Actigraphy-measured sleep concordance, night-wakings, intraindividual sleep variability in parents and their children-Associations with childhood sleep disturbances.

The relationship between the sleep of parents and their children has primarily been studied using self-reported measures, but data using objective sleep assessments are limited. In particular, objective assessments of sleep disturbance and night-wakings in parents in relation to their children's night-wakings is underexamined. This pilot study employed actigraphy to determine concordance in sleep-wake patterns between parents and their children, and examine temporal links between their wakings lasting five min or longer. The study also explored individual variability in parents' sleep based on parent-reported sleep disturbances in children. A total of 20 parents and children (aged 2-12 years, no co-sleepers) contributed actigraphy data for the 14-night study, totalling 280 nights of data. Parents reported their sleep quality using the Pittsburgh Sleep Quality Index, and children's sleep using the Children Sleep Habits Questionnaire. Concordance analysis of actigraphy data revealed an average of 70.6% match in sleep/wake state between parents and children. Parents were three times more likely to have an awakening within 10 min of their child waking than vice versa. Parent-reported sleep disturbances in children were associated with poorer actigraphic sleep outcomes for both the parent and child. Parents of poorly sleeping children demonstrated greater variability in their bedtime, and wake after sleep onset. Further examination of temporal links between parent-child sleep can improve our understanding of factors that predispose or precipitate sleep disturbances across families. Given the high concordance in parent-child sleep and poorer actigraphy sleep outcomes in parents of children with sleep disturbances, there is a need to deliver efficacious sleep interventions at the family level.

Strange themes in pandemic dreams: Insomnia was associated with more negative, anxious and death-related dreams during the COVID-19 pandemic.

Dreaming and insomnia are important markers of distress in times of crisis. Here, we present a longitudinal, mixed-methods study examining changes in dreaming between individuals with and without insomnia symptoms and their relationship to mental health during the COVID-19 pandemic. A global survey examining insomnia symptoms, dreams and mental health was launched in April 2020 and followed participants over 12 months. Of 2240 participants, 1009 (45%) reported dream changes at baseline. A higher proportion of participants with new-onset insomnia reported dream changes (55%) than those with pre-existing insomnia (45%) or good sleepers (36%). Overall, thematic analysis identified key dream change themes of increased dream activity, with participants dreaming vividly, in high-definition, and with a strong negative charge. Themes around survival, adjusting to pandemic life, meaning-making and poor sleep quality were also noted. Linguistic Inquiry Word Count showed that individuals with insomnia used more negative words to describe their dream changes than good sleepers. Specifically, the new-onset insomnia group used more anxious and death-related words than those who slept well. Notably, all groups experienced a significant reduction in dream activity by 3-month follow-up. Lastly, dream changes were associated with worse mental health symptoms over time, and this effect was more pronounced in individuals with insomnia. Our results highlight that insomnia symptoms, especially new-onset insomnia, are associated with more negative dream changes during collective stressful events, potentially compounding daytime distress and mental health symptoms over time. During times of crisis, dreaming and insomnia may reveal an important target for mental health interventions.

Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis.

BACKGROUND: Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. PARTICIPANTS/METHODS: A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 731 good sleepers), adjusted for demographic differences. RESULTS: Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81). CONCLUSION: Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.

Development of a Novel Behavioral Sleep Medicine Education Workshop Designed to Increase Trainee Psychologists' Knowledge and Skills in Insomnia Management.

OBJECTIVES: Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management. METHODS: The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data. RESULTS: Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep. CONCLUSIONS: The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.

Mindfulness-Based Strategies for Improving Sleep in People with Psychiatric Disorders.

PURPOSE OF THE REVIEW: To review the recent literature on mindfulness-based strategies for improving self-report and objective measures of sleep, in individuals with psychiatric disorders. RECENT FINDINGS: Currently, research provides some support for the use of mindfulness-based interventions to improve sleep amongst individuals with psychiatric comorbidities. The strongest evidence was for the use of standardized programs, particularly for improving sleep in anxiety and depressive disorders. There is a paucity of well-controlled studies using validated subjective or objective measures of sleep. As these interventions were not specifically designed to target sleep, observed improvements may be an indirect consequence of reduced psychiatric symptoms. There is insufficient research into the application of mindfulness-based strategies to improve sleep or treat sleep disorders in people with psychiatric disorders. Well-controlled studies using standardized, mindfulness-based interventions developed to target sleep, such as mindfulness-based therapy for insomnia, may optimize the potential benefits of mindfulness for sleep in psychiatric populations.

Does continuous positive airways pressure treatment improve clinical depression in obstructive sleep apnea? A randomized wait-list controlled study.

BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is associated with a range of adverse daytime sequelae, including significantly higher rates of clinical depression than is seen in the general community. Improvements in depressive symptoms occur after treatment of the primary sleep disorder, suggesting that comorbid depression might be an intrinsic feature of OSA. However, there are limited data on whether treatment for OSA in patients diagnosed with clinical depression improves mood symptoms meaningfully enough to lead to the remission of the psychiatric diagnosis. METHODS: N = 121 untreated OSA patients were randomized to either continuous positive airway pressure (CPAP) treatment or waitlist control, and depressive symptoms, sleepiness and clinical depression (using a structured clinical interview) were assessed at baseline and 4 months. Linear and logistic regression analyses were conducted, controlling for baseline scores, stratification factors and antidepressant use. RESULTS: Depressive symptoms (odds ratio [OR] = -4.19; 95% confidence interval [CI] = -7.25, -1.13; p = .008) and sleepiness (OR = -4.71; 95% CI = -6.26, -3.17; p < .001) were significantly lower at 4 months in the CPAP group compared to waitlist. At 4 months, there was a significant reduction in the proportion of participants in the CPAP group meeting criteria for clinical depression, compared to the waitlist controls (OR = 0.06, 95% CI = 0.01, 0.37; p = .002). CONCLUSION: Treatment of OSA may be a novel approach for the management and treatment of clinical depression in those with comorbid sleep disordered breathing. Larger trials of individuals with clinical depression and comorbid OSA are needed.

Prevalence of sleep-disordered breathing in people with tetraplegia-a systematic review and meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVES: To determine the prevalence of sleep-disordered breathing (SDB) in people with tetraplegia and to identify the characteristics associated with SDB. METHODS: A systematic literature search using Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature sources was conducted using a combination of spinal cord injury (SCI) and SDB related terms. Articles were restricted to publication dates between 1/1/2000 and 4/9/2020 and with objectively measured SDB with an overnight sleep study. The frequency of SDB stratified by the apnoea hypopnea index (AHI) was extracted and weighted averages, using a random effects model, were calculated with 95% confidence intervals. Sub-group analyses were performed where possible. RESULTS: Twelve articles were included in the review; of these nine were included in meta-analysis (combined sample = 630). Sample sizes and case detection methods varied. Reported SDB prevalence rates ranged from 46 to 97%. The prevalence of at least mild (AHI ≥ 5), moderate (AHI ≥ 15) and severe (AHI ≥ 30) SDB were 83% (95% CI = 73-91), 59% (46-71) and 36% (26-46), respectively. Sub-group analyses found that prevalence increased with age (p < 0.001). There were no statistically significant differences in SDB prevalence by sex (p = 0.06), complete/incomplete SCI (p = 0.06), body mass index (p = 0.07), acute/chronic SCI (p = 0.73) or high/low level of cervical SCI (p = 0.90). CONCLUSION: Our results confirm that SDB is highly prevalent in people with tetraplegia, and prevalence increases with age. The high prevalence suggests that routine screening and subsequent treatment should be considered in both acute and community care.

Assessing the validity of eyelid parameters to detect impairment due to benzodiazepines.

OBJECTIVE: Benzodiazepines impair driving ability and psychomotor function. Eyelid parameters accurately reflect drowsiness; however, the effects of benzodiazepines on these measures have not been extensively studied. The aim of this study was to investigate the effect of benzodiazepines on eyelid parameters and evaluate their accuracy for detecting psychomotor impairment. METHODS: Eyelid parameters were recorded during a psychomotor vigilance task (PVT) and driving simulation over 2 days, baseline, and after 20-mg oral temazepam. The utility of eyelid parameters for detecting PVT lapses was evaluated using receiver operating characteristic curves, and cut-off levels indicating impairment (≥1 and ≥2 PVT lapses per min) were identified. The accuracy of these cut-off levels for detecting driving simulator crashes was then examined. RESULTS: PVT and driving simulator performance was significantly impaired following benzodiazepine administration (p < .05). Average eyelid closure duration (inter-event duration) was a reliable indicator of PVT lapses (area under the curve [AUC] of 0.87-0.90). The cut-off value of eyelid closure duration derived from PVT AUC was able to predict driving simulator crashes with moderately high sensitivity and specificity (76.23% and 75.00%). CONCLUSIONS: Eyelid parameters were affected by benzodiazepines and accurately detected the psychomotor impairment. In particular, eyelid closure duration is a promising real-time indicator of benzodiazepine impairment.

A Cluster Analysis of Sleep Quality, Self-Care Behaviors, and Mental Health Risk in Australian University Students.

