Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time

BACKGROUND

More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths.

OBJECTIVE

This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms.

METHODS

This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments.

RESULTS

Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions.

CONCLUSIONS

This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.

Improvements in Adolescents' Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study

BACKGROUND

Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors.

OBJECTIVE

This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents' disordered eating behaviors.

METHODS

Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care.

RESULTS

Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001).

CONCLUSIONS

Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms.

Improvements in sleep problems and their associations with mental health symptoms: A study of children and adolescents participating in a digital mental health intervention

Objective

A growing number of youth are utilizing digital mental health interventions (DMHIs) for treatment of mental health problems such as anxiety, depression, and ADHD. Although these mental health symptoms are closely related to sleep problems, it is unknown whether nonsleep DMHIs indirectly confer improvements in sleep. Using retrospective data, the current study assesses (1) whether youth sleep problems improve over participation in a nonsleep DMHI, and (2) whether mental health symptom severity and improvement are correlated with sleep problem severity over time.

Methods

Sleep problems and mental health symptoms were assessed every 30 days among children (ages 5-12) and adolescents (ages 13-17) participating in a pediatric digital mental health intervention (DMHI; N = 1219).

Results

Children and adolescents with elevated sleep problems (39.3%; n = 479) were older (P < .001), more predominantly female (P < .001), and more likely to have elevated anxiety (P < .001), depressive (P < .001) and inattention symptoms (P = .001), as compared to those with nonelevated sleep problems (60.7%; n = 740). From the baseline to last assessment, 77.3% (n = 269) of members with elevated sleep problems exhibited improvements, with sleep problems decreasing significantly over each month in care (P < .001). Members with improvements in anxiety, depressive, and/or ADHD symptoms had larger improvements in sleep over time compared to their peers with no improvement in their mental health symptoms (Months in care*Change type: P < .001 for all).

Conclusions

Our results provide preliminary evidence that participation in a pediatric DMHI is associated with improvements in sleep problems, even when youth are not being treated directly for sleep problems. These findings highlight a valuable secondary benefit of participating in mental health care within pediatric DMHIs and warrant further experimental research.

Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis

BACKGROUND

Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth.

OBJECTIVE

This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression.

METHODS

We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms.

RESULTS

Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents.

CONCLUSIONS

Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people.

Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study

BACKGROUND

Although evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants' satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs.

OBJECTIVE

To address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children's and adolescents' engagement in the DMHI.

METHODS

Members (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members.

RESULTS

This study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI.

CONCLUSIONS

This study provides valuable preliminary evidence that caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs.

Using Digital Measurement-Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data

BACKGROUND

A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents.

OBJECTIVE

This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI.

METHODS

Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61).

RESULTS

Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement.

CONCLUSIONS

As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc.

Effects of total sleep deprivation on components of top-down attentional control using a flexible attentional control task

Sleep deprivation consistently decreases vigilant attention, which can lead to difficulty in performing a variety of cognitive tasks. However, sleep-deprived individuals may be able to compensate for degraded vigilant attention by means of top-down attentional control. We employed a novel task to measure the degree to which individuals overcome impairments in vigilant attention by using top-down attentional control, the Flexible Attentional Control Task (FACT). The FACT is a two-choice task that has trials with valid, invalid, and neutral cues, along with an unexpected switch in the probability of cue validity about halfway in the task. The task provides indices that isolate performance components reflecting vigilant attention and top-down attentional control. Twelve healthy young adults completed an in-laboratory study. After a baseline day, the subjects underwent 39 hours of total sleep deprivation (TSD), followed by a recovery day. The FACT was administered at 03:00, 11:00, and 19:00 during sleep deprivation (TSD condition) and at 11:00 and 19:00 after baseline sleep and at 11:00 after recovery sleep (rested condition). When rested, the subjects demonstrated both facilitation and interference effects on cued trials. While sleep deprived, the subjects showed vigilant attention deficits on neutral cue trials, and an impaired ability to reduce these deficits by using predictive contextual cues. Our results indicate that the FACT can dissociate vigilant attention from top-down attentional control. Furthermore, they show that during sleep deprivation, contextual cues help individuals to compensate partially for impairments in vigilant attention, but the effectiveness of top-down attentional control is diminished.

