Identifying the most proximal multi-level factors associated with meeting each of the 24-h movement behavior recommendations in a sample of autistic adults

BACKGROUND

Autistic adults have poorer 24-h movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-h movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-h movement behavior guidelines among autistic adults.

OBJECTIVE

This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-h movement behaviors of aerobic physical activity, sedentary behavior, and sleep.

METHODS

We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs >0 indicate predictive variables/domains.

RESULTS

A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep.

CONCLUSIONS

These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.

0003 On the Same Wavelength? Quantifying the Associations between Eating Timing and Rest-Activity Rhythms in Free-Living Adults

Introduction

Misalignment between the central circadian clock and daily behaviors increases cardiometabolic morbidity and mortality risk, likely due to internal misalignment between central and peripheral circadian rhythms. Experimental studies suggest food intake may act as a time cue (‘zeitgeber’) for resetting circadian rhythms, representing a potential behavioral target to ameliorate circadian misalignment and associated health consequences. However, the extent to which eating timing relates to circadian rhythms in free-living adults is unclear. Therefore, we tested the associations between eating timing with 24-h rest-activity-rhythms (RAR), a free-living proxy for endogenous circadian rhythms, in non-shift-working adults.

Methods

Adults without chronic health conditions or sleep disorders completed 14 days of 24/7 wrist accelerometry to evaluate RAR variables of interdaily stability (IS; day-to-day stability in RAR), intradaily variability (IV; within-day fragmentation of RAR), relative amplitude (RA; difference between peak vs. trough activity), L5 onset time (5-h period with lowest activity), and M10 onset time (10-h period with highest activity). Concurrently, time-stamped image-assisted diet records were obtained to generate average eating timing variables, including daily eating onset (time of first caloric intake after awakening), offset (last caloric intake time), duration (time elapsed between eating onset and offset), and caloric midpoint (time at which 50% of daily kcals were consumed), and variables illustrating irregularity in eating timing (standard deviation of eating timing variables). Pearson’s correlations quantified the associations between RAR and eating timing variables.

Results

Participants (N=30) were 28.0±6.6 years, 57% female, with a BMI of 23.8±2.5 kg/m2. Higher IS was correlated with lower irregularity in both eating onset (r=-0.55, p<0.01) and duration (r=-0.51, p<0.01). Higher RA correlated with earlier eating onset (r=-0.47, p<0.01), longer eating duration (r=0.53, p<0.01), and lower eating onset irregularity (r=-0.37, p<0.05). Later L5 correlated with later eating onset (r=0.67, p<0.001), offset (r=0.58, p<0.001), caloric midpoint (r=0.56, p<0.01), and greater eating offset irregularity (r=0.53, p<0.01). Later M10 correlated with later eating offset (r=0.40, p<0.05).

Conclusion

Preliminary findings indicate that eating timing and RAR are moderately correlated in free-living adults. Earlier eating timing, increased eating regularity, and longer daily eating duration may represent behavioral targets for improving circadian rhythms and subsequent cardiometabolic outcomes.

Support (If Any): Support provided by the American Heart Association (#831488) and a University of Delaware Research Fund-Strategic Initiative Award.

0586 Extending Sleep in Short Sleeping Middle-aged Adults at Risk for the Metabolic Syndrome

Introduction

Short sleep predicts the metabolic syndrome (MetS). Extending sleep improves certain MetS factors, specifically insulin sensitivity and blood pressure in adults without MetS. The absence of sleep intervention studies in community-dwelling adults with MetS limits progress in advancing sleep extension interventions to this subgroup. This study evaluated the feasibility, acceptability, and impact on End-of-Treatment (EOT) sleep outcomes of a 12-week sleep intervention.

Methods

Middle aged adults who were short sleepers and at risk for METs participated in a single-arm 12-week, 12-session sleep intervention based on cognitive behavioral therapy for insomnia delivered via videoconferencing platform. Feasibility and acceptability were assessed using retention and attendance rates as well as mean sleep diary completions (≥4 diaries/week). Anticipated (baseline) and experienced (EOT) acceptability were assessed using a 16-item survey that estimated self-reported acceptability, feasibility, perceived benefit, satisfaction, and overall satisfaction. Sleep was estimated from baseline and EOT 2-week wrist actigraphy data. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in acceptability, feasibility, perceived benefit, satisfaction, overall satisfaction, sleep and daytime sleepiness from baseline to EOT.

