59), and mean BMI of 32.4, SD=7.04. Mean sleep duration (as reported by sleep diary) was 6.64, SD=1.35. Black, white differences were not observed for sleepiness (M=8.60; 10.43, p=0.11) or DBAS (M=4.61; M=5.04, p=0.30). Blacks, reported clinically significant insomnia (M=15.00, SD=7.17) compared to whites (M=12.02, SD=6.83, p=0.05). On the individual ISI items, blacks were significantly more likely to endorse difficulty falling asleep (M=1.58, SD=1.54; M=0.75, SD=0.93,p=0.002) and waking up too early (M=2.09, SD=1.26; M=1.45, SD=0.93,p=0.021) compared to whites. Resilience (M=30.04, SD=6.42) and social support scores (M=74.13, SD=21.36) did not differ by race/ethnicity. In adjusted linear analysis, resilience had significant effect on ISI score (b=-0.36, SE=0.12, p=0.003) but not social support (b=-0.06, SE=0.08, p=0.31). Conclusion In this study we did not observe race/ethnic differences for sleepiness and dysfunctional beliefs about sleep. With respect to the protective factors, race/ethnic differences were not observed. Resilience, not social support, was related to insomnia complaints. Future studies should examine a variety of factors that may serve black and other racial/ethnic groups with OSA, and help elucidate protective processes. Support K23HL125939