Factors affecting pediatric adherence to positive airway pressure: Patient- and caregiver-reported treatment barriers and sleep difficulties.

OBJECTIVE/BACKGROUND: Adherence to positive airway pressure (PAP) treatment among children and adolescents is often suboptimal. Little is understood about modifiable determinants of PAP adherence. We evaluated whether patient and caregiver-perceived treatment barriers (across behavioral, environmental, emotional, and physical domains), as well as insomnia severity, were associated with PAP adherence among youth with sleep disordered breathing (SDB). PATIENTS/METHODS: We conducted a retrospective review of 188 patients prescribed PAP, ages 2-19 years. At the clinical visit, PAP adherence was assessed via objective download/smartcard and patients and their caregivers completed validated standardized questionnaires on barriers to PAP adherence and sleep onset and maintenance difficulties. We tested predictors of PAP adherence using linear regression. RESULTS: On average, patients wore their PAP 2/3 of nights for 5.3 ± 3.4 h. Patients reported more barriers overall compared to caregivers, and specifically more behavioral and emotional barriers (e.g., over a third of patients reported they just want to forget about sleep apnea). After controlling for demographic/treatment characteristics, patient-reported barriers accounted for a significant proportion of the variance in percent nights used (51%) and average nightly use (42%). Greater difficulties with sleep maintenance predicted poorer PAP adherence (percent nights and nightly duration). CONCLUSIONS: Study findings suggest that assessment of both patient and caregiver-perceived barriers to PAP adherence, as well as evaluating for sleep maintenance concerns, may provide important treatment targets for promoting PAP adherence among youth. Results also support the potential benefit of a multi-disciplinary team-based approach to managing SDB and promoting PAP adherence.

Earlier bedtimes and more sleep displace sedentary behavior but not moderate-to-vigorous physical activity in adolescents.

OBJECTIVES: Correlational models suggest increased cardiometabolic risk when sleep replaces moderate-to-vigorous (but not sedentary or light) physical activity. This study tested which activity ranges are impacted by experimentally altering adolescents' bedtime. METHOD: Adolescents completed a 3-week within-subjects crossover experiment with 5 nights of late bedtimes and 5 nights early bedtimes (6.5- and 9.5-hours sleep opportunity, respectively). Experimental condition order was randomized. Waketimes were held constant throughout to mimic school start times. Sleep and physical activity occurred in the natural environments, with lab appointments following each 5-day condition. Waist-worn accelerometers measured physical activity and sedentary behavior. Wrist-worn actigraphs confirmed sleep condition adherence. Wilcoxon tests and linear mixed effects models compared waking activity levels between conditions and across time. RESULTS: Ninety healthy adolescents (14-17 years) completed the study. When in the early (vs. late) bedtime condition, adolescents fell asleep 1.96 hours earlier (SD = 1.08, d = 1.82, p < .0001) and slept 1.49 hours more (SD = 1.01, d = 1.74, p < .0001). They spent 1.68 and 0.32 fewer hours in sedentary behavior (SD = 1.67, d = 1.0, p < .0001) and light physical activity (SD = 0.87, d = 0.37, p = .0005), respectively. This pattern was reflected in increased proportion of waking hours spent in sedentary and light activity. Absolute and proportion of moderate-to-vigorous physical activity did not differ between conditions (d = 0.02, p = .89; d = 0.14, p = .05, respectively). CONCLUSIONS: Inducing earlier bedtimes (allowing for healthy sleep opportunity) did not affect moderate-to-vigorous physical activity. Alternatively, later bedtimes (allowing for ≤ 6.5 hours of sleep opportunity, mimicking common adolescent school night sleep) increased sedentary behavior. Results are reassuring for the benefits of earlier bedtimes.

Sleep Patterns Related to Emotion Dysregulation Among Adolescents and Young Adults.