Results

The intent-to-treat sample included 44 adults (mean age 52y, 59% female, 41% Black, 48% White, 11% Other, 82% non-Hispanic). Three participants withdrew leaving N=41 (retention rate=93%). Eighty-six percent attended >80% of sessions and mean sleep diary completion was 6.7 diaries/week. There were statistically significant changes in self-reported anticipated (baseline) and experienced (EOT) acceptability surveys indicating greater EOT acceptability (p<0.001), perceived benefit (p<0.001), satisfaction (p<0.001), and overall evaluation (p<0.001). Statistically significant improvements in sleep from baseline to EOT included increased time-in-bed (Mbaseline=6.00h SD= 0.68h – MEOT=7.48, SD= 1.21; p<0.001), increased total sleep times (Mbaseline=5.16, SD= 0.63 – MEOT=6.26, SD= 1.23 p<0.001), earlier sleep onsets (Mbaseline=12.26am, SD= 0.05 – MEOT=11.53pm, SD= 0.06 p<0.05), more regular sleep onsets (Mbaseline=0.06, SD= 0.04 – MEOT=0.04, SD= 0.02 p<0.01), a higher sleep regularity index (Mbaseline=44.02, SD= 17.25 – MEOT=55.88, SD= 12.82 p<0.01), and reduced daytime sleepiness (Mbaseline=7.26, SD= 4.30 – MEOT=3.15, SD= 2.46, p<0.001).

Conclusion

Extending sleep, as well as improving sleep timing and regularity in racially/ethnically diverse middle-aged short sleepers using a videoconferencing platform is acceptable and feasible.

Support (If Any)

 

181 Sleep health concordance among socioeconomically disadvantaged caregiver-child dyads

Introduction

Child and caregiver sleep typically occurs within a family system. Disadvantaged families experience disproportionately poorer sleep health than more advantaged families. The extent to which objectively measured sleep health metrics (e.g. duration, timing, regularity, efficiency) are concordant within disadvantaged family systems, such as caregiver-child dyads, is not clear. To address this gap, this study aimed to: (1) characterize sleep health metrics, and (2) identify levels of sleep health concordance among disadvantaged caregiver-child dyads.

Methods

23 disadvantaged dyads were recruited from Philadelphia and Delaware communities. Dyads were eligible if the child was between 6-14 years, slept in the same house as the caregiver at least four nights/week, had no diagnosis of a sleep disorder or use of sleep medication, and qualified for federally funded food assistance programs (e.g., food stamps, WIC or SNAP benefits). Sleep health of the dyads was objectively measured for 7-14 days. Sleep metrics used to characterize the sample were: nighttime sleep duration (hours), time-to-bed, sleep regularity (standard deviation of sleep duration), sleep midpoint (halfway point between sleep onset and wake time) and efficiency (percentage of time spent asleep versus awake). Concordance in sleep health metrics within dyads was calculated using Pearson’s correlation coefficients of the average sleep metrics over the monitoring period.

Results

Children (46.2% female) slept, on average, 7.96 hours per night, with 1.25 hours of nightly sleep variability, bedtime of 10:47 PM, sleep midpoint of 2:56 AM, and sleep efficiency of 83.55%. Caregivers (mean age = 40.5 years, 85.0% female) slept, on average, 6.92 hours per night, with 1.22 hours of nightly sleep variability, bedtime of 11:24 PM, sleep midpoint of 3:04 AM, and sleep efficiency of 76.29%. Bedtime (r = 0.19, p < 0.001), sleep midpoint (r = 0.39, p < 0.001), and sleep efficiency (r = 0.24, p < 0.001) were significantly concordant among caregiver-child dyads.

Conclusion

Given their level of concordance, bedtime, sleep midpoint and efficiency are modifiable factors of sleep health in disadvantaged dyads that could be targeted using family versus individual level interventions.

Support (if any)

University of Delaware General University Research Grant and School of Nursing SEED funding.

