Michael Grandner

Interests

Research

Insufficient sleep and sleep disorders are implicated in 4 of the 7 leading causes of death (cardiovascular disease, diabetes, stroke and accidents). Over 40 studies across several decades have documented that sleep duration is a significant predictor of mortality. Insufficient sleep and sleep disorders are also associated with weight gain, obesity, hypertension, dyslipidemia, insulin resistance, depression, cognitive deficits, and many other adverse outcomes. Sleep is an important part of overall health.My research interests include the broad application of Behavioral Sleep Medicine, including studies of sleep as a domain of health behavior and the development and implementation of behavioral interventions for insufficient sleep and sleep disorders. Specific areas of focus include: (1) adverse cardiovascular, metabolic, and behavioral health outcomes associated with short sleep and/or insufficient sleep, (2) biopsychosocial determinants of short sleep, insufficient sleep, and poor sleep quality, and (3) behavioral interventions for sleep as a domain of health behavior. In summary, it is my belief that we need to better understand the downstream adverse outcomes of insufficient or poor quality sleep, the upstream determinants of sleep and sleep behaviors, and how knowledge of sleep determinants can inform behavioral interventions for adverse outcomes.1. Adverse cardiovascular, metabolic, and behavioral health outcomes associated with short sleep and/or insufficient sleepExisting epidemiological and laboratory studies have demonstrated associations between short and/or insufficient sleep and a number of adverse health outcomes. Despite provocative findings, several important questions remain, including: (1) How do existing studies (which often rely on unvalidated survey items or assess sleep deprivation in normal sleepers) generalize to the phenomenon of short sleep as it exists in the population? (2) If short sleepers do show impairments, how are these effects modified by individual differences in need for sleep, ability to sleep, and ability to adapt to decreased sleep? (3) How can we tell the difference between someone who is a “true short sleeper” and someone obtaining insufficient sleep? I have several ongoing or recently completed studies in this area. For example, I am currently overseeing a multi-phase study of habitual short sleepers (<6 hours) compared to normal sleepers (7-8 hours). The overall goal of the study is to evaluate (1) Subjective and objective sleep and sleep disorders in self-reported short sleepers, (2) Whether short sleepers are, as a group, impaired relative to normal sleepers, (3) Which cardiometabolic and/or cognitive variables differentiate short and normal sleepers, and (4) Potential subgroups within short sleepers, including “true short sleepers” and “impaired short sleepers.” This will allow for the characterization of the phenotype (and potential endophenotypes) of short sleepers for future genetic and epigenetic studies. This study includes online screening, at-home sleep apnea testing, saliva for DNA, clinical interview, 2-week monitoring with sleep diary and actigraphy, questionnaires assessing sleep, health and psychological factors, ambulatory and in-lab performance tests, neuropsychological testing, overnight in-lab polysomnography, oral glucose tolerance test, assays for metabolic hormones and inflammatory cytokines, and nutritional analysis. Other studies include, for example, secondary analyses of existing national datasets exploring the relative contributions of short sleep vs. insufficient sleep, interactions with insomnia and sleep apnea, etc.2. Biopsychosocial determinants of short sleep, insufficient sleep, and poor sleep qualitySleep is an important domain of health behavior that is largely overlooked in the Health Psychology literature. Unlike diet, smoking, exercise, and alcohol, little is known about the determinants of habitual sleep across the biopsychosocial spectrum. This is important, since successful behavioral interventions will need to account for the behaviors, beliefs, attitudes, and environmental factors that determine sleep-related behaviors. Important questions include: (1) How are determinants of sleep associated with social determinants of health in general? (2) What are the habitual sleep-related practices, attitudes, and beliefs that predict healthy sleep? (3) Can health disparities be partially mitigated by addressing sleep disparities? I have several ongoing or recently completed studies in this area as well. For example, I am working (with collaborators) to develop and publish the first instrument for assessment of sleep-related practices, beliefs and attitudes. This is important because it will give us an understanding of determinants of sleep and help elucidate potential intervention pathways. Developing this measure involved generating pools of items grounded in the Health Belief Model, Theory of Reasoned Action and Transtheoretical Model of Behavior Change, and refining this measure through an iterative process that included input from a panel of experts and members of the community, four focus groups (results in press), and implementation as part of a research study (in preparation). This resulted in a final draft of the questionnaire, which was assessed psychometrically. These results will be published with the initial publication of the questionnaire (manuscript submitted, invited to Social Science and Medicine). These initial data will allow us to evaluate behaviors and beliefs associated with sleep practices. In addition, publication of this questionnaire will allow future studies to expand these findings. In addition to this study, I worked with collaborators on a study of sleep quality in the Philadelphia area, documenting a “sleep disparity” related to poverty and race. Other ongoing or recently completed projects are documenting how sleep duration and sleep symptoms are associated with various sociodemographic factors (e.g., age, sex, race/ethnicity, marital status, immigrant status, geography), socioeconomic factors (e.g., income, education, food insecurity, access to healthcare), health behaviors (e.g., diet, exercise, smoking, alcohol use), and the role of social stressors (e.g., racism).Finally, I was first author on the publication that introduced a social-ecological model of sleep and health (the first social ecological model published for sleep), and I am currently working, along with several collaborators at other institutions, to formally introduce a refined version of this model as a framework for future research in the area of sleep at the interface of biopsychosocial factors and health outcomes.3. Behavioral interventions for sleep as a domain of health behaviorWell-described behavioral interventions exist for a number of sleep disorders. However, no interventions currently exist that address habitual unhealthy sleep habits, except for poorly-applied “sleep hygiene” instructions. Much work is needed in this domain to address these questions: (1) How can knowledge about determinants and outcomes of insufficient sleep translate into successful interventions that target habitual sleep practices? (2) Do behavioral interventions for insufficient sleep produce improvements in behavioral and cardiometabolic domains? (3) How can individual-level interventions be translated into community-level and population-level interventions?Although knowledge from the aforementioned areas will be important in informing future interventions, work has already begun to address how to develop and implement a strategy for increasing sleep time as a healthy behavior. I have completed a pilot study of 8 individuals in an open-label trial of an 8-week behavioral sleep extension protocol for habitual short sleepers. Pre-post assessments included sleep, psychological functioning, blood pressure, glucose tolerance and insulin resistance, inflammatory markers, metabolic hormones, neurobehavioral performance, objective sleep propensity, polysomnographic sleep, actigraphic sleep, and other measures. Analysis is ongoing, in preparation for a future grant application.

Teaching

I have been fortunate to have had many excellent teachers and mentors. This has led to my current attitude, which sees teaching and mentoring as a very important part of my work.In the classroom: Courses and lectures to studentsWhile still a graduate student, I had the opportunity to assume the role of an instructor for 2 sections of Statistics for Psychology for two consecutive semesters at San Diego State University. I was responsible for the design of the course, preparing and delivering all lectures, holding office hours, writing and grading all exams and homework assignments, and all other activities. The classes were generally 30-45 students in size. This was an incredibly rewarding experience. I chose to teach statistics because not only do I love the subject, but I know that many Psychology students dread their undergraduate statistics course because it is often taught in a way that is not engaging. I see statistics as a set of useful tools that we can use to make sense of data. I looked forward to seeing if I could translate this to the classroom.My approach seemed to be successful. For all of the sections that I taught, my ratings were very high – what was usually the lowest-rated course in the department was suddenly one of the highest. This work was recognized in an award from the Department of Psychology. More importantly, though, I received a “Professor of the Year” award from a student group.Although I was not able to teach any courses during my postdoctoral fellowship, I look forward to continuing this experience in a faculty position. In addition to teaching Statistics, I would be interested in teaching a number of courses within Psychology. These range from the more general (e.g., Introduction to Psychology, Psychophysiology, Health Psychology, Research Methods, Abnormal Psychology, Clinical Psychology) to more focused (e.g., Sleep and Dreams, Biological Rhythms, Behavioral Assessment, Translational Research). In addition to full courses, I could contribute as a lecture to an existing course, as I have experience in this area (e.g., “Sleep Disorders” for Abnormal Psychology or “Overview of Insomnia” for medical students). In the lab: Mentored research experiencesOver the past several years, I have worked with a number of students in the lab. Having benefitted substantially from outstanding mentors, I strongly believe in the value of mentored research activities. I took the initiative to secure funding for hiring student workers and work-study students in my lab. As word spread regarding what I can offer, I have begun taking on unpaid students who simply want to work with me. Part of the reason why I have developed this reputation is that I offer a very wide range of experiences, which can be tailored to the student’s interests. For example, while all students participate in recruitment, screening, data entry, and other basic activities, they do other things as well. Students interested in medical school learn how to administer oral glucose tolerance tests, process and store plasma samples, and perform assays. Students interested in bioengineering and computer applications are taught statistical programming and they work with specialized equipment and software. Students interested in clinical careers (e.g., Clinical or Counseling Psychology) are encouraged to obtain informed consent, conduct structured clinical interviews, and conduct neuropsychological assessments. In short, the experiences students gain are applicable to their goals. This may be why past students have been very successful in securing admission to graduate schools and/or jobs following graduation.In addition, if students are able to meet their regular goals, I will mentor them through a research project of their own. I talk with them about research studies and how to think like a researcher. We talk about ideas that interest them, and I walk them through the process of developing an idea, turning that idea into a question, finding an existing dataset that can address that question, operationalizing it, forming a data analysis plan, interpreting data, and writing up and presenting the results. In addition, I offer them the opportunity to team up, where one student is primary author and another is secondary author, so they can work together. In the community: Workshops and outreachI believe that an important part of the job of an academician is to engage in outreach to the community. To that end, I have led a number of community-based workshops and focus groups, talking about sleep and behavioral sleep practices for several groups, including new parents, older adults, etc. I look forward to continuing this work.

Courses

Scholarly Contributions

Books

• Grandner, M., & Athey, A. (2024). Sleep and Sport: Physical Performance, Mental Performance, Injury Prevention, and Competitive Advantage for Athletes, Coaches, and Trainers. Elsevier. doi:10.1016/C2019-0-04426-3
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  The relationship between sleep and both mental and physical performance in athletes has become a key issue over the past several years. Sleep and Sport: Physical Performance, Mental Performance, Injury Prevention, and Competitive Advantage for Athletes, Coaches, and Trainers aims to synthesize the growing scientific evidence in this area to help researchers, clinicians, and others interested in sport to understand the fundamentals of sleep health and how these factors relate to athletes. Serving as an important bridge between the sleep and athletics field, this book educates sleep professionals about how their field of expertise relates to various aspects of athletics, while educating sports professionals about the basics of sleep and how it relates to their field of expertise. This is accomplished by explaining some of the basics of sleep health; reviewing the literature on sleep disorders, treatments, and risk factors for athletes; discussing ways that sleep health impacts physical and mental performance; and addressing key specific areas where these fields overlap. In all cases, this text will draw from the existing peer-reviewed literature, in order to provide evidence-based guidance that is objective and well explained.
• Nowakowski, S., Garland, S., Grandner, M., & Cuddihy, L. (2022). Adapting Cognitive Behavioral Therapy for Insomnia. Elsevier. doi:10.1016/C2019-0-03656-4
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  Cognitive behavioral therapy for insomnia (CBT-I) has emerged as the standard first-line treatment for insomnia. The number of patients receiving non-medication treatments is increasing, and there is a growing need to address a wide range of patient backgrounds, characteristics, and medical and psychiatric comorbidities. Adapting Cognitive Behavioral Therapy for Insomnia identifies for clinicians how best to deliver and/or modify CBT-I based on the needs of their patients. The book recommends treatment modifications based on patient age, comorbid conditions, and for various special populations.
• Grandner, M. (2019). Sleep and Health. United Kingdom: Elsevier.

Chapters

• Athey, A., Grandner, M., & Mills, J. (2024). Resources and further reading. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00014-6
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  The following resources include suggestions for learning more about the overlap between sleep and sport. Profssional organizations, key textbooks in the field, and other resources are provided.
• Charest, J., & Grandner, M. (2024). Sleep, nutrition, and supplements: Implications for athletes. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00002-X
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  Sleep has fundamental physiological and cognitive functions that are crucial for athletes. However, athletes are particularly susceptible to sleep inadequacies such a poor quality sleep and short sleep. In recent years, athletes, coaches, and support teams have exponentially increased their knowledge about sleep and recovery and its importance to athletic performance. Evidence supports the positive ergogenic influence of certain supplements on athletic performance such as caffeine and creatine. In addition, different conclusions have been drawn on high, low, and mixed carbohydrate diets. The topic of “train low” and “train high” is also discuss and remains a fundamental point to emphasize to long distance and endurance athletes for optimal training and performances. However, research on nutrition and sleep in athletes remains in its infancy and makes it difficult to draw and formulate specific recommendations. There is a paucity of high-quality, randomized control trials on nutrition and athlete sleep. Several limitations persist, including the type, dosage, and timing of macronutrient intake as well as sleep measurement (subjective and objective). Additionally, different forms and types of supplements are no regulated by the US Food and Drug Administration and may present a safety risk and ultimately be contaminated by a prohibited substances listed for professional athletes. Ultimately, future research may help shed light on the potential benefits of nutrition on sleep in athletes and help clear misconceptions surrounding sport nutrition.
• Grandner, M., Mills, J., Clarke, M., & Athey, A. (2024). Sleep and circadian health promotion programs for athletes. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00020-1
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  This chapter addresses the idea of a sleep and circadian health program within an athletics program. It describes different types of programs, including single-day workshops, multiday workshops, short-term ongoing programs, and long-term ongoing programs. Recommendations for sleep hygiene tips are presented and described. Strategies for conducting a needs assessment survey are described. Issues around identification and management of sleep disorders are reviewed. The importance of developing an education program that also addresses a culture of healthy sleep is discussed. Leveraging sleep and circadian rhythms for optimizing performance is also considered for those without sleep problems. Finally, some concepts for implementing a travel and jet lag management program are reviewed.
• Hale, L., Hartstein, L. E., Robbins, R., Grandner, M. A., LeBourgeois, M. K., Garrison, M. M., & Czeisler, C. A. (2024). What do we know about the link between screens and sleep health?. In Handbook of Children and Screens: Digital Media, Development, and Well-Being from Birth Through Adolescence. Springer Nature. doi:10.1007/978-3-031-69362-5_14
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  Screen-based digital media devices potentially impact pediatric sleep health, which is fundamental to healthy development. Systematic reviews of the literature consistently show that screen use is associated with delayed bedtimes, shorter sleep duration, and reduced sleep quality. Studies also demonstrate that interactivity, content, and timing of exposure influence sleep health and that the effects of interventions are small and difficult to achieve. The mechanisms underlying these associations include (1) activity displacement, (2) decreased interoceptive awareness, (3) psychological/emotional stimulation from the content or social interaction, (4) physiological effects of light exposure, and (5) noises, beeps, and vibrations from devices during the sleep period. Due to limitations in both data quality and study design, future research should seek to improve measurement of timing and content of digital media. Efforts should be invested in developing, implementing, and evaluating sustainable interventions to reduce the negative effects of screen use on sleep health. These studies should also consider potential moderating factors (e.g., age, sex, race/ethnicity) and other downstream consequences on child health and development. We conclude with recommendations to help mitigate the possible effects of screen use on sleep, including making sleep a priority, facilitating screen-free bedtime routines, and removal of devices from bedrooms.
• Kennedy, K., Ghani, S., Mason, B., Hansen, E., & Grandner, M. (2024). Basics of sleep–wake physiology for athletes and sports professionals. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00007-9
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  Sleep is an essential process for mind and body health, allowing for restoration and optimal daytime performance. It consists of several different stages and is carefully orchestrated by the nervous system. Insufficient sleep quantity or quality can result in adverse health outcomes including reduced cognitive function, increased risk of injury, a compromised immune system, as well as cardiometabolic health conditions. These can have a negative impact on athletic performance. This chapter will discuss the foundations of sleep health and introduce key concepts relevant to athletes.
• Lujan, M., Perez-Pozuelo, I., & Grandner, M. (2024). Wearables and sleep tracking in athletics programs. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00013-4
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  Movement-based sleep–wake detection devices (i.e., actigraphy devices) were first developed in the early 1970s and have repeatedly been validated against polysomnography, which is considered the “gold-standard” of sleep measurement. Indeed, they have become important tools for objectively inferring sleep in free-living conditions. Standard actigraphy devices are rooted in accelerometry to measure movement and make predictions, via scoring algorithms, as to whether the wearer is in a state of wakefulness or sleep. Two important developments have become incorporated in newer devices. First, additional sensors, including measures of heart rate and heart rate variability and higher resolution movement sensing through triaxial accelerometers, have been introduced to improve upon traditional, movement-based scoring algorithms. Second, these devices have transcended scientific utility and are now being manufactured and distributed to the general public. This review will provide an overview of: (1) the history of actigraphic sleep measurement, (2) the physiological underpinnings of heart rate and heart rate variability measurement in wearables, (3) the refinement and validation of both standard actigraphy and newer, multisensory devices for real-world sleep-wake detection, (5) the practical applications of actigraphy, (6) important limitations of actigraphic measurement, and lastly (7) future directions within the field.
• Mason, B., Fernandez, F., Ghani, S., Lujan, M., & Grandner, M. (2024). Basics of circadian rhythms: Essentials for athletes and sport professionals. In Sleep and Sport. Elsevier. doi:10.1016/B978-0-12-822969-9.00009-2
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  Circadian rhythms are intrinsic properties of every cell in the body, governed by a molecular clockwork that orchestrates temporal variations in protein levels that match the 24-hour day. All cellular and molecular processes in the body are entrained by light cues via the retinohypothalamic tract. Light entrainment is mediated by the brain's master pacemaker, the suprachiasmatic nucleus, which is the region of the hypothalamus that synchronizes the rest of the brain and periphery to the external environment. Peripheral tissues have their own circadian regulators but are all ultimately synchronized under the direction of the suprachiasmatic nucleus.
• Rasmussen, E. F., Gorovoy, S. B., & Grandner, M. A. (2023). Mechanistic Role Of Sleep In Cardiovascular And Metabolic Diseases. In Advances in the Psychobiology of Sleep and Circadian Rhythms. Taylor and Francis. doi:10.4324/9781003296966-8
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  In this chapter, sleep is contextualised as a proposed mechanism in cardiovascular and metabolic diseases. First, the multidimensional nature of sleep and the various unidimensional models for the assessment of sleep in cardiometabolic research are compared, highlighting several important caveats to the field of study. Two key associations that motivated interest in sleep as a proposed mechanism in cardiovascular health are reviewed: (1) habitual sleep and mortality and (2) sleep apnoea and cardiovascular events. The authors then discuss the nuances of measuring sleep as part of the Lifes Essential 8 framework. Behavioural and physiological pathways between sleep health and cardiometabolic health are proposed and the authors hypothesise that a culmination of impacts results in changes to a wide range of complex behavioural and physiologic processes that affect cardiometabolic health. Specifically, food intake and exercise are evaluated as pathways between sleep health and obesity; the roles of sleep duration, insufficient sleep and insomnia are evaluated in hypertension and sympathetic activation; the role of sleep in dyslipidaemia is evaluated; and sleep and sleep disorders are examined in the context of type 2 diabetes. Lastly, the authors highlight clinical considerations and propose future directions for research: (1) mechanistic studies linking sleep and outcomes to help delineate the specific molecular and behavioural pathways involved, (2) studies examining the role of sleep and cardiometabolic health in the context of a broad range of individual, social and societal factors and (3) studies to clarify the causal pathways linking various aspects of sleep health and various aspects of cardiometabolic health.
• Cuddihy, L., Nowakowski, S., Grandner, M., Meers, J., & Smith, M. (2022). CBT-I for patients with chronic pain. In Adapting Cognitive Behavioral Therapy for Insomnia. Elsevier. doi:10.1016/B978-0-12-822872-2.00021-9
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  Sleep and pain are strongly connected. Sleep disturbance is reported by 67%-88% of patients with chronic pain, and 50% of patients with insomnia suffer from chronic pain. Patients with chronic pain may have difficulty implementing strategies of traditional CBT-I, such as stimulus control or sleep restriction, due to physical limitations (e.g., unable to get in-and-out of bed easily) or behavioral strategies of pain management (e.g., “sleeping off” headaches). This chapter is a guide to modifications to CBT-I that may help patients with chronic pain adhere to and benefit more from treatment.
• Grandner, M. (2022). Sleep Disorders and Sleep Concerns. In Mental Health Care for Elite Athletes. Springer International Publishing. doi:10.1007/978-3-031-08364-8_5
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  Sleep is a universal, biological need, foundational to human biology. Poor sleep health is associated with worse physical performance, greater likelihood of illness, injury risk, decreased recovery, metabolic dysregulation, cardiovascular risk, cognitive dysfunction, worse mental health, and decreased longevity. Most outcomes that are important for athletes are at least partially impacted by sleep. Yet, sleep-related problems are common among athletes, under-recognized, and under-addressed. This chapter will outline the basics of sleep and sleep–wake regulation, how it is measured, and how sleep problems arise. It will also describe different types of sleep disorders, describing presentation and symptoms, as well as treatment approaches. Then, the relationship between sleep and outcomes in athletes will be discussed, as well as strategies for developing a robust sleep health program within an athletics organization. Finally, recommendations for athletics programs are provided.
• Grandner, M., Esquivel, D., & Dawson, S. (2022). CBT-I for people who failed CBT-I. In Adapting Cognitive Behavioral Therapy for Insomnia. Elsevier. doi:10.1016/B978-0-12-822872-2.00020-7
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  CBT-I is an effective and efficacious treatment modality. However, many patients come to clinic having previously failed CBT-I. This chapter addresses the possible reasons why CBT-I could fail, how to approach patients who have previously failed CBT-I, and how to address the problems often seen in these patients. There are a number of reasons that CBT-I might have failed—perhaps the patient was not a good candidate for CBT-I in the first place, the CBT-I they received was not administered properly, or there was some element of the treatment that was not suited to their condition. In any case, many of these patients are pessimistic, cautious, or apprehensive about re-initiating therapy. This can be because they are afraid that their problems are not fixable, or that behavioral sleep medicine is not equipped to address their problem, or that that therapy cannot help them. Whatever the reason, there are several approaches that may benefit these patients. For example, more thorough assessment may identify problems that need to be addressed. A more deliberate attempt to maximize therapeutic alliance and rapport will help address unhelpful beliefs and attitudes, as well as fears. Some slight modifications to CBT-I may help adapt the treatment to better fit this patient's problem.
• Nowakowski, S., Garland, S., Grandner, M., & Cuddihy, L. (2022). Preface. In Adapting Cognitive Behavioral Therapy for Insomnia. Elsevier. doi:10.1016/B978-0-12-822872-2.09998-9
• Tubbs, A., & Grandner, M. (2022). CBT-I for patients with schizophrenia and other psychotic disorders. In Adapting Cognitive Behavioral Therapy for Insomnia. Elsevier. doi:10.1016/B978-0-12-822872-2.00015-3
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  Patients with psychotic disorders show profound disturbances in sleep, including insomnia, nightmares, and unstable sleep/wake rhythms. While emerging research shows that disrupted sleep reduces the quality of life, increases suicide risk, and provokes psychotic symptoms, patients often lack access to evidence-based behavioral sleep medicine treatments. The goal of this chapter is to prepare behavioral sleep medicine clinicians to treat sleep disturbances in individuals with psychotic disorders.
• Grandner, M. A. (2019). Epidemiology of insufficient sleep and poor sleep quality. In Sleep and Health. Elsevier. doi:10.1016/b978-0-12-815373-4.00002-2
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  Insufficient sleep duration and poor sleep quality have emerged as key behavioral risk factors for cardiometabolic disease risk, daytime functioning deficits, and other adverse outcomes, including mortality. Understanding the degree to which these exist in the population and how this prevalence differs based on demographic and other characteristics can provide context for the scope of the problem as it affects the population. Insufficient sleep is common, affecting about 1/3 of the general population. In addition, sleep complaints and symptoms - including nonrestorative sleep, difficulty initiating or maintaining sleep, daytime sleepiness, and snoring - are also common in the general population. Further, factors such as age, sex, race/ethnicity, and socioeconomic status can impact the prevalence of sleep problems.
• Grandner, M. A., & Rosenberger, M. (2019). Actigraphic sleep tracking and wearables: Historical context, scientific applications and guidelines, limitations, and considerations for commercial sleep devices. In Sleep and Health. Academic Press. doi:10.1016/b978-0-12-815373-4.00012-5
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  Abstract Objective estimation of sleep can utilize a range of technologies. For field-based recordings, the most accepted approach is “actigraphy,” or movement-based estimation of sleep versus wake. Actigraphy is based on technology developed over several decades and has been repeatedly validated against in-lab polysomnography. This chapter reviews the history and technology behind actigraphy, addresses the issues around validation, and describes the chronology of this tool as a way to characterize habitual sleep. In addition, this chapter addresses newer implementations of this technology, including the use of consumer-grade wearables and integration with other approaches to improve measurement (e.g., optical plethysmography). Finally, the chapter provides recommendations for implementation of an actigraphy program and guidelines for understanding actigraphy validation.
• Grandner, M., & Rosenberger, M. (2019). Actigraphic sleep tracking and wearables: Historical context, scientific applications and guidelines, limitations, and considerations for commercial sleep devices. In Sleep and Health. Elsevier. doi:10.1016/B978-0-12-815373-4.00012-5
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  Objective estimation of sleep can utilize a range of technologies. For field-based recordings, the most accepted approach is “actigraphy,” or movement-based estimation of sleep versus wake. Actigraphy is based on technology developed over several decades and has been repeatedly validated against in-lab polysomnography. This chapter reviews the history and technology behind actigraphy, addresses the issues around validation, and describes the chronology of this tool as a way to characterize habitual sleep. In addition, this chapter addresses newer implementations of this technology, including the use of consumer-grade wearables and integration with other approaches to improve measurement (e.g., optical plethysmography). Finally, the chapter provides recommendations for implementation of an actigraphy program and guidelines for understanding actigraphy validation.
• Shenoy, S., Seixas, A., & Grandner, M. (2019). Obesity, Diabetes, and Metabolic Syndrome. In Handbook of Sleep Disorders in Medical Conditions. Elsevier. doi:10.1016/B978-0-12-813014-8.00007-X
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  This book chapter provides an overview of extant research and evidence on associations and effects of sleep in obesity, diabetes, and metabolic syndrome (MetS). Specifically, the chapter describes the role sleep plays in the etiology of overweight-obesity, diabetes, and MetS. The chapter also describes the public health relevance of sleep in these three health outcomes and provides population and public health insights as to how improving sleep at the population level may impact the obesity, diabetes, and cardiometabolic disease epidemics in the United States. Lastly, the chapter describes evidence-based assessments and interventions of sleep disturbances that may stave off or better manage health risk.
• Shenoy, S., Seixas, A., & Grandner, M. A. (2019). Obesity, Diabetes, and Metabolic Syndrome. In Handbook of Sleep Disorders in Medical Conditions. Academic Press. doi:10.1016/b978-0-12-813014-8.00007-x
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  Abstract This book chapter provides an overview of extant research and evidence on associations and effects of sleep in obesity, diabetes, and metabolic syndrome (MetS). Specifically, the chapter describes the role sleep plays in the etiology of overweight–obesity, diabetes, and MetS. The chapter also describes the public health relevance of sleep in these three health outcomes and provides population and public health insights as to how improving sleep at the population level may impact the obesity, diabetes, and cardiometabolic disease epidemics in the United States. Lastly, the chapter describes evidence-based assessments and interventions of sleep disturbances that may stave off or better manage health risk.
• Tubbs, A. S., Tubbs, A., Dollish, H. K., Dollish, H. K., Fernandez, F., Grandner, M. A., Fernandez, F. K., & Fernandez, F. A. (2019). The basics of sleep physiology and behavior. In Sleep and Health. Academic Press. doi:10.1016/b978-0-12-815373-4.00001-0
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  Abstract Sleep is an essential element of human health, supporting a wide range of systems including immune function, metabolism, cognition, and emotional regulation. To understand everything that sleep does, however, it is necessary to understand what sleep is. This chapter provides that foundation by discussing the conceptualization, physiology, and measurement of sleep.
• Grandner, M. A., & Mian, R. (2017). Effects of sleep deprivation and sleepiness on society and driving. In Sleep Medicine. Springer New York. doi:10.1007/978-1-4939-6578-6_4
• Grandner, M., & Mian, R. (2017). Effects of Sleep Deprivation and Sleepiness on Society and Drving. In Sleep Disorders Medicine(pp 41-53). New York, NY: Springer. doi:https://doi.org/10.1007/978-1-4939-6578-6_4
• Grandner, M., & Mian, R. M. (2017). Effects of Sleep Deprivation and Sleepiness on Society and Driving. In Sleep Disorders Medicine, 4th Edition(p. 12). New York: Springer. doi:https://doi.org/10.1007/978-1-4939-6578-6_4
• Grandner, M. (2015). Sleep Deprivation: Societal Impact and Long-Term Consequences. In Sleep Medicine: A Comprehensive Guide to Its Development, Clinical Milestones, and Advances in Treatment(pp 495-510). New York: Springer.
• Grandner, M. (2015). Sleep Disparities in the American Population: Prevalence, Potential Causes, Relationships for Cardiometabolic Health Disparities, and Future Directions for Research and Policy. In Kelly Report 2015: Health Disparities in America.(pp 126-132). Washington, DC: House of Representatives.
• Pigeon, W. R., & Grandner, M. A. (2013). Creating an Optimal Sleep Environment. In Encyclopedia of Sleep. Elsevier Inc. doi:10.1016/b978-0-12-378610-4.00022-x
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  The environment in which sleep occurs can either facilitate or hinder the mental and physiologic processes involved in scheduling sleep, initiating and maintaining sleep, and achieving good-quality sleep. Aspects of the physical environment commonly associated with these functions include ambient light, sudden and/or continuous noise, temperature, tactile attributes of the sleeping surface, aromas, the presence of others, and the presence of arousing stimuli, such as electronic devices. Other aspects of the environment, including bodily, mental, and behavioral factors, also contribute to the sleep environment. In creating an optimum sleep environment, a thorough assessment of all of these factors will identify likely candidates for intervention.
• Pigeon, W., & Grandner, M. (2013). Creating an Optimal Sleep Environment. In Encyclopedia of Sleep. doi:10.1016/B978-0-12-378610-4.00022-X
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  The environment in which sleep occurs can either facilitate or hinder the mental and physiologic processes involved in scheduling sleep, initiating and maintaining sleep, and achieving good-quality sleep. Aspects of the physical environment commonly associated with these functions include ambient light, sudden and/or continuous noise, temperature, tactile attributes of the sleeping surface, aromas, the presence of others, and the presence of arousing stimuli, such as electronic devices. Other aspects of the environment, including bodily, mental, and behavioral factors, also contribute to the sleep environment. In creating an optimum sleep environment, a thorough assessment of all of these factors will identify likely candidates for intervention.
• Grandner, M. A. (2012). Short Sleep. In Encyclopedia of Sleep. Bloomsbury Publishing Plc.