OBJECTIVE: Adolescents and young adults in the college setting often report poor sleep hygiene and quality. These sleep difficulties may be related to emotion dysregulation, which is highly relevant to broader adjustment. The current study aimed to empirically identify latent groups of healthy college students with distinct subjective sleep patterns and examine differences in emotion dysregulation between subgroups. METHODS: College students (N = 476; Mage=19.38) completed the Adolescent Sleep-Wake Scale-Revised, Adolescent Sleep Hygiene Scale-Revised, and Difficulties in Emotion Dysregulation Scale. Most participants were White (78%), non-Hispanic/Latinx (85%), and female (77%). Latent profile analysis identified patterns of sleep with maximum likelihood estimation. Bolck-Croon-Hagenaars procedure evaluated differences in emotion dysregulation by class. RESULTS: A three-class model had optimal fit, Bayesian information criterion = 11,577.001, Bootstrapped Parametric Likelihood Ratio Test = -5,763.042, p < .001, entropy = .815. The three profiles identified were good sleep (overall high sleep quality and hygiene; n = 219), moderate sleep (low sleep quality with mix of low and high sleep hygiene; n = 221), and poor sleep (very low sleep quality and hygiene; n = 36). Those in the good sleep group (M = 68.06, SE = 1.5) reported significantly less emotion dysregulation than the moderate sleep group (M = 92.12, SE = 1.67; X2(2) = 98.34, p = .001) and the poor sleep group (M = 99.51, SE = 4.10; p < .001). The moderate and poor sleep groups did not significantly differ, X2(2) = 2.60, p = .11. CONCLUSIONS: Emotion dysregulation differed across three sleep profiles, with participants classified in the good sleep group reporting, on average, the lowest emotion dysregulation, compared to the moderate and poor sleep groups. These findings highlight contextual factors of sleep that may be clinically targeted to promote emotion regulation.

Prevalence of somatic and pain complaints and associations with sleep disturbance in adolescents with insomnia presenting to a behavioral sleep medicine clinic.

STUDY OBJECTIVES: Sleep problems are highly comorbid with pediatric pain, yet there is a dearth of research on how pain and somatic complaints impact adolescent insomnia presentation and response to cognitive-behavioral therapy for insomnia (CBT-I). This study aims to (1) determine the prevalence of parent-reported somatic/pain complaints in adolescents with insomnia presenting to a behavioral sleep clinic, (2) assess the impact of somatic/pain complaints on initial sleep presentation, and (3) assess the impact of baseline somatic/pain complaints on response to CBT-I. METHODS: Participants included adolescents (n = 375) presenting to a behavioral sleep medicine center with a primary diagnosis of insomnia. As a part of clinical care, pre-evaluation measures were completed including the Pediatric Insomnia Severity Index, Adolescent Sleep Hygiene Scale, Adolescent Sleep Wake Scale, and Child Behavior Checklist. The Somatic Syndrome Scale of the Child Behavior Checklist measured somatic complaints and teens were categorized as endorsing pain if reported to experience aches/pains, headaches, or stomachaches. Adolescents completed the Pediatric Insomnia Severity Index at end of treatment. RESULTS: Most adolescents had parent-reported somatic (61.1%) and/or pain complaints: headaches (66.6%), stomachaches (48.5%), and aches/pains (45.1%). Greater somatic and pain complaints predicted a worse sleep presentation at intake (all P < .05). After controlling for insomnia severity at intake, neither end-of-treatment insomnia severity nor treatment status were predicted by somatic and pain complaints at intake. CONCLUSIONS: Results suggest that parent-reported somatic/pain complaints are prevalent in > 50% of adolescents seeking behavioral insomnia treatment. Although complaints are associated with more severe insomnia at intake, they do not appear to interfere with treatment response. CITATION: Van Dyk TR, Krietsch KN, King CD, Byars KC. Prevalence of somatic and pain complaints and associations with sleep disturbance in adolescents with insomnia presenting to a behavioral sleep medicine clinic. J Clin Sleep Med. 2022;18(1):151-160.

Losing sleep by staying up late leads adolescents to consume more carbohydrates and a higher glycemic load.