013 Associations Between Rest-Activity Rhythms and Nocturnal Blood Pressure are Sex-Dependent in Apparently Healthy Emerging Adults

Introduction

Misalignment between endogenous circadian rhythms and environmental signals – an emerging risk factor for cardiovascular disease (CVD) – can disrupt diurnal blood pressure (BP) rhythms, resulting in higher nocturnal BP and less-pronounced BP dipping (i.e., % decline in nighttime systolic BP [SBP] relative to daytime values). Daily patterns of rest and activity (‘rest-activity rhythms’ [RAR]) are a proxy for estimating circadian disruption in free-living settings and have been independently associated with elevated CVD risk. However, the relation between RAR and nocturnal BP is unclear. Thus, we aimed to quantify the associations between RAR and nocturnal BP characteristics in male and female emerging adults (18-25y).

Methods

Fifty healthy emerging adults (20±1y; 20M/30F) underwent 24-h ambulatory BP monitoring following 14 consecutive days of continuous wrist actigraphy. RAR variables of interdaily stability (IS; day-to-day consistency in RAR), intradaily variability (IV; within-day fragmentation of RAR), and relative amplitude (RA; difference between trough vs. peak activity) were computed. Bivariate correlations were used to quantify associations between RAR variables and nocturnal BP characteristics for all participants, and separately for males and females. Linear regression models of mean nocturnal SBP, nocturnal diastolic BP (DBP), and SBP dipping were also generated to test main and interactive effects of sex and RAR. Potential confounders (variables associated with outcomes at p<0.10) of daytime BP, race, body mass index, physical activity, sleep duration, alcohol, caffeine, and sodium intake were also included as indicated.

Results

Overall, IS and RA positively correlated with % SBP dipping (IS: r=0.33, p=0.02; RA: r=0.35, p=0.01). Among females only, correlations strengthened (IS: r=0.50, p<0.01; RA: r=0.52, p<0.01) and an inverse association between RA and mean nocturnal SBP emerged (r=-0.46, p=0.01). Conversely, among males, no significant associations were apparent. Multivariate regressions revealed a significant sex*RAR interaction, such that in females, every 1-standard deviation increase in IS and RA were associated with an average decrease in nocturnal SBP of 5.4 mmHg (95% CI: -10.0, -0.73) and 4.8 mmHg (95% CI: -9.2, -0.34), respectively.

Conclusion

Findings suggest that consistent and high-amplitude RAR associate with more favorable nocturnal BP characteristics, particularly in emerging female adults.

Support (if any)

Supported in part by NIH P20-GM113125.

An exploration of clinical, behavioral, and community factors associated with sleep duration and efficiency among middle-aged Black/African American smokers

STUDY OBJECTIVES

We examined the most important correlates to sleep duration and efficiency from a comprehensive array of multilevel factors.

METHODS

Baseline data from a cohort of 216 Black/African American smokers aged 40-65 years were examined. The binary outcomes of healthy sleep duration (6-8 h/night) and efficiency (≥85%) were ascertained from 14 consecutive days of actigraphy. Seventy-three independent variables from socio-demographic, individual behavioral, individual physiological, interpersonal, and community domains were assessed. Random survival forest decision trees were generated for each outcome, and variable importance metrics used to rank the predictive abilities of exposure variables. The 5 most predictive exposure variables for each outcome were entered into a regression model of the respective outcome (with age and sex).

RESULTS

Study participants (N = 216) had a mean age of 54.57 years (SD = 6.17) and 57% were male. Healthy sleep duration was achieved by 56.5% and healthy sleep efficiency by 13.6% of the sample. Regression models showed every additional minute of light physical activity was associated with 1% increased odds, while every unit decrease in the inflammation marker of interleukin-8 was associated with 12% increased odds, of achieving a healthy sleep duration. Every unit increase in total social support was associated with a 34% increased odds, while every unit increase in the hazardous drinking score corresponded with 30% decreased odds, of achieving healthy sleep efficiency.

CONCLUSIONS

Light physical activity, social support, and alcohol consumption may be key modifiable intervention targets to improving sleep duration and sleep efficiency in this population.