0785 Associations Between Circadian Preference And Sleep-related Thoughts: Data From The 2015 Sleep In America Poll

Introduction

Evening types of sleep tend to have poorer sleep quality and sleep habits than morning types. Maladaptive beliefs or thoughts about sleep can affect one’s sleep and may differ between evening and morning types. We examined the association between the circadian preference and sleep-related thoughts in U.S adults.

Methods

A secondary analysis used survey data from the 2015 National Sleep Foundation’s Sleep in America Poll. Questions included normal bedtime and wake-up time for week/work days and weekend/non-work days. Circadian preference was determined by midpoint of sleep calculated as midpoint of sleep on weekends corrected for average nightly sleep duration. Participants were excluded if their sleep midpoint was from noon to midnight. Midpoint of sleep was divided into two groups using median split (“earlier” vs. “later”). Sleep-related thoughts were “worry about getting a good sleep”, “overwhelming thoughts about getting enough sleep”, “motivation to get sleep”, and “concern about serious physical consequences due to poor sleep”; responded often/always or extremely to somewhat for these items were coded as maladaptive. Logistic regression analysis controlling for socio-demographics, sleep duration, and sleep disturbance (PROMIS Scale; higher scores = greater sleep disturbance) was conducted to examine the relationships between midpoint of sleep and sleep-related thoughts.

Results

The sample (N = 1011) was primarily White (73.6%), male (50.9%), college educated (62.2%), married/partnered (67.6%) with a mean age of 51.65 ± 17.05 years. Mean midpoint of sleep in “earlier” type was 2:33AM and 5:29AM in “later” type. “Later” type had shorter sleep duration on weekdays and longer sleep duration on weekends than “earlier” type (p < .01), but average sleep duration was similar between two types. “Later” type had more “worry” and “overwhelming thoughts” (p < .05) about sleep. In logistic models, midpoint of sleep was significant only for “concern” (p = .02).

Conclusion

In this study, late chronotype was associated with increased sleep disturbances and greater variability in sleep duration. The relationship between the timing of sleep and thoughts about the impact of impaired sleep remains unclear and an area for further study with objective measures.

Support

 

1056 Perceived Financial Difficulty Predicts Sleep Quality In Participants With Type 2 Diabetes And Obstructive Sleep Apnea

Introduction

People with multiple chronic conditions such as type 2 diabetes (T2D) and obstructive sleep apnea (OSA) are at increased risk for poor sleep quality. It is unclear if social determinants of health (SDoH) such as race, perceived financial difficulty, education, gender, and marital status are associated with sleep quality in this population. The purpose of this cross-sectional secondary analysis of data from the Diabetes Sleep Treatment Trial was to explore SDoH and disease severity as predictors of sleep quality in persons with both OSA and T2D.

Methods

Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and A1C for glycemic control. SDoH included perceived financial difficulty (none/moderate-severe), race (White/African American), sex (f/m), marital status (no/yes), education (≤ or > 2 years post high school), and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Correlations and linear regression modeling investigated associations between SDoH and disease severity on sleep quality. Post-hoc correlations were explored for significant relations among SDoH.

Results

The sample (N = 229) was middle-aged (57.6 ± 10.0; 66 % White and 34% African American; and 54 % men vs. 46% women. Participants carried a high burden of disease (mean AHI = 20.7±18.1, mean A1C = 7.9 %±1.7%). Disease severity was not significantly associated with sleep quality (all p >.05). The perception of worse financial difficulty was the only SDoH that predicted worse sleep quality (b=-1.54, p=.015). Characteristics significantly associated with worse financial difficulty were being African American, female, ≤ 2 years post high school, and younger (all p<.01).

Conclusion

Financial difficulty may be a more important predictor of subjective measures of sleep quality than disease severity in patients with OSA and T2D. Researchers and clinicians should be aware of these characteristics as potential markers of vulnerability to poor sleep quality in this population.

Support

The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK096028) and through the Clinical +Translational Research Institute grants UL1TR001857 and UL1TR000005.

0020 Differentially Expressed Genes Using Saliva Samples from Nurses Rotating Shifts

Introduction

Globally, millions of people work night or rotating shifts (i.e., shift work), including nurses and other healthcare providers. Shift work can cause insufficient and mistimed sleep which disrupts the normal circadian rhythm. Shift work is associated with an increased risk for cardio-metabolic disorders and certain cancers. This descriptive, single group, within-subject, repeated-measures study explored the effect of shift work on gene expression levels in a sample of female nurses engaged in rotating shifts.