This study examined how short sleep impacts dietary consumption in adolescents by testing whether experimentally shortening sleep influences the amount, macronutrient content, food types, and timing of food consumed. Ninety-three adolescents completed a within-subjects crossover paradigm comparing five nights of short sleep (6.5-hour sleep opportunity) to five nights of Healthy Sleep (9.5-hour sleep opportunity). Within each condition, adolescents completed three multiple-pass dietary recalls that recorded the types, amount, and timing of food intake. The following outcomes were averaged across days of dietary recall within condition: kilocalories, grams of carbohydrates, fat, protein, and added sugars, glycemic load of foods, and servings of specific types of foods (low-calorie drinks, sweetened drinks, fruits/vegetables, meats/proteins, processed snacks, "fast food" entrees, grains, and sweets/desserts). Timing of consumption of kilocalorie and macronutrient outcomes were also examined across four noncumulative time bins: 06:00-10:59, 11:00-15:59, 16:00-20:59, and 21:00-01:00. Adolescents slept 2 h and 20 min longer in Healthy Sleep than in Short Sleep (p < .0001). While in Short Sleep, adolescents ate more grams of carbohydrates (p = .031) and added sugars (p = .047), foods higher in glycemic load (p = .013), and servings of sweet drinks (p = .023) and ate fewer servings of fruits/vegetables (p = .006) compared to Healthy Sleep. Differences in consumption of kilocalories, fat, and carbohydrates emerged after 9:00 pm (ps = .012, .043, .006, respectively). These experimental findings suggest that adolescents who have insufficient sleep exhibit dietary patterns that may increase the risk for negative weight and cardiometabolic outcomes. Future health promotion efforts should include promoting optimal sleep to increase healthy dietary habits.

Improvements in Sleep Correlate With Improvements in Clinical Outcomes Among Adolescents Undergoing Intensive Interdisciplinary Pain Treatment.

OBJECTIVES: Intensive interdisciplinary pain treatment (IIPT) programs have been shown to restore function, improve coping, and reduce pain in adolescents with chronic pain. Yet, little is known about patients' sleep during IIPT and whether or not improvements in pain treatment outcomes are associated with changes in sleep pre-to-post IIPT treatment. The objectives of the current study were to describe sleep among adolescents entering IIPT and examine associations between sleep parameters and IIPT treatment effects. MATERIALS AND METHODS: Self-reported sleep measures and clinical outcomes (eg, functional disability, coping, average pain), were collected from 44 adolescents (mean age=14.57, 68.2% female) at admission and discharge from an inpatient IIPT program. Wrist-worn actigraphy data and sleep diaries from participants' first week and last week in the program were analyzed to characterize sleep parameters. RESULTS: Participants self-reported poor sleep/wake patterns, high levels of insomnia symptoms, and subclinical problems with daytime sleepiness upon admission into IIPT, although actigraphic indices of sleep from the first week of IIPT admission were only just under clinical guidelines for healthy adolescent sleep. Better self-reported sleep quality assessed via aggregated sleep diaries from the first week was associated with improvement in average pain and disability over the course of the program. Furthermore, improvements in insomnia symptoms and daytime sleepiness throughout the program were positively correlated with concurrent improvements in functional disability and coping. DISCUSSION: Taken together, results suggest that sleep may be associated with IIPT treatment effects and pave the way for future research to continue examining these relationships.

Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment.

Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program-"FIRST Program"), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.-8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1-2 months later), FIRST Patients' sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.

The impact of short sleep on food reward processes in adolescents.

Short sleep has been linked to adolescent risk of obesity, but questions remain regarding the dietary mechanisms by which this occurs. We tested whether mildly shortening sleep influences how rewarding and appealing healthy adolescents find several kinds of foods. Eighty-eight healthy adolescents completed a within-subjects crossover sleep experiment comparing 5 days of Short Sleep (6.5 hr sleep opportunity) with 5 days of Healthy Sleep (9.5 hr sleep opportunity). Following each condition, adolescents completed measures of food appeal and reinforcing value of food across five food types: sweets/desserts, fruits/vegetables, lean meats/eggs, fast food and processed snacks. Adolescents averaged 2.2 hr/night longer sleep periods in Healthy Sleep versus Short Sleep. We observed a significant interaction of experimental order with sleep condition on three of four primary outcomes related to the appeal and reinforcing value of foods (p's < .005). When Short Sleep preceded Healthy Sleep, adolescents endorsed significantly greater appeal (p < .04) and rewarding value of food (p's ranging from <.01 to .048) during Short Sleep (compared to Healthy Sleep). However, when Healthy Sleep preceded Short Sleep, we did not observe a main effect of sleep condition on the same outcomes (p's > .05). This study provides evidence that restricting adolescents' sleep opportunity to 6.5 hr (compared to sleeping a healthy amount) increases the appeal and reinforcing value of a variety of foods, but this may occur only under protracted short sleep. Increased food reward may be one mechanism linking chronically shortened sleep with risk of obesity in adolescence.