Background: University students have high levels of poor sleep quality (SQ) and mental health, and low adherence to healthy nutrition and physical activity (PA). Objective: This study examined what clusters of self-care behaviors (SCB) were associated with SQ and mental health in Australian university students. Method: 355 Australian university students, ranging in age from 18 to 24 years (M = 20, SD = 1.5, 286 females) completed surveys relating to fruit and vegetable consumption, alcohol binge behavior, PA, mental health measured by the Depression Anxiety Stress Scales 21, and SQ measured by the Pittsburgh SQ Index (PSQI). Fruit and vegetable consumption, alcohol binge behavior, and PA were assessed according to current Australian guidelines. Results: Almost two thirds of participants (62.0%) met the criteria for poor SQ. Good SQ was significantly associated with meeting PA guideline levels (rb = .14) and inversely associated with higher levels of depression (rpb = -.34), anxiety (rpb = -.36), and stress levels (rpb = -.42). Four distinct SCB and mental health risk clusters were created. The "healthiest SCB" cluster had 1.6 times better SQ than the average. This cluster had higher levels of moderate and vigorous PA, higher levels of fruit consumption, and less binge drinking, the least sedentary behavior, and the lowest levels of depression, anxiety, and stress compared to the other clusters. Conclusion: This research corroborates with previous literature on the importance of regular vigorous PA as a lifestyle intervention to facilitate better sleep outcomes and improved mental health outcomes in university students.

Autobiographical Memory From Different Life Stages in Individuals With Obstructive Sleep Apnea.

OBJECTIVES: Autobiographical memory dysfunction is a marker of vulnerability to depression. Patients with obstructive sleep apnea (OSA) experience high rates of depression and memory impairment, and autobiographical memory impairments have been observed compared to healthy controls; however, these groups were not age-matched. This study aimed to determine whether individuals with untreated OSA have impaired autobiographical memory when compared to age-matched controls, and to assess the quality of autobiographical memories from three broad time points. METHODS: A total of 44 participants with OSA (M age=49.4±13.0) and 44 age-matched controls (M age=50.0±13.1) completed the Autobiographical Memory Interview (AMI) to assess semantic and episodic memories from three different life stages, and 44 OSA participants and 37 controls completed the Autobiographical Memory Test (AMT) to assess overgeneral memory recall (an inability to retrieve specific memories). RESULTS: OSA participants had significantly poorer semantic recall of early adult life on the AMI (p<.001), and more overgeneral autobiographical memories recalled on the AMT (=.001), than controls. Poor semantic recall from early adult life was significantly correlated with more depressive symptoms (p=0.006) and lower education (p<0.02), while higher overgeneral memory recall was significantly associated with older age (p=.001). CONCLUSIONS: A specific deficit in semantic autobiographical recall was observed in individuals with OSA. OSA patients recalled more overgeneral memories, suggesting that aspects of the sleep disorder affect their ability to recollect specific details of events from their life. These cognitive features of OSA may contribute to the high incidence of depression in this population. (JINS 2019, 25, 266-274).

Exploring gene expression biomarker candidates for neurobehavioral impairment from total sleep deprivation.

BACKGROUND: Although sleep deprivation is associated with neurobehavioral impairment that may underlie significant risks to performance and safety, there is no reliable biomarker test to detect dangerous levels of impairment from sleep loss in humans. This study employs microarrays and bioinformatics analyses to explore candidate gene expression biomarkers associated with total sleep deprivation (TSD), and more specifically, the phenotype of neurobehavioral impairment from TSD. Healthy adult volunteers were recruited to a sleep laboratory for seven consecutive days (six nights). After two Baseline nights of 10 h time in bed, 11 subjects underwent an Experimental phase of 62 h of continuous wakefulness, followed by two Recovery nights of 10 h time in bed. Another six subjects underwent a well-rested Control condition of 10 h time in bed for all six nights. Blood was drawn for measuring gene expression on days two, four, and six at 4 h intervals from 08:00 to 20:00 h, corresponding to 12 timepoints across one Baseline, one Experimental, and one Recovery day. RESULTS: Altogether 212 genes changed expression in response to the TSD Treatment, with most genes exhibiting down-regulation during TSD. Also, 28 genes were associated with neurobehavioral impairment as measured by the Psychomotor Vigilance Test. The results support previous findings associating TSD with the immune response and ion signaling, and reveal novel candidate biomarkers such as the Speedy/RINGO family of cell cycle regulators. CONCLUSIONS: This study serves as an important step toward understanding gene expression changes during sleep deprivation. In addition to exploring potential biomarkers for TSD, this report presents novel candidate biomarkers associated with lapses of attention during TSD. Although further work is required for biomarker validation, analysis of these genes may aid fundamental understanding of the impact of TSD on neurobehavioral performance.