Using digital measurement-based care to address symptoms of inattention, hyperactivity, and opposition in youth: A retrospective analysis of Bend Health (Preprint)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents.

OBJECTIVE

The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors.

METHODS

Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%).

RESULTS

Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores.

CONCLUSIONS

This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.

The rat Lux Actuating Search Task (LAST) and effects of sleep deprivation on task reversal performance

Sleep deprivation (SD) causes significant deficits in multiple aspects of cognition, including sustained attention and working memory. Investigating the neural processes underpinning these cognitive losses has proven challenging due to the confounds of current animal tasks; many employ appetitive or aversive stimuli to motivate behavior, while others lack task complexity that translates to human studies of executive function. We established the Lux Actuating Search Task (LAST) to circumvent these issues. The LAST is performed in a circular, open-field arena that requires rats to find an unmarked, quasi-randomly positioned target. Constant low-level floor vibrations motivate ambulation, while light intensity (determined by the rodent's proximity to the target destination) provides continuous visual feedback. The task has two paradigms that differ based on the relationship between the light intensity and target proximity: the Low Lux Target (LLT) paradigm and the High Lux Target paradigm (HLT). In this study, on days 1–6, the rats completed nine trials per day on one of the two paradigms. On day 7, the rats were either sleep deprived by gentle handling or were left undisturbed before undertaking the opposite (reversal) paradigm on days 7–9. Our results showed that SD significantly impeded the ability of Long Evans rats to learn the reversal paradigm, as indicated by increased times to target and increased failure percentages compared to rats whose sleep was undisturbed. Rats also showed reduced learning with the HLT paradigm, as the initial task or as the reversal task, likely due to the rodents' photophobia limiting their motivation to navigate toward a bright light, which is required to succeed.

•

A continuous feedback paradigm examining the effects of sleep loss on cognitive flexibility in rats is introduced.

•

Floor vibrations motivate and variable light intensity directs navigation to an unmarked location in an open field arena.

•

The reversal of light intensity cues from light to dark and vice versa is disrupted by sleep deprivation.

0119 Effects of Total Sleep Deprivation on Performance on a Continuous Performance Matching Task

Introduction

Tasks requiring individuals to identify specific stimuli may create response/non-response conflict, which may impair performance depending on stimulus feature overlap. Whether sleep deprivation interacts with such impairment is unknown. We investigated the effects of total sleep deprivation (TSD) on stimulus identification in a continuous performance matching task (CPMT).

Methods

N=85 adults (ages 21–40; 50f) completed a 4-day laboratory study with 10h baseline sleep (22:00–08:00), a 38h acute TSD or 10h sleep opportunity (control condition), and 10h recovery sleep. The ~6min CPMT was administered every 2–4h during wakefulness. Participants completed 300 trials where a 3-digit number was flashed on the screen for 100ms. They were instructed to respond (mouse-click) within 900ms, but only if the number was the same as the preceding number (i.e., a repeat); for all other trials a response was to be withheld. The 5 daytime testing sessions (09:00–21:00) at baseline (day 2) and after TSD/control (day 3) were used for analysis. Trials were classified based on number of digits matching the preceding trial (stimulus feature overlap): none (180 trials), one (30 trials), two (near-repeat; 30 trials), or all (repeat; 60 trials). Hit and false alarm (FA) rates were analyzed with mixed-effects ANOVA for day, condition, trial type, and their interactions. Mean response time (MRT) was analyzed equivalently for repeat trials only.

Results

Hit rate declined from day 2 to day 3 in the TSD group (F[1,83]=0.15, p&lt;0.001), but not the control group (F[1,83]=0.018, p=0.335). Though FA rate was low overall (&lt;0.06), FA frequency was higher on trials with greater stimulus feature overlap. FA rate increased on day 3 for the TSD group (all p&lt;0.004), especially for near-repeats (F[1,415]=-0.014, p&lt;0.001). Changes in MRT were statistically significant, but negligible (&lt;20ms).