Journals/Publications

• Rojo-Wissar, D. M., Womack, S. R., Baka, T., Spira, A. P., Davidson, R. D., Zhou, E. S., Alfano, C. A., Jackson, C. L., Grandner, M. A., & Parade, S. H. (2026). Biological Indicators of Cardiovascular Health by Foster Care History in Adults. American Journal of Preventive Medicine, 70(Issue 1). doi:10.1016/j.amepre.2025.108097
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  Introduction: Childhood adversity contributes to adult cardiovascular health disparities, but the cardiovascular health of foster care alumni, who experience unique compounded stressors such as attachment disruption and environmental upheaval, is understudied. In this study, biological cardiovascular health indicators were described among U.S. adults with and without a foster care placement history. Methods: Cross-sectional data from 4,625 adults (representing 17,226,361 U.S. adults) approaching and in early midlife (2016–2018) from The National Longitudinal Study of Adolescent to Adult Health were used. Biological indicators of cardiovascular health included BMI, blood lipids, blood glucose, and blood pressure, which were each scored on a standardized scale of 0–100, with higher scores indicating better cardiovascular health. An unweighted average of these standardized scores was also computed. Incorporating sampling weights, nationally representative estimates of cardiovascular health by foster care history were generated in 2024–2025. Results: There were 113 participants who reported a foster care placement history (1.8% [weighted]), representing 313,604 adults. Foster care alumni had poorer overall cardiovascular health scores (mean=61.8, 95% CI=56.6, 66.9) and blood pressure health scores (mean=48.7 [indicates hypertension], 95% CI=39.8, 57.5) than those without a foster care history (cardiovascular health: mean=70.2, 95% CI=69.1, 71.4; blood pressure: mean=61.6, 95% CI=59.9, 63.2). Notably, common protective factors (e.g., female sex, higher income) did not mitigate cardiovascular health risk in the foster care group. Conclusions: Childhood foster care placement is associated with poorer cardiovascular health, particularly hypertension, even in groups generally at lower risk. Research and clinical initiatives are needed to better understand and address cardiovascular health inequities and promote cardiovascular wellness in this population.
• Aggarwal, B., Gao, Y., Alfini, A., Azarbarzin, A., Anafi, R. C., Glazer Baron, K., Bautch, V. L., Bowles, N., Broussard, J. L., Brown, M., Cheng, P., Cook, S. H., Cortese, R., Fernandez, F. X., Galis, Z., Johnson, D. A., Jelic, S., Lipton, J. O., Lutsey, P. L., , Miao, Q., et al. (2025). Sleep and circadian rhythms in cardiovascular resilience: mechanisms, implications, and a Roadmap for research and interventions. Nature Reviews Cardiology. doi:10.1038/s41569-025-01188-1
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  The interaction between sleep, circadian rhythms and cardiovascular resilience is a crucial yet underexplored research area with important public health implications. Disruptions in sleep and circadian rhythms exacerbate hypertension, diabetes mellitus and obesity, conditions that are increasingly prevalent globally and increase the risk of cardiovascular disease. A National Heart, Lung, and Blood Institute workshop examined these connections, as well as the emerging concept of cardiovascular resilience as a dynamic and multifaceted concept spanning molecular, cellular and systemic levels across an individual’s lifespan. The workshop emphasized the need to expand the focus from solely understanding whether and how sleep and circadian rhythm disturbances contribute to disease, to also exploring how healthy sleep and aligned circadian rhythms can increase cardiovascular resilience. To develop a Roadmap towards this goal, workshop participants identified key knowledge gaps and research opportunities, including the need to integrate biological, behavioural, environmental and societal factors in sleep and circadian health with cardiovascular research to identify therapeutic targets. Proposed interventions encompass behavioural therapies, chronotherapy, lifestyle changes, organizational policies and public health initiatives aimed at improving sleep and circadian health for better cardiovascular outcomes. Future cross-disciplinary research and translation of discoveries into public health strategies and clinical practices could improve cardiovascular resilience across the lifespan in all populations.
• Alfonso-Miller, P., Ellis, J. G., Bastien, C. H., Hale, L., Branas, C. C., Perlis, M. A., Rasmussen, E., Gorovoy, S. B., & Grandner, M. A. (2025). Child Abuse Exposure and Adult Sleep Continuity Disturbance, Sleep Duration, and Bedroom Safety. Behavioral Sleep Medicine, 23(Issue). doi:10.1080/15402002.2025.2529871
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  Background: While prior research has shown that early life events can impact sleep during adulthood. However, the specific aspects of sleep affected in those who experienced abuse as a child and potential environmental factors that may help ameliorate these difficulties is less understood. Objectives: The present cross-sectional study examined the relationship between abuse as a child and several key dimensions of poor sleep (sleep quality, insomnia symptoms and typical sleep duration). Additionally, perceived bedroom safety was examined as a potential moderator. Participants and Methods: A sample of 1,002 individuals completed measures of current sleep problems and perceived levels of safety in the bedroom. Additionally, participants indicated whether they had been exposed to physical or sexual abuse as a child. 204 participants reported being abused during childhood, defined as sexual or physical abuse. Results: A series of linear regressions demonstrated–a) associations between a history of abuse as a child and adult poorer sleep quality, increased insomnia symptomology, and shorter sleep durations and b) these associations, in the main, were moderated by current perceived bedroom safety. Of those who had experienced abuse as a child, perceiving the bedroom as a safe environment was associated with a 52% reduction in perceived poor sleep quality, 19% reduction in insomnia symptoms and 37% increase in sleep duration compared to those who currently slept in an environment they perceived to be unsafe. Conclusions: While childhood abuse is associated with worse sleep health, these self-reported results indicate that the adult perception of safe bedroom mitigates that association.
• Beranek, P., Turner, M., Lo, J., Grandner, M., Dunican, I. C., & Cruickshank, T. (2025). Sleep environment is associated with sleep control in fly-in, fly-out mining shift workers. Sleep and Breathing, 29(Issue 5). doi:10.1007/s11325-025-03454-5
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  Control over sleep timing, duration, and quality is essential for obtaining healthy sleep. Fly-in, Fly-out (FIFO) mining shift workers face unique challenges in maintaining control over their sleep due to their roster. However, the impact of their sleep environment on perceived sleep control in this population remains underexplored. This study evaluates the sleep environment of FIFO mining shift workers and its association with sleep control. A cross-sectional study was conducted (2023–2024) on Australian FIFO mining shift workers residing in remote camp accommodations. Data were collected via an online survey using the Assessment of Sleep Environment (ASE) and the Brief Index of Sleep Control (BRISC). Linear regression and Random Forest analyses were used to explore associations and identify key environmental factors influencing sleep control. Respondents (n = 538, 29% female) reported a mean ASE score of 12.6 ± 7.4 and a BRISC score of 2.3 ± 0.9. Two-thirds (n = 366) rated their sleep environment as moderately or highly sleep-disruptive. Higher ASE scores were negatively associated with BRISC scores (p < 0.001). Key environmental factors included pillow/blanket comfort, mattress comfort, room temperature, noise, light, and safety, of which all were negatively correlated (p < 0.05) with sleep control. The findings highlight the importance of optimising sleep environments to improve FIFO mining shift workers’ sleep control. Addressing bedding comfort, noise and light levels, temperature, and safety could improve sleep in this population. However, the cross-sectional design does not allow for the identification of causal relationships. Longitudinal and objective studies are warranted to confirm causality and guide interventions.
• Büsser, A. J., Durrer, R., Freidank, M., Togninalli, M., Olivieri, A., Grandner, M. A., & McCall, W. V. (2025). Medical ontology learning framework to investigate daytime impairment in insomnia disorder and treatment effects. Communications Medicine, 5(Issue 1). doi:10.1038/s43856-024-00698-2
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  Background: Specificity challenges frequently arise in medical ontology used for the representation of real-world data, particularly in defining mental health disorders within widely used classification systems such as the International Classification of Diseases (ICD). This study aims to address these challenges by introducing the Disease-Specific Medical Ontology Learning (DiSMOL) framework, designed to generate precise disease representations from clinical physician notes, with a focus on daytime impairment in insomnia disorder. Methods: The study applied the Disease-Specific Medical Ontology Learning framework to clinical notes to better represent daytime impairment. The framework’s performance was compared to insomnia expert-selected codes from ICD. Key statistical methods included sensitivity and F1-score comparisons, as well as analysis of symptom changes after the use of various medications, including benzodiazepines, non-benzodiazepine receptor agonists, and trazodone. Results: The DiSMOL framework significantly enhances the identification of daytime impairment in people with insomnia. Sensitivity increases from 17% to 98%, and the F1-score improves from 28% to 86%, compared with expert-selected ICD codes. Additionally, the framework reveals significant increases in daytime impairment symptoms following benzodiazepine use (18.9%), while traditional ICD codes do not detect any significant change. Conclusions: The study demonstrates that DiSMOL offers a more accurate method for identifying specific disease aspects, such as daytime impairment in insomnia, than traditional coding systems. These findings highlight the potential of specialized ontologies to enhance the representation and analysis of real-world clinical data, with important implications for healthcare policy and personalized medicine.
• Costa, G. A., Grandner, M. A., & Marques, D. R. (2025). Playing sports in higher education as a protective factor against social jetlag: An exploratory study. Sleep Medicine: X, 10(Issue). doi:10.1016/j.sleepx.2025.100152
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  Background: Student-athletes face challenges balancing academic and athletic commitments, often leading to dysfunctional sleep patterns. Social jetlag - a misalignment between biological and social clocks - has emerged as a potential contributor to mental and physical strain. The current study is aimed at determining the social jetlag frequency and its associations with other sleep and health variables among student-athletes in higher education. Methods: Sixty-seven European Portuguese student-athletes (mean age = 21.4 years) were evaluated for chronotype, social jetlag, sleep effort, daytime sleepiness, psychological distress, and perceived academic and athletic performance. Results: Social jetlag was computed using a corrected midpoint of sleep approach (SJLsc). Most participants (62.7 %) reported moderate social jetlag (1–2 h), and only 6 % of the sample presented high social jetlag (>2 h). Higher social jetlag was negatively correlated with academic performance and positively associated with evening chronotypes. Although group differences across social jetlag levels and chronotypes were not statistically significant, there is a trend suggesting morning types experience lower misalignment. Compared to normative data derived from Portuguese samples, participants showed higher sleep effort and lower perceived daytime sleepiness. Conclusions: The prevalence of significant social jetlag among student-athletes was low, suggesting that participation in sports may serve as a protective factor, possibly due to greater health awareness and monitoring. However, further studies with larger samples are needed.
• Dollish, H. K., Snider, J. M., Doskicz, H., Grandner, M. A., & Fernandez, F. X. (2025). Circadian and photoperiodic control of melatonin in Drosophila ananassae. Biochemistry and Biophysics Reports, 44. doi:10.1016/j.bbrep.2025.102255
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  Melatonin is a widely conserved indoleamine with well-established roles in circadian timekeeping, sleep regulation, and physiological coordination across taxa. In Drosophila melanogaster, early studies reported daily melatonin rhythms, but little is known about melatonin dynamics in other Drosophila species. Here, we measured melatonin secretion in >14,000 Drosophila ananassae across 12 circadian timepoints under four simulated photoperiods: LD 8:16 (short day), LD 12:12 (equatorial), LD 16:8 (long day), and LD 20:4 (arctic summer). Using LC-MS/MS detection in pooled whole-fly samples, we identified robust, bimodal melatonin rhythms across all conditions, with conserved peaks at approximately ZT7 and ZT13 irrespective of daylength. Melatonin levels were significantly elevated under the short-day photoperiod compared to all others (p < 0.0005), indicating photoperiod-sensitive amplitude modulation. These findings confirm the presence of circadian melatonin rhythms in Drosophila, replicate a previously reported early-day peak observed in D. melanogaster, and reveal a second rhythm component not described in earlier studies. The data suggest that melatonin secretion in Drosophila is governed by an endogenous clock and phase-locked to lights-on, even in the absence of nighttime darkness. This work refines our understanding of melatonin rhythmicity in insects and underscores its potential role as a conserved circadian output across species.
• Driller, M. W., Halson, S. L., Mah, C. D., Suppiah, H., Lastella, M., Miller, D. J., Cooke, M. B., Rio, E., Gibson, A. S., Bender, A. M., Harris, R., Armstrong, S., Slater, G., & Grandner, M. A. (2025). Teamwork Makes the Dream Work: Who Should Be Managing Athletes on Matters Related to Sleep?. Sports Medicine, 55(Issue). doi:10.1007/s40279-025-02282-7
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  Optimising sleep health is essential for athlete recovery and performance, but responsibility for managing sleep in high-performance sports is often unclear. Although performance support teams include diverse professionals such as coaches, sport scientists, physiotherapists, sports dietitians, psychologists, and physicians, guidance may be fragmented and inconsistent across training environments and competition schedules. This paper proposes a collaborative multidisciplinary model in which sleep specialists may integrate with existing support staff to deliver unified, evidence-based sleep strategies throughout all phases of athlete preparation. By fostering open communication channels, aligning screening protocols, and coordinating interventions, this model ensures consistent messaging and implementation of sleep initiatives. We also address sleep monitoring via wearable technologies, highlighting device performance and data confidentiality considerations to ensure accurate and ethical use of athlete sleep metrics. Emphasis is placed on creating organisation-wide policies that recognise sleep as an important component to health and performance. Adopting this integrated approach to sleep may enhance overall physical and mental health, reduce injury risk, improve recovery, and ultimately, enhance athletic performance.
• Espie, C. A., Grandner, M. A., & Drake, C. L. (2025). PRO: CBT-I for insomnia treatment can be delivered by a range of healthcare providers. Sleep, 48(Issue 10). doi:10.1093/sleep/zsaf124
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  The following argument was prepared in response to the question without the knowledge of the contents of the opposing argument. Cognitive behavioral therapy for insomnia (CBT-I) adapts core cognitive and behavioral principles to treatment of insomnia disorder. The same is true for CBT when adapted for anxiety, depression and other mental health disorders. A diverse range of professional groups (including psychologists, nurses, therapists, occupational therapists, physicians, and social workers) provide CBT worldwide and based on research evidence and common practice this is also the case for CBT-I. All health care systems require generalists and specialists to meet population need with appropriate levels of care delivered within the boundaries of their statutory regulation and competence. Consequently, who may deliver CBT-I is a generic matter of clinical governance. Professionals need to have a license to practice, which confers the qualified right to, and accountability for, treating patients. Core registration and any other credentials and expertise should be in the in the public domain, and open to scrutiny and challenge. Professionals delivering CBT-I need to operate safely, effectively, and within the limits of their qualifications and expertise. Core licensing bodies must ensure necessary standards of training, supervision, and treatment practice are established and maintained. Stepped care offers not only an efficient model for managing the large number of patients with insomnia, making best use of the professional skill-mix, but also may be adopted by services as a clinical governance model to ensure best treatment and best practice.
• Grandner, M. A., Dzierzewski, J. M., Gozal, D., Lopos, J. G., Miller, A. N., & Redline, S. (2025). Screen use and sleep health in children, adolescents, and adults: National Sleep Foundation consensus considerations and practical suggestions. Sleep Health, 11(Issue 5). doi:10.1016/j.sleh.2025.05.002
• Grandner, M. A., Gugliotta, A. A., Kolla, B. P., Gorovoy, S. B., Ellis, J. G., Bastien, C. H., & Fox, R. S. (2025). Cognitive and behavioral therapies for insomnia: must they always be in bed together?. Journal of Clinical Sleep Medicine, 21(Issue 10). doi:10.5664/jcsm.11862
• Mangar, S., Grandner, M., Airlodi, L., Moreira, H. C., & Dimitriou, D. (2025). The Development of Chronic Insomnia in Prostate Cancer Patients Receiving Androgen Deprivation Therapy: DEPRIVED Study. Psycho-Oncology, 34(Issue 11). doi:10.1002/pon.70316
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  Background: Both a diagnosis of prostate cancer and its treatment with Androgen Deprivation Therapy (ADT) can lead to negative side effects on patients' daily functioning, including hot flashes, sweating, and fatigue. Despite this, there is little objective data characterizing the relative contribution of these factors to sleep disturbance, impact on fatigue and quality of life. Aim: The aim of this study is to conduct a longitudinal analysis of sleep disturbances in patients with prostate cancer, comparing those undergoing ADT with those who are treatment-naïve. Methods: Subjective data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), while objective sleep assessment was conducted using actigraphy. The study included both ADT and ADT-naïve patients. Data collection occurred over two timepoints within a 3–4–month period. Clinical parameters, such as nocturia, were also explored in the analysis. Results: Actigraphy data analyses revealed that patients who commenced ADT treatment (LHRHa) between timepoints 1 and 2 experienced a significant decline in sleep quality and duration, along with reduced daytime napping. No correlation was found between nocturia and frequent night wakings. In contrast, the ADT-naïve group demonstrated improved sleep quality and duration at timepoint 2. Conclusion: The current study highlights how sleep quality and duration change over time in response to different treatments and their side effects. It provides clear evidence that sleep disturbances in patients on ADT are not temporary but long-lasting, thereby classifying as chronic insomnia (DSM-5). Future research should aim to validate these results in larger groups and explore targeted interventions to mitigate sleep-related side effects of ADT.
• Moloney, M. E., Moga, D. C., Grandner, M., & Schoenberg, N. (2025). “No rest for me tonight”: A social-ecological exploration of insomnia in rural Appalachian women. Sleep Health, 11(Issue). doi:10.1016/j.sleh.2025.04.009
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  Objectives: Insomnia disproportionally affects women and is prevalent among rural Appalachian adults at higher rates than in the general US population. Given the strong, bi-directional relationship between sleep and health, a better understanding of insomnia in this health-disparate population is critical. The present study focused on the sex (females), gender (women), and age group (45+) at highest insomnia risk and explores the social determinants of sleep that contributed to insomnia. Methods: Semistructured telephone interviews were conducted to understand factors associated with insomnia among rural Appalachian women who self-reported insomnia symptoms ≥3 nights per week for ≥3 months. Interviews were recorded with permission and transcribed. We used a multistage, inductive and deductive coding process aided by NVIVO 12.0 software. Results: Participants were 46 cisgender women in rural Appalachia who met the criteria for insomnia. The social-ecological model was our interpretative framework. Findings illuminate individual (e.g., rumination, menopause, pain, depression), social (e.g., family roles, grief, caregiving, financial concerns), and societal (e.g., gender norms, technology use) factors that likely contribute to insomnia among middle-aged rural Appalachian women. Conclusions: Across levels of the social-ecological model, factors of female sex (e.g., menopause) and gendered behaviors, roles, and norms (e.g., caregiving close and extended kin) played a central role in the precipitation and perpetuation of insomnia in this population. Attending to the regional cultural norms of heightened self-sufficiency, domestic work, and inter-generational familial care may aid healthcare providers and policy makers aiming to address insomnia among rural Appalachian women as well as other rural populations.
• Parthasarathy, S., Wendel, C., Grandner, M., Haynes, P., Guerra, S., Combs, D., & Quan, S. (2025). Peer-Driven Intervention for Care Coordination and Adherence Promotion for Obstructive Sleep Apnea A Randomized, Parallel-Group Clinical Trial. American Journal of Respiratory and Critical Care Medicine, 211(2). doi:10.1164/rccm.202309-1594OC
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  Rationale: Obstructive sleep apnea (OSA) is a common condition that is usually treated by continuous positive airway pressure (CPAP) therapy, but poor adherence is common and is associated with worse patient outcomes and experiences. Patient satisfaction is increasingly adopted as a quality indicator by healthcare systems. Objectives: We tested the hypothesis that peer-driven intervention effected through an interactive voice response (IVR) system leads to better patient satisfaction (primary outcome), care coordination, and CPAP adherence than active control. Methods: We performed a 6-month randomized, parallel-group, controlled trial with CPAP-naive patients recruited from four centers and CPAP-adherent patients who were trained to be mentors delivering support through an IVR system. Measurements and Main Results: In 263 patients, intention-to-treat analysis of global satisfaction for sleep-specific services was better in the intervention group (4.57 6 0.71 Likert scale score; mean 6 SD) than in the active-control group (4.10 6 1.13; P, 0.001). CPAP adherence was greater in the intervention group (4.5 6 0.2 h/night; 62.0% 6 3.0% of nights .4 h use) versus the active-control group (3.7 6 0.2 h/night; 51.4% 6 3.0% of nights .4 h use; P = 0.014 and P = 0.023). When compared with the active-control group, the Patient Assessment of Chronic Illness Care rating was moderately increased by an adjusted difference of 0.33 6 0.12 (P = 0.009), Consumer Assessment of Healthcare Provider and Systems rating was not different (adjusted difference, 0.46 6 0.26; P = 0.076), and Client Perception of Coordination Questionnaire was mildly better in the intervention group (adjusted difference, 0.15 6 0.07; P = 0.035). Conclusions: Patient satisfaction with care delivery, CPAP adherence, and care coordination were improved by peer-driven intervention through an IVR system. New payor policies compensating peer support may enable implementation of this approach.
• Perlis, M., Grandner, M., Posner, D., Spiegelhalder, K., & Riemann, D. (2025). Sleep diaries and other subjective measures are essential for the assessment of insomnia. Journal of Sleep Research, 34(1). doi:10.1111/jsr.14313
• St-Onge, M. P., Aggarwal, B., Fernandez-Mendoza, J., Johnson, D., Kline, C. E., Knutson, K. L., Redeker, N., & Grandner, M. A. (2025). Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation: Cardiovascular Quality and Outcomes. doi:10.1161/hcq.0000000000000139
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  Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life’s Essential 8. Although chronic sleep duration is the sole metric used in Life’s Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.
• Vitale, J., McCall, A., Cina, A., Skorski, S., Sargent, C., Rossiter, A., Roach, G. D., van Rensburg, A. J., Nedelec, M., Miller, D., Lastella, M., Gupta, L., Grandner, M., Fullagar, H., Filip-Stachnik, A., Dohi, M., Charest, J., Biggins, M., Bender, A., , Alonso, J. M., et al. (2025). “Can We Trust Them?” An Expert Evaluation of Large Language Models to Provide Sleep and Jet Lag Recommendations for Athletes. Sports Medicine. doi:10.1007/s40279-025-02303-5
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  Background: With the increasing use of artificial intelligence in healthcare and sports science, large language models (LLMs) are being explored as tools for delivering personalized, evidence-based guidance to athletes. Objective: This study evaluated the capabilities of LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) to deliver evidence-based advice on sleep and jet lag for athletes. Methods: Conducted in two phases between January and June 2024, the study first identified ten frequently asked questions on these topics with input from experts and LLMs. In the second phase, 20 experts (mean age 43.9 ± 9.0 years; ten females, ten males) assessed LLM responses using Google Forms surveys administered at two intervals (T1 and T2). Inter-rater reliability was evaluated using Fleiss' Kappa, and intra-rater agreement using the Jaccard Similarity Index (JSI), and content validity through the content validity ratio (CVR). Differences among LLMs were analyzed using Friedman and Chi-square tests. Results: Experts’ response rates were high (100% at T1 and 95% at T2). Inter-rater reliability was minimal (Fleiss' Kappa: 0.21–0.39), while intra-rater agreement was high, with 53% of experts achieving a JSI ≥ 0.75. ChatGPT-4 had the highest CVR for sleep (0.67) and was the only model with a valid CVR for jet lag (0.68). Google Bard showed the lowest CVR for jet lag (0%), with significant differences compared to ChatGPT-3.5 (p = 0.0073) and ChatGPT-4 (p < 0.0001). Reasons for inappropriate responses varied significantly for jet lag (p < 0.0001), with Google Bard criticized for insufficient information and frequent errors. ChatGPT-4 outperformed other models overall. Conclusions: This study highlights the potential of LLMs, particularly ChatGPT-4, to provide evidence-based advice on sleep but underscores the need for improved accuracy and validation for jet lag recommendations.
• Boyle, J., Morales, K., Muench, A., Ellis, J., Vargas, I., Grandner, M., Posner, D., & Perlis, M. (2024). The natural history of insomnia: evaluating illness severity from acute to chronic insomnia; is the first the worst?. Sleep, 47(4). doi:10.1093/sleep/zsae034
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  Study Objectives: The 3P and 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst during acute onset. The 4P model suggests that illness severity crescendos with chronicity. The present analysis from an archival dataset assesses illness severity with new onset illness (i.e. from good sleep [GS] to acute insomnia [AI] to chronic insomnia [CI]). Illness severity is quantified in terms of total wake time (TWT). Methods: GSs (N = 934) were followed up to 1 year with digital sleep diaries, and classified as GS, AI, or CI. Data for CIs were anchored to the first of 14 days with insomnia so that day-to-day TWT was represented prior to and following AI onset. A similar graphic (+/− acute onset) was constructed for number of days per week with insomnia. GS data were temporally matched to CI data. Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS-to-AI period. Results: Twenty-three individuals transitioned to AI and then CI. Average TWT rose during the first 2 weeks of AI onset (b = 1.8, SE = 0.57, p = 0.001) and was then stable for 3 months (b = −0.02, SE = 0.04, p = 0.53). Average number of affected days was stable from AI to CI (b = 0.0005, SE = 0.002, p = 0.81). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident. Conclusions: In our sample of CIs, primarily with middle insomnia, the average severity and number of affected days were worst with the onset of AI (worst is first) and stable thereafter.
• Palencia-Lamela, I., Coppello, M., Carasco, M., Garchitorena, L., Grandner, M. A., Chung, D., Jean-Louis, G., & Seixas, A. (2024). 0252 Association Between Sleep Environment and Insomnia Among Hispanics in Florida. SLEEP, 47(Supplement_1), A109-A109. doi:10.1093/sleep/zsae067.0252
• Skiba, M., Badger, T., Pace, T., Grandner, M., Haynes, P., Segrin, C., & Fox, R. (2024). Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers. Journal of Behavioral Medicine, 48(Issue 1). doi:10.1007/s10865-024-00523-0
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  Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged–No MVPA, Least Engaged–Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged–No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.
• Tauman, R., Henig, O., Rosenberg, E., Marudi, O., Dunietz, T., Grandner, M., Spitzer, A., Zeltser, D., Mizrahi, M., Sprecher, E., Ben-Ami, R., Goldshmidt, H., Goldiner, I., Saiag, E., & Angel, Y. (2024). Relationship among sleep, work features, and SARS-cov-2 vaccine antibody response in hospital workers. Sleep Medicine, 116(Issue). doi:10.1016/j.sleep.2024.02.045
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  Study objectives: Immunity is influenced by sleep and the circadian rhythm. Healthcare workers are predisposed to both insufficient sleep and circadian disruption. This study aimed to evaluate the relationship between sleep and work characteristics and the antibody response to the mRNA SARS-CoV-2 vaccine BNT162b2. Methods: The authors' prospective cohort study (“COVI3”) evaluated the effect of a third (booster) dose of the BNT162b2 vaccine. A subset of participants provided information on anthropometric measures, sleep, stress and work characteristics including shift work and number of work hours per week. Blood samples for anti-S1-RBD IgG antibody levels were obtained 21 weeks following receipt of the third dose of the vaccine. Results: In total, 201 healthcare workers (73% women) were included. After adjustment for age, body mass index (BMI), shift work, smoking status, and perceived stress, short sleep duration (
• Tubbs, A. S., Taneja, K., Ghani, S. B., Nadorff, M. R., Drapeau, C. W., Karp, J. F., Fernandez, F. X., Perlis, M. L., & Grandner, M. A. (2024). Sleep continuity, timing, quality, and disorder are associated with suicidal ideation and suicide attempts among college students. Journal of American College Health, 72(Issue 9). doi:10.1080/07448481.2022.2155828
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  Objective: To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18–25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.
• Tubbs, A., Fernandez, F., Klerman, E., Karp, J., Basner, M., Chakravorty, S., Watkins, E., Perlis, M., & Grandner, M. (2024). Risk for Suicide and Homicide Peaks at Night: Findings From the National Violent Death Reporting System, 35 States, 2003–2017. Journal of Clinical Psychiatry, 85(2). doi:10.4088/JCP.23m15207
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  Objective: The Mind after Midnight hypothesis proposes that nocturnal wakefulness increases the risk for dysregulated behaviors. Prior studies highlight a greater risk for suicide at night after adjusting for population wakefulness. How this risk varies hour to hour, differs across subgroups, or applies to other behaviors is unknown. Methods: Data on 78,647 suicides and 50,526 homicides from the National Violent Death Reporting System were combined with population wakefulness data for 2003–2017 from the American Time Use Survey. Hourly incident risk ratios (IRRs) were estimated after adjusting for population wakefulness. Two-way analysis of variances identified significant time-by-subgroup interactions that were quantified in post hoc analyses. Results: Suicide counts peaked at 12:00 PM while homicide counts peaked at 10:00–11:00 PM. Adjusting for demographics and population wakefulness revealed a 5-fold greater risk for suicide at 3:00 AM (aIRR: 5.20 [4.74–5.70]) and an 8-fold greater risk for homicide at 2:00 AM (aIRR: 8.04 [6.35–10.2]). Hourly risk for suicide varied by age, ethnicity, blood alcohol level, and current partner conflict. Hourly risk for homicide varied by sex and blood alcohol level. Conclusions: Risk for suicide and homicide is greater at night than expected based on the number of people awake at that time. Nighttime risk was greater among young adults and those intoxicated with alcohol, but not among those with a history of suicidal ideation or attempts. Further research should evaluate mechanisms of risk and confirm these findings at an individual level.
• Tubbs, A., Perlis, M., Killgore, W., Karp, J., Grandner, M., & Fernandez, F. (2024). Empirical clustering to identify individuals for whom insomnia is more closely related to suicidal ideation. Journal of Affective Disorders, 362(Issue). doi:10.1016/j.jad.2024.06.101
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  Background: Although the effect sizes are modest, insomnia is consistently associated with suicidal thoughts and behaviors. Subgroup analyses can efficiently identify for whom insomnia is most relevant to suicidal ideation. To improve clinical case identification, the present study sought to identify subclusters of lifetime suicidal ideators for whom insomnia was most closely related to current suicidal ideation. Methods: Data on N = 4750 lifetime suicidal ideators were extracted from the Military Suicide Research Consortium's Common Data Elements. Data on sociodemographic characteristics, severity and history of suicidal thoughts and behaviors, and related clinical characteristics were clustered by unsupervised machine learning algorithms. Robust Poisson regression estimated cluster by insomnia associations with current suicidal ideation. Results: Three clusters were identified: a modest symptom severity cluster (N = 1757, 37.0 %), an elevated severity cluster (N = 1444 30.4 %), and a high severity cluster (N = 1549 32.6 %). In Cluster 1, insomnia was associated with current suicidal ideation (PRR 1.29 [1.13–1.46]) and remained significant after adjusting for sociodemographic and clinical covariates. In Cluster 2, insomnia was associated with current suicidal ideation (PRR 1.14 [1.01–1.30]), but not after adjusting for sociodemographic and clinical covariates. In Cluster 3, insomnia was associated with current suicidal ideation (PRR 1.12 [1.03–1.21]) and remained significant after adjusting for sociodemographic covariates, but not clinical covariates. Limitations: Cross-sectional design, lack of diagnostic data, non-representative sample. Conclusion: Insomnia appears more closely related to current suicidal ideation among modest severity individuals than other subgroups. Future work should use prospective designs and more comprehensive risk factor measures to confirm these findings.
• Yakpogoro, N., Desai, S., Huskey, A., Henderson-Arredondo, K., Jankowski, S., Patel, S., Hildebrand, L., Trapani, C., Franca, G., Reich-Fuehrer, M. M., Grandner, M. A., Chen, Y. (., Chou, Y., Dailey, N., & Killgore, W. (2024). 0432 Neuromodulation of REM Sleep: Age-Associated Effects of Transcranial Magnetic Stimulation. SLEEP, 47(Supplement_1), A185-A186. doi:10.1093/sleep/zsae067.0432
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  Abstract Introduction We recently reported findings from a project that used a form of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS) to modulate connectivity within the brain’s Default Mode Network (DMN) as a potential treatment for insomnia. Continuous theta-burst stimulation(cTBS) was used to reduce cortical excitability within the DMN. Our prior analyses showed that the approach significantly improved total sleep time, sleep efficiency, N3 latency, and the arousal index, but rapid eye-movement (REM) did not appear affected. Based on growing evidence that REM sleep may show changes in the third decade and beyond, and that the effects of rTMS may be, at least partially, influenced by age, we further explored the potential effect of age in this dataset. Methods cTBS was administered to a total of 20 participants with self-reported insomnia symptoms (Mage=26.90, SD=6.56). Each participant underwent one round of sham stimulation and one round of active cTBS in a randomized order with one week in between. Participants were monitored with polysomnography (PSG) during a 7-hour sleep window. We first examined the association between age and REM sleep at each visit. A repeated measures ANOVA was employed, incorporating age as a covariate to assess potential age-dependent effects on cTBS effects. Results REM duration was positively correlated with age for the active cTBS visits (r=0.506, p=0.023) but not for the sham (r=-0.059, p= .806). With age as a covariate, the ANOVA revealed a significant effect of TMS treatment on REM sleep duration, F(1,18)=7.507, p=0.013. Participants in the TMS treatment group experienced an increase in REM sleep duration compared to the sham group when age was controlled in the analysis. Conclusion Age significantly influenced the effect of cTBS on REM sleep outcomes. The finding that older individuals demonstrated a greater effect of stimulation on REM duration suggests potential implications for clinical application in individuals with insomnia. Future work may focus on refining therapeutic strategies for sleep modulation, advocating for a personalized and age-aware approach. Support (if any) US Army Medical Research Acquisition Activity Grant: W81XWH2010173
• Addison, C., Grandner, M. A., & Baron, K. G. (2023). Sleep medicine provider perceptions and attitudes regarding consumer sleep technology. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 19(8), 1457-1463.
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  This study assessed perceptions and attitudes of sleep medicine providers regarding consumer sleep technology (CST).
• Bhushan, B., Zee, P. C., Grandner, M. A., Jaser, S. S., Hazkani, I., Maddalozzo, J. P., Xu, S., Ahluwalia, V., Chandra, A., Schroeder, J. W., Sharma, M., Suittens, D. A., & Berg, C. A. (2023). Associations of deep sleep and obstructive sleep apnea with family relationships, life satisfaction and physical stress experience in children: a caregiver perspective. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Obstructive sleep apnea and poor quality of sleep negatively impacts health-related quality of life (HR-QoL) in adults, but few studies have evaluated the association between sleep disturbance (e.g., obstructive sleep apnea, inadequate sleep) and HR-QoL domains (e.g., family relations, life satisfaction) in children.
• Boeve, A., Boyle, J., Muench, A., Emert, S., Vargas, I., Thompson, M., Grandner, M., & Perlis, M. (2023). 0355 Insomnia Identity’s Association with Insomnia Problem Chronicity and Treatment History. SLEEP, 46(Supplement_1), A157-A158. doi:10.1093/sleep/zsad077.0355
• Boyle, J., Rosenfield, B., Di Tomasso, R., Moye, J., Bamonti, P., Grandner, M., Vargas, I., & Perlis, M. (2023). Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?. Behavioral Sleep Medicine, 21(4). doi:10.1080/15402002.2022.2124994
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  Objectives: Sleep continuity (i.e., ability to initiate and/or maintain sleep) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, a large archival dataset was used to examine age differences in sleep continuity, problem endorsement, and sleep related daytime dysfunction. Method: Participants were categorized as: Young Adults (18–29 years); Adults (30–44 years); Middle Aged Adults (45–64 years); and Older Adults (65–89 years). Young Adults, Adults, and Middle Aged Adults were 1:1 matched with Older Adults (n = 233) on the basis of gender, race, ethnicity, and BMI. MANOVA, ANOVAs, and chi-square analysis were performed to assess for age-related differences. Results: In a sample of 932 adults with self-reported sleep continuity disturbance (i.e., insomnia), sleep continuity was significantly worse in older age groups. This effect was limited to middle and late insomnia with middle aged and older adults waking up with greater frequency and for longer durations of time during the night and in the early morning than younger cohorts. Problem endorsement largely increased across age groups (except for sleep latency) but reports of overall sleep-related daytime dysfunction showed no difference by age. Conclusion: When evaluating sleep continuity disturbance, assessing whether the patient identifies their sleep continuity disturbance as a problem and whether it affects their daytime function can be informative, particularly in older adults. It may serve to reveal (case-by-case) when there are discordances between incidence/severity of illness and problem endorsement/daytime dysfunction. Such information may better inform if treatment should be initiated.
• Ghani, S. B., Granados, K., Wills, C. C., Alfonso-Miller, P., Buxton, O. M., Ruiz, J. M., Parthasarathy, S., Patel, S. R., Molina, P., Seixas, A., Jean-Louis, G., & Grandner, M. A. (2023). Association of Birthplace for Sleep Duration, Sleep Quality, and Sleep Disorder Symptoms, at the US–Mexico Border. Behavioral Sleep Medicine, 22(4), 1-17. doi:10.1080/15402002.2023.2279308
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  Objectives: The present study investigated the roles birthplace and acculturation play in sleep estimates among Hispanic/Latino population at the US–Mexico border. Measures: Data were collected in 2016, from N = 100 adults of Mexican descent from the city of Nogales, AZ, at the US–Mexico border. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index categorized as none, mild, moderate, and severe, and Multivariable Apnea Prediction Index (MAP) categorized as never, infrequently, and frequently. Acculturation was measured with the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II). Results: The sample consisted of majority Mexican-born (66%, vs. born in the USA 38.2%). Being born in the USA was associated with 55 fewer minutes of nighttime sleep (p =.011), and 1.65 greater PSQI score (p =.031). Compared to no symptoms, being born in the USA was associated with greater likelihood of severe difficulty falling asleep (OR = 8.3, p =.030) and severe difficulty staying asleep (OR = 11.2, p =.050), as well as decreased likelihood of breathing pauses during sleep (OR = 0.18, P =.020). These relationships remained significant after Mexican acculturation was entered in these models. However, greater Anglo acculturation appears to mediate one fewer hour of sleep per night, poorer sleep quality, and reporting of severe difficulty falling asleep and staying asleep. Conclusions: Among individuals of Mexican descent, being born in the USA (vs Mexico) is associated with about 1 hour less sleep per night, worse sleep quality, more insomnia symptoms, and less mild sleep apnea symptoms. These relationships are influenced by acculturation, primarily the degree of Anglo rather than the degree of Mexican acculturation.
• Glick, D. R., Abariga, S. A., Thomas, I., Shipper, A. G., Gunia, B. C., Grandner, M. A., Rosenberg, E., Hines, S. E., Capaldi, V., Collen, J., & Wickwire, E. M. (2023). Economic Impact of Insufficient and Disturbed Sleep in the Workplace. PharmacoEconomics, 41(7), 771-785.
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  Insufficient and disturbed sleep are associated with significant morbidity among working-age adults. Poor sleep results in negative health outcomes and increases economic costs to employers. The current systematic review surveyed the peer-reviewed scientific literature and aggregated scientific evidence of sleep-related economic burdens borne by employers.
• Gorovoy, S. B., Campbell, R. L., Fox, R. S., & Grandner, M. A. (2023). App-Supported Sleep Coaching: Implications for Sleep Duration and Sleep Quality. Frontiers in sleep, 2.
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  The present study evaluated whether completers of a 12-week app-based, personalized text supported sleep coaching program demonstrated improvements in sleep continuity, sleep duration, and reduced use of sleep aids.
• Gorovoy, S. B., Campbell, R. L., Fox, R. S., & Grandner, M. A. (2023). App-supported sleep coaching: implications for sleep duration and sleep quality. Frontiers in Sleep, 2. doi:10.3389/frsle.2023.1156844
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  Objectives: The present study evaluated whether completers of a 12-week app-based, personalized text supported sleep coaching program demonstrated improvements in sleep continuity, sleep duration, and reduced use of sleep aids. Methods: Data were obtained from Sleep Reset, a 12-week consumer product that offers app-based sleep education and monitoring, along with personalized text-based sleep coaching provided by live coaches. Five hundred sixty-four completers were included in the study. Pre-post changes for sleep latency (SL), wake after sleep onset (WASO), number of awakenings (NWAK), total sleep time (TST), sleep efficiency (SE%) and use of “sleep aids” were evaluated. To evaluate whether the program produced meaningful results, the proportion of participants who demonstrated reductions in SL, WASO, and NWAK, and increases in TST and SE% were examined. Results: Mean SL was reduced by 11 min, mean WASO was reduced by 28 min, mean SE% increased by 6.6%, and mean TST increased by about 44 min. Of those who reported using “sleep aids” during Week 1, 41% no longer used them by week 12. Those with low SE% at baseline demonstrated greater improvements in SL (16.2 vs. 5.7 min), WASO (47.3 vs. 7.2 min), SE% (11.2 vs. 1.6%), and TST (65.3 vs. 31.2 min). Those with ≤ 6 h of sleep at baseline demonstrated greater improvements in WASO (36.8 vs. 22.3 min), SE% (10.1 vs. 4.3%), and TST (85.1 vs. 25.5 min). Conclusion: Participants that completed the app-based, personalized text supported coaching intervention reported subjective improvements in sleep duration and quality that suggest more beneficial effects particularly in those with lower sleep efficiency or sleep duration at baseline. An effective sleep coaching program that utilizes trained sleep coaches with access to board-certified providers, may provide a valuable resource for subclinical populations.
• Gorovoy, S. B., Grandner, M. A., & Patterson, F. (2023). Abstract P466: Relationship Between Smoking and Sleep Duration Depends on Age. Circulation, 147(Suppl_1). doi:10.1161/circ.147.suppl_1.p466
• Gorovoy, S. B., Tubbs, A. S., & Grandner, M. A. (2023). Sleep disorders symptoms in children, adolescents, and emerging adults: Reducing mortality and population health burden through improved identification, referral, and treatment. Sleep health.
• Gorovoy, S., & Grandner, M. (2023). 0940 Reductions in Use of Sleep Aids Following an App-Based Sleep Coaching Platform. SLEEP, 46(Supplement_1), A414-A415. doi:10.1093/sleep/zsad077.0940
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  Abstract Introduction Use of sleep supplements and other sleep aids is increasing. Yet, many of these are not supported strategies for ameliorating sleep problems. Providing educational and behavioral strategies may reduce reliance on these substances. Methods Data were obtained from N=93 individuals who participated in the 12-week Sleep Reset program. The Sleep Reset program (Simple Habit, Inc.) includes ongoing text-based communication with coaches trained to support sleep behavior change, and a mobile app that includes a sleep diary, educational modules, mindfulness exercises, and progress tracking. Potential users are screened prior to entry and if they demonstrate a contraindicated medical or psychiatric problem, they were not admitted to the coaching program. If they demonstrate a likely sleep disorder (including insomnia disorder) they are referred for additional support. The coaching communications included information about basic sleep and circadian principles (e.g., sleep hygiene, behavioral scheduling, light exposure, relaxation) and techniques based on CBTI (e.g., stimulus control). Participants were asked if they used any “sleep aids” (which could include medications or melatonin/supplements) daily while in the program. Type of substance was not assessed. Data were binned by week, dichotomized as yes/no regarding any use in that week. Results Of the N=93 participants, N=46 (49%) indicated that they used “sleep aids” at least once in the first week. Among Sleep Reset participants who reported using sleep aids at least once in their first week in the program, use was reduced to N=13 (28.9%) by week 12. This difference was statistically significant (t(44)=10.4, p< 0.0005). Reductions from week 1 were already seen in week 2 (57.8%; t(44)=5.7, p< 0.0005). Another reduction was seen between weeks 3 and 4 (51.1% to 37.8%, t(44)=1.8, p=0.042), and a trend was seen between weeks 9 and 10 (35.6% to 26.7%, t(44)=1.7, p=0.052). Conclusion In an app-led sleep coaching program, those who used sleep aids in week 1 reduced use by 71.1% by the end of the 12-week period, with the largest reductions in the first week. Future controlled studies are needed to validate whether a sleep coaching program can reduce use of sleep aid such as supplements that may not be helpful. Support (if any)
• Gorovoy, S., Phan, S., Begay, T., Valencia, D., Hale, L., Robbins, R., Killgore, W., Williamson, A., & Grandner, M. (2023). Neighborhood-level sleep health and childhood opportunities. Frontiers in Public Health, 11. doi:10.3389/fpubh.2023.1307630
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  Objectives: Regional sleep differences may reflect other important indicators of health and well-being. Examining sleep health at the regional level can help inform policies to improve population health. We examined the relationship between neighborhood-level adult sleep health (modeled in this study via adult sleep duration) and other health metrics and multiple indicators of child-relevant opportunity. Methods: Data were obtained from the “500 Cities” data collected by the CDC, including the proportion of the adult population in each tract that report obtaining at least 7 h of sleep. The Child Opportunity Index (COI) provides indices for “education,” “health and environment,” and “social and economic” domains, as well as a global score. When data were merged, 27,130 census tracts were included. Linear regression analyses examined COI associated with the proportion of the adult population obtaining 7 h of sleep. Results: Adult sleep duration was associated with global COI, such that for each additional percent of the population that obtains ≥ 7 h of sleep, COI increases by 3.6 points (95%CI[3.57, 3.64]). Each component of COI was separately related to adult sleep duration. All associations were attenuated but significant in adjusted analyses. In stepwise analyses, sleep health via adult sleep duration emerged as the strongest correlate of global COI, accounting for 57.2% of the variance (p < 0.0001). Similarly, when stepwise analyses examined each component of COI as dependent variable, sleep health consistently emerged as the most substantial correlate (all p < 0.0001). Conclusion: Community levels of sufficient sleep are associated with greater childhood opportunities, which itself is robustly associated with a wide range of health and economic outcomes. Future work can examine whether this association can develop into scalable interventions.
• Grandner, M. A., Bromberg, Z., Hadley, A., Morrell, Z., Graf, A., Hutchison, S., & Freckleton, D. (2023). Performance of a multisensor smart ring to evaluate sleep: in-lab and home-based evaluation of generalized and personalized algorithms. Sleep, 46(1).
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  Wearable sleep technology has rapidly expanded across the consumer market due to advances in technology and increased interest in personalized sleep assessment to improve health and mental performance. We tested the performance of a novel device, the Happy Ring, alongside other commercial wearables (Actiwatch 2, Fitbit Charge 4, Whoop 3.0, Oura Ring V2), against in-lab polysomnography (PSG) and at-home electroencephalography (EEG)-derived sleep monitoring device, the Dreem 2 Headband.
• Grandner, M. A., Min, J. S., Saad, R., Leary, E. B., Eldemir, L., & Hyman, D. (2023). Health-related impact of illness associated with excessive daytime sleepiness in patients with obstructive sleep apnea. Postgraduate Medicine, 135(Issue 5). doi:10.1080/00325481.2023.2203623
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  Objectives: This real-world study aimed to characterize the impact of illness of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) who are adherent to continuous positive airway pressure (CPAP). Methods: This cross-sectional study surveyed participants in Evidation Health’s Achievement app (November 2020–January 2021), a mobile consumer platform that encourages users to develop healthy habits and provides incentives to participate in research. Participants were US-resident adults who self-reported a physician diagnosis of OSA and adherence to CPAP (≥4 hours/night, ≥5 nights/week) for≥6 months. The survey included the Functional Outcomes of Sleep Questionnaire-Short Version (FOSQ-10), Epworth Sleepiness Scale (ESS), and questions regarding comorbidities, CPAP use, caffeine consumption, and physical activity. EDS was defined as ESS score >10. There were more female than male participants; therefore, data were reported separately for females/males. Results: In total, 476 participants (female, n = 283 [59%]; mean [SD] age, 49.7 [10.8] years; obese, 74.4%) completed the survey; 209 had EDS (mean [SD] ESS, 13.8 [2.5]) and 267 did not (mean [SD] ESS, 6.3 [2.5]). Self-reported duration of CPAP use was consistent between the EDS/no EDS cohorts, with most participants using CPAP for 7 to 9 hours/night, 7 nights/week. Participants with EDS commonly reported anxiety ([EDS/no EDS] males: 31.5%/20.0%; females: 53.7%/39.5%), depression (males: 35.6%/24.2%; females: 55.9%/44.9%), and insomnia (males: 19.2%/6.7%; females: 25.7%/12.9%) and showed impairment on the FOSQ-10 ([EDS/no EDS] males: 80.8%/35.0%; females: 91.9%/53.1%). Participants with EDS reported that sleepiness ‘very often’ prevented physical activity and influenced dietary choices. Conclusion: EDS influences choices related to physical activity, caffeine consumption, and diet in patients who are adherent with CPAP. More research is needed to understand the association between EDS and choices of CPAP-adherent patients. Future research should explore the health-related consequences of residual EDS associated with OSA and whether they can be mitigated by improving EDS.
• Grandner, M. A., Min, J. S., Saad, R., Leary, E. B., Eldemir, L., & Hyman, D. (2023). Health-related impact of illness associated with excessive daytime sleepiness in patients with obstructive sleep apnea. Postgraduate medicine, 135(5), 501-510.
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  This real-world study aimed to characterize the impact of illness of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) who are adherent to continuous positive airway pressure (CPAP).
• Grandner, M., Olivieri, A., Ahuja, A., Büsser, A., Freidank, M., & McCall, W. V. (2023). The burden of untreated insomnia disorder in a sample of 1 million adults: a cohort study. BMC public health, 23(1), 1481.
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  Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data assessing the burden of insomnia disorder on daytime functioning and its association with comorbidities. The objective of this study was to leverage large-scale, real-world data to assess the burden of untreated insomnia disorder in terms of daytime impairment and clinical outcomes.
• Heller, H. C., Herzog, E., Brager, A., Poe, G., Allada, R., Scheer, F., Carskadon, M., de la Iglesia, H. O., Jang, R., Montero, A., Wright, K., Mouraine, P., Walker, M. P., Goel, N., Hogenesch, J., Van Gelder, R. N., Kriegsfeld, L., Mah, C., Colwell, C., , Zeitzer, J., et al. (2023). The Negative Effects of Travel on Student Athletes Through Sleep and Circadian Disruption. Journal of Biological Rhythms, 39(1), 5-19. doi:10.1177/07487304231207330
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  Collegiate athletes must satisfy the academic obligations common to all undergraduates, but they have the additional structural and social stressors of extensive practice time, competition schedules, and frequent travel away from their home campus. Clearly such stressors can have negative impacts on both their academic and athletic performances as well as on their health. These concerns are made more acute by recent proposals and decisions to reorganize major collegiate athletic conferences. These rearrangements will require more multi-day travel that interferes with the academic work and personal schedules of athletes. Of particular concern is additional east-west travel that results in circadian rhythm disruptions commonly called jet lag that contribute to the loss of amount as well as quality of sleep. Circadian misalignment and sleep deprivation and/or sleep disturbances have profound effects on physical and mental health and performance. We, as concerned scientists and physicians with relevant expertise, developed this white paper to raise awareness of these challenges to the wellbeing of our student-athletes and their co-travelers. We also offer practical steps to mitigate the negative consequences of collegiate travel schedules. We discuss the importance of bedtime protocols, the availability of early afternoon naps, and adherence to scheduled lighting exposure protocols before, during, and after travel, with support from wearables and apps. We call upon departments of athletics to engage with sleep and circadian experts to advise and help design tailored implementation of these mitigating practices that could contribute to the current and long-term health and wellbeing of their students and their staff members.
• Kennedy, K. E., & Grandner, M. A. (2023). Sleep, rhythms, and food intake: Mechanistic insights. Sleep medicine reviews, 69, 101791.
• Kennedy, K. E., Wills, C. C., Holt, C., & Grandner, M. A. (2023). A randomized, sham-controlled trial of a novel near-infrared phototherapy device on sleep and daytime function. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 19(9), 1669-1675.
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  Near-infrared light exhibits several therapeutic properties, but little is known about the benefits to sleep and daytime function. The purpose of this study was to investigate the effects of red and near-infrared exposure before bed on sleep and next-day function.
• Rasmussen, E. F., Barnard, S., Athey, A., Gorovoy, S., & Grandner, M. A. (2023). Adverse childhood experiences associated with sleep health in collegiate athletes. Sleep health.
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  The relationship between adverse childhood experiences and sleep disturbances in collegiate athletes was examined.
• Scott, H., Cheung, J. M., Muench, A., Ivers, H., Grandner, M. A., Morin, C. M., & Perlis, M. L. (2023). Baseline sleep characteristics are associated with gains in sleep duration after cognitive behavioral therapy for insomnia. Sleep medicine, 102, 199-204.
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  Cognitive behavioural therapy for insomnia (CBT-I) substantially reduces total wake time (TWT) by the end of treatment. In contrast, total sleep time (TST) does not increase above baseline levels for most patients following 4-8 sessions of treatment. In the 6-12 months following CBT-I, without any further intervention, up to 64% of participants substantially increase their TST (by ≥ 30 min). The current study investigated which baseline characteristics are associated with increases in TST after CBT-I.
• Taylor, D. J., Huskey, A., Kim, K. N., Emert, S. E., Wardle-Pinkston, S., Auerbach, A., Ruiz, J. M., Grandner, M. A., Webb, R., Skog, M., Milord, T., & , P. M. (2023). Internal consistency reliability of mental health questionnaires in college student athletes. British journal of sports medicine, 57(10), 595-601.
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  To examine the internal consistency reliability and measurement invariance of a questionnaire battery designed to identify college student athletes at risk for mental health symptoms and disorders.
• Tubbs, A. S., Taneja, K., Ghani, S. B., Nadorff, M. R., Drapeau, C. W., Karp, J. F., Fernandez, F. X., Perlis, M. L., & Grandner, M. A. (2023). Sleep continuity, timing, quality, and disorder are associated with suicidal ideation and suicide attempts among college students. Journal of American college health : J of ACH, 1-9.
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  To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Eight hundred eighty-five undergraduates aged 18-25 in the southwestern United States. Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. A total of 363 (40.1%) individuals reported lifetime suicidal ideation, of whom 172 (19.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.
• Tubbs, A., Hendershot, S., Ghani, S., Nadorff, M., Drapeau, C., Fernandez, F., Perlis, M., & Grandner, M. (2023). Social Jetlag and Other Aspects of Sleep Are Linked to Non-Suicidal Self-Injury Among College Students. Archives of Suicide Research, 27(2). doi:10.1080/13811118.2022.2057262
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  Introduction: Disrupted sleep is associated with non-suicidal self-injury (NSSI) in young adults, but many specific features of sleep continuity and timing have yet to be examined. Additionally, the psychological mechanisms linking sleep to NSSI are unclear. The present study evaluated 14 sleep variables as classifiers of lifetime or recent NSSI and examined potential confounding and mediating factors. Methods: A sample of 885 college students provided measures of sleep continuity (e.g., duration, timing, fragmentation), nightmares, insomnia, and perceived sleep control. Lifetime and past 3-month NSSI were measured using a self-report version of the Columbia Suicide Severity Ratings Scale. Bidirectional stepwise regression identified significant sleep classifiers and subsequent models examined their associations with NSSI after adjusting for covariates and through potential psychological mediators. Results: Only absolute social jetlag was associated with recent NSSI, even after adjusting for covariates, such that each additional hour difference between weekday and weekend sleep schedules was associated with a 17% greater risk of recent NSSI. Nightmares, weekend sleep efficiency, and perceived sleep control were associated with lifetime NSSI, although only weekend sleep efficiency remained associated after adjusting for covariates. Bootstrap mediations identified negative urgency as a partial mediator for recent and lifetime NSSI, and lack of premeditation and perceived burdensomeness as partial mediators for lifetime NSSI. Conclusions: The timing and consistency of young adults’ sleep schedules may be of greater importance to NSSI among college students than insomnia or insufficient sleep. Future studies of sleep and NSSI should include these measures as potential risk factors. HIGHLIGHTS Differences between weekday/weekend sleep timing are linked to recent NSSI. Negative urgency partially mediates poor sleep on recent and lifetime NSSI. Sleep shares a multifaceted relationship with NSSI risk in college students.
• Valencia, D. Y., Gorovoy, S., Tubbs, A., Jean-Louis, G., & Grandner, M. A. (2023). Sociocultural context of sleep health: modeling change over time. Sleep, 46(1).
• Vargas, I., Muench, A., Grandner, M. A., Irwin, M. R., & Perlis, M. L. (2023). Insomnia symptoms predict longer COVID-19 symptom duration. Sleep Medicine, 101(Issue). doi:10.1016/j.sleep.2022.11.019
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  Objective: /Background: The goal of the present study was to assess the prevalence and incidence of insomnia in the United States during the COVID-19 pandemic, and whether, among those that contracted COVID-19, insomnia predicted worse outcomes (e.g., symptoms of greater frequency, duration, or severity). Methods: A nationwide sample of 2980 adults living in the United States were surveyed online at two points during the COVID-19 pandemic (T1 = April–June 2020; T2 = January–March 2021). Insomnia symptoms were assessed at both time points using the Insomnia Severity Index (ISI). The T2 survey also asked questions regarding COVID-19 testing and symptoms. Results: The prevalence of insomnia (defined as ISI ≥15) was 15% at T1 and 13% at T2. The incidence rate of insomnia (i.e., new cases from T1 to T2) was 5.6%. Participants with insomnia were not more likely to contract COVID-19 relative to those participants without insomnia. Among those participants in our sample that contracted the virus during the study interval (n = 149), there were no significant group differences in COVID-19 symptom outcomes, with one exception, participants with insomnia were more likely to report a longer symptom duration (insomnia = 24.8 sick days, no insomnia = 16.1 sick days). Conclusions: The present study suggests the prevalence of insomnia in the U.S. population remained high during the COVID-19 pandemic. The data also support that insomnia may be related to experiencing more chronic COVID-19 symptoms. These findings have more general implications for the role of sleep and insomnia on immune functioning.
• Vargas, I., Muench, A., Grandner, M. A., Irwin, M. R., & Perlis, M. L. (2023). Insomnia symptoms predict longer COVID-19 symptom duration. Sleep medicine, 101, 365-372.
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  /Background: The goal of the present study was to assess the prevalence and incidence of insomnia in the United States during the COVID-19 pandemic, and whether, among those that contracted COVID-19, insomnia predicted worse outcomes (e.g., symptoms of greater frequency, duration, or severity).
• Wickwire, E. M., Collen, J., Capaldi, V. F., Williams, S. G., Assefa, S. Z., Adornetti, J. P., Huang, K., Venezia, J. M., Jones, R. L., Johnston, C. W., Thomas, C., Ann Thomas, M., Mounts, C., Drake, C. L., Businelle, M. S., Grandner, M. A., Manber, R., & Albrecht, J. S. (2023). Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations. JMIR Formative Research, 7(Issue 1). doi:10.2196/47356
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  Background: Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. Objective: The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. Methods: Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. Results: In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. Conclusions: Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.
• Wieman, S. T., Arditte Hall, K. A., Park, E. R., Gorman, M. J., Comander, A., Goldstein, M. R., Cunningham, T. J., Mizrach, H. R., Juhel, B., Li, R., Markowitz, A., Grandner, M., Liverant, G. I., & Hall, D. L. (2023). Treatment-related changes in insomnia, anticipatory pleasure, and depression symptoms: A proof-of-concept study with cancer survivors. Sleep medicine, 103, 29-32.
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  Cancer survivors have elevated rates of insomnia and depression. Insomnia increases risk for depression onset, and the Integrated Sleep and Reward (ISR) Model suggests that impairments in reward responding (e.g., ability to anticipate and/or experience pleasure) plays a central role in this relationship. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating chronic insomnia and reducing depression in cancer survivor populations. The effects of CBT-I on anticipatory and consummatory pleasure are theoretically and clinically meaningful, yet remain unexamined.
• Abdelwadoud, M., Collen, J., Edwards, H., Mullins, C. D., Jobe, S. L., Labra, C., Capaldi, V. F., Assefa, S. Z., Williams, S. G., Drake, C. L., Albrecht, J. S., Manber, R., Mahoney, A., Bevan, J., Grandner, M. A., & Wickwire, E. M. (2022). Engaging Stakeholders to Optimize Sleep Disorders' Management in the U.S. Military: A Qualitative Analysis. Military medicine, 187(7-8), e941-e947.
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  Sleep disorders' are highly prevalent among U.S. active duty service members (ADSMs) and present well-documented challenges to military health, safety, and performance. In addition to increased need for sleep medicine services, a major barrier to effective sleep management has been a lack of alignment among patients, health providers, and economic-decision-makers. To address this gap in knowledge, the purpose of the present study was to engage diverse stakeholders vested in improving sleep disorders' management in the military.
• Alfonso-Miller, P., Begay, T., Delgadillo, M., Ghani, S., Granados, K., Grandner, M., Klingman, K., Molina, P., Perlis, M., Valencia, D., & Wills, C. (2022). 0073 A Mexican Spanish Version of the Sleep Disorders Symptom Checklist. Sleep, 45(Supplement_1), A33-A34. doi:10.1093/sleep/zsac079.071
• Arora, T., Grey, I., Östlundh, L., Alamoodi, A., Omar, O. M., Hubert Lam, K. B., & Grandner, M. (2022). A systematic review and meta-analysis to assess the relationship between sleep duration/quality, mental toughness and resilience amongst healthy individuals. Sleep medicine reviews, 62, 101593.
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  The majority of sleep research has focused on deleterious health outcomes, with little attention to positive sequels. A systematic review of the literature regarding sleep duration and/or sleep quality in relation to mental toughness and resilience amongst non-clinical, healthy populations was completed. Eight databases and selected sources for grey literature were searched from their inception to April 2021. A total of 1925 unique records (1898 from the database search and 27 from grey sources) were identified and screened against the pre-set inclusion and exclusion criteria. Of these, 68 studies were eligible and 63 were included in the meta-analysis. Pooled results indicated a weak, positive correlation between sleep duration and resilience (r = 0.11, p 
• Boyle, J. T., Rosenfield, B., Di Tomasso, R. A., Moye, J., Bamonti, P. M., Grandner, M., Vargas, I., & Perlis, M. (2022). Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?. Behavioral sleep medicine, 1-12.
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  Sleep continuity (i.e., ability to initiate and/or maintain sleep) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, a large archival dataset was used to examine age differences in sleep continuity, problem endorsement, and sleep related daytime dysfunction.
• Boyle, J. T., Vargas, I., Rosenfield, B., Grandner, M. A., & Perlis, M. L. (2022). Insomnia Severity and Degree of Dysfunction: What Is to Be Learned When These Domains are Discordant?. Behavioral sleep medicine, 20(2), 164-172.
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  Illness severity and resultant dysfunction are often linearly related and tightly coupled (concordant). Some percentage of individuals, however, exhibit discordant associations (high illness severity and low dysfunction [HL] or low illness severity and high dysfunction [LH]). In the present study, a sample of subjects with insomnia complaints were evaluated to determine what percentage of subjects exhibited discordant associations.
• Bromberg, Z., Freckleton, D., Graf, A., Grandner, M. A., Hadley, A., Hutchison, S., & Morrell, Z. (2022). Performance of a multisensor smart ring to evaluate sleep: in-lab and home-based evaluation of generalized and personalized algorithms. Sleep, 46(1), A271-A271. doi:10.1093/sleep/zsac152
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  Abstract Study Objectives Wearable sleep technology has rapidly expanded across the consumer market due to advances in technology and increased interest in personalized sleep assessment to improve health and mental performance. We tested the performance of a novel device, the Happy Ring, alongside other commercial wearables (Actiwatch 2, Fitbit Charge 4, Whoop 3.0, Oura Ring V2), against in-lab polysomnography (PSG) and at-home electroencephalography (EEG)-derived sleep monitoring device, the Dreem 2 Headband. Methods Thirty-six healthy adults with no diagnosed sleep disorders and no recent use of medications or substances known to affect sleep patterns were assessed across 77 nights. Subjects participated in a single night of in-lab PSG and two nights of at-home data collection. The Happy Ring includes sensors for skin conductance, movement, heart rate, and skin temperature. The Happy Ring utilized two machine-learning derived scoring algorithms: a “generalized” algorithm that applied broadly to all users, and a “personalized” algorithm that adapted to individual subjects’ data. Epoch-by-epoch analyses compared the wearable devices to in-lab PSG and to at-home EEG Headband. Results Compared to in-lab PSG, the “generalized” and “personalized” algorithms demonstrated good sensitivity (94% and 93%, respectively) and specificity (70% and 83%, respectively). The Happy Personalized model demonstrated a lower bias and more narrow limits of agreement across Bland-Altman measures. Conclusion The Happy Ring performed well at home and in the lab, especially regarding sleep/wake detection. The personalized algorithm demonstrated improved detection accuracy over the generalized approach and other devices, suggesting that adaptable, dynamic algorithms can enhance sleep detection accuracy.
• Burke, S., Grudzien, A., Li, T., Abril, M., Spadola, C., Barnes, C., Hanson, K., Grandner, M., & DeKosky, S. (2022). Correlations between sleep disturbance and brain structures associated with neurodegeneration in the National Alzheimer's Coordinating Center Uniform Data Set. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 106, 204-212.
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  This study aimed to 1) determine the association between sleep disturbance and brain structure volumes, 2) the moderation effect of apolipoprotein ε4 genotype on sleep disturbance and brain structures, and 3) the moderation effect of sleep disturbance on cognitive status and regional brain volumes. Using the National Alzheimer's Coordinating Center Uniform Data Set (n = 1,533), multiple linear regressions were used to evaluate the association between sleep disturbance and brain volumes. Sleep disturbance was measured using one question from the NPI-Q. After controlling for intracranial volume, age, sex, years of education, race, ethnicity, and applying the FDR correction, total cerebrospinal fluid volume, left lateral ventricle volume, total lateral ventricle volume, and total third ventricle volume demonstrated significantly higher means for those with sleep disturbance. Total brain volume, total white and gray matter volume, total cerebrum brain volume (including gray but not white matter), left hippocampus volume, total hippocampal volume, the left, right, and total frontal lobe cortical gray matter volume, and the left, right, and total temporal lobe cortical gray matter volume demonstrated significantly lower mean volumes for those with sleep disturbance. Sleep disturbance moderated the association between cognitive status and lateral ventricular volumes. These findings suggest that disrupted sleep is associated with atrophy across multiple brain regions and ventricular hydrocephalus ex vacuo.
• Charest, J., & Grandner, M. A. (2022). Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health: An Update. Sleep medicine clinics, 17(2), 263-282.
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  Sleep health is an important consideration for athletic performance. Athletes are at high risk of insufficient sleep duration, poor sleep quality, daytime sleepiness and fatigue, suboptimal sleep schedules, irregular sleep schedules, and sleep and circadian disorders. These issues likely have an impact on athletic performance via several domains. Sleep loss and/or poor sleep quality can impair muscular strength, speed, and other aspects of physical performance. Sleep issues can also increase risk of concussions and other injuries and impair recovery after injury. Cognitive performance is also impacted in several domains, including vigilance, learning and memory, decision making, and creativity.
• Charest, J., Cook, J. D., Bender, A. M., Walch, O., Grandner, M. A., & Samuels, C. H. (2022). Associations between time zone changes, travel distance and performance: A retrospective analysis of 2013-2020 National Hockey League Data. Journal of science and medicine in sport, 25(12), 1008-1016.
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  Many studies have investigated the role that travel plays in athletic performance. However, these studies lacked a holistic representation of travel. For instance, they do not consider travel distance and uniquely focuses on travel direction.
• Collen, J., Capaldi, V. F., Williams, S. G., Labra, C., Assefa, S. Z., Abdelwadoud, M., Mullins, C. D., Manber, R., Mahoney, A., Bevan, J., Drake, C. L., Albrecht, J. S., Edwards, H., Grandner, M. A., & Wickwire, E. M. (2022). Moving Beyond "Leaning In"-It Is Time to Reach Out and Partner to Solve the Military Sleep Problem. Military medicine, 187(5-6), 158.
• Ghani, S. B., Delgadillo, M. E., Granados, K., Okuagu, A. C., Wills, C. C., Alfonso-Miller, P., Buxton, O. M., Patel, S. R., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Jean-Louis, G., & Grandner, M. A. (2022). Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border. Behavioral sleep medicine, 20(2), 212-223.
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  : Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration. Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status. Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint. Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.
• Ghani, S. B., Kapoor, A., Tubbs, A. S., Wills, C. C., Karp, J. F., Perlis, M. L., Killgore, W. D., Fernandez, F. X., & Grandner, M. A. (2022). Associations between Insomnia Symptoms and Anxiety Symptoms in Adults in a Community Sample of Southeastern Pennsylvania, USA. Diseases (Basel, Switzerland), 10(4).
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  Although insomnia is reliably associated with anxiety symptoms, aspects of insomnia may differentially relate to one anxiety symptom versus another. Therefore, treatment for insomnia comorbidity with anxiety might be individually tailored to optimize treatment response. Working from this hypothesis, we analyzed data from a survey of 1007 community-dwelling adults. Insomnia was measured using the Insomnia Severity Index (ISI), categorizing items as nighttime disturbances, daytime dysfunction, or self-perceived dissatisfaction. Anxiety symptoms were measured with the Generalized Anxiety Disorder 7-item questionnaire (GAD-7). Linear and binomial logistic regression were used and adjusted for covariates. Post hoc forward stepwise analyses determined which components of the insomnia contributed to individual anxiety symptoms. Significant associations between nighttime disturbance (β = 0.88 [0.44, 1.3]), daytime dysfunction (β = 1.30 [0.81, 1.80]), dissatisfaction (β = 1.20 [0.60, 1.7]) and total GAD-7 score were maintained after adjusting for covariates. Nighttime disturbance was associated with excess worrying, restlessness, irritability, and fear of catastrophe. Daytime dysfunction was associated with all symptoms except for fear of catastrophe, and self-perceived dissatisfaction was associated with all symptoms except irritability. Stepwise analyses revealed that daytime dysfunction and dissatisfaction were most consistently related to anxiety symptoms.Greater attention should be paid to daytime dysfunction in patients with insomnia and anxiety, as improving daytime functioning may improve anxiety.
• Grandner, M. A. (2022). Sleep, Health, and Society. Sleep medicine clinics, 17(2), 117-139.
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  Insufficient sleep and sleep disorders are highly prevalent in the population and are associated with significant morbidity and mortality. Adverse outcomes of insufficient sleep and/or sleep disorders are weight gain and obesity, cardiovascular disease, diabetes, accidents and injuries, stress, pain, neurocognitive dysfunction, psychiatric symptoms, and mortality. Exposure to sleep difficulties varies by age, sex, race/ethnicity, and socioeconomic status; significant sleep health disparities exist in the population. Societal influences, such as globalization, technology, and public policy, affect sleep at a population level.
• Grandner, M. A., Valencia, D. Y., Seixas, A. A., Oliviér, K., Gallagher, R. A., Killgore, W. D., Hale, L., Branas, C., & Alfonso-Miller, P. (2022). Development and Initial Validation of the Assessment of Sleep Environment (ASE): Describing and Quantifying the Impact of Subjective Environmental Factors on Sleep. International journal of environmental research and public health, 19(20).
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  The purpose of this study was to develop and test the reliability and validity of a 13-item self-report Assessment of Sleep Environment (ASE). This study investigates the relationship between subjective experiences of environmental factors (light, temperature, safety, noise, comfort, humidity, and smell) and sleep-related parameters (insomnia symptoms, sleep quality, daytime sleepiness, and control over sleep). The ASE was developed using an iterative process, including literature searches for item generation, qualitative feedback, and pilot testing. It was psychometrically assessed using data from the Sleep and Healthy Activity Diet Environment and Socialization (SHADES) study (N = 1007 individuals ages 22-60). Reliability was determined with an internal consistency and factor analysis. Validity was evaluated by comparing ASE to questionnaires of insomnia severity, sleep quality, daytime sleepiness, sleep control, perceived stress, and neighborhood disorder. The ASE demonstrated high internal consistency and likely reflects a single factor. ASE score was associated with insomnia symptoms (B = 0.09, < 0.0001), sleep quality (B = 0.07, < 0.0001), and sleep control (B = -0.01, < 0.0001), but not daytime sleepiness. The ASE was also associated with perceived stress (B = 0.20, < 0.0001) and neighborhood disorder (B = -0.01, < 0.0001). Among sleep environment factors, only smell was not associated with sleep quality; warmth and safety were negatively associated with sleepiness; and of the sleep environment factors, only light/dark, noise/quiet, and temperature (warm/cool) were not associated with insomnia symptoms. The ASE is a reliable and valid measure of sleep environment. Physical environment (light, temperature, safety, noise, comfort, humidity, and smell) was associated with insomnia symptoms and sleep quality but not sleepiness.
• Gupta, P., Martin, J. L., Malhotra, A., Bergstrom, J., Grandner, M. A., & Kamdar, B. B. (2022). Circadian rest-activity misalignment in critically ill medical intensive care unit patients. Journal of sleep research, 31(5), e13587.
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  Circadian alignment of rest-activity rhythms is an essential biological process that may be vulnerable to misalignment in critically ill patients. We evaluated circadian rest-activity rhythms in critically ill patients and their association with baseline (e.g. age) and clinical (e.g. mechanical ventilation status) variables, along with intensive care unit light-dark cycles. Using wrist actigraphy, we collected 48-hr activity and light exposure data from critically ill patients in a tertiary care medical intensive care unit. We evaluated circadian rest-activity rhythms using COSINOR and non-parametric circadian rhythm analysis models, and stratified these data across baseline and clinical variables. We used linear regression to evaluate the association of circadian rest-activity and light-dark exposure rhythms. In COSINOR and non-parametric circadian rhythm analysis analyses, the 34 medical intensive care unit patients completing 48-hr actigraphy recordings exhibited mean MESOR (mean activity levels of a fitted curve) and amplitudes of 0.50 ± 0.32 and 0.20 ± 0.19 movements per 30-s epoch, with high interdaily variability. Patients who were older, mechanically ventilated, sedated, restrained and with higher organ failure scores tended to exhibit greater circadian rest-activity misalignment, with three of 34 (9%) patients exhibiting no circadian rhythmicity. Circadian light-dark exposure misalignment was observed as well and was associated with rest-activity misalignment (p = 0.03). Critically ill patients in our MICU experienced profound circadian rest-activity misalignment, with mostly weak or absent rhythms, along with circadian light-dark exposure misalignment. Potentially modifiable factors contributing to rest-activity misalignment (i.e. mechanical ventilation, restraints, low daytime light levels) highlight possible targets for future improvement efforts.
• Hall, D. L., Arditte Hall, K. A., Gorman, M. J., Comander, A., Goldstein, M. R., Cunningham, T. J., Wieman, S., Mizrach, H. R., Juhel, B. C., Li, R., Markowitz, A., Grandner, M., & Park, E. R. (2022). The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors. Cancer, 128(7), 1532-1544.
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  For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorship-specific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]).
• Hughes, A. J., Gunn, H., Siengsukon, C., Stearns, M. A., James, E., Donley, T., Grandner, M. A., Thomas, S. J., Hansen, K., & Williams, N. J. (2022). Eliminating Sleep Health Disparities and Achieving Health Equity: Seven Areas for Action in the Behavioral Sleep Medicine Community. Behavioral sleep medicine, 1-13.
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  Racial and ethnically minoritized and under-resourced populations do not reap the same benefits of sufficient sleep as their white counterparts resulting in insufficient sleep and sleep health disparities. Research exploring these disparities have documented a plethora of factors including social determinants of health, community violence, and structural issues - all of which are associated with adverse sleep. There are robust evidence base behavioral intervention that can be leveraged to improve sleep health among racial and ethnic groups. However, EBIs are not well leveraged. In 2021, with participation from members of the society of behavioral sleep medicine, we conducted this report to bring together the field of behavioral sleep medicine including researchers, clinicians and trainees to discuss gaps and opportunities at the intersection of the COVID-19 pandemic, systemic racism, and sleep health. The goals were anchored around seven recommendations toward reducing disparities in the near-term and longer-term approaches to eliminating disparities. Furthermore, we acknowledge that reducing and eliminating disparities in sleep health requires a multifaceted approach that includes a focus on individual, community, health care and societal levels of influence with participation from diverse partners including federal, state and local.
• Jean-Louis, G., Grandner, M. A., & Seixas, A. A. (2022). Social determinants and health disparities affecting sleep. The Lancet Neurology, 21(Issue 10). doi:10.1016/s1474-4422(22)00347-7
