P103 Impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic

Introduction

This study aimed to assess the impact of the COVID-19 pandemic on the sleep of adult patients of a multidisciplinary sleep clinic.

Methods

Patients were invited to complete online surveys: Survey 1 in October 2020 (increased COVID-19 restrictions) followed by Survey 2 in February 2021 (after easing of restrictions for a COVIDSafe summer).

Results

Of the 746 patients invited to participate, 73 completed and 8 partially returned Survey 1 (mean age 50.1 years, range 21–83 years, 58% female). Subsequently, 46 completed and 5 partially answered Survey 2. In Survey 1, 22/74 (29.7%) reported reduced sleep quantity and 31/75 (41.3%) indicated worse sleep quality compared with prior to the pandemic. In Survey 2, 33/46 (71.7%) described unchanged sleep quantity whilst 5/46 (10.9%) reported increased sleep quantity since easing COVID-19 restrictions. 36/46 (78.3%) indicated unchanged sleep quality whereas 5/46 (10.9%) described improved sleep quality since easing restrictions. However, 9/46 (19.6%) reported that their sleep remained worse compared with pre-pandemic. For patients who completed both surveys, there was no significant change in Insomnia Severity Index scores (Survey 1 mean 13.6, Survey 2 mean 12.9, mean difference -0.67 [95%CI -2.02, 0.68], p=0.32) or PROMIS Sleep-Related Impairment 8a T-scores (Survey 1 mean 59.0, Survey 2 mean 59.5, mean difference 0.44 [95%CI -1.55, 2.42], p=0.66).

Discussion

The COVID-19 pandemic has negatively affected the sleep of 44% of patients. Following easing of restrictions, symptoms of insomnia and sleep-related impairment did not change significantly, and 19.6% reported that their sleep was not back to their pre-pandemic baseline.

0534 Cognitive Behavioral Therapy for Perinatal Insomnia: Effects on Postpartum Depressive Symptoms

Introduction

Poor sleep during pregnancy is a risk for postpartum depression. Using data from an RCT of CBT-I for insomnia disorder during pregnancy, we examined whether improvement in insomnia reduced postpartum depression symptom severity. We hypothesized that better response to treatment during pregnancy would result in lower depressive symptom severity during the postpartum.

Methods

Pregnant women (N=179; gestation age 18-30 weeks) with insomnia disorder were randomized to CBT-I or an active control (CTRL) therapy (5 sessions during pregnancy, one at 6 weeks postpartum). Women with depressive disorders and those using prescription medications that impact sleep were excluded. The Insomnia Severity Index (ISI) and the Edinburgh Postpartum Depression Scale (EPDS) were administered at baseline, during pregnancy, and at 8, 18, and 30 weeks postpartum. The Perinatal Risk Questionnaire (PRQ) was administered at baseline. Included in the analyses were women who provided data for at least one of three postpartum assessments (62 in CBT-I; 55 in CTRL).

Results

Mixed effects models revealed that lower ISI following the pregnancy treatment phase (p < .001) and greater reduction in ISI during pregnancy (p = .053) predicted overall lower EPDS scores during postpartum; but these effects did not differ significantly between treatment arms. Average postpartum EPDS scores, which were low overall, were higher in women with ISI score at or above the median of 9 (6.6±3.9), compared to those below the median (3.5±3.3). Compared to CTRL, participants in the CBT-I condition were nearly twice likely to have ISI scores below the median following the pregnancy treatment phase (29.1% versus 56.5%). Although higher PRQ scores were associated with overall higher postpartum EPDS (p=.0026), PRQ did not moderate postpartum EPDS trajectories.

Conclusion

We have previously shown that CBT-I is effective for antenatal insomnia, which is a risk for postpartum depression. Our current findings suggest that improving insomnia in pregnancy may reduce the risk for postpartum depression. Limitations include a small sample and missing data during the postpartum follow-up. A larger study among women specifically at risk for postpartum depression could help identify patient related factors that predict therapeutic benefits of CBT-I on postpartum depression.

Support

NR013662

0326 Daily Sleep and Affect in Adolescents: Differential Associations During Constrained Versus Unconstrained Sleep

Introduction

Few studies have examined bi-directional associations between daily sleep and affect in adolescents, and even fewer assessed both high and low arousal affect under naturalistically-occurring constrained (school) and unconstrained (vacation) sleep opportunities.