Conclusion

Our results suggest that greater stimulus feature overlap on the CPMT was associated with greater costs required to resolve conflict. Sleep deprivation exacerbated these costs. Interpretation is limited however, because a response was not required for non-repeat trials. Implementing a two-alternative forced choice version of the task in future TSD studies would address this limitation.

Support (If Any)

PRMRP W81XWH-16-1-0319 and W81XWH-20-1-0442

0021 The effect of video gaming on the sleep patterns and well-being of U.S. Marines

Introduction

Video gaming (VGs) is a popular activity among active-duty service members (ADSMs) and can have both positive and negative impacts on ADSM well-being and behavior. The overall aim of the project was to assess attributes and aspects of video gaming in the United States Navy and Marine Corps (USMC). Our current results specifically address the effects of video gaming on the sleep patterns of Marines.

Methods

Data were collected from 927 Marines from three USMC commands. Volunteers completed a survey and participated in semi-structured focus groups. The survey items focused on demographic and occupational characteristics, behavioral habits, video gaming habits, why ADSMs play video games, and functional effects. Validated tools were used to assess depression (Patient Health Questionnaire-8), generalized anxiety (GAD-7), excessive daytime sleepiness (Epworth Sleepiness Scale), and drinking habits (Alcohol Use Disorders Identification Test for Consumption-AUDIT-C).

Results

The study sample included predominantly males (854, 92.3%) and enlisted personnel (771, 83.3%). Also, 850 (91.7%) Marines reported playing video games (799 [94.0%] males). Gamers reported playing VGs predominantly later in the day (i.e., after work and before bedtime). Approximately 16% of gamers reported sleeping later because of playing VGs when at home/off duty, ~14% when on duty/in port, and ~5% when deployed/underway. When deployed/underway, most gamers reported playing video games in their racks (93.2%). Gamers reported symptoms of depression (~23% of ADSMs), generalized anxiety (~19%), excessive daytime sleepiness (~33%), and AUDIT-C scores suggestive of heavy drinking (39%). Excessive gamers tended to be younger, used dysfunctional coping styles more frequently, and played VGs more frequently and for more hours. Excessive gamers were more likely to report sleeping later because of playing VGs and to be identified with symptoms of depression, anxiety, and excessive daytime sleepiness.

Conclusion

This study provided valuable insight into how video gaming habits affect ADSM sleep patterns. Further research is needed to objectively assess the relationship between video gaming and sleep in operational conditions.

Support (If Any)

Supported by the Manpower and Reserve Affairs (M&RA), Headquarters Marine Corps (HQMC), and the Office of the Chief of Naval Operations/21st Century Sailor Office (OPNAV/N17).

0165 Prevalence of insomnia and/or obstructive sleep apnea in a sample of fit-for-duty U.S. Navy sailors

Introduction

Obstructive sleep apnea (OSA) and insomnia are prevalent sleep disorders, known to negatively impact sleep and well-being in civilian populations. Studies of these sleep disorders in military populations have focused on individuals seeking treatment for a sleep disorder, rather than the general active-duty service member (ADSM). In this study, we investigated the prevalence of OSA and insomnia in U.S. Navy sailors serving on surface ships.

Methods

We analyzed pre-collected data from 548 fit-for-duty sailors (MD age=25 years, IQR=9; 79.4% males) serving on nine US Navy surface ships. Sailors reported their demographic information, health-related habits, and whether they had been diagnosed with OSA and/or insomnia. Sleep was assessed with wrist-worn actigraphy (371 sailors).

