Impact of Remote Teaching on Japanese Medical University Students' Sleeping Habits : a Longitudinal Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has changed our daily life. Owing to the imposed restrictions, many educational facilities have introduced remote teaching. This study aims to understand the impact of remote teaching on Japanese university students' sleeping habits.Methods: The participants were medical university students. We used data from an ongoing longitudinal sleeping habits survey. For 684 participants who enrolled in the university during 2018–2020, multilevel analyses of sleep duration during weekdays and weekends across 3 years were conducted, adjusting for gender, grade, place of stay, sleep problems and lifestyle habits. Results: Among the participants, 356 male (mean ± standard deviation: 22 ± 3, 18–37 years old) and 288 female (22 ± 3, 18–32 years old) students in 2018, 365 male (24 ± 3,18–36 years old) and 284 female (22 ± 2, 18–33 years old) students in 2019, and 226 male (20 ± 3,18-36 years old) and 167 female (21 ± 2, 18–34 years old) students in 2020 answered the questionnaire. The mean sleep duration during weekdays (in minutes) was 407.6 ± 60.3 in 2018, 406.9 ± 63.0 in 2019, and 417.3 ± 80.9 in 2020. The mean sleep duration during weekends (in minutes) was 494.5 ± 82.5 in 2018, 488.3 ± 87.9 in 2019, and 462.3 ± 96.4 in 2020. The analysis showed that sleep duration during weekdays was associated with the place of stay and survey year. Moreover, students reported significantly longer sleep duration during weekdays in 2020 than 2019, but no significant difference in sleep duration between 2018 and 2019. Sleep duration during weekends was found to be associated with the survey year, gender and always doing something before going to bed. Sleep duration during weekends was shorter in 2020 than 2019 and longer in male students and students who always do something before going to bed. Ten students were reported to have a delayed sleep phase in 2020. Conclusions: Students' sleep duration increased during weekdays and decreased during weekends in 2020. This difference could be explained by the COVID-19 pandemic and the introduction of remote teaching.

EFFECT OF MELATONIN ON PAIN SYNDROME IN DELAYED SLEEP PHASE DISORDER IN PATIENTS WITH PARKINSON'S DISEASE

Parkinson’s disease is characterized mainly by damage to the neurons of the substantia nigra and other brain structures and manifested by motor and non-motor symptoms. In patients with Parkinson’s disease receiving dopaminergic therapy, a later onset of sleep has been identified that is associated with the development of the delayed sleep phase disorder. The delayed sleep phase disorder is characterized by a persistent delay in the circadian rhythm that causes a delay in the desired time of falling asleep and waking up. According to clinical guidelines for the treatment of delayed sleep phase disorder, exogenous melatonin is recommended. Along with this, its analgesic properties have been reported. At the same time circadian regulation of fluctuations of painful sensations transmission by either peripheral or central alarm system has been reported. In particular, the two-way connection between the nociceptive system and the circadian rhythm in the human body determines the possibility of mutual influence between these systems. However, the question of the therapeutic effect of melatonin in the presence of concomitant pathology on the circadian rhythm disorders, and, in particular, delayed sleep phase disorder that is a topical issue for patients with Parkinson's disease, is still remaining unexplored. The aim of the study is to compare the changes in subjective perception of pain in patients with Parkinson's disease, who received melatonin therapy and who did not, in delayed sleep phase disorder. We conducted a prospective study that included 48 patients with Parkinson's disease. Circadian rhythm disorders were diagnosed according to the criteria of the International Classification of Sleep Disorders-3. The diagnosis of delayed sleep phase disorder was made on the basis of a clinical interview, filling in a sleep diary and daily thermometry for 7 days. The examined patients were divided into 2 groups according to the chosen method of treatment: group 1 - patients with Parkinson's disease and delayed sleep phase disorder receiving melatonin; group 2 - patients with Parkinson's disease and delayed sleep phase disorder receiving only general recommendations for improving sleep quality and daily functioning without medical intervention. The Unified Parkinson's Disease Rating Scale was used to assess the severity of patients’ clinical condition. The intensity of the pain syndrome was assessed on a visual-analogue scale. The McGill Questionnaire was used to analyze subjective experiences of pain. The patients of group 1 were prescribed to take melatonin, 1 tablet in a dose of 3 mg at 22:00. Individuals in group 2 received general recommendations on the schedule of sleep-wake cycles, light regime and sleep hygiene. Patients with Parkinson's disease and delayed sleep phase disorder have been diagnosed with mild to moderate pain. Treatment of delayed sleep phase disorder in patients with Parkinson's disease reduces the intensity and modality of the pain syndrome, which may be due to improved functioning of the descending pain modulation system and restoration of rhythmic expression of internal clock genes. The administration of melatonin as part of a comprehensive approach to the treatment of circadian rhythm disorders helps to reduce sensory sensations and affective experiences caused by pain that indicates the potential antinociceptive effect of melatonin in the treatment of circadian disorders.