• Jean-Louis, G., Grandner, M. A., & Seixas, A. A. (2022). Social determinants and health disparities affecting sleep. The Lancet. Neurology, 21(10), 864-865.
• Kennedy, K. E., & Grandner, M. A. (2022). Long Sleep: Is There Such Thing as Too Much of a Good Thing?. Current Sleep Medicine Reports, 8(Issue 3). doi:10.1007/s40675-022-00224-7
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  There exists a U-shaped relationship between sleep length and mortality, with short (9h) sleep both associated with poor health. However, given that the propensity for sleep and the circadian drive for wakefulness bookend a sleep period even when further opportunity presents itself, it remains unclear whether long sleepers are indeed sleeping longer than an average sleep duration, or simply spending longer in bed. Given that self-reported long sleepers are more likely to have poor physical or mental health, preexisting health conditions may predispose these individuals to excess time in bed that is not necessarily a longer-than-average sleep duration. Depression, chronic pain, and frailty could all be likely contributors. There may be a genetic basis for long sleep, or impairments in the neural circuitry in some individuals, as well as sex differences. However, while long sleep is generally associated with elevated cardiovascular disease risk and worse mental health, some studies—particularly among older adults and cancer survivors—have suggested benefits to a longer sleep duration. More studies that incorporate objective as well as self-reported measures of sleep duration are needed.
• Kennedy, K. E., Bastien, C. H., Ruby, P. M., Killgore, W. D., Wills, C. C., & Grandner, M. A. (2022). Nightmare content during the COVID-19 pandemic: Influence of COVID-related stress and sleep disruption in the United States. Journal of sleep research, 31(1), e13439.
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  Nightmares are often associated with psychiatric disorders and acute stress. This study explores how the COVID-19 pandemic may have influenced the content of nightmares. A sample of N = 419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked about the degree to which they agreed with statements linking greater general stress, worse overall sleep and more middle-of-the-night insomnia with the COVID-19 pandemic. They were also asked if, during the pandemic, they experienced nightmares related to various themes. Logistic regression analyses examined each nightmare content as outcome and increased stress, worse sleep and more middle-of-the-night insomnia as predictors, adjusted for age, sex and race/ethnicity. Those who reported greater general COVID-related stress were more likely to have nightmares about confinement, failure, helplessness, anxiety, war, separation, totalitarianism, sickness, death, COVID and an apocalypse. Those who reported worsened sleep were more likely to have nightmares about confinement, oppression, failure, helplessness, disaster, anxiety, evil forces, war, domestic abuse, separation, totalitarianism, sickness, death, COVID and an apocalypse. Those who reported worsened middle-of-the-night insomnia were more likely to have nightmares about confinement, oppression, failure, helplessness, disaster, anxiety, war, domestic abuse, separation, totalitarianism, sickness, death, COVID and an apocalypse. These results suggest that increased pandemic-related stress may induce negatively-toned dreams of specific themes. Future investigation might determine whether (and when) this symptom indicates an emotion regulation mechanism at play, or the failure of such a mechanism.
• Kennedy, K. E., Onyeonwu, C., Nowakowski, S., Hale, L., Branas, C. C., Killgore, W. D., Wills, C. C., & Grandner, M. A. (2022). Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample. Journal of Sleep Research, 31(Issue 1). doi:10.1111/jsr.13434
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  Female menstrual health and its relationship with sleep is an understudied subject. The aim of this investigation was to determine the association between the two in a community sample. Data were obtained from n = 579 menstruating females who participated in the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study, a community-based sample of adults aged 22–60 years. Participants were asked, “How regular is your period?”, with response choices of “very regular”, “mostly regular”, “fairly regular” and “not regular”. They were also asked, “How much bleeding do you usually experience during your period?” Response choices were: “very heavy”, “heavy”, “medium”, “light” or “very light”. These were evaluated as ordinal outcomes. Sleep-related predictors included sleep duration (in hr; ≤ 6 [short], 7–9 [normal] and ≥ 9 [long]), Insomnia Severity Index score, Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score and Fatigue Severity Scale score. Covariates included age, education, income, race/ethnicity and body mass index. Short sleep duration was associated with heavier bleeding (odds ratio = 1.46, p = 0.026) and greater cycle irregularity (odds ratio = 1.44, p = 0.031) as compared with normal sleep. Higher Pittsburgh Sleep Quality Index score was associated with greater cycle irregularity (odds ratio = 1.05, p = 0.022). Higher Fatigue Severity Scale score was associated with heavier bleeding (odds ratio = 1.02, p = 0.003) and greater cycle irregularity (odds ratio = 1.02, p = 0.008). Long sleep, Insomnia Severity Index and Epworth Sleepiness Scale were not associated with either outcome. These results demonstrate an association between short sleep duration, poor sleep quality, fatigue, stress and depression with heavier bleeding and menstrual cycle irregularity, highlighting the need for further studies to improve treatment options.
• Kennedy, K. E., Onyeonwu, C., Nowakowski, S., Hale, L., Branas, C. C., Killgore, W. D., Wills, C. C., & Grandner, M. A. (2022). Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample. Journal of sleep research, 31(1), e13434.
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  Female menstrual health and its relationship with sleep is an understudied subject. The aim of this investigation was to determine the association between the two in a community sample. Data were obtained from n = 579 menstruating females who participated in the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study, a community-based sample of adults aged 22-60 years. Participants were asked, "How regular is your period?", with response choices of "very regular", "mostly regular", "fairly regular" and "not regular". They were also asked, "How much bleeding do you usually experience during your period?" Response choices were: "very heavy", "heavy", "medium", "light" or "very light". These were evaluated as ordinal outcomes. Sleep-related predictors included sleep duration (in hr; ≤ 6 [short], 7-9 [normal] and ≥ 9 [long]), Insomnia Severity Index score, Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score and Fatigue Severity Scale score. Covariates included age, education, income, race/ethnicity and body mass index. Short sleep duration was associated with heavier bleeding (odds ratio = 1.46, p = 0.026) and greater cycle irregularity (odds ratio = 1.44, p = 0.031) as compared with normal sleep. Higher Pittsburgh Sleep Quality Index score was associated with greater cycle irregularity (odds ratio = 1.05, p = 0.022). Higher Fatigue Severity Scale score was associated with heavier bleeding (odds ratio = 1.02, p = 0.003) and greater cycle irregularity (odds ratio = 1.02, p = 0.008). Long sleep, Insomnia Severity Index and Epworth Sleepiness Scale were not associated with either outcome. These results demonstrate an association between short sleep duration, poor sleep quality, fatigue, stress and depression with heavier bleeding and menstrual cycle irregularity, highlighting the need for further studies to improve treatment options.
• Killgore, W. D., Alkozei, A., Vanuk, J. R., Reign, D., Grandner, M. A., & Dailey, N. S. (2022). Blue light exposure increases functional connectivity between dorsolateral prefrontal cortex and multiple cortical regions. Neuroreport, 33(5), 236-241.
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  Blue light is a powerful environmental stimulus that can produce significant phase shifts in the circadian rhythm of melatonin and sleep propensity as well as acute effects on alertness of neurobehavioral performance. Here, we undertook an expansion and reanalysis of our previously published findings to examine the effect of acute blue light exposure on the strength of resting-state functional connectivity (rsFC) between a previously identified region of the left dorsolateral prefrontal cortex (DLPFC) and 106 cortical and subcortical regions.
• Killgore, W. D., Grandner, M. A., Tubbs, A. S., Fernandez, F. X., Doty, T. J., Capaldi Ii, V. F., & Dailey, N. S. (2022). Sleep loss suicidal ideation: the role of trait extraversion. Frontiers in behavioral neuroscience, 16, 886836.
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  It is known that sleep disturbance is associated with increased suicidal thinking. Moreover, completed suicides, when adjusted for the proportion of the populace that is awake at a given time, are more probable during the late night/early morning hours. Despite these concerns, no studies have examined the role of trait-like individual differences in vulnerability to suicidal ideation during sleep deprivation or insomnia. In two separate studies, we examined whether the trait of extraversion is predictive of changes in suicidal thinking following two nights of sleep deprivation and among individuals meeting the criteria for insomnia. Study 1: Twenty-five healthy military personnel (20 males), ages 20-35 completed the NEO-PI-R Extraversion scale and the Suicidal Ideation (SUI) scale of the Personality Assessment Inventory (PAI). Participants completed 77 h of continuous sleep deprivation. After 56 h of sleep deprivation, participants completed the SUI scale a second time. We predicted a change in SUI scores from baseline extraversion. Study 2: 2,061 adults aged 18-79 (900 males) were divided into two groups based on the clinical threshold (≥ 10) on the Insomnia Severity Index (ISI) and completed measures of extraversion and depression, including the suicide item of the Patient Health Questionnaire-9 (PHQ9). Study 1: After controlling for the caffeine group and changes in PAI Depression, Extraversion scores were used to predict changes in SUI scores using stepwise multiple linear regression. Higher Extraversion was significantly associated with increased non-clinical suicidal ideation following sleep loss, β = 0.463, partial = 0.512, = 0.013. Study 2: After controlling for depression, the effect of insomnia on suicidal ideation was moderated by trait extraversion ( < 0.0001). Overall, the presence or absence of insomnia had little effect on individuals low in trait extraversion (i.e., introverts), but insomnia was associated with significantly higher suicidal ideation among high trait extraverted individuals. Higher trait extraversion was associated with increased vulnerability to suicidal ideation between rested baseline and total sleep deprivation and was associated with greater suicidal ideation among those meeting criteria for clinically severe insomnia. These findings point to a potential trait-like vulnerability factor that may further our understanding of sleep disruption in the phenomenology of suicide.
• Killgore, W. D., Vanuk, J. R., Persich, M. R., Cloonan, S. A., Grandner, M. A., & Dailey, N. S. (2022). Sleep quality and duration are associated with greater trait emotional intelligence. Sleep health, 8(2), 230-233.
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  Prior work suggests that short sleep and total sleep deprivation are associated with reduced trait Emotional Intelligence (trait EI) but not reduced ability Emotional Intelligence (ability EI). To expand this knowledge base, we investigated the role of habitual sleep quality on trait and ability EI above and beyond the known effects of recent sleep duration.
• Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A., Black, T., Brewer, L. C., Foraker, R. E., Grandner, M. A., Lavretsky, H., Perak, A. M., Sharma, G., Rosamond, W., & , A. H. (2022). Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation, 146(5), e18-e43.
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  In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
• Lloyd-Jones, D. M., Ning, H., Labarthe, D., Brewer, L., Sharma, G., Rosamond, W., Foraker, R. E., Black, T., Grandner, M. A., Allen, N. B., Anderson, C., Lavretsky, H., & Perak, A. M. (2022). Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018. Circulation, 146(11), 822-835.
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  The American Heart Association recently published an updated algorithm for quantifying cardiovascular health (CVH)-the Life's Essential 8 score. We quantified US levels of CVH using the new score.
• Mansfield, D. R., Wasgewatta, S., Reynolds, A., Grandner, M. A., Tubbs, A. S., King, K., Johnson, M., Mascaro, L., Durukan, M., Paul, E., Drummond, S. P., & Perlis, M. L. (2022). Nocturnal Wakefulness and Suicide Risk in the Australian Population. The Journal of clinical psychiatry, 83(4).
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  Temporal patterns for suicide over a 24-hour period have shown mixed results among prior studies. However, analyses of 24-hour temporal patterns for wakeful actions including suicidal behavior should adjust for expected sleep requirements that inherently skew such activities to conventional wakeful times. This study analyzed the time-of-day for suicide cases from the Australian population for the year 2017, adjusting for expected sleep patterns. Identification of time-of-day trends using this methodology may reveal risk factors for suicide and potentially modifiable contributors. The Australian National Coronial Information System database was accessed, and data for completed suicide were extracted for the most recent completed year (2017). Time of suicide was allocated to one of four 6-hourly time bins across 24 hours, determined from time last seen alive and time found subsequently. Prevalence of suicide for each time bin was adjusted for the likelihood of being awake for each bin according to sleep-wake norms published from a large Australian community survey. Observed prevalence of suicide was compared to expected values predicted from likelihood of being awake across each time bin calculated as a standardized incidence ratio (SIR). For the year 2017, there were 2,808 suicides, of which 1,417 were able to be allocated into one of four 6-hourly time bins. When compared to expected values, suicides were significantly more likely to occur in the overnight bin (2301-0500; SIR = 3.93,  
• Martinez, S. M., Chodur, G. M., Esaryk, E. E., Kaladijian, S., Ritchie, L. D., & Grandner, M. (2022). Campus Food Pantry Use Is Linked to Better Health Among Public University Students. Journal of nutrition education and behavior, 54(6), 491-498.
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  To examine retrospectively whether access to a campus food pantry (CFP) is related to improvements in sleep, mental health, and physical health among college students in a public university system.
• Marupuru, S., Bell, M. L., Grandner, M. A., & Taylor-Piliae, R. E. (2022). The Effect of Physical Activity on Sleep Quality among Older Stroke Survivors: Secondary Analysis from a Randomized Controlled Trial. International journal of environmental research and public health, 19(20).
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  Poor sleep quality constitutes one of the most common difficulties faced by stroke survivors. Physical activity has been shown to improve sleep quality among healthy adults. The study objective was to examine the effect of physical activity on sleep outcomes in community-dwelling stroke survivors previously enrolled in a randomized clinical trial (RCT). Secondary analysis of data collected in the RCT was used to examine the effects of physical activity (PA) on sleep outcomes using the Pittsburgh Sleep Quality Index (PSQI), compared to usual care (controls). Unadjusted and adjusted mixed effects models were used to model changes in sleep quality between groups. At baseline, poor sleep quality (PSQI > 5) was reported by about half of the participants (PA group = 48.5%, n = 47/97; controls = 56.3%, n = 27/48). Results from the unadjusted and adjusted models for sleep quality were similar and showed no statistically significant differences between groups ( > 0.05). In the unadjusted model, the difference between groups (change from baseline to 24 weeks) showed that the PA group had better sleep quality than the controls (difference= -1.02 points, 95% CI -2.12, 0.07, = 0.07). In the model adjusted for age, social support, and marital status, the difference between groups (change from baseline to 24 weeks) showed that the PA group had better sleep quality than the controls (difference= -1.07 points, 95% CI -2.19, 0.05, = 0.06). PA did not significantly improve sleep quality in older community-dwelling stroke survivors. Further research is needed to confirm or refute these findings.
• Mason, B. J., Tubbs, A. S., Fernandez, F. X., & Grandner, M. A. (2022). Spectrophotometric properties of commercially available blue blockers across multiple lighting conditions. Chronobiology international, 39(5), 653-664.
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  Lenses that filter short-wavelength ("blue") light are commercially marketed to improve sleep and circadian health. Despite their widespread use, minimal data are available regarding their comparative efficacy in curtailing blue light exposure while maintaining visibility. Fifty commercial lenses were evaluated using five light sources: a blue LED array, a computer tablet display, an incandescent lamp, a fluorescent overhead luminaire, and sunlight. Absolute irradiance was measured at baseline and for each lens across the visual spectrum (380-780 nm), which allowed calculation of percent transmission. Transmission specificity was also calculated to determine whether light transmission was predominantly circadian-proficient (455-560 nm) or non-proficient (380-454 nm and 561-780 nm). Lenses were grouped by tint and metrics were compared between groups. Red-tinted lenses exhibited the lowest transmission of circadian-proficient light, while reflective blue lenses had the highest transmission. Orange-tinted lenses transmitted similar circadian-proficient light as red-tinted lenses but transmitted more non-circadian-proficient light, resulting in higher transmission specificity. Orange-tinted lenses had the highest transmission specificity while limiting biologically active light exposure in ordinary lighting conditions. Glasses incorporating these lenses currently have the greatest potential to support circadian sleep-wake rhythms.
• Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D., Bastien, C. H., Drummond, S. P., & Perlis, M. L. (2022). We know CBT-I works, now what?. Faculty reviews, 11, 4.
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  Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be efficacious and now is considered the first-line treatment for insomnia for both uncomplicated insomnia and insomnia that occurs comorbidly with other chronic disorders (comorbid insomnia). The purposes of this review are to provide a comprehensive summary of the efficacy data (for example, efficacy overall and by clinical and demographic considerations and by CBT-I formulation) and to discuss the future of CBT-I (for example, what next steps should be taken in terms of research, dissemination, implementation, and practice).
• Robbins, R., Beebe, D. W., Byars, K. C., Grandner, M., Hale, L., Tapia, I. E., Wolfson, A. R., & Owens, J. A. (2022). Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being. Sleep Health, 8(Issue 6). doi:10.1016/j.sleh.2022.08.001
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  Objective: Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents. Method: We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth. Results: Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) “Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time,” reported by 74% of parents/caregivers; (2) “If school starts later, adolescents will stay up that much later,” reported by 69% of parents/caregivers; and (3) “Melatonin supplements are safe for adolescents because they are natural,” reported by 66% of parents/caregivers. Conclusion: Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.
• Robbins, R., Beebe, D. W., Byars, K. C., Grandner, M., Hale, L., Tapia, I. E., Wolfson, A. R., & Owens, J. A. (2022). Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being. Sleep health, 8(6), 632-639.
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  Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents.
• Scott, H., Cheung, J. M., Muench, A., Ivers, H., Grandner, M. A., Lack, L., Morin, C. M., & Perlis, M. (2022). Does total sleep time substantially increase after cognitive behavioral therapy for insomnia?. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(7), 1823-1829.
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  In most standardized approaches to cognitive behavioral therapy for insomnia, it is commonly the case that total wake time is reduced substantially during sleep restriction, but self-reported total sleep time (TST) is minimally affected. By follow-up, however, TST increases by almost 1 hour on average. A secondary analysis was undertaken to assess what percentage of participants meet or appreciably exceed baseline TST after cognitive behavioral therapy for insomnia.
• Tubbs, A. S., Fernandez, F. X., Grandner, M. A., & Perlis, M. L. (2022). Emerging evidence for sleep instability as a risk mechanism for nonsuicidal self-injury. Sleep, 45(6).
• Tubbs, A. S., Fernandez, F. X., Grandner, M. A., Perlis, M. L., & Klerman, E. B. (2022). The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology. Frontiers in network physiology, 1.
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  Sufficient sleep with minimal interruption during the circadian/biological night supports daytime cognition and emotional regulation. Conversely, disrupted sleep involving significant nocturnal wakefulness leads to cognitive and behavioral dysregulation. Most studies to-date have examined how fragmented or insufficient sleep affects next-day functioning, but recent work highlights changes in cognition and behavior that occur when someone is awake during the night. This review summarizes the evidence for day-night alterations in maladaptive behaviors, including suicide, violent crime, and substance use, and examines how mood, reward processing, and executive function differ during nocturnal wakefulness. Based on this evidence, we propose the hypothesis in which attentional biases, negative affect, altered reward processing, and prefrontal disinhibition interact to promote behavioral dysregulation and psychiatric disorders.
• Tubbs, A. S., Ghani, S. B., Naps, M., Grandner, M. A., Stein, M. D., & Chakravorty, S. (2022). Past-year use or misuse of an opioid is associated with use of a sedative-hypnotic medication: a US National Survey on Drug Use and Health (NSDUH) study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(3), 809-816.
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  Prescription use and misuse of opioids are linked to greater sleep disturbance. However, there are limited data on the prevalence of sedative-hypnotic medication use among persons who use opioids. Therefore, this study examined whether past-year sedative-hypnotic use among persons who used/misused opioids was higher than among individuals who did not use opioids.
• Tubbs, A. S., Ghani, S. B., Valencia, D., Jean-Louis, G., Killgore, W. D., Fernandez, F. X., & Grandner, M. A. (2022). Racial/ethnic minorities have greater declines in sleep duration with higher risk of cardiometabolic disease: An analysis of the U.S. National Health Interview Survey. Sleep Epidemiology, 2. doi:10.1016/j.sleepe.2022.100022
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  Objective: Habitual insufficient sleep may contribute to cardiometabolic disease in the United States, particularly among racial and ethnic minorities. However, there is mixed evidence on secular trends in U.S. sleep duration. Study design: Cross-sectional data from 413,417 individuals were acquired from the National Health Interview Survey from 2005–2018. Variables included self-reported sleep duration as well as lifetime diagnosis of hypertension, coronary heart disease, diabetes, and pre-diabetes, and obesity. Population-weighted robust Poisson models estimated annual trends in sleep duration and the prevalence risk ratios (PRR) of cardiometabolic disease as a function of sleep duration. Setting: Population-based survey. Results: Daily sleep duration decreased -0.62 min ([-0.71, 0.54], p < 0.01) annually from 2005–2018. However, this decline began only after 2010, when sleep duration fell by 1.04 min ([-1.21, -0.86], p < 0.01) each year. This trend varied by race (two-way ANOVA, p = 0.02), such that Mexican Hispanic individuals saw a greater decline (-1.83 [-2.37, -1.30] min per year, p < 0.01) than whites (-0.83 [-1.02, -0.64] min per year, p < 0.01). Additionally, a 1-h loss in daily sleep duration was linked to 4% greater prevalence of hypertension (PRR: 1.04, [1.04, 1.05]), 3% greater prevalence of diabetes (PRR: 1.03 [1.01, 1.05]), and 8% greater prevalence of obesity (PRR: 1.08 [1.07, 1.09]) after adjusting for age, sex, employment, marital status, and survey year. Conclusions: There is a secular decline in U.S. daily sleep duration that is greater among Mexican Hispanic individuals. Moreover, reduced sleep duration is associated with more prevalent cardiometabolic disease.
• Tubbs, A. S., Hendershot, S., Ghani, S. B., Nadorff, M. R., Drapeau, C. W., Fernandez, F. X., Perlis, M. L., & Grandner, M. A. (2022). Social Jetlag and Other Aspects of Sleep Are Linked to Non-Suicidal Self-Injury Among College Students. Archives of suicide research : official journal of the International Academy for Suicide Research, 1-18.
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  Disrupted sleep is associated with non-suicidal self-injury (NSSI) in young adults, but many specific features of sleep continuity and timing have yet to be examined. Additionally, the psychological mechanisms linking sleep to NSSI are unclear. The present study evaluated 14 sleep variables as classifiers of lifetime or recent NSSI and examined potential confounding and mediating factors.
• Tubbs, A. S., Killgore, W. D., Karp, J. F., Fernandez, F. X., & Grandner, M. A. (2022). Insomnia and the Interpersonal Theory of suicide among civilians, service members, and veterans. Journal of psychiatric research, 155, 534-541.
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  Insomnia is associated with suicide risk in civilian and military populations. Thwarted belongingness is proposed as a mediator of this relationship under the Interpersonal Theory of Suicide (IPTS). The present study explored how insomnia relates to suicidal ideation in conjunction with thwarted belongingness among civilians, Service members, and Veterans.
• Wickwire, E. M., Abdelwadoud, M., Collen, J., Edwards, H., Labra, C., Capaldi, V. F., Williams, S. G., Manber, R., Assefa, S. Z., Drake, C. L., Albrecht, J. S., Bevan, J., Mahoney, A., Tatum, E. D., Pierre, E., Mantua, J., Grandner, M. A., & Mullins, C. D. (2022). Active Duty Service Members, Primary Managers, and Administrators' Perspectives on a Novel Sleep Telehealth Management Platform in the U.S. Military Healthcare System. Military medicine, 187(9-10), e1201-e1208.
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  Sleep disorders are common in the military, and there is a gross shortage of sleep specialists in the military health system. The purposes of the present study were to (1) understand perceptions and expectations surrounding sleep telehealth approaches and (2) solicit feedback to optimize and refine a proposed novel sleep telehealth management platform. To accomplish these objectives, we investigated the perceptions, expectations, and preferences of active duty service members (ADSMs) with sleep disorders, primary care managers (PCMs), and administrative stakeholders regarding sleep telehealth management.
• Xu, S., Turakhia, S., Miller, M., Johnston, D., Maddalozzo, J., Thompson, D., Trosman, I., Grandner, M., Sheldon, S. H., Ahluwalia, V., & Bhushan, B. (2022). Association of obstructive sleep apnea and total sleep time with health-related quality of life in children undergoing a routine polysomnography: a PROMIS approach. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 18(3), 801-808.
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  Obstructive sleep apnea (OSA) negatively impacts health-related quality of life (HR-QoL) in adults, but few pediatric studies have explored this relationship or the relationships between HR-QoL domains.
• de Zambotti, M., Menghini, L., Grandner, M. A., Redline, S., Zhang, Y., Wallace, M. L., & Buxton, O. M. (2022). Rigorous performance evaluation (previously, "validation") for informed use of new technologies for sleep health measurement. Sleep health, 8(3), 263-269.
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  New sleep technologies have become pervasive in the consumer space, and are becoming highly common in research and clinical sleep settings. The rapid, widespread use of largely unregulated and unstandardized technology has enabled the quantification of many different facets of sleep health, driving scientific discovery. As sleep scientists, it is our responsibility to inform principles and practices for proper evaluation of any new technology used in the clinical and research settings, and by consumers. A current lack of standardized methods for evaluating technology performance challenges the rigor of our scientific methods for accurate representation of the sleep health facets of interest. This special article describes the rationale and priorities of an interdisciplinary effort for rigorous, standardized, and rapid performance evaluation (previously, "validation") of new sleep and sleep disorders related technologies of all kinds (eg, devices or algorithms), including an associated article template for a new initiative for publication in Sleep Health of empirical studies systematically evaluating the performance of new sleep technologies. A structured article type should streamline manuscript development and enable more rapid writing, review, and publication. The goal is to promote rapid and rigorous evaluation and dissemination of new sleep technology, to enhance sleep research integrity, and to standardize terminology used in Rigorous Performance Evaluation papers to prevent misinterpretation while facilitating comparisons across technologies.
• Abdelwadoud, M., Albrecht, J. S., Assefa, S. Z., Bevan, J., Capaldi, V. F., Collen, J., Drake, C. L., Edwards, H., Grandner, M. A., Jobe, S. L., Labra, C., Mahoney, A., Manber, R., Mullins, C. D., Wickwire, E. M., & Williams, S. G. (2021). Engaging Stakeholders to Optimize Sleep Disorders' Management in the U.S. Military: A Qualitative Analysis.. Military medicine, 187(7-8), e941-e947. doi:10.1093/milmed/usab341
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  Sleep disorders' are highly prevalent among U.S. active duty service members (ADSMs) and present well-documented challenges to military health, safety, and performance. In addition to increased need for sleep medicine services, a major barrier to effective sleep management has been a lack of alignment among patients, health providers, and economic-decision-makers. To address this gap in knowledge, the purpose of the present study was to engage diverse stakeholders vested in improving sleep disorders' management in the military..We elicited feedback from ADSMs with sleep disorders (five focus group discussion, n = 26) and primary care managers (PCMs) (11 individual semi-structured interview) in two military treatment facilities (MTFs) in the National Capitol Region, in addition to national level military and civilian administrative stakeholders (11 individual semi-structured interview) about their experiences with sleep disorders' management in U.S. MTFs, including facilitators and barriers for reaching a definitive sleep diagnosis, convenience and effectiveness of sleep treatments, and key desired outcomes from interventions designed to address effectively sleep disorders in the U.S. military health care system (MHS). Recordings from focus groups and semi-structured interviews were transcribed verbatim and analyzed using QSR International's NVivo 12 software using inductive thematic analysis. The study was approved by Walter Reed National Military Medical Center Department of Research Programs..Active duty service members with sleep disorders often fail to recognize their need for professional sleep management. Whereas PCMs identified themselves as first-line providers for sleep disorders in the military, patients lacked confidence that PCMs can make accurate diagnoses and deliver effective sleep treatments. Active duty service members cited needs for expeditious treatment, educational support and care coordination, and support for obtaining sleep treatments during deployment. Challenges that PCMs identified for effective management include insufficient time during routine care visits, delays in scheduling testing procedures, and limited number of sleep specialists. Primary care managers suggested offering evidence-based telehealth tools and enhanced care coordination between PCMs and specialists; standardized medical education, materials, and tools; patient preparation before appointments; self-administered patient education; and including behavioral sleep specialists as part of the sleep management team. For administrative stakeholders, key outcomes of enhanced sleep management included (1) improved resource allocation and cost savings, and (2) improved ADSM safety, productivity, and combat effectiveness..Current military sleep management practices are neither satisfactory nor maximally effective. Our findings suggest that solving the military sleep problem will require sustained effort and ongoing collaboration from ADSM patients, providers, and health systems leaders. Important potential roles for telehealth and technology were identified. Future research should seek to enhance implementation of sleep management best practices to improve outcomes for patients, providers, MHS, and the military as a whole.
• Abdelwadoud, M., Albrecht, J. S., Assefa, S. Z., Bevan, J., Capaldi, V. F., Collen, J., Drake, C. L., Edwards, H., Grandner, M. A., Labra, C., Mahoney, A., Manber, R., Mullins, C. D., Wickwire, E. M., & Williams, S. G. (2021). Moving Beyond "Leaning In"-It Is Time to Reach Out and Partner to Solve the Military Sleep Problem.. Military medicine, 187(5-6), 158-158. doi:10.1093/milmed/usab530
• Abdi, H., Charest, J., Grandner, M. A., Kennedy, K., Killgore, W. D., Knowlden, A. P., & Wills, C. (2021). 204 Changes in Physical Activity During the COVID-19 Pandemic Associated with Changes in Sleep. Sleep, 44(Supplement_2), A82-A82. doi:10.1093/sleep/zsab072.203
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  Abstract Introduction The COVID-19 global pandemic has likely led to changes in physical activity as behavioral patterns were disrupted. This is important because sleep and physical activity are interrelated and promote health, and well-being. This study examined whether changes to physical activity were related to changes to sleep health as a result of the COVID-19 pandemic. Methods A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked to estimate the number of minutes per day they engaged in physical activity during the pandemic, as well as before. These were subtracted from each other, and a difference score was computed. Then, responses were categorized as no change (
• Adhikari, S., Grandner, M. A., Jean-louis, G., Pantaleo, N. P., & Seixas, A. (2021). 694 Insufficient sleep linked with higher COVID-19 infection cases and deaths in the United States. Sleep, 44(Supplement_2), A271-A271. doi:10.1093/sleep/zsab072.692
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  Abstract Introduction Causes of COVID-19 burden in urban, suburban, and rural counties are unclear, as early studies provide mixed results implicating high prevalence of pre-existing health risks and chronic diseases. However, poor sleep health that has been linked to infection-based pandemics may provide additional insight for place-based burden. To address this gap, we investigated the relationship between habitual insufficient sleep (sleep
• Alfonso-miller, P., Athey, A., Gehrels, J. A., Gehrels, J., Grandner, M. A., Hall, C., Poling, K., Turner, R. W., & Vissa, K. (2021). Sleep problems are associated with academic performance in a national sample of collegiate athletes.. Journal of American college health : J of ACH, 69(1), 74-81. doi:10.1080/07448481.2019.1655027
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  Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Participants: Data were obtained from the National College Health Assessment of US college/university students from 2011-2014 (N = 8,312 collegiate athletes). Methods: Univariate comparisons for all sleep variables and demographics were stratified across GPA, using one-way ANOVA for continuous variables and chi-square for categorical variables. Multinomial logistic regression models, with GPA as outcome (reference = A) and sleep variable as predictor, were examined and adjusted for age, sex, and survey year. Ordinal regression examined a 1-level change in GPA associated with each sleep variable, adjusted for covariates. Results: Sleep difficulty was associated with increased likelihood of B/C averages. Initial-insomnia was associated with increased likelihood of B/C, and D/F averages. Tiredness was associated with increased likelihood of B/C, and D/F averages. Conclusions: Sleep problems are highly prevalent and associated with poorer academic performance in collegiate athletes.
• Alfonso-miller, P., Branas, C. C., Carrazco, N., Chakravorty, S., Gallagher, R. A., Gehrels, J. A., Gehrels, J., Grandner, M. A., Hale, L., Haynes, P. L., Killgore, W. D., Nunez, A., Patterson, F., & Rhee, J. U. (2021). Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration.. Sleep health, 7(2), 177-182. doi:10.1016/j.sleh.2020.10.006
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  Insomnia is a clinically verified nicotine withdrawal symptom. As nicotine is a stimulant, it is plausible that smoking at night could disturb sleep more than smoking at earlier times of the day, but this remains empirically unclear. This study examined smoking status and its associations with insomnia severity and sleep duration while considering the potential role of smoking time..Data were derived from the Sleep and Healthy Activity Diet Environment and Socialization study, a community-based study of 1007 adults (nnonsmokers = 818; nsmokers = 189) aged 22-60 from the Philadelphia area. Smoking status and time of smoking were self-reported. Insomnia was assessed with the Insomnia Severity Index and categorized as none, mild, and moderate-to-severe. Sleep duration was assessed with one item from the National Health and Nutrition Examination Survey and categorized as very short, short, normal, and long. Ordinal and multinomial logistic regressions were used to determine the association of smoking status including smoking time with insomnia severity and sleep duration controlling for sociodemographic covariates..Compared to nonsmoking, smoking was associated with experiencing increased insomnia (odds ratio = 2.5, 95% confidence interval [CI] 1.9, 3.4, P < .001) as well as very short (relative risk ratio = 1.9, 95% CI 1.1, 3.3) and short (relative risk ratio = 1.5, 95% CI 1.0, 2.3) sleep (vs normal sleep duration). Night-time smoking was significantly associated with greater insomnia and shorter sleep duration..Findings provide evidence that smoking is associated with increased insomnia severity and shorter sleep duration, particularly nightly smoking. Sleep health should be considered in smoking cessation efforts.
• Alfonso-miller, P., Branas, C. C., Ellis, J., Fernandez, F., Grandner, M. A., Hale, L., Jean-louis, G., Khader, W. S., Killgore, W. D., Knowlden, A. P., Perlis, M. L., Seixas, A., & Williams, N. J. (2021). What makes people want to make changes to their sleep? Assessment of perceived risks of insufficient sleep as a predictor of intent to improve sleep.. Sleep health, 7(1), 98-104. doi:10.1016/j.sleh.2020.07.003
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  The objective of the present study is to identify which underlying beliefs about the impact of sleep on health may motivate change in sleep behavior..A cross-sectional study conducted between 2012 and 2014..Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study conducted in Philadelphia, PA, and its surrounding regions..Participants consisted of N = 1007 community-dwelling adults age 22-60..Respondents indicated behaviors they could improve on to facilitate sleep and their corresponding readiness to change. They were also asked items from the Sleep Practices and Attitudes Questionnaire (SPAQ) regarding the degree to which they agree with whether "not getting enough sleep" can impact a variety of health factors..In adjusted analyses, stage of change was associated with degree of agreement that insufficient sleep can cause sleepiness (odds ratio [OR] = 1.17, P = .035), weight gain (OR = 1.20, P < .0005), heart disease (OR = 1.21, P = .001), cholesterol (OR = 1.13, P = .047), hypertension (OR = 1.16, P = .014), moodiness (OR = 1.42, P < .0005), decreased energy (OR = 1.30, P = .002), absenteeism (OR = 1.13, P = .007), decreased performance (OR = 1.20, P = .003), concentration/memory problems (OR = 1.23, P = .004), diabetes (OR = 1.14, P = .042), and feeling tired (OR = 1.39, P < .0005). When sleep duration was added to the model, significant associations remained for all except cholesterol. When accounting for insomnia, significant associations were maintained for only weight, moodiness, performance, diabetes, and tiredness..Degree of belief that insufficient sleep can cause outcomes such as moodiness, occupational problems, and health problems may impact whether an individual is contemplating/attempting to change their sleep-related behaviors. Targeting these key messages about the associations between sleep health with moodiness and weight gain in informational material may enhance education/outreach efforts aimed at adults.
• Alfonso-miller, P., Buxton, O. M., Delgadillo, M. E., Ghani, S. B., Granados, K., Grandner, M. A., Haynes, P. L., Jean-louis, G., Molina, P., Okuagu, A. C., Parthasarathy, S., Patel, S. R., Ruiz, J. M., Seixas, A., & Wills, C. C. (2021). Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border.. Behavioral sleep medicine, 20(2), 1-12. doi:10.1080/15402002.2021.1902814
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  Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration.Methods: Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status.Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint.Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.
• Arce, R., Delgadillo, M., Ghani, S., Grandner, M. A., Jean-louis, G., Killgore, W. D., Krupp, K., Madhivanan, P., Ruiz, J. M., Seixas, A., Valencia, D., & Wills, C. (2021). 200 COVID-19 Pandemic Sleep Changes Related to Social and Financial Impacts at the US-Mexico Border. Sleep, 44(Supplement_2), A80-A81. doi:10.1093/sleep/zsab072.199
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  Abstract Introduction The COVID-19 pandemic has caused major impacts to social and financial status for many people, including those living in the vulnerable US-Mexico border region. This study examined relationships between changes in sleep and perceived impacts to social and financial stability due to the pandemic. Methods Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). Participants were asked if the COVID-19 pandemic was causing them to feel more socially isolated, negatively impacting their finances, causing increased worry about finances, affecting their primary job, causing a job loss, and impacting their belief life will one day return to normal. In addition, they were asked to report the degree to which they experienced pandemic-related changes to sleep, including a regularity, overall improvement/worsening, initial and middle-of-the-night insomnia, daytime sleepiness, and napping. Logistic regression analyses were adjusted for age, sex, socioeconomics, and mental health (PHQ4). Results Those who kept a more regular schedule had lower odds of endorsing isolation (OR=0.32,p
• Athey, A. B., Charest, J., Grandner, M. A., Mcduff, D., & Turner, R. W. (2021). Substance Use Among Collegiate Athletes Versus Non-athletes. Athletic Training & Sports Health Care, 13(6). doi:10.3928/19425864-20210720-01
• Auerbach, A., Emert, S. E., Grandner, M. A., Huskey, A., Kim, K., Skog, M., Taylor, D. J., & Webb, R. (2021). 315 Athlete Sleep and Mental Health: Differences by Gender, Race, and Ethnicity. Sleep, 44(Supplement_2), A125-A126. doi:10.1093/sleep/zsab072.314
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  Abstract Introduction Sleep is important for athletic and academic performance, injury risk and recovery, and physical and mental health. However, athletes commonly have poor and insufficient sleep, which may be worsened by their inflexible schedules, stress, traveling, and timing of competition. To date, little is known about the relationship between sleep problems and risk for mental health problems in college student athletes. Almost nothing is known about gender, racial and ethnic sleep disparities in this group. The current study aimed to examine the cross-sectional relationships between sleep disorder symptoms and mental health symptoms, further examining differences by gender, race, and ethnicity. Methods Student athletes (N = 1033) from four universities within the Pacific Athletic Conference (PAC-12) were surveyed using previously-validated mental health questionnaires. Since few individuals self-identified as Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, or “Other,” the race variable was recoded into three groups: White, Black, and Other Underrepresented groups. Gender, race, and ethnicity differences on Athlete Sleep Screening Questionnaire (ASSQ) total scores were examined using a three separate MANOVAs. Next, sleep-disorder symptoms were classified as clinically relevant (n=174) or not (n=733) based on established cutoff values on the ASSQ. Gender and sleep disorder differences on mental health total scores were examined using a MANOVA. Results Women athletes reported significantly worse sleep disorder symptoms as a whole. In addition, Black athletes had worse sleep disorder symptoms. There was a trend for women with sleep problems to have higher PC-PTSD scores than women without sleep problems. In addition, athletes in the Other Underrepresented race group with sleep problems also had greater depression, PTSD, and psychotic symptom severity than White or Black student athletes. There was also a trend for Hispanic athletes with sleep disorder symptoms to have greater ADHD symptom severity. Conclusion To further examine individual differences in specific components of sleep symptoms, sleep duration, insomnia symptoms, medication, quality will be reported in the poster presentation. Future studies are needed to understand whether frequency and chronicity of athletic and external stressors, explain elevations in sleep and other psychiatrics symptoms in student athletes. Support (if any) This project was funded by a PAC-12, Mental Health Coordinating Unit Grant.
• Barger, L. K., Czeisler, C. A., Grandner, M. A., Quan, S. F., Robbins, R., Rosenberg, E., & Weaver, M. D. (2021). Employee Sleep Enhancement and Fatigue Reduction Programs: Analysis of the 2017 CDC Workplace Health in America Poll.. American journal of health promotion : AJHP, 35(4), 503-513. doi:10.1177/0890117120969091
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  Poor sleep health, including sleep deficiency and sleep disturbance, is common among employed adults in the U.S. and is associated with undesirable workplace outcomes. Adoption of workplace health promotion programs (WHPPs) is increasing, yet few programs aim to reduce fatigue or improve sleep among employees..We analyzed data from the nationally representative 2017 Centers for Disease Control Workplace Health in America poll to identify the prevalence of sleep enhancement or fatigue reduction WHPPs and the characteristics of employers that offer these programs..A stratified random sample of nationally-representative worksites with ≥10 employees was generated. It comprised 2,843 worksites. Worksite representatives reported workplace characteristics, health promotion activities, and the likelihood of offering WHPPs relating to sleep enhancement or fatigue reduction. Logistic regression analyses were utilized to identify characteristics associated with offering a sleep enhancement or fatigue reduction WHPP, controlling for WHPP budget and size of the company, and contingent on worksites having a comprehensive workplace health plan..Less than 1 in 10 worksites (10%) reported offering a sleep enhancement or fatigue reduction WHPP. Worksites most likely to offer a sleep-focused WHPP were those in retail, wholesale, or technology industries (OR = 2.71, 95%CI: 1.08-6.8) vs. those in the finance, information, technology industries; those with a large WHPP budget (>$500,000, OR = 6.85, 95%CI: 2.1-22.35) vs. those with no budget; and those that had visible support of WHPP initiatives from senior leadership (OR = 4.74, 95%CI: 1.91-11.75) vs. those without such support..Our results highlight how few worksites reported offering sleep-focused programs for their employees. Those worksites that did feature such programs, were commonly well-resourced and had senior leadership support for WHPP initiatives in general. Future research should consider working directly with leaders to expand the implementation of employee sleep enhancement and fatigue reduction WHPPs.
• Bastien, C. H., Begay, T. K., Delgadillo, M., Ghani, S., Grandner, M. A., Killgore, W. D., Krupp, K., Madhivanan, P., Ruiz, J. M., Valencia, D., & Wills, C. (2021). 198 COVID-19 Pandemic Nightmares at the US-Mexico Border. Sleep, 44(Supplement_2), A79-A80. doi:10.1093/sleep/zsab072.197
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  Abstract Introduction The COVID-19 pandemic has impacted individuals in many ways, including anecdotal reports of nightmares. However, little data exists regarding the experience of COVID-related nightmares, especially among the distressed population at the US-Mexico Border. This is especially relevant given the clinical importance of nightmares as risk factors for poor mental health and sleep disturbances. Methods Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). Participants were asked for the number of nightmares that they have experienced since the pandemic started. They were also asked whether they had nightmares about confinement, claustrophobia, suffocation, oppression, drowning, failure, helplessness, natural disasters, anxiety, evil forces, war, separation from loved ones, being chased, sickness, death, COVID, and apocalypse. They were also asked whether they experienced, due to the pandemic, increased general, financial, food, housing, familial, relationship, and media-related stress. Each of these items was coded from 0 (“Strongly Disagree”) to 3 (“Strongly Agree”), with total scores ranging from 0-21. Regression analyses (linear for frequency and binary logistic for content) examined stress score as independent variable, adjusted for age, sex, financial status, education, and mental health (PHQ4). Results Those who experienced greater pandemic-related stress reported more nightmares (age/sex-adjusted B=0.23, p
• Bastien, C. H., Charest, J., Grandner, M. A., Lawson, D., & Samuels, C. (2021). 294 Impacts of travel and time zone differences in the National Hockey League (NHL). Sleep, 44(Supplement_2), A117-A118. doi:10.1093/sleep/zsab072.293
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  Abstract Introduction Elite athletes are at risk of poor sleep which can be exacerbated by frequent travel. The present exploratory study investigated the impact of travel on the winning percentage, number of goals scored in the 3rd period and the number of penalties in the 3rd period over the 2013–2020 seasons in the National Hockey League (NHL). Methods Data from away and home games from the 2013–2020 seasons in the NHL were included in this study. The outcomes were based on winning percentage with additional covariates including home and away games; timing of the game (afternoon/17:30 or earlier; evening/18:00 or later; number of time zones travelled (one, two or three); direction of the travel (eastward or westward); length of the game (regular, overtime or shootout). Additionally, data exclusively from the 3rd period were assessed for the number of penalties received and the number of goals scored for and against. Data were analyzed with logistic regressions to evaluate the effects of the aforementioned variables on winning percentage for both eastern and western conference teams. Results Regardless of the length of the game, results indicated no difference between eastern and western teams on winning percentage. However, there was a significant impact of home-ice on winning percentage for both conferences (p
• Bastien, C. H., Delgadillo, M., Ghani, S., Grandner, M. A., Isalva, L., Killgore, W. D., Krupp, K., Madhivanan, P., Ruiz, J. M., Valencia, D., & Wills, C. (2021). 199 COVID-19 Pandemic Sleep and Dreams at the US-Mexico Border. Sleep, 44(Supplement_2), A80-A80. doi:10.1093/sleep/zsab072.198
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  Abstract Introduction The impact of the COVID-19 pandemic in the border region is not well-described, including the impact of pandemic-related sleep disturbances on dream experiences, despite frequent reports of meaningful changes to dreams in the population. Methods Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and a COVID sub-study (95% Hispanic/Latino). Participants were asked whether, as a result of the pandemic, they have experienced more schedule regularity, improved/worsened sleep, more initial or middle-of-the-night insomnia, more sleepiness, and more napping. They were also asked whether they experienced more, fewer, or the same amount of dreams in general, positive dreams, and negative dreams. Multinomial logistic regressions were used to examine overall, positive, and negative dream recall (more or less vs same) as outcome and perceived change in sleep as independent variable, adjusted for age, sex, socioeconomics, and mental health symptoms (assessed with PHQ4). Results Those who reported more schedule regularity were less likely to report more negative dreams (Relative Risk Ratio [RRR]=0.40, p=0.010). Those who reported improved sleep were also more likely to report more positive dreams (RRR=3.97, p=0.004). Those with worsened sleep were more likely to report fewer dreams overall (RRR=2.23, p=0.037), fewer positive dreams (RRR=2.24, p=0.003) and more negative dreams (RRR=3.69, p
• Bastien, C. H., Grandner, M. A., Kennedy, K., Killgore, W. D., Ruby, P., & Wills, C. (2021). 209 Nightmare Content During the COVID-19 Pandemic: Influence of COVID-Related Stress and Sleep Disruption. Sleep, 44(Supplement_2), A84-A84. doi:10.1093/sleep/zsab072.208
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  Abstract Introduction Nightmares are often associated with psychiatric disorders, though acute stress can also induce them. This study explores how the COVID-19 pandemic may have influenced the frequency and content of nightmares. Methods A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked the degree to which they agree with statements including that due to the COVID-19 pandemic, they have greater general stress, worse overall sleep, and more middle-of-the-night insomnia. They were also asked if they experienced nightmares during the pandemic on a range of topics, including confinement, claustrophobia, suffocation, oppression, drowning, failure, helplessness, natural disasters, anxiety, evil forces, war, domestic abuse, separation from loved ones, totalitarian regimes, being chased, dangerous animals, sickness, death, COVID-19, and apocalypse. Logistic regression analyses examined each nightmare content as outcome and increased stress, worse sleep, and more middle-of-the-night insomnia as predictors, adjusted for age, sex, and race/ethnicity. Results Those who reported greater general COVID-related stress were more likely to have nightmares about confinement (OR=1.66,p
• Bastien, C. H., Grandner, M. A., Kennedy, K., Killgore, W. D., Ruby, P., & Wills, C. (2021). 210 Changes in Dream Recall During the COVID-19 Pandemic: Associations with Sleep, Stress and Dream Content. Sleep, 44(Supplement_2), A84-A85. doi:10.1093/sleep/zsab072.209
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  Abstract Introduction During the COVID-19 pandemic, individuals have faced unprecedented events, which are often stressful. Stress has an important impact on dreams, and stress-induced sleep difficulties may also impact dream recall. The present study evaluated associations between sleep, stress and dream content on dream recall during the pandemic. Methods A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked if they remember more, fewer or about the same amount of dreams as before the pandemic. They were also asked whether the pandemic was associated with more stress, a more regular schedule, improved sleep, worse sleep, more early insomnia, more middle-of-the-night insomnia, more sleepiness, and more naps. They also completed the Insomnia Severity Index, Fatigue Severity Scale, Epworth Sleepiness Scale, Brief Index of Sleep Control, Assessment of Sleep Environment, GAD-7 anxiety scale, and PHQ9 depression scale. Multinomial logistic regressions examined correlates of increased or decreased recall (versus same), adjusted for age, sex, and race/ethnicity. Results Those who experienced greater schedule regularity were less likely to report decreased recall (RRR=0.50,p
• Begay, T. K., Delgadillo, M., Ghani, S., Grandner, M. A., Jean-louis, G., Killgore, W. D., Krupp, K., Madhivanan, P., Ruiz, J. M., Seixas, A., Valencia, D., & Wills, C. (2021). 201 COVID-19 Pandemic Sleep Disturbances Related to Stress Experiences at the US-Mexico Border. Sleep, 44(Supplement_2), A81-A81. doi:10.1093/sleep/zsab072.200
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  Abstract Introduction The COVID-19 pandemic has impacted many individuals at the vulnerable US-Mexico border region in a variety of ways. Fear, worry, and stress have increased for many, as has poor sleep. The present study evaluated the degree to which worsened sleep due to the pandemic impacted stress experiences. Methods Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). They were asked the degree to which their sleep worsened due to the pandemic. They also reported the degree to which they agreed with statements regarding various pandemic-related stress experiences. These included infection-related stresses, stresses about community impact, personal psychosocial stresses, stresses about consequences of potential infection, media and society-related stresses, feelings of safety, and how the pandemic has impacted home life. Ordinal logistic regressions were used to determine whether changes in sleep were associated with agreement with statements about pandemic-related stress experiences, adjusted for age, sex, financial status, education, and mental health (PHQ4). Results Those who perceived that their sleep worsened were more likely to report greater endorsement of beliefs that they were infected (ordinal Odds Ratio [oOR]=2.82,p
• Bhushan, B., Chamberlain, S., Ghani, S., Gorovoy, S., Grandner, M. A., Hanley, B., Killgore, W. D., & Wills, C. (2021). 147 Within-Family Dynamics Influencing Parent and Child Sleep Quality and Nighttime Activities. Sleep, 44(Supplement_2), A60-A61. doi:10.1093/sleep/zsab072.146
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  Abstract Introduction Increasing efforts have focused on child sleep due to its benefits to academics and physical/mental health. Less understood are the within-family dynamics that drive sleep-related behavior. Methods Data were obtained from the 2014 National Sleep Foundation Sleep in America Poll (N=1102 parent/child dyads). Variables including age, gender, sleep quality (Excellent/Good/Fair/Poor), evening activities including reading, TV-watching, and online browsing/gaming (Never/Rarely/Sometimes/Often) were reported for parent and child. Ordinal logistic regressions examined child nighttime activity as outcome and nighttime activities (entered simultaneously in the model, adjusted for each other) as independent variables, adjusted for parent and child age, sex, and sleep quality. Results Worse sleep quality in parents was associated with worse sleep quality in their children. Moreover, increased likelihood of child television-watching at night was not associated with parental sleep quality, but it was associated with child sleep quality, with “Fair” and “Poor” sleepers more likely to watch TV (Fair: oOR=1.7,p=0.018; Poor: oOR=8.0,p=0.001). Child television-watching was not associated with likelihood of parental reading, but it was associated with likelihood of parental online browsing/gaming (Rarely oOR=1.7,p=0.001; Sometimes oOR=2.3,p
• Blair, R., Brewer, B., Criner, G., Davey, A., Dronamraju, V., Grace, G., Grandner, M., Hoopes, E., Patterson, F., & Satti, A. (2021). ASSOCIATIONS BETWEEN PATTERNS OF SEDENTARY BEHAVIOR AND QUALITY OF LIFE IN BLACK/AFRICAN AMERICAN SMOKERS IN GOLD STAGE 0-2. Chest, 160(4), A1782-A1783. doi:10.1016/j.chest.2021.07.1620
• Bobadilla, V., Fernandez, F., Grandner, M. A., Killgore, W. D., Mason, B., & Tubbs, A. (2021). 258 Blue Blockers’ Ability to Block Circadian-Active Light Emitted from a Tablet. Sleep, 44(Supplement_2), A103-A104. doi:10.1093/sleep/zsab072.257
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  Abstract Introduction Short-wavelength light emitted from electronic devices in the evening can harm circadian health by suppressing endogenous melatonin and phase-delaying the timing of the wake-sleep cycle. Blue-blocking glasses are one possible intervention to reduce this exposure. The present study evaluated the differential ability of commercially available blue-blockers to filter out the blue range of visible-spectrum light emitted by a common electronic device. Methods A calibrated spectroradiometer (Ocean Insight), cosine corrector, optic fiber, and software package were used to measure the absolute irradiance (uW/cm^2/nm) emitted from a commercially-available computer tablet (iPad) displaying a blank white screen in a closeted dark room. Thirty-one commercially-available blue-blockers were individually placed between the cosine corrector and the tablet. At a standardized distance and angle, the resulting intensity profile was measured and analyzed. Each lens was evaluated individually relative to the light source and then evaluated across subtypes, including red-tinted lenses (RTL), orange-tinted lenses (OTL), orange-tinted lenses with blue reflectivity (OBL), brown-tinted lenses (BTL), yellow-tinted lenses (YTL), and clear reflective blue lenses (RBL). Results There was significant variation in tablet-generated light-blocking across the full spectrum (one-way ANOVA, p < 0.0001) and for the 440-530nm range in particular (one-way ANOVA, p < 0.0001). RTL blocked 99%, OTL blocked 81%, OBL blocked 75%, BTL blocked 83%, YTL blocked 33%, and RBL blocked 17% of broadspectrum light (380-780nm). In the 440nm-530nm range, RTL, OTL, and OBL blocked 100% of the emission, while BTL blocked 81%, YTL blocked 47%, and RBL blocked 18% of it. Conclusion When using a popular tablet device, RTL, OTL and OBL blocked the most circadian photosensitive parts of the light exposure, indicating they can best preserve the timing of endogenous melatonin secretion in the presence of tablet light at night. By contrast, RBL demonstrated very little efficacy. Support (if any) R01MD011600, R01DA051321
• Boyle, J. T., Grandner, M. A., Perlis, M. L., Rosenfield, B., & Vargas, I. (2021). Insomnia Severity and Degree of Dysfunction: What Is to Be Learned When These Domains are Discordant?. Behavioral sleep medicine, 20(2), 1-9. doi:10.1080/15402002.2021.1895794
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  Objective/Background: Illness severity and resultant dysfunction are often linearly related and tightly coupled (concordant). Some percentage of individuals, however, exhibit discordant associations (high illness severity and low dysfunction [HL] or low illness severity and high dysfunction [LH]). In the present study, a sample of subjects with insomnia complaints were evaluated to determine what percentage of subjects exhibited discordant associations. Participants: Archival data were drawn from a community-based sample (n = 4,680; 61.8% female; Ages 18-105). Methods: Median splits were calculated for illness severity and daytime dysfunction and each individual was typed as High (H) or Low (L) for the concordant (HH and LL) and discordant domains (HL and LH). Results: Given this typology, 61% were classified as concordant and 39% were classified as discordant. Of these, 38% were sub-typed as HH, 23% as LL, 26% as LH, and 13% as HL. Conclusions: We propose that some of the discordance may be ascribable to a mismatch between sleep need and sleep ability. Those "who need a lot, may suffer a lot, in the face of only a little (LH)", whereas those "who need a little, may suffer only a little, in the face of a lot (HL)".
• Charest, J., Bastien, C. H., Ellis, J. G., Killgore, W. D., & Grandner, M. A. (2021). The Impact of Perceived Sleep, Mood and Alcohol Use on Verbal, Physical and Sexual Assault Experiences among Student Athletes and Student Non-Athletes. International journal of environmental research and public health, 18(6).
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  Previous research has shown that student athletes are more likely to be involved in a physical altercation or be a victim of verbal, physical and/or sexual abuse than student non-athletes, which can have long-lasting negative effects on mood, behavior and quality of life. In addition, among college students, sleep difficulties are ubiquitous and may deteriorate the unique life experience that university represents. The influences of poor sleep quality, mood and alcohol consumption related to these events are examined here between student athletes and student non-athletes. A series of hierarchical logistic regressions explored the relationship between verbal, physical and sexual assault risk factors. Results suggest that poor sleep, alcohol consumption and mood are all associated with exposure to a physical altercation or episode of abuse, irrespective of athlete status. Results also show that variables targeting self-reported difficulty sleeping and experiences of verbal, physical and sexual assault were positively associated. However, given the cross-sectional nature of the study, it is impossible to establish the direction of these relationships.
• Charest, J., Samuels, C. H., Bastien, C. H., Lawson, D., & Grandner, M. A. (2021). Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association. Journal of Clinical Sleep Medicine, 17(Issue 11). doi:10.5664/jcsm.9446
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  Study Objectives: Travel fatigue and circadian disruptions are known factors that can hinder performance in professional athletes. The present study focused on travel distance and direction on back-to-back games over the 2013–2020 seasons in the National Basketball Association (NBA). Methods: The outcomes were based on winning percentage with additional covariates including the direction of travel (eastward or westward), the distance traveled (0–500 km; 501–1,000 km; 1,001–1,500 km; 1,501 km and more), team quality, and season. If a team played both games of a back-to-back sequence on the road, they were considered Away-Away; if a team played the first game of a back-to-back sequence at home they were considered Home-Away; if a team played the first game of a back-to-back sequence on the road they were considered Away-Home. Results: The sequence Away-Home significantly increases the likelihood of winning compared with the Away-Away and Home-Away sequences: 54.4% (95% confidence interval [CI], 54.4%–54.5%), 39.2% (95% CI, 37.2%–41.2%), and 36.8% (95% CI, 36.7%–36.8%), respectively. When teams travel back home, every additional 500 km reduces the likelihood of winning by approximately 4% (P = .038). Finally, after withdrawing the Away-Home sequence, traveling eastward significantly increases the chance of winning (P = .024) compared with westward travel but has no significant impact on the probability of winning compared with neutral time zone travel (P = .091). Conclusions: The accumulation of travel fatigue and the chronic circadian desynchronization that occurs over the NBA season can acutely disturb sleep and recovery. It appears that tailored sleep and recovery strategies need to be dynamically developed throughout the season to overcome the different challenges of the NBA schedule.
• Charest, J., Samuels, C. H., Bastien, C. H., Lawson, D., & Grandner, M. A. (2021). Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(11), 2269-2274.
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  Travel fatigue and circadian disruptions are known factors that can hinder performance in professional athletes. The present study focused on travel distance and direction on back-to-back games over the 2013-2020 seasons in the National Basketball Association (NBA).
• Chaudhary, N. S., Taylor, B. V., Grandner, M. A., Troxel, W. M., & Chakravorty, S. (2021). The effects of caffeinated products on sleep and functioning in the military population: A focused review. Pharmacology, biochemistry, and behavior, 206, 173206.
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  Military personnel rely on caffeinated products such as coffee or energy drinks (ED) to maintain a maximal level of vigilance and performance under sleep-deprived and combat situations. While chronic caffeine intake is associated with decreased sleep duration and non-restful sleep in the general population, these relationships are relatively unclear in the military personnel. We conducted a focused review of the effects of caffeinated products on sleep and the functioning of military personnel. We used a pre-specified search algorithm and identified 28 peer-reviewed articles published between January 1967 and July 2019 involving military personnel. We classified the findings from these studies into three categories. These categories included descriptive studies of caffeine use, studies evaluating the association between caffeinated products and sleep or functioning measures, and clinical trials assessing the effects of caffeinated products on functioning in sleep-deprived conditions. Most of the studies showed that military personnel used at least one caffeine-containing product per day during active duty and coffee was their primary source of caffeine. Their mean caffeine consumption varied from 212 to 285 mg/day, depending on the type of personnel and their deployment status. Those who were younger than 30 years of age preferred ED use. Caffeine use in increasing amounts was associated with decreased sleep duration and increased psychiatric symptoms. The consumption of caffeinated products during sleep deprivation improved their cognitive and behavioral outcomes and physical performance. Caffeine and energy drink consumption may maintain some aspects of performance stemming from insufficient sleep in deployed personnel, but excessive use may have adverse consequences.
• Cheung, J., Grandner, M., Ivers, H., Lack, L., Morin, C., Muench, A., Perlis, M., & Scott, H. (2021). P129 A substantial percentage of patients with Chronic Insomnia do not appreciably increase Total Sleep Time after Cognitive Behavioural Therapy for Insomnia. SLEEP Advances, 2(Supplement_1), A63-A63. doi:10.1093/sleepadvances/zpab014.170
• Cloonan, S. A., Dailey, N. S., Grandner, M. A., Killgore, W. D., & Taylor, E. C. (2021). 715 Insomnia as a Risk for PTSD During the COVID-19 Pandemic. Sleep, 44(Supplement_2), A279-A279. doi:10.1093/sleep/zsab072.713
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  Abstract Introduction The COVID-19 pandemic and associated attempts to curb its spread have led to a significant increase in mental health issues. Evidence suggests that sleep provides a protective resilience against the adverse effects of stress. Moreover, sleep disruption is often considered the “hallmark symptom” of posttraumatic stress disorder (PTSD). Here we hypothesized that insomnia would increase during the first six months of the pandemic, and that higher insomnia would be associated with elevated rates of PTSD. Methods A total of 6,190 adults ranging in age from 18 to 84 years (53.6% female), completed an online cross-sectional survey at one of six time points between April and September 2020 (~1,000 per administration). Instruments included the Insomnia Severity Index (ISI), Primary Care PTSD Checklist (PC-PTSD), and the PTSD Checklist-5 (PCL-5). Standard clinical cutoffs were used for ISI (≥10) and PCL-5 (≥38). Data were analyzed with analysis of variance, chi-square contingency tables, and bivariate correlations. Results Over the first six-months of the pandemic, PTSD increased with each passing month on both the PC-PTSD (p=.001) and PCL-5 (p
• Cloonan, S. A., Grandner, M. A., & Killgore, W. D. (2021). 716 Loneliness and Lockdowns: The Effects of the COVID-19 Pandemic on Insomnia Symptoms. Sleep, 44(Supplement_2), A279-A280. doi:10.1093/sleep/zsab072.714
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  Abstract Introduction Insomnia is a critical health issue that has serious consequences for both psychological and physical health. These consequences have become even more exacerbated during the course of the ongoing COVID-19 pandemic, as fears of the virus continue to grow and community lockdowns persist. Loneliness has also become a growing mental health concern as a result of the pandemic, and previous research has identified COVID-19 loneliness as a contributing factor to higher rates of insomnia. The current study aimed to investigate the relationship between insomnia, loneliness, and lockdown orders across the first 6-months of the pandemic. We hypothesized that being lonely and under lockdown would lead to greater insomnia, even after controlling for anxiety, and this would become more pronounced over the course of the pandemic. Methods 6,101 English-speaking adults from across the U.S. (18–84 years old; 53.6% female) completed an online, monthly, cross-sectional (~1000 participants per month), battery of assessments that included the Insomnia Severity Index (ISI), UCLA Loneliness Scale – Version 3, Generalized Anxiety Disorder-7 scale (GAD 7), demographic questions, and a COVID-19 questionnaire between April 2020 and September 2020. A 2 (lonely vs. not lonely) x 2 (lockdown vs. no lockdown) x 2 (Time 1 April-June vs. Time 2 July-September) ANCOVA was conducted to determine the effects of these variables on insomnia, while also controlling for anxiety symptoms. Results Significant main effects of lockdown status, F(1,8) = 22.72, p < .001, time, F(1,8) = 4.94, p = .026, and loneliness, F(1,8) = 65.18, p < .001, were observed, as a well as a significant interaction effect between lockdown status and time, F(1,8) = 8.47, p = .004, after controlling for anxiety. Conclusion Overall, lonely people under lockdown had the highest levels of insomnia at both Time 1 and Time 2. Non-lonely people consistently had lower levels of insomnia than lonely people across the 6-month period; however, being under lockdown also contributed to higher levels of insomnia regardless of loneliness, which increased with each passing month of the pandemic. Loneliness and lockdowns each appear to be independently associated with elevated insomnia during the COVID-19 pandemic. Support (if any):
• Cloonan, S. A., Grandner, M. A., Killgore, W. D., & Persich, M. R. (2021). 106 Self-Reported Sleep and Resilience. Sleep, 44(Supplement_2), A43-A44. doi:10.1093/sleep/zsab072.105
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  Abstract Introduction Psychological resilience is the ability to withstand setbacks, adapt positively to challenges, and bounce back from the adversities of life. While the construct of resilience is broadly understood, the specific individual factors that contribute to the ability to be resilient and persevere in the face of difficulties remain poorly understood. We recently showed that psychological resilience during the COVID-19 pandemic was associated with a number of factors, including fewer complaints of insomnia, and others have suggested that sleep is an important contributor. We therefore tested the hypothesis that sleep quality and acute sleep quantity would combine to predict measures of psychological resilience and perseverance (i.e. “grit”). Methods We asked 447 adults (18–40 yrs; 72% female) to report the number of hours of sleep obtained the night before their assessment session (SLEEP), and complete several questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Connor-Davidson Resilience Scale (CD-RISC), Bartone Dispositional Resilience Scale (Hardiness), and the Grit Scale. Sleep metrics were used to predict resilience, hardiness, and grit using multiple linear regression. Results For resilience, PSQI (β=-.201, p
• Cloonan, S. A., Grandner, M. A., Killgore, W. D., & Taylor, E. C. (2021). 719 Insomnia in Those Diagnosed with COVID-19. Sleep, 44(Supplement_2), A280-A281. doi:10.1093/sleep/zsab072.717
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  Abstract Introduction Recent meta-analyses suggest that as many as 75% of COVID-19 patients report sleep problems. Here, we sought to characterize this in terms of self-reported insomnia. We hypothesized that those endorsing a positive COVID-19 diagnosis would also report greater levels of insomnia than those with a negative diagnosis. Methods Between April and September 2020 we administered the Insomnia Severity Index (ISI), each month to a total of 6162 English speaking adults in the United States ranging in age from 18–84 (M=36.2 years, SD=12.1; 53.9% female), recruited from all 50 states and the District of Columbia using Amazon Mechanical Turk (MTurk) crowdsourcing platform. Data collections occurred cross-sectionally, approximately one month apart. Data were analyzed using Kruskal-Wallis H tests. Results In total, 247 (4.01%) participants responded “Yes” to the question “Have you been formally diagnosed with COVID-19?” (male=128, female=119). Those reporting “yes” had a higher mean score on the ISI (M=14.52, SD=5.56) compared to reporting “no” (M=9.98, SD=6.55). Total ISI scores were higher for those who reported that they were diagnosed with COVID-19 than those that did not, χ2(1)=121.818, p=0.0001. Among those that reported that they were diagnosed with COVID-19, 57.11% had ISI scores indicating moderate to severe clinical insomnia compared to 25.42% of those who were not diagnosed with COVID-19. Conclusion Those who reported that they had been diagnosed with COVID 19 had greater insomnia compared to those without such a diagnosis. This could be due to greater stress and anxiety in those who had a positive COVID-19 diagnosis due to the many uncertainties surrounding the short and long-term prognosis as well as potential impacts on the individual’s family and workplace. However, it is important to consider the broader health picture of those diagnosed with COVID-19. This study is limited by the nature of the self-reported data, where we cannot verify a positive COVID-19 test. Causality cannot be inferred due to the cross-sectional nature of this study. Future work will need to determine the extent to which sleep-related factors are due to biological versus psychological factors associated with the diagnosis of COVID-19. Support (if any):
• Delgadillo, M., Ghani, S., Grandner, M. A., Jean-louis, G., Killgore, W. D., Krupp, K., Madhivanan, P., Ruiz, J. M., Seixas, A., Valencia, D., & Wills, C. (2021). 202 COVID-19 Pandemic Sleep Disturbances Related To Dietary Behavior at the US-Mexico Border. Sleep, 44(Supplement_2), A81-A81. doi:10.1093/sleep/zsab072.201
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  Abstract Introduction The COVID-19 pandemic has disrupted life at the US-Mexico border in many ways, including sleep and dietary behavior. Given the potential long-term impact of worsening sleep and metabolic health due to the pandemic, the present study examines whether changes to dietary behavior were associated with changes to sleep. Methods Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and were contacted about completing a COVID-19 sub-study (95% Hispanic/Latino). Participants reported the degree to which they experienced pandemic-related changes to sleep, including a more regular schedule, overall improvement, overall worsening, more initial insomnia, more middle-of-the-night insomnia, more daytime sleepiness, and more napping. They were also asked whether as a result of the pandemic they consumed an overall healthier diet, more homecooked meals, more processed meals, more regular meals, whether they enjoyed food more, and degree of overeating. Ordinal regressions with diet change as outcome and sleep change as predictor were adjusted for age, sex, education, and socioeconomics. Results Those who reported more regular sleep were more likely to report a healthier overall diet (oOR=3.12,p
• Ellis, J. G., Perlis, M. L., Espie, C. A., Grandner, M. A., Bastien, C. H., Barclay, N. L., Altena, E., & Gardani, M. (2021). The natural history of insomnia: predisposing, precipitating, coping, and perpetuating factors over the early developmental course of insomnia. Sleep, 44(9).
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  While there is an extensive literature on predisposing, precipitating, coping, and perpetuating factors in those with chronic insomnia, very little work has been undertaken to evaluate these factors over the early developmental course of insomnia. The present aim was to determine whether several hypothesized factors in each domain (predisposing, precipitating, coping, and perpetuating), assessed during an episode of acute insomnia (AI), are related to its persistence or remission to normal sleep. Participants comprised n = 140 people with AI and n = 737 normal sleepers (NS) recruited from the general public. Participants completed measures assessing predisposing characteristics (personality traits, arousal predisposition, and insomnia vulnerability), precipitating events and outcomes (life events, perceived stress, anxiety, and depression), coping styles (thought control strategies and coping styles), and perpetuating factors (sleep preoccupation, pre-sleep arousal, dysfunctional beliefs, and fatigue). Additionally, insomnia status (from AI at baseline to its persistence or natural remission [NR]) was assessed 1 month later (n = 129). Baseline differences between NS and individuals with AI were observed in each domain with increasing age, lower openness to experience and conscientiousness, higher insomnia severity, levels of anxiety, and affective sleep preoccupation significantly predicting AI status. Further, a previous episode of insomnia, higher depression scores, and affective sleep preoccupation scores significantly predicted its persistence, as opposed to its NR. Results are discussed with reference to the conceptualization of insomnia and how the findings may influence the design of preventative interventions to circumvent the transition from acute to chronic insomnia.
• Fernandez, F., Grandner, M. A., Killgore, W. D., Mason, B., & Tubbs, A. (2021). 257 How Much Blue Do Blue-Blockers Block if Blue-Blockers Do Block Blue?. Sleep, 44(Supplement_2), A103-A103. doi:10.1093/sleep/zsab072.256
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  Abstract Introduction Short-wavelength light (440-530nm) can suppress endogenous melatonin secretion from the pineal gland. This has been observed in realworld settings when people use electronic media at night that emits light from this part of the visible spectrum. Blue-blocking glasses are a possible intervention to reduce blue light exposure. The present study evaluated the ability of commercially available blue-blockers to block blue light emitted by LEDs. Methods A calibrated spectroradiometer (Ocean Insight), cosine corrector, optic fiber, and software package were used to measure the absolute irradiance (uW/cm^2/nm) generated from a blue light source (Phillips Go Lite Blu) in an otherwise completely dark room. Thirty-one different commercially-available blue-blockers were individually placed between the cosine corrector and the light source at a standardized distance, and then intensity was measured and analyzed. Lenses were evaluated with regards to the amount of blue light they suppressed both individually and grouped by lens tint: red-tinted lenses (RTL), orange-tinted lenses (OTL), orange-tinted lenses with blue reflectivity (OBL), brown-tinted lenses (BTL), yellow-tinted lenses (YTL), and clear lenses with blue reflectivity (RBL). Results RTL blocked 100% of the short-wavelength light, while OTL and OBL blocked 99%, BTL blocked 66%, YTL blocked 38%, and RBL blocked 11% of it. This represented a statistically significant between-group difference (one-way ANOVA, < 0.0001). Within groups, there was variability in performance among individual lenses, though this variability was small compared to the between-group differences. Conclusion The RTL, OTL, and OBL block light best capable of suppressing melatonin secretion at night (440-530 nm); with slightly less efficacy, BTL and YTL also restricted much of the light exposure. Lastly, RBL were not effective at curtailing short-wavelength light. Those looking to optimize blue-blocking capabilities should use RTL, OTL, and OBL, rather than other lens types. Support (if any):
• Ghani, S. B., Begay, T. K., & Grandner, M. A. (2021). Sleep-disordered Breathing and Insomnia as Cardiometabolic Risk Factors among U.S. Hispanics/Latinx(s). American journal of respiratory and critical care medicine, 203(3), 285-286.
• Ghani, S. B., Taneja, K., Wills, C. C., Tubbs, A. S., Delgadillo, M. E., Valencia, D., Halane, M., Killgore, W. D., & Grandner, M. A. (2021). Culturally-consistent diet among individuals of Mexican descent at the US-Mexico border is associated with sleep duration and snoring. BMC Nutrition, 7(Issue 1). doi:10.1186/s40795-021-00452-0
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  Background: Existing studies show that consuming food consistent with one’s culture reduces cardiometabolic risk. However, few studies have assessed whether these dietary choices influence sleep health. Accordingly, this study assessed how Mexican food consumption by individuals of Mexican descent residing at the US-Mexico border, was associated with various measures of sleep, after accounting for acculturation. Methods: Data were provided by 100 adults between the ages of 18–60, in the city of Nogales, AZ. Questionnaires were provided in either Spanish or English. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II), with an additional question, asking how often “my family cooks Mexican foods.” Frequency of cooking Mexican food was coded as either “yes” or “no.” Sleep was assessed, using validated measures that include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and sleep duration with the item “how many hours of actual sleep did you get at night?” Regression models estimated the associations between sleep health variables as outcomes and consumption of Mexican food as the independent variable. Covariates included age, sex, and acculturation scores. Parental education level was also included, as an indicator of childhood socioeconomic status and since food culture likely involves parents. Result: We found that among individuals who identified as Mexican-Americans who consumed culturally-consistent foods, was associated with, on average, 1.41 more hours of sleep (95% CI 0.19, 2.62; p = 0.024) and were less likely to report snoring (OR: 0.25; 95% CI 0.07, 0.93; p = 0.039). Consuming Mexican food was not associated with sleep quality, insomnia severity or sleepiness. Conclusion: Individuals of Mexican descent residing at the US-Mexico border who regularly consumed Mexican food, reported more sleep and less snoring. Mexican acculturation has been shown previously to improve sleep health. This is likely due to consumption of a culturally- consistent diet. Future studies should examine the role of acculturation in sleep health, dietary choices, and subsequent cardiometabolic risk.