Results

Approximately 66.8% of sailors reported having an exercise routine, 83.6% reported drinking caffeinated beverages, and 29.1% used nicotine products. In terms of disorders, 15 (2.7%) male sailors reported having been diagnosed with OSA, 12 (2.2%) with insomnia (8 males, 4 females), and one (0.2%) male sailor with comorbid insomnia and OSA. Compared to sailors without a sleep disorder, sailors with OSA were older (MD=34 years, IQR=7; p&lt;0.001) and had a higher proportion of nicotine users (53.3%) (p=0.041). Sailors with insomnia did not differ from sailors with no sleep disorder in terms of demographics and habits. The average daily sleep duration was 6.4±1.0 hours, which did not differ between disorder groups. However, sailors with insomnia had more sleep episodes per day (MD=1.7; IQR=0.9) than sailors without a sleep disorder (MD=1.3, IQR=0.5; p=0.042).

Conclusion

Only ~5% of the sailors in our study reported a diagnosis of OSA and/or insomnia, whereas one in three people in the general population has a sleep disorder. Notably, all sailors, regardless of sleep disorder diagnosis, exhibited short sleep durations. Previous studies of ADSMs found that ~48% reported poor enough sleep quality to meet the diagnostic criteria for a sleep disorder. Thus, our results suggest that, despite evidence that many Sailors exhibited sleep problems, sleep disorders are significantly underdiagnosed in ADSMs.

Support (If Any)

This work was supported in part by the Naval Medical Research Center's Naval Advanced Medical Development Program (MIPR N3239820WXHN007).

0024 ARC Genotype Modulates EEG Spectral Power Following Total Sleep Deprivation

Introduction

Sleep homeostasis is manifested by a robust increase in slow wave sleep (SWS) following acute total sleep deprivation (TSD), with concomitant changes in spectral power of the non-REM (NREM) sleep EEG marked by substantial interindividual differences. We previously found that a single nucleotide polymorphism of the activity-regulated cytoskeleton associated protein (ARC) gene modulates SWS rebound following TSD. Here we sought to determine whether ARC genotype is also associated with interindividual differences in spectral power of the NREM sleep EEG.

Methods

50 healthy adults (27.3±4.9 years; 28 females) participated in one of two in-laboratory studies. Each participant had a 10h baseline sleep opportunity (22:00–08:00), 38h TSD, and a 10h recovery sleep opportunity (22:00–08:00). Sleep periods were recorded polysomnographically and visually scored according to AASM criteria. Genomic DNA was assayed for the ARC c.*742 + 58C&gt;T non-coding SNP, rs35900184. Log-transformed NREM sleep EEG spectral power (C3-M3 derivation) over 0.2 Hz frequency bins in each of four frequency bands – delta (0.8–4.0 Hz), theta (4.2–8.0 Hz), alpha (8.2–12.0 Hz), and beta (12.2–16.0 Hz) – was analyzed by band using mixed-effects ANOVA with fixed effects for ARC genotype, night (baseline, recovery), frequency bin, and their interactions. Analyses included study and age as covariates and a random effect over subjects on the intercept.

Results

The genotype distribution in this sample was 33 C/C homozygotes, 11 C/T heterozygotes, and 6 T/T homozygotes. There was a significant ARC by night interaction in the theta (F2,1833=5.94, p=0.003) and alpha (F2,1833=8.58, p&lt;0.001) bands. Compared to baseline sleep, during recovery sleep C/C homozygotes had 18.9% more theta power and 8.7% more alpha power, C/T heterozygotes had 17.9% more theta power and 7.6% more alpha power, and T/T homozygotes had 20.0% more theta power and 15.1% more alpha power.

Conclusion

Our results show that ARC genotype mediates the NREM sleep EEG response to TSD; compared to C allele carriers, homozygosity for the T allele is associated with a much more pronounced increase in alpha power, as well as a larger increase in theta power. The functional implications of this ARC effect remain to be determined.

Support (If Any)

ONR N00014-13-1-0302, NIH R21CA167691, and USAMRDC W81XWH-18-1-0100.

Clamping Cortisol and Testosterone Mitigates the Development of Insulin Resistance during Sleep Restriction in Men

CONTEXT

Sleep loss in men increases cortisol and decreases testosterone, and sleep restriction by 3 to 4 hours/night induces insulin resistance.

OBJECTIVE

We clamped cortisol and testosterone and determined the effect on insulin resistance.