Experimental sleep restriction increases somatic complaints in healthy adolescents.

Short duration sleep and somatic complaints (bodily complaints like aches/pains or GI distress) are common in adolescence and may be linked, yet no published studies have tested causation. In this study, healthy adolescents (n = 30; 14-18yrs) completed a three-week, within-subject cross-over experiment. Following a sleep stabilization week, adolescents were randomized (in counterbalanced order) to five nights of 6.5hrs in bed (Insufficient Sleep) or 9.5hrs in bed (Sufficient Sleep), each preceded by a two-night "washout." Somatic complaints were assessed via the Children's Somatic Symptoms Inventory (CSSI-24) and the Pain and Symptom Assessment Tool (PSAT) concluding each condition. Adherence to experimental condition was confirmed via actigraphy. Adolescents slept two fewer hours and reported significantly greater frequency and severity of somatic complaints during the Insufficient Sleep (vs. Sufficient Sleep) condition. Restricting sleep opportunity to a level common in adolescence causally increased somatic complaints in otherwise healthy adolescents. Findings support clinical and preventative efforts to address pervasively inadequate sleep in adolescence.

Poor sleep and adolescent obesity risk: a narrative review of potential mechanisms.

Poor sleep is related to increased obesity risk in adolescents, though the mechanisms of this relationship are unclear. This paper presents a conceptual framework of the various pathways that have been proposed to drive this relationship. In this framework, increased food reward, emotional reactivity, decreased inhibitory control, metabolic disturbances, poorer dietary quality, and disrupted meal timings may increase the likelihood of increasing overall energy intake. This paper further notes how poor sleep increases sedentary behavior and screen time, which likely limits overall energy expenditure. The model posits that these mechanisms result in an imbalance of energy intake and expenditure following poor sleep, intensifying the overall risk for obesity. Increases in food reward processes, decreases in insulin sensitivity, disrupted meal timing, and increases in sedentary behavior seem to be the most compelling mechanisms linking poor sleep with increased obesity risk in adolescents. Future directions and clinical implications of this framework are discussed.

Sleep and weight-related factors in youth: A systematic review of recent studies.

There has been much speculation about mechanisms driving the pediatric sleep/obesity link. However, conjectures have not been matched by a systematic review of pediatric data investigating sleep and behaviors directly influencing weight. This raises the risk of biased, "cherry-picked" interpretations and hampers focused research efforts. This systematic review synthesized recent studies, discussed literature gaps, and provided recommendations for future research on sleep and weight-related factors in youth. Of the 4,302 articles (published between 2012 and 2017) initially screened, 86 were included in this review, which investigated the relationship between sleep and dietary intake, altered eating behavior, physical/sedentary activity, or hormones regulating hunger/satiety. Despite prior systematic reviews indicating associations with body mass, this systematic review of proposed mechanisms revealed highly variable findings and studies showed a high risk of bias. There were some consistent patterns showing no cross-sectional association between sleep duration and caloric intake (despite experimental evidence), and shorter or later sleep associating with greater sedentary or screen time. Considerable variability in methodology, weak sleep and dietary intake measurement, and a paucity of longitudinal or experimental designs likely contributed to variability in results. Findings highlight the need for more rigorous measurement and design methods in order to move the field forward.

Feasibility of a Single-Subject Protocol to Shift Young Children's Sleep Schedules.