• Ghani, S. B., Taneja, K., Wills, C. C., Tubbs, A. S., Delgadillo, M. E., Valencia, D., Halane, M., Killgore, W. D., & Grandner, M. A. (2021). Culturally-consistent diet among individuals of Mexican descent at the US-Mexico border is associated with sleep duration and snoring. BMC nutrition, 7(1), 53.
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  Existing studies show that consuming food consistent with one's culture reduces cardiometabolic risk. However, few studies have assessed whether these dietary choices influence sleep health. Accordingly, this study assessed how Mexican food consumption by individuals of Mexican descent residing at the US-Mexico border, was associated with various measures of sleep, after accounting for acculturation.
• Ghani, S., Grandner, M. A., Jean-louis, G., Kennedy, K., Killgore, W. D., Knowlden, A. P., Seixas, A., & Wills, C. (2021). 205 Changes in Sleep Due to COVID Pandemic Associated with Changes to Dietary Patterns. Sleep, 44(Supplement_2), A82-A83. doi:10.1093/sleep/zsab072.204
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  Abstract Introduction The COVID-19 pandemic has affected sleep and diet for many people. The present study sought to examine potential associations between changes to sleep and eating habits during the COVID-19 pandemic. Methods A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Questions for diet asked, “since quarantine: I’m eating healthier, eating more processed foods, home-cooked meals and more regularly,” “I’m enjoying food in quarantine and I’m struggling with overeating in quarantine.” Sleep questions asked “since quarantine: I have managed to keep a regular sleep-wake schedule, my sleep has improved, I’m struggling to fall asleep, I’m waking up more during the night, I’m more sleepy during the day and I’m taking more naps during the day.” Answers were reported on a 4-point scale ranging from “strongly disagree to strongly agree.” Ordinal logistic regressions were used, adjusted for age and sex and examined each dietary variable as ordinal outcome and each sleep variable as predictor. Results Those who report that they kept a more regular schedule were more likely to report eating healthier (oOR=3.13, p=0.007), eating more home-cooked meals (oOR=3.19, p=0.005), and less likely to be eating more processed foods (oOR=0.39, p=0.02), struggle with overeating (oOR=0.39, p=0.02) or undereating (oOR=0.30, p=0.004) or snacking (oOR=0.25, p=0.001). Those reporting more difficulty falling asleep were less likely to be eating healthier (oOR=0.25, p=0.002) and more likely to be eating more processed foods (oOR=3.07, p=0.009) and snacking (oOr=2.36, P=0.04). Those reporting more difficulty with awakenings were less likely to report eating healthier (oOR=0.34, p=0.03) and more likely to report eating more processed foods (oOR=4.52, p=0.001). Those with more sleepiness were less likely to report eating healthier (oOR=0.29, p=0.01) and more homecooked meals (oOR=0.40, p=0.046) and more likely to report eating more processed foods (oOR=6.42, p
• Grandner, M. A., & Fernandez, F. X. (2021). The translational neuroscience of sleep: A contextual framework. Science (New York, N.Y.), 374(6567), 568-573.
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  Sleep is entwined across many physiologic processes in the brain and periphery, thereby exerting tremendous influence on our well-being. Yet sleep exists in a social-environmental context. Contextualizing sleep health with respect to its determinants—from individual- to societal-level factors—would enable neuroscientists to more effectively translate sleep health into clinical practice. Key challenges and opportunities pertain to (i) recognizing and exploring sleep’s functional roles, (ii) clarifying causal mechanisms in relation to key outcomes, (iii) developing richer model systems, (iv) linking models to known contextual factors, and (v) leveraging advances in multisensory technology. Meeting these challenges and opportunities would help transcend disciplinary boundaries such that social-environmental considerations related to sleep would become an ever-greater presence in the clinic.
• Grandner, M. A., & Knowlden, A. P. (2021). 138 Short Sleep and Insomnia as Independent Predictors of Obesity, Hypertension, and Diabetes. Sleep, 44(Supplement_2), A56-A56. doi:10.1093/sleep/zsab072.137
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  Abstract Introduction Epidemiological evidence of short sleep’s (
• Grandner, M. A., & Knowlden, A. P. (2021). Abstract 039: Insomnia And Short Sleep Uniquely Predict Obesity, Hypertension, And Diabetes. Circulation, 143(Suppl_1). doi:10.1161/circ.143.suppl_1.039
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  Background: Epidemiological evidence of short sleep’s (
• Grandner, M. A., & Rezaei, N. (2021). Abstract MP38: Longitudinal Population-Level Changes In Resting Heart Rate During The COVID-19 Pandemic: Impact Of Changes In Sleep, Circadian, And Physical Activity Variables. Circulation, 143(Suppl_1). doi:10.1161/circ.143.suppl_1.mp38
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  Introduction: Population-level objective estimates of changes in health metrics over the course of the COVID-19 pandemic are sparse. This study evaluated change in resting heart rate (RHR) determined by optical plethysmography and relationships to changes in other lifestyle health behaviors (sleep and activity). Methods: Data were obtained from N=197,988 Fitbit users who wore their heart-rate enabled Fitbit device to sleep and had detected sleep stages at least 10 days in the month of January, the baseline period; and synced their devices at least once in the last 10 days of April. In addition, potential participants needed to reside in one of 6 target cities: Chicago, Illinois; Houston, Texas; Los Angeles, California; San Francisco, California; New York City, New York; and Miami, Florida. Users who met these criteria were randomly selected. Daily RHR, sleep duration (minutes), sleep duration variability (standard deviation), bedtime, step count, and active minutes were estimated by the device. Differences between January (before the pandemic) and April (peak of stay-at-home orders) was computed. Correlations between change in RHR and change in other variables were evaluated, stratified by age and sex. Results: For all age groups, in both men and women, mean RHR declined from January to April by about 1bpm, with the highest reductions in the youngest adults (all p=65 are displayed in the Table. Discussion: During the COVID-19 pandemic, RHR decreased robustly but very slightly. Reductions in RHR were correlated with improvements in other health behaviors (sleep and activity). Causal relationships could not be evaluated, but future studies may explore whether even small changes in health behaviors can measurably impact population RHR.
• Grandner, M. A., Hall, C., Jaszewski, A., Alfonso-Miller, P., Gehrels, J. A., Killgore, W. D., & , A. A. (2021). Mental Health in Student Athletes: Associations With Sleep Duration, Sleep Quality, Insomnia, Fatigue, and Sleep Apnea Symptoms. Athletic training & sports health care, 13(4), e159-e167.
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  To quantify the relationship between sleep difficulties and poor mental health among student athletes using validated measures.
• Grandner, M. A., Holbert, C., Kennedy, K., Killgore, W. D., & Wills, C. (2021). 206 Changes in Sleep Due to the COVID Pandemic Associated with Sleep Environment. Sleep, 44(Supplement_2), A83-A83. doi:10.1093/sleep/zsab072.205
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  Abstract Introduction The COVID-19 pandemic has resulted in adverse impacts on sleep for many people. The physical environment has been a focus for health-related behaviors during the pandemic since movement restrictions have led to a heightened awareness of the living environment. This study examined whether those whose physical environment was more disruptive to sleep systematically experienced more pandemic-related sleep problems. Methods A sample of N=419 US adults completed online surveys (mostly during the summer months) about sleep and COVID-19 experiences. Participants were asked the degree to which they endorsed statements that due to the pandemic, (1) they were able to keep a regular schedule, (2) they had more problems falling asleep, (3) they had more problems with nighttime awakenings, (4) they experienced more daytime sleepiness, and (5) they napped more. Sleep environment was assessed using the Assessment of Sleep Environment (ASE), a 13-item questionnaire that quantifies the degree to which sleep is disrupted environmental influences (scores range from 0-39). Ordinal logistic regression analyses, with degree of agreement with statements about changing sleep due to the pandemic as outcome, ASE score as independent variable, and age and sex as covariates. Results Worse sleep environment was associated with a decreased likelihood of being able to keep a regular schedule (oOR=0.96, p
• Grandner, M. A., Lujan, M. R., & Ghani, S. B. (2021). Sleep-tracking technology in scientific research: looking to the future. Sleep, 44(5).
• Grandner, M. A., Muench, A., Perlis, M. L., & Vargas, I. (2021). 654 Potential Longitudinal Association Between COVID-19 Infection Outcomes and Insomnia Symptoms. Sleep, 44(Supplement_2), A256-A256. doi:10.1093/sleep/zsab072.652
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  Abstract Introduction The COVID-19 pandemic has had an unequivocal negative impact worldwide, including increases in stress related to social isolation, unemployment, grief, and fear of contracting the virus. This increased stress has likely led to a greater prevalence of sleep continuity disturbance (i.e., insomnia) in the general population. The goal of the present study was to assess the prevalence of sleep continuity disturbance (i.e., insomnia) in the United States during the initial months of the pandemic. In addition, longitudinal assessment is currently ongoing in order to further assess participant experiences with COVID-19. Specifically, these follow-up data will be used to assess whether, among those that contracted COVID-19, insomnia at baseline (Time 1) predicts worse outcomes (e.g., symptoms of greater frequency, duration, or severity) upon follow-up (Time 2). Methods A national survey was conducted from April-June 2020. Participants answered questions regarding social distancing practices, mood, sleep, physical activity, and COVID-19 symptoms. Insomnia symptom prevalence and severity were estimated with a retrospective sleep diary and the Insomnia Severity Index (ISI). A follow-up assessment is currently ongoing and will be completed in March 2021. The follow-up survey consists of similar questions and additional items regarding COVID-19 testing, symptoms [frequency, duration, and severity], and outcomes [outpatient treatment, incidence and duration of hospitalization, and incidence and type of respiratory assistance]. Results 4,133 adults (Mage = 45.8 years; range = 18 - 86 years; 78.7% female) completed the baseline survey. The prevalence of clinically significant sleep continuity disturbance (≥ 30 minutes) was 44.6% for sleep latency problems and 36.2% for wake after sleep onset problems. Nearly 34% of subjects reported average total sleep times of less than 7 hours. Over 17% of subjects (n = 719) reported total ISI scores in the clinical range (ISI total score ≥ 15). Conclusion The present study suggests the prevalence of clinically significant insomnia symptoms during COVID-19 remain high in the general population (17–45% depending on definition of insomnia). Similarly, the prevalence of short sleep is elevated. Whether these incident data are associated with COVID-19 outcomes remains to be determined and will be the subject of follow-up analyses in January/February 2021. Support (if any) Vargas: K23HL141581; Perlis: K24AG055602
• Grandner, M. A., Naps, M., Rivera, L., & Tubbs, A. (2021). 350 Opioid Use and Abuse are Associated with Use of Sedative Hypnotic Medications. Sleep, 44(Supplement_2), A140-A140. doi:10.1093/sleep/zsab072.349
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  Abstract Introduction The Department of Health and Human Services recently reported that 10.3 million people misused opioid drugs in 2018. Recent research attributed 21% of the deaths from opioid overdose to benzodiazepines. The overdose data and clinical experience show that opioid misusers commonly complain of insomnia and use hypnotic medications to self-medicate their sleep disturbance. At the same time, it remains unclear from a scientific perspective whether those who use/abuse opioids are more likely to use drugs in the sedative-hypnotic medication category. Consequently, the present study explores the relationship between comorbid use of opioids and sedative-hypnotic medications. Methods We extracted data from the 2015–2018 waves of the National Survey on Drug Use and Health (N=171,766). The primary outcome was the use of sedative-hypnotic medications, either in the z-class (zaleplon, zolpidem, eszopiclone) or sedating benzodiazepines (temazepam, flurazepam, triazolam). The primary exposures were prescription use of an opioid or abuse of an opioid (i.e., use of an illegal opioid such as heroin or misuse of a prescription opioid). Covariates included age, sex, race, income, education, and predicted mental illness category (none, mild, moderate, severe). Exposures were balanced on covariates using inverse probability of treatment weighting. Sequential binomial logistic regression estimated the association between opioid use/abuse and sedative-hypnotic use after adjusting for covariates. Results Opioid use and abuse varied by age, sex, race, education, and income (all p < 0.001). When adjusted for age, sex, and race (Model 1), sedative benzodiazepine use was more common among opioid users (OR 4.4 [4.04–4.79] and opioid abusers (OR 11.9 [9.72–14.5]). The use of z-class drugs was also more prevalent in opioid users (OR 3.69 [3.48–3.89]) and abusers (OR 7.74 [6.97–8.60]). Further adjusting for income and education (Model 2) and mental illness category (Model 3) attenuated but did not eliminate these associations. Conclusion Individuals who use or abuse opioids are significantly more likely to receive a sedative-hypnotic medication, a finding that is of concern and one that also suggests that sleep disturbance is common in this population. Further research is needed to determine the underlying nature and prevalence of sleep continuity disturbances in this population. Support (if any) VA grant IK2CX000855 and I01 CX001957 (S.C.).
• Grandner, M., Hsu, C., Morrison, H., & Taylor-Piliae, R. (2021). Changes in symptoms, sleep, oxidative stress, and inflammatory markers among community-dwelling stroke survivors after a tai chi exercise intervention. European Journal of Cardiovascular Nursing, 20(Supplement_1). doi:10.1093/eurjcn/zvab060.075
• Hoopes, E. K., Witman, M. A., D'Agata, M. N., Berube, F. R., Brewer, B., Malone, S. K., Grandner, M. A., & Patterson, F. (2021). Rest-activity rhythms in emerging adults: implications for cardiometabolic health. Chronobiology international, 1-14.
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  Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (
• Jean-Louis, G., Grandner, M. A., & Pandi-Perumal, S. R. (2021). Sleep Health and Longevity-Considerations for Personalizing Existing Recommendations. JAMA network open, 4(9), e2124387.
• Kennedy, K. E., & Grandner, M. A. (2021). Sleep, Dreams, and Nightmares During the COVID-19 Pandemic. American journal of health promotion : AJHP, 35(8), 1168-1173.
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  The COVID-19 pandemic has affected the sleep and dreams of many individuals. Some have experienced improvements, while others have had more complaints. The changes to daily life such as working from home and spending more time indoors in confinement may have disturbed the circadian rhythms of some individuals. There were many reports of a shift towards a later bedtime during the pandemic, with several studies showing that in general, females experienced worse sleep than males, including more nighttime awakenings and nightmares. Increased dream and nightmare frequency during the pandemic has been shown in multiple studies. It has been postulated that because dreams are often guided by the dominant emotional state, that dreams and nightmares related to pandemic themes are a result of specific stressors related to COVID-19. Those experiencing unwanted sleep disturbances and nightmares could stand to benefit from mindfulness and relaxation practices that can ease stress and anxiety before bedtime. Striving to maintain a regular sleep schedule and enhance exposure to daylight-particularly during the first half of the day-may also be helpful.
• Knowlden, A. P., Higginbotham, J. C., Grandner, M. A., & Allegrante, J. P. (2021). Modeling Risk Factors for Sleep- and Adiposity-Related Cardiometabolic Disease: Protocol for the Short Sleep Undermines Cardiometabolic Health (SLUMBRx) Observational Study. JMIR research protocols, 10(3), e27139.
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  Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors.
• Krupp, K., Madhivanan, P., Killgore, W. D., Ruiz, J. M., Carvajal, S., Coull, B. M., & Grandner, M. A. (2021). Neurological Manifestations in COVID-19: An Unrecognized Crisis in Our Elderly?. Advances in geriatric medicine and research, 3(3).
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  As of December 2020, there were more than 900,000 COVID-19 hospitalizations in the US with about 414,000 among individuals aged 65 years and older. Recent evidence suggests a growing number of older patients continue to suffer serious neurological comorbidities including polyneuropathy, cerebrovascular disease, central nervous system infection, cognitive deficits, and fatigue following discharge. Studies suggest that complaints manifest late in disease and persist beyond resolution of acute COVID-19 symptoms. Recent research reports that neurocognitive symptoms are correlated with severe disease, older age, male gender, and comorbidities including hypertension, renal failure, and neoplastic disease. The underlying causes are unclear, but current hypotheses include hypoxic-ischemic brain injury, immunopathological mechanisms, and neurotropism of SARS-CoV-2 infection. There is a pressing need for more research into the underlying mechanisms of post-COVID-19 neurological sequela, particularly in the elderly, a population already burdened with neurocognitive disorders.
• Lee, R., Tapia, A., Kaladchibachi, S., Grandner, M. A., & Fernandez, F. X. (2021). Meta-analysis of light and circadian timekeeping in rodents. Neuroscience and biobehavioral reviews, 123, 215-229.
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  We conducted a meta-analysis of papers published over the past half-century (1964-2017) that quantified the phase-shifting effects of timed light exposure on rodent locomotor rhythms. Descriptive statistics were tabulated in order to explore the extent to which these studies were generalizable across species, sex, age, circadian timing, and light sources. Attempts at understanding photic resetting were primarily targeted at younger male animals, with particular emphases placed on characterizing the pacemaker systems of C57BL/6 mice and Syrian hamsters during the parts of their subjective night most sensitive to delivery of white-fluorescent light. With subsequent analyses restricted to these rodent models, we then assessed the relationship between luminous exposure (via broadspectrum emission) and phase-shifting through a series of linear regressions. Monotonically increasing illuminance-response functions were noted at most circadian times surveyed. In the aggregate, our results show that previous research conducted on light's regulation of circadian timekeeping has been skewed in design with respect to several important biological variables. This bias might limit translation of phototherapy-relevant data to women and older individuals.
• Lujan, M. R., Perez-Pozuelo, I., & Grandner, M. A. (2021). Past, Present, and Future of Multisensory Wearable Technology to Monitor Sleep and Circadian Rhythms. Frontiers in digital health, 3, 721919.
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  Movement-based sleep-wake detection devices (i.e., actigraphy devices) were first developed in the early 1970s and have repeatedly been validated against polysomnography, which is considered the "gold-standard" of sleep measurement. Indeed, they have become important tools for objectively inferring sleep in free-living conditions. Standard actigraphy devices are rooted in accelerometry to measure movement and make predictions, scoring algorithms, as to whether the wearer is in a state of wakefulness or sleep. Two important developments have become incorporated in newer devices. First, additional sensors, including measures of heart rate and heart rate variability and higher resolution movement sensing through triaxial accelerometers, have been introduced to improve upon traditional, movement-based scoring algorithms. Second, these devices have transcended scientific utility and are now being manufactured and distributed to the general public. This review will provide an overview of: (1) the history of actigraphic sleep measurement, (2) the physiological underpinnings of heart rate and heart rate variability measurement in wearables, (3) the refinement and validation of both standard actigraphy and newer, multisensory devices for real-world sleep-wake detection, (4) the practical applications of actigraphy, (5) important limitations of actigraphic measurement, and lastly (6) future directions within the field.
• Martinez, S. M., Blanco, E., Tschann, J. M., Butte, N. F., Grandner, M. A., & Pasch, L. A. (2021). Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis. The international journal of behavioral nutrition and physical activity, 18(1), 93.
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  Obesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets.
• Patterson, F., Brewer, B., Blair, R., Grandner, M. A., Hoopes, E., Ma, G., Criner, G. J., & Satti, A. (2021). An exploration of clinical, behavioral, and community factors associated with sleep duration and efficiency among middle-aged Black/African American smokers. Sleep health, 7(3), 397-407.
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  We examined the most important correlates to sleep duration and efficiency from a comprehensive array of multilevel factors.
• Perlis, M. L., Morales, K. H., Vargas, I., Muench, A., Seewald, M., Gooneratne, N., Grandner, M. A., Thase, M. E., Kaptchuk, T. J., & Ader, R. (2021). Durability of treatment response to zolpidem using a partial reinforcement regimen: does this strategy require priming?. Sleep medicine, 87, 56-61.
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  Previous research has shown that after one month of full dose nightly treatment with zolpidem (priming), subjects with chronic insomnia (CI) switched to intermittent dosing with medication and placebos were able to maintain their treatment responses. This approach to maintenance therapy is referred to as partial reinforcement. The present study sought to assess whether priming is required for partial reinforcement or whether intermittent dosing with placebos (50% placebos and 50% active medication) can, by itself, be used for both acute and extended treatment.
• Perlis, M. L., Morales, K. H., Vargas, I., Posner, D. A., Grandner, M. A., Muench, A. L., Seewald, M. W., Gooneratne, N. S., Kloss, J. D., Gencarelli, A. M., Khader, W. S., Thase, M. E., & Ellis, J. G. (2021). The natural history of insomnia: Does sleep extension differentiate between those that do and do not develop chronic insomnia?. Journal of sleep research, 30(5), e13342.
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  According to the "3P model" of insomnia, the variable that mediates the transition from acute insomnia (AI) to chronic insomnia is "sleep extension" (the behavioural tendency to expand sleep opportunity to compensate for sleep loss). In the present analysis, we sought to evaluate how time in bed (TIB) varies relative to the new onset of AI and chronic insomnia. A total of 1,248 subjects were recruited as good sleepers (GS). Subjects were monitored over 1 year with sleep diaries. State transitions were defined, a priori, for AI, recovered from AI (AI-REC), and for chronic insomnia (AI-CI). Two additional groupings were added based on profiles that were unanticipated: subjects that exhibited persistent poor sleep following AI (AI-PPS [those that neither recovered or developed chronic insomnia]) and subjects that recovered from chronic insomnia (CI-REC). All the groups (GS, AI-REC, AI-CI, AI-PPS and CI-REC) were evaluated for TIB differences with longitudinal mixed effects models. Post hoc analyses for the percentage of the groups that were typed as TIB "restrictors, maintainers, and expanders" were conducted using longitudinal mixed effects models and contingency analyses. Significant differences for pre-post AI TIB were not detected for the insomnia groups. Trends were apparent for the AI-CI group, which suggested that minor increases in TIB occurred weeks before the declared onset of AI. Additionally, it was found that a significantly larger percentage of AI-CI subjects engaged in sleep extension (as compared to GS). The present data suggest that transition from AI to chronic insomnia does not appear to be initiated by sleep extension and the transition may occur before the elapse of 3 months of ≥3 nights of sleep continuity disturbance. Given these findings, it may be that the mismatch between sleep ability and sleep opportunity is perpetuated over time given the failure to "naturally" engage in sleep restriction (as opposed to sleep extension).
• Perlis, M. L., Pigeon, W. R., Grandner, M. A., Bishop, T. M., Riemann, D., Ellis, J. G., Teel, J. R., & Posner, D. A. (2021). Why Treat Insomnia?. Journal of primary care & community health, 12, 21501327211014084.
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  "Why treat insomnia?" This question grows out of the perspective that insomnia is a symptom that should only receive targeted treatment when temporary relief is needed or until more comprehensive gains may be achieved with therapy for the parent or precipitating medical or psychiatric disorders. This perspective, however, is untenable given recent data regarding the prevalence, course, consequences, and costs of insomnia. Further, the emerging data that the treatment of insomnia may promote better medical and mental health (alone or in combination with other therapies) strongly suggests that the question is no longer "why treat insomnia," but rather "when isn't insomnia treatment indicated?" This perspective was recently catalyzed with the American College of Physicians' recommendation that chronic insomnia should be treated and that the first line treatment should be cognitive-behavioral therapy for insomnia (CBT-I).
• Rezaei, N., & Grandner, M. A. (2021). Changes in sleep duration, timing, and variability during the COVID-19 pandemic: Large-scale Fitbit data from 6 major US cities. Sleep health, 7(3), 303-313.
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  The COVID-19 pandemic has resulted in societal-level changes to sleep and other behavioral patterns. Objective data would allow for a greater understanding of sleep-related changes at the population level. About 163,524 active Fitbit users from 6 major US cities contributed data, representing areas particularly hard-hit by the pandemic (Chicago, Houston, Los Angeles, New York, San Francisco, and Miami). Sleep variables extracted include nightly and weekly mean sleep duration and bedtime, and variability (standard deviation) of sleep duration and bedtime. Deviation from similar timeframes in 2018 and 2019 were examined, as were changes in these sleep metrics during the pandemic, relationships to changes in resting heart rate, and changes during re-opening in May and June. Overall, compared to 2019, mean sleep duration in 2020 was higher among nearly all groups, mean sleep phase shifted later for nearly all groups, and mean sleep duration and bedtime variability decreased for nearly all groups (owing to decreased weekday-weekend differences). Over the course of January to April 2020, mean sleep duration increased, mean bedtime shifted later, and mean sleep duration variability decreased. Changes in observed resting heart rate correlated positively with changes in sleep and negatively with activity levels. In later months (May and June), many of these changes started to drift back to historical norms.
• Robbins, R., Grandner, M., Knowlden, A., & Severt, K. (2021). Examining key hotel attributes for guest sleep and overall satisfaction. Tourism and Hospitality Research, 21(Issue 2). doi:10.1177/1467358420961544
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  Introduction: Despite the fact that hotels provide a venue for sleeping, there is surprisingly little research that has explored sleep among hotel guests. The aim of this study is to identify the relationship between hotel attributes (e.g., light in the guestroom, bed linens), guest sleep, and overall guest satisfaction. Methods: Cross-sectional survey data were obtained from frequent business and leisure travelers (N = 609). Guest sleep satisfaction and overall guest satisfaction were measured on 5-point Likert scales. Participants were asked to report the extent to which hotel attributes (e.g., “Room too light or too dark”) related to their sleep on a scale from 1 (not at all) to 5 (very much). We used ordinal logistic regression to predict guest sleep and hotel satisfaction using hotel attributes as predictors while controlling for age, sex, and relationship status. Results: Hotel guest sleep did not differ between business and leisure travelers. Hotel guest sleep was inversely associated with “uncomfortable bed linen,” “uncomfortable pillows,” and “sound from the air conditioning unit or heater.” Regression revealed that sleep satisfaction was a strong predictor of overall hotel satisfaction. Conclusions: Our study suggests that guest sleep is be a critical component of the guest satisfaction equation. Importantly, our study illuminated the hotel attributes that offer the biggest contribution to hotel guest sleep and the specific steps for improving guest sleep.
• Robbins, R., Grandner, M., Knowlden, A., & Severt, K. (2021). Examining key hotel attributes for guest sleep and overall satisfaction. Tourism and hospitality research : the Surrey quarterly review, 21(2), 144-155.
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  Despite the fact that hotels provide a venue for sleeping, there is surprisingly little research that has explored sleep among hotel guests. The aim of this study is to identify the relationship between hotel attributes (e.g., light in the guestroom, bed linens), guest sleep, and overall guest satisfaction.
• Robbins, R., Piazza, A., Martin, R. J., Jean-Louis, G., Knowlden, A. P., & Grandner, M. A. (2021). Examining the relationship between poor sleep health and risky driving behaviors among college students. Traffic injury prevention, 22(8), 599-604.
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  Risky driving behaviors, such as texting while driving, are common among young adults and increase risk of traffic accidents and injuries. We examine the relationship between poor sleep and risky driving behaviors among college students as potential targets for traffic injury prevention. Data for this study were obtained from a cross-sectional survey administered to a college student sample in the United States Midwest (n = 1,305). Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI). Risky driving behaviors were measured, including sending texts/emails; reading texts/emails while driving; talking on the phone while driving; falling asleep while driving; and driving under the influence. Risky driving behavior was defined as a response of "just once," "rarely," "sometimes," "fairly often" or "regularly" (reference = "never"). Logistic regression was used to examine the relationship between sleep and risky driving, after adjusting for confounders. Among participants, 75% reported sending texts/emails while driving, 82% reported reading texts/emails while driving, and 84% reported phone talking while driving; 20% reported falling asleep while driving; 8% reported driving under the influence; and 62% reported 3 or more risky behaviors. Compared to those reporting no sleep disturbance, those with sleep disturbance "once or twice a week" were more likely to report sending a text/email while driving (aOR: 2.9, 95%CI:1.7-4.9), reading a text/email while driving (aOR:3.1,95%CI:1.5-5.5), talking on the phone while driving (aOR:1.9, 95%CI:1.0-3.4), and falling asleep while driving (aOR:3.4,95%CI:1.5-7.4). Compared to those reporting no daytime dysfunction, those reporting issues "once or twice a week" were more likely to report talking on the phone while driving (aOR:1.7, 95%CI:1.1-2.7) and falling asleep while driving (aOR:3.6,95%CI:2.3-5.6). Future research may consider designing behavioral interventions that aim to improve sleep, reduce drowsy driving among young adults.
• Taylor-Piliae, R. E., Morrison, H. W., Hsu, C. P., Whitman, S., & Grandner, M. (2021). The Feasibility of Tai Chi Exercise as a Beneficial Mind-Body Intervention in a Group of Community-Dwelling Stroke Survivors with Symptoms of Depression. Evidence-based complementary and alternative medicine : eCAM, 2021, 8600443.
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  Depression is prevalent among one-third to two-thirds of acute and chronic stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5-10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms. Thus, the feasibility of Tai Chi, alongside conventional care, to manage poststroke depression was investigated using a single-group pre-post intervention design. Recruitment and retention, intervention adherence, safety, acceptability, and fidelity were assessed. Symptoms of depression, anxiety, and stress were assessed using standardized questionnaires, objective sleep was assessed via a research-grade triaxial accelerometer, and blood samples were taken to measure oxidative stress, inflammatory markers, and a neurotrophic growth factor using commercially available kits per manufacturer's protocol. Pre-post intervention changes were assessed using paired -tests. We enrolled stroke survivors ( = 11, mean age = 69.7 ± 9.3) reporting depression symptoms. After the intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, =0.01), anxiety (-2.2 ± 2.4, =0.01), and stress (-4.6 ± 4.8, =0.01), along with better sleep efficiency (+1.8 ± 1.8, =0.01), less wakefulness after sleep onset (-9.3 ± 11.6, =0.04), and less time awake (-9.3 ± 11.6, =0.04). There was a 36% decrease in oxidative stress (=0.02), though no significant changes in the other biomarkers were found (all values >0.05). Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage poststroke depression, aid in reducing symptoms of anxiety and stress, and improve sleep.
• Tubbs, A. S., Fernandez, F. X., Ghani, S. B., Karp, J. F., Patel, S. I., Parthasarathy, S., & Grandner, M. A. (2021). Prescription medications for insomnia are associated with suicidal thoughts and behaviors in two nationally representative samples. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 17(5), 1025-1030.
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  Z-drugs (eszopiclone, zolpidem, and zaleplon) are commonly used for insomnia but are also associated with suicide risk. However, it is unclear if this association is unique to Z-drugs. Therefore, the present study estimated the associations between multiple prescription insomnia medications and suicidal thoughts and behaviors.
• Tubbs, A. S., Fernandez, F. X., Johnson, D. A., Perlis, M. L., & Grandner, M. A. (2021). Nocturnal and Morning Wakefulness Are Differentially Associated With Suicidal Ideation in a Nationally Representative Sample. The Journal of clinical psychiatry, 82(6).
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  Prior studies indicate nocturnal wakefulness is associated with suicide, while morning wakefulness is linked to reduced suicidal ideation. These relationships, however, may be confounded by sociodemographic factors. Therefore, this study investigated whether timing of wakefulness was associated with suicidal ideation in a nationally representative sample. Data were collected from the US National Health and Nutrition Examination Survey for the years 2015 to 2018, resulting in a final sample of 10,166 participants (51.1% female) with complete data available on suicidal ideation status, time to bed, and time out of bed. Population-weighted logistic regression models estimated the associations between time spent out of bed (ie, being awake) and suicidal ideation. A total of 385 survey participants (47.5% female) reported suicidal ideation in the past 2 weeks for a population-weighted prevalence of 3.37% (95% CI, 2.85%-3.87%). Wakefulness between 11:00 pm and 5:00 am was associated with suicidal ideation (OR = 1.16; 95% CI, 1.08-1.24 per hour), even after adjustment for sociodemographic factors and symptoms of sleep disorders, but not after adjustment for the severity of depression symptoms. Conversely, wakefulness between 5:00 am and 11:00 am was associated with reduced odds of suicidal ideation (OR = 0.77; 95% CI, 0.70-0.85 per hour) in all models. Individuals who spent more time awake at night were more likely to have recent suicidal ideation, while the opposite was true for those with more time spent awake in the morning. Moreover, these associations were independent of sociodemographic factors and thus not confounded by varying rates of suicidal ideation in different populations.
• Tubbs, A. S., Fernandez, F. X., Perlis, M. L., Hale, L., Branas, C. C., Barrett, M., Chakravorty, S., Khader, W., & Grandner, M. A. (2021). Suicidal ideation is associated with nighttime wakefulness in a community sample. Sleep, 44(Issue 1). doi:10.1093/sleep/zsaa128
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  Study Objectives: Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends. Methods: Data were collected from 888 adults aged 22-60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm-5 am) and morning (5 am-11 am) wakefulness and suicidal ideation. Results: Nocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28-1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08-1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72-0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75-0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09-1.44] per hour awake, p = 0.002). Conclusion: Wakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
• Tubbs, A. S., Kennedy, K. E., Alfonso-Miller, P., Wills, C. C., & Grandner, M. A. (2021). A Randomized, Double-Blind, Placebo-Controlled Trial of a Polyphenol Botanical Blend on Sleep and Daytime Functioning. International journal of environmental research and public health, 18(6).
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  Despite the high prevalence of subclinical sleep disturbances, existing treatments are either potent prescription medications or over-the-counter supplements with minimal scientific support and numerous side effects. However, preliminary evidence shows that polyphenols such as rosmarinic acid and epigallocatechin gallate can support healthy sleep without significant side effects. Therefore, the present study examined whether a polyphenol botanical blend (PBB) could improve sleep and/or daytime functioning in individuals with subclinical sleep disturbances. A total of 89 individuals completed a double-blind, randomized trial of daily treatment with PBB ( = 43) or placebo ( = 46) 30 min before bed for 30 days. Participants were monitored for changes in sleep (by sleep diary and an activity tracker), mood, and neurocognitive functioning. After 30 days, PBB improved diary sleep quality ( = 0.008) and reduced insomnia severity ( = 0.044) when compared to placebo. No other changes in sleep outcomes were observed. Additionally, PBB did not impair neurocognitive functioning, and some improvement was noted in vigilant attention, working memory, and risk assessment. Among individuals with subclinical sleep disturbances, PBB improved sleep quality, insomnia severity, and neurocognitive functioning over placebo. These findings indicate that polyphenol compounds may be useful for improving certain aspects of sleep without compromising neurocognitive functioning.
• Tubbs, A., Fernandez, F., Grandner, M., Perlis, M., & Klerman, E. (2021). The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology. Frontiers in Network Physiology, 1(Issue). doi:10.3389/fnetp.2021.830338
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  Sufficient sleep with minimal interruption during the circadian/biological night supports daytime cognition and emotional regulation. Conversely, disrupted sleep involving significant nocturnal wakefulness leads to cognitive and behavioral dysregulation. Most studies to-date have examined how fragmented or insufficient sleep affects next-day functioning, but recent work highlights changes in cognition and behavior that occur when someone is awake during the night. This review summarizes the evidence for day-night alterations in maladaptive behaviors, including suicide, violent crime, and substance use, and examines how mood, reward processing, and executive function differ during nocturnal wakefulness. Based on this evidence, we propose the Mind after Midnight hypothesis in which attentional biases, negative affect, altered reward processing, and prefrontal disinhibition interact to promote behavioral dysregulation and psychiatric disorders.
• Vargas, I., Perlis, M. L., Grandner, M., Gencarelli, A., Khader, W., Zandberg, L. J., Klingaman, E. A., Goldschmied, J. R., Gehrman, P. R., Brown, G. K., & Thase, M. E. (2021). Insomnia Symptoms and Suicide-Related Ideation in U.S. Army Service Members. Behavioral sleep medicine, 18(6), 820-836.
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  : Insomnia has been identified as a key risk factor for suicide, though most studies have been limited to global measures of these constructs. The aim of the present study was to evaluate the link between insomnia symptoms and five different aspects of suicide-related ideation. : 1,160 active U.S. Army service members (719 male; M = 31.2; SD = 8.62). : As part of an archival analysis, retrospectively assessed insomnia, depression, anxiety symptoms, as well as suicide-related ideation, were evaluated. Suicide-related ideation was assessed in terms of: thoughts of death, thoughts of suicide, suicidal plan, suicidal intent, and suicidal communication. : Subjects with clinically significant insomnia symptoms were 3.5 times more likely to report any suicide-related ideation, and approximately 3 times more likely to report thoughts of death and thoughts of suicide. More frequent nocturnal awakenings (i.e., waking up three or more times during a single night) were associated with a greater likelihood of reporting thoughts of death or suicide, whereas greater middle insomnia (i.e., waking up and having difficulty getting back to sleep) was associated with lower odds of experiencing thoughts of suicide, suicidal plan, and suicidal intent. : A more refined delineation of insomnia and suicide-related ideation may serve to clarify the nature of the association, and potentially offer some clues as to the underlying mechanisms. With regard to potential clinical implications, the results support that careful assessment of insomnia symptoms, suicide-related ideation, and their respective subtypes, is important and may influence how we estimate risk for suicide.
• Walsh, N., Halson, S., Sargent, C., Roach, G., Gupta, L., Leeder, J., Fullagar, H., Coutts, A., Edwards, B., Pullinger, S., Robertson, C., Burniston, J., Lastella, M., Le Meur, Y., Hausswirth, C., Bender, A., Grandner, M., Samuels, C., & Nédélec, M. (2021). Sleep and the athlete: Narrative review and 2021 expert consensus recommendations. British Journal of Sports Medicine, 55(7). doi:10.1136/bjsports-2020-102025
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  Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (
• Wills, C., Ghani, S., Tubbs, A., Fernandez, F. X., Athey, A., Turner, R., Robbins, R., Patterson, F., Warlick, C., Alfonso-Miller, P., Killgore, W. D., & Grandner, M. A. (2021). Chronotype and social support among student athletes: impact on depressive symptoms. Chronobiology international, 38(9), 1319-1329.
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  Previous studies have shown individuals with evening chronotype to have a greater likelihood for depression (self-reported and clinical ratings), especially in young adults. However, the mechanisms for this relationship remain unknown. Low levels of social support may be a plausible mechanism: young adults with evening chronotypes are awake when others are sleeping, which may lead to feelings of isolation or low support. This study examined links between chronotype, depression, and social support in relationship subtypes within a group of university student athletes. Data were obtained from 189 NCAA Division-I student athletes across all sports. Chronotype was assessed with the Circadian Energy Scale and ranged from -2 (definitely morning type) to +2 (definitely evening type). Depressive symptoms were assessed with Center for Epidemiological Studies Depression scale. Social support was assessed with the Multidimensional Scale of Perceived Social Support, which included subscales for Family, Friends, and Significant Other. A subscale for Team was created using the items from the Friends subscale (changing the word "friends" to "teammates"). Regression analyses adjusted for age, sex, and minority status. More evening chronotype was associated with higher reported depressive symptoms ( = .018), lower overall perceived social support ( = .001), and lower perceived social support specifically provided by family (
• Zhu, B., Grandner, M. A., Jackson, N. J., Pien, G. W., Srimoragot, M., Knutson, K. L., & Izci-Balserak, B. (2021). Associations between Diet and Sleep Duration in Different Menopausal Stages. Western journal of nursing research, 43(10), 984-994.
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  This study aimed to determine which dietary factors were associated with habitual sleep duration in pre/peri- and post-menopausal women. Data from the 2007-2008 National Health and Nutrition Examination Survey were used ( = 1,783). Habitual sleep duration was categorized as very short (
• Abdi, H., Athey, A., Auerbach, A., Grandner, M. A., Killgore, W. D., Turner, R. W., Turner, R., Wills, C. C., & Wills, C. C. (2020). 0240 College Football Players Compared to Other Collegiate Athletes: Symptoms of Insufficient Sleep Duration, Insomnia, and Sleep Apnea. Sleep, 43(Supplement_1), A92-A92. doi:10.1093/sleep/zsaa056.238
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  Abstract Introduction College athletes experience frequent sleep disturbances. Data from professional football players suggests high rates of sleep apnea symptoms. Little data is available on college football players, especially compared to other athletes. Methods Data were obtained from N=189 NCAA Division-I student athletes, including N=45 football players). Outcomes of interest came from the Sleep Disorders Symptom Check List (SDSCL) which rated symptoms on a frequency scale of 0: never and 4: >5 times/week. Symptoms evaluated were daytime tiredness, any snoring, loud snoring, breathing pauses during sleep, and waking up choking/gasping sleep apnea), as well as difficulty falling asleep, difficulty with nighttime awakenings, and early morning awakenings (insomnia). Other outcomes include self-reported sleep duration, Insomnia Severity Index, frequency of caffeine use, and frequency of use of medications to help with sleep. Linear and ordinal logistic regression analyses were adjusted for age, sex, year in school, socioeconomic status, and mood. Post-hoc analyses examined men only. Results Regarding sleep apnea symptoms, football players reported more snoring (oOR=3.14, p=0.01), loud snoring (oOR=4.38, p=0.008), breathing pauses (oOR=5.42, p=0.0499), and choking/gasping (oOR=8.51), but not daytime tiredness. Regarding insufficient sleep, football players reported no difference in sleep duration but decreased caffeine use (oOR=0.27, p=0.002). Regarding insomnia, football players showed no difference in ISI scores or insomnia symptoms, but increased likelihood of sleeping pill use (oOR=3.01, p=0.03). When analyses were restricted to men only, all of these relationships were maintained. Conclusion College football athletes may exhibit different sleep symptoms than other college athletes, as they exhibit more sleep apnea-related symptoms, without the increase in daytime symptoms, such as tiredness. Support The REST study was funded by an NCAA Innovations grant. Dr. Grandner is supported by R01MD011600
• Alamoodi, A., Arora, T., Grandner, M., Grey, I., Omar, O. M., & Östlundh, L. (2020). A systematic review and meta-analysis protocol of observational studies to assess the association between sleep and mental resilience in healthy individuals. Sleep Medicine Reviews. doi:10.21203/rs.3.rs-48076/v2
• Alkozei, A., Bajaj, S., Dailey, N. S., Grandner, M. A., Killgore, W. D., Raikes, A. C., & Vanuk, J. R. (2020). 0070 The Effects of Acute Blue Wavelength Light Exposure on Functional Brain Connectivity and Mood. Sleep, 43(Supplement_1), A28-A29. doi:10.1093/sleep/zsaa056.068
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  Abstract Introduction Blue wavelength light is an effective treatment for delayed sleep phase syndrome, seasonal affective disorder and bipolar depression. The role of blue light in regulating melatonin production has been extensively studied, but other potential neurophysiological effects remain poorly understood. Some studies have suggested that daily blue light exposure may modulate functional brain responses within the amygdala and prefrontal cortex (PFC), potentially explaining blue light’s antidepressant effect. In this study we investigated the effects of a single 30-minute session of blue light exposure on functional resting state connectivity between the amygdala and PFC. Methods Twenty-nine healthy 18–32 year olds were randomly assigned to either receive 30 minutes of blue (n=17) or non-blue (amber) light (n=12) exposure followed by a 7-minute resting state scan. Pre- and post light exposure, participants completed the Positive and Negative Affect Scale, as a measure of state affect. Results Individuals who received blue versus amber light showed greater positive connectivity between the right amygdala and the left dorsolateral prefrontal cortex (DLPFC) (x=-24, y=46, z=18, k=90, volume p-FDR corrected, p
• Alkozei, A., Bullock, A., Burns, A. I., Gould, J., Gould, J., Grandner, M. A., Jecmen, D., Killgore, W. D., King, R., Mitchell, J., Mitchell, J., Ralston, K., & Ralston, K. (2020). 0038 The Effects of Morning Blue Light Therapy on Insomnia Severity and PTSD Symptoms in a Clinical Sample. Sleep, 43(Supplement_1), A15-A16. doi:10.1093/sleep/zsaa056.037
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  Abstract Introduction Individuals with Post Traumatic Stress Disorder (PTSD) often present with insomnia, which may exacerbate other symptoms of the disorder. Morning Blue Light Therapy (BLT) can regulate circadian rhythms and may even improve sleep and mood in individuals with major depressive disorder. However, it is unclear whether morning BLT could also be an effective treatment for the insomnia associated with PTSD. We investigated whether 6 weeks of daily morning BLT would improve insomnia severity and symptom presentation in individuals with PTSD in comparison to a placebo condition of amber light (ALT). We hypothesized that changes in insomnia severity would correlate with improvement in PSTD symptom severity. Methods Forty-one participants with a clinical diagnosis of PTSD were randomized to receive 6 weeks of either daily morning BLT (n=22) or ALT (n=19). Insomnia and PTSD symptom severity were evaluated at pre- and post-treatment using the Insomnia Severity Index (ISI) and the Clinician-Administered PTSD Scale (CAPS) for DSM-5, respectively. Results Both groups showed a significant decrease in their PTSD symptom severity (p
• Alkozei, A., Bullock, A., Burns, A. I., Gould, J., Gould, J., Grandner, M. A., Jecmen, D., Killgore, W. D., King, R., Mitchell, J., Mitchell, J., Ralston, K., & Ralston, K. (2020). 0081 Habitual Sleep Duration is Negatively Correlated with Emotional Reactivity within the Rostral Anterior Cingulate Cortex in Individuals with PTSD. Sleep, 43(Supplement_1), A32-A33. doi:10.1093/sleep/zsaa056.079
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  Abstract Introduction Sleep difficulties, such as insomnia, are highly prevalent in individuals with Post-Traumatic Stress Disorder (PTSD). However, sleep deprivation can also increase emotional reactivity to positive (as well as negative) stimuli. While the effects of sleep loss on emotional perception healthy individuals has been documented, it remains unclear how lack of sleep in individuals with PTSD may affect their emotional reactivity to positive stimuli. We hypothesized that lower habitual sleep duration would be associated with greater functional brain activation changes in response to subliminally presented happy faces in brain areas of the reward network, such as the rostral anterior cingulate cortex (rACC). Methods Thirty-nine individuals with DSM-5 confirmed PTSD were administered the Pittsburgh Sleep Quality Index (PSQI) as a measure of their average nightly sleep duration over the past month. Participants then underwent fMRI imagining while viewing subliminal presentations of faces displaying happiness, using a backward masked facial affect paradigm to minimize conscious awareness of the expressed emotion. Brain activation to masked happy expressions was regressed against sleep duration in SPM12. Results There was a negative correlation between habitual sleep duration and activation within the rACC in response to the masked happy faces (x=14,y=40,z=0; k=102, pFWE-corr= 0.008). Conclusion Individuals with PTSD who average less sleep at night showed greater emotional reactivity, as indexed by greater functional brain activation changes within an area of the reward network, than individuals who obtained more sleep per night. Future research involving actual sleep duration manipulation will be necessary to determine whether this finding reflects the well-known antidepressant effect of sleep deprivation or a form of greater emotional expression error monitoring among traumatized patients when lacking sleep. Regardless, these findings suggest that insufficient sleep could affect unconsciously perceived emotion in faces and potentially affect social and emotional responses among individuals with PTSD. Support US Army Medical Research and Materiel Command: W81XWH-14-1-0570
• Alkozei, A., Bullock, A., Burns, A. I., Grandner, M. A., Killgore, W. D., Miller, M. A., Taylor, E. C., & Taylor, E. (2020). 1076 Self-referential Language In Trauma Narratives Predicts Shorter Sleep Duration In Women With Ptsd. Sleep, 43(Supplement_1), A410-A410. doi:10.1093/sleep/zsaa056.1072
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  Abstract Introduction The use of self-referential language, defined as first-person singular pronouns (e.g. I, me, my), in trauma narratives has been found to predict post-traumatic stress disorder (PTSD) severity. Additionally, taking a self-immersed perspective correlates with higher blood pressure reactivity than a self-distanced perspective. Given this relationship between self-immersed perspectives and physiological processes, we investigated the relationship between self-referential language and sleep in people with PTSD, as dysfunctional sleep is a major treatment target in this disorder. Methods Seventy-five participants (49 females; Mage=31.8, SDage=8.8) meeting DSM-5 criteria for PTSD were administered the PTSD Checklist for the DSM-5 (PCL-5) and the Pittsburg Sleep Quality Index (PSQI). Sleep duration was assessed with the PSQI. Participants provided typed descriptions of their traumatic event, which were then analyzed using the Linguistic Inquiry and Word Count 2015 software to count instances of first-person singular pronouns (“I” words). Linear regression, with PCL-5 scores and “I” words entered stepwise, was used to predict scores on the PSQI sleep duration subscale. Use of “I” words between the sexes was also compared. Results For females but not males, PTSD severity significantly predicted sleep duration (R2=.207, p=.001). Additionally, the number of “I” words in the trauma narratives predicted an additional 8% of the variance in sleep duration for females (R2 change=.083, β=.288, p=.029) but not males. Females used significantly more self-referential language in their narratives (M=11.84, SD=8.42) compared to males (M=5.25, SD=6.10, p=.001). Conclusion After controlling for PTSD severity, self-referential language in trauma narratives significantly predicted shorter sleep duration in females. While speculative, this finding suggests that treatment approaches for PTSD may benefit from a focus on targeting self-referential processes to improve sleep and PTSD in females but not males. As dysfunctional sleep is a hallmark of PTSD, further investigation into this relationship may illuminate a new treatment avenue for this disorder. Support W81XWH-14-1-0570
• Alkozei, A., Dailey, N. S., Grandner, M. A., Killgore, W. D., Raikes, A. C., & Vanuk, J. R. (2020). 1158 Daytime Sleepiness, Depression, And Post-concussive Symptoms Improve Following Prescribed Morning Exposure To Blue Light. Sleep, 43(Supplement_1), A441-A442. doi:10.1093/sleep/zsaa056.1152
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  Abstract Introduction Long-term sleep disruption, fatigue, and depression are common after mild traumatic brain injuries (mTBIs). Efficacious treatments for these disturbances in the context of mTBIs are lacking. Morning blue light therapy (BLT) effectively treats sleep disruption and improves mood. This study evaluated the treatment effects of morning BLT on post-mTBI daytime sleepiness, depression, and post-concussion symptoms. Methods 62 individuals (Boston: n=31; age: 23.11±7.20y; 17 females; days post-injury: 236.00±121.40; Tucson: n=31; age: 26.35±8.08y; 20 females; days post-injury: 272.94±167.69) received either BLT (n=30) or placebo amber light therapy (ALT; n=32). All participants completed the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Rivermead Post-concussion Symptom Questionnaire (RPQ3 and RPQ13 subscales) pre- and post-treatment. Treatment consisted of direct exposure to either blue or amber light (30 minutes each morning), delivered via tabletop light-box, over six weeks. Baseline and post-treatment values were compared to a non-mTBI, non-treated control sample (Tucson: n=32, age: 23.94±5.41y; 19 females). Results Baseline scores were higher in both mTBI light groups (BLT, ALT, respectively) than controls for the ESS (Cohen’s d=0.83, 0.83), PSQI (d=1.45, 1.71), BDI (d=1.46, 1.62), RPQ3 (d=1.72, 1.62) and RPQ13 (d=1.86, d=1.76). BLT resulted in lower within-group ESS (d=-0.58), BDI (d=-0.50), PSQI (d=-0.57), and RPQ13 (d=-0.45, p=0.005) scores. No improvements were seen following ALT. Minimal ESS score differences between the BLT and controls were observed after treatment (d=0.25). Conclusion Daily morning BLT resulted in moderate improvements in post-mTBI daytime sleepiness, sleep quality, depression, and post-concussion symptoms. These improvements may contribute to enhanced academic and job performance, post-mTBI quality of life, and general recovery. Future work is needed to clarify optimal dosage and precision medicine factors indentifying those most likely to benefit from morning BLT. Support This research was supported by multiple grants from the US Army Medical Research and Materiel Command (USAMRMC) to Dr. William D. S. Killgore, including W81XWH-11-1-0056 and W81XWH-14-1-0571.
• Alkozei, A., Dailey, N. S., Grandner, M. A., Killgore, W. D., Raikes, A. C., Taylor, E. C., Taylor, E., & Vanuk, J. R. (2020). 0079 Blue Light Exposure Enhances Neural Efficiency of the Task Positive Network During a Cognitive Interference Task. Sleep, 43(Supplement_1), A32-A32. doi:10.1093/sleep/zsaa056.077
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  Abstract Introduction Light exposure has powerful effects on the circadian timing of sleep and wake, primarily through the regulation of the secretion of melatonin. However, it is becoming clear that light has additional alerting effects beyond its primary effect on the circadian system. Exposure to light, particularly blue-wavelength light, has been shown to acutely increase brain activation, alertness, and some elementary aspects of cognitive performance such as working memory and emotional anticipation during the day. Whether blue light exposure can have longer-lasting effects on brain activation and performance during more complex cognitive control tasks up to 30-minutes after light cessation is unknown. Methods In a sample of 30 healthy adults, we examined the effects of a single 30-minute exposure to either blue (n=14) or amber placebo (n=16) light on subsequent brain activation and performance during the Multi-Source Interference Task (MSIT) measured a half-hour after light cessation using functional magnetic resonance imaging. Mean activation in all regions showing increased task-related activation (i.e., Task Positive Network; TPN) and regions showing decreased activation (i.e., Default Mode Network; DMN) at p
• Alkozei, A., Dailey, N. S., Grandner, M. A., Killgore, W. D., Raikes, A. C., Taylor, E. C., Taylor, E., & Vanuk, J. R. (2020). 0314 Resilience to Inhibitory Deficits During Sleep Deprivation is Predicted by Gray Matter Volume in the Ventrolateral and Ventromedial Prefrontal Cortex. Sleep, 43(Supplement_1), A118-A119. doi:10.1093/sleep/zsaa056.311
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  Abstract Introduction Stable, trait-like inter-individual resilience to sleep loss has been demonstrated for psychomotor vigilance, mood, subjective sleepiness, and some reasoning tasks, some of which have been associated with specific genetic or neurobiological markers. Resilience to executive control deficits induced by sleep deprivation (SD) has not been explored in terms of neurobiological markers. We, therefore, collected magnetic resonance imaging (MRI) scans of healthy individuals when well rested and correlated gray matter volume with resistance to inhibitory declines during 29 hours of SD. Methods Forty-five healthy individuals (22 female) ranging in age from 20 to 43 underwent structural MRI. Within 2-4 days after scanning, participants returned to the lab to undergo one night of SD, during which they completed a standard go/no-go task involving inhibitory processing every 4 hours. Scores were calculated as throughput (correct responses per working minute). The difference between performance in the evening (22:45) versus the performance the next morning (06:45) was calculated as an index of “inhibitory resilience.” Gray matter volume was regressed against the inhibitory resilience measure. Based on prior research, regions were constrained to the ventrolateral prefrontal cortex and ventromedial prefrontal cortex. Results Greater resilience against declines in inhibitory capacity during SD was predicted by 1) larger gray matter volume within the ventrolateral prefrontal cortex and 2) reduced volume within the ventromedial prefrontal cortex (p
• Ashare, R. L., Edwards, D. G., Grandner, M. A., Malone, S. K., Patterson, F., & Pohlig, R. T. (2020). Efficacy of a sleep health intervention to optimize standard smoking cessation treatment response: Results from a pilot randomized controlled trial. The Journal of Smoking Cessation, 15(2), 113-117. doi:10.1017/jsc.2020.8
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  BackgroundWe tested if an adjunctive sleep health (SH) intervention improved smoking cessation treatment response by increasing quit rates. We also examined if baseline sleep, and improvements in sleep in the first weeks of quitting, were associated with quitting at the end of treatment.MethodsTreatment-seeking smokers (N = 29) aged 21–65 years were randomized to a SH intervention (n = 16), or general health (GH) control (n = 13) condition. Participants received six counseling sessions across 15-weeks: SH received smoking cessation + SH counseling; GH received smoking cessation + GH counseling. Counseling began 4-weeks before the target quit date (TQD), and varenicline treatment began 1-week prior to TQD. Smoking status and SH were assessed at baseline (week 1), TQD (week 4), 3 weeks after cessation (week 7), week 12, and at the end of treatment (EOT; week 15).ResultsSH versus GH participants had higher Carbon Monoxide (CO) -verified, 7-day point prevalence abstinence at EOT (69% vs. 54%, respectively; adjusted odds ratio (aOR) = 2.10, 95% confidence interval (CI) = 0.40–10.69, P = 0.77). Higher baseline sleep efficiency (aOR = 1.42, 95% CI = 1.03–1.96, P = 0.03), predicted higher EOT cessation. Models were adjusted for age, sex, education, and baseline nicotine dependence.ConclusionsImproving SH in treatment-seeking smokers prior to cessation warrants further examination as a viable strategy to promote cessation.
• Athey, A., Auerbach, A., Charest, J., Charest, J., Clay, M. A., Grandner, M. A., Killgore, W. D., Turner, R. W., Wills, C. C., & Wills, C. C. (2020). 0236 Team-Based Athletes Sleep Less Than Individual Athletes, But Do Not Report More Insomnia or Fatigue. Sleep, 43(Supplement_1), A91-A91. doi:10.1093/sleep/zsaa056.234
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  Abstract Introduction Collegiate student-athletes face challenges balancing academics and athletics, and getting an adequate amount of sleep is one factor that can assist in sustaining an elite level of play. Team-based sports may present with systematically different sets of demands. Methods Data were obtained at the start of the academic semester from N=189 NCAA Division-1 athletes from a wide range of sports. The sample was 46% female. Individuals were classified as playing in a team sport (e.g., football, basketball, baseball, softball, volleyball) or an individual sport (e.g., swimming, track, golf). Sleep-related outcomes included self-reported sleep duration and sleep latency, frequency of sleeping pill use (Never, Rarely, Sometimes, Often), Insomnia Severity Index score, and Fatigue Severity Scale score. Regression analyses were adjusted for age and sex. Results In adjusted analyses, team-based athletes reported 22.4 minutes less sleep than individual athletes (95%CI -42.8,-1.9; p
• Barger, L. K., Czeisler, C. A., Grandner, M. A., Quan, S. F., Robbins, R., Rosenberg, E., Rosenberg, E., Weaver, M. D., & Zeepvat, J. (2020). 1187 What Types Of Organizations Provide Sleep-focused Workplace Health Promotion Programs For Their Employees? An Analysis Of The 2017 CDC Workplace Health In America Survey. Sleep, 43(Supplement_1), A453-A454. doi:10.1093/sleep/zsaa056.1181
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  Abstract Introduction There has been a rise in workplace health promotion programs (WHPP)’s in the U.S., designed to improve a variety of employee health behaviors such as exercise and nutrition. Yet, relatively few focus on the third pillar of health: Sleep. Methods The CDC collected data from a nationally-representative cohort of companies in 2017. Participants in this Workplace Health in America study completed online surveys reporting the type of WHPP offerings at their worksite and characteristics of their worksite, including occupational field (e.g., agriculture, management, wholesale/retail), workforce size (i.e., small:
• Barrett, M. S., Bastien, C. H., Branas, C. C., Grandner, M. A., Hale, L., Kapoor, A., Kapoor, A., Killgore, W. D., Perlis, M. L., Williams, N. J., Wills, C. C., & Wills, C. C. (2020). 1108 Associations Between Insomnia And Anxiety Symptoms: Which Elements Of Insomnia Are Associated With Which Elements Of Anxiety?. Sleep, 43(Supplement_1), A421-A422. doi:10.1093/sleep/zsaa056.1103
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  Abstract Introduction It is still not clear which aspects of insomnia are associated with various aspects of anxiety problems. Knowing this could better guide treatment of insomnia comorbid with anxiety. Methods Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 adults age 22-60. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty sleeping), DAYTIME symptoms (difficulty functioning), and PERCEPTION symptoms (dissatisfaction). GAD7 items included anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and fear. Logistic regression analyses examined each symptom, with each component of the ISI as predictor, as well as age, sex, race/ethnicity and education as covariates. Results SLEEP symptoms were independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were independently associated with anxiety level (OR=1.3, p
• Barrett, M. S., Branas, C. C., Chakravorty, S., Fernandez, F., Fernandez, F., Grandner, M. A., Hale, L., Khader, W. S., Killgore, W. D., Tubbs, A. S., Tubbs, A., Wills, C. C., & Wills, C. C. (2020). 0243 Community-Level Daytime Sleepiness and Substance Use: Implications of Sleep Time and Mental Health. Sleep, 43(Supplement_1), A93-A93. doi:10.1093/sleep/zsaa056.241
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  Abstract Introduction Daytime sleepiness is associated with impaired functioning and well-being. Those with more sleepiness may turn to illicit substances to overcome these problems. The present study examined whether community-level daytime sleepiness is associated with the likelihood of drug use. Methods Data were pulled from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 community adults (age 22–60). Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Use of different substances was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). The present analyses examined use within the past month of alcohol, tobacco, cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens, and illicit opioids. A separate item assessed caffeine. Ordinal logistic regression analyzed ESS score as a predictor of frequency of substance use adjusted for age, sex, education, and race/ethnicity. Additional models included habitual sleep duration and score on the PHQ9 depression scale. Results In sociodemographically-adjusted analyses, ESS score was associated with an increased risk of using tobacco (OR=1.04, p=0.015), cannabis (OR=1.04, p=0.014), cocaine (OR=1.07, p=0.009), amphetamines (OR=1.06, p=0.025), inhalants (OR=1.13, p=0.002), sedatives (OR=1.07, p=0.003), hallucinogens (OR=1.12, p=0.001), and opioids (OR=1.12, p=0.0001). Controlling for sleep duration did not significantly affect these relationships, while controlling for depression made every association non-significant except hallucinogens (OR=1.09, p=0.040). Conclusion Daytime sleepiness was associated with increased use of nearly all drug categories, but not alcohol or caffeine. Public consumption of alcohol and caffeine might be sufficiently common that the presence of their use cannot be adequately associated with sleepiness. Moreover, the increased frequency of drug use with sleepiness is not linked to sleep deprivation but may reflect emotional distress. Support This work was supported by a grant from Jazz Pharmaceuticals Dr. Grandner is supported by R01MD011600
• Barrett, M. S., Branas, C. C., Grandner, M. A., Hale, L., Killgore, W. D., Mason, B., Mason, B., Tubbs, A. S., Tubbs, A., Wills, C. C., & Wills, C. C. (2020). 1095 Use Of Mobile Devices At Night Associated With Mental Health In Young Adults. Sleep, 43(Supplement_1), A416-A417. doi:10.1093/sleep/zsaa056.1090
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  Abstract Introduction Mobile technology use in bed is becoming commonplace and associated with habitual short sleep duration. The present study examined whether device use at night was related to mental health. Methods Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study comes from a community-based sample, which was restricted to N=473 between the ages of 22-29. Device use was assessed as presence in the room at night, any use at night, texting, emailing, browsing the internet, making or receiving calls, and using social media. Participants were also asked how often they are woken by a call/alert from their phone (unplanned), how often they are woken by their phone alarm (planned), and how often they check their phone at night. These were recorded as never, rarely, some nights, almost every night, and every night, and were assessed as an ordinal outcome. Predictors included score on the Patient Health Questionnaire depression scale (PHQ9), GAD7 anxiety scale, Perceived Stress Scale (PSS), and Multidimensional Scale of Perceived Social Support (MSPSS). Ordinal logistic regression analyses were adjusted for age, sex, race/ethnicity, education, and income. Results Depression was associated with texting (oOR=1.03, p=0.025), email (oOR=1.03, p=0.022), internet (oOR=1.05, p=0.003), unplanned awakenings (oOR=1.05, p=0.001), and checking the phone (oOR=1.09, p
• Beebe, D. W., Byars, K. C., Carskadon, M. A., Grandner, M. A., Gruber, R., Hale, L., Mindell, J. A., Montgomery-downs, H. E., Owens, J. A., Robbins, R., Tapia, I. E., Wise, M. S., & Wolfson, A. R. (2020). 0408 Myths About Infant, Child, and Adolescent Sleep: Addressing False Beliefs That Hinder Sleep Health During These Crucial Developmental Stages. Sleep, 43(Supplement_1), A156-A156. doi:10.1093/sleep/zsaa056.405
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  Abstract Introduction Sleep is vital for healthy development from infancy through adolescence. Despite its importance, false beliefs that conflict with scientific evidence (myths) may be common among caregivers and impair sleep health during these crucial stages. Methods Researchers compiled a list of potential myth statements using internet searches of popular press and scientific literature. We utilized a Delphi process with experts (n=12) from the fields of pediatric, sleep, and circadian research and clinical practice. Selection and refinement of myths by sleep experts proceeded in three phases, including: focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on two dimensions: (1) falseness and (2) public health significance using 5-point Likert scale: 1 (“not at all”) to 5 (“extremely false/important”). Results Thirty-two sleep myths were identified across three developmental categories: infant (14 myths), child (6 myths), and adolescent (12 myths). Mean expert ratings illuminated the most pressing myths in each developmental category: infant sleep (“Sleep training causes psychological harm, including reduced parent-child attachment:” falseness =4.7, s.d.=0.7; public health significance=4.0, s.d.=1.1); child sleep (“Heavy, loud snoring for my child means he’s sleeping deeply:” falseness=4.8, s.d.=0.6; public health significance=4.7, s.d.=0.7), and teenager sleep (“Falling asleep in class means your teenager is lazy and not motivated:” falseness=4.8, s.d.=0.5; public health significance=4.3, s.d.=0.8). Conclusion The current study identified commonly-held myths about infant, child, and adolescent sleep that are not supported by (or worse, counter to) scientific evidence. If unchecked, these myths may hinder sleep at a critical developmental stage. Future research may include public health education to correct myths and promote healthy sleep among infants, children, and teenagers. Support 5T32HL007901
• Benca, R. M., Bertisch, S. M., Biddle, J., Boustani, M., Culpepper, L., Ferziger, R., Gooneratne, N. S., Grandner, M. A., Lett, J., Manderscheid, R., Mehra, R., Reynolds, C. F., & Wickwire, E. M. (2020). 1185 Developing A Care Pathway For Insomnia In Older Adults And Adults With Dementia: Results Of A Consensus Meeting. Sleep, 43(Supplement_1), A452-A453. doi:10.1093/sleep/zsaa056.1179
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  Abstract Introduction Insomnia among older adults and dementia patients carries a high public health burden. Yet, treatment is inconsistent or absent. Standardized, programmatic carepaths can be implemented in clinics/systems/communities to address this after tailoring to local environments. To determine what elements should be included, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building among diverse stakeholders. Methods Participants represented a wide range of stakeholders and specialties, including academic research, clinical care, industry, government, payors, sleep medicine, primary care, geriatrics, psychiatry, neurology, nursing, pharmacy, quality, and implementation science. 27 statements regarding key components of carepaths for insomnia in elderly and dementia populations were presented and discussed. These represented items addressing identification of patients, screening and assessment, deciding treatment modality and delivery, providing behavioral treatment, providing pharmacotherapy, addressing combined therapy, addressing comorbidities, and incorporating outcome evaluation. All N=20 participants voted individually whether they agreed or disagreed with each statement. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree. Results Despite diversity among attendees, median rate of agreement was 95% (IQR=85-95%). Mean score was 0.69 (SD=0.31). 95%CIs were computed for each proportion and compared to the mean. The following elements were significantly different from the mean (p
• Blair, R., Brewer, B., Gangemi, A., Grandner, M. A., Patterson, F., Satti, A., & Zantah, M. (2020). INCREASED SLEEP EFFICIENCY ASSOCIATED WITH INCREASED LUNG FUNCTION IN AFRICAN AMERICAN LIGHT SMOKERS: RESULTS FROM A PROSPECTIVE COHORT EXAMINATION. Chest, 157(6), A293. doi:10.1016/j.chest.2020.05.354
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  TYPE: Abstract Publication TOPIC: Obstructive Lung Diseases PURPOSE: We tested the extent to which improvements in sleep efficiency (percentage of time in bed, asleep) predicted improvements in lung function (FEV1/FVC ratio) in African American (AA) smokers. METHODS: Prospective data from 70 AA smokers, 40-65 years with Apnea–Hypopnea Index (AHI) 50%), were enrolled. Change in the FEV1/FVC ratio (measured by spiromotery) and sleep efficiency (measured using overnight WatchPAT) from baseline to a 1-year follow-up were calculated and dichotomized as increased from baseline or decreased. A logistic regression model of increased FEV1/FVC ratio was estimated, with increase in sleep efficiency as the key independent variable. Baseline smoking rate, age, sex, education, and AHI were covariates. RESULTS: The sample was 69% (n=48) female, mean age was 56.44 years (SD=5.6), and mean cigarettes per day (cpd) was 9.15 (7.0). Mean baseline FEV1/FVC was 0.87 (SD=.16), and sleep efficiency was 70% (SD=13.9). 53% (n=37) had increased FEV1/FVC, and 39% (n=27) had increased sleep efficiency. In a model of increased FEV1/FVC, increased sleep efficiency was not significant. However, the interaction term between increased sleep efficiency*smoking rate was significant (aOR=0.77, 95% CI=0.57-0.99) such that smokers who smoked
• Bombarda, A., Grandner, M. A., Jean-louis, G., Killgore, W. D., Seixas, A., Seixas, A. C., St-onge, M., Williams, N. J., Wills, C. C., & Wills, C. C. (2020). 0235 Sleep Duration and Timing Associated with Eating Behaviors: Data from NHANES 2015–2016. Sleep, 43(Supplement_1), A90-A91. doi:10.1093/sleep/zsaa056.233
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  Abstract Introduction Previous studies have shown that, in the laboratory, sleep deprivation leads to unhealthy eating patterns. In real-world samples, lack of sleep is associated with obesity. Few real-world studies of sleep and food intake patterns exist, especially from nationally-representative samples. Methods Data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) were used. NHANES is a national-representative survey collected by the CDC. N=6,291 participants provided data about dietary behaviors and sleep timing. Dietary behaviors included the number of meals not made at home in the past 7 days (NOTHOME), number of fast food/pizza meals in the past 7 days (FASTFOOD), number of pre-made meals in the past 30 days (PREMADE), and number of frozen meals in the past 30 days (FROZEN). Linear regression models examined these as outcomes and predictors including bedtime (minutes), waketime (minutes), sleep duration (hours), and daytime tiredness/fatigue (never, rarely, sometimes, often). Covariates included age, sex, education, income/poverty ratio, race/ethnicity, and body mass index. Results Number of meals not made at home (NOTHOME) was associated with a later bedtime (B=2.25, p=0.01) and shorter sleep duration (B=-0.12, p=0.01). FASTFOOD was associated with shorter sleep (B=-0.13,p=0.003) and tiredness/sleepiness sometimes (B=0.77, p=0.007) and often (B=0.55, p=0.03). FROZEN meals were associated with a later waketime (B=3.31, p=0.003) and tiredness/sleepiness sometime (B=1.20, p=0.025) and often (B=1.60, p=0.04). A sleep duration by bedtime interaction was not significant for any outcomes. In models that included overall levels of anxiety, these relationships were maintained. Conclusion This is one of the largest studies to show that habitual sleep patterns are associated with real-world food choices. In particular, shorter sleep duration and tiredness/sleepiness are associated with more ready-made and fast food meals. It is possible that lack of sleep leads to worse food choices, or that stress leads to both lack of sleep and easier food options. Given the often poor nutritive value of foods consumed outside the home and pre-prepared foods, these associations may in part explain the influence of sleep on cardiometabolic risk factors. Support Dr. Grandner is supported by R01MD011600
• Boyle, J. T., Ditomasso, R. A., Grandner, M. A., Perlis, M. L., Rosenfield, B., & Vargas, I. (2020). 0351 Sleep Continuity, Sleep-Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?. Sleep, 43(Supplement_1), A133-A133. doi:10.1093/sleep/zsaa056.348
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  Abstract Introduction It is well documented that sleep continuity (i.e., SC [ability to initiate and/or maintain sleep]) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, an analysis was undertaken to assess whether initial, middle, and/or late insomnia all exhibit age related change and whether problem endorsement and/or daytime dysfunction show comparable age-related changes. Methods The study utilized a cross-sectional group design in an archival/community dataset (www.sleeplessinphilly.com). This dataset (N=932) was comprised of adults between 18 and 89 years of age with self-reported sleep complaints. Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Age Adults (45-64 years); and Older Adults (65-89 years). Age groups were matched to the Older Adults group (n=233) by sex, race, and BMI. ANOVAs with Bonferroni corrections (alpha = .001), and contingency analyses were performed to assess for age group differences. Results It was found that, as expected, SC worsens with age but that this was limited to middle and late insomnia. Further, problem endorsement increased with age (except for SL) but sleep-related daytime dysfunction did not (except for concentration issues). Conclusion These results have several implications. Methodologically speaking, when evaluating the effects and/or correlates of SC, it may be wise to concomitantly assay “is this a problem for you” and “does this affect your daytime function”, as SC can occur without perceived daytime consequences, especially in older adults. Conceptually speaking, the observed discordance requires further exploration. In the past, it has been argued that sleep need is reduced in older adults. While this is a reasonable hypothesis (no need, no functional consequence), it remains to be demonstrated that older adults require less sleep. Support
• Brewer, B., Gangemi, A. J., Grandner, M. A., Hernandez, Y., Mayberry, S., Patterson, F., Satti, A., & Zantah, M. (2020). DUAL SMOKING AND VAPING ASSOCIATED WITH GREATER SLEEP DISTURBANCES. Chest, 157(6), A434. doi:10.1016/j.chest.2020.05.487
• Brewer, B., Grandner, M. A., & Patterson, F. (2020). Abstract MP24: Does Sleep Disturbance Vary Between Current Combustible and Electronic Cigarette Users?. Circulation, 141(Suppl_1). doi:10.1161/circ.141.suppl_1.mp24
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  Smoking cessation is critical to the goal of reducing cardiovascular diseases. Combustible cigarette smokers are more likely to have poor sleep health that is exacerbated upon cessation and can cause relapse. Use of electronic cigarettes has increased exponentially since their introduction to the market in 2007. Not known is the extent to which sleep disturbances that is common in combustible cigarette smokers is also associated with e-cigarette use. Using data collected as part of the Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between non-smoking, smoking combustible, electronic, and dual (combustible + electronic) cigarettes with sleep disturbances (short sleep duration, daytime sleepiness, insomnia symptoms). Exact matching was used to generate matched samples of non-smokers (n=472), combustible only (n=472), e-cigarette only (n=472), and dual use (n=472) smokers on the variables of age, sex, race, educational attainment, overweight/obese, and days of poor mental health in the last month. In a univariate linear regression model of insomnia symptoms, when compared to non-smokers, cigarette only smokers reported an average of 0.87 (p=0.038) more days of insomnia symptoms in the last month while dual users reported an average of 0.77 (p=0.063) more (Table 1). For daytime sleepiness, dual users reported an average of 0.85 (p=0.002) more days with daytime sleepiness in the last month as compared to non-smokers. In terms of sleep duration, when compared to non-smokers, cigarette smokers reported getting 0.28 (p=.021) fewer hours of sleep, and dual users reported getting 0.34 fewer hours of sleep (p=0.005). Overall, as compared to non-smokers, combustible and dual cigarette smokers in this sample reported more disturbed sleep. Dual use smokers may be particularly vulnerable to sleep deficits, that in turn, may impede efforts to quit smoking and improve cardiovascular health.
• Chakravorty, S., Fernandez, F., Fernandez, F., Grandner, M. A., Jean-louis, G., Khader, W. S., Killgore, W. D., Seixas, A. A., Tubbs, A. S., Tubbs, A., Williams, N. J., Wills, C. C., & Wills, C. C. (2020). 0232 Impact of Mental Health on 10-Year Trends in Habitual Sleep Duration. Sleep, 43(Supplement_1), A89-A90. doi:10.1093/sleep/zsaa056.230
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  Abstract Introduction Public health efforts aimed at reducing the decline in habitual sleep duration have not been successful. It is possible that this decline is differentially experienced relative to individuals’ mental health status. This would further support the need to focus on mental health as a strategy for improving sleep in the general population. Methods We examined 10 years of the National Health Interview Survey data (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height and weight (used to compute body mass index) were recorded in the same way. In addition, depressed mood in the past 30 days was evaluated (coded as none, mild, moderate, or severe). Weighted regression analyses examined sleep duration as an outcome, year and depressed mood as predictors, and sociodemographics as covariates. A year-by-depressed mood interaction was computed, and analyses were stratified by group. Results There was a significant year-by-depression interaction on linear change in sleep duration over the 10 year period (p=0.0001). Analyses were then stratified by depressed mood. In adjusted analyses, individuals with no depressed mood lost an average of 0.68 minutes of sleep per year (95%CI -0.82,-0.55; p
• Chakravorty, S., Grandner, M. A., Parthasarathy, S., Perlis, M. L., Rosenberg, E. A., Rosenberg, E. A., Wills, C. C., & Wills, C. C. (2020). 0120 Association Between Sleep Duration and Daytime Memory and Cognition Depends on Sleep Quality: Data from the 2017 Israel Social Survey. Sleep, 43(Supplement_1), A47-A48. doi:10.1093/sleep/zsaa056.118