METHODS

This was a randomized double-blind, in-laboratory crossover study in which 34 healthy young men underwent 4 nights of sleep restriction of 4 hours/night under 2 treatment conditions in random order: dual hormone clamp (cortisol and testosterone fixed), or matching placebo (cortisol and testosterone not fixed). Fasting blood samples, and an additional 23 samples for a 3-hour oral glucose tolerance test (OGTT), were collected before and after sleep restriction under both treatment conditions. Cytokines and hormones were measured from the fasting samples. Overall insulin sensitivity was determined from the OGTT by combining complementary measures: homeostasis model assessment of insulin resistance of the fasting state; Matsuda index of the absorptive state; and minimal model of both fasting and absorptive states.

RESULTS

Sleep restriction alone induced hyperinsulinemia, hyperglycemia, and overall insulin resistance (P < 0.001 for each). Clamping cortisol and testosterone alleviated the development of overall insulin resistance (P = 0.046) and hyperinsulinemia (P = 0.014) by 50%. Interleukin-6, high-sensitivity C-reactive protein, peptide YY, and ghrelin did not change, whereas tumor necrosis factor-α and leptin changed in directions that would have mitigated insulin resistance with sleep restriction alone.

CONCLUSION

Fixing cortisol-testosterone exposure mitigates the development of insulin resistance and hyperinsulinemia, but not hyperglycemia, from sustained sleep restriction in men. The interplay between cortisol and testosterone may be important as a mechanism by which sleep restriction impairs metabolic health.

108 Attentional Control Deficits during Total Sleep Deprivation: Independence from Reduced Vigilant Attention

Introduction

Total sleep deprivation (TSD) has been shown to impair performance on a two-phase attentional control task, the AX-type continuous performance task with switch (AX-CPTs). Here we investigate whether the observed AX-CPTs impairments are a downstream consequence of TSD-induced non-specific effects (e.g., reduced vigilant attention) or reflect a distinct impact on attentional control.

Methods

N=55 healthy adults (aged 26.0±0.7y; 32 women) participated in a 4-day laboratory study with 10h baseline sleep (22:00-08:00) followed by 38h TSD and then 10h recovery sleep. At baseline (09:00 day 2) and after 25h and 30h TSD (09:00 and 14:00 day 3), subjects were tested on a 10min psychomotor vigilance test (PVT), an assay of vigilant attention, and on the AX-CPTs. The AX-CPTs required subjects to differentiate designated target from non-target cue-probe pairs. In phase 1, target trials occurred frequently, which promoted prepotent anticipatory responses; in phase 2, the target pair was switched. Accuracy of responses to various different AX-CPTs trial types was expressed relative to accuracy on phase 1 neutral (non-target cue and probe) trials, which should capture non-specific impairments on the task. For all three test sessions, these relative accuracy measures, along with accuracy on phase 1 neutral trials and lapses (RT&gt;500ms) on the PVT, were subjected to principal component analysis (PCA).

Results

The PCA revealed three statistically independent factors. Following varimax rotation, factor 1 (36.3% variance explained) and factor 3 (14.8% variance explained) each had high loadings for relative accuracy on multiple AX-CPTs trial types from phases 1 and 2; whereas factor 2 (17.9% variance explained) had high loadings for accuracy on phase 1 neutral trials, relative accuracy on phase 1 target trials, and PVT lapses.

Conclusion

These results indicate a statistical separation between AX-CPTs phase 1 neutral trials and phase 1 target trials, in conjunction with PVT lapses, versus the various other AX-CPTs trial types. This suggests a dissociation between TSD-induced, non-specific impairments on the task—potentially related to reduced vigilant attention—and TSD-induced specific impairments related to attentional control. Thus, TSD-induced deficits in attentional control are unlikely to be a downstream consequence of non-specific impairments.