Methods

Saliva samples were collected from ten nurses without sleep or alertness medication use or a sleep disorder. The samples were collected using DNA Genotek RNA stabilizing saliva kits after participants worked at least 3 consecutive day shifts (~ 7:30 pm) and 3 consecutive night shifts (~7:30 am). Takara Smarter Stranded Total RNA Seq Kit was used following manufacturer’s instructions on an Illumina NextSeq500. CLC Genomic Workbench 12 (Qiagen) was used for quality control, aligning the sequence reads, normalization, and differential expression analyses. Genes with log2 fold changes of ± 2.0 were included in gene set enrichment and pathway analyses using Ingenuity Pathway Analysis (IPA; Qiagen).

Results

Participants were all female, white, and mostly healthy with a mean ± SD age of 27.2 ± 4.5 years. Compared to the post-day shift samples, a total of 287 genes were differentially expressed at a log2 fold change of ± 2.0 in the post-night shift samples. The genes with the greatest increase in expression levels were: PRDX5, SLC7A5, FCGR1A, DNAJC7, PSMD4, and PER1. The genes with the greatest decrease in expression levels were: PPIP5K2, SCART1, CASP10, SLC24A4, and OSBP. Based on the IPA analyses, the differentially expressed genes play a role in gene expression, cell signaling, cell death and survival, and RNA damage and repair.

Conclusion

Significant differential gene expression in pathways associated with poor health were observed among female nurses engaged in rotating shifts. Potential molecular and cellular functions were identified that may be the mechanisms resulting in the increased health risks associated with shift work.

Support

University of Pittsburgh School of Nursing Center for Research and Evaluation Pilot/Feasibility Study Program

1033 Sleep and Patient-Reported Outcomes in Persons With Heart Failure With Preserved Ejection Fraction

Introduction

Sleep quality has a significant bearing on disease. A better understanding of sleep quality may help identify opportunities to improve patient-reported outcomes (PROs) in persons with heart failure with preserved ejection fraction (HFpEF). We aimed to explore the association between sleep and PROs in patients clinically diagnosed with HFpEF.

Methods

Cross-sectional study of 22 participants (71.2±7.2 years, 95% male, 86.4% white) with HFpEF, recruited from a heart failure (n=14) and sleep clinic (n=8). Sleep disordered breathing was measured objectively using one-night in-home obstructive sleep apnea (OSA) testing (ApneaLink). Actigraphy (7 days) was used to assess sleep duration, efficiency, and wake after sleep onset (WASO). Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). PROs included functional status (Functional Outcomes Sleep Questionnaire [FOSQ]), depression (PROMIS Depression), fatigue (PROMIS Fatigue), and heart failure specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]; overall summary score [KCCQ-os] and clinical summary score [KCCQ-cs]). The KCCQ-cs includes physical function and symptom scores to corresponds with NYHA Classification.

Results

Fifty percent of the participants had poor sleep quality (PSQI >5) and 2 (9.1%) had ISI scores >14. The majority (64%; n=14) had OSA; 10 currently on OSA therapy. Mean oxygen desaturation index (ODI) was 20.8±17.8. Mean actigraphy data indicated poor sleep (sleep duration 302±116 minutes, sleep efficiency 70.0±18.6%, and WASO 52±28 minutes) despite only 5 (22.7%) participants reporting excessive daytime sleepiness (ESS>10). Greater insomnia symptom severity was associated with lower heart failure specific quality of life (KCCQ-os) and functional status, and, greater fatigue and depression (all p-values <.05). FOSQ was negatively associated with PSQI (r= -.710, p= <.001) and positively with sleep efficiency (r=.496, p=.026). The KCCQ-cs was positively associated with sleep duration (r=.496, p=.026) and negatively but not significantly associated with ODI (r= -.453, p=.07).

Conclusion

Impaired sleep and OSA are highly prevalent in patients with HFpEF and both are adversely associated with PROs. Goals to improve sleep is important for effective symptom management and for potential improvements in PROs.

Support

American Nurses Foundation, Preventative Cardiovascular Nurses Association

0686 Diabetes Sleep Treatment Trial: The Effect Of Treatment Of OSA With CPAP On Glycemic Control In Type 2 Diabetes

Introduction

Evidence remains unclear whether treatment of OSA with CPAP results in improved glycemic control. This study evaluated if CPAP improved glucose control compared to sham-CPAP and the effect of adherence to active CPAP on glucose control after 6 and 12 weeks of treatment.

Methods

This was a multi-center, double-blind clinical trial. Participants were adults with type 2 diabetes (T2D), A1C≥6.5%, apnea + hypopnea index (AHI)≥10, and naïve to CPAP. All participants received diabetes education. Glucose control was evaluated with frucostamine and A1C levels; CPAP adherence with a wireless modem system. Statistical analysis followed an “intent-to-treat” approach with linear mixed modeling. The dose of active CPAP was calculated as the percentage of days with active CPAP use≥4 hours and the average adherence of active CPAP with sham coded as “0”dose”.

