Al-Saleh, Stacy

Abstract Introduction Individuals with ostomies commonly report poor sleep quality years after ostomy surgery; however, little is known about the trajectory of insomnia and objective sleep characteristics in the early postoperative period. The purpose of this study was to describe the trajectory of insomnia and sleep characteristics in the first 3 months following ileostomy surgery. Methods We conducted a prospective, observational feasibility study of adults (18-65 years) undergoing ileostomy surgery. Sleep characteristics were obtained via Garmin smartwatches (vívosmart® 5) worn from 2 weeks to 3 months postoperatively. The Insomnia Severity Index (ISI) was used to elicit insomnia severity perioperatively and at postoperative months 1, 2, and 3. Descriptive and univariate statistics were used. Results We enrolled 22 participants [Mean age 41.55 years (SD 10.77), 10 female (45.5%), 19 White (86.4%), 9 colorectal cancer (40.9%), and 8 inflammatory bowel disease (36.3%)]. There was little change in insomnia severity from the perioperative period (mean = 9.95, SD 5.57) to 3 months after surgery (∆ = 0.76). At the time of ostomy surgery, most participants (n = 13, 59.1%) had insomnia (ISI≥8). Fifteen participants completed the postoperative surveys. Of those, 2 participants (13.3%) experienced resolution of insomnia symptoms, 3 participants (20%) continued to report no insomnia symptoms, 5 participants (33.3%) developed new insomnia symptoms, and 5 (33.3%) experienced persistent insomnia symptoms. There was little change in sleep duration (m = 462.10 min, SD = 79.07, ∆ = -24.1), deep sleep (m = 81.21 min, SD = 16.97, ∆ = -8.01), light sleep (m = 297.93 min, SD = 44.26, ∆ = -3.93), REM sleep (m = 82.82 min, SD = 44.50, ∆ = -12.02), wake after sleep onset (m = 51.87 min, SD = 29.93, ∆ = -3.05), or sleep score out of 100 (m = 59.15, SD = 11.83, ∆ = -1.74) from month 1 to month 3 after surgery. Conclusion Individuals undergoing ileostomy surgery experience symptoms of insomnia which often persist throughout the early postoperative period. Future research should explore the impact of insomnia on ostomy outcomes and should test interventions to treat insomnia in the early postoperative period. Support (if any) LabfrontXGarmin

Individuals with inflammatory bowel disease (IBD) experience overlooked deficits in objectively measured cognitive functioning; however, there is limited knowledge about self-reported cognitive symptoms in this group. Sleep characteristics, such as insomnia, poor sleep quality, or fragmented sleep, may be key modifiable factors that are associated with cognitive symptoms among individuals with IBD. This study aimed to describe cognitive symptoms and examine the relationship between these symptoms and sleep characteristics among adults with IBD. We conducted a descriptive, cross-sectional study using the Pittsburgh Sleep Quality Index, wrist actigraphy, the Insomnia Severity Index, and the FACT-Cog Perceived Cognitive Impairments subscale. Bivariate statistics were used to evaluate relationships between variables. The sample included 83 participants (mean age 40.44 years [standard deviation 10.7], 71% female). Over 77% ( n = 60) had poor self-reported sleep quality, and 69.5% ( n = 57) had clinically meaningful insomnia. The most frequently reported cognitive symptoms (experienced two or more times a week) were trouble concentrating (51.3%), forgetting names (43.8%), forgetting intended tasks (38.9%), and slow thinking (37.6%). Insomnia severity was moderately correlated with three out of the four most common cognitive symptoms (trouble concentrating: r s = .51, p < .01; forgetting intended tasks: r s = .38, p < .01; slow thinking: r s = .46, p < .01). Future research is needed to examine relationships between objective cognitive measures and sleep characteristics and to test the effects of insomnia treatment on daytime cognitive symptoms in this complex patient population.