Support (if any)

CDMRP grant W81XWH-16-1-0319

008 ARC Genotype Modulates Slow Wave Sleep Following Total Sleep Deprivation

Introduction

The activity-regulated cytoskeleton associated protein (ARC) gene is an immediate early gene that is involved in synaptic plasticity. Recent evidence from a rodent model suggests that Arc may also be involved in sleep homeostasis. However, little is known about the molecular mechanisms regulating the sleep homeostat. In humans, sleep homeostasis is manifested by a marked increase in slow wave sleep (SWS) following acute total sleep deprivation (TSD). There are large, trait individual differences in the magnitude of this SWS rebound effect. We sought to determine whether a single nucleotide polymorphism (SNP) of the ARC gene is associated with individual differences in SWS rebound following TSD.

Methods

64 healthy normal sleepers (ages 27.2 ± 4.8y; 32 females) participated in one of two in-laboratory TSD studies. In each study, subjects had a baseline day with 10h sleep opportunity (TIB 22:00–08:00) which was followed by 38h TSD. The studies concluded with 10h recovery sleep opportunity (TIB 22:00–08:00). Baseline and recovery sleep were recorded polysomnographically and scored visually by a trained technician. Genomic DNA was extracted from whole blood. The ARC c.*742 + 58C&gt;T non-coding SNP, rs35900184, was assayed using real-time PCR. Heterozygotes and T/T homozygotes were combined for analysis. The genotype effect on time in SWS was assessed using mixed-effects ANOVA with fixed effects for ARC genotype (C/C vs. T carriers), night (baseline vs. recovery), and their interaction, controlling for study.

Results

The genotype distribution in this sample – C/C: 41; C/T: 17; T/T: 6 – did not vary significantly from Hardy-Weinberg equilibrium. There was a significant interaction between ARC genotype and night (F1,62=7.27, p=0.009). Following TSD, T allele carriers exhibited 47.6min more SWS compared to baseline, whereas C/C homozygotes exhibited 62.3min more SWS compared to baseline. There was no significant difference in SWS between genotypes at baseline (F1,61=0.69, p=0.41).

Conclusion

ARC T allele carriers exhibited an attenuated SWS rebound following TSD compared to those homozygous for the C allele. This suggests that the ARC SNP is associated with trait individual differences related to sleep homeostasis, and may thus influence molecular mechanisms involved in long-term memory.

Support (if any)

ONR N00014-13-1-0302, NIH R21CA167691, and USAMRDC W81XWH-18-1-0100.

0301 Different Indices of Vigilant Attention During Sleep Deprivation: Evidence of Multiple Vigilance Constructs?

Introduction

Total sleep deprivation (TSD) causes profound vigilant attention deficits, with large, trait-like individual differences, as evidenced convincingly by response lapses on the psychomotor vigilance test (PVT). There is debate, however, about the role of vigilant attention deficits in the effects of TSD on other speeded performance tasks besides the PVT. We addressed this issue by testing whether PVT response lapses are related to delays in responding to stimuli under strict deadlines in two decision making tasks.

Methods

N=54 healthy adults (aged 21-38y; 31 females) completed an in-laboratory TSD study. Following a 10h baseline sleep opportunity, cognitive testing occurred after 25h and 29h of TSD (09:00 and 13:00). Testing included an AX continuous performance task with switch (AX-CPTs), which is a dynamic decision making task requiring subjects to respond to a frequently occurring cue-probe combination; an identical pairs continuous performance task (CPT-IP), which is a 1-back go/no-go task; and a 10min PVT. Lapses (RTs&gt;500ms) on the PVT and target accuracy on the AX-CPTs and CPT-IP were calculated as indices of vigilant attention. Intraclass correlation coefficients (ICCs) were used to quantify the stability of individual differences, and absolute rank-order correlation (|ρ|) was used to compare the three indices.

Results

The stability of individual differences ranged from fair to substantial (PVT: ICC=0.44; AX-CPTs: ICC=0.73; CPT-IP: ICC=0.31). The rank-order correlation between the AX-CPTs and CPT-IP vigilant attention indices was relatively high (|ρ|=0.44), whereas correlations with PVT lapses were much lower (AX-CPTs: |ρ|=0.14; CPT-IP: |ρ|=0.04).