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  Abstract Introduction This study examines the relationship between sleep duration, sleep disturbance, and cognitive problems in a representative sample of the Israeli population. Methods 7,230 Israelis responded to an Israeli Bureau of Statistics population-based survey of households from the year 2017. All variables were self-reported. Outcome of interest was difficulty with memory/concentration (none, mild, or severe). Predictors included previous month sleep duration (=9hrs) and sleep disturbance (none [reference], mild [1/week], moderate [2–3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Multinomial logistic regressions evaluated the relationships between variables, and post-hoc testing identified relationships within specific subgroups. Results 72.9% denied cognitive problems, 22.2% reported mild problems, and 4.9% severe problems. In adjusted analyses, Sleep =9hrs were associated with mild (RRR=1.39, p
• Chakravorty, S., Grandner, M. A., Parthasarathy, S., Perlis, M. L., Rosenberg, E., & Rosenberg, E. (2020). 0405 Sleep Duration and Sleep Disturbance Related to Obesity, Health, Motor Vehicle Safety, and Daytime Functioning in Israel: Data From the 2017 Israel Social Survey. Sleep, 43(Supplement_1), A155-A155. doi:10.1093/sleep/zsaa056.402
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  Abstract Introduction Previous studies suggest the Israeli population exhibits relatively short sleep duration and experiences sleep difficulties. This analysis evaluates the relationships between habitual sleep and outcomes of interest in this population. Methods Data were obtained from 7,230 Israeli individuals. The sample consisted a 2017 population-based survey of households, conducted by the Israeli Bureau of Statistics. All variables were self-reported. Outcomes of interest included drowsy driving, sleep medication use, functional impairment, sleepiness, overall health, 1-year health change, and obesity. Predictors included categories of sleep duration (=9 hours) and sleep disturbance in the past month (none [reference], mild [1/week], moderate [2-3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Binary and ordinal logistic regressions were employed to evaluate the relationship between them and post-hoc analyses evaluated the relationships between subgroups. Results Drowsy driving was associated with
• Charest, J., & Grandner, M. A. (2020). Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep medicine clinics, 15(1), 41-57.
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  Research has characterized the sleep of elite athletes and attempted to identify factors associated with athletic performance, cognition, health, and mental well-being. Sleep is a fundamental component of performance optimization among elite athletes, yet only recently embraced by sport organizations as an important part of training and recovery. Sleep plays a crucial role in physical and cognitive performance and is an important factor in reducing risk of injury. This article aims to highlight the prevalence of poor sleep, describe its impacts, and address the issue of sport culture surrounding healthy sleep.
• Crew, E. C., Baron, K. G., Grandner, M. A., Ievers-Landis, C. E., McCrae, C. S., Nadorff, M. R., Nowakowski, S., Margolies, S. O., & Hansen, K. (2020). The Society of Behavioral Sleep Medicine (SBSM) COVID-19 Task Force: Objectives and Summary Recommendations for Managing Sleep during a Pandemic. BEHAVIORAL SLEEP MEDICINE, 18(4), 570-572.
• Crew, E. C., Baron, K. G., Grandner, M. A., Ievers-Landis, C. E., McCrae, C. S., Nadorff, M. R., Nowakowski, S., Ochsner Margolies, S., & Hansen, K. (2020). The Society of Behavioral Sleep Medicine (SBSM) COVID-19 Task Force: Objectives and Summary Recommendations for Managing Sleep during a Pandemic. Behavioral Sleep Medicine, 18(Issue 4). doi:10.1080/15402002.2020.1776288
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  Objective/Background: As a response to clinical observations that the pervasive stress and social/environmental disruptions from the 2020 COVID-19 pandemic have also impacted sleep, the Society of Behavioral Sleep Medicine (SBSM) convened the COVID-19 Task Force with goals to identify and disseminate information that could be useful in addressing sleep concerns during this crisis. Participants Members of the SBSM COVID-19 Task Force. Results/Conclusions Herein is a summary of the resources developed by the SBSM COVID-19 Task force, which includes links to online materials developed for use by providers and patients, as well as brief descriptions of key recommendations by the Task Force for specific sleep conditions (e.g., acute insomnia, nightmares) and vulnerable populations (e.g., parents, essential/healthcare workers, older adults).
• Crew, E. C., Baron, K. G., Grandner, M. A., Ievers-Landis, C. E., McCrae, C. S., Nadorff, M. R., Nowakowski, S., Ochsner Margolies, S., & Hansen, K. (2020). The Society of Behavioral Sleep Medicine (SBSM) COVID-19 Task Force: Objectives and Summary Recommendations for Managing Sleep during a Pandemic. Behavioral sleep medicine, 1-3.
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  As a response to clinical observations that the pervasive stress and social/environmental disruptions from the 2020 COVID-19 pandemic have also impacted sleep, the Society of Behavioral Sleep Medicine (SBSM) convened the COVID-19 Task Force with goals to identify and disseminate information that could be useful in addressing sleep concerns during this crisis. Members of the SBSM COVID-19 Task Force. Herein is a summary of the resources developed by the SBSM COVID-19 Task force, which includes links to online materials developed for use by providers and patients, as well as brief descriptions of key recommendations by the Task Force for specific sleep conditions (e.g., acute insomnia, nightmares) and vulnerable populations (e.g., parents, essential/healthcare workers, older adults).
• D'antonio, B., Giller, J., Grandner, M. A., Muench, A., & Perlis, M. L. (2020). 0464 Sleep Continuity by Neighborhood: Are There Differences?. Sleep, 43(Supplement_1), A178-A178. doi:10.1093/sleep/zsaa056.461
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  Abstract Introduction To our knowledge, no prior work has been conducted on whether sleep continuity disturbance (e.g., SL; WASO; EMA, etc.) varies by neighborhood. While differences on these metrics have been found by, e.g., race and socioeconomic status, it may also be that sleep continuity disturbance varies relative to where one lives and works. Accordingly, an analysis was undertaken to assess whether regional differences exist with respect to sleep continuity disturbance (SCD). Methods The study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area (www.sleeplessinphilly.com). This dataset (n = 2840) was comprised of adults between 18 and 89 years of age with self-reported sleep complaints (63.4% female; 36.6% male; average age 38). Study subjects who endorsed >30 minutes on >3 days/week on SL, WASO & EMA were categorized by zip code and into four regional groups: Center City (n=258); South Philadelphia (n=103); North & Northeast Philadelphia (n=400) and West Philadelphia (n=345). Contingency analyses and ANOVAS were used to assess for regional group differences. Results It was found that SCD rates significantly differed by region. Differences in percent endorsement by region were as follows, SL:, 64.1% (Northeast/North), 63.5 (South), 56.3% (West Philadelphia), & 48.7% (Center City); WASO: 45% (Northeast/North), 40% (South), 36.5% (West Philly), & 32.4% (Center City); EMA: 46.4% (South); 43.7 (Northeast/North); 43.7 (West Philly); 43.1 (Center City). Conclusion The Northeast/North region of Philadelphia had the highest rates, and center city had the lowest rates of SCD for the early part of the night (SL & WASO). Early morning SCD was most common for “South Philly and least common for Center City. Analyses are on-going in relation to other regional differences (demographic, income, crime stats, etc.) and those found to vary by region will be assessed for their predictive value. Support No support was provided for this abstract
• Dailey, N. S., Grandner, M. A., Killgore, W. D., Raikes, A. C., & Vanuk, J. R. (2020). 0305 Grey Matter Volumetric Differences are Predictive of Attentional Lapses During Sleep Deprivation. Sleep, 43(Supplement_1), A115-A115. doi:10.1093/sleep/zsaa056.302
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  Abstract Introduction Inter-individual differences in resistance to cognitive effects of sleep loss are well established and extend from basic vigilance capacities to more nuanced emotional processing. Neurobiological markers related to gray matter volumetric differences associated with resilience to sleep deprivation (SD) have yet to be explored. We collected anatomical magnetic resonance imaging on well-rested healthy adults and correlated gray matter volume (GMV) with the number of lapses on a psychomotor vigilance test (PVT) subsequently occurring over 29-hours of SD. Methods 45 individuals (23 males; mean age: 25.36 ± 5.62y) completed a baseline neuroimaging session while well-rested and returned 2-4 days later to complete 29h of SD. The PVT was administered at one-hour intervals across SD. High-resolution T1 structural scans were used for a volume-based morphometric analysis (CAT12). Images were segmented and normalized following automated procedures and smoothed at 8 mm FWHM. Regions of interest were constrained to the anterior cingulate and ventral frontal areas of the cortex. GM volume was correlated with the total number of lapses across all PVT administrations, after controlling for age, sex, and total intracranial volume. Results Total number of lapses positively correlated with GMV in two clusters comprised of areas in the anterior cingulate cortex (FWE corrected, p = 0.046), as well as the opercular and triangular parts of the inferior frontal gyrus (FWE corrected, p = 0.006). Conclusion Susceptibility to attentional lapses was predicted by greater gray matter volume in the ventrolateral prefrontal and anterior cingulate cortices. Current findings support that individual differences in attentional resiliency during SD may be, in part, due to differences in gray matter volume within cortical areas previously shown to be functionally affected by sleep loss. Support DARPA (12-12-11-YFA11-FP-029)
• Fernandez, F. X., Flygare, J., & Grandner, M. A. (2020). Narcolepsy and COVID-19: sleeping on an opportunity?. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(8), 1415.
• Fernandez, F., Fernandez, F., Grandner, M. A., Jean-louis, G., Khader, S., Killgore, W. D., Patterson, F., Seixas, A. A., Williams, N. J., Wills, C. C., & Wills, C. C. (2020). 0374 Decline in Habitual Sleep Duration Over 10 Years and Worsening Sleep Disparities: Data From NHIS (2006-2015). Sleep, 43(Supplement_1), A143-A143. doi:10.1093/sleep/zsaa056.371
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  Abstract Introduction Despite claims in the media, evidence that habitual sleep has declined in recent years is scant. Few data sources exist that systematically document sleep duration in a nationally representative sample, in the same way, over several years. Methods Data from 10 years of the National Health Interview Survey were used (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height/weight were recorded in the same way. Weighted regression analyses examined sleep duration as the outcome, year as linear predictor, and sociodemographics as covariates. Then, interaction terms examined whether the linear change associated with years was differentially experienced by different sociodemographic groups. Results The linear trend of sleep duration over the past 10 years is a loss of 0.78 minutes per year (95%CI -0.91,-0.64; p
• Gangemi, A. J., Satti, A., Zantah, M., Blair, R., Brewer, B., Ma, G., Grandner, M. A., Davey, A., Criner, G. J., & Patterson, F. (2020). Sleep Duration and Efficiency Associated With Better Functional Exercise Capacity in Black Smokers at Risk for COPD. Chest.
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  Black smokers have earlier development of lung disease as well as poorer sleep health than whites.
• Ghani, S. B., Delgadillo, M. E., Granados, K., Okuagu, A. C., Alfonso-Miller, P., Buxton, O. M., Patel, S. R., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Williams, N., Jean-Louis, G., & Grandner, M. A. (2020). Acculturation Associated with Sleep Duration, Sleep Quality, and Sleep Disorders at the US-Mexico Border. International journal of environmental research and public health, 17(19).
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  Sleep disparities exist among Hispanics/Latinos, although little work has characterized individuals at the United States (US)-Mexico border, particularly as it relates to acculturation. This study examined the association of Anglo and Mexican acculturation to various facets of sleep health among those of Mexican descent at the US-Mexico border. Data were collected from = 100 adults of Mexican descent in the city of Nogales, Arizona (AZ). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II). Insomnia was assessed with the Insomnia Severity Index (ISI), sleepiness was assessed with the Epworth Sleepiness Scale (ESS), sleep apnea risk was assessed with the Multivariable Apnea Prediction (MAP) index, weekday and weekend sleep duration and efficiency were assessed with the Sleep Timing Questionnaire, sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and sleep duration and sleep medication use were assessed with PSQI items. No associations were found between Mexican acculturation and any sleep outcomes in adjusted analyses. Anglo acculturation was associated with less weekend sleep duration and efficiency, worse insomnia severity and sleep quality, and more sleep apnea risk and sleep medication use. These results support the idea that sleep disparities may depend on the degree of acculturation, which should be considered in risk screening and interventions.
• Gooding, H. C., Gidding, S. S., Moran, A. E., Redmond, N., Allen, N. B., Bacha, F., Burns, T. L., Catov, J. M., Grandner, M. A., Harris, K. M., Johnson, H. M., Kiernan, M., Lewis, T. T., Matthews, K. A., Monaghan, M., Robinson, J. G., Tate, D., Bibbins-Domingo, K., & Spring, B. (2020). Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. Journal of the American Heart Association, 9(19), e016115.
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  Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants
• Grandner, M. A. (2020). Abstract P392: Nocturia Frequency As A Novel Cardiometabolic Disease Risk Factor. Circulation, 141(Suppl_1). doi:10.1161/circ.141.suppl_1.p392
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  Introduction: Nocturia causes sleep disturbances and is more common as people age. Therefore, it often overlaps with cardiometabolic risk factors. However, relationships between nocturia frequency ...
• Grandner, M. A. (2020). Sleep, Health, and Society. Sleep medicine clinics, 15(2), 319-340.
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  Biological needs for sleep are met by engaging in behaviors that are largely influenced by the environment, social norms and demands, and societal influences and pressures. Insufficient sleep duration and sleep disorders such as insomnia and sleep apnea are highly prevalent in the US population. This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology.
• Grandner, M. A., & Lujan, M. R. (2020). Sleep Science Edited by Hawley Montgomery-Downs: 475 pages, Oxford University Press, Oxford, UK.. Sleep and Vigilance, 4(2), 253-254. doi:10.1007/s41782-020-00116-2
• Grandner, M. A., Guerra, S., Haynes, P. L., Parthasarathy, S., & Quan, S. F. (2020). Does a Peer Support Program Improve Satisfaction With Treatment Among Patients With Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine. doi:10.25302/04.2020.ihs.130602505
• Grandner, M. A., Jean-louis, G., Jin, P., Jin, P., Liu, M., Mcfarlane, S. I., Nunes, J., Rogers, A., & Seixas, A. C. (2020). 1062 The Role of Sleep in Sex and Racial/Ethnic Differences in 10-Year CVD Risk in the Sleep Heart Health Study: The Use of Machine-Learnt and Precision Insights to Understand Racial/Ethnic and Sex Differences in Sleep-CVD Disparity. Sleep, 43(Supplement_1), A403-A405. doi:10.1093/sleep/zsaa056.1058
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  Abstract Introduction The current study investigated whether insufficient sleep (
• Grandner, M. A., Killgore, W. D., Meinhausen, C. E., & Vanuk, J. R. (2020). 0307 Gray Matter Volume Correlates of Psychomotor Vigilance Speed During Sleep Deprivation. Sleep, 43(Supplement_1), A116-A116. doi:10.1093/sleep/zsaa056.304
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  Abstract Introduction Sleep deprivation has often been associated with decreased cognitive control, including deficits in the ability to sustain attention. Psychomotor vigilance speed slows following a period of fatigue, and can lead to disastrous results in daily life. In order to determine the brain areas correlated with reduced psychomotor vigilance speed, as a result of diminished sleep, a voxel-based morphometry analysis was performed prior to a period of monitored sleep deprivation. The mean speed of response time during the final 17 hours of a 29-hour sleep deprivation was then measured with the Psychomotor Vigilance Test (PVT), a reaction-timed task that measures the speed participants respond to a visual stimulus. Methods 45 healthy individuals (male=23 female=22) between the ages of 20-43 years (M=25.4 SD=5.6) participated in the study. Structural neuroimaging data were collected using a T3 magnetic resonance imaging scanner following a typical night’s sleep. Mean PVT speed was monitored with an hourly 10-minute PVT assessment during a monitored overnight sleep deprivation session. Speed was defined as the reciprocal of reaction time (1/RT). Results PVT speed was negatively correlated with grey matter volume (P
• Grandner, M. A., Klingman, K. J., Morse, A. M., Perlis, M. L., & Williams, N. J. (2020). 1174 Assessing Sleep Disorders in Primary Care: A Provider Survey About the Importance of Sleep Health. Sleep, 43(Supplement_1), A448-A448. doi:10.1093/sleep/zsaa056.1168
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  Abstract Introduction Conditions commonly managed by primary care providers (PCPs) such as depression, diabetes, and heart disease, commonly co-occur with sleep disorders. If PCPs could readily identify comorbid sleep disorders in this context, it may provide a pathway to more effective management of both types of disorders. Currently, it is unknown what might encourage or discourage PCPs from routinely screening their patients for sleep disorders. Methods PCPs from UPENN and GHS completed surveys regarding sleep health. The 30-item instrument comprised demographic, 14 VAS (0%-100%=strongly disagree-strongly agree), 4 open-ended, 3 yes/no, and 2 multiple-choice questions. Results Ninety-nine PCPs responded and were predominately female (61% F, 37%M, 2% other), Caucasian (81%), on-average 45yrs old (25-70) and in primary care for 16yrs (1-43). Fifty-six percent were MDs, 21%DOs, 17%PAs, and 6%NPs. PCPs rated sleep disorders as highly important for cardiopulmonary, mental, and general health (85, 84, & 83%), with no difference (per linear regression, p>0.05) according to system or provider characteristics. PCPs reported high importance for knowing about and diagnosing sleep disorders (88% & 82%) within their practices. Lower comfort levels were reported for discussing (78%) sleep disorders, overseeing/following (62%), diagnosing (60%), or treating (48%) patients. Eighty percent of PCPs stated an efficient sleep disorders screener would be useful for their practice; this perception varied (per logistic regression) according to provider credentials (Wald=0.037) and Hispanic/Latino ethnicity (Wald=0.025). PCPs reported time constraints limit their responsiveness to sleep disorders Conclusion A large disparity exists between the importance PCPs place on sleep disorders and their low comfort levels with following, diagnosing, and treating sleep disorders. PCPs endorsed the need to have available an efficient sleep disorders screener to use in their practice. Support No funding was received for this study.
• Grandner, M. A., Klingman, K. J., Morse, A. M., Perlis, M. L., & Williams, N. J. (2020). 1175 Sleep Disorders Screening in Primary Care: Prevalence of Diagnosis and Treatment in the EMR. Sleep, 43(Supplement_1), A448-A449. doi:10.1093/sleep/zsaa056.1169
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  Abstract Introduction Undetected and untreated sleep disorders likely precipitate or exacerbate medical and/or psychiatric illnesses. Given this, primary care is an ideal point for managing sleep disorders, yet prior research shows that PCPs diagnose and/or treat sleep disorders at rates far below population prevalences. The purpose of this study was to determine the current rate of detection and treatment of sleep disorders within primary care settings. Methods EMR data from two health care systems was analyzed. The proportion of PCPs diagnosing and treating one or more sleep disorders was calculated (per year) for 5 years (2014-2018). Also calculated was the percent of PCP caseload diagnosed and/or treated for sleep disorders. Results The two systems comprised n=1021 PCPs. From 2014-2018, the proportion of PCPs diagnosing patients with sleep disorders fluctuated between 58-89%. The proportion treating sleep disorders fluctuated between 50-91%. Non-parametric one-sample run tests (SPSS) indicate these are random distributions (p>0.05). PCPs’ use of medications to treat sleep disorders is trending downward over time within one system (per linear regression, p=0.03, R-squared=0.8). Other temporal trends were not evidenced. The average percentage of diagnosed and treated patients per PCP was around 2.5% of their caseloads. Between-system differences were observed. Conclusion There is a profound mismatch between percentage of PCPs identifying patients with sleep disorders (60-90%) and the percentage of patient caseload diagnosed and/or treated for sleep disorders (2.5%). This suggests that the majority of PCPs are willing to assess for sleep health but do so in only a small minority of patients. These data, along with our survey data (elsewhere in this volume) suggest that the intention-action gap could be closed if PCPs were appropriately resourced. Support There was no funding for this study.
• Grandner, M. A., Olivier, K., Gallagher, R., Hale, L., Barrett, M., Branas, C., Killgore, W. D., Parthasarathy, S., Gehrels, J. A., & Alfonso-Miller, P. (2020). Quantifying impact of real-world barriers to sleep: The Brief Index of Sleep Control (BRISC). Sleep health.
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  Lack of control over sleep may contribute to population-level sleep disturbances, yet relatively little work has explored the degree to which an individual's sense of control over their sleep may represent an important factor.
• Khader, W. S., Fernandez, F. X., Seixas, A., Knowlden, A., Ellis, J., Williams, N., Hale, L., Branas, C., Perlis, M., Jean-Louis, G., Killgore, W. D., Alfonso-Miller, P., & Grandner, M. A. (2020). What makes people want to make changes to their sleep? Assessment of perceived risks of insufficient sleep as a predictor of intent to improve sleep. Sleep health.
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  The objective of the present study is to identify which underlying beliefs about the impact of sleep on health may motivate change in sleep behavior.
• Khader, W. S., Tubbs, A. S., Haghighi, A., Athey, A. B., Killgore, W. D., Hale, L., Perlis, M. L., Gehrels, J. A., Alfonso-Miller, P., Fernandez, F. X., & Grandner, M. A. (2020). Onset insomnia and insufficient sleep duration are associated with suicide ideation in university students and athletes. Journal of affective disorders, 274, 1161-1164.
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  Previous work has shown that poor sleep is a prospective risk factor for suicide in clinical populations and might contribute to risk in the general population. The present study evaluated whether sleep distress, onset insomnia, and insufficient sleep are associated with suicide ideation in university students and athletes participating in the 2011-2014 National College Health Assessment (NCHA; n = 113,185).
• Khader, W. S., Tubbs, A. S., Haghighi, A., Athey, A. B., Killgore, W., Hale, L., Perlis, M. L., Gehrels, J., Alfonso-Miller, P., Fernandez, F., & Grandner, M. A. (2020). Onset insomnia and insufficient sleep duration are associated with suicide ideation in university students and athletes. JOURNAL OF AFFECTIVE DISORDERS, 274, 1161-1164.
• Killgore, W. D., Cloonan, S. A., Taylor, E. C., Fernandez, F., Grandner, M. A., & Dailey, N. S. (2020). Suicidal ideation during the COVID-19 pandemic: The role of insomnia. Psychiatry research, 290, 113134.
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  There is growing concern over the potential for increased suicide risk in vulnerable populations as the COVID-19 pandemic unfolds. To contextualize this risk during the first weeks of the nationwide lockdown efforts, we had 1,013 U.S. adults complete questionnaires assessing worries over COVID-19, insomnia severity, and suicidal ideation. Anxiety about COVID-19 correlated positively with insomnia severity and suicidal ideation. Analysis revealed that the statistical association between pandemic fears and suicidal thinking was fully accounted for by insomnia severity, suggesting that interventions aimed at improving sleep may be useful in reducing suicide risk during the current pandemic.
• Perlis, M. L., Vargas, I., Ellis, J. G., Grandner, M. A., Morales, K. H., Gencarelli, A., Khader, W., Kloss, J. D., Gooneratne, N. S., & Thase, M. E. (2020). The Natural History of Insomnia: the incidence of acute insomnia and subsequent progression to chronic insomnia or recovery in good sleeper subjects. SLEEP, 43(6).
• Perlis, M. L., Vargas, I., Ellis, J. G., Grandner, M. A., Morales, K. H., Gencarelli, A., Khader, W., Kloss, J. D., Gooneratne, N. S., & Thase, M. E. (2020). The natural history of Insomnia: The incidence of acute insomnia and subsequent progression to chronic insomnia or recovery in good sleeper subjects. Sleep, 43(Issue 6). doi:10.1093/sleep/zsz299
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  Study Objectives: The primary aim of the present study was to estimate the incidence per annum of acute insomnia and to what extent those that develop acute insomnia recover good sleep or develop chronic insomnia. Unlike prior studies, a dense-sampling approach was used here (i.e. daily diaries) and this allowed for a more precise detection of acute insomnia and the follow-on states (the transitions to either recovery or chronic insomnia). Methods: Good sleeper subjects (n = 1,248; 67% female) that were at least 35 years old participated in this prospective study on the natural history of insomnia. Subjects were recruited nationwide and completed online assessments for 1 year. The online measures consisted primarily of daily sleep diaries, as well as weekly/ bi-weekly and monthly measures of sleep, stress, and psychological and physical health. Results: The 1-year incidence rate of acute insomnia was 27.0% (n = 337). The incidence rate of chronic insomnia was 1.8% (n = 23). Of those that developed acute insomnia, 72.4% (n = 244) went on to recover good sleep. 19.3% (n = 65) of the acute insomnia sample continued to experience persistent poor sleep, but did not meet criteria for chronic insomnia. Conclusions: The incidence rate of acute insomnia (3 or more nights a week for between 2 and 12 weeks) is remarkably high. This said, most incident cases resolve within a few days to weeks. Incident chronic insomnia only occurs in about 2 in 100 individuals.
• Petrov, M. E., Long, D. L., Grandner, M. A., MacDonald, L. A., Cribbet, M. R., Robbins, R., Cundiff, J. M., Molano, J. R., Hoffmann, C. M., Wang, X., Howard, G., & Howard, V. J. (2020). Racial differences in sleep duration intersect with sex, socioeconomic status, and U.S. geographic region: The REGARDS study. Sleep health.
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  Short and long sleep duration are associated with poor health outcomes and are most prevalent among racial/ethnic minorities. Few studies have investigated the intersection of other sociodemographic characteristics with race/ethnicity on sleep duration prevalence.
• PhD, A. N., Rhee, J. U., Haynes, P., Chakravorty, S., Patterson, F., Killgore, W. D., Gallagher, R. A., Hale, L., Branas, C., Carrazco, N., Alfonso-Miller, P., Gehrels, J. A., & Grandner, M. A. (2020). Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration. Sleep health.
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  Insomnia is a clinically verified nicotine withdrawal symptom. As nicotine is a stimulant, it is plausible that smoking at night could disturb sleep more than smoking at earlier times of the day, but this remains empirically unclear. This study examined smoking status and its associations with insomnia severity and sleep duration while considering the potential role of smoking time.
• Raikes, A. C., Athey, A., Alfonso-Miller, P., Killgore, W., & Grandner, M. A. (2020). Author response: concussion assessment tools - A possible measure of sleepiness?. SLEEP MEDICINE, 66, 260-261.
• Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., Derevensky, J. L., Glick, I. D., Gorczynski, P., Gouttebarge, V., Grandner, M. A., Han, D. H., McDuff, D., Mountjoy, M., Polat, A., , Purcell, R., et al. (2020). Infographic. Sleep disorders in athletes. British journal of sports medicine, 54(3), 188-189.
• Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., Derevensky, J. L., Glick, I. D., Gorczynski, P., Gouttebarge, V., Grandner, M. A., Han, D. H., McDuff, D., Mountjoy, M., Polat, A., , Purcell, R., et al. (2020). Infographic: Mental health in elite athletes. An IOC consensus statement. British journal of sports medicine, 54(1), 49-50.
• Robbins, R., Weaver, M. D., Quan, S. F., Rosenberg, E., Barger, L. K., Czeisler, C. A., & Grandner, M. A. (2020). Employee Sleep Enhancement and Fatigue Reduction Programs: Analysis of the 2017 CDC Workplace Health in America Poll. American journal of health promotion : AJHP, 890117120969091.
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  Poor sleep health, including sleep deficiency and sleep disturbance, is common among employed adults in the U.S. and is associated with undesirable workplace outcomes. Adoption of workplace health promotion programs (WHPPs) is increasing, yet few programs aim to reduce fatigue or improve sleep among employees.
• Seixas, A. A., Moore, J., Chung, A., Robbins, R., Grandner, M., Rogers, A., Williams, N. J., & Jean-Louis, G. (2020). Benefits of Community-Based Approaches in Assessing and Addressing Sleep Health and Sleep-Related Cardiovascular Disease Risk: a Precision and Personalized Population Health Approach. CURRENT HYPERTENSION REPORTS, 22(8).
• Seixas, A. A., Moore, J., Chung, A., Robbins, R., Grandner, M., Rogers, A., Williams, N. J., & Jean-Louis, G. (2020). Benefits of Community-Based Approaches in Assessing and Addressing Sleep Health and Sleep-Related Cardiovascular Disease Risk: a Precision and Personalized Population Health Approach. Current hypertension reports, 22(8), 52.
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  In this current review, we describe the benefits of community-based and "precision and personalized population health" (P3H) approaches to assessing and addressing sleep health problems and sleep-related cardiovascular diseases (CVD) among vulnerable populations such as racial/ethnic minorities, the elderly, and the socioeconomically disadvantaged.
• Tubbs, A. S., Fernandez, F. X., Perlis, M. L., Hale, L., Branas, C. C., Barrett, M., Chakravorty, S., Khader, W., & Grandner, M. A. (2020). Suicidal ideation is associated with nighttime wakefulness in a community sample. Sleep.
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  Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends.
• Tubbs, A. S., Gallagher, R., Perlis, M. L., Hale, L., Branas, C., Barrett, M., Gehrels, J., Alfonso-Miller, P., & Grandner, M. A. (2020). Relationship between insomnia and depression in a community sample depends on habitual sleep duration. SLEEP AND BIOLOGICAL RHYTHMS, 18(2), 143-153.
• Tubbs, A. S., Harrison-Monroe, P., Fernandez, F. X., Perlis, M. L., & Grandner, M. A. (2020). When reason sleeps: attempted suicide during the circadian night. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Disrupted sleep and nocturnal wakefulness are evidence-based risk factors for suicidal thoughts and behaviors. We present a suicide attempt following a rapid increase in nocturnal wakefulness. This case illustrates how nocturnal wakefulness may drive suicide risk through circadian misalignment.
• Tubbs, A. S., Khader, W., Fernandez, F., & Grandner, M. A. (2020). The common denominators of sleep, obesity, and psychopathology. CURRENT OPINION IN PSYCHOLOGY, 34, 84-88.
• Tubbs, A. S., Perlis, M. L., Basner, M., Chakravorty, S., Khader, W., Fernandez, F., & Grandner, M. A. (2020). Relationship of Nocturnal Wakefulness to Suicide Risk Across Months and Methods of Suicide. The Journal of clinical psychiatry, 81(2).
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  Insomnia is a risk factor for suicide, and the risk of suicide after accounting for population wakefulness is disproportionately highest at night. This study investigated whether this risk varied across months and/or methods of suicide.
• Walsh, N. P., Halson, S. L., Sargent, C., Roach, G. D., Nédélec, M., Gupta, L., Leeder, J., Fullagar, H. H., Coutts, A. J., Edwards, B. J., Pullinger, S. A., Robertson, C. M., Burniston, J. G., Lastella, M., Le Meur, Y., Hausswirth, C., Bender, A. M., Grandner, M. A., & Samuels, C. H. (2020). Sleep and the athlete: narrative review and 2021 expert consensus recommendations. British journal of sports medicine.
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  Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (
• Young, D. R., Sidell, M. A., Grandner, M. A., Koebnick, C., & Troxel, W. (2020). Dietary behaviors and poor sleep quality among young adult women: watch that sugary caffeine!. Sleep Health, 6(Issue 2). doi:10.1016/j.sleh.2019.12.006
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  Purpose: Associations of dietary patterns with sleep quality have not been sufficiently studied, particularly among young adults. Studying factors associated with sleep quality among young adults are especially important given the significant life changes they are experiencing, which can influence not only sleep quality but also dietary behaviors. Methods: We examined the cross-sectional association of sleep quality among 462 women at age 23 years. We used the Pittsburg Sleep Quality Index (PSQI) to define sleep quality. Intake over the previous 7 days of fruits and vegetables, soda, sports drinks, other sweetened drinks, and coffee drinks was assessed by a self-report questionnaire. Linear regression analysis examined the association between PSQI scores and dietary intake. Results: About 47% of participants were White, 25% Black, 10% Hispanic, and 18% Other. Almost ½ (45%) reported poor sleep quality. Compared with participants reporting consuming no energy drinks, participants who reported consuming any energy drinks had PSQI scores that were 0.84 points higher (7.08 ± 0.51 vs 6.24 ± 0.39; p=0.04) (indicating poorer sleep quality). Participants who reported drinking one or more high-calorie coffee drinks had PSQI scores that were 1.00 points higher compared with those reporting drinking no high-calorie coffee drinks (7.14 ± 0.51 vs 6.14 ± 0.42; p=0.02). Fruit or vegetable intake was not associated with PSQI score. Conclusions: Poor sleep quality is prevalent among young women. Young women with poor sleep quality should consider their sugary caffeine use to determine if it may be associated with their sleep.
• Young, D. R., Sidell, M. A., Grandner, M. A., Koebnick, C., & Troxel, W. (2020). Dietary behaviors and poor sleep quality among young adult women: watch that sugary caffeine!. Sleep health, 6(2), 214-219.
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  Associations of dietary patterns with sleep quality have not been sufficiently studied, particularly among young adults. Studying factors associated with sleep quality among young adults are especially important given the significant life changes they are experiencing, which can influence not only sleep quality but also dietary behaviors.
• Alfonso-miller, P., Bliznak, V., Ellis, J., Grandner, M. A., Hale, L., Killgore, W. D., Perlis, M. L., & Warlick, C. (2019). 0010 What is the Ideal Bedtime? Data from a Community Sample. Sleep, 42(Supplement_1), A4-A4. doi:10.1093/sleep/zsz067.009
• Alfonso-miller, P., Branas, C. C., Gehrels, J., Grandner, M. A., Hale, L., Khader, W. S., Perlis, M. L., & Tubbs, A. S. (2019). 0926 Sleep Timing And The Prevalence Of Suicidal Ideation In A Community Sample. Sleep, 42(Supplement_1), A372-A373. doi:10.1093/sleep/zsz067.924
• Alfonso-miller, P., Granados, K., Grandner, M. A., Okuagu, A., & Olivier, K. (2019). Abstract P278: Patterns of Eating Associated With Sleep Duration, Insomnia, Daytime Sleepiness, and Overall Sleep Quality Among Individuals of Mexican Descent at the US-Mexico Border. Circulation, 139(Suppl_1). doi:10.1161/circ.139.suppl_1.p278
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  Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and stu...
• Alkozei, A., Burns, A. I., Grandner, M. A., Killgore, W. D., Ozcan, M., Pace-schott, E. F., Shepard, K. C., & Vanuk, J. R. (2019). 0884 Morning Blue Light Exposure Improves Sleep and Fear Extinction Recall in PTSD. Sleep, 42(Supplement_1), A355-A356. doi:10.1093/sleep/zsz067.882
• Bailey, O., Combs, D., Sans-Fuentes, M., Havens, C. M., Grandner, M. A., Poongkunran, C., Patel, S., Berryhill, S., Provencio, N., Quan, S. F., & Parthasarathy, S. (2019). Delayed Sleep Time in African Americans and Depression in a Community-Based Population. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(6), 857-864.
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  Studies have shown racial differences in circadian rhythm in African Americans when compared to non-Hispanic whites, and an association between circadian dyssynchrony and depression. We hypothesized that the prevalence of delayed sleep time is greater in African Americans when compared to whites and that delayed sleep time is associated with depression.
• Balserak, B. I., Zhu, B., Grandner, M. A., Jackson, N., & Pien, G. W. (2019). Obstructive sleep apnea in pregnancy: performance of a rapid screening tool. Sleep & breathing = Schlaf & Atmung, 23(2), 425-432.
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  The Sleep Apnea Symptom Score (SASS) has been commonly used to assess obstructive sleep apnea (OSA). The aim of this study was to examine the psychometric properties of the SASS and the predictive value of SASS incorporating bedpartner-reported information in identifying OSA in pregnant women.
• Bastien, C. H., Ellis, J. G., Athey, A., Chakravorty, S., Robbins, R., Knowlden, A. P., Charest, J., & Grandner, M. A. (2019). Driving After Drinking Alcohol Associated with Insufficient Sleep and Insomnia among Student Athletes and Non-Athletes. Brain sciences, 9(2).
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  The proportion of university/college students (UCS) consuming alcohol is similar to the number of those reporting poor sleep, at approximately 30%, the proportion being greater in student athletes (SA). What remains to be understood is if poor sleep potentiates risky behaviors.
• Bastien, C. H., Ellis, J. G., Athey, A., Chakravorty, S., Robbins, R., Knowlden, A. P., Charest, J., & Grandner, M. A. (2019). Driving after drinking alcohol associated with insufficient sleep and insomnia among student athletes and non-athletes. Brain Sciences, 9(Issue 2). doi:10.3390/brainsci9020046
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  Introduction: The proportion of university/college students (UCS) consuming alcohol is similar to the number of those reporting poor sleep, at approximately 30%, the proportion being greater in student athletes (SA). What remains to be understood is if poor sleep potentiates risky behaviors. Objective: Our aim was to examine the association among sleep difficulties, insomnia symptoms, and insufficient sleep on the risk of driving under the influence of alcohol in a sample of UCS and whether these associations were more pertinent in SA. Methods: Data from the National University/College Health Assessment was used from the years 2011–2014. Questions on number of drinks consumed and behaviors such as driving after drinking alcohol were related to answers to questions pertaining to sleep difficulties, insufficient sleep, and insomnia symptoms. Results: Mean alcohol intake was of about 3 drinks; SA consumed significantly more than student non-athletes (SNA). Binge-drinking episodes were significantly higher among SA than SNA. Difficulty sleeping was associated with an increased likelihood of driving after any drinks and after 5 or more drinks in both groups, effects being stronger among SA. Insomnia was associated with an increased likelihood of driving after any drinks and after 5 or more drinks in SA and after 5 or more drinks in SNA. These effects were stronger among athletes. Conclusion: The present study found that self-reported difficulties sleeping, insomnia symptoms, and insufficient sleep are associated with driving after drinking alcohol. This relationship applied to driving after drinking any alcohol or binge drinking and was again stronger among SA than SNA.
• Begay, T. K., & Grandner, M. A. (2019). Sleep and cardiometabolic health in indigenous populations: importance of socio-cultural context. Sleep medicine, 59, 88-89.
• Boyle, J. T., Butler, M., Grandner, M. A., Jean-louis, G., Klingman, K. J., Perlis, M. L., & Williams, N. J. (2019). 0343 Does Insomnia Symptom Severity Vary By Race/ethnicity?. Sleep, 42(Supplement_1), A140-A141. doi:10.1093/sleep/zsz067.342
• Boyle, J. T., D'antonio, B., Ditomasso, R. A., Ellis, J., Grandner, M. A., Muench, A., Perlis, M. L., Posner, D., Rosenfield, B., Seewald, M., Vargas, I., & Williams, N. J. (2019). Sleep Disorder Symptom Endorsement by Age. Sleep, 42(Supplement_1), A275-A275. doi:10.1093/sleep/zsz067.685
• Brauer, A. A., Athey, A. B., Ross, M. J., & Grandner, M. A. (2019). Sleep and Health Among Collegiate Student Athletes. Chest, 156(6), 1234-1245.
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  Although the link between sleep, health, and performance has been well documented, research on this link in collegiate student athletes is still in its infancy. A large body of evidence indicates that collegiate student athletes are not obtaining enough sleep, but less is known about their sleep quality, patterns, and the impact on health and performance. Consequently, short sleep negatively affects physical and mental health, as well as several domains of performance (ie, aerobic, anaerobic, sport-specific, cognitive). The majority of studies examining the links between short sleep, health, and performance have been conducted with healthy adults or noncollegiate athlete samples; however, collegiate student athletes have demands unlike those of their nonathlete or noncollegiate athlete counterparts. Poor sleep health and sleep disorders are of increasing concern among the college athlete population and have recently been recognized by national and international sports governing bodies. The purpose of this review is to summarize the available literature on sleep and its impact on health and performance among athletes, specifically addressing gaps where little to no data is available on collegiate student athletes. Consideration is also given to evidence-based sleep interventions that have been utilized with athletes, as well as recommendations for future research and intervention development.
• Bremer, E., Ellis, J., Grandner, M. A., Kloss, J., Morales, K. H., Perlis, M. L., Posner, D., & Vargas, I. (2019). 0394 Do Patients Change TIB When Starting Hypnotics and Does This Affect Outcomes. Sleep, 42(Supplement_1), A160-A160. doi:10.1093/sleep/zsz067.393
• Chinkers, M. A., Grandner, M. A., Huang, Y., Killgore, W. D., Richards, M. M., & Skalamera, J. (2019). 0080 The Influence of Habitual Sleep Duration on Rational Thinking Ability. Sleep, 42(Supplement_1), A33-A33. doi:10.1093/sleep/zsz067.079
• Grandner, M. A., & Perlis, M. L. (2019). Pharmacotherapy for Insomnia Disorder in Older Adults. JAMA network open, 2(12), e1918214.
• Grandner, M. A., Ivers, H., Morin, C. M., Muench, A., Perlis, M. L., & Posner, D. (2019). 0380 Does TST Appreciably Change During or After CBT-I?. Sleep, 42(Supplement_1), A154-A155. doi:10.1093/sleep/zsz067.379
• Grandner, M. A., Khader, W. S., Warlick, C. D., & Fernandez, F. (2019). Acculturation and sleep: implications for sleep and health disparities. Sleep, 42(3).
• Grandner, M. A., Killgore, W. D., Satterfield, B. C., & Silveri, M. M. (2019). 0233 Baseline GABA Levels Predict Time-On-Task Performance during Sleep Deprivation. Sleep, 42(Supplement_1), A95-A97. doi:10.1093/sleep/zsz067.232
• Ji, X., Bastien, C. H., Ellis, J. G., Hale, L., & Grandner, M. A. (2019). Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia. Sleep health, 5(4), 376-381.
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  Insomnia and depression are closely related. However, few studies have investigated whether certain insomnia symptoms differentially relate to certain depressive symptoms. The present study aimed to examine relationship between specific types of insomnia symptoms (sleep symptoms, daytime symptoms, and perception symptoms) and specific symptoms of depression.
• Klingman, K. J., Williams, N. J., Perlis, M. L., & Grandner, M. A. (2019). Doctor-patient sleep discussions for US adults: results from the SHADES study. Sleep Health, 5(Issue 6). doi:10.1016/j.sleh.2019.07.004
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  Objectives: Determine the current rate of patient-provider sleep discussions and identify factors associated with occurrence of these discussions. Design: Secondary cross-sectional analysis of self-report data collected during the Sleep and Healthy Activity Diet Environment and Socialization study. Logistic regressions were used. Setting: Urban and suburban Southeastern Pennsylvania Participants: A total of n = 998 adults (aged 22-60), 38.6% female, racially and socioeconomically diverse, from urban and suburban Southeastern Pennsylvania. Measurements: Outcome measures were responses to 3 questions: (1) ever discussed sleep with a provider, (2) a provider ever discussed importance of sleep schedule, and (3) a provider ever discussed importance of enough sleep. Descriptive/independent variables included demographic factors and a wide range of patient-reported measures of health and sleep habits. Results: About a third of individuals have ever discussed sleep with a provider. Factors associated with higher odds of sleep-related discussions included sleep medication use, worse insomnia severity, race (Black/African American, Hispanic, Latino, other/multiracial), female sex, higher education, higher body mass index, and worse depression severity. Factors associated with lower odds were Asian race and low income. Sleep discussions were not associated with certain factors indicative of sleep disorders: sleep duration, snoring, shift work schedule, not working, and anxiety. Conclusions: Low rates of patient-provider sleep discussions and factors associated (or not) with their occurrence indicate missed opportunities for improved health outcomes.
• Klingman, K. J., Williams, N. J., Perlis, M. L., & Grandner, M. A. (2019). Doctor-patient sleep discussions for US adults: results from the SHADES study. Sleep health, 5(6), 658-665.
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  Determine the current rate of patient-provider sleep discussions and identify factors associated with occurrence of these discussions.
• Kroshus, E., Wagner, J., Wyrick, D., Athey, A., Bell, L., Benjamin, H. J., Grandner, M. A., Kline, C. E., Mohler, J. M., Roxanne Prichard, J., Watson, N. F., & Hainline, B. (2019). Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness. British journal of sports medicine, 53(12), 731-736.
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  Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes' sleep.
• Mai, Q. D., Hill, T. D., Vila-Henninger, L., & Grandner, M. A. (2019). Employment insecurity and sleep disturbance: Evidence from 31 European countries. Journal of sleep research, 28(1), e12763.
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  For nearly half a century, jobs have become increasingly characterized by employment insecurity. We examined the implications for sleep disturbance with cross-sectional data from the European Working Conditions Survey (2010). A group of 24,553 workers between the ages of 25 and 65 years in 31 European countries were asked to indicate whether they suffered from "insomnia or general sleep difficulties" in the past 12 months. We employed logistic regression to model the association between employment insecurity and sleep disturbance for all countries combined and each individual country. For all countries combined, employment insecurity increased the odds of reporting insomnia or general sleep difficulties in the past 12 months. Each unit increase in employment insecurity elevated the odds of sleep disturbance by approximately 47%. This finding was remarkably consistent across 27 of 31 European countries, including Albania, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Slovakia, Slovenia, Spain, Sweden, Turkey and UK. These results persisted with adjustments for age, gender, immigrant status, household size, partnership status, number of children, child care, elder care, education, earner status, precarious employment status, workplace sector, workplace tenure and workplace size. Employment insecurity was unrelated to sleep disturbance in four European countries: Malta, Poland, Portugal and Romania. Our research continues recent efforts to reveal the human costs associated with working in neoliberal postindustrial labour markets. Our analyses contribute to the external validity of previous research by exploring the impact of employment insecurity across European countries.
• Martinez, S. M., Grandner, M. A., Nazmi, A., Canedo, E. R., & Ritchie, L. D. (2019). Pathways from Food Insecurity to Health Outcomes among California University Students. Nutrients, 11(6).
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  The prevalence of food insecurity (FI) among college students is alarmingly high, yet the impact on student health has not been well investigated. The aim of the current study was to examine the simultaneous relationships between food insecurity and health-related outcomes including body mass index (BMI) and overall health in a college student population. Randomly sampled students in the University of California 10 campus system were invited to participate in an online survey in spring 2015. The analytic sample size was 8705 graduate and undergraduate students. Data were collected on FI in the past year, daily servings of fruits and vegetables (FV), number of days in the past week of enough sleep and moderate- to vigorous-intensity physical activity (MVPA), height and weight, self-rated health, and student characteristics. Using path analysis, mediated pathways between FI, BMI, and poor health were examined through FV intake, number of days of MVPA and enough sleep. Analyses controlled for student characteristics. Mean BMI was 23.6 kg/m (SD, 5.0), and average self-rated health was good. FI was directly and indirectly related to higher BMI and poor health through three pathways. First, FI was related to fewer days of enough sleep, which in turn was related to increased BMI and poor health. Second, FI was related to fewer days of MVPA, which in turn was related to increased BMI and poor health. Third, FI was related to fewer daily servings of FV, which in turn was related to poor health. FI is associated with poor health behaviors among college students, which may contribute to higher weight status and poor health. These findings highlight the importance of food security for a healthy college experience.
• Parthasarathy, S., Grandner, M., Combs, D., & Tubbs, A. S. (2019). Obstructive Sleep Apnea in Jacobsen Syndrome. Sleep and Vigilance.
• Patterson, F., Connick, E., Brewer, B., & Grandner, M. A. (2019). HIV status and sleep disturbance in college students and relationship with smoking. Sleep health, 5(4), 395-400.
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  Adults with HIV have greater sleep difficulties and are more likely to smoke cigarettes. We tested whether current smoking plays a role in sleep difficulties experienced by young adults with HIV.
• Patterson, F., Grandner, M., Malone, S. K., Rizzo, A., Davey, A., & Edwards, D. G. (2019). Sleep as a Target for Optimized Response to Smoking Cessation Treatment. Nicotine and Tobacco Research, 21(2), 139-148. doi:10.1093/ntr/ntx236
• Perlis, M. L., Vargas, I., Ellis, J. G., Grandner, M. A., Morales, K. H., Gencarelli, A., Khader, W., Kloss, J. D., Gooneratne, N. S., & Thase, M. E. (2019). The Natural History of Insomnia: The Incidence of Acute Insomnia and Subsequent Progression to Chronic Insomnia or Recovery in Good Sleeper Subjects. Sleep.
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  The primary aim of the present study was to estimate the incidence per annum of acute insomnia and to what extent those that develop acute insomnia recover good sleep or develop chronic insomnia. Unlike prior studies, a dense-sampling approach was used here (i.e., daily diaries) and this allowed for a more precise detection of acute insomnia and the follow-on states (the transitions to either recovery or chronic insomnia).
• Raikes, A. C., Athey, A., Alfonso-Miller, P., Killgore, W. D., & Grandner, M. A. (2019). Author response: concussion assessment tools - A possible measure of sleepiness?. Sleep medicine.
• Raikes, A. C., Athey, A., Alfonso-Miller, P., Killgore, W. D., & Grandner, M. A. (2019). Insomnia and daytime sleepiness: risk factors for sports-related concussion. Sleep medicine, 58, 66-74.
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  Poor quality and inadequate sleep are associated with impaired cognitive, motor, and behavioral components of sport performance and increased injury risk. While prior work identifies sports-related concussions as predisposing factors for poor sleep, the role of sleep as a sports-related concussion risk factor is unknown. The purpose of this study was to quantify the effect of poor sleep quality and insomnia symptoms on future sports-related concussion risk.
• Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., Derevensky, J. L., Glick, I. D., Gorczynski, P., Gouttebarge, V., Grandner, M. A., Han, D. H., McDuff, D., Mountjoy, M., Polat, A., , Purcell, R., et al. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British journal of sports medicine, 53(11), 667-699.
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  Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
• Redeker, N. S., Caruso, C. C., Hashmi, S. D., Mullington, J. M., Grandner, M., & Morgenthaler, T. I. (2019). Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(4), 649-657.
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  The purpose of this review is to synthesize the published literature that addresses employer-initiated interventions to improve the sleep of workers and in turn improve health, productivity, absenteeism, and other outcomes that have been associated with sleep disorders or sleep deficiency.
• Robbins, R., Grandner, M. A., Buxton, O. M., Hale, L., Buysse, D. J., Knutson, K. L., Patel, S. R., Troxel, W. M., Youngstedt, S. D., Czeisler, C. A., & Jean-Louis, G. (2019). Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep health, 5(4), 409-417.
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  False beliefs about sleep can persist despite contradicting scientific evidence, potentially impairing population health. Identifying commonly held false beliefs lacking an evidence base ("myths") can inform efforts to promote population sleep health.
• Robbins, R., Jean-Louis, G., Gallagher, R. A., Hale, L., Branas, C. C., Gooneratne, N., Alfonso-Miller, P., Perlis, M., & Grandner, M. A. (2019). Examining social capital in relation to sleep duration, insomnia, and daytime sleepiness. Sleep medicine, 60, 165-172.
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  Sleep, which plays an important role in health and well-being, is socially patterned such that certain demographic groups have worse sleep health than others. One possible mechanism driving sleep disparities is social capital. The current study examines the association between social capital and self-reported sleep variables (eg, duration, insomnia symptoms, and daytime sleepiness) among a sample of 1007 participants from the Sleep Health and Activity, Diet and Environment Study (SHADES).
• Rosenberger, M. E., Fulton, J. E., Buman, M. P., Troiano, R. P., Grandner, M. A., Buchner, D. M., & Haskell, W. L. (2019). The 24-Hour Activity Cycle: A New Paradigm for Physical Activity. Medicine and science in sports and exercise, 51(3), 454-464.
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  The physiologic mechanisms by which the four activities of sleep, sedentary behavior, light-intensity physical activity, and moderate-to-vigorous physical activity (MVPA) affect health are related, but these relationships have not been well explored in adults. Research studies have commonly evaluated how time spent in one activity affects health. Because one can only increase time in one activity by decreasing time in another, such studies cannot determine the extent that a health benefit is due to one activity versus due to reallocating time among the other activities. For example, interventions to improve sleep possibly also increase time spent in MVPA. If so, the overall effect of such interventions on risk of premature mortality is due to both more MVPA and better sleep. Further, the potential for interaction between activities to affect health outcomes is largely unexplored. For example, is there a threshold of MVPA minutes per day, above which adverse health effects of sedentary behavior are eliminated? This article considers the 24-h Activity Cycle (24-HAC) model as a paradigm for exploring inter-relatedness of health effects of the four activities. It discusses how to measure time spent in each of the four activities, as well as the analytical and statistical challenges in analyzing data based on the model, including the inevitable challenge of confounding among activities. The potential usefulness of this model is described by reviewing selected research findings that aided in the creation of the model and discussing future applications of the 24-HAC model.
• Tubbs, A. S., Combs, D., Grandner, M. A., & Parthasarathy, S. (2019). Obstructive Sleep Apnea in Jacobsen Syndrome. Sleep and Vigilance, 3(Issue 1). doi:10.1007/s41782-019-00060-w
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  Purpose: Many congenital disorders are associated with an elevated risk of obstructive sleep apnea due to craniofacial abnormalities, hypotonia, and obesity. We describe a male with an 11q deletion (Jacobsen syndrome) with obstructive sleep apnea. Report of Case: The patient was diagnosed with severe obstructive sleep apnea, but was unable to adhere to positive airway pressure therapy due to mask discomfort. Discussion: Obstructive sleep apnea is common in many congenital disorders. Implications for cognitive functioning, as well as the potential for cognitive improvements following treatment are discussed. Screening polysomnography may be indicated in patients with Jacobsen syndrome given their high likelihood of obstructive sleep apnea.
• Tubbs, A. S., Grandner, M. A., & Combs, D. (2019). Refractory Insomnia in an Adolescent with Total Blindness. The Yale journal of biology and medicine, 92(2), 201-204.
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  We present a totally blind adolescent with refractory insomnia due to a combination of Non-24 hour sleep-wake disorder and restless leg syndrome that was successfully treated with tasimelteon, iron replacement, and gabapentin. To our knowledge, this is the first published report of treatment of N24 with tasimelteon in an adolescent. In addition, this case highlights the importance of recognizing and treating multifactorial causes of insomnia.
• Tubbs, A. S., Grandner, M. A., & Combs, D. (2019). Refractory insomnia in an adolescent with total blindness. Yale Journal of Biology and Medicine, 92(Issue 2).
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  We present a totally blind adolescent with refractory insomnia due to a combination of Non-24 hour sleepwake disorder and restless leg syndrome that was successfully treated with tasimelteon, iron replacement, and gabapentin. To our knowledge, this is the first published report of treatment of N24 with tasimelteon in an adolescent. In addition, this case highlights the importance of recognizing and treating multifactorial causes of insomnia.
• Tubbs, A. S., Khader, W., Fernandez, F., & Grandner, M. A. (2019). The common denominators of sleep, obesity, and psychopathology. Current opinion in psychology, 34, 84-88.
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  Sleep is an important contributor to mental and physical health. Insomnia, nightmares, and other sleep disturbances are closely linked to depression, anxiety, weight gain, diabetes, and progression of cardiometabolic disease. The high comorbidity between sleep problems, obesity, and mental illness suggest that common mechanisms are at work between them. This review discusses the presence of bivariate relations between sleep, obesity, and psychopathology, as well as the limited evidence suggesting interactions among all three. While the review identifies obstructive sleep apnea, food intake, and inflammation as potential linking mechanisms, the dearth of current literature limits strong conclusions. More data is needed to evaluate the potential moderating/mediating influences between sleep, obesity, and mental health.
• Tubbs, A. S., Perlis, M. L., & Grandner, M. A. (2019). Surviving the long night: The potential of sleep health for suicide prevention. Sleep medicine reviews, 44, 83-84.
• Tubbs, A., Grandner, M., & Combs, D. (2019). Refractory insomnia in a visually impaired adolescent. Yale Journal of Biology and Medicine.
• Turner, R. W., Vissa, K., Hall, C., Poling, K., Athey, A., Alfonso-Miller, P., Gehrels, J. A., & Grandner, M. A. (2019). Sleep problems are associated with academic performance in a national sample of collegiate athletes. Journal of American college health : J of ACH, 1-8.
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  Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Data were obtained from the National College Health Assessment of US college/university students from 2011-2014 ( = 8,312 collegiate athletes). Univariate comparisons for all sleep variables and demographics were stratified across GPA, using one-way ANOVA for continuous variables and chi-square for categorical variables. Multinomial logistic regression models, with GPA as outcome (reference = A) and sleep variable as predictor, were examined and adjusted for age, sex, and survey year. Ordinal regression examined a 1-level change in GPA associated with each sleep variable, adjusted for covariates. Sleep difficulty was associated with increased likelihood of B/C averages. Initial-insomnia was associated with increased likelihood of B/C, and D/F averages. Tiredness was associated with increased likelihood of B/C, and D/F averages. Sleep problems are highly prevalent and associated with poorer academic performance in collegiate athletes.
• Wills, C. C., & Grandner, M. A. (2019). Review of The Science of Sleep: What It Is, How It Works, and Why It Matters. Sleep, 42(8).
• Wills, C., Turner, R., Tubbs, A., Alfonso-miller, P., Athey, A., Grandner, M. A., Killgore, W. D., Patterson, F., Robbins, R., Tubbs, A. S., Turner, R. W., Warlick, C., & Wills, C. C. (2019). 0900 Chronotype and Social Support Among Student Athletes: Impact on Depressive Symptoms. Sleep, 42(Supplement_1), A361-A362. doi:10.1093/sleep/zsz067.898
• Alfonso-miller, P., Athey, A., Barnard, S., Grandner, M. A., & Killgore, W. D. (2018). 0962 Adverse Childhood Experiences Among Student Athletes Are Associated with Sleep Disturbances: Evaluating the Mediating Roles of Depression and Anxiety. Sleep, 41(suppl_1), A357-A357. doi:10.1093/sleep/zsy061.961
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  Experiencing traumatic life events in childhood has previously been found to increase the likelihood of health-risk behavior, leading to poor physical health in adulthood. Student athletes are a group at risk for poor sleep, as well as adverse childhood experiences (ACEs). The present study examined the relationship between ACEs in student athletes with the experience of poor sleep, and the role of depression/anxiety. Survey data from N=189 NCAA Division-I student-athletes were collected. Sleep assessments included insomnia (Insomnia Severity Index [ISI]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), fatigue (Fatigue Severity Scale [FSS]), and sleep duration (item from the PSQI). The following ACEs were assessed: verbal abuse, physical abuse, sexual abuse, feeling alone, neglect, living with addict, living with mentally ill, and loss of parent. Regression analyses examined ACEs total score, adjusted for age and sex, in predicting insomnia, poor sleep quality, sleep duration, and fatigue scores. Post-hoc analyses examined whether these relationships were mediated by depression (CESD) and/or anxiety (GAD7), and whether specific ACEs were more related to sleep than others. ACES score was associated with worse insomnia (B=0.7, 95%CI[0.4,1.5], p=0.039) and sleep quality (B=0.7, 95%CI[0.2,1.1], p=0.003) and less sleep (B=-14.0, 95%CI[-23.5,-4.4], p=0.004), but not greater fatigue. Results were mediated by mental health for all outcomes except sleep duration. “Feeling alone” was the ACE that demonstrated the strongest individual relationships with sleep outcomes. Child exposures to trauma are associated with sleep disturbances in early adulthood, especially feeling alone. These relationships are largely accounted for by depression/anxiety, except for shortened sleep duration. NCAA Innovations Grant.
• Alfonso-miller, P., Athey, A., Bliznak, V., Bliznak, B., Gehrels, J., Grandner, M. A., & Killgore, W. D. (2018). 1030 History of Concussion In Student Athletes: A Risk Factor for Short Sleep Duration and Insomnia. Sleep, 41(suppl_1), A382-A383. doi:10.1093/sleep/zsy061.1029
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Haghighi, A., & Killgore, W. D. (2018). 0979 Insufficient Sleep Duration and Insomnia Symptoms Independently Predict Suicide Ideation in Student Athletes and Non-Athletes. Sleep, 41(suppl_1), A363-A363. doi:10.1093/sleep/zsy061.978
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  Suicide is a major cause of death, especially among young adults. Previous work has shown that poor sleep is an important suicide risk factor. The present study evaluated sleep as risk factors for suicide ideation among college/university students. Data from the 2011–2014 National College Health Assessment were used (N=113,185). Self-reported suicide ideation within the past 12 months. SLEEP-DIFFICULTY was assessed with an item indicating that “sleep difficulties” were “particularly traumatic or difficult to handle” in the past 12 months. INSOMNIA was assessed as at least 3 nights/week or “extremely hard time falling asleep.” INFUFFICIENT-SLEEP was assessed as number of days/week of not “enough sleep to feel rested.” All variables were yes/no except INSUFFICIENT-SLEEP, which was categorized as 0–1 (reference), 2–3, 4–5, or 6–7 nights. Binary logistic regression analyses examined suicide ideation as outcome, sleep variable as predictor, adjusted for age, sex, year in school, depressed mood within the past 30 days, and survey year. Interactions with student athlete status were examined. 7.4% reported suicide ideation within the past 12 months. In adjusted models, this was significantly predicted by SLEEP-DIFFICULTY (OR=3.01, 95%CI[2.86,3.16], p
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Jean-louis, G., Killgore, W. D., Okuagu, A., Prichard, R., & Williams, N. J. (2018). 1058 Racial/Ethnic Sleep Disparities Among College Students Are Different in Majority-White vs Majority-Minority Institutions. Sleep, 41(suppl_1), A393-A394. doi:10.1093/sleep/zsy061.1057
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  Racial/ethnic sleep disparities are well-documented and may be related to discrimination. The present study examined sleep among minority college/university students, and whether these sleep disparities exist differently at institutions that are predominantly White versus non-predominantly White. Data from the 2011–2014 National College Health Assessment conducted by the American College Health Association was used (N=112,849 students). Race/ethnicity was categorized as Non-Hispanic White, Black/African-American, Hispanic/Latino, Asian, Native American, Multiracial, or Other. Schools with a majority of respondents who were not Non-Hispanic White were classified as majority minority schools. Sleep was assessed as whether sleep difficulties had been “particularly traumatic or difficult to handle in the past 12 months” and as number of nights per week they got “enough sleep to feel refreshed,” categorized as 0–1, 2–3, 4–5, or 6–7 (reference). Covariates included age, sex, year in school, and survey year. Logistic regressions examined prevalence of sleep difficulty or insufficient sleep by race/ethnicity, stratified by school type. A race/ethnicity by school type interaction was significant for both sleep variables (p
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Killgore, W. D., & Liu, S. (2018). 0964 Sleep Paralysis and Hypnogogic/Hypnopompic Hallucinations: Prevalence in Student Athletes and Relationship to Depressive Symptoms. Sleep, 41(suppl_1), A358-A358. doi:10.1093/sleep/zsy061.963
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Killgore, W. D., & Meridew, C. (2018). 0190 Academic Performance Associated with Sleep Duration among Student Athletes: Impact of Insomnia, Fatigue, and Depression. Sleep, 41(suppl_1), A74-A75. doi:10.1093/sleep/zsy061.189
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  Poor sleep is linked to neurocognitive deficits which in turn may translate into poor academic performance. In this study, we evaluated how sleep duration, insomnia, fatigue, and depression may impact GPA. Data were collected from N=189 NCAA Division-1 student athletes across 13 different sports (46% women). Overall GPA category was self-reported (A, A-, B+, B, B-, C+, C, C-, D). Sleep duration as assessed as habitual nightly total sleep time in 15-minute increments. Insomnia was assessed with the Insomnia Severity Index. Fatigue was assessed with the Fatigue Severity Scale. Depression was assessed with the Center for Epidemiological Studies Depression Scale. Ordinal logistic regression assessed likelihood of a directional change in GPA level associated with sleep duration, insomnia, fatigue, and depression, adjusted for age and sex. Post-hoc analyses examined significant factors together in a combined model. Habitual sleep duration was associated with improved GPA, such that every extra hour of sleep was associated with a 39.5% increased likelihood of an increase in GPA level (95%CI[1.12,1.74], p=0.003). Neither insomnia nor fatigue were associated with GPA. Depression was associated such that each CESD point was associated with a decreased likelihood of a higher GPA (OR=0.94, 95%CI[0.91,0.98), p=0.001). When sleep duration and depression were combined, both remained significant, with increasing sleep duration associated with an increased likelihood of a higher GPA (OR=1.29, 95%CI[1.02,1.63], p=0.031) and depression associated with a decreased likelihood (OR=0.96, 95%CI[0.92,0.99], p=0.014). There was a positive relationship between sleep duration and an increase in GPA level. Also, higher depression score is associated with a decrease in GPA. When both depression and sleep duration were evaluated together, they both remained significant with their relationship to GPA. NCAA Innovations Grant
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Killgore, W. D., & Tang, R. (2018). 0186 Drowsy Driving In Student Athletes: Impact of Insomnia, Sleepiness, and Mood. Sleep, 41(suppl_1), A73-A73. doi:10.1093/sleep/zsy061.185
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  Drowsy driving is a major cause of automotive crashes, especially among young adults. The present study investigates the various factors, such as insomnia, depression, anxiety, and sleepiness, that influence drowsy driving among student athletes. Data were collected from N=189 NCAA Division-1 student athletes across 13 different sports (46% women). Measures included the Insomnia Severity Index (ISI), Fatigue Severity Scale (FSS), Centers for Epidemiologic Studies Depression Scale (CESD), GAD-7 Anxiety Questionnaire, and items assessing typical bedtime and waketime (to compute midpoint of sleep), typical sleep duration (TST), and daytime sleepiness (item taken from NHANES, categorized as problems ≥1/wk). Drowsy driving was assessed with the item from the BRFSS, “During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?” Logistic regression analyses examined likelihood of drowsy driving, adjusted for age, sex, and year in school. Possible predictors included ISI, FSS, TST, midpoint, sleepiness, CESD, and GAD7 scores. Post-hoc analyses examined models including ISI, TST, and sleepiness those with and without depression (CESD>=16) separately. Drowsy driving was prevalent among 17.5% of student athletes. Increased risk was associated with ISI (OR=1.13, 95%CI [1.05,1.22], p=0.001), CESD (OR=1.10, 95%CI[1.04,1.16], p=0.001), GAD7 (OR=1.17, 95%CI[1.07,1.27], p
• Alfonso-miller, P., Bastien, C. H., Branas, C. C., Ellis, J. G., Gallagher, R., Grandner, M. A., Hale, L., & Perlis, M. L. (2018). 0377 The Impact of Abuse during Childhood on Adult Sleep and the Moderating Influence of Bedroom Safety. Sleep, 41(suppl_1), A144-A144. doi:10.1093/sleep/zsy061.376
• Alfonso-miller, P., Branas, C. C., Gallagher, R., Gehrels, J., Grandner, M. A., Hale, L., Killgore, W. D., & Sanchez, C. (2018). 0185 Relationships between Dietary Supplement Intake and Sleep Duration, Insomnia, and Fatigue. Sleep, 41(suppl_1), A72-A73. doi:10.1093/sleep/zsy061.184
• Alfonso-miller, P., Branas, C. C., Gallagher, R., Gehrels, J., Grandner, M. A., Hale, L., Killgore, W. D., Perlis, M. L., & Yang, R. (2018). 0189 Work Productivity Loss Associated with Sleep Duration, Insomnia Severity, Sleepiness, and Snoring. Sleep, 41(suppl_1), A74-A74. doi:10.1093/sleep/zsy061.188
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  The present study examined the relationship between sleep symptoms and work productivity in a diverse community sample. Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study was used, including N=1,007 adults age 22–60. Work productivity was assessed with the validated Well-being Assessment of Productivity (WBAP), which includes items assessing impact of health, caregiving, lack of resources, coworker issues, overscheduling, supervisor issues, worries, depression/anxiety, financial stress, technical issues, and lack of training (each scored 0–2). Sleep duration was assessed using the NHANES item for typical weekday sleep and categorized as very short (≤4h) short (5-6h), normal (7-8h, reference), and long (≥9h). Other measures included the Insomnia Severity Index (none, mild, moderate/severe), Epworth Sleepiness Scale (low/high), and loud snoring (none,
• Alfonso-miller, P., Gehrels, J., Grandner, M. A., Jean-louis, G., Killgore, W. D., & Warlick, C. (2018). 0953 Experiences of Discrimination among College Students and Impact on Sleep Quality, Depression, Anxiety, and Suicide Ideation: Does Sleep Account for Relationships with Depressive Symptoms?. Sleep, 41(suppl_1), A353-A354. doi:10.1093/sleep/zsy061.952
• Alfonso-miller, P., Gehrels, J., Grandner, M. A., Killgore, W. D., & Olivier, K. (2018). 0954 Domestic Violence as a Risk Factor for Insomnia and Short Sleep Duration, and the Role of Depressed Mood and Anxiety Symptoms. Sleep, 41(suppl_1), A354-A354. doi:10.1093/sleep/zsy061.953
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  This study examined domestic violence as a risk factor for insomnia and the role of anxiety and depressed mood. Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) Study, consisting of N=1007 adults age 22–60. Domestic violence was assessed with the HITS scale, which consists of 4 items, asking how often a partner “physically hurt you” (physical), “insult or talk down to you” (verbal), “threaten you with harm” (threaten), or “scream or curse at you” (scream). Insomnia was assessed with the insomnia severity index. Sleep duration was assessed as typical weekday sleep. Depressed mood and anhedonia were measured with items from the PHQ9. Anxiety was assessed with the GAD7. Feeling unsafe at night was assessed. Additional covariates included age, sex, race/ethnicity, and education. Forward stepwise regression evaluated unique contributors of variance in HITS score. Sobel test evaluated insomnia as a partial mediator between HITS and GAD7 scores. N=816 adults reported a partner and were administered the HITS scale. Both insomnia and sleep duration were associated with all 4 domestic violence items and total score. After adjusting for covariates, demographics, mood, and feeling unsafe, domestic violence exposure predicted insomnia (Physical B=1.09,95%CI[0.30,1.87],p=0.007; Verbal B=0.50,95%CI[0.07,0.93],p=0.02; Threaten B=1.07,95%CI[0.37,1.78],p=0.003; Scream B=0.57,95%CI[0.14,1.00],p=0.01; Total B=0.27,95%CI[0.10,0.44],p=0.002). When anxiety was added to the model, these were all non-significant. For sleep duration, relationships were non-significant when insomnia was included in the model. Stepwise analysis showed that unique contributors of variance to domestic violence score were, in order, anxiety (B=0.11,p
• Alfonso-miller, P., Gehrels, J., Grandner, M. A., Killgore, W. D., & Sanchez, C. (2018). 0127 Nighttime Snacking: Prevalence And Associations With Poor Sleep, Health, Obesity, And Diabetes. Sleep, 41(suppl_1), A49-A50. doi:10.1093/sleep/zsy061.126
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  Nighttime food cravings may contribute to unhealthy eating behaviors and represent a potential link between poor sleep and obesity. Data were collected from a nationwide, phone-based survey of N=3,105 US adults from 23 metropolitan areas. Participants were asked, “Do you crave junk food more when you lack sleep?” coded No, Some, and Much, and if they eat a snack before going to bed. Participants were also asked for bedtime and waketime (to compute habitual sleep period), poor sleep quality (0=Not at all, 4=Very much), and history of obesity, diabetes, or any other health problem. Covariates included age, sex, race/ethnicity, history of depression, and marital status. Prevalence of nighttime snacking was 59.9%, and junk food craving 49.8% (Some) and 17.1% (Much). Cravings due to sleep loss were more likely among younger individuals with depression and poor sleep quality, and less likely among adults who never married. No relationship was seen for sex, race/ethnicity, or sleep duration. “Very much” poor sleep quality was associated with increased likelihood of “much” junk food cravings (OR=12.7, 95%CI[7.7,21.0], p
• Alfonso-miller, P., Gehrels, J., Grandner, M. A., Killgore, W. D., & Sandino, M. (2018). 0082 Sleep Duration and Perceived Cognitive Decline. Sleep, 41(suppl_1), A34-A34. doi:10.1093/sleep/zsy061.081
• Alkozei, A., Challener, S. A., Grandner, M. A., Killgore, W. D., Ozcan, M., Raikes, A. C., & Yung, A. (2018). 0941 Functional Impairment Due to Excessive Daytime Sleepiness is Associated with Greater Activation in the Default Mode Network When Anticipating Negative Stimuli in Individuals with PTSD. Sleep, 41(suppl_1), A349-A349. doi:10.1093/sleep/zsy061.940
• Alkozei, A., Grandner, M. A., Killgore, W. D., Knight, S., Miller, M. A., Miller, M., & Weber, M. (2018). 1027 Daily Morning Blue Light Exposure Enhances Executive Functioning in Individuals with Mild Traumatic Brain Injury. Sleep, 41(suppl_1), A381-A381. doi:10.1093/sleep/zsy061.1026
• Boyle, J. T., Ellis, J., Gencarelli, A. M., Grandner, M. A., Khader, W., Kloss, J. D., Morales, K. H., Muench, A., Perlis, M. L., & Vargas, I. (2018). 0420 Evaluating the Association Between Life Events, Perceived Stress, and Insomnia Status: Data from a National Cohort of Good Sleepers (The NITES Study). Sleep, 41(suppl_1), A159-A159. doi:10.1093/sleep/zsy061.419
• Boyle, J. T., Ellis, J., Grandner, M. A., Kloss, J. D., Morales, K. H., Muench, A. L., Perlis, M. L., & Vargas, I. (2018). 0955 Depressive Symptoms in Good Sleepers and Subjects That Develop Acute Insomnia, Recover From Acute Insomnia, and/or Develop Chronic Insomnia. Sleep, 41(suppl_1), A354-A355. doi:10.1093/sleep/zsy061.954
• Bremer, E., Ellis, J., Grandner, M. A., Moreales, K., Perlis, M. L., & Vargas, I. (2018). 0415 Does Time In Bed Vary with the Use of Hypnotics. Sleep, 41(suppl_1), A157-A158. doi:10.1093/sleep/zsy061.414
• Chakravorty, S., Chaudhary, N. S., Morales, K., Grandner, M. A., & Oslin, D. W. (2018). Is family history of alcohol dependence a risk factor for disturbed sleep in alcohol dependent subjects?. Drug and Alcohol Dependence, 188(Issue). doi:10.1016/j.drugalcdep.2018.04.017
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  Background: Disturbed sleep and a family history of alcohol dependence (AD) are risk factors for developing AD, yet the underlying relationship between them is unclear among individuals with AD. Understanding these inherited associations will help us not only identify risk for development of these comorbid disorders, but also individualize treatment at this interface. We evaluated whether a first-degree family history of AD (FH+) was a risk factor for sleep continuity disturbance in patients with AD. We also evaluated whether alcohol use or mood disturbance moderated the relationship between FH and sleep. Methods: We analyzed cross-sectional baseline data from an alcohol clinical trial in a sample of individuals with AD (N = 280). Their family history of AD among nuclear family members, sleep complaints, alcohol use (over the last 90 days), and mood disturbance were assessed using the Family History Interview for Substance and Mood Disorders, Medical Outcomes Study Sleep Scale, Time Line Follow-Back Interview, and Profile of Mood States–Short Form, respectively. Results: A FH + status (65% of subjects) was significantly associated with lower model estimated mean sleep adequacy (β = - 7.05, p = 0.02) and sleep duration (β = - 0.38, p = 0.04) scale scores. FH was not associated with sleep disturbance scale. No significant moderating effect involving alcohol use or mood disturbance was seen. Conclusion: Family history of AD is a unique risk factor for sleep complaints in AD. Non-restorative sleep and sleep duration may be noteworthy phenotypes to help probe for underlying genotypic polymorphisms in these comorbid disorders.
• Chakravorty, S., Chaudhary, N. S., Morales, K., Grandner, M. A., & Oslin, D. W. (2018). Is family history of alcohol dependence a risk factor for disturbed sleep in alcohol dependent subjects?. Drug and alcohol dependence, 188, 311-317.
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  Disturbed sleep and a family history of alcohol dependence (AD) are risk factors for developing AD, yet the underlying relationship between them is unclear among individuals with AD. Understanding these inherited associations will help us not only identify risk for development of these comorbid disorders, but also individualize treatment at this interface. We evaluated whether a first-degree family history of AD (FH+) was a risk factor for sleep continuity disturbance in patients with AD. We also evaluated whether alcohol use or mood disturbance moderated the relationship between FH and sleep.
• Chakravorty, S., Smith, R. V., Perlis, M. L., Grandner, M., & Kranzler, H. R. (2018). Circadian Pattern of Deaths Due to Suicide in Intoxidated Alcohol-Dependent Individuals. Journal of Clinical Psychiatry, 79(6). doi:10.4088/JCP.17m11800
• Cohen, J. B., Cohen, D. L., Gislason, T., Grandner, M. A., Kuna, S. T., Pack, A. I., Shulman, R., & Townsend, R. R. (2018). Abstract 073: Sleep Duration and 24-hour Ambulatory Blood Pressure in Adults not on Antihypertensive Medications. Hypertension, 72(Suppl_1). doi:10.1161/hyp.72.suppl_1.073
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  Background: Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality, although the underlying mechanisms for this relationship remain unclear. Maladaptive cir...
• Dailey, N. S., Alkozei, A., Bajaj, S., Grandner, M. A., Killgore, W. D., Raikes, A. C., Rauch, S. L., Rosso, I. M., Satterfield, B. C., Vanuk, J. R., & Weber, M. (2018). 1026 Impact Of Blue Light Therapy On Cortical Structure, Sleep, And Anxiety Symptoms Following Mild Traumatic Brain Injury. Sleep, 41(suppl_1), A381-A381. doi:10.1093/sleep/zsy061.1025
• Ellis, J., Gencarelli, A. M., Grandner, M. A., Khader, W., Kloss, J. D., Morales, K. H., Perlis, M. L., & Vargas, I. (2018). 0359 A One Year Study Of 1,069 Good Sleepers: The Incidence Of Acute And Chronic Insomnia. Sleep, 41(suppl_1), A137-A138. doi:10.1093/sleep/zsy061.358
• Ellis, J., Grandner, M. A., Khader, W., Kloss, J. D., Morales, K. H., Perlis, M. L., & Zandberg, L. J. (2018). 0362 Does Time in Bed Differentiate Between Good Sleepers and Subjects that Develop Acute Insomnia, Recover from Acute Insomnia, and/or Develop Chronic Insomnia?. Sleep, 41(suppl_1), A138-A139. doi:10.1093/sleep/zsy061.361
• Fox, E. C., Wang, K., Aquino, M., Grandner, M., Xie, D., Branas, C. C., & Gooneratne, N. S. (2018). Sleep Dept at the Community Level: Impact of Age, Sex, Race/Ethnicity and Health. Sleep Health, 4(4), 317-324. doi:10.1016/j.sleh.2018.05.007
• Full, K. M., Kerr, J., Grandner, M. A., Malhotra, A., Moran, K., Godoble, S., Natarajan, L., & Soler, X. (2018). Validation of a Physical Activity Accelerometer Device Worn on the Hip and Wrist against Polysomnography. Sleep Health, 4(2), 209-216. doi:10.1016/j.sleh.2017.12.007
• Garland, S. N., Rowe, H., Repa, L. M., Fowler, K., Zhou, E. S., & Grandner, M. (2018). A Decade's Difference: 10-year Change in Insomnia Symptom Prevalence in Canada Depends on Sociodemographics and Health Status. Sleep Health, 4(2), 160-165. doi:10.1016/j.sleh.2018.01.003
• Garland, S. N., Vargas, I., Grandner, M., & Perlis, M. L. (2018). Treating Insomnia in Patients with Comorbid Psychiatric Disorders: A Focused Review. Canadian Psychology, 59(2), 176-186. doi:10.1037/cap0000141
• Gilles, A., & Grandner, M. A. (2018). 0872 Sleep Duration and Cardiometabolic Disease Risk in Native Hawaiians. Sleep, 41(suppl_1), A324-A324. doi:10.1093/sleep/zsy061.871
• Gonzalez, B. D., Grandner, M., Caminiti, C. B., & Hui, S. A. (2018). Cancer Survivors in the Workplace: Sleep Disturbance Mediates the Impact of Cancer on Healthcare Expenditures and Work Absenteeism. Journal of Supportive Care in Cancer, 26(12), 4049-4055. doi:10.1007/s00520-018-4272-4
• Grandner, M. (2018). Abstract P344: Sleep Duration and Obesity: Impact of Demographics, Socioeconomic Status, Health Behaviors, and Health Status. Circulation, 137(suppl_1). doi:10.1161/circ.137.suppl_1.p344
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  Introduction: Many studies have shown that sleep duration is associated with obesity. It is unclear, though, whether this relationship exists equally across groups and whether it depends on demographics, socioeconomics, or aspects of health. Methods: Nationally-representative data from the 2016 BRFSS was used. Obesity was calculated as BMI≥30. Sleep duration was categorized as very short (≤4), short (5-6), normal (7-8), and long (≥9). Covariates included demographics (age, sex, race/ethnicity, education, marital status), socioeconomics (education, income, employment, # children), health risk factors (smoking, heavy drinking, sedentary lifestyle, access to a doctor, foregoing medical care due to cost), and health status (physical health, mental health, health-related limitations). Weighted logistic regression examined 5 models (unadjusted, demographics, add socioeconomics, add health behaviors, add health status). Whether relationships depended on covariates were evaluated with interaction terms and followed up by stratified analyses. Results: See Table for associations between sleep duration and obesity across all 5 models. In all models, very short, short, and long sleep were all associated with obesity, with very short sleep carrying the greatest risk. Note that as the number of covariates increased, the analytic samples were smaller. Interaction terms for all variables were statistically significant (p
• Grandner, M. (2018). The Cost of Sleep Lost: Implications for Health, Performance, and the Bottom Line. American Journal of Health Promotion, 32(7), 1480-1485. doi:10.1177/0890117118790621a