The objective of this study is to describe children's adherence to changing sleep schedules within a small-scale, single-subject, at-home sleep manipulation experiment. Subjects were six healthy children (male = 4, ages 6-8). Children underwent: baseline, a 7-day self-selected sleep pattern; Condition A1, a 3- to 12-day stabilized sleep pattern (assigned time into/out of bed set at baseline averages); Condition B, a 3- to 12-day phase-delayed sleep pattern (time into/out of bed 2 h later than Condition A); and Condition A2, a 3- to 7-day return-to-stabilized sleep pattern (time into/out of bed at Baseline averages, identical to Condition A1). All children completed conditions. Per parent report, adherence to assigned time into/out of bed was good; sleep onset/offset adherence was variable. Within this small-scale, short-term sleep manipulation, children effectively got into/out of bed at assigned times despite manipulating sleep schedules by 2 h. However, they struggle to shift their sleep onset and offset times to match the time they were in bed.

Inducing more sleep on school nights reduces sedentary behavior without affecting physical activity in short-sleeping adolescents.

OBJECTIVES/BACKGROUND: Short sleep duration during adolescence is associated with increased dietary intake and greater risk for overweight/obesity. However, findings are mixed on the relationship between sleep and physical activity (PA) during the school year, when short sleep duration is most common. Furthermore, there is concern that increasing sleep duration may interfere with opportunities for PA, yet this has not been directly tested. This study examined the impact of an at-home experimental sleep extension protocol on PA during the school year among short-sleeping adolescents. PARTICIPANTS/METHODS: Participants included 18 adolescents (67% female, 78% white) who reported regularly sleeping between 5-7 h on school nights. Adolescents completed a five-week, at-home sleep manipulation protocol with an initial baseline week followed in a randomized, counterbalanced order by two experimental conditions, each lasting two weeks. During prescribed habitual sleep (HAB), bedtimes and rise times were set to match the baseline sleep pattern, and during sleep extension (EXT), adolescents were instructed to increase time in bed on school nights by 1.5 h per night relative to baseline. Wrist-mounted actigraphy was employed to monitor sleep and waist-mounted accelerometers were used to measure daytime PA. RESULTS: Adolescents slept for an average duration of 71 min longer on school nights during EXT than during HAB (p < 0.001). During HAB, adolescents spent more time in sedentary behavior (p = 0.002) than during EXT, but there were no cross-condition differences in light activity (p = 0.184) or moderate-to-vigorous PA (p = 0.102). CONCLUSIONS: Extending sleep duration on school nights in short-sleeping adolescents reduces time spent in sedentary behavior, without having a negative impact on health-promoting moderate-to-vigorous PA.

Influence of asthma status on sleep variability in overweight/obese youth.

OBJECTIVE: Pediatric asthma and overweight/obesity (OV/OB) frequently co-occur and youth with both conditions exhibit poor sleep/bedtime habits. This study assessed differences in week-to-weekend bedtime/wake time variability among OV/OB youth with/without comorbid asthma, and tested whether variability predicted weekday sleep. METHODS: OV/OB youth (n = 142; 28% comorbid asthma; 7-12 years) wore an Accelerometer for 5 days (2 weekend days), providing estimates of week-to-weekend bedtime/wake-time variability, weekday Total Sleep Time (TST), weekday time in bed (TIB), and weekday wake after sleep onset (WASO). RESULTS: There were no demographic differences between groups beyond lower family income for the OV/OB+asthma group. The OV/OB+asthma group exhibited later weekday (mean OV/OB+asthma = 10:39 pm, mean OV/OB only = 10:30pm) and weekend (mean OV/OB+asthma = 11:41 pm, mean OV/OB only = 11:17pm) bedtimes, earlier weekday waketimes (mean OV/OB+asthma = 6:40 am, mean OV/OB only = 6:51 am), and similar weekend waketimes (mean OV/OB+asthma = 7:54 pm, mean OV/OB only = 7:52 pm. Univariate MANOVA follow-ups indicated a main effect of asthma group for week-to-weekend bedtime and waketime variability, with the OV/OB+asthma group evidencing approximately 30 minutes greater bedtime (OV/OB+asthma mean = 90 minutes) and waketime (OV/OB+asthma mean = 108 minutes) variability. Within the OV/OB+asthma group, greater waketime variability predicted fewer minutes of weekday TIB and WASO. Within the OV/OB only group, wake time variability predicted fewer minutes of weekday TIB. CONCLUSION: Findings suggest that asthma status confers risk for more week-to-weekend variability among currently OV/OB youth, and that greater variability shortens the weekday sleep period. Further research on reasons for greater week-to-weekend sleep variability in asthma is needed.