Conclusion

Individual differences during TSD were moderately stable for each index of vigilant attention, but the relationships between PVT lapses and the other indices were weak. This suggests that any or all of the indices considered here are not pure measures of vigilant attention, or that vigilant attention may constitute multiple, distinct constructs.

Support

CDMRP grant W81XWH-16-1-0319

0208 The Effect of Mastication on Psychomotor Vigilance Performance

Introduction

Sustained attention is important for optimal neurobehavioral performance, but many biological and environment factors (e.g., circadian rhythm, distraction) may cause sustained attention deficits. Mastication (chewing) has been suggested to provide a countermeasure to sustained attention deficits. To investigate this, we conducted a randomized, within-subjects, cross-over study of sustained attention with a mastication condition and a control condition.

Methods

N=58 adults (ages 18–45; 38 females) completed a 5h in-laboratory study. Subjects entered the laboratory at 09:00. Following training on performance tasks, they had a 1h break before beginning the first of two test bouts at 11:00. Each test bout was 40min long and included subjective rating scales, the Sustained Attention to Response Task, and the Psychomotor Vigilance Test (PVT). Here we focus on PVT lapses of attention (RT &gt; 500 ms), false starts, and mean reaction time (RT) as measures of sustained attention. In between test bouts, subjects had a 1h break inside the laboratory. During one of the two test bouts, subjects were instructed to chew a piece of gum at a steady, comfortable rate. Mastication activity was verified via electromyography (EMG). Half of the sample was assigned to the mastication condition during the first test bout, the other half during the second test bout.

Results

Controlling for order of conditions, there were no significant differences between conditions for PVT lapses (F1,56=0.40, P=0.54) or false starts (F1,56=0.10, P=0.80). Mean RT was higher in the mastication condition by 8.9±2.5ms (F1,56 =12.68, P&lt;0.001).

Conclusion

Using this test paradigm, we were unable to detect any significant improvement in PVT performance, although mastication resulted in a very small increase in mean RT. However, subjects were not sleep-deprived, distracted, or otherwise perturbed. A follow-up study under conditions of sleep deprivation and/or with longer task duration may provide further insight into the countermeasure potential of mastication.

Support

Mars Wrigley Confectionery, U.S., LLC

0332 Effect of Prior Sleep Duration on Distinct Measures of Daytime Cognitive Performance in Late Adolescence

Introduction

A recent longitudinal study of sleep need changes across adolescence reported how prior sleep duration affects daytime sleepiness and vigilant attention in children ages 10-16 years. In a follow-up study, we extend the age range in a new group of participants and add additional performance tests. Here we report year 1 data on the effect of systematically varied time in bed (TIB) on daytime vigilance, working memory, and decision making.

Methods

Data are for 52 participants aged 15.0-20.4 years (mean±SD: 17.7±1.8 years). Annually, participants keep each of three different TIB schedules: 7h, 8.5h or 10h TIB for 4 consecutive nights. The 4th night is followed by a laboratory day of performance testing. The day includes four 10-minute psychomotor vigilance tests (PVT); a serial position Sternberg working memory task; and an AX continuous performance test with switch (AX-CPTs) measuring cognitive flexibility in decision making.

Results

PVT performance evaluated by the log of the signal to noise ratio (LSNR) improved monotonically with increasing TIB (p&lt;0.0001). TIB also affected serial position Sternberg task accuracy (p=0.008) but not the probe position effect (p=0.66), indicating that TIB did not affect working memory. TIB also affected AX-CPTs accuracy (p&lt;0.0001), but TIB did not significantly affect decision making and cognitive flexibility measures extracted from this task (all p&gt;0.09).

Conclusion

The initial data from this longitudinal study on older adolescents confirm what we observed for younger adolescents. Increasing TIB improves daytime vigilance but does not affect working memory. These initial results also do not indicate a TIB related improvement in decision making. Data from the entire three year longitudinal study will allow us to further investigate relations of performance to prior sleep duration and whether these relations change with age. Results from dose-response studies such as these can help guide sleep duration recommendations.

Support

PHS grant R01 HL116490 supported this work.