• Grandner, M. A. (2018). Abstract P344: Sleep Duration and Obesity: Impact of Demographics, Socioeconomic Status, Health Behaviors, and Health Status. Circulation.
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  Introduction: Many studies have shown that sleep duration is associated with obesity. It is unclear, though, whether this relationship exists equally across groups and whether it depends on demogra...
• Grandner, M. A., Hashmi, S. D., Morgenthaler, T. I., Mullington, J., Redeker, N. S., & Watson, N. F. (2018). 0867 Sleep Duration and Hypertension among >700,000 Adults by Age and Sex: A Report of the National Healthy Sleep Awareness Project. Sleep, 41(suppl_1), A322-A322. doi:10.1093/sleep/zsy061.866
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  The present study evaluated the cross-sectional relationship between sleep duration and hypertension in a large, nationally-representative dataset that spans 10 years. This analysis may provide detailed information with high resolution about how sleep duration is related to hypertension and how this differs by demographic groups. Data were aggregated from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) (N=433,386) and the combined 2007–2016 National Health Interview Surveys (NHIS) (N=295,331). These data were collected by the CDC from nationally-representative samples. Surveys were combined and survey-specific weights were used in all analyses. Sleep duration was assessed with the item, “On average, how many hours of sleep do you get in a 24-hour period?” in both surveys. Hypertension was assessed as self-reported history. Covariates were assessed identically in both datasets and included, age (in 5-year groupings), sex, race/ethnicity, and employment status. In adjusted analyses, compared to 7hrs, increased risk of hypertension was seen among those sleeping ≤4hrs (OR=1.86,p
• Grandner, M. A., Jean-louis, G., Kalinowskisi, J., Madhavaram, S., Rogers, A., Seixas, A. C., Williams, S., & Williams, N. J. (2018). 0879 Associations Between Self-Reported Sleep Duration and the new AHA/ACC High Blood Pressure Guidelines: Results from the National Health and Nutrition Examination Survey. Sleep, 41(suppl_1), A327-A327. doi:10.1093/sleep/zsy061.878
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  The new AHA/ACC guidelines define high blood pressure requiring lifestyle changes and treatment at 130/80 mmHg, rather than 140/90 mmHg, allowing for earlier detection, prevention, and management of high blood pressure. This might enable better cardiovascular outcomes. Sleep and sleep duration, has been associated with cardiovascular outcomes. However, there is no literature that examines the relationship between sleep measures and the new high blood pressure guidelines. The National Health and Nutrition Examination Survey (NHANES) is a collection of cross-sectional surveys based on nationally representative samples of the US civilian non-institutionalized population, utilizing a stratified, multistage sampling design to recruit participants from households. Utilizing data from NHANES, high blood pressure was defined as systolic blood pressure >130 mmHg and diastolic blood pressure >80 mmHg as per the new guidelines. Self-reported sleep duration was determined from household interview questions with about sleep duration, less than usual sleep duration or more than usual amount of sleep. Statistical hypotheses were tested using chi-square tests and logistic regressions to estimate the likelihood of high blood pressure among adults with varying sleep groupings. When high blood pressure is redefined by the new guidelines, there are varying differences in the percentage of individuals reporting less than usual amount of sleep in each category of increased blood pressure. Among individuals classified as having elevated blood pressure by the new guidelines, 63.4% of individuals reported having less than usual amount of sleep versus 62.2% based on the old guidelines. Among individuals classified as having Stage 1 hypertension by the new guidelines, 59.5% reported less than usual sleep versus 65.3% based on the old guidelines. For those classified as having Stage 2 hypertension based on the new guidelines, 64.5% of individuals reported less than usual sleep versus 60% based on the old guidelines. The new high blood pressure classifications allowed for significant differences in percentage of individuals reporting less than usual sleep by comparison with the old hypertension guidelines. Grant K07AG052685.
• Grandner, M. A., Ji, X. W., & Petrov, M. E. (2018). 0894 The Role of Age, Sex, Race/ethnicity, Education, and Marital Status in the Relationship of Chronic Health Conditions and Habitual Sleep Duration. Sleep, 41(suppl_1), A332-A332. doi:10.1093/sleep/zsy061.893
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  This study aims to investigate the associations between diagnosis history of chronic conditions and habitual sleep duration, and the role of sociodemographic factors in-between the associations. 2013 Behavioral Risk Factor Surveillance System was used. Multinomial regressions were performed to investigate the risk for extreme sleep durations among those with depression or chronic diseases. Stratified regression analyses were further done to investigate the interactions of sociodemographic variable and depression/chronic diseases on habitual sleep durations. Among 491,773 respondents, most diagnoses were associated with suboptimal sleep durations except skin cancer. In general, the risk for very short sleep duration is higher than that for short and long sleep durations across the diagnoses and groups. Age, sex, education level, race and marital status significantly moderated the relationship between the diagnosis history and extreme sleep durations. Moreover, with depression or arthritis, people in younger age group were more likely to report very short sleep durations than the older group. Men are more likely to report very short sleep duration than women if they had depression. Yet, females are more likely to report very short sleep duration than males if they had the diagnosis of physical diseases. Higher education was associated with lower risk for very short sleep duration in depression, but the trend reversed for heart diseases. For white population, the associations between diagnosis and extreme sleep durations were significant across all chronic conditions. In contrast, black people are less like to have long sleep durations if they had the previous diagnosis of pulmonary diseases, asthma, and arthritis. Sociodemographic factors significantly moderated the relationship between previous chronic illness and sleep duration extremes. Nature of the chronic conditions and social-economic status may account for the discrepancies in medical diagnosis-sleep duration associations. Further study was required to understand sleep duration, as a health behavior, in the context of antecedent chronic conditions. none.
• Grandner, M. A., Knowlden, A. P., Nowakowski, S., & Petrov, M. E. (2018). 0278 Gender Differences in the Relationship between Short Sleep and Obesity Depend on Age. Sleep, 41(suppl_1), A107-A107. doi:10.1093/sleep/zsy061.277
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  The purpose of this study was to examine the relationship between sleep duration and body mass index among adults across the lifespan, stratified by sex and age. Analysis for this study was based on 2013 Behavioral Risk Factor Surveillance System (BRFSS), a state-based, random-digit-dialed telephone survey of non-institutionalized U.S. adults (≥18 years), N=385,054. Short sleep was operationalized as ≤6 hours; age was categorized into 5-year groupings, ranging from 18 to 80+; Body Mass Index (BMI) was based on self-reported height and weight (kg/m2); values ≥30 were classified as “obese.” Logistic regression analyses were stratified by age and sex, and for each age group, the sleep-by-sex interaction was evaluated. The relationship between sleep duration and obesity differed by sex for nearly all age groups except later adulthood. Short sleep was associated with greater obesity risk in men between the ages of 18 and 74, with ORs ranging from 1.19 (both 18–25 and 70–74) to 1.41 (both 30–34 and 35–39). For women, short sleep was associated with obesity for ages 18–69, with ORs ranging from 1.23 (65–69) to 1.64 (30–34). Short sleep duration was more prevalent among men (37.92–40.00%) than women (35.51–36.85%) between the ages of 25 and 49 (p
• Grandner, M. A., Pack, A. I., Parthasarathy, S., & Perlis, M. L. (2018). 0877 Systematic Sleep Time Extension: A Novel Approach to Extending Sleep in Habitual Short Sleepers. Sleep, 41(suppl_1), A326-A326. doi:10.1093/sleep/zsy061.876
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  Few real-world strategies exist for increasing sleep duration. As with other health behaviors, short sleep may be relatively intractable, as people give up sleep for increased work time, social activities, etc. Accordingly, a protocol was developed to evaluate whether an individualized, systematic upward titration of sleep opportunity would result in increased sleep duration. The sleep extension intervention was conducted over 8 weeks and entailed (1) standardizing the sleep-wake schedule by assigning bed/wake times based on mean sleep ability determined by 2 weeks of sleep diary average total sleep time, and (2) increasing sleep opportunity by 15 minutes per week provided sleep efficiency remained at the standard CBTI cutoff of >90%. If sleep efficiency was moderate, no additional time was added for that week. If sleep efficiency was lower than 85%, sleep opportunity was reduced by 15 minutes for the week. Five men aged 26–51 (M=33.4) who self-reported ≤6 hours of habitual sleep and did not have other medical, psychiatric, or sleep disorders were recruited. Subjects were not recruited on the basis of motivation to increase sleep duration. Based on electronic daily sleep diaries, mean sleep duration at Week 1 was 5.8 hours (SD=1.2 hours) with a corresponding mean sleep efficiency of 86.8% (SD=7.8%). By the end of 8 weeks, these were increased to a mean 7.4 hours (SD=1.4 hours) with a sleep efficiency of 93.6 (SD=3.5%). Mean increase in sleep duration was 97.25 minutes per person (SD=23.9, range=57.7–118.0, effect size d=1.23). A paired t-test was significant (t(4)=-9.10,p=0.0008). In summary, a “real-world,” data-driven protocol that slowly increases sleep opportunity can be effective in extending sleep duration. The cardio-metabolic and neurocognitive health benefits of such an effective intervention need to be explored. Support (If Any):
• Grandner, M. A., Watson, N. F., Kay, M., Ocaño, D., & Kientz, J. A. (2018). Addressing the need for validation of a touchscreen psychomotor vigilance task: important considerations for sleep health research. Sleep Health, 4(Issue 5). doi:10.1016/j.sleh.2018.08.003
• Grandner, M., Mullington, J. M., Hashmi, S. D., Redeker, N. S., Watson, N. F., & Morgenthaler, T. I. (2018). Sleep Duration and Hypertension: Analysis of > 700,000 Adults by Age and Sex. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1031-1039.
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  The objective of this study was to evaluate the cross-sectional relationship between sleep duration and hypertension in a large, nationally-representative dataset that spans 10 years. This analysis may provide detailed information with high resolution about how sleep duration is related to hypertension and how this differs by demographic group.
• Grandner, M., Watson, N. F., Kay, M., Ocano, D., & Kientz, J. A. (2018). Addressing the Need for Validation of a Touchscreen Psychomotor Vigilance Task:Important Considerations for Sleep Health Research. Sleep Health, 4(5), 387-389. doi:10.1016/j.sleh.2018.08.003
• Klimentidis, Y. C., Grandner, M. A., Havens, C. M., Klimentidis, Y. C., Malone, S. K., Parthasarathy, S., & Patterson, F. (2018). 0016 Sleep Traits Accentuate the Association of Genetic Markers with Obesity: Results from the UK Biobank. Sleep, 41(suppl_1), A7-A7. doi:10.1093/sleep/zsy061.015
• Knowlden, A. P., Robbins, R., & Grandner, M. (2018). Social Cognitive Models of Fruit and Vegetable Consumption, Moderate Physical Activity, and Overweight and Obese Men. American Academy of Health Behavior, 1(2).
• Kools, F. R., Mirali, S., Holst-Bernal, S., Nijhof, S. L., Cavalli, G., & Grandner, M. A. (2018). Publications Are Not the Finish Line: Focusing on Societal Rather Than Publication Impact. Frontiers in medicine, 5, 314.
• Mai, Q. D., Hill, T. D., Vila‐Henninger, L., & Grandner, M. A. (2018). Employment insecurity and sleep disturbance: Evidence from 31 European countries. Journal of Sleep Research, 28(1). doi:10.1111/jsr.12763
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  Summary For nearly half a century, jobs have become increasingly characterized by employment insecurity. We examined the implications for sleep disturbance with cross‐sectional data from the European Working Conditions Survey (2010). A group of 24,553 workers between the ages of 25 and 65 years in 31 European countries were asked to indicate whether they suffered from “insomnia or general sleep difficulties” in the past 12 months. We employed logistic regression to model the association between employment insecurity and sleep disturbance for all countries combined and each individual country. For all countries combined, employment insecurity increased the odds of reporting insomnia or general sleep difficulties in the past 12 months. Each unit increase in employment insecurity elevated the odds of sleep disturbance by approximately 47%. This finding was remarkably consistent across 27 of 31 European countries, including Albania, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Slovakia, Slovenia, Spain, Sweden, Turkey and UK. These results persisted with adjustments for age, gender, immigrant status, household size, partnership status, number of children, child care, elder care, education, earner status, precarious employment status, workplace sector, workplace tenure and workplace size. Employment insecurity was unrelated to sleep disturbance in four European countries: Malta, Poland, Portugal and Romania. Our research continues recent efforts to reveal the human costs associated with working in neoliberal postindustrial labour markets. Our analyses contribute to the external validity of previous research by exploring the impact of employment insecurity across European countries.
• Ong, J. C., Arand, D., Schmitz, M., Baron, K., Blackburn, R., Grandner, M. A., Lichstein, K. L., Nowakowski, S., Teixeira, C., Boling, K., C Dawson, S., & Hansen, K. (2018). A Concept Map of Behavioral Sleep Medicine: Defining the Scope of the Field and Strategic Priorities. Behavioral sleep medicine, 16(6), 523-526.
• Patel, S. N., Quan, S. F., Bailey, O., Berryhill, S., Combs, D., Grandner, M. A., Havens, C. M., Parthasarathy, S., Poongkunran, C., Provencio, N., & Sans-fuentes, M. A. (2018). 0652 Delayed Sleep Time In African Americans And Depression In A Community-Based Population. Sleep, 41(suppl_1), A242-A242. doi:10.1093/sleep/zsy061.651
• Patterson, F., Grandner, M., Lozano, A., Satti, A., & Ma, G. (2018). Transitioning from Adequate to Inadequate Sleep Duration Associated with Higher Smoking Rate and Greater Nicotine Dependence in a Populaiton Sample. Addictive Behaviors, 77, 47-50.
• Patterson, F., Grandner, M., Lozano, A., Satti, A., & Ma, G. (2018). Transitioning from adequate to inadequate sleep duration associated with higher smoking rate and greater nicotine dependence in a population sample. Addictive Behaviors, 77, 3. doi:10.1016/j.addbeh.2017.09.011
• Patterson, F., Malone, S. K., Grandner, M., Lozano, A., Perkett, M., & Hanlon, A. (2018). Interactive Effects of Sleep Duration and Morning/ Evening Preference on Cardiovascular Risk Factors. European Journal of Public Health, 28(1), 155-161.
• Petrov, M. E., Howard, G., Grandner, M. A., Kleindorfer, D., Molano, J. R., & Howard, V. J. (2018). Sleep duration and risk of incident stroke by age, sex, and race: The REGARDS study. Neurology, 91(18), e1702-e1709.
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  To investigate the association between reported sleep duration and incident stroke in a US cohort of black and white adults, and evaluate race, age, and sex as potential effect modifiers.
• Petrov, M. E., Howard, G., Grandner, M., Kleindorfer, D., Molano, J. R., & Howard, V. J. (2018). Sleep Duration and Risk of Incident Stroke by Age, Sex, and Race: The REGARDS Study. Neurology, 91(18). doi:https://doi.org/10.1212/WNL.0000000000006424
• Seixas, A. A., Vallon, J., Barnes-Grant, A., Butler, M., Langford, A. T., Grandner, M. A., Schneeberger, A. R., Huthchinson, J., Zizi, F., & Jean-Louis, G. (2018). Mediating effects of body mass index, physical activity, and emotional distress on the relationship between short sleep and cardiovascular disease. Medicine (United States), 97(Issue 37). doi:10.1097/md.0000000000011939
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  The current study investigated the mediating effects of body mass index (BMI), physical activity, and emotional distress on the association between short sleep duration (
• Seixas, A. A., Vallon, J., Barnes-Grant, A., Butler, M., Langford, A. T., Grandner, M. A., Schneeberger, A. R., Huthchinson, J., Zizi, F., & Jean-Louis, G. (2018). Mediating effects of body mass index, physical activity, and emotional distress on the relationship between short sleep and cardiovascular disease. Medicine, 97(37), e11939.
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  The current study investigated the mediating effects of body mass index (BMI), physical activity, and emotional distress on the association between short sleep duration (
• Seixas, A., Alfonso-miller, P., Gehrels, J., Grandner, M. A., Killgore, W. D., Liang, O., & Seixas, A. C. (2018). 0888 Sleep Duration And Diabetes In The Us For 2007–2015: Moderation By Age, Sex, Race/ethnicity, And Body Mass Index. Sleep, 41(suppl_1), A330-A330. doi:10.1093/sleep/zsy061.887
• Shulman, R., Cohen, D. L., Grandner, M. A., Gislason, T., Pack, A. I., Kuna, S. T., Townsend, R. R., & Cohen, J. B. (2018). Sleep duration and 24-hour ambulatory blood pressure in adults not on antihypertensive medications. Journal of clinical hypertension (Greenwich, Conn.), 20(12), 1712-1720.
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  Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality. We performed a post hoc analysis of 24-hour ambulatory blood pressure monitoring (ABPM) in the Lifestyle Modification in Blood Pressure Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. The 24-hour mean systolic blood pressure (BP) was 12.7 mm Hg higher in LIMBS (P 
• Tubbs, A., Alfonso-miller, P., Basner, M., Chakravorty, S., Gehrels, J., Grandner, M. A., Killgore, W. D., Perlis, M. L., & Tubbs, A. S. (2018). 0978 Does Increased Risk of Suicide at Night Favor One Method of Suicide Over Another. Sleep, 41(suppl_1), A363-A363. doi:10.1093/sleep/zsy061.977
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  In a prior investigation, it was shown that the incidence of suicide is higher at night than would be expected. This follow-up analysis evaluates whether the time-of-day-patterning of suicide was different depending on the method/weapon used. Data for N=33,813 suicides, including time of fatal injury and method used, were collected from the National Violent Death Reporting System for years 2002–2010. The most common methods included Firearms (N=20,583), Suffocation (N=6,670), Poisoning (N=3,647), Falling (N=939), Sharp Instrument (N=533), Drowning (N=406), Motor Vehicle (N=339), and Fire (N=224). As with the prior analysis, time of fatal injury was categorized into one-hour bins and grouped into four categories: Morning (06:00 to 11:59), Afternoon (12:00 to 17:59), Evening (18:00 to 23:59), and Night (00:00 to 05:59). American Time Use Survey data from the same years estimated of the proportion of the population awake at each hour. This was used to calculate a standardized incidence ratio (SIR), representing the ratio of observed to expected suicides given the proportion of the population likely awake. In the present analysis, each of the four temporal categories were evaluated for differences with respect to method of suicide. Compared to other times of day, nighttime SIRs were statistically significant for drowning (3.72 ± 1.55), falling (4.268 ± 2.234), fire (6.478 ± 3.15), firearms (4.345 ± 1.682), motor vehicle (6.577 ± 3.487), poisoning (4.222 ± 1.749), sharp instrument (3.792 ± 1.463), and suffocation (4.850 ± 1.864). The nighttime SIR for each method did not differ from the total SIR (one-way ANOVA, p=0.54). Suicides occur disproportionately at night, but nighttime wakefulness does not favor one mechanism of suicide over another. This suggests that being awake at night may influence the initial decision to commit suicide, and not the means by which suicide is accomplished. Support (If Any):
• Tubbs, A., Alfonso-miller, P., Basner, M., Chakravorty, S., Gehrels, J., Grandner, M. A., Killgore, W. D., Perlis, M. L., & Tubbs, A. S. (2018). 0988 Seasonal Changes in Nocturnal Suicide Risk. Sleep, 41(suppl_1), A366-A366. doi:10.1093/sleep/zsy061.987
• Alfonso-miller, P., Athey, A., Chakravorty, S., Gehrels, J., Grandner, M. A., Grandner, G., Hall, C., Killgore, W. D., & Warlick, C. (2017). 1135 DIFFICULTY SLEEPING ASSOCIATED WITH SUBSTANCE USE AMONG STUDENT ATHLETES. Sleep, 40(suppl_1), A423-A423. doi:10.1093/sleepj/zsx050.1134
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  Sleep problems are common among student athletes, who are often over-scheduled while trying to balance academics and athletics. Sleep disturbance may be a risk factor for substance use in this population. The aim of this study was to evaluate the association between sleep disturbance and different psychoactive substances in student athletes. Data were collected from the National College Health Assessment, a survey of US colleges/universities. Data from 2011–2014 included N=8,683 student athletes. Participants were asked whether, in the past 12 months, “sleep difficulties” had “been traumatic or very difficult for you to handle” (yes/no). Students were also asked whether they used the following in the past 30 days: cigarettes, hookahs, cigars/cloves, smokeless tobacco, alcohol, marijuana, cocaine, methamphetamine, other amphetamines, sedatives, hallucinogens, steroids, opiates, inhalants, ecstasy, club drugs, or other drugs. They were also asked whether “the typical student at your school” used these substances in the past 30 days. Regression analyses examined whether use of any of these substances was associated with sleep difficulties, adjusted for age, sex, and survey year. Also, discrepancy between student use and perceived typical use (more or less vs typical) and sleep was examined. Depression score was explored as a possible mediator. Sleep difficulties were associated with increased use of cigarettes (OR=2.51,p
• Alfonso-miller, P., Athey, A., Chakravorty, S., Gehrels, J., Grandner, M. A., Grandner, G., Killgore, W. D., & Till, K. (2017). 1134 INSOMNIA AND DAYTIME TIREDNESS IN STUDENT ATHLETES ASSOCIATED WITH RISKY BEHAVIORS AND POOR DECISION MAKING WHEN UNDER THE INFLUENCE OF ALCOHOL. Sleep, 40(suppl_1), A422-A423. doi:10.1093/sleepj/zsx050.1133
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Grandner, G., Jaszewski, A., & Killgore, W. D. (2017). 1136 SLEEP DURATION AND QUALITY ASSOCIATED WITH MENTAL WELL-BEING IN STUDENT ATHLETES. Sleep, 40(suppl_1), A423-A423. doi:10.1093/sleepj/zsx050.1135
• Alfonso-miller, P., Athey, A., Gehrels, J., Grandner, M. A., Grandner, G., Jaszewski, A., Killgore, W. D., Meridew, C., & Wd, K. (2017). 1208 IMPACT OF TIME AND ACTIVITY DEMANDS ON SLEEP OF STUDENT ATHLETES: IT’S NOT ABOUT REDUCED SLEEP OPPORTUNITY. Sleep, 40(suppl_1), A450-A450. doi:10.1093/sleepj/zsx050.1207
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  Student athletes are at high risk for poor sleep, yet sleep impacts academic and athletic performance. Despite speculation about the role of over-scheduling, little evidence examines time demands relative to sleep duration and insomnia in this population. Data were collected from N=190 Division-1 student athletes. Sleep duration was assessed using the Pittsburgh Sleep Quality Index (PSQI) item. Insomnia was assessed using the Insomnia Severity Index (ISI). Students were asked how many hours/week were spent in training/practice/competition, work, class, and studying/homework. They were also asked to rate whether activities interfered with sleep: practice, competition, training, class, homework/studying, and work/job. Regression analyses were adjusted for sex and year in school. Also, analyses examining interference of activities adjusted for time in that activity. Mean sleep duration was 6.96 (SD=1.17) hours and mean ISI score was 7.68 (SD=5.15). Mean weekly time spent in training/practice/competition, work, class, and studying/homework were 16.21 (SD=9.02), 1.81 (SD=5.47), 8.36 (SD=6.12), and 8.86 (SD=6.82) hours, respectively. Percent reporting interference with sleep were as follows: practice:40%, competition:33%, training:44%, class:33%, homework:51%, and job:7%. Neither sleep duration nor insomnia were associated with hours spent in any activity. Shorter sleep duration was seen among those who indicated that the following interfered with sleep: practice (B=-0.43hrs,p=0.013), competition (B=-0.49hrs,p=0.007), training (B=-0.4hrs,p=0.012), and homework (B=-0.56hrs,p=0.001). Higher ISI score was seen among those who indicated that the following interfered with sleep: practice (B=3.86pts,p
• Alfonso-miller, P., Athey, A., Grandner, M. A., & Grandner, G. (2017). 1206 EVALUATION OF A SLEEP HEALTH INTERVENTION IN STUDENT ATHLETES: INSIGHTS FOR INTERVENTION DEVELOPMENT. Sleep, 40(suppl_1), A450-A450. doi:10.1093/sleepj/zsx050.1205
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  Student athletes are at high risk of sleep problems, perhaps due to over-scheduling and difficulty balancing academics and athletics. To address this, a pilot intervention that focused on education and tracking was implemented. This program was evaluated to determine (1) what did participants learn from the educational content, and (2) what elements of the intervention were most helpful. A pilot sleep health intervention was conducted across the Fall 2016 semester among student athletes. It included an intake survey, education session, 10 weeks of tracking (sleep diary, sleep/fitness tracker, and daily text message reminders), 24/7 access to support, a weekly drawing providing financial incentive for adherence, and a follow-up survey. N=40 students were enrolled, though N=35 have yet completed. Participants were asked to evaluate the helpfulness of various components of the survey (0=10 scale, >5=“helpful”). Also, participants were asked whether they learned from the intervention, rated on a scale of 0–4. Responses ≥3 (“a lot” or “very much”) were coded as “learned a lot.” Eighty-nine percent reported benefit from the educational session (basic sleep knowledge and sleep tips were equally helpful). Only 29% found the daily text messages helpful, 54% found the 24/7 access helpful, 43% found the sleep diary helpful, 80% found the sleep/fitness tracker helpful, and 83% found the financial incentive helpful. Seventy-four percent reported that they learned a lot about the importance of sleep, 86% each about how sleep affects daytime functioning, athletic performance, and mental health, 60% about how to tell if they are sleepy, 80% about their own sleep patterns, and 77% about how their sleep affects daytime function. Respondents found many elements helpful, especially the educational content, sleep/fitness tracker, and financial incentive. Participants reported learning a lot about sleep in general, how it affects performance, and how this relates to their own sleep patterns. K23HL110216 and NCAA Innovation Grant
• Alfonso-miller, P., Athey, A., Grandner, M. A., Grandner, G., & Killgore, W. D. (2017). 0793 PRELIMINARY RESULTS OF A SLEEP HEALTH INTERVENTION IN STUDENT ATHLETES: CHANGES IN SLEEP, ENERGY LEVEL, AND MENTAL WELL-BEING, AND BODY WEIGHT. Sleep, 40(suppl_1), A294-A294. doi:10.1093/sleepj/zsx050.792
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  Student athletes are at high risk of sleep problems, perhaps due to over-scheduling and difficulty balancing academics and athletics. Although many athletics programs use nutrition, physical activity, and stress reduction programs to improve quality of life for student athletes, few are employing sleep interventions. The present study evaluated a relatively simple sleep health intervention to see if it improved sleep, energy level, stress, and weight. This single-group pilot of a sleep health intervention was conducted across the Fall semester among student athletes. It included an intake survey, a 90min education session, 10 weeks of daily sleep diary, sleep/fitness tracker use, and text message reminders, 24/7 access to peer support and study staff for questions, and a follow-up survey at the end of the study. N=40 students were enrolled, though only N=35 have yet completed the follow-up survey. For those that completed baseline and follow-up surveys, paired t-tests (one-tailed due to lack of power in this pilot study) examined changes in Pittsburgh Sleep Quality Index (PSQI, total score, bedtime, waketime, sleep latency, sleep duration), Insomnia Severity Index (ISI), GAD7 anxiety scale, drowsy driving in the past 30 days, (CIRENS energy scale; energy level in the morning, night, and total), and body weight. The intervention resulted in reduced sleep latency (12mins,p=0.0002), advanced waketime (32mins,p=0.033), lower PSQI score (1.3pts,p=0.04), lower ISI score (3.5pts,p=0.0007), lower GAD score (1.6pts,p=0.025), decreased drowsy driving (67%,p=0.009), increased morning energy (19%,p=0.05), increased evening energy (22%,p=0.027), increased total energy level (16%,p=0.019), and decreased weight (19.2lbs,p=0.038). No changes were seen for other variables. A relatively simple intervention based on education and monitoring in a small group of student athletes produced measurable improvements in sleep, energy level, mental health, and reductions in body weight. K23HL110216 and NCAA Innovation Grant
• Alfonso-miller, P., Athey, A., Grandner, M. A., Grandner, G., & Killgore, W. D. (2017). 1207 PRELIMINARY RESULTS OF A SLEEP HEALTH INTERVENTION IN STUDENT ATHLETES: PERCEIVED CHANGES TO SLEEP, PERFORMANCE, AND MENTAL AND PHYSICAL WELL-BEING. Sleep, 40(suppl_1), A450-A450. doi:10.1093/sleepj/zsx050.1206
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  Student athletes are at high risk of sleep problems, perhaps due to over-scheduling and difficulty balancing academics and athletics. The present study evaluated whether students perceived benefits of a relatively simple sleep health intervention. This single-group pilot of a sleep health intervention was conducted across the Fall 2016 semester among student athletes. It included an intake survey, a 90min education session, 10 weeks of tracking, 24/7 access to peer support and study staff for questions, and a follow-up survey. N=40 students were enrolled, though only N=35 have yet completed the follow-up survey. During the follow-up survey, participants were asked if they agreed with statements about changes as a result of the intervention. Most participants reported benefits of the intervention: “I sleep better” (83% agreed), “I am more satisfied with my sleep” (83%), “I fall asleep easier” (77%), “Awakenings at night are less of a problem” (74%), “My sleep timing is better” (91%), “I know what to do if I have trouble sleeping” (86%), and “I know what to do if I am sleepy during the day” (97%). The percent that agreed that they experienced positive changes in the following are reported: “Stress” (66%), “Academic performance” (77%). “Athletic performance” (89%), “Social Life” (77%), “Family Life” (71%), “Mental Health” (77%), “Physical Health” (86%), “Energy Level” (91%), and “Ability to Focus” (83%). Of these 16 domains, improvement was reported in M=13.2(SD=3.3) domains per student. A relatively simple intervention based on education and monitoring in a small group of student athletes produced perceived improvements across many domains of sleep, performance, and mental and physical health. K23HL110216 and NCAA Innovation Grant
• Alfonso-miller, P., Barrett, M. S., Branas, C. C., Fisseha, E., Gallagher, R., Gehrels, J., Grandner, M. A., Grandner, G., Hale, L., Jean-louis, G., Killgore, W. D., Seixas, A. C., & Williams, N. J. (2017). 0831 HABITUAL WEEKDAY SLEEP DURATION ASSOCIATED WITH MULTIPLE DIMENSIONS OF SOCIOECONOMIC STATUS. Sleep, 40(suppl_1), A308-A308. doi:10.1093/sleepj/zsx050.830
• Alfonso-miller, P., Barrett, M. S., Branas, C. C., Gallagher, R., Gehrels, J., Grandner, M. A., Grandner, G., Hale, L., Killgore, W. D., Olivier, K., & Parthasarathy, S. (2017). 0769 DEVELOPMENT AND INITIAL VALIDATION OF A BRIEF MEASURE OF CONTROL OVER SLEEP. Sleep, 40(suppl_1), A285-A285. doi:10.1093/sleepj/zsx050.768
• Alfonso-miller, P., Barrett, M. S., Branas, C. C., Gallagher, R., Gehrels, J., Grandner, M. A., Grandner, G., Hale, L., Killgore, W. D., Parthasarathy, S., Perlis, M. L., & Yang, R. (2017). 0814 WOULD YOU CALL YOURSELF A SHORT OR LONG SLEEPER? PERCEPTIONS OF SLEEP CATEGORY ASSOCIATED WITH REPORTED SLEEP DURATION, INSOMNIA, AND HEALTH. Sleep, 40(suppl_1), A301-A301. doi:10.1093/sleepj/zsx050.813
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  Short and long sleep durations are prevalent and associated with poor health. This study examined whether an individual’s self-identified sleep category (e.g., “short” or “long”) relates to observed sleep duration. The study also explored whether perceptions of sleep durations are affected by the presence of insomnia and whether self-described category predicts poor health above observed sleep duration. Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) Study, a community-based survey of 1,007 adults (22–60 years old). Sleep duration was assessed with the BRFSS item (sleep per 24h period) and the NHANES item (weekday nighttime sleep) for comparison purposes. Insomnia was measured with the Insomnia Severity Index. Respondents were asked whether they considered themselves a “Very-Short-Sleeper,” “Short-Sleeper,” “Average-Length-Sleeper,” “Long-Sleeper,” or “Very-Long-Sleeper.” Self-described groups were compared to groups derived from reported sleep duration (8h=long). Linear regression, adjusted for age, sex, race/ethnicity, and education, evaluated sleep duration differences across groups. Multinomial logistic regression, adjusted for covariates and sleep duration, examined whether insomnia predicts self-described group and whether self-described group predicts poor health. Overlap between derived and self-described category was modest, with only 62% of 7-8hr sleepers identifying as “average-duration.” Similarly, overlap for “short” and “long” sleep was 67% and 52%, respectively. This is in comparison to overlap between BRFSS and NHANES of 77%, 88%, and 33% for average-duration, short, and long sleep. Self-identified “very short sleepers” reported 93 fewer minutes of sleep, vs “average-duration sleepers” (p
• Alfonso-miller, P., Barrett, M. S., Branas, C. C., Gallagher, R., Gooneratne, N. S., Grandner, M. A., Hale, L., Jean-louis, G., Perlis, M. L., Robbins, R., & Sundarajan, A. (2017). 0809 SOCIAL CAPITAL AND SOCIAL CONNECTEDNESS RELATED TO SLEEP DURATION, INSOMNIA SYMPTOMS, AND DAYTIME SLEEPINESS. Sleep, 40(suppl_1), A299-A299. doi:10.1093/sleepj/zsx050.808
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  Social capital refers to quality of networks of relationships among people who live and work together. Poor social capital predicts adverse outcomes, including cardiovascular disease, diabetes, and increased mortality. Little is known about how social capital relates to sleep health. The current study explored the relationship between social capital and sleep duration, insomnia symptoms, and daytime sleepiness. A sample of 1,007 participants from the Sleep Health and Activity, Diet and Environment Study (SHADES) was used. Social Capital was assessed as number of group/club memberships, neighborhood helping behavior, willingness to improve their neighborhood, sense of community belongingness, and trust of others in a community. Sleep duration was assessed with the NHANES questionnaire asking participants to report bed/wake time, then categorized as very short (8hrs). Insomnia was assessed with the Insomnia Severity Index and categorized as none, mild, and moderate-severe. Sleepiness was assessed with the Epworth Sleepiness Scale. Logistic regression examined whether sleep variables and social capital measures were associated. Compared with healthy sleepers, decreased likelihood of group membership was seen for very short (OR=0.50;95%CI[0.26,0.98];p
• Alfonso-miller, P., Barrett, M. S., Branas, C. C., Gallagher, R., Grandner, M. A., Grandner, G., Hale, L., & Keenan, B. T. (2017). 0810 SLEEP AND HEALTHY ACTIVITY, DIET, ENVIRONMENT, AND SOCIALIZATION: THE SHADES STUDY. Sleep, 40(suppl_1), A300-A300. doi:10.1093/sleepj/zsx050.809
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  Identifying the relative contribution of predictors of insufficient sleep can help identify fruitful intervention targets. The goal of this study was to broadly assess the relative contributions of a large number of sleep predictors in a real-world setting. Survey data were collected from N=1,007 adults aged 22–60 from the Philadelphia area. Sleep duration was measured using the Sleep Timing Questionnaire, with a 5/2 weighted average of weekday/weekend computed sleep duration. Regression analyses involved hierarchical models assessing relative contributions of a number of domains to sleep duration: demographics (age, gender, race and BMI); overall health (health rating, fatigue, diabetes, and hypertension); mental health (depression, anxiety, and ratings of satisfaction with life, financial situation, health, relationships and sleep); diet (unhealthy diet); activity level (vigorous and moderate activity and sitting); substance use (smoking status, alcohol use, drug use); disturbed environment (sleep environment); socioeconomic status (income quintile, education, social standing in community and U.S., food security, ability to afford basics); social functioning (social support); occupational stress (trouble at work); and measures of underlying sleep disorders (insomnia, poor sleep quality, daytime sleepiness, sleep apnea risk). Neighborhood-level crime rates, demographics, and quality, and relative pollution and traffic levels were also assessed. Combined, 27.29% of the variance in sleep duration (p=3.9x1021) was explained. In individual models, the variables that contributed significant variance included underlying sleep disorders (R2=0.154,p=1.2x10-28), mental health (R2=0.092,p=6.6x10-17), socioeconomic status (R2=0.043,p=0.001), demographics (R2=0.029,p=0.0003), social functioning (R2=0.024,p=1.8x10-6), neighborhood-level crime (R2=0.021,p=0.048), overall health (R2=0.019,p=0.01), physical activity (R2=0.015,p=0.003), occupational stress (R2=0.008,p=0.006), and diet (R2=0.006,p=0.014). In a combined model, the following were significant unique contributors: underlying sleep disorders, health, demographics, and disturbed environment. Poor sleep quality and mental health are the strongest predictors of insufficient sleep, though overall health, activity, diet, the environment, and social functioning are all related to less sleep in a real-world setting. R21ES022931 and K23HL110216
• Alfonso-miller, P., Branas, C. C., Gallagher, R., Gehrels, J., Grandner, M. A., Grandner, G., Hale, L., Jean-louis, G., Killgore, W. D., Parthasarathy, S., Poling, K., & Seixas, A. (2017). 0832 SLEEP PARTIALLY MEDIATES THE ASSOCIATION BETWEEN FOOD INSECURITY AND OBESITY: ROLES OF SHORT SLEEP DURATION, INSOMNIA, AND SOCIOECONOMIC FACTORS. Sleep, 40(suppl_1), A308-A308. doi:10.1093/sleepj/zsx050.831
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  Food insecurity (inability to afford enough healthy food) is a socioeconomic stressor with profound health consequences, including increased obesity (perhaps through replacing nutritious food with cheap alternatives). The present study examines the direct associations between food insecurity and both sleep duration and an insomnia index. Further we investigated the potentially mediating role of sleep duration and insomnia in the association between food insecurity and obesity. Data were collected as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) Study, a diverse, community-based survey of adults aged 22–60 (N=1,007). Food insecurity was assessed as the frequency over the past 12 months of the following: worry that food would run out, food actually running out, and inability to afford balanced meals. Items were scored as “0=never (reference),” “1=sometimes,” or “2=often” and summed as a total score (0=6). Sleep duration was assessed using the NHANES question and categorized as very short (≤4h), short (5-6h), normal (7-8h, reference), or long (≥9h). Insomnia was assessed with the Insomnia Severity Index and categorized as none (≤7, reference), mild (8–14), and moderate-severe (≥15). Obesity reflected BMI≥30 based on self-reported height and weight. Multinomial logistic regressions were adjusted for demographic (age, sex, and race/ethnicity) and socioeconomic factors (education, income, and shiftwork). Each individual food-insecurity item was associated with both short and very short sleep duration, as well as both mild and moderate-severe insomnia, even after adjustment for demographic and socioeconomic factors. In the full model, total food-insecurity score was associated with both very short (OR=1.23/pt,p=0.002) and short (OR=1.15/pt,p=0.001) sleep duration, as well as both mild (OR=1.28/pt,p
• Alfonso-miller, P., Molina, P., Buxton, O. M., Gehrels, J., Granados, K., Grandner, M. A., Grandner, G., Haynes, P. L., Jean-louis, G., Molina, P., Okuagu, A., Parthasarathy, S., Patel, S. R., Ruiz, J. M., Seixas, A. C., & Williams, N. J. (2017). 0836 BORN IN THE USA OR BORN IN MEXICO? IMPLICATIONS FOR SLEEP DURATION, SLEEP QUALITY, SLEEP DISORDERS SYMPTOMS AT THE US-MEXICO BORDER. Sleep, 40(suppl_1), A309-A310. doi:10.1093/sleepj/zsx050.835
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  Previous studies have shown that at the population level, being born in Mexico is associated with fewer sleep disturbances. However, previous studies generally did not use standardized/validated instruments and were not able to account for acculturation. The present study examined these relationships in a small city at the US-Mexico border. Data were collected from N=100 adults (age 18–60, 53% female) of Mexican descent from the city of Nogales, AZ, on the US-Mexico border. Questionnaires were in English or Spanish. Participants were asked if they were born in the USA or Mexico. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI; sleep quality score and sleep duration single-item), and Insomnia Severity Index (items for difficulty falling asleep, difficulty staying asleep, early morning awakenings, categorized as none, mild, moderate, and severe). Regression analyses (linear for continuous variables and multinomial for symptoms) adjusted for age, sex, and education level. Post-hoc analyses examined acculturation (measured with the Acculturation Rating Scale for Mexican-Americans, Mexican and Anglo Orientation Scales) as a mediator. 66% of the sample was born in Mexico. Being born in the USA was associated with 56 fewer minutes of nighttime sleep (p
• Alfonso-miller, P., Molina, P., Buxton, O. M., Gehrels, J., Granados, K., Grandner, M. A., Grandner, G., Haynes, P. L., Jean-louis, G., Molina, P., Okuagu, A., Parthasarathy, S., Patel, S. R., Ruiz, J. M., Seixas, A., & Williams, N. J. (2017). 0837 ACCULTURATION ASSOCIATED WITH SLEEP DURATION, INSOMNIA, AND SLEEP QUALITY AT THE US-MEXICO BORDER. Sleep, 40(suppl_1), A310-A310. doi:10.1093/sleepj/zsx050.836
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  Sleep disparities exist among Hispanics/Latinos, though little work has characterized individuals at the US-Mexico border, particularly as it relates to acculturation/assimilation. Acculturation refers to the extent that an individual identifies with and engages in the attitudes/practices of a certain culture. At the border, there are issues of cultural exchange, leading to differential degrees of Mexican and Anglo (“White”) acculturation. This study examined the association of acculturation to sleep problems among those of Mexican descent at the US-Mexico border. Data were collected from N=100 adults (age 18–60, 53% female) of Mexican descent in the city of Nogales, AZ (66% not born in the US, 33% 1st-generation). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II), which has separate scales for Mexican and Anglo acculturation (subscale range 0–4), and a combined “Assimilation” score ([Anglo]-[Mexican]). Insomnia was assessed with the Insomnia Severity Index (ISI), Sleepiness with the Epworth Sleepiness Scale (ESS), Sleep Quality with the Pittsburgh Sleep Quality Index (PSQI), and Sleep duration and sleep medication use with PSQI items. Covariates includes age, sex, and education. Regression analyses examined Difference scores associated with ISI, PSQI, and ESS scores, as well as sleep duration and sleep medication use. Post-hoc analyses examined Mexican and Anglo scales separately. Mean Mexican acculturation score was 2.90(SD=0.75) and mean Anglo score was 1.94(SD=0.94); mean “Assimilation” score was -0.95(SD=1.23). No associations were found between acculturation and ESS. “Assimilation” was associated with higher ISI (B=0.89;95%CI[0.22,1.57];p=0.010) and PSQI (B=0.82pts;95%CI[0.28,1.36];p=0.004). Higher “Assimilation” was also associated with shorter sleep duration (B=-0.49hrs;95%CI[-0.76,-0.21];p=0.001) and increased sleep medication use (OR=1.62;95%CI[1.02,2.56];p=0.04). In all cases, post-hoc analyses demonstrated that these effects were fully mediated by Anglo acculturation score and not related to Mexican score. Among individuals of Mexican descent at the US-Mexico border, a greater degree of Anglo acculturation is associated with poor sleep, insomnia, shorter sleep duration, and increased sleep medication use. These results support the idea that sleep disparities across groups may depend on acculturation, which should be considered in risk screening and interventions. K23HL110216 and the University of Arizona Health Sciences
• Alkozei, A., Bajaj, S., Grandner, M. A., Grandner, G., & Killgore, W. D. (2017). 1172 EFFECT OF BRIGHT LIGHT THERAPY ON BRAIN AND BEHAVIORAL ABNORMALITIES FOLLOWING A MILD TRAUMATIC BRAIN INJURY. Sleep, 40(suppl_1), A437-A437. doi:10.1093/sleepj/zsx050.1171
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  Mild traumatic brain injury (mTBI) can lead to alterations in sleep, circadian function, and cognition. Evidence suggests that blue wavelength light can alter circadian timing and fatigue in patients with mTBI, but no studies have examined the structural brain correlates of these effects. Here, we explored the impact of morning bright (amber/blue) light exposure therapy (ALT/BLT) on white matter structure and its neurocognitive correlates. 28 mTBI survivors underwent diffusion tensor imaging (DTI) before and after six weeks of either ALT or BLT. 39 healthy-controls (HCs) were used as a normal comparison group. First, for both groups, raw quantitative anisotropy (QA) and normalized QA (NQA) were estimated for 11 regions of interest (ROIs): the dorsal-lateral prefrontal cortex (DLPFC), genu, splenium and body of the corpus callosum (CC), the left/right uncinate fasciculus (UF), the left/right superior longitudinal fasciculus, the left/right anterior corona radiata (ACR) and the thalamus. Finally, impact of light on changes in diffusion parameters of these ROIs was analyzed among those with mTBI. At baseline, all 11 ROIs had significantly higher QA (p
• Alkozei, A., Dormer, A., Challener, S., Fridman, A., Grandner, M. A., Grandner, G., & Smith, R. (2017). 1078 DAILY MORNING BLUE LIGHT EXPOSURE LEADS TO CHANGES IN FUNCTIONAL BRAIN RESPONSES DURING EMOTIONAL ANTICIPATION IN INDIVIDUALS WITH PTSD. Sleep, 40(suppl_1), A401-A402. doi:10.1093/sleepj/zsx050.1077
• Athey, A., Bastien, C. H., Chakravorty, S., Charest, J., Ellis, J., Grandner, M. A., Knowlden, A., & Robbins, R. (2017). Driving after alcohol consumption is associated with insufficient sleep and insomnia among student athletes and non-athletes. Sleep Medicine, 40, e27. doi:10.1016/j.sleep.2017.11.073
• Bajaj, S., Castellanos, A., Franco, J., Grandner, M. A., Killgore, W. D., Millan, M., Shane, B., & Vanuk, J. R. (2017). 952. Light Therapy Facilitates Thalamo-Cortical Brain Recovery from Mild Traumatic Brain Injury. Biological Psychiatry, 81(10), S385. doi:10.1016/j.biopsych.2017.02.678
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  Mild traumatic brain injury (mTBI) or “concussion” is often associated with persistent problems with sleep for up to 50% of patients. We hypothesized that regular morning blue light exposure therapy may re-entrain the circadian rhythm and improve sleep, potentially enhancing brain repair and neuropsychological recovery.
• Bastien, C. H., Ellis, J. G., & Grandner, M. (2017). CBT-I and the Short Sleep Duration Insomnia Phenotype: A Comment on Bathgate, Edinger and Krystal. Annals of Translational Medicine, 5(16), 335. doi:10.21037/atm.2017.04.27
• Bastien, C. H., Ellis, J. G., & Grandner, M. (2017). CBT-I and the short sleep duration insomnia phenotype: A comment on Bathgate, Edinger and Krystal. Annals of Translational Medicine, 5(Issue 16). doi:10.21037/atm.2017.04.27
• Bastien, C. H., Ellis, J. G., & Grandner, M. (2017). CBT-I and the short sleep duration insomnia phenotype: a comment on Bathgate, Edinger and Krystal. Annals of Translational Medicine, 5(16), 1. doi:10.21037/atm.2017.04.27
• Chaudhary, N. S., Grandner, M. A., Jackson, N. J., & Chakravorty, S. (2017). Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample. Nutrition (Burbank, Los Angeles County, Calif.), 32(11-12), 1193-9.
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  Insomnia symptoms have been individually associated with both caffeine consumption and sleep duration abnormalities in prior studies. The goal of this study was to determine whether caffeine consumption was associated with insomnia symptoms from a population perspective and whether this relationship depended on habitual sleep duration.
• Choi, H. J., Grandner, M. A., Grandner, G., Lewis-powell, Z., Lyons, E., Meers, J. M., Nowakowski, S., Stout-aguilar, J., Swartz, M., & Swartz, M. C. (2017). 0762 ACCURACY OF CONSUMER MONITORS FOR MEASURING SLEEP ACROSS SEVEN NIGHTS. Sleep, 40(suppl_1), A282-A283. doi:10.1093/sleepj/zsx050.761
• Cohen, D. L., Grandner, M. A., & Townsend, R. R. (2017). Abstract P360: 24-hour Blood Pressure Profiles Associated With Sleep Duration. Circulation.
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  Introduction: Insufficient sleep is associated incident hypertension. Because blood pressure (BP) varies across 24h, shorter sleep may be associated with increased BP across all 24h. Additionally, ...
• Cohen, D. L., Grandner, M., & Townsend, R. R. (2017). Abstract P360: 24-hour Blood Pressure Profiles Associated With Sleep Duration. Circulation, 135(suppl_1). doi:10.1161/circ.135.suppl_1.p360
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  Introduction: Insufficient sleep is associated incident hypertension. Because blood pressure (BP) varies across 24h, shorter sleep may be associated with increased BP across all 24h. Additionally, we evaluated whether BP variability was also associated with shorter sleep. Methods: Participants were adults with untreated prehypertension or stage-1 hypertension assessed at baseline as part of a clinical trial. Recordings took place during overnight visits in a Clinical Research Center. Sleep was reported by nurses continuously monitoring patients. Those with
• Cribbet, M., Cribbet, C., Cundiff, J., Grandner, M. A., Grandner, G., Hoffmann, N., Howard, V., Howard, G., Long, L., Macdonald, L., Molano, J., Petrov, M. E., & Robbins, R. (2017). 0830 SLEEP DURATION BY SOCIODEMOGRAPHIC, SOCIOECONOMIC, AND GEOGRAPHICAL STATUS: THE REGARDS STUDY. Sleep, 40(suppl_1), A307-A307. doi:10.1093/sleepj/zsx050.829
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  Short (
• Ellis, J. G., Seed, J., Bastien, C. H., & Grandner, M. (2017). Is it time to get some SHUT-i?. Annals of Translational Medicine, 5(16), 1. doi:10.21037/atm.2017.04.28
• Ellis, J. G., Seed, J., Bastien, C. H., & Grandner, M. (2017). Is it time to get some SHUT-i?. Annals of Translational Medicine, 5(16), 336. doi:10.21037/atm.2017.04.28
• Franco, J., Millan, M., Bajaj, S., Castellanos, A., Franco, J., Grandner, M. A., Grandner, G., Killgore, W. D., Millan, M., Shane, B., & Vanuk, J. R. (2017). 1143 SHORT WAVELENGTH LIGHT THERAPY FACILITATES RECOVERY FROM MILD TRAUMATIC BRAIN INJURY. Sleep, 40(suppl_1), A426-A427. doi:10.1093/sleepj/zsx050.1142
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  Mild traumatic brain injury (mTBI) or “concussion” is often associated with persistent problems with sleep and fatigue in up to 50% of those injured. We hypothesized that regular morning blue light exposure therapy may re-entrain the circadian rhythm and improve overall sleep quality, potentially enhancing brain repair, thereby improving brain functioning, symptom expression, and neurocognitive problems. Twenty-eight individuals (15 female; aged 18–48 years) who experienced an mTBI during the preceding 18 months underwent a comprehensive neuropsychological assessment and multi-modal neuroimaging. In a double-blind design, participants were randomly assigned to complete daily morning exposure with a light device fitted with an array of light emitting diodes in the blue (n=14) or amber wavelength (placebo; n=14). Participants used the device for 6-weeks at home (30-minutes daily, prior to 11:00am), and returned for follow-up assessment and imaging. Blue light exposure led to an earlier bedtime and rise time, lower daytime sleepiness, and improved balance stability compared to placebo light (p
• Grandner, M. (2017). Sleep and obesity risk in adults: possible mechanisms; contextual factors; and implications for research, intervention, and policy. Sleep Health, 3(5), 7. doi:10.1016/j.sleh.2017.07.014
• Grandner, M. (2017). Sleep, Health, and Society. Sleep Medicine Clinics, 12(1), 22. doi:http://dx.doi.org/10.1016/j.jsmc.2016.10.012
• Grandner, M. A. (2017). Sleep and obesity risk in adults: possible mechanisms; contextual factors; and implications for research, intervention, and policy. Sleep health, 3(5), 393-400.
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  Obesity is a major public health problem among US adults. Insufficient sleep and sleep disorders are prevalent and may contribute to the public health problem of obesity. This review addresses several key questions regarding sleep and obesity in adults, including the following: (1) What constitutes adequate sleep in adults? (2) What are the consequences of inadequate sleep in adults? (3) What factors influence sleep in adults? (4) How can adults improve their sleep? (5) How can we implement these in adults? (6) How can these issues be addressed in future research and policy decisions? Although a comprehensive review of all of these is beyond the scope of this article, this review brings these concepts together toward a discussion of the role of sleep in the health of US adults.
• Grandner, M. A., & Winkelman, J. W. (2017). Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PloS one, 12(6), e0178465.
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  Nocturnal leg cramps (NLC) are common and poorly understood.
• Grandner, M. A., Grandner, G., Havens, C. M., Pandey, A., Parthasarathy, S., & Youngstedt, S. D. (2017). 0318 INTERNATIONAL VARIABILITY IN THE PREVALENCE OF INSOMNIA AND USE OF SLEEP-PROMOTING MEDICATIONS, SUPPLEMENTS, AND OTHER SUBSTANCES. Sleep, 40(suppl_1), A117-A118. doi:10.1093/sleepj/zsx050.317
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  Few studies have compared insomnia prevalence across multiple countries using standardized measures. Further, it is likely that medications/supplements/substances used to treat insomnia varies across countries. An international web-based survey was conducted across 10 countries (United States, France, Japan, China, Brazil, South Korea, Germany, Australia, United Kingdom, and Netherlands), with 7,817 respondents (3,723 men; 25% of respondents aged 30–39 years). History of insomnia was assessed, as was prevalence of prescription medications, over-the-counter medications, supplements, alcohol, and other beverages. Regression analyses adjusted for age, sex, shiftwork, other sleep disorders, and presence of other relevant medical conditions. Prevalence of insomnia was 5.4% (Netherlands), 10.0% (Japan), 10.5% (Australia), 11.0% (UK), 13.4% (US), 14.6% (Germany), 21.7% (France), 23.5% (South Korea), 24.0% (China), and 30.5% (Brazil). Compared to the US, increased prevalence was seen in France (RR=2.01,p
• Grandner, M. A., Grandner, G., Kay, M. W., Kay, M., Kientz, J. A., Ocano, D., & Watson, N. F. (2017). 0240 VALIDATION OF A TOUCHSCREEN PSYCHOMOTOR VIGILANCE TASK FOR ANDROID DEVICES. Sleep, 40(suppl_1), A88-A88. doi:10.1093/sleepj/zsx050.239
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  The Psychomotor Vigilance Task (PVT) is a gold-standard, widely used, and highly sensitive tool to quantify effects of sleep loss. Current portable versions are either costly, not validated, or based on out-of-date platforms. Our goal was to develop a low-cost, widely accessible version of the PVT that runs on touchscreen devices. This study evaluated a new application (PVT-Touch), compared to the industry-standard PVT-192. Subjects included N=44 healthy adults without symptoms of sleep disorders. They were administered the PVT-Touch and the standard PVT-192. Order of administration was block-randomized to ensure balanced presentation. Tests were 10 minutes each and administered in sequence. Mean and median reaction time (RT) and performance lapses (RT>500ms) were assessed and correlations were computed, with 95% confidence intervals. Regression analyses determined appropriate transforms that generated comparable scores. Following transforms, paired t-tests evaluated differences. Despite differences in input style and device hardware, PVT-Touch and PVT-192 values correlated highly for mean RT (r=0.83; 95%CI[0.71,0.91]; p
• Grandner, M. A., Jean-louis, G., Li, Y., Mcfarlane, S. I., Pagan, J. A., Seixas, A. C., Youngstedt, S. D., & Zizi, F. (2017). 1064 THE ROLE OF SLEEP AND PHYSICAL ACTIVITY IN REDUCING THE PREVALENCE OF DIABETES IN THE UNITED STATES: AN AGENT-BASED SIMULATION MODEL APPROACH. Sleep, 40(suppl_1), A395-A396. doi:10.1093/sleepj/zsx050.1063
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  Diabetes is one of the leading causes of health-related morbidity and mortality in the United States. To reduce the burden of diabetes, several behavioral strategies (e.g., healthy diet and increased physical activity) have been implemented. Unfortunately, these strategies have yielded modest improvements, and in some groups (racial/ethnic minorities) the diabetes burden is mounting yearly. Recent evidence that sleep is associated with increased diabetes risk suggests that sleep may be a novel and potentially impactful target to alleviate this burden. The current study explored the long-term impact of reducing the prevalence of insufficient sleep on diabetes burden in the U.S., relative to potential positive health benefits of physical activity. Using a representative sample of 100,000 hypothetical participants who do not experience healthy sleep in an Agent-Based Model simulation (a dynamic simulation technique). In this model, we investigated whether reducing the prevalence of insufficient sleep (≤6 hrs.) by 10% or 20% would have a significant impact on attenuating the prevalence of diabetes over a 10-year period. We also explored whether similar observations would be made by increasing the prevalence of individuals engaging in 150 mins/week of moderate physical activity as an alternative to healthy sleep, given the difficulty many have experienced in increasing their habitual sleep time. Based on the simulation model, reducing the prevalence of insufficient sleep by 10% or 20% attenuated the prevalence of diabetes among insufficient sleepers by 1.7% or 2.6%, respectively. By contrast, increasing the prevalence of physical activity by 10% or 20% seemed to be much less impactful. Indeed, the prevalence of diabetes was only reduced by 0.4% or 1.6%, respectively. Despite mixed results shown in experimental and clinical studies, in this particular model, reducing the prevalence of insufficient sleep at the population level could be more impactful in preventing diabetes than increasing physical activity alone in the United States. Future research should determine whether results of our simulated model could be replicated at the population level. NIH/NINDS U54NS081765 NIMHD R01MD007716 NHLBI R25HL105444
• Grandner, M. A., Mohan, Y. D., Sidell, M. A., Troxel, W., & Young, D. R. (2017). Abstract MP086: Cross-sectional and Longitudinal Predictors of Poor Sleep Among Adolescent Girls and Young Adult Women. Circulation, 135(suppl_1). doi:10.1161/circ.135.suppl_1.mp086
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  Sleep is important for the psychosocial and physical health of adolescents and young adults. Predictors of poor sleep include family demographics and living situation, neighborhood factors, psychosocial health and health behaviors. Previous studies have examined these associations across the range of adolescence, without considering how they may differ across adolescent stages or into young adulthood. We examined the cross-sectional and longitudinal predictors of poor sleep among a cohort of 474 girls at 3 distinct ages: 14, 17, and 22 years. We used the item “during the past week my sleep was restless” to define sleep quality. Responses were categorized as poor sleep “no” (restless sleep “rarely or none of the time” or “some or a little of the time”) or “yes” (restless sleep “a lot of the time” or most or all of the time”). Independent variables were chosen from previous research examining demographic, psychosocial, and behavioral predictors of sleep quality among adolescents; race/ethnicity, family structure, socioeconomic status, neighborhood crime, depressive symptoms (excluding the sleep item) (all assessed from self-report), and physical activity and sedentary time (assessed from accelerometers). About 46% of the cohort was white, 25% Black, and 20% Hispanic. At each age, about 25% reported poor sleep, with 50% reporting no restless sleep at any time and 4.2% reporting restless sleep at all 3 time points. Cross-sectional correlates are displayed in the Table. Fully-adjusted longitudinal predictors of restless sleep were higher depression scores (OR: 1.10, 95% CI: 1.08, 1.11) and fewer sedentary minutes (OR: 0.99, 95% CI: 0.99, 0.99). Results demonstrate that sleep problems are prevalent across adolescence and persist into early adulthood. While correlates change over time, depressive symptoms and sedentary time are consistently predictive of sleep quality. Interventions that focus on improving mental health and increasing physical activity may also benefit sleep quality among adolescents and young adults.
• Grandner, M., & Chakravorty, S. (2017). Insomnia in Primary Care: Misreported, Mishandled, and Just Plain Missed. Journal of Clinical Sleep Medicine, 13(8), 2. doi:10.5664/jcsm.6688
• Grandner, M., & Chakravorty, S. (2017). Insomnia in Primary Care: Misreported, Mishandled, and Just Plain Missed. Journal of Clinical Sleep Medicine, 13(8), 937-939. doi:10.5664/jcsm.6688
• Grandner, M., & Malhotra, A. (2017). Connecting insomnia, sleep apnea, and depression. Respirology, 22(7), 1249-1250. doi:10.1111/resp.13090
• Grandner, M., & Malhotra, A. (2017). Connecting insomnia, sleep apnoea and depression. Respirology, 22(7), 1. doi:10.1111/resp.13090
• Grandner, M., & Winkelman, J. (2017). Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS ONE, 12(6). doi:10.1371/journal.pone.0178465
• Grandner, M., Segal, A., Perlis, M. L., Nowakowski, S., Tal, J. Z., & Grandner, M. (2017). Sleep Disturbance Partially Mediates the Relationship between Intimate Partner Violence and Physical/Mental Health. Journal of Interpersonal Violence, 32(16), 2471-2495.
• Ji, X., Grandner, M., & Liu, J. (2017). The relationship between micronutrient status and sleep patterns: a systematic review.. Public Health Nutrition, 20(4), 14. doi:10.1017/S1368980016002603
• Lalley-Charecko, L., Segal, A., Perlis, M. L., & Grandner, M. (2017). Sleep Disturbance Partially Mediates the Relationship Between Intimate Partner Violence and Physical/ Mental Health in Women and Men. Journal of Interpersonal Violence, 32(16), 24. doi:10.1177/0886260515592651
• Li, J., Grandner, M., Chang, Y., Jungquist, C., & Porock, D. (2017). Person-Centered Dementia Care and Sleep in Assisted Living Residents With Dementia: A Pilot Study.. Behavioral Sleep Medicine, 15(2), 16. doi:10.1080/15402002.2015.1104686
• Millan, M., Bajaj, S., Grandner, M. A., Killgore, W. D., Millan, M., Shane, B., & Vanuk, J. R. (2017). 1171 SHORT-WAVELENGTH LIGHT THERAPY AS A WAY OF IMPROVING SLEEP, COGNITION, AND FUNCTIONAL CONNECTIVITY FOLLOWING A MILD TRAUMATIC BRAIN INJURY. Sleep, 40(suppl_1), A437-A437. doi:10.1093/sleepj/zsx050.1170
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  Mild traumatic brain injury (mTBI) has been associated with disruptions in sleep, limbic function, and increases in symptoms related to anxiety as a consequence of the injury. Evidence suggests that there is a relationship between improvements in neurobehavioral impairments and more regulated sleep architecture, but this relationship is not well understood. We hypothesized that among patients recovering from an mTBI, daily morning blue light therapy (BLT) would yield improvement in brain function, as evidenced by greater post-treatment functional connectivity between the medial prefrontal cortex (MPFC) and amygdala, and this would be associated with improvements in sleep and anxiety. Twenty-six adults (12 male; M age: 21.6 ± 3.9) with self-reported sleep disturbances subsequent to a documented mTBI within the preceding 18 months were recruited to receive either BLT or a placebo amber light therapy (ALT) for 30-minutes each morning over a six-week period. Participants underwent a six-minute resting state functional magnetic resonance imaging (fMRI) scan at 3T and completed neurocognitive testing at baseline and again at the conclusion of treatment. Regions of interest were placed in the amygdala (bilateral) and MPFC. Functional connectivity was analyzed utilizing the CONN toolbox with SPM12, p
• Millan, M., Gottschlich, M., Grandner, M. A., Grandner, G., Hyman, S., Killgore, W. D., Knight, S., Millan, M., Pisner, D., & Singh, A. (2017). 1169 POST-CONCUSSION SEVERITY IS ASSOCIATED WITH SLEEP PROBLEMS AND NEUROPSYCHOLOGICAL STATUS. Sleep, 40(suppl_1), A436-A436. doi:10.1093/sleepj/zsx050.1168
• Nunes, J., Chung, D., Grandner, M. A., Jean-louis, G., Nunes, J., Richards, S., Seixas, A. C., Tan, N., & Zizi, F. (2017). 1150 SLEEP IMPACTS QUALITY OF LIFE AND NEUROCOGNITIVE CHARACTERISTICS OF BLACK AND HISPANIC STROKE SURVIVORS. Sleep, 40(suppl_1), A429-A429. doi:10.1093/sleepj/zsx050.1149
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  Evidence suggesting that poor sleep is linked to compromised neurocognitive function and poorer quality of life, as well as evidence that stroke survivors suffer from poor sleep have laid the groundwork for the current study. This study investigated the association between sleep and quality of life and neurocognitive characteristics among Blacks and Hispanic stroke survivors. Using a sample of twenty-three Black and Hispanic stroke survivors, we analyzed associations of sleep parameters (which included sleep duration, sleep quality, insomnia symptoms, being tired, and daytime sleepiness) with quality of life (as measured by the Stroke Specific Quality of Life [SSQOL]) and neurocognitive factors (e.g. working and episodic memory, attention and control, executive function, and processing speed). Additionally, we ascertained whether sleep parameters were associated with SSQOL total score and neurocognitive domains, after adjusting for effects of age and gender. The mean age of the sample was 57 yrs. (S.D.=10.73); 54.5% were female, 59.1% were born in the U.S., 72.7% were primary English speakers, 68.2% were unemployed, 85.7% had at least a Bachelor’s degree, 54.5% reported trouble sleeping, and the mean self-reported sleep duration was 6.55 hrs. (S.D.=2.11). Bivariate correlational analyses indicated that individuals who reported “trouble sleeping” (r= -0.47, p
• Patterson, F., Grandner, M., Malone, S. K., Rizzo, A., Davey, A., & Edwards, D. G. (2017). Sleep as a Target for Optimized Response to Smoking Cessation Treatment. Nicotine and Tobacco Research. doi:10.1093/ntr/ntx236
• Patterson, F., Malone, S. K., Grandner, M., Lozano, A., Perkett, M., & Hanlon, A. (2017). Interactive effects of sleep duration and morning/evening preference on cardiovascular risk factors.. European Journal of Public Health. doi:10.1093/eurpub/ckx029
• Shetty, S., Fernandes, A., Patel, S., Combs, D., Grandner, M. A., & Parthasarathy, S. (2017). Unanticipated nocturnal oxygen requirement during positive pressure therapy for sleep apnea and medical comorbidities. Journal of Clinical Sleep Medicine, 13(Issue 1). doi:10.5664/jcsm.6392
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  Study Objectives: Home-based management of sleep-disordered breathing (SDB) generally excludes patients with significant medical comorbidities, but such an approach lacks scientific evidence. The current study examined whether significant medical comorbidities are associated with persistent hypoxia that requires unanticipated nocturnal O2 supplementation to positive airway pressure (PAP) therapy. Conceivably, in such patients, home-based management of SDB may not detect or therefore adequately treat persistent hypoxia. Methods: In this retrospective study of 200 patients undergoing laboratory-based polysomnography, we ascertained significant medical comorbidities (chronic obstructive pulmonary disease, congestive heart failure, and morbid obesity) and their association with the need for unanticipated O2 supplementation to PAP therapy. Postural oxygen (SpO2) desaturations between upright and reclining positions were determined during calm wakefulness. Results: Postural change in SpO2 during calm wakefulness was greater in patients who eventually needed nocturnal O2 supplementation to PAP therapy than those needing PAP therapy alone (p < 0.0001). The presence of chronic obstructive pulmonary disease (odds ratio [OR] 6.0; 95% confidence interval [CI]; 2.1, 17.5; p = 0.001), morbid obesity (OR 3.6; 95% CI 1.9, 7.0; p < 0.0001), and age older than 50 y (OR 2.8; 95% CI 1.3, 5.9; p = 0.007) but not heart failure were associated with unanticipated need for nocturnal O2 supplementation. A clinical prediction rule of less than two determinants (age older than 50 y, morbid obesity, chronic obstructive pulmonary disease, and postural SpO2 desaturation greater than 5%) had excellent negative predictive value (0.92; 95% CI 0.85, 0.96) and likelihood ratio of negative test (0.08; 95% CI 0.04, 0.16). Conclusions: Medical comorbidities can predict persistent hypoxia that requires unanticipated O2 supplementation to PAP therapy. Such findings justify the use of medical comorbidities to exclude home management of SDB.
• Shetty, S., Fernandes, A., Patel, S., Combs, D., Grandner, M., & Parthasarathy, S. (2017). Unanticipated Nocturnal Oxygen Requirement during Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities.. Journal of Clinical Sleep Medicine, 13(1), 6. doi:10.5664/jcsm.6392
• Thomas, A., Grandner, M., Nowakowski, S., Nesom, G., Corbitt, C., & Perlis, M. L. (2017). Where are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment. Behavioral sleep medicine, 14(6), 687-98.
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  Although it is widely acknowledged that there are not enough clinicians trained in either Behavioral Sleep Medicine (BSM) in general or in Cognitive Behavioral Therapy for Insomnia (CBT-I) in specific, what is unclear is whether this problem is more acute in some regions relative to others. Accordingly, a geographic approach was taken to assess this issue. Using national directories as well as e-mail listservs (Behavioral Sleep Medicine group and Behavioral Treatment for Insomnia Roster), the present study evaluated geographic patterning of CBSM and BSM providers by city, state, and country. Overall, 88% of 752 BSM providers worldwide live in the United States (n = 659). Of these, 58% reside in 12 states with ≥ 20 providers (CA, NY, PA, IL, MA, TX, FL, OH, MI, MN, WA, and CO), and 19% reside in just 2 states (NY and CA). There were 4 states with no BSM providers (NH, HI, SD, and WY). Of the 167 U.S. cities with a population of > 150,000, 105 cities have no BSM providers. These results clearly suggest that a targeted effort is needed to train individuals in both the unserved and underserved areas.
• Young, D. R., Grandner, M. A., Mohan, Y., Sidell, M. A., & Troxel, W. M. (2017). Abstract MP086: Cross-sectional and Longitudinal Predictors of Poor Sleep Among Adolescent Girls and Young Adult Women. Circulation.
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  Sleep is important for the psychosocial and physical health of adolescents and young adults. Predictors of poor sleep include family demographics and living situation, neighborhood factors, psychos...
• Airhihenbuwa, C. O., Cuffee, Y. L., Grandner, M. A., Jean-louis, G., Ogedegbe, G., Okuyemi, K. S., Wallace, D. M., & Williams, N. J. (2016). Social and behavioral predictors of insufficient sleep among African Americans and Caucasians.. Sleep medicine, 18(Issue), 103-7. doi:10.1016/j.sleep.2015.02.533
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  Few studies have examined the social and behavioral predictors of insufficient sleep..To assess the social and behavioral predictors of insufficient sleep in the U.S..Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design..The mean age for the sample was 56 ± 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (
• Chaudhary, N., Grandner, M., Jackson, N., & Chakravorty, S. (2016). Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample. Nutrition, 32(11), 6. doi:10.1016/j.nut.2016.04.005 0899-9007
• Grandner, M. (2016). Healthy sleep for student-athletes: A guide for athletics departments and coaches.. NCAA Sport Science Institute Newsletter, 4(2).
• Grandner, M. (2016). Mental Health Best Practices: Inter-Association Consensus Document: Best Practices for Understanding and Supporting Student-Athlete Mental Wellness.. National Collegiate Athletics Association.
• Grandner, M. (2016). Sleep, health, and society. Clinics in Sleep Medicine..
• Grandner, M. A., & Jean-louis, G. (2016). Importance of recognizing sleep health disparities and implementing innovative interventions to reduce these disparities.. Sleep medicine, 18(Issue), 1-2. doi:10.1016/j.sleep.2015.08.001
• Grandner, M. A., Alfonso-Miller, P., Fernandez-Mendoza, J., Shetty, S., Shenoy, S., & Combs, D. (2016). Sleep: important considerations for the prevention of cardiovascular disease. Current opinion in cardiology, 31(5), 551-65.
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  Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors.
• Grandner, M. A., Hanlon, A., Haynes, P., Malone, S. K., Parthasarathy, S., Patterson, F., & Petrov, M. (2016). Abstract MP95: Should Habitual Sleep Duration be Added to “Life’s Simple 7?”. Circulation, 133(suppl_1). doi:10.1161/circ.133.suppl_1.mp95
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  Introduction: The AHA introduced the “Life’s Simple 7” guidelines. Sleep is not mentioned in these guidelines. The present analyses examine whether sleep duration is associated with each of the “Simple 7,” and whether sleep duration contributes unique variance to health over and above the “Simple 7.” Methods: Pooled data from the 2005-2008 NHANES was used. NHANES is a nationally-representative survey conducted by the CDC. High blood pressure and high cholesterol were assessed as self-reported history. High blood sugar was assessed as measured fasting glucose ≥100 mg/dL. Low physical activity was assessed as 2000 kcal for women and >2500 kcal for men. Measured obesity was defined as ≥30 kg/m2. Current smoking was self-reported. Habitual sleep duration was assessed as self-reported weeknight sleep and categorized as Very Short (≤4h), Short (5-6h), Normal (7-8h), and long (≥9h). Overall health was rated on a 5-point scale, with Excellent, Very Good and Good coded as “Good,” and Poor and Very Poor coded as “Poor.” All analyses were weighted and adjusted for age, sex, race, education, and body mass index (except obesity analyses). Results: Habitual sleep duration was associated with each of the components of the “Simple 7,” including high blood pressure, high cholesterol, high blood sugar, low physical activity, high calorie diet, obesity, and smoking (see Table). Further, even after adjusting for all 7 components as well as covariates, sleep duration was related to overall health, such that overall poor health was associated with both very short (OR=1.81, 95% CI[1.31-2.49], p
• Grandner, M. A., Seixas, A., Shenoy, S., & Shetty, S. (2016). Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms.. Current diabetes reports, 16(11), 106. doi:10.1007/s11892-016-0805-8
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  Sleep is important for regulating many physiologic functions that relate to metabolism. Because of this, there is substantial evidence to suggest that sleep habits and sleep disorders are related to diabetes risk. In specific, insufficient sleep duration and/or sleep restriction in the laboratory, poor sleep quality, and sleep disorders such as insomnia and sleep apnea have all been associated with diabetes risk. This research spans epidemiologic and laboratory studies. Both physiologic mechanisms such as insulin resistance, decreased leptin, and increased ghrelin and inflammation and behavioral mechanisms such as increased food intake, impaired decision-making, and increased likelihood of other behavioral risk factors such as smoking, sedentary behavior, and alcohol use predispose to both diabetes and obesity, which itself is an important diabetes risk factor. This review describes the evidence linking sleep and diabetes risk at the population and laboratory levels.
• Grandner, M. A., Williams, N. J., Knutson, K. L., Roberts, D., & Jean-Louis, G. (2016). Sleep disparity, race/ethnicity, and socioeconomic position. SLEEP MEDICINE, 18, 7-18.
• Grandner, M., Chaudhary, S., Perlis, M. L., Brown, G. K., Basner, M., Chakravorty, S., Morales, K. H., Gehrman, P. R., Thase, M. E., & Dinges, D. F. (2016). Nocturnal wakefulness: A previously unrecognized risk factor for suicide.. Journal of Clinical Psychiatry.
• Grandner, M., Orzech, K. M., Roane, B., & Carskadon, M. (2016). Digital media use in the 2 hours before bedtime is associated with sleep variables in university students.. Computers in Human Behavior.
• Ji, X., Grandner, M. A., & Liu, J. (2016). The relationship between micronutrient status and sleep patterns: a systematic review. Public health nutrition, 1-15.
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  To review articles on the relationship of dietary and circulating micronutrients with sleep patterns, and to identify issues surrounding implications for future research and public health practice.
• Lam, M. T., Grandner, M. A., & Malhotra, A. (2016). Lungs can tell time-a highlight from 2016 ATS session on clock genes, inflammation, immunology, and sleep. Journal of thoracic disease, 8(Suppl 7), S579-81.
• Orzech, K. M., Grandner, M. A., Roane, B. M., & Carskadon, M. A. (2016). Digital media use in the 2 h before bedtime is associated with sleep variables in university students. Computers in human behavior, 55(A), 43-50.
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  Digital media use is widespread in University students, and use of digital media near bedtime has a broadly negative effect on sleep outcomes. Adequate and good quality sleep is important for physical and mental health, but few studies have rigorously measured both sleep and digital media use. In this study, we investigated whether self-reported sleep patterns were associated with digital media use in a first-year University student (N = 254, 48% male) population. Students tracked their sleep through daily online diaries and provided digital media use data in 15-min blocks for 2 h prior to bedtime on nine occasions. A longer duration of digital media use was associated with reduced total sleep time and later bedtime, while greater diversity of digital media use was associated with increased total sleep time and earlier bedtime. Analysis of activities in the last hour before bedtime indicated that activity type plays a role in digital media's effect on sleep, with computer work, surfing the Internet, and listening to music showing the strongest relationship to multiple sleep variables. These findings have implications for physical and mental health of University students and can inform design of devices to minimize negative effects of digital media on sleep.
• Orzech, K. M., Roane, B., Grandner, M., & Carskadon, M. (2016). Digital media use in the 2 h before bedtime is associated with sleep variables in university students. Computers in Human Behavior, 55, 7. doi:10.1016/j.chb.2015.08.049
• Patterson, F., Malone, S. K., Lozano, A., Grandner, M. A., & Hanlon, A. L. (2016). Smoking, Screen-Based Sedentary Behavior, and Diet Associated with Habitual Sleep Duration and Chronotype: Data from the UK Biobank. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 50(5), 715-726.
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  Sleep duration has been implicated in the etiology of obesity but less is known about the association between sleep and other behavioral risk factors for cardiovascular disease.
• Patterson, F., Malone, S. K., Lozano, A., Grandner, M., & Hanlon, A. L. (2016). Smoking, sedentary behavior, and diet associated with habitual sleep duration and chronotype: Data from the UK Biobank. Annals of Behavioral Medicine, 50(5), 11. doi:10.1007/s12160-016-9797-5
• Perlis, M. L., Grandner, M. A., Brown, G. K., Basner, M., Chakravorty, S., Morales, K. H., Gehrman, P. R., Chaudhary, N. S., Thase, M. E., & Dinges, D. F. (2016). Nocturnal Wakefulness as a Previously Unrecognized Risk Factor for Suicide. The Journal of clinical psychiatry, 77(6), e726-33.
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  Suicide is a major public health problem and the 10th leading cause of death in the United States. The identification of modifiable risk factors is essential for reducing the prevalence of suicide. Recently, it has been shown that insomnia and nightmares significantly increase the risk for suicidal ideation, attempted suicide, and death by suicide. While both forms of sleep disturbance may independently confer risk, and potentially be modifiable risk factors, it is also possible that simply being awake at night represents a specific vulnerability for suicide. The present analysis evaluates the frequency of completed suicide per hour while taking into account the percentage of individuals awake at each hour.
• Perlis, M. L., Grandner, M., Chakravorty, S., Bernert, R. A., Brown, G. K., & Thase, M. E. (2016). Suicide and sleep: Is it a bad thing to be awake when reason sleeps?. Sleep Medicine Reviews, 29, 6. doi:10.1016/j.smrv.2015.10.003
• Shetty, S., Fernandes, A., Patel, S., Combs, D., Grandner, M. A., & Parthasarathy, S. (2016). Unanticipated Nocturnal Oxygen Requirement During Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
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  Home-based management of sleep-disordered breathing (SDB) generally excludes patients with significant medical comorbidities, but such an approach lacks scientific evidence. The current study examined whether significant medical comorbidities are associated with persistent hypoxia that requires unanticipated nocturnal O2 supplementation to positive airway pressure (PAP) therapy. Conceivably, in such patients, home-based management of SDB may not detect or therefore adequately treat persistent hypoxia.
• St-Onge, M. P., Coons, M., Bhatt, D. L., Brown, D., Conroy, M. B., Grandner, M., & Jean-Louis, G. (2016). Sleep duration and quality: Impact on lifestyle behaviors and cardiometabolic health: An advisory from the American Heart Association. Circulation, 134(18), 20. doi:10.1161/CIR.0000000000000444
• St-Onge, M. P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., Bhatt, D. L., & , A. H. (2016). Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation, 134(18), e367-e386.
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  Sleep is increasingly recognized as an important lifestyle contributor to health. However, this has not always been the case, and an increasing number of Americans choose to curtail sleep in favor of other social, leisure, or work-related activities. This has resulted in a decline in average sleep duration over time. Sleep duration, mostly short sleep, and sleep disorders have emerged as being related to adverse cardiometabolic risk, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. Here, we review the evidence relating sleep duration and sleep disorders to cardiometabolic risk and call for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.
• St-Onge, M., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., & Bhatt, D. L. (2016). Sleep duration and quality: Impact on lifestyle behaviors and cardiometabolic health: An advisory from the American Heart Association.. Circulation.
• Thomas, A., Grandner, M., Nesom, G., Corbitt, C., & Perlis, M. L. (2016). Where are the behavioral sleep medicine providers and where are they needed? A geographic assessment. Behavioral Sleep Medicine, 14(6), 11. doi:10.1080/15402002.2016.1173551
• Truong, K. K., Lam, M., Grandner, M., Sassoon, C. S., & Malhotra, A. (2016). Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer.. Annals of the American Thoracic Society, 13(7), 1144-1154.
• , C. C., Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(8), 931-52.
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  The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.
• , C. C., Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep, 38(8), 1161-83.
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  The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.
• , C. C., Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., , N. O., Twery, M., Croft, J. B., , Maher, E., et al. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(6), 591-2.
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  Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.
• Arble, D. M., Bass, J., Behn, C. D., Butler, M. P., Challet, E., Czeisler, C., Depner, C. M., Elmquist, J., Franken, P., Grandner, M. A., Hanlon, E. C., Keene, A. C., Joyner, M. J., Karatsoreos, I., Kern, P. A., Klein, S., Morris, C. J., Pack, A. I., Panda, S., , Ptacek, L. J., et al. (2015). Impact of Sleep and Circadian Disruption on Energy Balance and Diabetes: A Summary of Workshop Discussions. Sleep, 38(12), 1849-60.
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  A workshop was held at the National Institute for Diabetes and Digestive and Kidney Diseases with a focus on the impact of sleep and circadian disruption on energy balance and diabetes. The workshop identified a number of key principles for research in this area and a number of specific opportunities. Studies in this area would be facilitated by active collaboration between investigators in sleep/circadian research and investigators in metabolism/diabetes. There is a need to translate the elegant findings from basic research into improving the metabolic health of the American public. There is also a need for investigators studying the impact of sleep/circadian disruption in humans to move beyond measurements of insulin and glucose and conduct more in-depth phenotyping. There is also a need for the assessments of sleep and circadian rhythms as well as assessments for sleep-disordered breathing to be incorporated into all ongoing cohort studies related to diabetes risk. Studies in humans need to complement the elegant short-term laboratory-based human studies of simulated short sleep and shift work etc. with studies in subjects in the general population with these disorders. It is conceivable that chronic adaptations occur, and if so, the mechanisms by which they occur needs to be identified and understood. Particular areas of opportunity that are ready for translation are studies to address whether CPAP treatment of patients with pre-diabetes and obstructive sleep apnea (OSA) prevents or delays the onset of diabetes and whether temporal restricted feeding has the same impact on obesity rates in humans as it does in mice.