Methods

205 adolescents (54.1% females, age M±SD=16.9±0.87 years) completed daily measures of sleep and affect over 28 continuous days (2-week school and 2-week vacation). Total sleep time (TST) and sleep efficiency (SE) were measured using actigraphy and sleep diary. High- and low-arousal positive and negative affect (PA, NA) were self-reported each afternoon. Cross-lagged, multilevel models were conducted: affect predicted same-night sleep controlling for previous-night sleep; sleep predicted next-day affect controlling for previous-day affect. Day of week, study day, and sociodemographics were controlled.

Results

During both school and vacation, adolescents with overall higher low-arousal PA also had greater self-reported SE. Other aspects of sleep-affect associations differ between school and vacation (all p<.05). During school, significant associations were between, not within individuals. Bi-directional associations were found between longer actigraphy-TST and greater high-arousal PA, and between higher self-reported SE and lower low-arousal NA. High-arousal PA and NA were associated with self-reported TST (positive and negative respectively). During vacation, between-individuals, higher NA was bi-directionally associated with lower self-reported SE, regardless of arousal. Longer self-reported TST was associated with lower low-arousal NA. On the within-person level, regardless of sleep measurement, nights with longer-than-average TST were associated with lower NA the next day (high- and low- arousal). Nights with higher-than-average SE predicted lower next-day low-arousal NA.

Conclusion

Sleep-affect associations differed based on sleep opportunity and arousal, suggesting potentially different mechanisms of action. When sleep is typically constrained, overall levels of sleep-affect associations were stronger than daily fluctuations. When sleep is typically unconstrained, significant associations were found both between- and within- persons. In particular, daily fluctuations in sleep were predictive of next-day NA, rather than the other direction.

Support

Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship

0459 Is It Having a Baby or Me? Differentiating Insomnia Disorder and Sleep Disruption from Pregnancy to 2 Years Postpartum

Introduction

Insomnia Disorder (Insomnia) diagnosis requires sleep complaints to persist despite “sleep-conducive conditions and adequate sleep opportunity”. Women experience significant sleep disruption during pregnancy and postpartum periods due to physiological changes and night-time infant care, but not all women with sleep complaints meet Insomnia criteria. This study examined sleep and mental health correlates of Insomnia Disorder and sleep complaints in the context of a randomised controlled trial for improving maternal sleep.

Methods

163 generally healthy first-time mothers (age M±SD=33.4±3.5) with singleton pregnancy repeated the following assessments at 28-30 and 35-36 weeks’ gestation, and 1.5, 3, 6, 12, and 24 months postpartum: the Insomnia module of the Duke Structured Interview for Sleep Disorders, PROMIS Sleep-Related Impairment, Depression, and Anxiety Short Forms. We compared clinical features when DSM-5 Insomnia criteria (less the 3-month criteria) were (1) met (Insomnia), (2) not met only because of the sleep condition/opportunity criteria (Sleep Disruption), and (3) not met due to low symptom/distress (Low Complaint).

Results

944 interviews and 1009 questionnaire were collected across 7 time-points. Proportions of women meeting Insomnia criteria were 16.0% and 19.8% during early and late third trimester, and ranged 5.3-11.7% during the 5 postpartum time-points. If the sleep condition/opportunity criteria were not considered, rates of “Insomnia” would have been 2-4 times higher at 21.4-40.4% across all time-points. Mixed effects models, controlling for intervention allocation, showed that compared with Insomnia, Sleep Disruption had comparable depression (p=.68) and anxiety (p=.23), and somewhat lower sleep-related impairment (p=.06). These symptoms were lowest for Low Complaint.

Conclusion

Both Insomnia and Sleep Disruption were associated with significant daytime impairment, depression, and anxiety. Assessing sleep complaints without considering sleep condition/opportunity can result in over-diagnosis of perinatal Insomnia in these women with primarily sleep disruption; these women may have limited benefits from Insomnia-specific treatment. Interventions for maternal sleep should carefully differentiate between Insomnia and other sleep concerns (e.g., sleep disruption/opportunity, sleepiness/fatigue) and appropriately address each.

Support

Australasian Sleep Association, Monash University, Royal Women’s Hospital Foundation. National Health and Medical Research Council, Department of Education and Training.