Temporal Associations Between Sleep and Physical Activity Among Overweight/Obese Youth.

OBJECTIVE: Examine average interindividual and temporal intraindividual associations between time of sleep onset (sleep onset), total sleep time (TST), and minutes in moderate-to-very-vigorous physical activity per hour (MVPA/h) among overweight/obese youth. METHODS: Overweight/obese youth (n = 134; 7-12 years) wore an accelerometer for 16+ hr/day, 5-7 days, which provided daily objective estimates of MVPA/h, TST, and sleep onset. RESULTS: Multilevel models revealed an intraindividual effect of TST, such that nights with longer TST preceded less MVPA/h during the midnight-to-midnight monitoring period; a significant random effect qualified this relationship. Average interindividual TST did not predict mean MVPA/h, whereas sleep onset significantly predicted mean MVPA/h. CONCLUSIONS: Later time of sleep onset (as opposed to TST) was the strongest predictor of group-level decreased physical activity. At the individual level, longer TST than usual predicted less MVPA/h than usual. Results suggest the need for more person-centered research and a greater focus on sleep timing among youth.

Day-to-Day Variation of Subjective Sleep Quality and Emotional States Among Healthy University Students--a 1-Week Prospective Study.

BACKGROUND: In spite of the apparently bidirectional relationship between daytime emotions and nocturnal sleep quality, relatively few studies have examined the day-to-day co-variation of daytime emotional states and sleep quality. PURPOSE: In order to address this issue, we used a 7-day prospective design allowing for the simultaneous investigation of the bidirectional link between sleep quality and affective states. METHOD: Seventy-five healthy university students completed a daily log during 7 days, reporting subjective sleep quality after their final morning awakenings. Eight hours later, they completed the Positive and Negative Affect Schedule measuring daytime affective states. Multilevel modeling was applied in order to examine level 1 (day-to-day co-variation of sleep quality and affective states within individuals) as well as level 2 (averaged between-subjects) effects. RESULTS: Individuals reporting poor sleep quality (on average) were characterized by lower positive and higher negative affect during daytime. Similarly, higher positive and lower negative affect (on average) predicted better subjective sleep quality during the assessment period. Moreover, daily ratings of positive and negative affect were related to the subjective sleep quality of the preceding night: On occasions in which participants reported poor (below average) sleep quality, they also reported lower positive and higher negative affect during the day. Nevertheless, daytime positive and negative affective states did not predict subsequent sleep quality ratings. CONCLUSION: These findings suggest daily dynamic associations between subjective sleep quality and next day's emotional states in a group of healthy individuals, while in the inverse, the co-variation between daytime affective states and subsequent sleep quality was not supported.

Sleep complaints predict increases in resting blood pressure following marital separation.

OBJECTIVE: Although marital separation and divorce are associated with many negative health outcomes, few studies examine the psychophysiological mechanisms that may give rise to these outcomes. This study examined changes in resting blood pressure (BP) as a function of sleep complaints in recently divorced adults. METHOD: Recently separated adults (n = 138; 38 men) completed a self-report measure of sleep complaints and a resting blood pressure (BP) assessment in the laboratory at three occasions across 7.5 months. RESULTS: Multilevel analyses revealed that although sleep complaints were not associated with concurrent BP, sleep complaints predicted significant increases in both systolic and diastolic BP at the subsequent laboratory visit. In addition, time since the separation from an ex-partner moderated the association between sleep complaints at baseline and resting systolic blood pressure (SBP) 3 months later. People who reported high sleep complaints 10 weeks or more after their separation demonstrated greater increases in SBP. CONCLUSIONS: In recently separated adults, greater sleep complaints may index increased risk for future increases in BP. This work helps pinpoint one potential mechanistic pathway linking marital separation with an important, health-relevant biological outcome.