Circadian Disorders, Insomnia, and Parasomnias

Circadian rhythm disorders have misalignment between the desired sleep schedule and the circadian (24-hour) sleep-wake rhythm. Many persons experience this misalignment with jet lag. Other common circadian rhythm disorders include delayed sleep-phase disorder, advanced sleep-phase disorder, and shift-work sleep disorder. Insomnia is one of the most common medical concerns, and its prevalence increases with age. Patients may have difficulty initiating sleep or maintaining sleep and generally have a poor quality of sleep. Causes of insomnia are multifactorial.

Demographic, psychological, chronobiological, and work-related predictors of sleep disturbances during the COVID-19 lockdown in Italy

The first COVID-19 contagion wave caused unprecedented restraining measures worldwide. In Italy, a period of generalized lockdown involving home confinement of the entire population was imposed for almost two months (9 March–3 May 2020). The present is the most extensive investigation aimed to unravel the demographic, psychological, chronobiological, and work-related predictors of sleep disturbances throughout the pandemic emergency. A total of 13,989 Italians completed a web-based survey during the confinement period (25 March–3 May). We collected demographic and lockdown-related work changes information, and we evaluated sleep quality, insomnia and depression symptoms, chronotype, perceived stress, and anxiety using validated questionnaires. The majority of the respondents reported a negative impact of confinement on their sleep and a delayed sleep phase. We highlighted an alarming prevalence of sleep disturbances during the lockdown. Main predictors of sleep disturbances identified by regression models were: female gender, advanced age, being a healthcare worker, living in southern Italy, confinement duration, and a higher level of depression, stress, and anxiety. The evening chronotype emerged as a vulnerability factor, while morning-type individuals showed a lower predisposition to sleep and psychological problems. Finally, working from home was associated with less severe sleep disturbances. Besides confirming the role of specific demographic and psychological factors in developing sleep disorders during the COVID-19 pandemic, we propose that circadian typologies could react differently to a particular period of reduced social jetlag. Moreover, our results suggest that working from home could play a protective role against the development of sleep disturbances during the current pandemic emergency.