Autobiographical memory impairment in obstructive sleep apnea patients with and without depressive symptoms.

Obstructive sleep apnea is associated with memory impairments, and higher rates of depressive symptoms and major depressive disorder compared with community estimates. Autobiographical memory overgenerality, a behaviour characterized by difficulty recalling specific memories from one's own life, is recognized as a marker of depression. Previous studies have demonstrated the predictive quality of specific autobiographical memory recall on the course of depression in patients with obstructive sleep apnea. However, it remains unclear whether impaired autobiographical memory is simply a feature of depression, or whether it is also impaired in patients with obstructive sleep apnea without depression. This study aimed to investigate whether autobiographical memory impairments can be observed in patients with obstructive sleep apnea, independent of the severity of depressive symptoms. Twenty-one patients with obstructive sleep apnea symptomatic for depressive symptoms (mean age = 43.43 years, SD = 9.97), 17 patients with obstructive sleep apnea asymptomatic for depressive symptoms (mean age = 40.65 years, SD = 9.39), and 20 healthy controls without sleep-disordered breathing (mean age = 32.80 years, SD = 6.69) completed an Autobiographical Memory Test. Patients with obstructive sleep apnea symptomatic for depressive symptoms recalled significantly fewer specific memories when compared with healthy controls (P = 0.010). No difference in the recall of specific autobiographical memory was observed between symptomatic and asymptomatic patients with obstructive sleep apnea. With regard to valence, symptomatic patients with obstructive sleep apnea recalled significantly fewer negative specific memories when compared with controls (P = 0.010). Impairment in specific autobiographical memory recall can be observed in patients with obstructive sleep apnea, regardless of the severity of depressive symptoms; however, this effect may not be as prominent in younger patients with obstructive sleep apnea.

Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women.

Previous longitudinal studies have demonstrated that poor sleep may precede depression and anxiety. The current study examined the association between self-reported sleeping difficulties and new onset depression and anxiety in young women. A nationally representative sample of 9,683 young women from the Australian Longitudinal Study of Women's Health was analyzed. Women were surveyed in 2000 (aged 22 to 25 years), 2003, 2006, and 2009. Generalized estimating equations were used to examine the association between sleeping difficulties in 2000 and new-onset depression (excluding postnatal depression) and anxiety at each subsequent survey. Significant increased risk of new onset depression (odds ratio (OR)=2.6 in 2003; OR=4.4 in 2006; OR=4.4 in 2009) and anxiety (OR=2.4 in 2006; OR=2.9 in 2009) was found at each follow-up survey in women who reported sleeping difficulties "often" in 2000. Further research is needed to uncover the mechanisms underlying the link between sleep problems and mental health.

Understanding the Relationships Between Sleep Quality and Depression and Anxiety in Neurotrauma: A Scoping Review.

Sleep problems, depression, and anxiety are highly prevalent after a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in persons with SCI and TBI, and to identify gaps in the literature. A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety after SCI or TBI were synthesized. The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety. The findings of this review suggest that sleep and psychopathology are related in persons with neurotraumatic injuries. This has important therapeutic implications, because individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships and how they impact patient outcomes.

Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms.

STUDY OBJECTIVES: The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms. METHODS: This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020-May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only. RESULTS: Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes. CONCLUSIONS: Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.

REducing Sleep Apnoea for the PrEvention of Dementia (REShAPED): Protocol for a multi-site feasibility randomised controlled trial.

There is accumulating evidence that has linked OSA with increased risk of cognitive decline and dementia. Here we present the protocol for an Australian, multi-site randomised controlled, parallel open-label trial which will evaluate the feasibility for a full-scale trial investigating the effects of treating OSA on cognitive decline in older adults at risk of dementia within memory clinic settings. We will randomise 180 older adults to either the treatment intervention group or control group for 2 years. Inclusion criteria include: 50-85 years; mild-severe OSA (defined average ODI ≥ 10 with 3% oxygen desaturation determined by wrist oximetry over two nights); and subjective cognitive complaints or mild cognitive impairment. The treatment intervention arm aims to achieve an optimal treatment response based on reducing hypoxic burden with either CPAP, mandibular advancement splint, positional therapy, or oxygen therapy. Furthermore, participants will receive up to 8 sessions which involve motivational interviewing, collaborative goal setting, and behavioural sleep management. The control arm will not receive OSA treatment as part of this trial, however there will be no OSA treatment restrictions, and any treatment will be documented. Primary outcomes are 1) acceptability based upon willingness of participants to be randomised; 2) alleviating hypoxic burden by reducing OSA severity; 3) tolerability of the trial burden based upon collection of outcomes over the 2-year follow-up. Secondary outcomes include safety and cognitive function. Outcomes will be collected at 0, 6 and 24-months. This feasibility study aims to will provide the basis for a larger longer-term trial of dementia prevention.

Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 Infection.

BACKGROUND: Obstructive sleep apnea is associated with COVID-19 infection. Less clear is whether obstructive sleep apnea is a risk factor for the development of post-acute sequelae of SARS-CoV-2 infection (PASC). STUDY DESIGN: Cross-sectional survey of a general population of 24,803 US adults to determine the association of obstructive sleep apnea with PASC. RESULTS: COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence of persistent (>3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models, obstructive sleep apnea was associated with all putative PASC-related symptoms with the highest adjusted odds ratios being fever (2.053) and nervous/anxious (1.939). In 4 logistic regression models of overall PASC derived from elastic net regression, obstructive sleep apnea was associated with PASC (range of adjusted odds ratios: 1.934-2.071); this association was mitigated in those with treated obstructive sleep apnea. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. CONCLUSION: In a general population sample, obstructive sleep apnea is associated with the development of PASC-related symptoms and a global definition of PASC. Treated obstructive sleep apnea mitigates the latter risk. The presence of 3 or more PASC symptoms may be useful in identifying cases and for future research.

Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions.

Study Objectives: Insomnia, poor sleep quality and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Methods: Cross-sectional survey of a general population of 24,803 U.S. adults to determine the association of insomnia, poor sleep quality and sleep duration with PASC. Results: Prevalence rates of PASC among previously COVID-19 infected participants for three definitions of PASC were COPE (21.9%), NICE (38.9%) and RECOVER PASC Score (15.3%). PASC was associated with insomnia in all 3 models in fully adjusted models with adjusted odds ratios (aORs) and 95% confidence intervals (CI) ranging from 1.30 (95% CI: 1.11-1.52, p≤0.05, PASC Score) to 1.52 (95% CI: 1.34-1.71, p≤0.001, (NICE). Poor sleep quality was related to PASC in all models with aORs ranging from 1.77 (95% CI: 1.60-1.97, p≤0.001, NICE) to 2.00 (95% CI: 1.77-2.26, p≤0.001, COPE). Sleep <6 hours was associated with PASC with aORs between 1.59 (95% CI: 1.40-1.80, p≤0.001, PASC Score) to 1.70 (95% CI: 1.53-1.89, p≤0.001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality and short sleep duration with PASC in any of the models. Conclusions: Insomnia, poor sleep quality and short sleep duration are potential risk factors for PASC. Interventions to improve sleep may decrease the development of PASC.

Association of Chronotype and Shiftwork With COVID-19 Infection.

OBJECTIVE: This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: This study used a cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration, and comorbidities, morning chronotype was associated with a higher (adjusted odds ratio [aOR]: 1.15, 95% CI: 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.

A randomized controlled trial of a multi-dimensional intervention to improve CPAP use and self-efficacy.

OBJECTIVES: To assess the utility of a tailored intervention program to improve continuous positive airway pressure (CPAP) use and self-efficacy in individuals with obstructive sleep apnea (OSA). METHODS: 81 participants (mean age 52.1 ± 11.6 years; 35 females) with OSA were randomized to either a multi-dimensional intervention (PSY CPAP, n = 38) or treatment as usual (TAU CPAP, n = 43). The intervention included a psychoeducation session prior to CPAP initiation, a booster psychoeducation session in the first weeks of commencing CPAP, follow-up phone calls on days 1 and 7, and a review appointment on day 14. CPAP use was compared between the PSY CPAP and TAU CPAP groups at 1 week, 1 month, and 4 months. Self-efficacy scores (risk perception, outcome expectancies, and CPAP self-efficacy) were compared between groups following the initial psychoeducation session and again at 1 month and 4 months. RESULTS: CPAP use was higher in the PSY CPAP group compared to the TAU CPAP group for all time points (p = .02). Outcome expectancies improved significantly over time in PSY CPAP participants (p = .007). Change in risk perception was associated with CPAP use at 1 week (p = .02) for PSY CPAP participants. However, risk perception did not mediate the effect between group and CPAP use at 1 week. CONCLUSIONS: Interventions designed to increase self-efficacy and administered prior to CPAP initiation, repeated in the early stages of CPAP therapy, and combined with a comprehensive follow-up regime are likely to improve CPAP use. Sustained improvement in CPAP use is the ultimate goal but remains to be investigated.