• Baldwin, C. M., Baldwin, C. M., Buman, M. P., Buman, M. P., Grandner, M. A., Grandner, M. A., Petrov, M. E., Petrov, M. E., Youngstedt, S. D., & Youngstedt, S. D. (2015). Abstract P072: Short Sleep Duration is Associated with Elevated Homocysteine Levels. Circulation, 131(suppl_1). doi:10.1161/circ.131.suppl_1.p072
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  Introduction: Short and long sleep durations are associated with heightened risk for cardiovascular disease and vascular risk factors. Elevated homocysteine is also associated with greater risk for cardiovascular disease; however, studies have yet to investigate the relationship between sleep duration and homocysteine. Hypothesis: We hypothesized that short and long sleep duration would be associated with clinical levels of homocysteine. Methods: Adults (n=2,469; ≥20y) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were assessed for habitual sleep duration (coded as
• Bhatt, S., Chakravorty, S., Grandner, M. A., Gurubhagavatula, I., & Petrov, M. E. (2015). Abstract P069: Association Between Habitual Sleep Duration and Cardiometabolic Disease, and the Mediating Role of Foregoing Care: Data From the 2013 Behavioral Risk Factor Surveillance System. Circulation, 131.
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  Introduction: Sleep duration is associated with cardiometabolic disease risk, as well as lower socioeconomic position. Shorter sleepers may be at increased risk of adverse outcomes due to the myriad pathophysiologic consequences of decreased sleep, but also partially because social/financial pressures that may lead to less health care use, interact with physiologic risks, and result in under-treatment of conditions that may lead to chronic disease. METHODS: The 2013 BRFSS was used (N=483,495 adults). Sleep duration was assessed by a survey item of 24h habitual sleep. Responses were categorized as very short ( RESULTS: See Table. Very short, short, and long sleep were associated with all assessed health outcomes. Foregoing healthcare due to cost was more likely to occur among very short (OR=2.68, 95%CI=2.47-2.90, p CONCLUSIONS: Habitual sleep duration is associated with prevalent cardiometabolic disease. Very short and short sleep duration are associated with foregoing medical care, which partially explains the relationship with cardiometabolic disease. This suggests that a non-physiologic pathway (reduced medical care) may play a role in the relationship of sleep to chronic disease.
• Chakravorty, S., Siu, H. Y., Lalley-Chareczko, L., Brown, G. K., Findley, J. C., Perlis, M. L., & Grandner, M. A. (2015). Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample. The primary care companion for CNS disorders, 17(6).
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  Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms.
• Chaudhary, N. S., Kampman, K. M., Kranzler, H. R., Grandner, M. A., Debbarma, S., & Chakravorty, S. (2015). Insomnia in alcohol dependent subjects is associated with greater psychosocial problem severity. Addictive behaviors, 50, 165-72.
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  Although psychosocial problems are commonly associated with both alcohol misuse and insomnia, very little is known about the combined effects of insomnia and current alcohol dependence on the severity of psychosocial problems. The present study evaluates whether the co-occurrence of insomnia and alcohol dependence is associated with greater psychosocial problem severity.
• Cox, S., Geraghty, M., Giglia, E. R., Grandner, M. A., Jean-pierre, P., Jean-pierre, A., & Saphic, H. (2015). Effects of memory and sleep on functional status in cancer survivors.. Journal of Clinical Oncology, 33(15_suppl), e20642-e20642. doi:10.1200/jco.2015.33.15_suppl.e20642
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  e20642 Background: Cognitive functioning (e.g., memory performance) is important to an individual’s functional abilities. Sleep impairments have implications for both cognitive function and sleep. ...
• Grandner, M. A., & Malhotra, A. (2015). Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep. Sleep health, 1(1), 11-12.
• Grandner, M. A., & Perlis, M. L. (2015). Treating Insomnia Disorder in the Context of Medical and Psychiatric Comorbidities. JAMA internal medicine, 175(9), 1472-3.
• Grandner, M. A., Jackson, N. J., Izci-Balserak, B., Gallagher, R. A., Murray-Bachmann, R., Williams, N. J., Patel, N. P., & Jean-Louis, G. (2015). Social and Behavioral Determinants of Perceived Insufficient Sleep. Frontiers in neurology, 6, 112.
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  Insufficient sleep is associated with cardiometabolic disease and poor health. However, few studies have assessed its determinants in a nationally representative sample. Data from the 2009 behavioral risk factor surveillance system were used (N = 323,047 adults). Insufficient sleep was assessed as insufficient rest/sleep over 30 days. This was evaluated relative to sociodemographics (age, sex, race/ethnicity, marital status, region), socioeconomics (education, income, employment, insurance), health behaviors (diet, exercise, smoking, alcohol), and health/functioning (emotional support, BMI, mental/physical health). Overall, insufficient sleep was associated with being female, White or Black/African-American, unemployed, without health insurance, and not married; decreased age, income, education, physical activity; worse diet and overall health; and increased household size, alcohol, and smoking. These factors should be considered as risk factors for insufficient sleep.
• Grandner, M. A., Jackson, N. J., Izci-Balserak, B., Gallagher, R. A., Murray-Bachmann, R., Williams, N. J., Patel, N. P., & Jean-Louis, G. (2015). Social and behavioral determinants of perceived insufficient sleep: Analysis of the behavioral risk factor surveillance system. Frontiers in Neurology, 6(Issue MAY). doi:10.3389/fneur.2015.00112
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  Insufficient sleep is associated with cardiometabolic disease and poor health. However, few studies have assessed its determinants in a nationally representative sample. Data from the 2009 behavioral risk factor surveillance system were used (N = 323,047 adults). Insufficient sleep was assessed as insufficient rest/sleep over 30 days. This was evaluated relative to sociodemographics (age, sex, race/ethnicity, marital status, region), socioeconomics (education, income, employment, insurance), health behaviors (diet, exercise, smoking, alcohol), and health/functioning (emotional support, BMI, mental/physical health). Overall, insufficient sleep was associated with being female, White or Black/African-American, unemployed, without health insurance, and not married; decreased age, income, education, physical activity; worse diet and overall health; and increased household size, alcohol, and smoking. These factors should be considered as risk factors for insufficient sleep.
• Grandner, M. A., Nowakowski, S., Kloss, J. D., & Perlis, M. L. (2015). Insomnia symptoms predict physical and mental impairments among postmenopausal women. Sleep Medicine, 16(Issue 3). doi:10.1016/j.sleep.2015.01.002
• Grandner, M. A., Nowakowski, S., Kloss, J. D., & Perlis, M. L. (2015). Insomnia symptoms predict physical and mental impairments among postmenopausal women. Sleep medicine, 16(3), 317-8.
• Grandner, M. A., Schopfer, E. A., Sands-Lincoln, M., Jackson, N., & Malhotra, A. (2015). Relationship between sleep duration and body mass index depends on age. Obesity (Silver Spring, Md.), 23(12), 2491-8.
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  Sleep duration is associated with obesity and cardiometabolic disease. It is unclear, though, how these relationship differs across age groups.
• Grandner, M. A., Smith, T. E., Jackson, N., Jackson, T., Burgard, S., & Branas, C. (2015). Geographic distribution of insufficient sleep across the United States: a county-level hotspot analysis. Sleep health, 1(3), 158-165.
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  Insufficient sleep is associated with cardiometabolic risk and neurocognitive impairment. Determinants of insufficient sleep include many social and environmental factors. Assessment of geographic hot/coldspots may uncover novel risk groups and/or targets for public health intervention. The aim of this study was to discern geographic patterns in the first data set to include county-level sleep data.
• Grandner, M., & Malhotra, A. (2015). Sleep as a vital sign: Why medical practitioners need to routinely ask their patients about sleep. Sleep Health, 1, 11-12.
• Grandner, M., Chakravorty, S., Siu, H. Y., Oliver, L., Brown, G. K., Findley, J., & Findley, M. L. (2015). Insomnia symptoms and sleep duration as risk factors for suicidal ideation. Primary Care Companion for CNS Disorders.
• Grandner, M., Jean-Louis, G., Youngstedt, S. D., Williams, N. J., Sarpong, D., Zizi, F., & Ogedegbe, G. (2015). Unequal burden of sleep-related obesity among black and white Americans.. Sleep Health.
• Grandner, M., Smith, T. E., Jackson, T., Jackson, N., Burgard, S., & Branas, C. (2015). Geographic distribution of insufficient sleep across the US: A county-level hotspot analysis. Sleep Health.
• Hui, S. A., & Grandner, M. A. (2015). Associations between Poor Sleep Quality and Stages of Change of Multiple Health Behaviors among Participants of Employee Wellness Program. Preventive medicine reports, 2, 292-299.
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  Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change.
• Hui, S. A., & Grandner, M. A. (2015). Trouble Sleeping Associated With Lower Work Performance and Greater Health Care Costs: Longitudinal Data From Kansas State Employee Wellness Program. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, 57(10), 1031-8.
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  To examine the relationships between employees' trouble sleeping and absenteeism, work performance, and health care expenditures over a 2-year period.
• Hui, S. k., & Grandner, M. A. (2015). Associations between poor sleep quality and stages of change of multiple health behaviors among participants of employee wellness program. Preventive Medicine Reports, 2(Issue). doi:10.1016/j.pmedr.2015.04.002
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  Objective: Using the Transtheoretical Model of behavioral change, this study evaluates the relationship between sleep quality and the motivation and maintenance processes of healthy behavior change. Methods: The current study is an analysis of data collected in 2008 from an online health risk assessment (HRA) survey completed by participants of the Kansas State employee wellness program (N = 13,322). Using multinomial logistic regression, associations between self-reported sleep quality and stages of change (i.e. precontemplation, contemplation, preparation, action, maintenance) in five health behaviors (stress management, weight management, physical activities, alcohol use, and smoking) were analyzed. Results: Adjusted for covariates, poor sleep quality was associated with an increased likelihood of contemplation, preparation, and in some cases action stage when engaging in the health behavior change process, but generally a lower likelihood of maintenance of the healthy behavior. Conclusions: The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.
• Jean-Louis, G., & Grandner, M. (2015). Importance of recognizing sleep health disparities and implementing innovative interventions to reduce these disparities. Sleep medicine.
• Jean-Louis, G., Grandner, M. A., Youngstedt, S. D., Williams, N. J., Zizi, F., Sarpong, D. F., & Ogedegbe, G. G. (2015). Differential increase in prevalence estimates of inadequate sleep among black and white Americans. BMC public health, 15(1), 1185.
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  The National Health Interview Survey (NHIS) was used to ascertain whether increases in inadequate sleep differentially affected black and white Americans. We tested the hypothesis that prevalence estimates of inadequate sleep were consistently greater among blacks, and that temporal changes have affected these two strata differentially.
• Jean-Pierre, P., Grandner, M. A., Garland, S. N., Henry, E., Jean-Louis, G., & Burish, T. G. (2015). Self-reported memory problems in adult-onset cancer survivors: effects of cardiovascular disease and insomnia. Sleep medicine, 16(7), 845-9.
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  Cancer and its treatments can deleteriously affect memory. Cardiac function and insomnia can exacerbate memory problems.
• Jen, R., Grandner, M. A., & Malhotra, A. (2015). Future of Sleep-Disordered Breathing Therapy Using a Mechanistic Approach. The Canadian journal of cardiology, 31(7), 880-8.
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  Sleep disordered breathing (SDB) is highly prevalent among patients with cardiovascular disease (CVD), and the relationship between SDB and CVD may be bidirectional. However, SDB remains underdiagnosed and undertreated. One of the major barriers identified by cardiologists is lack of satisfaction with SDB therapy. This situation could be the result of the discordance between treatment and the pathophysiological characteristics of SDB. This condition is caused by multiple pathophysiological mechanisms, which could be classified into upper airway anatomic compromise, pharyngeal dilator muscle dysfunction, and ventilatory control instability. However, the effective treatment of SDB remains limited, and positive airway pressure therapy is still the mainstay of the treatment. Therefore, we review the pathophysiological characteristics of SDB in this article, and we propose to provide individualized treatment of SDB based on the underlying mechanism. This approach requires further study but could potentially improve adherence and success of therapy.
• Lalley-Chareczko, L., Segal, A., Perlis, M. L., Nowakowski, S., Tal, J. Z., & Grandner, M. A. (2015). Sleep Disturbance Partially Mediates the Relationship Between Intimate Partner Violence and Physical/Mental Health in Women and Men. Journal of interpersonal violence.
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  Intimate partner violence (IPV) is a worldwide health concern and an important risk factor for poor mental/physical health in both women and men. Little is known about whether IPV leads to sleep disturbance. However, sleep problems may be common in the context of IPV and may mediate relationships with mental/physical health. Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were used (N = 34,975). IPV was assessed in female and male participants for any history of being threatened by, physically hurt by, or forced to have sex with an intimate partner (THREAT, HURT, and SEX, respectively), and, further, as being forced to have sex with or physically injured by an intimate partner within the past year (SEXyr and HURTyr, respectively). These survey items were coded yes/no. Sleep disturbance was assessed as difficulty falling asleep, staying asleep, or sleeping too much at least 6 of the last 14 days. Logistic regression analyses, adjusted for age, sex, race, income, education, and physical/mental health, assessed whether IPV predicted sleep disturbance. Sobel-Goodman tests assessed whether relationships between IPV and physical/mental health were partially mediated by sleep disturbance. All IPV variables were associated with sleep disturbance, even after adjusting for the effects of age, sex, race/ethnicity, income, education, employment, marital status, physical health and mental health. THREAT was associated with sleep disturbance (odds ratio [OR] = 2.798, p < .0001), as was HURT (OR = 2.683, p < .0001), SEX (OR = 3.237, p < .0001), SEXyr (OR = 7.741, p < .0001), and HURTyr (OR = 7.497, p < .0001). In mediation analyses, all IPV variables were associated with mental health (p < .0001), and all were associated with physical health (p < .007) except SEXyr. Sleep disturbance partially mediated all relationships (Sobel p < .0005 for all tests). Mediation was around 30%, ranging from 18% (HURTyr and mental health) to 41% (HURT and physical health). IPV was strongly associated with current sleep disturbance above the effect of demographics and overall mental/physical health, even if the IPV happened in the past. Furthermore, sleep disturbance partially mediates the relationship between IPV and mental/physical health. Sleep interventions may potentially mitigate negative effects of IPV.
• Li, J., A Grandner, M., Chang, Y., Jungquist, C., & Porock, D. (2015). Person-Centered Dementia Care and Sleep in Assisted Living Residents with Dementia: A Pilot Study. Behavioral sleep medicine, 1-17.
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  The sleep of people with dementia living in long-term care is known to be disturbed. This pre-post controlled pilot study examined the effects of a person-centered dementia care intervention on sleep in assisted living residents with dementia. The three-month intervention included in-class staff training plus supervision and support in practice. The sleep-wake patterns were measured using actigraphy for three consecutive days at baseline and postintervention. Sixteen residents from the intervention and six from the control groups completed the study. The intervention group had significantly more nighttime sleep at posttest. After adjusting for baseline, the intervention group exhibited significantly less daytime sleep and more nighttime sleep. Person-centered dementia care may be effective for improving sleep of residents with dementia.
• Pak, V. M., Keenan, B. T., Jackson, N., Grandner, M. A., Maislin, G., Teff, K., Schwab, R. J., Arnardottir, E. S., Júlíusson, S., Benediktsdottir, B., Gislason, T., & Pack, A. I. (2015). Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity. International journal of obesity (2005), 39(3), 472-9.
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  Elevated levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear.
• Perlis, M., Grandner, M., Zee, J., Bremer, E., Whinnery, J., Barilla, H., Andalia, P., Gehrman, P., Morales, K., Thase, M., Bootzin, R., & Ader, R. (2015). Durability of treatment response to zolpidem with three different maintenance regimens: a preliminary study. Sleep medicine, 16(9), 1160-8.
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  At present, there is no consensus regarding how to medically manage chronic insomnia in the long term. The unstated standard of practice is for patients to use hypnotics intermittently. The present study aimed to compare a partial reinforcement strategy with nightly and intermittent dosing strategies for its potential as a maintenance therapy.
• Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., & Tasali, E. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843-4.
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  Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.
• Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., Twery, M., Croft, J. B., Maher, E., Barrett, J. A., , Thomas, S. M., et al. (2015). Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: Methodology and discussion. Sleep, 38(Issue 8). doi:10.5665/sleep.4886
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  The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.
• Williams, N. J., Grandne, M. A., Snipes, A., Rogers, A., Williams, O., Airhihenbuwa, C., & Jean-Louis, G. (2015). Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context. Sleep health, 1(1), 28-35.
• Williams, N. J., Grandner, M. A., Wallace, D. M., Cuffee, Y., Airhihenbuwa, C., Okuyemi, K., Ogedegbe, G., & Jean-Louis, G. (2015). Social and behavioral predictors of insufficient sleep among African Americans and Caucasians. Sleep medicine.
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  Few studies have examined the social and behavioral predictors of insufficient sleep.
• Chakravorty, S., Chakravorty, S., Grandner, M. A., Grandner, M. A., Gurubhagavatula, I., Gurubhagavatula, I., Oliver, L., Oliver, L., Perlis, M. L., & Perlis, M. (2014). Abstract P108: Habitual Short Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiovascular and Metabolic Disease Risk Factors: Data from NHANES. Circulation, 129(suppl_1). doi:10.1161/circ.129.suppl_1.p108
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  Background: Self-reported short and long sleep duration have been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodological issues. Methods: We analyzed adult 2007-2008 US National Health and Nutrition Examination Survey (NHANES) data (N=5,649). Average self-reported nightly sleep duration was reported and categorized as either very short (
• Chakravorty, S., Grandner, M. A., Gurubhagavatula, I., Oliver, L., & Perlis, M. L. (2014). Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors.. Sleep medicine, 15(1), 42-50. doi:10.1016/j.sleep.2013.09.012
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  Self-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues..Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5649). Self-reported sleep duration was categorized as very short (
• Chakravorty, S., Grandner, M. A., Mavandadi, S., Oslin, D. W., Perlis, M. L., & Sturgis, E. B. (2014). Suicidal ideation in veterans misusing alcohol: relationships with insomnia symptoms and sleep duration.. Addictive behaviors, 39(2), 399-405. doi:10.1016/j.addbeh.2013.09.022
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  The aim of this investigation was to assess the relationships between suicidal ideation and insomnia symptoms in Veterans misusing alcohol..Data were extracted in this retrospective chart review of Veterans referred from primary care for a behavioral health evaluation (N=161) based on evidence of heavy drinking, drug use or another behavioral problem. Suicidal ideation (SI) was assessed using the Paykel questionnaire. Insomnia symptoms were assessed with standard diary questions in an interview format and pertained to sleep latency (SL), wake after sleep onset time (WASO), sleep quality (SQ), and habitual sleep duration (HSD). The relations between suicidal ideation and insomnia symptoms were assessed using ordinal regression analyses adjusted for socio-demographic, psychiatric and addiction-related variables..Suicidal ideation was reported in 62 (39%) of the Veterans interviewed. In a multivariable model, only inadequate SQ was associated with suicidal ideation. Short sleepers were more likely to endorse suicidal ideation and have attempted suicide in the past year. In addition, older age, inadequate financial status, and the presence of a psychiatric disorder were also significantly associated with suicidal ideation in most of the adjusted models..Given their association with suicidal ideation, insomnia symptoms in Veterans misusing alcohol should prompt an assessment of underlying psychiatric and social factors.
• Chakravorty, S., Jackson, N., Chaudhary, N., Kozak, P. J., Perlis, M. L., Shue, H. R., & Grandner, M. A. (2014). Daytime sleepiness: associations with alcohol use and sleep duration in americans. Sleep disorders, 2014, 959152.
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  The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 (N = 2919) using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58-0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83-0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67-0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P = 0.004). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.
• Garland, S. N., Grandner, M. A., Jean-pierre, P., Jean-pierre, A., Maciorowski, G., & Richards, E. (2014). Characterizing self-reported memory problems in adult-onset cancer survivors in the United States: Importance of sleep duration and insomnia.. Journal of Clinical Oncology, 32(15_suppl), 9588-9588. doi:10.1200/jco.2014.32.15_suppl.9588
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  9588 Background: Memory dysfunction is a debilitating adverse effect of cancer and its treatments. We examined the relationships between self-reported memory problems (SRMP) and sleep disorders in adult-onset cancer survivors. Methods: We used data from 151 adults, 41-64 years old, cancer survivors who completed the 2007-2008 National Health and Nutrition Examination Survey. Population-weighted binary logistic regression analyses examined SRMP as outcome and included age, sex, education, race-ethnicity, income, and overall health as covariates. Sleep duration was categorized as very short ( =9hrs). Initial insomnia was assessed as difficulty falling asleep. Middle insomnia was assessed as difficulty maintaining sleep. Late insomnia was assessed as waking too early. These insomnia subgroup were categorized as none, mild ( =15 days/month). A combined insomnia variable categorized individuals as insomnia if they had severe insomnia...
• Garland, S. N., Grandner, M. A., Jean-pierre, P., Jean-pierre, A., Maciorowski, G., & Richards, E. (2014). Clinical correlates of memory problems in middle-aged adult-onset cancer survivors in the United States: A national cross-sectional study.. Journal of Clinical Oncology, 32(15_suppl), e20588-e20588. doi:10.1200/jco.2014.32.15_suppl.e20588
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  e20588 Background: Cancer and its treatments can deleteriously impact cognitive functioning in cancer patients and survivors. The etiology of cancer/treatment-related memory problems is generally attributed to various genetics, biological, and psychosocial factors. The present study assessed clinical predictors of self-reported memory problems (SRMP). Methods: We analyzed data from 160 adult cancer survivors, aged 41-64 years, who completed the 2007-2008 National Health and Nutrition Examination Survey. Participants with a history of brain tumor/stroke were excluded since these conditions generally cause direct brain insults/cognitive impairments. Clinical variables assessed obesity (body mass index evaluated [1] continuously or [2] dichotomized at 30kg/m2), hypertension ([1] previous diagnosis and/or current treatment for hypertension and [2] measured blood pressure >140/90mmHg), high cholesterol ([1] previous diagnosis and/or current treatment for high lipids and [2] serum cholesterol, assessed continuo...
• Grandner, M. A. (2014). Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease?. International review of psychiatry (Abingdon, England), 26(2), 155-76.
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  There is increasing awareness of the role of sleep disturbance as an important factor in health and disease. Although sub-clinical sleep disturbances (insufficient sleep duration or inadequate sleep quality) may be difficult to assess with conceptual and/or methodological clarity, this review attempts to summarize and synthesize these findings. First, the concept of sleep disturbance in a public health context is introduced, to provide context and rationale. Second, operational definitions of 'cardiometabolic disease' and 'sleep disturbance' are offered, to address many unclear operationalizations. Third, the extant literature is summarized regarding short or long sleep duration and/or insufficient sleep, insomnia and insomnia symptoms, general (non-specific sleep disturbances), circadian rhythm abnormalities that result in sleep disturbances, and, briefly, sleep-disordered breathing. Fourth, the review highlights the social/behavioural context of sleep, including discussions of sleep and race/ethnicity, socio-economic position, and other social/environmental factors, in order to place these findings in a social-environmental context relevant to public health. Fifth, the review highlights the issue of sleep as a domain of health behaviour and addresses issues regarding development of healthy sleep interventions. Finally, a research agenda of future directions is proposed.
• Grandner, M. A., Grandner, M., Howard, V. J., Howard, V. J., Howard, G., Howard, G., Kleindorfer, D. O., Kleindorfer, D., Molano, J. R., Molano, J. R., Petrov, M. E., & Petrov, M. E. (2014). Abstract P215: Sleep Medication and Incident Stroke: The REGARDS Study. Circulation, 129.
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  Introduction: Preliminary evidence suggests sleep medications are associated with risk of vascular events; however, the long-term association with stroke risk is understudied. The aim of this study was to investigate the relation between sleep medication use and incident stroke. Methods: Within the REasons for Geographic And Racial Differences in Stroke study, 21,678 black and white participants (≥45 years) with no history of stroke were studied. Participants were recruited from 2003–2007. From 2008–2010, participants self-reported their prescription and over-the-counter sleep medication use over the past month. Suspected stroke events were identified on 6-month telephone contact, and associated medical records retrieved and physician adjudicated. Proportional hazards analysis was used to the estimate hazard ratios for incident stroke associated with sleeping medication use (0, 1–14, and 15+ days per month) controlling for sociodemographics, stroke risk factors, mental health symptoms, and sleep apnea ris...
• Grandner, M. A., Knutson, K. L., Troxel, W., Hale, L., Jean-Louis, G., & Miller, K. E. (2014). Implications of sleep and energy drink use for health disparities. Nutrition reviews, 72 Suppl 1, 14-22.
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  The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions.
• Grandner, M. A., Shechter, A., & St-onge, M. (2014). The Role of Sleep in the Control of Food Intake.. American journal of lifestyle medicine, 8(6), 371-374. doi:10.1177/1559827614545315
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  Short sleep duration is increasingly recognized as a risk factor for obesity. Sleep is now considered 1 of the 3 lifestyle behaviors, along with diet and exercise, which are closely associated with health. If sleep duration is a causal factor in the etiology of obesity, it must affect energy intake and/or energy expenditure to create a positive energy balance. The preponderance of evidence to date points to an effect of sleep restriction on energy intake that exceeds the added energy costs of maintaining longer wakefulness. Observational studies describe greater intakes of energy, fat, and possibly carbohydrates in short sleepers and this is corroborated by clinical interventions. These intervention studies further provide mechanistic explanations, via alterations in hormonal and neuronal controls of food intake, for an association between short sleep and obesity.
• Jackson, N., Gerstner, J. R., Grandner, M. A., & Knutson, K. L. (2014). Sleep symptoms associated with intake of specific dietary nutrients.. Journal of sleep research, 23(1), 22-34. doi:10.1111/jsr.12084
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  Sleep symptoms are associated with weight gain and cardiometabolic disease. The potential role of diet has been largely unexplored. Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) were used (n = 4552) to determine which nutrients were associated with sleep symptoms in a nationally representative sample. Survey items assessed difficulty falling asleep, sleep maintenance difficulties, non-restorative sleep and daytime sleepiness. Analyses were adjusted for energy intake, other dietary factors, exercise, body mass index (BMI) and sociodemographics. Population-weighted, logistic regression, with backwards-stepwise selection, examined which nutrients were associated with sleep symptoms. Odds ratios (ORs) reflect the difference in odds of sleep symptoms associated with a doubling in nutrient. Nutrients that were associated independently with difficulty falling asleep included (in order): alpha-carotene (OR = 0.96), selenium (OR = 0.80), dodecanoic acid (OR = 0.91), calcium (OR = 0.83) and hexadecanoic acid (OR = 1.10). Nutrients that were associated independently with sleep maintenance difficulties included: salt (OR = 1.19), butanoic acid (0.81), carbohydrate (OR = 0.71), dodecanoic acid (OR = 0.90), vitamin D (OR = 0.84), lycopene (OR = 0.98), hexanoic acid (OR = 1.25) and moisture (OR = 1.27). Nutrients that were associated independently with non-restorative sleep included butanoic acid (OR = 1.09), calcium (OR = 0.81), vitamin C (OR = 0.92), water (OR = 0.98), moisture (OR = 1.41) and cholesterol (OR = 1.10). Nutrients that were associated independently with sleepiness included: moisture (OR = 1.20), theobromine (OR = 1.04), potassium (OR = 0.70) and water (OR = 0.97). These results suggest novel associations between sleep symptoms and diet/metabolism, potentially explaining associations between sleep and cardiometabolic diseases.
• Jackson, N., Gooneratne, N. S., Grandner, M. A., & Patel, N. P. (2014). The development of a questionnaire to assess sleep-related practices, beliefs, and attitudes.. Behavioral sleep medicine, 12(2), 123-42. doi:10.1080/15402002.2013.764530
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  There are no established questionnaires that evaluate habitual sleep practices in the context of beliefs and attitudes about sleep. This study describes an effort to develop and evaluate a questionnaire that assesses habitual sleep; behaviors associated with sleep and potential sleep problems; sleep hygiene; social and environmental determinants of sleep; beliefs and attitudes about sleep as it relates to health, safety, and functioning; and knowledge about sleep. A total of 124 participants completed the final questionnaire. Overall, the questionnaire and subscales demonstrated moderate internal consistency, and concurrent and divergent validity were demonstrated by comparing various subscales to existing measures. Future studies may utilize the descriptive data to determine the role of behavioral, social, and environmental determinants of healthy sleep.
• Pak, V. M., Grandner, M. A., & Pack, A. I. (2014). Circulating adhesion molecules in obstructive sleep apnea and cardiovascular disease.. Sleep medicine reviews, 18(1), 25-34. doi:10.1016/j.smrv.2013.01.002
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  Over 20 years of evidence indicates a strong association between obstructive sleep apnea (OSA) and cardiovascular disease. Although inflammatory processes have been heavily implicated as an important link between the two, the mechanism for this has not been conclusively established. Atherosclerosis may be one of the mechanisms linking OSA to cardiovascular morbidity. This review addresses the role of circulating adhesion molecules in patients with OSA, and how these may be part of the link between cardiovascular disease and OSA. There is evidence for the role of adhesion molecules in cardiovascular disease risk. Some studies, albeit with small sample sizes, also show higher levels of adhesion molecules in patients with OSA compared to controls. There are also studies that show that levels of adhesion molecules diminish with continuous positive airway pressure therapy. Limitations of these studies include small sample sizes, cross-sectional sampling, and inconsistent control for confounding variables known to influence adhesion molecule levels. There are potential novel therapies to reduce circulating adhesion molecules in patients with OSA to diminish cardiovascular disease. Understanding the role of cell adhesion molecules generated in OSA will help elucidate one mechanistic link to cardiovascular disease in patients with OSA.
• Petrov, M. E., Howard, V. J., Kleindorfer, D., Grandner, M. A., Molano, J. R., & Howard, G. (2014). Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 23(8), 2110-6.
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  Preliminary evidence suggests sleep medications are associated with risk of vascular events; however, the long-term vascular consequences are understudied. This study investigated the relation between sleep medication use and incident stroke.
• Whinnery, J., Jackson, N., Rattanaumpawan, P., & Grandner, M. A. (2014). Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position. Sleep, 37(3), 601-11.
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  Short and/or long sleep duration are associated with cardiometabolic disease risk and may be differentially experienced among minorities and the socioeconomically disadvantaged. The present study examined nationally representative data along multiple dimensions of race/ ethnicity and socioeconomic status.
• Chakravorty, S., Grandner, M. A., Kling, M. A., Kranzler, H. R., Mavandadi, S., Oslin, D. W., & Perlis, M. L. (2013). Insomnia in alcohol dependence: predictors of symptoms in a sample of veterans referred from primary care.. The American journal on addictions, 22(3), 266-70. doi:10.1111/j.1521-0391.2012.12009.x
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  Patients with alcohol dependence presenting for treatment may have multiple associated co-morbid conditions and limited social supports, which complicate treatment. Each of these factors has been independently associated with complaints of insomnia. In this preliminary study, we investigated the relations between insomnia complaints and socio-demographic factors and psychiatric co-morbidity in treatment-seeking patients with alcohol dependence..We conducted a retrospective chart review on 84 consecutive patients referred to the Behavioral Health Laboratory of the Philadelphia Veterans Affairs Medical Center for evaluation of psychiatric and substance use disorders. Patients met DSM-IV diagnostic criteria for alcohol dependence and completed a series of self-assessments of sleep. Univariate and multivariable analyses were used to examine the relations amongst the variables of interest..In multivariable models, Sleep Latency was significantly greater in individuals without partners (p = .01), those with psychiatric disorders (p = .03) and smokers (p = .01), with a non-significant trend for those with past-year suicidal ideation. No significant predictor of Wake Time After Sleep Onset was seen. Poor Sleep Quality was predicted by younger age (OR = .93 [.88, .98], p = .004) and the presence of a psychiatric disorder (OR = 20.80 [4, 102], p = .0002), with a non-significant trend for suicidal ideation..Insomnia symptoms in treatment-seeking alcohol dependent patients should prompt consideration of the individuals' psychiatric and psychosocial features.
• Cole, R. J., Elliott, J. A., Grandner, M. A., & Kripke, D. F. (2013). Short wavelength light administered just prior to waking: a pilot study.. Biological rhythm research, 44(1), 13-32. doi:10.1080/09291016.2011.632578
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  Bright light in the blue-green range, administered in the early morning hours (prior to waking) may be particularly effective in shifting circadian rhythms and may increase gonadotropin production. Accordingly, we tested the feasibility and utility of a mask that emits bright blue/green light (compared to a similar mask that emitted a dim red light) towards the end of sleep in a randomized, placebo-controlled pilot study. The study included a 3-day baseline period, immediately followed by a 12-day intervention period. Subjects were 30 healthy young men with minimal-mild depression. The bright light masks were well-tolerated and demonstrated adequate safety and feasibility. Following the intervention, those who wore the bright light mask demonstrated altered sleep timing suggestive of an earlier sleep period, and excreted a slight increase in follicle-stimulating hormone. Overall, light masks may prove useful in future studies of bright light therapy.
• Culnan, E., Grandner, M. A., & Kloss, J. D. (2013). A prospective study of weight gain associated with chronotype among college freshmen.. Chronobiology international, 30(5), 682-90. doi:10.3109/07420528.2013.782311
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  A prospective study of chronotype as a predictor of increased weight gain and body mass index (BMI) among college freshman was undertaken. At baseline, 137 college freshmen were characterized as morning, neutral, or evening types using the reduced version of the Morningness-Eveningness Questionnaire. Additionally, information was collected regarding weight, BMI, and health habits (e.g., junk food and alcohol consumption). These additional measures consisted of a descriptive questionnaire, the Pittsburgh Sleep Quality Index, the International Physical Activity Questionnaire, the Gray-Donald Eating Patterns Questionnaire, and the Positive and Negative Affect Scale. Participants included 79 females and 80 males with a mean age of 18.25 (SD = 0.56) yrs. Eight weeks later, participants returned (N = 54) to complete follow-up measures, which were identical to baseline assessments with the exception of the descriptive questionnaire, in which demographic questions were removed. Evening types had a significantly greater BMI gain (p < 0.05) when compared with morning/neutral types. Health behaviors did not differ by chronotype. Future studies should seek to clarify the mechanisms underlying the chronotype-BMI/weight gain relationship.
• Findley, J. C., Grandner, M. A., Gurubhagavatula, I., & Maia, Q. (2013). Short and long sleep duration and risk of drowsy driving and the role of subjective sleep insufficiency.. Accident; analysis and prevention, 59(Issue), 618-22. doi:10.1016/j.aap.2013.07.028
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  Experimental sleep restriction increases sleepiness and impairs driving performance. However, it is unclear whether short sleep duration in the general population is associated with drowsy driving. The goal of the present study was to evaluate whether individuals in the general population who obtained sleep of 6h or less are more likely to report drowsy driving, and evaluate the role of perceived sleep sufficiency. Data exploring whether subgroups of short sleepers (those who report the most or least unmet sleep need) show different risk profiles for drowsy driving are limited. From the 2009 Behavioral Risk Factor Surveillance System (N=31,522), we obtained the following self-reported data: (1) sleep duration (≤5, 6, 7, 8, 9, or ≥10 h/night); (2) number of days/week of perceived insufficient sleep; (3) among drivers, yes/no response to: "During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?" (4) demographics, physical/mental health. Using 7 h/night as reference, logistic regression analyses evaluated whether self-reported sleep duration was associated with drowsy driving. Overall, 3.6% reported drowsy driving. Self-identified short-sleepers reported drowsy driving more often, and long sleepers, less often. Among those who perceived sleep as always insufficient, drowsy driving was reported more often when sleep duration was ≤5 h, 6 h, or ≥10 h. Among those who perceived sleep as always sufficient, drowsy driving was reported more often among ≤5 h and 6h sleepers. Overall, drowsy driving was common, particularly in self-identified short-sleepers as a whole, as well as subgroups based on sleep insufficiency.
• Grandner, M. A., & Perlis, M. L. (2013). Insomnia as a cardiometabolic risk factor. Sleep, 36(1), 11-2.
• Grandner, M. A., & Perlis, M. L. (2013). Short sleep duration and insomnia associated with hypertension incidence.. Hypertension research : official journal of the Japanese Society of Hypertension, 36(11), 932-3. doi:10.1038/hr.2013.83
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  Insomnia and short sleep duration are potentially separate but overlapping constructs, both of which may confer independent risk for adverse health outcomes. Accordingly, it is important to consider both in the context of epidemiologic research. The paper by Meng et al.1 adopts precisely this approach when exploring if and how insomnia and/or short sleep duration may confer risk for hypertension.
• Grandner, M. A., Buxton, O. M., Jackson, N., Sands-Lincoln, M., Pandey, A., & Jean-Louis, G. (2013). Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group. Sleep, 36(5), 769-779E.
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  We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk.
• Grandner, M. A., Gallagher, R. A., & Gooneratne, N. S. (2013). The use of technology at night: impact on sleep and health. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 9(12), 1301-2.
• Grandner, M. A., Henry, E., & Jean-pierre, P. (2013). Abstract B20: Self-reported memory problems in adult-onset cancer survivors in the United States: Effects of cardiac complications, short sleep duration, and general health. Cancer Prevention Research, 6. doi:10.1158/1940-6215.prev-13-b20
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  Background: Memory impairments are debilitating adverse effects of malignant tumors and their various treatments. Factors such as cardiac complications and sleep loss/impairment can exacerbate memory problems for cancer patients and survivors. We examined the relationships among history of cardiac complications, short sleep duration, and self-reported memory problems (SRMP) in adult-onset cancer survivors. Methods: We included data from middle-aged (41 to 64 years) participants who completed the 2007-2008 National Health and Nutrition Examination Survey (NHANES), a nationally representative, stratified, multistage probability sample of the civilian, non-institutionalized population of the United States. We excluded participants with a history of brain cancer or stroke since these conditions are expected to cause cognitive problems because of direct insults to the brain. Using binary a logistic regression, we determined the prevalence of SRMP in cancer survivors relative to cardiac complications and short sleep duration ( Results: The sample included 2,289 adults (49% female). There were 46% Whites, 20% Blacks, 29% Hispanics, and 4% Asian/other. A total of 9% of the sample were cancer survivors. Cardiac complications (Odds ratio (OR), 6.97, p 0.05). Conclusion: The likelihood of SRMP is higher in cancer survivors with a history of cardiac complications or short sleep duration. Future studies are needed to systematically delineate the cardiac-sleep-memory relationships, which could inform the development of reliable assessment and intervention to mitigate memory impairments and sleep problems for cancer survivors. Citation Format: Pascal Jean-Pierre, Michael Grandner, Elizabeth Henry. Self-reported memory problems in adult-onset cancer survivors in the United States: Effects of cardiac complications, short sleep duration, and general health. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B20.
• Grandner, M. A., Petrov, M. E., Rattanaumpawan, P., Jackson, N., Platt, A., & Patel, N. P. (2013). Sleep symptoms, race/ethnicity, and socioeconomic position. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 9(9), 897-905; 905A-905D.
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  Growing evidence indicates sleep is a major public health issue. Race/ethnicity and socioeconomics may contribute to sleep problems. This study assessed whether sleep symptoms were more prevalent among minorities and/or the socioeconomically disadvantaged.
• Grandner, M. A., Sands-Lincoln, M. R., Pak, V. M., & Garland, S. N. (2013). Sleep duration, cardiovascular disease, and proinflammatory biomarkers. Nature and science of sleep, 5, 93-107.
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  Habitual sleep duration has been associated with cardiometabolic disease, via several mechanistic pathways, but few have been thoroughly explored. One hypothesis is that short and/or long sleep duration is associated with a proinflammatory state, which could increase risk for cardiovascular and metabolic diseases. This hypothesis has been largely explored in the context of experimental sleep deprivation studies which have attempted to demonstrate changes in proinflammatory markers following acute sleep loss in the laboratory. Despite the controlled environment available in these studies, samples tend to lack generalization to the population at large and acute sleep deprivation may not be a perfect analog for short sleep. To address these limitations, population based studies have explored associations between proinflammatory markers and habitual sleep duration. This review summarizes what is known from experimental and cross-sectional studies about the association between sleep duration, cardiovascular disease, and proinflammatory biomarkers. First, the association between sleep duration with both morbidity and mortality, with a focus on cardiovascular disease, is reviewed. Then, a brief review of the potential role of proinflammatory markers in cardiovascular disease is presented. The majority of this review details specific findings related to specific molecules, including tumor necrosis factor-α, interleukins-1, -6, and -17, C-reactive protein, coagulation molecules, cellular adhesion molecules, and visfatin. Finally, a discussion of the limitations of current studies and future directions is provided.
• Jackson, N., Gehrman, P. R., Gooneratne, N. S., Grandner, M. A., Jean-louis, G., Patel, N. P., & Perlis, M. L. (2013). Sleep-related behaviors and beliefs associated with race/ethnicity in women.. Journal of the National Medical Association, 105(1), 4-15. doi:10.1016/s0027-9684(15)30080-8
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  Explore how social factors influence sleep, especially sleep-related beliefs and behaviors. Sleep complaints, sleep hygiene behaviors, and beliefs about sleep were studied in 65 black/African American and white/European American women. Differences were found for snoring and discrepancy between sleep duration and need. Sleep behaviors differed across groups for napping, methods for coping with sleep difficulties, and nonsleep behaviors in bed. Beliefs also distinguished groups, with differences in motivation for sleep and beliefs about sleep being important for health and functioning. These findings have important public health implications in terms of developing effective sleep education interventions that include consideration of cultural aspects.
• Jackson, N., Gerstner, J. R., Grandner, M. A., & Knutson, K. L. (2013). Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample.. Appetite, 64(Issue), 71-80. doi:10.1016/j.appet.2013.01.004
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  Short sleep duration is associated with weight gain and obesity, diabetes, cardiovascular disease, psychiatric illness, and performance deficits. Likewise, long sleep duration is also associated with poor physical and mental health. The role of a healthy diet in habitual sleep duration represents a largely unexplored pathway linking sleep and health. This study evaluated associations between habitual sleep parameters and dietary/nutritional variables obtained via the National Health and Nutrition Examination Survey (NHANES), 2007-2008. We hypothesized that habitual very short (
• Jackson, N., Grandner, M. A., Gurubhagavatula, I., & Sands, M. (2013). Abstract P196: Sleep Apnea Symptoms Help Screen for Risk of Metabolic Syndrome in a Nationally-representative Sample. Circulation, 127.
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  Introduction: Sleep apnea increases the risk for developing metabolic syndrome (MetS). Polysomnography remains the diagnostic gold standard, but its expense makes it inappropriate for population-wide screening for sleep apnea. We evaluated a simpler, more feasible approach, to identify which self-reported symptoms of sleep apnea best delineate risk for MetS at a population level. Methods: We reviewed available sleep symptom data from the 2007-2008 NHANES (N=4,099) cohort, which included: snoring and snorting/gasping (coded as 0, 1-2, 3-4, or 5+ nights/week), and non-restorative sleep and daytime sleepiness (coded as 0, 1, 2-4, 5-15, or 16-30 times/month). MetS was defined as ≥3 of: (1) Abdominal obesity (waist ≥102 cm men and ≥88 cm women); (2) Hypertension (HTN) (systolic ≥130 or diastolic ≥85 or HTN meds); (3) High-density lipoprotein (HDL) ( Results: Although all four variables predicted MetS in adjusted models, snoring and snorting/gasping were stronger predictors and the only significant predictors in fully-adjusted models. Frequent snoring and/or snorting/gasping was associated with a 2-3-fold risk of MetS. Among components, snoring and snorting/gasping generally predicted elevated risk. (See Table). Conclusion: In a nationally-representative sample, self-reported snoring and snorting/gasping were associated with risk of MetS and its components, even after controlling for confounding. Risk related to non-restorative sleep and daytime sleepiness did not remain after controlling for confounding.
• Jackson, N., Grandner, M. A., Gurubhagavatula, I., Keenan, B. T., Sands-lincoln, M., & Whinnery, J. (2013). The association between obstructive sleep apnea and hypertension by race/ethnicity in a nationally representative sample.. Journal of clinical hypertension (Greenwich, Conn.), 15(8), 593-9. doi:10.1111/jch.12144
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  The association between obstructive sleep apnea (OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable (pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index (BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [OR], 1.82; 95% confidence interval [CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos (OR, 1.69; 95% CI, 1.13-2.53) and whites (OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/African Americans (OR, 4.74; 95% CI, 1.86-12.03), overweight whites (OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/Latino participants (OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis.
• Barrett, J. S., Cuellar, N. G., Edwards, A. Y., Gooneratne, N. S., Grandner, M. A., & Zhou, C. (2012). Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults.. Journal of pineal research, 52(4), 437-45. doi:10.1111/j.1600-079x.2011.00958.x
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  Melatonin is increasingly used for the treatment of sleep disorders. Surge-sustained formulations consisting of combined immediate release and controlled release dosing may mimic the endogenous melatonin physiologic profile. However, relatively little is known about the pharmacokinetic properties of low-dose (2mg) melatonin in a combined immediate release/controlled release dose, especially in older adults who may also exhibit altered melatonin disposition. To assess this, we conducted a randomized, double-blind, placebo-controlled study of low-dose (0.4mg) and high-dose (4.0mg) melatonin (25% immediate release+75% controlled release) in 27 older adults with insomnia complaints and low endogenous melatonin levels to determine whether melatonin pharmacokinetic properties differ between these two doses. The time to maximum level (1.3hrs versus 1.5hrs), elimination half-life (1.8hrs versus 2.1hrs), and apparent total clearance (379L/hr versus 478L/hr) did not differ significantly between the low- and high-dose arms, respectively. The maximum concentration was 405 ±93pg/mL for the low-dose arm and 3999±700pg/mL for the high-dose arm, both of which are substantially higher than physiologic melatonin levels for this age group. In addition, subjects in the high-dose arm maintained melatonin levels >50pg/mL for an average of 10hrs, which could result in elevated melatonin levels beyond the typical sleep period. Renal and liver function parameters remained stable after 6wks of treatment. The linear pharmacokinetic behavior of melatonin observed in the elderly can form the basis for future studies exploring a wider range of dosing scenarios to establish exposure-response relationships for melatonin-mediated sleep outcomes.
• Gehrman, P. R., Jackson, N., Gehrman, P. R., Grandner, M. A., Jackson, N. J., Grandner, M. A., Pack, A. I., Pack, A. I., Perlis, M. L., Perlis, M. L., Rattanaumpawan, P., & Rattanaumpawan, P. (2012). Abstract P201: Insomnia Symptoms Associated With Cardiometabolic Risk Factors. Circulation, 125.
• Gooneratne, N. S., Grandner, M. A., & Patel, N. P. (2012). Difficulties sleeping: a natural part of growing older?. Aging health, 8(3), 219-221. doi:10.2217/ahe.12.21
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  groups. For daytime tiredness, this pattern was similar, except that rates climbed steadily again, starting from the age of 70 years. When adjusted for cofactors such as socioeconomics, demographics, access to healthcare and overall health, this pattern became even stronger, with the highest rates in the youngest adults, an increase in middle age (especially in women) and a decline in older age. Interestingly, the rise in daytime tiredness in older adults was completely explained by these cofactors (rather than age itself). These results demonstrated that not only was there no notable increase in sleep-related complaints in older adults, there was a general decrease, with the highest rates in the youngest adults. Furthermore, these results showed that sleep complaints and, especially, daytime tiredness in older adults, can be largely explained by socioeconomic, health and mental health factors, rather than the process of aging per se. These findings are consonant with a growing
• Gooneratne, N. S., Grandner, M. A., & Platt, A. B. (2012). In Memoriam: Nirav P. Patel. Journal of Clinical Sleep Medicine, 08(04), 465-465. doi:10.5664/jcsm.2056
• Gooneratne, N., Edwards, A., Zhou, C., Cuellar, N., Grandner, M., & Barrett, J. (2012). Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults. Journal of Pineal Research, 52(4). doi:10.1111/j.1600-079X.2011.00958.x
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  Melatonin is increasingly used for the treatment of sleep disorders. Surge-sustained formulations consisting of combined immediate release and controlled release dosing may mimic the endogenous melatonin physiologic profile. However, relatively little is known about the pharmacokinetic properties of low-dose (2 mg) melatonin in a combined immediate release/controlled release dose, especially in older adults who may also exhibit altered melatonin disposition. To assess this, we conducted a randomized, double-blind, placebo-controlled study of low-dose (0.4 mg) and high-dose (4.0 mg) melatonin (25% immediate release + 75% controlled release) in 27 older adults with insomnia complaints and low endogenous melatonin levels to determine whether melatonin pharmacokinetic properties differ between these two doses. The time to maximum level (1.3 hrs versus 1.5 hrs), elimination half-life (1.8 hrs versus 2.1 hrs), and apparent total clearance (379 L/hr versus 478 L/hr) did not differ significantly between the low- and high-dose arms, respectively. The maximum concentration was 405 ± 93 pg/mL for the low-dose arm and 3999 ± 700 pg/mL for the high-dose arm, both of which are substantially higher than physiologic melatonin levels for this age group. In addition, subjects in the high-dose arm maintained melatonin levels >50 pg/mL for an average of 10 hrs, which could result in elevated melatonin levels beyond the typical sleep period. Renal and liver function parameters remained stable after 6 wks of treatment. The linear pharmacokinetic behavior of melatonin observed in the elderly can form the basis for future studies exploring a wider range of dosing scenarios to establish exposure-response relationships for melatonin-mediated sleep outcomes. © 2011 John Wiley & Sons A/S.
• Grandner, M. A. (2012). Sleep duration across the lifespan: implications for health.. Sleep medicine reviews, 16(3), 199-201. doi:10.1016/j.smrv.2012.02.001
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  Obtaining sufficient sleep of adequate quality is increasingly becoming recognized as an important domain of healthy behavior. The Institute of Medicine has released two separate reports in recent years focused on the public health and safety implications of untreated sleep disorders and insufficient sleep.1,2 Further, adequate sleep has been included as a national health priority in Healthy People 2020.3
• Grandner, M. A., Jackson, N. J., Pigeon, W. R., Gooneratne, N. S., & Patel, N. P. (2012). State and regional prevalence of sleep disturbance and daytime fatigue. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 8(1), 77-86.
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  Social and demographic influences are important for sleep attainment. Geographic location has not been previously explored.
• Grandner, M. A., Martin, J. L., Patel, N. P., Jackson, N. J., Gehrman, P. R., Pien, G., Perlis, M. L., Xie, D., Sha, D., Weaver, T., & Gooneratne, N. S. (2012). Age and sleep disturbances among American men and women: data from the U.S. Behavioral Risk Factor Surveillance System. Sleep, 35(3), 395-406.
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  Explore the prevalence of sleep-related complaints across age groups, examining effects of sex, general health, and depressed mood.
• Jackson, N. J., Pak, V. M., Gehrman, P. R., & Grandner, M. A. (2012). Sleep disturbance is associated with cardiovascular and metabolic disorders.. Journal of sleep research, 21(4), 427-33. doi:10.1111/j.1365-2869.2011.00990.x
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  Existing research has demonstrated associations between sleep duration and obesity, diabetes, cardiovascular disease and mortality. Sleep disorders research has shown that sleep apnoea, insomnia and other sleep disorders confer risk for cardiometabolic disease, particularly in the presence of reduced sleep duration. The aim of the present study was to examine the associations between general sleep disturbance, operationalized as 'difficulty falling asleep, staying asleep, or sleeping too much' as measured in a large, nationally representative sample, and self-reported history of myocardial infarction, stroke, coronary artery disease, diabetes and obesity. Data from the Behavioral Risk Factor Surveillance System were analysed. Complete data were available for 138,201 individuals. A hierarchical logistic regression analysis examined associations before and after adjustment for demographic, socioeconomic, medical and psychological factors. After adjusting for demographic, socioeconomic and health risk factors, sleep duration was associated with obesity [odds ratio (OR)=1.18, P
• Jackson, N., Altman, N. G., Gehrman, P. R., Grandner, M. A., Izci-balserak, B., Patel, N. P., Rattanaumpawan, P., & Schopfer, E. (2012). Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes.. Sleep medicine, 13(10), 1261-70. doi:10.1016/j.sleep.2012.08.005
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  The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time..A total of N=30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI ≥ 30kgm(-2)) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency..Results indicated that, when examined alone, sleep duration
• Jackson, N., Gooneratne, N. S., Grandner, M. A., Hale, L., Patel, N. P., & Troxel, W. M. (2012). Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue.. Behavioral sleep medicine, 10(4), 235-49. doi:10.1080/15402002.2012.654548
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  Perceived discrimination is a potential cause of racial and ethnic disparities in health. Disturbed sleep may serve as a mechanism linking perceived racism with health consequences. This study investigates data from 7,148 adults from Michigan and Wisconsin who participated in the 2006 Behavioral Risk Factor Surveillance System. Hierarchical logistic regression analyses explored associations between perceived racial discrimination and self-reported sleep disturbance and daytime fatigue. Sleep disturbance and daytime fatigue were reported in 19% and 21% of the sample, respectively. Black/African American respondents (21%) report perceiving worse experiences, compared to people of other races, when seeking health care at higher rates than non-Hispanic White respondents (3%). Results from logistic regression models show that perceived racial discrimination is associated with increased risks of sleep disturbance (odds ratio [OR] = 2.62, p < .0001) and daytime fatigue (OR = 2.07, p < .0001). After adjustment for all covariates, perceived discrimination remains a significant predictor of sleep disturbance (OR = 1.60, p = .04). The interaction between perceived racism and race (Black/African American vs. non-Hispanic White) was nonsignificant. This population-based research adds to the growing body of data, suggesting that perceived racism may impact health via its influence on sleep-wake behaviors.
• Gehrman, P. R., Gooneratne, N. S., Grandner, M. A., Patel, N. P., Perlis, M. L., Pigeon, W. R., Sha, D., Teff, K. L., Weaver, T. E., & Xie, D. (2011). Obesity, diabetes, and exercise associated with sleep-related complaints in the American population.. Zeitschrift fur Gesundheitswissenschaften = Journal of public health, 19(5), 463-474. doi:10.1007/s10389-011-0398-2
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  AIM: Previous studies have demonstrated relationships between sleep and both obesity and diabetes. Additionally, exercise may improve sleep and daytime function, in addition to weight and metabolic function. The present study extends these findings by examining how general sleep-related complaints are associated with body mass index (BMI), diabetes diagnosis, and exercise in a large, nationally representative sample. SUBJECT AND METHODS: Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS). Sleep complaint (SC) was measured with "Over the last 2 weeks, how many days have you had trouble falling asleep or staying asleep or sleeping too much?" Daytime complaint (DC) was measured with "Over the last 2 weeks, how many days have you felt tired or had little energy?" Responses were dichotomized, with ≥6 days indicating complaint. Covariates included age, race/ethnicity, income, and education. RESULTS: Being overweight was associated with DC in women only. Obesity was significantly associated with SC and DC in women, and DC in men. Diabetes was associated with SC and DC in both genders. Any exercise in the past 30 days did not attenuate any BMI or diabetes relationships, but was independently associated with a decrease in SC and DC in both men and women. CONCLUSION: These results suggest that for both men and women diabetes is a significant predictor of sleep and daytime complaints, and there is a relationship between obesity and sleep and complaints for women to a greater extent than men. Finally, exercise was associated with much fewer sleep and daytime complaints in both genders.
• Grandner, M. A., & Pack, A. I. (2011). Sleep disorders, public health, and public safety.. JAMA, 306(23), 2616-7. doi:10.1001/jama.2011.1833
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  rors (OR, 1.43; 95% CI, 1.23-1.67), safety violations (OR, 1.63; 95% CI, 1.43-1.85), falling asleep at the wheel (OR, 1.51; 95% CI, 1.20-1.90), uncontrolled anger toward citizensorsuspects(OR,1.25;95%CI,1.09-1.43),citizencomplaints(OR,1.35;95%CI,1.13-1.61),absenteeism(OR,1.23;
• Grandner, M. A., & Youngstedt, S. D. (2011). Sleep duration and cardiometabolic risk commentary on Abe et al., "Sleep duration is significantly associated with carotid artery atherosclerosis incidence in a Japanese population".. Atherosclerosis, 217(2), 324-5. doi:10.1016/j.atherosclerosis.2011.03.046
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  Dozens of studies, spanning over 40 years and multiple continents, have reliably documented that self-reported short and long sleep durations are associated with increased mortality risk [1,2]. A recent meta-analysis [3] reports that the pooled relative risk (RR) of all-cause mortality was RR = 1.10 for short sleep duration and RR = 1.23 for long sleep duration. Specific cardiovascular mortality was reported to be RR = 1.06 for short sleep and RR = 1.38 for long sleep. Epidemiologic studies of habitual short sleep duration have found that sleep ≤6 h is associated with abnormalities in blood pressure, lipoproteins, glucose regulation, metabolic hormones, and obesity [4,5]. Less well-studied has been long sleep duration. However, many studies in the past two decades have found that individuals who report long sleep duration are at risk for a number of negative health outcomes as well [2,6]. Associations with long sleep duration have been reported for depression [7], cardiovascular disease [8], stroke [9], hypertension [10], diabetes [11], obesity [12], metabolic syndrome [13], dyslipidemia [14], and a number of cardiometabolic risk factors [2,6]. The study by Abe and colleagues in this issue represents one of the first to carefully assess atherosclerosis relative to sleep duration. This study, of >2000 residents of a Japanese community consisting of individuals 40–84 years ol examined intimamedial thickness (IMT), a marker of carotid artery arteriosclerosis. Although the sample was rather small for an epidemiologic study, the authors found that mean IMT increased significantly as self-reported sleep duration increased from 6 to 7 to 8 to ≥9 h of sleep. Moreover, those with longer sleep durations were more likely to exhibit IMT ≥ 1.2 mm, which is a clinically accepted marker of atherosclerosis. The relationship of sleep duration with IMT was maintained even after controlling for a wide range of possible confounders, including sociodemographics, substance use, and other cardiometabolic measures. These data are consistent with other epidemiologic evidence linking long sleep with a higher risk of heart disease and stroke. Although other cardiovascular and metabolic markers were measured, including blood pressure, cholesterol, insulin, glucose, and others, the present study did not evaluate whether these also varied by sleep duration. This study is consistent with other epidemiologic studies indicating that risks of long sleep can be greater than risks associated with short sleep. Further, these studies demonstrate that the prevalence of long sleep (8+ h) may be greater than that of short sleep
• Branas, C. C., Gooneratne, N. S., Grandner, M. A., Patel, N. P., & Xie, D. (2010). "Sleep disparity" in the population: poor sleep quality is strongly associated with poverty and ethnicity.. BMC public health, 10(1), 475. doi:10.1186/1471-2458-10-475
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  Little is known about the social determinants of sleep attainment. This study examines the relationship of race/ethnicity, socio-economic status (SES) and other factors upon sleep quality..A cross-sectional survey of 9,714 randomly selected subjects was used to explore sleep quality obtained by self-report, in relation to socioeconomic factors including poverty, employment status, and education level. The primary outcome was poor sleep quality. Data were collected by the Philadelphia Health Management Corporation..Significant differences were observed in the outcome for race/ethnicity (African-American and Latino versus White: unadjusted OR = 1.59, 95% CI 1.24-2.05 and OR = 1.65, 95% CI 1.37-1.98, respectively) and income (below poverty threshold, unadjusted OR = 2.84, 95%CI 2.41-3.35). In multivariable modeling, health indicators significantly influenced sleep quality most prominently in poor individuals. After adjusting for socioeconomic factors (education, employment) and health indicators, the association of income and poor sleep quality diminished, but still persisted in poor Whites while it was no longer significant in poor African-Americans (adjusted OR = 1.95, 95% CI 1.47-2.58 versus OR = 1.16, 95% CI 0.87-1.54, respectively). Post-college education (adjusted OR = 0.47, 95% CI 0.31-0.71) protected against poor sleep..A "sleep disparity" exists in the study population: poor sleep quality is strongly associated with poverty and race. Factors such as employment, education and health status, amongst others, significantly mediated this effect only in poor subjects, suggesting a differential vulnerability to these factors in poor relative to non-poor individuals in the context of sleep quality. Consideration of this could help optimize targeted interventions in certain groups and subsequently reduce the adverse societal effects of poor sleep.
• Gehrman, P. R., Gooneratne, N. S., Grandner, M. A., Patel, N. P., Sha, D., Weaver, T. E., & Xie, D. (2010). Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints.. Sleep medicine, 11(5), 470-8. doi:10.1016/j.sleep.2009.10.006
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  Lower socioeconomic status is associated with short or long sleep duration and sleep disturbance (e.g., sleep apnea), which are all related to increased mortality risk. General sleep complaints, however, which may better approximate symptoms as they are experienced, have not been examined in a large population sample..Sample consisted of n=159,856 participants from the Behavioral Risk Factor Surveillance System, representing 36 states/regions across the US. Sleep complaints were measured with a telephone survey item that assessed "trouble falling asleep," "staying asleep" or "sleeping too much." Data analysis utilized hierarchical logistic regression and Rao-Schott chi(2)..Asian respondents reported the least complaints, and Hispanic/Latino and Black/African-American individuals reported fewer complaints than Whites. Lower income and educational attainment was associated with more sleep complaints. Employment was associated with less sleep complaints and unemployment with more. Married individuals reported the least sleep complaints. Significant interactions with race/ethnicity indicate that the relationship between sleep complaints and marital status, income and employment differs among groups for men, and the relationship with education differs among groups for women..Rates of sleep complaints in African-American, Hispanic/Latino and Asian/Other groups were similar to Whites. Lower socioeconomic status was associated with higher rates of sleep complaint.
• Gehrman, P. R., Grandner, M. A., Pack, A. I., Patel, N. P., & Perlis, M. L. (2010). Problems associated with short sleep: bridging the gap between laboratory and epidemiological studies.. Sleep medicine reviews, 14(4), 239-47. doi:10.1016/j.smrv.2009.08.001
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  Existing data from laboratory studies suggest a number of negative consequences of acute reductions in sleep time. Also, epidemiological data suggest links between shorter self-reported sleep duration and negative health outcomes. These bodies of work are growing, revealing several key points of convergence and opportunities for future exploration. In addition, they begin to highlight possible problems experienced by "short sleepers," who sleep approximately 6h or less per night. While it is likely that this group is heterogeneous, comprised both of individuals with less need for sleep and those not sleeping enough, the laboratory and epidemiological findings point towards directions that can be more fully explored in verified short sleepers. This paper discusses problems associated with the terminology used to describe "short sleep," summarizes laboratory studies exploring neurobehavioral performance, metabolism and obesity, and psychological health and epidemiological studies exploring mortality risk, obesity and metabolism, cardiovascular disease, and general health/psychosocial stress, describes studies of verified short sleepers and explores areas of convergence, laying out possible future directions.
• Grandner, M. A., Hale, L., Moore, M., & Patel, N. P. (2010). Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future.. Sleep medicine reviews, 14(3), 191-203. doi:10.1016/j.smrv.2009.07.006
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  This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social-ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research.
• Grandner, M. A., Kripke, D. F., Langer, R. D., & Naidoo, N. (2010). Relationships among dietary nutrients and subjective sleep, objective sleep, and napping in women.. Sleep medicine, 11(2), 180-4. doi:10.1016/j.sleep.2009.07.014
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  To describe which dietary nutrient variables are related to subjective and objective habitual sleep and subjective and objective napping..Participants were 459 post-menopausal women enrolled in the Women's Health Initiative. Objective sleep was estimated using one week of actigraphy. Subjective sleep was prospectively estimated with a daily sleep diary. Dietary nutrients were calculated from food frequency questionnaires..The most significant correlations were with subjective napping, including (from strongest to weakest): total fat, calories, saturated fat, monounsaturated fat, trans fat, water, proline, serine, tyrosine, phenylalanine, valine, cholesterol, leucine, glutamic acid, ash, isoleucine, histidine, sodium, tryptophan, protein, threonine, cystine, methionine, phosphorous, polyunsaturated fat, animal protein, aspartic acid, arginine, lysine, alanine, caffeine, riboflavin, gamma-tocopherol, glycine, retinol, delta-tocopherol, Vitamin D, and selenium. Actigraphic nocturnal sleep duration was negatively associated with total fat, monounsaturated fat, trans fat, saturated fat, polyunsaturated fat, calories, gamma-tocopherol, cholesterol, and alpha-tocopherol-eq..Actigraphic total sleep time was negatively associated with intake of fats. Subjective napping, which may be a proxy for subjective sleepiness, was significantly related to fat intake as well as intake of meat.
• Grandner, M. A., & Patel, N. P. (2009). From sleep duration to mortality: implications of meta-analysis and future directions.. Journal of sleep research, 18(2), 145-7. doi:10.1111/j.1365-2869.2009.00753.x
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  Although, to a large extent, the functions of sleep remain elusive, the amount of sleep that humans attain represents a health issue that has received growing attention. Over the past 60 years, accruing evidence demonstrates that self-reported short or long sleep duration (usually 8 h) is related to mortality risk. Intense interest in the sleep–mortality relationship has paralleled mounting evidence, laboratory-based and epidemiological, implicating sleep duration in a variety of health outcomes including obesity, cardiovascular disease and metabolic dysregulation. The act of sleeping, therefore, is a critical health behavior.
• Drummond, S. P., & Grandner, M. A. (2007). Who are the long sleepers? Towards an understanding of the mortality relationship.. Sleep medicine reviews, 11(5), 341-60. doi:10.1016/j.smrv.2007.03.010
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  While much is known about the negative health implications of insufficient sleep, relatively little is known about risks associated with excessive sleep. However, epidemiological studies have repeatedly found a mortality risk associated with reported habitual long sleep. This paper will summarize and describe the numerous studies demonstrating increased mortality risk associated with long sleep. Although these studies establish a mortality link, they do not sufficiently explain why such a relationship might occur. Possible mechanisms for this relationship will be proposed and described, including (1) sleep fragmentation, (2) fatigue, (3) immune function, (4) photoperiodic abnormalities, (5) lack of challenge, (6) depression, or (7) underlying disease process such as (a) sleep apnea, (b) heart disease, or (c) failing health. Following this, we will take a step back and carefully consider all of the historical and current literature regarding long sleep, to determine whether the scientific evidence supports these proposed mechanisms and ascertain what future research directions may clarify or test these hypotheses regarding the relationship between long sleep and mortality.
• Grandner, M. A., Kripke, D. F., & Langer, R. D. (2006). Light exposure is related to social and emotional functioning and to quality of life in older women.. Psychiatry research, 143(1), 35-42. doi:10.1016/j.psychres.2005.08.018
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  While there are data supporting the use of light in clinical populations, there has been less investigation of relationships among light and psychological variables in non-clinical samples. Subjects were 459 ethnically diverse women (mean age 67.68) recruited as part of the Women's Health Initiative. Light exposure and sleep were measured with an Actillume wrist actigraph. Subjects completed questionnaires, investigating Social Support, Social Functioning, Social Strain, Quality of Life, Satisfaction with Life, Emotional Well-being, Optimism, Negative Emotional Expressiveness, and Role Limitation Due to Emotional Problems. Significant partial correlations (controlling for age, education and ethnicity) were found between mesor light exposure and Social Functioning, Quality of Life, Satisfaction with Life, and Emotional Well-Being. Quality of Life and Satisfaction with Life were also found to be significantly correlated with morning light. The most parsimonious model to account for the variance shared between mesor light and the predictors included only Quality of Life. The variance shared between mesor light exposure and social and emotional functioning could be subsumed under the variance shared between mesor light exposure and Quality of Life. Increased light exposure is related to improved quality of life and social and emotional functioning.
• Grandner, M. A., Kripke, D. F., Yoon, I. Y., & Youngstedt, S. D. (2006). Criterion validity of the Pittsburgh Sleep Quality Index: Investigation in a non-clinical sample.. Sleep and biological rhythms, 4(2), 129-139. doi:10.1111/j.1479-8425.2006.00207.x
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  The objective of this study was to investigate the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) in a non-clinical sample consisting of younger and older adults. There has been little research validating the PSQI with respect to multinight recording as with actigraphy, and more validation is needed in samples not specifically selected for clinical disturbance. Also, the degree to which the PSQI scores may reflect depressive symptoms versus actual sleep disturbance remains unclear. One-hundred and twelve volunteers (53 younger and 59 older) were screened for their ability to perform treadmill exercises; inclusion was not based on sleep disturbance or depression. Internal homogeneity was evaluated by correlating PSQI component scores with the global score. Global and component scores were correlated with a sleep diary, actigraphy, and centers for epidemiological studies - depression scale scores to investigate criterion validity. Results showed high internal homogeneity. PSQI global score correlated appreciably with sleep diary variables and the depression scale, but not with any actigraphic sleep variables. These results suggest that the PSQI has good internal homogeneity, but may be less reflective of actual sleep parameters than a negative cognitive viewpoint or pessimistic thinking. The sleep complaints measured may often be more indicative of general dissatisfaction than of any specifically sleep-related disturbance.
• Elliott, J. A., Grandner, M. A., Knickerbocker, N. C., Kripke, D. F., & Loving, R. T. (2005). Bright light treatment of depression for older adults [ISRCTN55452501].. BMC psychiatry, 5(1), 41. doi:10.1186/1471-244x-5-41
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  The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery..In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (
• Grandner, M. A., Knickerbocker, N. C., Kripke, D. F., & Loving, R. T. (2005). Bright green light treatment of depression for older adults [ISRCTN69400161].. BMC psychiatry, 5(1), 42. doi:10.1186/1471-244x-5-42
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  Bright white light has been successfully used for the treatment of depression. There is interest in identifying which spectral colors of light are the most efficient in the treatment of depression. It is theorized that green light could decrease the intensity duration of exposure needed. Late Wake Treatment (LWT), sleep deprivation for the last half of one night, is associated with rapid mood improvement which has been sustained by light treatment. Because spectral responsiveness may differ by age, we examined whether green light would provide efficient antidepressant treatment in an elder age group..We contrasted one hour of bright green light (1,200 Lux) and one hour of dim red light placebo (
• Loving, R., Kripke, D., Knickerbocker, N., & Grandner, M. (2005). Bright green light treatment of depression for older adults [ISRCTN69400161]. BMC Psychiatry, 5. doi:10.1186/1471-244X-5-42
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  Background: Bright white light has been successfully used for the treatment of depression. There is interest in identifying which spectral colors of light are the most efficient in the treatment of depression. It is theorized that green light could decrease the intensity duration of exposure needed. Late Wake Treatment (LWT), sleep deprivation for the last half of one night, is associated with rapid mood improvement which has been sustained by light treatment. Because spectral responsiveness may differ by age, we examined whether green light would provide efficient antidepressant treatment in an elder age group. Methods: We contrasted one hour of bright green light (1,200 Lux) and one hour of dim red light placebo (
• Pandey, J., Grandner, M., Crittenden, C., Smith, M. T., & Perlis, M. L. (2005). Meteorologic factors and subjective sleep continuity: A preliminary evaluation. International Journal of Biometeorology, 49(Issue 3). doi:10.1007/s00484-004-0227-1
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  Little research has been undertaken to evaluate whether environmental factors other than bright light influence the individual's ability to initiate and maintain sleep. In the present analyses, nine meteorologic variables were evaluated for their possible relationship to self-reported sleep continuity in a sample of 43 subjects over a period of 105 days. In this preliminary analysis, high barometric pressure, low precipitation, and lower temperatures were significantly correlated with good sleep continuity. Interestingly, ambient light and lunar phase were not found to be strongly associated sleep diary measures. © ISB 2004.
• Grandner, M. A., & Kripke, D. F. (2004). Self-reported sleep complaints with long and short sleep: a nationally representative sample.. Psychosomatic medicine, 66(2), 239-41. doi:10.1097/01.psy.0000107881.53228.4d
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  Although the problems associated with insufficient sleep have been thoroughly researched, there has been far less substantiation of problems associated with long sleep. Recent evidence shows that habitual sleep duration greater than 7 hours is associated with increased rates of mortality. This study compared the rates of sleep problems in both long and short sleepers..Self-reported sleep complaints (eg, sleep onset latency, awakenings during the night, early morning awakenings, nonrestorative sleep, and daytime sleepiness) of nearly 1000 adults who participated in the National Sleep Foundation's 2001 Sleep in America Poll, were compared with reported hours of weekday sleep..There are U-shaped relationships of sleep complaints with reported weekday total sleep time. More specifically, 8-hour sleepers reported less frequent symptoms than long sleepers or 7-hour sleepers..Thus, long sleepers, as well as short sleepers, report sleep problems, focusing attention to the often-overlooked problems of the long sleeper.
• Grandner, M., & Kripke, D. (2004). Self-reported Sleep Complaints with Long and Short Sleep: A Nationally Representative Sample. Psychosomatic Medicine, 66(2). doi:10.1097/01.PSY.0000107881.53228.4D
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  Objective: Although the problems associated with insufficient sleep have been thoroughly researched, there has been far less substantiation of problems associated with long sleep. Recent evidence shows that habitual sleep duration greater than 7 hours is associated with increased rates of mortality. This study compared the rates of sleep problems in both long and short sleepers. Methods: Self-reported sleep complaints (eg, sleep onset latency, awakenings during the night, early morning awakenings, nonrestorative sleep, and daytime sleepiness) of nearly 1000 adults who participated in the National Sleep Foundation's 2001 Sleep in America Poll, were compared with reported hours of weekday sleep. Results: There are U-shaped relationships of sleep complaints with reported weekday total sleep time. More specifically, 8-hour sleepers reported less frequent symptoms than long sleepers or 7-hour sleepers. Conclusions: Thus, long sleepers, as well as short sleepers, report sleep problems, focusing attention to the often-overlooked problems of the long sleeper.