Abstract Introduction Solid organ transplant recipients experience high rates of cognitive impairment; however, little is known about what modifiable factors contribute to cognitive impairment after transplantation, limiting evidence-based treatment options. Insomnia is a sleep disorder that is associated with poor cognitive functioning in healthy adults and is amenable to interventions, but the relationship between insomnia and cognitive impairment after organ transplantation has not been explored. The purpose of this study was to identify relationships between insomnia, sleep characteristics, and perceived cognitive function after organ transplantation. Methods We conducted a descriptive, cross-sectional study of adult (&gt;18 years) transplant recipients. We used the Insomnia Severity Index to measure insomnia, 10 days of continuous wrist actigraphy (Ambulatory Monitoring Inc. MicroMotionlogger) to measure sleep characteristics, and the PROMIS Cognitive Function to elicit perceived cognitive function. Descriptive statistics, Spearman’s Rho correlations, and Pearson’s correlations were used to describe relationships. Results We enrolled 34 participants [Mean age 62.5 years (SD 10.7), 64.7% (n=22) female, 85.3% (n=29) white, 17 liver/9 heart/8 kidney, average time since transplant 4.8 years (SD 4.2)]. 73.3% had clinically significant insomnia [mean ISI: 12.9 (SD 6.9)]. Sleep characteristics were obtained using actigraphy (mean duration: 7.03 hours [SD 1.28], onset latency: 9.16 min [SD 4.90], efficiency: 89.49% [SD 8.96], wake after sleep onset: 49.61 [SD 37.37]). Perceived cognitive function for the sample was worse than that of the general population, with a mean T-score of 45.21 (SD 11.44). Lower perceived cognitive function scores were significantly associated with younger age (rs = -.416, p=.016) and shorter time since transplant (rs =-.386, p=.024). Longer wake after sleep onset (rs =.347, p=.048) and lower sleep efficiency (rs=-.358, p=.041) were associated with lower perceived cognitive function. Lower perceived cognitive function was strongly associated with higher insomnia severity scores (r=.817, p=&lt;.001). Conclusion Insomnia was common in our sample of transplant recipients and was strongly correlated with worse perceived cognitive function. Future research should incorporate objective measures of cognitive functioning and should consider insomnia treatment as a potential intervention to promote optimal cognitive functioning after organ transplantation. Support (if any) Mayo Clinic Center for Clinical and Translational Science.

Abstract Introduction The majority of adults with inflammatory bowel disease (IBD) experience disability which is not fully explained by disease activity. Up to 80% of adults with IBD experience poor sleep health, which is associated with disability in other populations; however, the relationship between disability and sleep health among patients with IBD is largely unexamined. The purpose of this study was to compare the sleep health characteristics of those with and without IBD-related disability. Methods We recruited adults (18 to 59 years old) with IBD from a single academic medical center from 2022 to 2024. We measured disease activity using the Manitoba IBD Index and sleep using the PROMIS Sleep Disturbance and PROMIS Sleep-Related Impairment scales, the Insomnia Severity Index, and 14 days of wrist-worn actigraphy (Phillips Spectrum Plus, Phillips Respironics). We asked participants how many days they missed or had at least 50% reduced productivity in paid work or household work or missed leisure activities in the last 3 months related to their IBD. Disability was defined as missing six or more day over three months. We conducted bivariate analyses and logistic regressions to study associations. Results Among 83 adults with IBD [mean age = 40.4 years (SD 10.7), 59 (71.1%) were female, 56 (71.1%) had Crohn’s disease], and 49 (62.0%) had IBD-related disability. Patients with disability had more severe sleep disturbance (56.4 vs. 51.0, p &lt;.001), sleep-related impairment (58.3 vs 50.3, p &lt;.001), more severe insomnia (12.7 vs. 9.4, p =.029), and actigraph-measured higher wake after sleep onset (41.6 minutes vs. 34.0 minutes, p = 0.012) and lower sleep efficiency (85.1% vs. 87.9%, p = 0.032) compared to those without disability. After controlling for age and disease activity, sleep-related impairment (OR = 1.1, 95% CI 1.03, 1.15) was independently associated with disability. Conclusion Patients with IBD-related disability experience poor sleep health. Sleep related daytime impairment uniquely contributed to disability when controlling for disease activity. Sleep interventions need to be tested in adults with IBD to determine if they are effective at addressing disability in this population. Support (if any) Mayo Clinic Bonner Fund