Results

Randomized participants (N=98, CPAP=50; sham-CPAP=48) were primarily middle-aged (age=58.7±9.8 years), White (75%), males (57%) obese (BMI=36.2±6.6), suboptimal glucose control (A1C=7.9%±0.9) and OSA (AHI=23.9±14.4). There were no significant baseline differences except in A1C (Active CPAP=7.7%±0.8; sham-CPAP=8.1%±1.0). There was no significant difference in use of their devices at 6 or 12 weeks. Based on linear mixed modeling, participants on active CPAP had improved A1C (b (SE): -.76 (.24), P<.01) and frucostamine (-21.8 (10.5), P=.04) at 6 weeks with A1C trending to significance at 12 weeks (p=0.10). Both the % of cumulative days of active CPAP usage (≥4 hours/day) (.002 (.003), P=.09) and cumulative hours of active CPAP use (.03 (.03), P=.08) showed a trend being associated with greater change in A1C but not in frucostamine (P=.61, P=.51). The rate of change in A1C varied by time, increasing the % of cumulative days of CPAP use (≥4 hours/day) at week 6 predicted greater change in A1C (.006 (.002), P=.01) than week 12 (.002 (.003), P=.38). Higher average hours of CPAP usage were associated with greater change in A1C (.08 (.03), P=.01) at week 6 compared to week 12 (.03 (.03), P=.47).

Conclusion

In our study, individuals with T2D and OSA, adherence to active CPAP use improved glycemic control over 6 weeks.

Support

NIDDK grant R01DK096028; CTRI grant UL1TR001857 and UL1TR000005.

Nocturnal problems in postpolio syndrome: sleep apnea symptoms and nocturia

Nocturia, generally accepted as an inevitable consequence of aging, is also a symptom of a potentially lethal condition--obstructive sleep apnea (OSA). The descriptive study reported in this article examined nocturia and sleep-related breathing problems in persons with postpolio syndrome (PPS) and tested the Sleep Disordered Breathing--Nocturia Model. This model describes the cascade of events that results in polyuria in persons with sleep-related breathing disorders. Data were analyzed with descriptive and inferential statistics. A 34-item questionnaire was published in the newsletter of a national polio support group, and the 584 respondents constituted a convenience sample. The results showed statistically significant associations between OSA symptoms, nocturia, poor sleep quality, daytime sleepiness, lower urinary tract symptoms, naps, and decreased self-rated health. Study limitations were the use of a convenience sample and possible self-selection of persons with more severe sleep and bladder problems. The results support the model and document how nocturia and sleep disturbances negatively impact persons with PPS.

Sleep apnea symptoms, nocturia, and diabetes in African-American community dwelling older adults

The primary aim of this exploratory study was to examine the association between obstructive sleep apnea (OSA) symptoms, nocturia and diabetes in African-American community-dwelling older adults. A pencil and paper survey was used to collect symptoms of OSA, nocturia, excessive daytime sleepiness (EDS), lower urinary tract symptoms (LUT), and self-rated health. The convenience sample of community dwelling African-Americans (n = 87) included a majority of women (61%) and obese persons (60% with BMI > 30). The mean age was 64 years (range 50-91), and 40% were self reported Type 2 diabetics. Diabetics had significantly more OSA symptoms, more nocturia, and decreased self-rated health. Results of a stepwise logistic regression showed that persons with diabetes and those who reported EDS experienced significant three to four-fold risks for OSA. Similarly, diabetics, women, persons with LUT symptoms and those reporting EDS, had significant three to six-fold risks for nocturia > or = 2/night.

Legal aspects of grading and student progression

In today's litigious environment, nurse educators must understand the legal issues involved in determining grades and deciding academic progression. Although the courts have consistently ruled that educators are the most qualified people to evaluate what constitutes academic success, the potential remains for students to legally challenge their grades. This article reviews legal cases and shows the change in the student-institution relationship from one of a child-surrogate parent (in loco parentis) to one in which students' rights and institutional responsibility are balanced. The courts continue to support the concept that educators are uniquely qualified to make determinations concerning grading and progression and defer to decisions made by the academic community. However, a series of legal decisions based on due process and contract law now protects students from arbitrary and capricious decisions made without a formal grievance process. The implications for nurse educators and administrators are far-reaching and include such issues as specific policies within syllabi, divisional policies, institutional policies, and adherence to formal grievance procedures.