Proceedings Publications

• Tubbs, A. S., Perlis, M. L., Basner, M., Chakravorty, S., Khader, W., Fernandez, F., & Grandner, M. A. (2020). Relationship of nocturnal wakefulness to suicide risk across months and methods of suicide. In Journal of Clinical Psychiatry, 81.
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  Objective: Insomnia is a risk factor for suicide, and the risk of suicide after accounting for population wakefulness is disproportionately highest at night. This study investigated whether this risk varied across months and/or methods of suicide. Methods: Time, date, method (eg, firearm, poisoning), and demographic information for 35,338 suicides were collected from the National Violent Death Reporting System for the years 2003-2010. Time of fatal injury was grouped into 1-hour bins and compared to the estimated hourly proportion of the population awake from the American Time Use Survey for 2003-2010. Negative binomial modeling then generated hourly incidence risk ratios (IRRs) of suicide. Risks were then aggregated into 4 categories: morning (6:00 AM to 11:59 AM), afternoon (noon to 5:59 PM), evening (6:00 PM to 11:59 PM), and night (midnight to 5:59 AM). Results: The risk of suicide was higher at night across all months (P < .001) and methods (P < .001). The mean nocturnal IRR across months was 3.18 (SD = 0.314), with the highest IRR in May (3.90) and the lowest in November (2.74). The mean (SD) nocturnal IRR across methods was 3.09 (0.472), with the highest IRR for fire (3.75) and the lowest for drowning (2.44). Additionally, nocturnal risk was elevated within all demographics (all P < .001). However, there were no month-bytime or method-by-time interactions across demographics (all P > .05). Conclusions: Regardless of month or method, the incidence risk of suicide at night is higher than at any other time of day. Additionally, demographic subgroups did not differentially experience higher risks across months or mechanisms at night.
• Blair, R. I., Carter, R., Criner, G. J., Gangemi, A. J., Grandner, M. A., Grandner, G., Ma, G. X., Patterson, F., Satti, A., Zantah, M., & Ziegler, M. (2019). Association Between Sleep Health and Lung Function in Smokers. In A34. SCREENING, DIAGNOSIS, AND TREATMENT IN SLEEP DISORDERS.
• Blair, R. I., Carter, R., Gangemi, A. J., Grandner, M. A., Kambo, A., Ma, G. X., Patterson, F., Satti, A., Zantah, M., & Ziegler, M. (2019). Association Between Sleep Health and Exercise Capacity in African American Smokers. In D52. SMOKING-ASSOCIATED MODIFIERS OF LUNG DISEASE.
• Davey, A., Gangemi, A. J., Grandner, M. A., Lin, K., Patterson, F., Perkett, M., Satti, A., & Zantah, M. (2019). Adequate Sleep Predicts Lung Function in Smokers. In D52. SMOKING-ASSOCIATED MODIFIERS OF LUNG DISEASE.
• Bailey, O., Sans-Fuente, M., Havens, C., Combs, D., Grandner, M., Poongkunran, C., Patel, S., Berryhill, N., Provencio, N., Quan, S. F., & Parthasarathy, S. (2018, April). Delayed Sleep Time In African Americans And Depression In A Community-Based Population. In SLEEP, 41, A242-A242.
• Bajaj, S., Raikes, A., Vanuk, J., Satterfield, B. C., Alkozei, A., Weber, M., Rosso, I. M., Rauch, S. L., Grandner, M., & Killgore, W. D. (2018, April). Impact Of Blue Light Therapy On Cortical Structure, Sleep, And Anxiety Symptoms Following Mild Traumatic Brain Injury. In SLEEP, 41, A381.
• Bernard, S., Athey, A., Killgore, W. D., Alfonso-Miller, P., & Grandner, M. (2018, April). Adverse Childhood Experiences Among Student Athletes are Associated with Sleep Disturbances: Evaluating the Mediating Roles of Depression and Anxiety. In SLEEP, 41, A357.
• Bliznak, V., Athey, A., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). History of Concussion in Student Athletes: A Risk Factor for Short Sleep Duration and Insomnia. In SLEEP, 41, A382.
• Bremer, E., Morales, K., Vargas, I., Grandner, M., Ellis, J., & Perlis, M. (2018, April). Does Time in Bed Vary with the Use of Hypotics?. In SLEEP, 41, A 157-158.
• Challener, S. A., Yung, A., Ozcan, M., Alkozel, A., Raikes, A. C., Grandner, M., & Killgore, W. (2018, April). Functional Impairment due to Excessive Daytime Sleepiness is Associated with Greater Activation in the Default Mode Network when Anticipating Negative Stimuli in Individuals with PTSD. In SLEEP, 41, A349.
• Ellis, J., Bastien, C. H., Gallagher, R., Alfonso-Miller, P., Hale, L., Perlis, M., & Grandner, M. (2018, April). The Impact of Abuse during Childhood on Adult Sleep and the Moderating Influence of Bedroom Safety. In SLEEP, 41, A144.
• Gencarelli, A. M., Khader, W., Morales, K., Grandner, M., Ellis, J., Kloss, J. D., & Perlis, M. (2018, April). A One Year Study Of 1,069 Good Sleepers: The Incidence Of Acute And Chronic Insomnia. In SLEEP, 41, A137-138.
• Gencarelli, A. M., Vargas, I., Khader, W., Muench, A., Boyle, J. T., Morales, K., Grandner, M., Ellis, J., Kloss, J. D., & Perlis, M. L. (2018, April). Evaluating the Association Between Life Events, Perceived Stress, and Insomnia Status: Data from a National Cohort of Good Sleepers (The NITES Study). In SLEEP, 41, A159.
• Gilles, A., & Grandner, M. (2018, April). Sleep Duration and Cardiometabolic Disease Risk in Native Hawaiians. In SLEEP, 41, A324.
• Grandner, M. (2018, April). Basics of Sleep and Relevance to Athletics. In Department of Athletics, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, April). Introduction to Statistics for Medical Residents Part 1: Descriptive Statistics and Correlation. In Department of Psychiatry, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, April). Sleep Basics: What you need to know to get the most out of your sleep. In Football, Department of Athletics, University of Arizona.
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• Grandner, M. (2018, April). Sleep and Mental Health/ Performance. In Department of Athletics, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, April). Sleep and Mental Health: Links with Memory, Thinking, Emotions, and Stress. In Football, Department of Athletics, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, April). Sleep and Performance: Physical and Mental Performance, and Injury and Pain Management. In Football, Department of Athletics, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, February). Sleep and Cardiometabloic Disease Risk. In PSY 478: Sleep and Sleep Disorders, Department of Psychology, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, February). Sleep as Medicine. In Arizona State University.
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  Invited lecture, symposia
• Grandner, M. (2018, January). Optimize Your Sleep for Health and Well-Being. In The Fountains.
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  Invited lecture, Colloquia
• Grandner, M. (2018, January). Sleep and Health Research. In Neuroscience Graduate Interdisciplinary Program, University of Arizona.
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  Invited lecture, symposia
• Grandner, M. (2018, January). Sleep and Health: Upstream Social/Behavioral Determinants and Downstream Cardiometabolic/Neurocognitive Consequences. In University of Iowa, Department of Health and Human Physiology.
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• Grandner, M. (2018, June). Building and Academic Career in Sleep Health: Shining a Light on Unanswered Questions When the Field is the Dark. In Seminar Series High School/ Undergraduate Program, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, June). Causes and Consequences of Sleep Disparities: Key Areas and Research Directions. In National Institute of Minority Health and Health Disparities.
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• Grandner, M. (2018, June). Contextual Determinants of Sleep Disparities. In National Institute of Minority Health and Health Disparities.
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• Grandner, M. (2018, June). Domestic Violence as a Risk Factor for Insomnia ans Short Sleep Duration, and the Role of Depressed Mood and Anxiety Symptoms. In Associated Professional Sleep Societies.
• Grandner, M. (2018, June). Health Disparities and Sleep. In Sleep Research Society.
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  Invited lecture, symposia
• Grandner, M. (2018, June). Sleep and Health at the US- Mexico Border and Beyond. In Arizona-Mexico Border Commission, Health Services Committee.
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• Grandner, M. (2018, June). Sleep, Health, and Performance: Implications for Athletes. In Drug Free Sport.
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• Grandner, M. (2018, March). Sleep and Developmental Psychopathology. In PSY 583a: Developmental Psychopathology, Department of Psychology Graduate Program, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, March). Sleep, Health, and Nutrition. In ExpoWest Natural Products Expo.
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• Grandner, M. (2018, May). Sleep Strategies: How to Fall Asleep, How to Wake Up, and Other Tips. In Football, Department of Athletics, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2018, May). Sleep and Diverse Populations. In American Thoracic.
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  seminar
• Grandner, M. (2018, May). Sleep, Health and Society: Cardiometabolic / Neurocognitive Outcomes and Social / Behavioral Determinants. In Duke- NUS.
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  Invited lecture, symposia
• Grandner, M., Olivier, K., Killgore, W., Gehrels, J., & Alfonso-Miller, P. (2018, April). Domestic Violence as a Risk Factor for Insomnia and Short Sleep Duration, and the Role of Depressed Mood and Anxiety Symptoms. In SLEEP, 41, A354.
• Grandner, M., Perlis, M., Parthasarathy, S., & Pack, A. (2018, April). Systematic Sleep Time Extension: A Novel Approach to Extending Sleep in Habitual Short Sleepers. In SLEEP, 41, A326-A326.
• Haghighi, H., Athey, A., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Insufficient Sleep Duration and Insomnia Symptoms Independently Predict Suicide Ideation in Student Athletes and Non-Athletes. In SLEEP, 41, A363.
• Havens, C. M., Parthasarathy, S., Grandner, M., Malone, S. K., Patterson, F., & Klimentidis, Y. C. (2018, April). Sleep Traits Accentuate the Association of Genetic Markers with Obesity: Results from the UK Biobank. In SLEEP, 41, A7.
• Ji, X. W., Grandner, M., & Petrov, M. (2018, April). The Role of Age, Sex, Race/ethnicity, Education, and Marital Status in the Relationship of Chronic Health Conditions and Habitual Sleep Duration. In SLEEP, 41, A332.
• Khader, W., Morales, K., Grandner, M., Ellis, J., Zandberg, L., Kloss, J., & Perlis, M. (2018, April). Does Time in Bed Differentiate Between Good Sleepers and Subjects that Develop Acute Insomnia, Recover from Acute Insomnia, and/or Develop Chronic Insomnia?. In SLEEP, 41, A138-A139.
• Killgore, W. D., Alkozei, A., Knight, S., Grandner, M., & Weber, M. (2018, April). Daily Morning Blue Light Exposure Enhances Executive Functioning in Individuals with Mild Traumatic Brain Injury. In SLEEP, 41, A381.
• Knowlden, A., Petrov, M., Nowakowski, S., & Grandner, M. (2018, April). Gender Differences in the Relationship between Short Sleep and Obesity Depend on Age. In SLEEP, 41.
• Liang, O., Seixas, A., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Sleep Duration And Diabetes In The Us For 2007–2015: Moderation By Age, Sex, Race/ethnicity, And Body Mass Index. In SLEEP, 41, A330.
• Liu, S., Athey, A., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Sleep Paralysis and Hypnogogic/Hypnopompic Hallucinations: Prevalence in Student Athletes and Relationship to Depressive Symptoms. In SLEEP, 41, A358.
• Madhavaram, A., Seixas, A., Williams, N., Kalinowskisi, J., Rogers, A., Williams, S., Grandner, M., & Jean-Louis, G. (2018, April). Associations Between Self-Reported Sleep Duration and the new AHA/ACC High Blood Pressure Guidelines: Results from the National Health and Nutrition Examination Survey. In SLEEP, 41, A327.
• Meridew, C., Athey, A., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Academic Performance Associated with Sleep Duration among Student Athletes: Impact of Insomnia, Fatigue, and Depression. In SLEEP, 41, A74-A75.
• Muench, A. L., Boyle, J. T., Morales, K., Vargas, I., Grandner, M., Ellis, J., Kloss, J. D., & Perlis, M. L. (2018, April). Depressive Symptoms in Good Sleepers and Subjects That Develop Acute Insomnia, Recover From Acute Insomnia, and/or Develop Chronic Insomnia. In SLEEP, 41, A354-A355.
• Okuagu, A., Athey, A., Prichard, R., Williams, N., Jean-Louis, G., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Racial/Ethnic Sleep Disparities Among College Students Are Different in Majority-White vs Majority-Minority Institutions. In SLEEP, 41, A393-A394.
• Sanchez, C., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Nighttime snacking: Prevalence and Associations with Poor Sleep, Health Obesity, and Diabetes. In SLEEP, 41, A49-A50.
• Sanchez, C., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Relationships between Dietary Supplement Intake and Sleep Duration, Insomnia and Fatigue. In SLEEP, 41, A72-A73.
• Sandino, M., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Sleep Duration and Perceived Cognitive Decline. In SLEEP, 41, A34.
• Tang, R., Athey, A., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Drowsy Driving In Student Athletes: Impact of Insomnia, Sleepiness, and Mood. In SLEEP, 41, A73.
• Tubbs, A., Perlis, M., Basner, M., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Does Increased Risk of Suicide at Night Favor One Method of Suicide Over Another?. In SLEEP, 41, A363.
• Tubbs, A., Perlis, M., Chakravorty, S., Basner, M., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Seasonal Changes in Nocturnal Suicide Risk. In SLEEP, 41, A366.
• Warlick, C., Jean-Louis, G., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Experiences of Discrimination among College Students and Impact on Sleep Quality, Depression, Anxiety, and Suicide Ideation: Does Sleep Account for Relationships with Depressive Symptoms?. In SLEEP, 41, A353-354.
• Yang, R., Hale, L., Branas, C., Perlis, M., Gallagher, R., Killgore, W., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2018, April). Work Productivity Loss Associated with Sleep Duration, Insomnia Severity, Sleepiness, and Snoring. In SLEEP, 41, A74.
• Alfonso-Miller, A., Athey, A., & Grandner, M. (2017, April). Evaluation of a sleep health intervention in student athletes: Insights for intervention development. In Sleep, 40, 1.
• Alkozei, A., Smith, R., Fridman, A., Dormer, A., Challener, S., & Grandner, M. (2017, April). Daily morning blue light exposure leads to changes in functional brain responses during emotional anticipation in individuals with PTSD. In Sleep, 40, 2.
• Athey, A., & Grandner, M. (2017, April). Studnet athletes" access to healthy sleep information in campus: How does it relate to other types of health information and to sleep difficulties?. In Sleep, 40, 1.
• Forbush, S., Fisseha, E., Gallagher, R., Hale, L., Malone, S., Patterson, F., Branas, C., Barrett, M., Killgore, W. D., Gehrels, J., Alfonso-Miller, P., & Grandner, M. (2017, April). Sociodemographics, poor overall health, cardiovascular disease, depression, fatigue, and daytime sleepiness associated with social jetlag independent of sleep duration and insomnia. In Sleep, 40, 2.
• Gottschlich, M., Hyman, S., Pisner, D., Singh, A., Millan, M., Knight, S., Grandner, M., & Killgore, W. D. (2017, April). Post-concussion severity is associated with sleep problems and neuropsychological status. In Sleep, 40, 1.
• Granados, K., Okuagu, A., Buxton, O., Patel, S., Ruiz, J., Parthasarathy, S., Haynes, P., Alfonso-Miller, P., Molina, P., Seixas, A., Williams, N., Jean-Louis, G., Gehrels, J., & Grandner, M. (2017, April). Acculturation associated with sleep duration, insomnia, and sleep quality at the US-Mexico border. In Sleep, 40, 1.
• Grandner, M. (2017, April). Sleep and Developmental Psychopathology. In Department of Psychology, Graduate Program.
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  invited guest, colloquia
• Grandner, M. (2017, April). Sleep for Peak Performance and Your Heart. In 30th Anniversary Community Lecture Series.
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  Invited lecture, Colloquia
• Grandner, M. (2017, April). Sleep, Cardiometabolic Disease Risk and Social- Environmental Determinants. In Human Biology Association Annual Meeting.
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• Grandner, M. (2017, April). Sleep: A New Dimension in Heart Health and Peak Performance. In Sarver Heart Center, Board of Directors.
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• Grandner, M. (2017, August). Careers in Sleep Medicine. In Department of Population Health, New York University.
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• Grandner, M. (2017, August). Physician Numeracy. In Child and Adolescent Psychiatry, Department of Psychiatry, University of Arizona.
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  Invited lecture, colloquia
• Grandner, M. (2017, August). Sleep and Cardiometabolic Disease Risk: New Insights. In Neuroscience Data Blitz.
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• Grandner, M. (2017, August). Sleep, Health and Functioning. In Science Cafe, Phoenix Public Library.
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• Grandner, M. (2017, August). Social Determinants of Sleep. In Department of Population Health, New York University.
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  Invited lecture, symposia
• Grandner, M. (2017, December). Sleep, Health and Nutrition. In Natrol, Inc.
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  Invited lecture, colloquia
• Grandner, M. (2017, December). Sleep: Athletic Performance and Emerging Technologies. In Major League Baseball Winter Meetings.
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  Invited lecture, Colloquia
• Grandner, M. (2017, February). Sleep and Cardiometabolic Disease Risk. In University of Arizona.
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  Invited lecture, colloquia
• Grandner, M. (2017, February). Sleep and Health in Athletes. In Big Sky Sport Psychology Conference.
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  Invited lecture, symposia
• Grandner, M. (2017, January). Insufficient Sleep and Risk for Cardiometabolic Disease and Neurocognitive Deficits. In Department of Neuroscience, University of Arizona.
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  Invited lecture, symposia
• Grandner, M. (2017, January). Neurocognitive and Cardiometabolic Risk Factors Associated with Insufficient Sleep. In Cognitive Sciences, University of Arizona.
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• Grandner, M. (2017, January). Project REST: Recovery Enhancement ans Sleep Training. In National Collegiate Athletics Association.
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  Invited lecture, conference
• Grandner, M. (2017, January). Sleep and Cardiometabolic Disease Risk in Women. In Sarver Heart Center.
• Grandner, M. (2017, January). Sleep and Health: Upstream Social/Behavioral Determinants and Downstream Cardiometabolic/Neurocognitive Consequences. In University of Iowa, Department of Health and Human Physiology.
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  Invited lecture, symposia
• Grandner, M. (2017, July). Sleep, Health, and Performance: Basic Principles and Applications to Baseball. In Major League Baseball.
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  Invited Lecture, Colloquia
• Grandner, M. (2017, June). How to get a K Award (and how not to get a K award). In Sleep Research Society, Trainee Symposia Series.
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  Invited lecture, colloquia
• Grandner, M. (2017, June). Sleep, Health, and Performance for Football. In Department of Athletics, Texas Tech University.
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  Invited lecture, Colloquia
• Grandner, M. (2017, June). Sleep: Basic Principles and Applications for Athletic Development. In Professional Association of Athletics Development Specialists.
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  Invited lecture, Colloquia
• Grandner, M. (2017, June). Writing and Submitting K Awards. In Sleep Research Society Trainee Symposia Series.
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  Seminar
• Grandner, M. (2017, March). Marijuana Use: Impacts on Sleep, Anxiety and Performance. In Milwaulkee Brewers Spring Training.
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  Invited lecture, colloquia
• Grandner, M. (2017, March). Polysomnography and Sleep Disorders. In Psychiatry Residency Program.
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  Invited lecture, Colloquia
• Grandner, M. (2017, March). Sleep and Health: Epidemiology, Physiologic Implications, and Health Disparities. In Department of Physiology.
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  invited lecture, colloquia
• Grandner, M. (2017, March). Sleep, Health, and Performance for Baseball. In Oakland Athletics Spring Training.
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  invited lecture, colloquia
• Grandner, M. (2017, March). Sleep. In Moderated poster session, Joint Scientific Sessions, American Heart Association.
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  Seminar
• Grandner, M. (2017, May). Insomnia in the Context of Sleep Apnea: When and How Should You Treat?. In American Thoracic Society Sunrise Workshop.
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  Invited lecture, symposia
• Grandner, M. (2017, May). Sleep and Cardiometabolic Disease Risk: A Public Health Issue. In American Thoracic Sociaety.
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  Invited lecture, symposia
• Grandner, M. (2017, May). Sleep and Health: Basic Principles and Applications to Athletics. In National Collegiate Athletics Association.
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  Invited lecture, symposia
• Grandner, M. (2017, May). Sleep: A Public Health Call to Action. In Annual Meeting of the American Thoracic Society.
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  Symposium
• Grandner, M. (2017, May). Sleep: Basic Principles and Applications for Sport Psychologists. In PAC-12 Medical Conference.
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  Invited lecture, symposia
• Grandner, M. (2017, November). Sleep Quantity and Quality. In American Heart Association.
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  Invited lecture, symposia
• Grandner, M. (2017, October). Delivering Insomnia Care: Challenges and Opportunities for Sleep Clinics, Primary Care and Healthcare Networks. In Arizona Sleep Society.
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  Invited lecture, symposia
• Grandner, M. (2017, October). Sleep and Cardiometabolic Disease Risk in the Population. In World Sleep Society.
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  Invited lecture, symposia
• Grandner, M. (2017, October). Sleep and Energy Balance in Humans. In World Sleep Society.
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  Invited lecture, symposia
• Grandner, M. (2017, October). Sleep and Metabolism: A Transnational Perspective. In World Sleep Society.
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  Seminar
• Grandner, M. (2017, October). Social Determinants of Sleep. In Department of Medicine, University of Arizona.
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• Grandner, M. (2017, September). Insomnia Diagnosis, Case Conceptualization and Conceptual Models. In Whole Health Clinic, Department of Psychiatry, University of Arizona.
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  Invited lecture, Colloquia
• Grandner, M. (2017, September). Insomnia: Treatment Approaches. In Whole Health Clinic, Department of Psychiatry, University of Arizona.
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  Invited lecture, seminar
• Grandner, M. (2017, September). Patient-Centered Outcomes Research in Insomnia: Ideas and Assessment. In Sleep Research Network.
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  Invited lecture, symposia
• Grandner, M. (2017, September). Sleep Health and Cardiovascular Risk in Young Adults. In National Heart, Lung, and Blood Institute.
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• Grandner, M. (2017, September). Sleep and Health: Spirit of the Senses. In Salon Series.
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  Invited lecture, Colloquia
• Grandner, M., Gallagher, R., Keenan, B., Hale, L., Alfonso-Miller, P., Branas, C., & Barrett, M. (2017, April). Sleep and Healthy activity, diet, environment, and socialization: The SHADES Study. In Sleep, 40, 1.
• Grandner, M., Ruiz, J., Patel, S., Buxton, O., Ingram, M., Haynes, P. L., & Parthasarathy, S. (2017, April). Acculturation Associated with Sleep Duration, Insomnia, and Sleep Quality at the US-Mexico Border. In Sleep, 40, 1.
• Grandner, M., Ruiz, J., Patel, S., Buxton, O., Ingram, M., Haynes, P. L., & Parthasarathy, S. (2017, June). Acculturation Associated with Sleep Duration, Insomnia, and Sleep Quality at the US-Mexico Border. In Sleep, 40, A310.
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  Submitted version authors: Granados, K., Okuagu, A., Buxton, O., Patel, S., Ruiz, J., Parthasarathy, S., Haynes, P., Alfonso-Miller, P.., Molina, P., Seixas, A., Williams, N., Jean-Louis, G., Gehrels, J., Grandner, M. A.
• Hall, C., Poling, K., Athey, A., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Sleep difficulties associated with academic performance in student athletes. In Sleep, 40, 1.
• Havens, C. M., Grandner, M., Youngstedt, S. D., Pandy, A., & Parthasarathy, S. (2017, April). International variability in the prevalence of insomnia and use of sleep-promoting medications, supplements, and other substances. In Sleep, 40, 2.
• Jaszewski, A., Athey, A., Killgore, W. D., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Sleep Duration and Quality Associated with Mental Well-Being in Student Athletes. In SLEEP, 40, 1.
• Ocano, D., Watson, N., Kay, M., Kientz, J., & Grandner, M. (2017, April). Validation of a touchscreen psychomotor vigilance task for Android devices. In Sleep, 40, 1.
• Okuagu, A., Granados, K., Alfonso-Miller, P., Buxton, O., Patel, S., Ruiz, J., Parthasarathy, S., Haynes, P. L., Molina, P., Seixas, A., Williams, N., Girardin, J. L., Gehrels, J., & Grandner, M. (2017, June). Born in the USA or Born in Mexico? Implications for Sleep Duration, Sleep Quality, Sleep Disorders Symptoms at the US-Mexico Border. In Sleep, 40, A309.
• Olivier, K., Gallagher, R., Hale, L., Barrett, M., Branas, C., Killgore, W. D., Parthasarathy, S., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Development and initial validation of a brief measure of control over sleep. In Sleep, 40, 1.
• Petrov, M. E., Long, L., Grandner, M., MacDonald, L., Cribbet, M. R., Robbins, R., Cundiff, J., Molano, J. R., Hoffmann, N., Howard, G., & Howard, V. J. (2017, April). Sleep duration by sociodemographic, socioeconomic, and geographical status. In Sleep, 40, 1.
• Poling, K., Gallagher, R., Hale, L., Branas, C., Seixas, A., Jean-Louis, G., Killgore, W., Alfonso-Miller, P., Parthasarthy, S., Gehrels, J., & Grandner, M. (2017, April). Sleep partially mediates the association between food insecurity and obesity: Roles of short sleep duration, insomnia, and socioeconomic factors. In Sleep, 40, 1.
• Richards, S., Seixas, A., Chung, D., Nunes, J., Grandner, M., Zizi, F., Tan, N., & Jean-Louis, G. (2017, April). Sleep impacts quality of life and neurocognitive characteristics of black and Hispanic stroke survivors. In Sleep, 40, 1.
• Robbins, R., Jean-Louis, G., Sundarajan, A., Hale, L., Gallagher, R. A., Barrett, M., Gooneratne, N., Branas, C., Alfonso-Miller, P., Perlis, M., & Grandner, M. (2017, April). Social capital and social connectness related to sleep duration, insomnia symptoms, and daytime sleepiness. In Sleep, 40, 1.
• Seixas, A., Li, Y., Pagan, J., Mcfarlane, S., Grandner, M., Youngstedt, S., Zizi, F., & Jean-Louis, G. (2017, April). The role of sleep and physical activity in reducing the prevalence of diabetes in the United States: An Agent-based simulation model approach. In Sleep, 40, 2.
• Till, K., Athey, A., Chakravorty, S., Killgore, W. D., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Insomnia and daytime tiredness in student athletes associated with risky behaviors and porr deicision making when under the influence of alcohol. In Sleep, 40, 2.
• Vanuk, J. R., Shane, B. R., Bajaj, S., Millan, M., Grandner, M., & Killgore, W. D. (2017, April). Short-wavelength light therapy as a way of improving sleep, cognition, and functional connectivity following a mild traumatic brain injury. In Sleep, 40, 1.
• Warlick, C., Hall, C., Athey, A., Chakravorty, S., Killgore, W. D., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Difficulty sleeping associated with substance use among student athletes. In Sleep, 40, 1.
• Yang, R., Gallagher, R., Hale, L., Perlis, M., Barrett, M., Branas, C., Killgore, W. D., Parthasarathy, S., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2017, April). Would you call yourself a short or long sleeper? Perceptions of sleep category associated with reported sleep duration, insomnia, and health. In Sleep, 40, 1.
• Alkozei, A., Grandner, M., & Killgore, W. (2016, June). Exposure to blue wavelength light is associated with increased dorsolateral prefrontal cortex responses, and increases in response times during a working memory task.. In SLEEP.
• Alkozei, A., Grandner, M., & Killgore, W. (2016, June). Exposure to blue wavelength light reduces activation within the anterior cingulate cortex during anticipation of certain reward stimuli.. In SLEEP.
• Bajaj, S., Alkozei, A., Grandner, M., & Killgore, W. D. (2016, April). Effect of bright light therapy on brain and behavioral abnormalities following a mild traumatic brain injury. In Sleep, 40, 1.
• Brownlow, J., Grandner, M., Gehrman, P. R., Ross, R. J., & Mellman, T. A. (2016, June). Rapid eye movement sleep mediates the relationship between sleep duration and verbal learning.. In Sleep.
• Chakravorty, S., Grandner, M., Kranzler, H., Brown, N., & Perlis, M. L. (2016, June). The Circadian Pattern of Suicides in Intoxicated Individuals with Alcohol Dependence.. In SLEEP.
• Corbitt, C., Ellis, J. A., Morales, K., Nesom, G., Khader, W., Grandner, M., & Perlis, M. L. (2016, June). The Natural History of Insomnia: The Incidence of Acute Insomnia and Subsequent Progression to Chronic Insomnia or Recovery. In SLEEP.
• Davis, B., Yang, R., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Nightmares in a community sample: Prevalence and associations with daytime function independent of poor sleep quality and depression. In SLEEP.
• Fisseha, E., Gallagher, R., Hale, L., Branas, C., Barrett, M., Killgore, W. D., Alfonso-Miller, P., Jean-Louis, G., Seixas, A., Williams, N., Gehrels, J., & Grandner, M. (2016, April). Habitual weekday sleep duration associated with multiple dimensions of socioeconomic status. In Sleep, 40, 1.
• Fisseha, E., Havens, C., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Sleep duration’s important role in the relationship among difficulty concentrating, fatigue, stress, and depressed mood: Data from the SHADES study. In SLEEP.
• Forbush, S., Hui, S. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Longitudinal co-occurrence of headaches and trouble sleeping: Data from the Kansas state employee wellness program. In SLEEP.
• Garland, S. N., Fowler, K., Zhou, E., & Grandner, M. (2016, June). A decade of sleep in Canada. In SLEEP.
• Graham, P. M., Goldstein, M., David, B. M., Perlis, M. L., Perfect, M. M., Frye, S., Killgore, W., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Longitudinal analysis of sleep duration using actigraphy and sleep diary: Stability and agreement over 8-11 months. In SLEEP.
• Granados, K., Rojo-Wissar, D. M., Chakravorty, S., Prather, A., Perfect, M. M., Frye, S., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Adverse childhood exposures associated with adult insomnia symptoms. In SLEEP.
• Grandner, M., & Killgore, W. (2016, June). Positive and negative mood ratings across 24 hours. In SLEEP.
• Grandner, M., & Winkelman, J. W. (2016, June). Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical comorbidity, and cardiometabolic risk factors.. In SLEEP.
• Haynes, P. L., Medici, K., Grandner, M., & Burgess, J. L. (2016, June). Ambient Light Exposure is Positively Associated with Calmness in Mental Health Care Providers. In Sleep, 39, A53.
• Haynes, P. L., Medici, K., Grandner, M., & Burgess, J. L. (2016, June). Ambient light exposure is positively associated with calmness in mental health care providers. In SLEEP.
• Jackson, N., Patterson, F., Seixas, A., Jean-Louis, G., Killgore, W., & Grandner, M. (2016, June). Using big data to determine social, behavioral, and environmental determinants of sleep duration in the US population: Application of a machine-learning approach to data from approximately 700,000 Americans. In SLEEP.
• Jaszewski, A., Meridew, C., Perlis, M. L., Kelly, M., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Sleep duration and insomnia associated with specific symptoms of depression. In SLEEP.
• Killgore, W., Tkachenko, O., Grandner, M., & Rauch, S. L. (2016, June). Default mode activation predicts vulnerability to sleep deprivation in the domains of mood, sleepiness, and vigilance. In SLEEP.
• Killgore, W., Weber, M., Grandner, M., & Penetar, D. M. (2016, June). Blue wavelength light therapy improves balance following mild traumatic brain injury. In SLEEP.
• Klingman, K., Grandner, M., Parthasarathy, S., Jungquist, C. R., & Perlis, M. L. (2016, June). Determinants of sleep health discussions between patients and providers. In SLEEP.
• Kotzin, M. D., Alkozei, A., Grandner, M., & Killgore, W. (2016, June). The effects of trait gratitude on quality of sleep, intrusiveness of pre-sleep cognitions, and daytime energy in healthy individuals. In SLEEP.
• Markowski, S. M., Alkozei, A., McIntosh, M. B., Grandner, M., & Killgore, W. (2016, June). Chronotype and risk-taking propensity. In SLEEP.
• McIntosh, M. B., Markowski, S. M., Grandner, M., & Killgore, W. (2016, June). Short-term sleep duration is negatively associated with impulsivity in women. In SLEEP.
• Meridew, C. M., Jaszewski, A., Newman-Smith, K., Killgore, W., Gallagher, R., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Sleep practices, beliefs, and attitudes associated with overall health. In SLEEP.
• Nowakowski, S., Kloss, J. D., Perlis, M. L., Borahay, M., Meers, J. M., Culnan, E. J., & Grandner, M. (2016, June). Insomnia associated with age at hysterectomy and partially mediates relationship with depression. In SLEEP.
• Nowakowski, S., Kloss, J. D., Perlis, M. L., Culnan, E. J., Meers, J. M., & Grandner, M. (2016, June). Insomnia associated with increased risk for pregnancies that do not result in live births in reproductive age women. In SLEEP.
• Ocano, D., Jean-Louis, G., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Sleep duration and decreased social support from family, friends, and significant other: Influence of insomnia and perceived stress level. In SLEEP.
• Okuagu, A., Perlis, M. L., Ellis, J. A., Prather, A. A., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Does thinking keep people awake? Or does it matter what they are thinking about? Self-directed cognitions associated with insomnia and insufficient sleep. In SLEEP.
• Olivier, K., Gallagher, R. A., Killgore, W., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Development and initial validation of the assessment of sleep environment: A novel inventory for describing and quantifying the impact of environmental factors on sleep. In SLEEP.
• Paine, K. N., Forbush, S., Ellis, J. A., Nowakowski, S., Newman-Smith, K., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Sleep duration and satisfaction with life, health, finances, and relationship. In SLEEP.
• Perlis, M. L., Ellis, J. A., Morales, K., Grandner, M., Corbitt, C., Nesom, G., & Khader, W. (2016, June). The Natural History of Insomnia: Does The 3rd P of The 3p Model Differentiate Between Recovery and the Transition from Acute Insomnia to Chronic Insomnia?. In SLEEP.
• Rhee, J. U., Haynes, P. L., Chakravorty, S., Patterson, F., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Susceptibility to smoking during the day and its relationship with insomnia and sleep duration. In SLEEP.
• Roberts, S. E., Singh, P., Grandner, M., & Killgore, W. (2016, June). Later wake up time and impulsivity. In SLEEP.
• Roopchand-Martin, S., Seixas, A., Jean-Louis, G., Zizi, F., Carrazco, N., Alfonso-Miller, P., & Grandner, M. (2016, June). Sex differences in sleep-related practices, beliefs, and attitudes of university students in Jamaica. In SLEEP.
• Roopchand-Martin, S., Seixas, A., Jean-Louis, G., Zizi, F., Carrazco, N., Alfonso-Miller, P., & Grandner, M. (2016, June). Sleep-related oractices, beliefs, and attitudes associated with sleep duration among university students in Jamaica. In SLEEP.
• Saccone, J., Davis, B., Chakravorty, S., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Habitual caffeine use and motivation to consume caffeine: Associations with sleep duration, sleepiness, fatigue, and insomnia severity. In SLEEP.
• Seixas, A., Hencelwood, D., Newsome, V., Robbins, R., Grandner, M., Butler, M., Zizi, F., & Jean-Louis, G. (2016, June). The impact of sleep and body mass index on stroke disparities between blacks and whites: A comparative analysis of structural equation modeling and Bayesian belief network machine learning analysis. In SLEEP.
• Singh, A., Fridman, A., Silveri, M. M., Grandner, M., & Killgore, W. (2016, June). Medial prefrontal GABA predicts hunger ratings during sleep deprivation for men but not women. In SLEEP.
• Sturgis, E., Perlis, M. L., Arnedt, J. T., Kranzler, H., Grandner, M., & Chakravorty, S. (2016, June). The effects of an 8‐week CBT‐I treatment on psychiatric symptoms, alcohol craving, and relapse to drinking in patients with co‐occurring insomnia and alcohol dependence. In SLEEP.
• Unbin Rhee, J., Haynes, P. L., Chakravorty, S., Patterson, F., Killgore, W. D., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Susceptibility to smoking during the day and its relationship with insomnia and sleep duration. In Sleep, 39, A189.
• Vanuk, J. R., Alkozei, A., Grandner, M., & Killgore, W. (2016, June). The effects of light exposure on heart rate variability predict sleepiness and vigilance. In SLEEP.
• Vanuk, J. R., Alkozei, A., Smith, R., Grandner, M., & Killgore, W. (2016, June). Changes in heart rate variability due to light exposure predict frontoparietal connectivity. In SLEEP.
• Warlick, C., Chakravorty, S., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Timing of alcohol intake associated with insomnia symptoms. In SLEEP.
• Waugaman, D. L., Markowski, S. M., Alkozei, A., Grandner, M., & Killgore, W. (2016, June). Chronotype and emotional intelligence. In SLEEP.
• Weber, M., Grandner, M., & Killgore, W. (2016, June). Blue wavelength light therapy reduces daytime sleepiness following mild traumatic brain injury. In SLEEP.
• Weber, M., Grandner, M., & Killgore, W. (2016, June). Grey matter correlates of daytime sleepiness.. In SLEEP.
• Yang, R., Ocano, D., Chakravorty, S., Killgore, W., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2016, June). Relationship between insomnia and depression moderated by caffeine.. In SLEEP.
• Grandner, M. (2017, June). Sleep Duration and Hypertension: Analysis of >700,000 Adults by Age and Sex. In Associated Professional Sleep Societies.
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  Invited lecture, symposia
• Grandner, M. (2018, April). Introduction to Statistics for Medical Residents Part 2: Hypothesis Testing and Group Differences. In Department of Psychiatry, University of Arizona.
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  invited lecture, seminar
• Unbin Rhee, J., Haynes, P. L., Chakravorty, S., Patterson, F., Killgore, W. D., Gallagher, R. A., Carrazco, N., Alfonso-Miller, P., Gehrels, J., & Grandner, M. (2015, Winter). Susceptibility to smoking during the day and its relationship with insomnia and sleep duration. In Sleep.
• Watson, N., Badr, M., Belenky, G., Bliwise, D., Buxton, O., Buysse, D., Dinges, D., Gangwisch, J., Grandner, M., Kushida, C., Malhotra, R., Martin, J., Patel, S., Quan, S., Tasali, E., Twery, M., Croft, J., Maher, E., Barrett, J., , Thomas, S., et al. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. In Journal of Clinical Sleep Medicine, 11.
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  Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.
• Watson, N., Badr, M., Belenky, G., Bliwise, D., Buxton, O., Buysse, D., Dinges, D., Gangwisch, J., Grandner, M., Kushida, C., Malhotra, R., Martin, J., Patel, S., Quan, S., Tasali, E., Twery, M., Croft, J., Maher, E., Barrett, J., , Thomas, S., et al. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. In SLEEP, 38.
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  Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine.

Poster Presentations

• Bedrossian, R. A., Fisher, J. M., Weltzer, R., Briggs, R., Ressel, A. C., Khachatryan, M., Matthews, J. C., Thai, B. Q., Tung, J., Grandner, M., Patterson, F., & Connick, E. (2022, February). Poor Sleep is Linked to CVD Risk in PLWH in a Southwestern US Clinic. Conference on Retroviruses and Opportunistic Infections 2022. Virtual.
• Grandner, M., Hsu, C., Morrison, H. W., Taylor-Piliae, R. E., Grandner, M., Hsu, C., Morrison, H. W., & Taylor-Piliae, R. E. (2021, Summer). Changes in Symptoms, Sleep, Oxidative Stress, and Inflammatory Markers Among Community-Dwelling Stroke Survivors After a Tai Chi Exercise Intervention.. European Society of Cardiology, EuroHeartCare 2021 Congress. online presentation due to COVID-19.
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  (Abstract selected for Press Release). Taylor-Piliae, R.E., Morrison, H., Hsu, C.H., Grandner, M. (2021). Changes in Symptoms, Sleep, Oxidative Stress, and Inflammatory Markers Among Community-Dwelling Stroke Survivors After a Tai Chi Exercise Intervention. European Journal of Cardiovascular Nursing, Volume 20, Issue Supplement_1, July 2021, zvab060.075, https://doi.org/10.1093/eurjcn/zvab060.075
• Grandner, M., Alfonso-Miller, P., Warlick, C., Killgore, W., Taylor-Piliae, R. E., & Jajoo, A. (2019, Spring). Types of Habitual Physical Activity Associated with Habitual Sleep Duration, Sleep Quality, and Daytime Sleepiness.. Sleep 2019: 33rd Annual Meeting of the Associated Professional Sleep Societies.. San Antonio, TX..
• Taylor-Piliae, R. E., Grandner, M., Bell, M. L., & Marupuru, S. (2019, Spring). The effect of physical activity on sleep quality among older stroke survivors: Secondary analysis from a randomized controlled trial.. International Society for Pharmacoeconomics and Outcomes Research. New Orleans, LA.

Reviews

• Grandner, M. A., Seixas, A., Shetty, S., & Shenoy, S. (2016. Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms(p. 106).
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  Sleep is important for regulating many physiologic functions that relate to metabolism. Because of this, there is substantial evidence to suggest that sleep habits and sleep disorders are related to diabetes risk. In specific, insufficient sleep duration and/or sleep restriction in the laboratory, poor sleep quality, and sleep disorders such as insomnia and sleep apnea have all been associated with diabetes risk. This research spans epidemiologic and laboratory studies. Both physiologic mechanisms such as insulin resistance, decreased leptin, and increased ghrelin and inflammation and behavioral mechanisms such as increased food intake, impaired decision-making, and increased likelihood of other behavioral risk factors such as smoking, sedentary behavior, and alcohol use predispose to both diabetes and obesity, which itself is an important diabetes risk factor. This review describes the evidence linking sleep and diabetes risk at the population and laboratory levels.
• Grandner, M. A., Williams, N. J., Knutson, K. L., Roberts, D., & Jean-Louis, G. (2015. Sleep disparity, race/ethnicity, and socioeconomic position.
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  Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue.
• Perlis, M. L., Grandner, M. A., Chakravorty, S., Bernert, R. A., Brown, G. K., & Thase, M. E. (2015. Suicide and sleep: Is it a bad thing to be awake when reason sleeps?(pp 101-107).
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  Suicide is the second leading cause of death, worldwide, for those between the ages of 24 and 44 y old. In 2013, more than 41,000 suicides occurred in the United States. These statistics underscore the need to 1) understand why people die by suicide and 2) identify risk factors that are potentially modifiable. While it has been posited that sleep disturbance may represent one such factor, systematic research in this arena did not begin until the 2000s. Since that time, sleep disturbance has been reliably identified as a risk factor for suicidal ideation, suicide attempts, and suicide. While insomnia, nightmares, and other sleep disorders have each been found to contribute to the risk for suicidal ideation and behavior, it is also possible that these factors share some common variance. One possibility is that sleep disturbance results in being awake at night, and being awake at night also confers risk. The hypothesis proffered here is that being awake when one is not biologically prepared to be so results in "hypofrontality" and diminished executive function, and that this represents a common pathway to suicidal ideation and behavior. Such a proposition is highly testable under a variety of possible protocols. The current review summarizes the extant literature on suicide rates by time-of-day, and discusses circadian, psychosocial, and neurocognitive explanations of risk. Such a focus promises to enhance our understanding of how sleep disturbance may confer risk, allows for the identification of future lines of research, and further justifies the need for interventions that promote good sleep continuity among at-risk individuals.

Creative Productions

• Grandner, M., Sharkey, K., & Baron, K. (2020. Pandemic sleep advice straight from experts. Elemental.

Others

• Grandner, M. (2018, June). Sleep to your Heart's Content. Sarver Heart Center Newsletter.
• Grandner, M. (2015, January). Sleep and Health Research Program. http://www.sleephealthresearch.com
• Grandner, M., & Hui, S. (2015, Spring). Poor sleep quality associated with lower work performance and greater healthcare costs: Longitudinal data from Kansas state employee wellness programs. SLEEP.
• Grandner, M., & Hui, S. (2015, Spring). The role of poor sleep quality in motivating and maintaining healthy behavior: Data from the Kansas state employee wellness program. SLEEP.
• Grandner, M., Chakravorty, S., Chaudhary, N. S., Khawaja, I. S., & Oslin, D. W. (2015, Spring). The association of a family history of alcoholism with sleep disturbance and alcohol consumption in alcoholic subjects. SLEEP.
• Grandner, M., Chheda, J., Barilla, H., & Gallagher, R. (2015, Spring). Physical activity and habitual sleep duration: Does the specific type of activity matter?. SLEEP.
• Grandner, M., Corbitt, C., Gehrman, P., Perlis, M., & Nesom, G. (2015, Spring). What factors predict sleep continuity complaints?. SLEEP.
• Grandner, M., Gallagher, R., Chakravorty, S., Gurubhagavatula, I., Barrett, M., Schuschu, J., Khader, W., Perlis, M., & Findley, J. (2015, Spring). Short sleep duration, insomnia, and snoring associated with drowsy driving.. SLEEP.
• Grandner, M., Gallagher, R., Chakravorty, S., Hale, L., Barrett, M., Schuschu, J., Khader, W., & Perlis, M. (2015, Spring). Comparing different methods of assessing habitual sleep duration for epidemiologic research. SLEEP.
• Grandner, M., Gallagher, R., Perlis, M., Chakravorty, S., Hale, L., Barrett, M., Schuschu, J., & Khader, W. (2015, Spring). Use of mobile electronic devices in bed associated with sleep duration, insomnia, and daytime sleepiness. SLEEP.
• Grandner, M., Khader, W., Brownlow, J., Chakravorty, S., Gehrman, P., & Rana, S. (2015, Spring). Daytime cognitive function associated with habitual sleep duration. SLEEP.
• Grandner, M., Nesom, G., Corbitt, C., Andalia, P., Findley, J., Perlis, M., & Gehrman, P. (2015, Spring). Case series review of CBT-I outcomes: The relevance of medication use and morbidity. SLEEP.
• Grandner, M., Perlis, M., Petrov, M., & Jean-Louis, G. (2015, Spring). Relationships among habitual sleep duration, race/ethnicity, and cardiometabolic disease outcomes: Data from > 450,000 us adults from the 2013 Behavioral Risk Factor Surveillance System. SLEEP.
• Grandner, M., Rana, S., & Chakravorty, S. (2015, Spring). Binge drinking and habitual sleep duration, and the roles of depression and smoking: Data from the 2013 Behavioral Risk Factor Surveillance System. SLEEP.
• Grandner, M., Schuschu, J., & Pigeon, W. (2015, Spring). The relationship between sleep duration and obesity depends on state of residence: Data from 50 states and the District of Columbia. SLEEP.
• Grandner, M., Schuschu, J., Pigeon, W., & Jean-Louis, G. (2015, Spring). Where are the sleep duration disparities? The relationship between sleep duration and race/ethnicity depends on state of residence: Data from 50 states and the District of Columbia. SLEEP.
• Grandner, M., Wang, J., Perlis, M., Chakravorty, S., Gallagher, R., Hale, l., Barrett, M., Schuschu, J., Khader, W., & Rana, S. (2015, Spring). Anxiety symptoms predict short sleep duration, but only in individuals who are not “natural” short sleepers. SLEEP.
• Grandner, M., Williams, N. J., Youngstedt, S., Sarpong, D., Zizi, F., Ogedegbe, G., & Jean-Louis, G. (2015, Spring). Unequal burden of sleep-related obesity among black and white Americans.. SLEEP.