Purpose: Fatigue is one of the most common and disabling symptoms experienced by people with inflammatory bowel disease; however, interventions to treat fatigue are limited. The purpose of this systematic review is to examine the relationship between sleep deficiency and fatigue in adults with inflammatory bowel disease and to describe the demographic and clinical factors associated with fatigue to inform future intervention work. Methods: We conducted a systematic review and reported the results using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted using MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL on 3/7/24. We included studies with adults (≥18 years of age) who had a diagnosis of inflammatory bowel disease (Crohn’s disease, ulcerative colitis, or indeterminate colitis) and measured fatigue and sleep using a validated self-report questionnaire or objective measurement. Results: Twenty-two studies met inclusion criteria for a total sample of 16 927, of whom 58.7% (n = 9937) had Crohn’s disease, and 66.3% (n = 11 226) were female. 56.1% of the participants experienced fatigue and 66.3% experienced sleep deficiency. Sleep quality and insomnia were consistently associated with fatigue. Baseline poor sleep quality was associated with persistent and worsening fatigue over 12 to 24 months. Clinical but not objective assessment of disease activity, anxiety, depression, female gender/sex, and younger age were also associated with more severe fatigue. Conclusions: Sleep quality and insomnia represent important modifiable contributors to fatigue. Future research should explore whether sleep interventions can improve fatigue in this population.

Abstract Introduction Inflammatory bowel disease (IBD) is a chronic immune-mediated disease that includes Crohn’s disease and ulcerative colitis. People with IBD experience poor sleep health, including short and highly fragmented sleep and extraintestinal manifestations including alterations to cognitive functioning; however, the relationships between sleep health and cognitive symptoms have not been evaluated in this population. The purpose of this study was to identify the associations between sleep health and perceived cognitive impairments in adults with IBD. Methods We conducted a descriptive, correlational study of adults (18 to 59 years old) with IBD. We used the Pittsburgh Sleep Quality Index (PSQI) to obtain self-reported data on sleep health, the FACT-Cog Perceived Cognitive Impairments questionnaire to elicit cognitive symptoms, and the Manitoba IBD Index to describe IBD disease activity. Descriptive statistics, point-biserial correlations, and Pearson’s correlations were used to describe relationships. Results Of the 59 participants [Mean age 40.8 (SD 10.5), 71.2% female, 94.9% white], 67.8% (n=40) had clinically active IBD. 79.7% (n=47) had a PSQI total score &gt;5, indicating poor sleep health. The most common cognitive symptoms, occurring two or more times a week, were trouble concentrating (55.9%), walking into a room and forgetting an intended task (44.1%), and forgetting the names of people soon after being introduced (44.0%). PSQI total score was positively and significantly correlated with 12 of 13 questions on the FACT-Cog. The strongest correlations included trouble concentrating (r = .497, P&lt;.001), slower thinking (r = .450, p&lt;.001), trouble forming thoughts (r=.550, p&lt;.001), and difficulty finding the right words to express oneself (r=.546, p&lt;.001). Longer self-reported sleep latency was associated with higher frequency of 12 out of 13 cognitive symptoms, while sleep efficiency was associated with 4 and sleep duration was associated with 2. Having clinically active IBD was associated with trouble forming thoughts (r=-.261, p=.046), slower thinking (r=-.307, p=.018), and trouble concentrating (r=-.346, p=.007). Conclusion Cognitive symptoms are common among people with IBD, highly correlated with sleep health, and not fully explained by IBD disease activity. Future studies should include objective measures of sleep health and cognition to further elucidate these relationships. Support (if any) Mayo Clinic Bonner Fund

Background: There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. Objective: The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. Methods: A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson’s correlations, and logistic regression were used to describe relationships. Results: Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. Conclusion: Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.