627 Adolescent Delayed Sleep Phase and Circadian Irregularity Associated with Substance (Mis)Use in Young Adulthood

Introduction Substance use disorders are reaching epidemic proportions among adolescents and young adults. While disturbed, insufficient sleep is known to be associated with substance use, little is known about the role of circadian misalignment in precipitating or perpetuating substance misuse. Methods The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). In adolescence, a delayed sleep phase was defined as a 7-night actigraphy-measured mean sleep midpoint later than 4:00 AM, while an irregular circadian phase as a within-subjects standard deviation in sleep midpoint greater than 1 hour. Alcohol, tobacco, and drug use was ascertained by parent- and/or self-reports in adolescence, while alcohol, tobacco and marijuana use was ascertained by self-reports in young adulthood. Logistic regression models tested the association between delayed and irregular circadian phase with substance use adjusted for age, sex, race/ethnicity, BMI, SES, mental health problems and psychoactive medications. Results Adolescents with a delayed sleep phase (n=164) showed later bed and wakeup times, lower morningness scores and greater circadian phase irregularity. Cross-sectionally, a delayed sleep phase in adolescence was associated with 1.9-fold odds (95%CI=1.1–3.2) of alcohol, tobacco and/or drug use; specifically, the odds of alcohol and tobacco use associated with a delayed sleep phase were 1.9-fold (95%CI=1.1–3.4) and 2.4-fold (95%CI=1.1–5.3), respectively, while non-significant for drug use (n=28) for which mental health problems were among the strongest risk factors (OR=3.0, 95%CI=1.3–6.8). Longitudinally, an irregular circadian phase in adolescence was associated with 2.2-fold odds (95%CI=1.1–4.5) of alcohol, tobacco and/or marijuana use in young adulthood; specifically, the odds of alcohol use in young adulthood associated with an irregular circadian phase in adolescence were 1.9-fold (95%CI=1.1–3.5), while non-significant for tobacco (n=58) or marijuana use (n=76) for which mental health problems were the strongest risk factor (OR=2.2, 95%CI=1.3–3.7). Conclusion A delayed or irregular circadian phase in adolescence is associated with substance use, particularly alcohol use in the transition to adulthood. Beyond disturbed and insufficient sleep, circadian misalignment should become a target of early interventions to prevent substance use disorders. Support (if any) R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127

Sleeping During the First Wave: Demographic, Psychological, Chronobiological, and Work-Related Predictors of Sleep Disturbances Throughout the COVID-19 Lockdown

The first COVID-19 contagion wave caused unprecedented restraining measures worldwide. In Italy, a period of generalized lockdown involving home confinement of the entire population was imposed for almost two months (9 March–3 May 2020). The present is the most extensive investigation aimed to unravel the demographic, psychological, chronobiological, and work-related predictors of sleep disturbances throughout the pandemic emergency. A total of 13989 Italians completed a web-based survey during the confinement period (25 March–3 May). We collected demographic and lockdown-related work changes information, and we evaluated sleep quality, insomnia and depression symptoms, chronotype, perceived stress, and anxiety using validated questionnaires. The majority of the respondents reported a negative impact of confinement on their sleep and a delayed sleep phase. We highlighted an alarming prevalence of sleep disturbances during the lockdown. Main predictors of sleep disturbances identified by regression models were: female gender, advanced age, being a healthcare worker, living in southern Italy, confinement duration, and a higher level of depression, stress, and anxiety. The circadian evening preference turned out as a vulnerability factor, while morning-type individuals showed a lower predisposition to sleep and psychological problems. Finally, working from home emerged as a protective factor against the development of sleep disturbances. Besides confirming the role of specific demographic and psychological factors in developing sleep disorders during the COVID-19 pandemic, we demonstrated circadian typologies react differently to a particular period of reduced social jetlag. Finally, our results indicated working from home promotes well-being during the current pandemic period.

Symptomatological Variants and Related Clinical Features in Adult Attention Deficit Hyperactive Disorder

A large amount of the current literature has focused on the characteristic symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents. In contrast, less attention has been devoted to ADHD clinical subtypes in adult patients. We evaluated 164 consecutive adult ADHD (A-ADHD) outpatients using DSM-5 criteria and many specific rating scales and questionnaires. A principal component factor analysis was performed on clinical and symptomatological variables to describe potential clinical variants. We sought to determine different A-ADHD variants focusing on demographic and clinical features. A four-factor solution was identified, and patients were clustered, according to their z-score, in 4 subgroups. The first was marked out by Emotional Dysregulation (ED), the second by Substance Use (SU), the third by Core-ADHD Symptoms (Co-ADHD) and the fourth by Positive Emotionality (PE). Predominantly ED patients showed worse overall function, early treatment with antidepressants and a greater presence of borderline personality disorder than predominantly Co-ADHD patients. Predominantly SU patients reported high rates of bipolar disorder and severe general psychopathology. The PE factor was related to hyperthymic temperament and hypomania and showed a higher level of functioning. Females with A-ADHD showed a lower risk of being included in SU, and A-ADHD patients with co-occurring delayed sleep phase had less risk of being included in the SU factor than the prevailing Co-ADHD group. Our empirically based description of four clinical A-ADHD variants shows several aspects beyond the definition given by the DSM-5 diagnostic criteria.