Redeker, Nancy S.

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 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.

Background: Individual symptoms are predictors of mortality in adults with heart failure (HF). However, symptom clusters may be more predictive of future risks than isolated symptoms, yet research on these symptom clusters in older adults with HF is limited. Aims: To explore the extent to which symptom cluster profiles predict all-cause mortality among community-dwelling older adults with HF, while adjusting for known risk factors. Methods: We conducted a secondary analysis of data of the 2008 to 2016 surveys of the U.S. Health and Retirement Study using latent class analysis to identify baseline cluster profiles, and survival analysis for time to death with Cox proportional hazard (Cox PH) models, and Kaplan Meier survival analyses. Results: We included 684 participants [mean age=74.9, (SD=10) years, 56.6% female, 16.2% Black/African American]. Three baseline symptom cluster profiles were identified: high-burden (pain, shortness of breath, fatigue, swelling, depressive symptoms, dizziness), low-burden, and cardiopulmonary-depressive (shortness of breath, pain, and dizziness). The estimated median time-to-death was 71 (95% CI=64, 79) months. Of the 364 participants in the cardiopulmonary-depressive profile, 240 (65.9%) died (median time= 65 months, 95% CI= 55, 73) compared to those in the low-burden profile, of which 49% died. Approximately 61% in the high burden profile died (median time=67 months, 95% CI= 51, 90). A significant difference in survival times between the 3 cluster profiles was found (Log-rank= 9.13, p = 0.01). In the adjusted Cox PH model, participants in the high symptom burden and respiratory-depressive distress profiles had adjusted HR of 1.48 (95% CI=1.15, 1.94) and 1.44 (95% CI=1.14, 1.80) compared to those in the low burden symptom cluster profile, after controlling for age, gender, smoking, and comorbidities. Conclusions: The identified symptom cluster profiles predict 8-year all-cause mortality in older adults with HF, after controlling for known risk factors. An evaluation of symptom clusters, rather than individual symptoms, may provide additive prognostic information.

Abstract Background Heart failure (HF) has a high mortality risk in older adults. Individual symptoms as predictors of mortality in HF patients; however, symptoms often manifest in clusters, which may be more predictive of future risks than isolated symptoms. However, research on symptom clusters in older adults who have HF is limited. To explore the extent to which symptom cluster profiles predict all-cause mortality among older adults with HF, while adjusting for demographic and clinical factors. Methods A secondary study was conducted using the data from the Health and Retirement Study. We measured six symptoms (fatigue, shortness of breath, pain, swelling, depressive symptoms, and dizziness), and used latent class analysis to identify baseline symptom cluster profile. We performed survival analysis for time to death with Kaplan Meier survival analyses and Cox Proportional Hazard models. Results The sample included 684 participants (mean age = 74.9 (SD = 10.0) years) who demonstrated three symptom cluster profiles (high-burden, low-burden, and cardiopulmonary-depressive). The estimated median time-to-death was 71 (95% CI= [64, 79]) months. Participants in the high symptom burden and respiratory-depressive distress profiles had adjusted hazard ratios of 1.48 (95% CI = 1.15, 1.94) and 1.44 (95% CI = 1.14, 1.80) for time to death compared to those in the low burden profile. Conclusion Symptom profiles can assist in identifying older adults with HF who are at risk for earlier mortality. Further research is needed to determine whether alleviating these symptom clusters decreases the risk of mortality.

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

Abstract Introduction Sleep disturbance and circadian rhythm disruptions are common among adults with chronic heart failure (HF), and are related to cognitive impairment. Although light levels are known to influence sleep quality, cognition, and the circadian system, little is known about the role of light among adults with HF. The purpose of this study is to investigate the association between light exposure and sleep, diurnal rest-activity rhythms (RAR), and cognitive function among adults with HF. Methods We retrospectively analyzed baseline data from a randomized controlled trial of cognitive behavioral therapy for insomnia for adults with HF and insomnia. We measured light levels and sleep with 24-hour wrist actigraphy and computed the circadian quotient, inter-daily stability, and intra-daily variability (strength of the RAR) using cosinor and non-parametric methods. We computed time above threshold (TAT) (100, 500, and 1000 lux), ratio of light exposure in daytime to evening (AUC ratio), and light regularity index (LRI) (20, 50, and 100 lux) to assess the intensity and consistency of light exposure patterns. Lapses in performance on the Psychomotor Vigilance Task (PVT lapse) measured cognitive function. Multiple linear regressions tested if the light exposure metrics could predict the RAR, sleep efficiency, and PVT lapses after adjusting for age, sex, and comorbidities. Results The sample included 167 participants (M age=63.8 (SD =12.9) years; 45.5%female). The AUC ratio and TAT500 were associated with a stronger circadian quotient in males (0.339 ± 0.095, p=.0005; 0.296 ± 0.085, p=.0006) compared to females (0.058 ± 0.106, p=.5800; -0.061 ± 0.128, p=.6364), after controlling for age and comorbidities. TAT500 was associated with better inter-daily stability (0.221 ± 0.077, p=.0044) than the other thresholds. Higher light exposure intensity (TAT100) (0.129 ± 0.065, p=.0492) and a greater circadian quotient (0.267±0.076, p=.0006) were associated with improved sleep efficiency. TAT100 was associated with fewer PVT lapses (-0.229 ± 0.082, p=.0061), after controlling for total sleep time, circadian quotient, and demographics. Conclusion Light exposure, particularly at certain intensities and regularity, predicted RARs, sleep efficiency, and cognitive function in adults with HF. Future tailored light interventions with varying intensities and regularity may improve HF outcomes. Support (if any)

Abstract Introduction Sleep disordered breathing (SDB: obstructive & central sleep apnea) and insomnia are common in heart failure (HF). However, most studies have not addressed the presence of combined SDB and insomnia (COMISA). The purposes of this study were to (1) describe COMISA among adults with stable chronic HF; (2) compare the clinical and demographic characteristics between groups with COMISA, insomnia, SDB, and normal sleep; and (3) examine the risk of COMISA in the presence of normal sleep, insomnia, SDB and other clinical and demographic characteristics. Methods Secondary analysis of an observational study of sleep among adults with stable HF. COMISA was defined as an apnea hypopnea index (AHI) &gt; 15 with difficulty initiating or maintaining sleep or waking too early in the morning (Insomnia). We measured self-reported (Pittsburgh Sleep Quality Index) and objective sleep characteristics (polysomnography – PSG), symptoms (depression, sleepiness); used chi-square and ANOVA; and calculated the risks of COMISA for normal sleepers and with insomnia or SDB under different conditions (depression, poor sleep quality, left ventricular ejection fraction, age, race, and sex). Results The sample included 170 [(M age = 60.3 ± 16.8 years; n = 60 (35%] female. They had normal sleep (n = 37/22%); insomnia only (n = 48/28%): SDB only (n = 46/27%); and COMISA (n = 39/23%). Those with COMISA were significantly more likely to be obese (32.1%) compared to others [13.6% -29.6%, p = 0.0128]. They had the shortest total sleep time (TST) (mean = 291 ± 109 mins) and poorest sleep efficiency (M = 65.8 ± 20.5%) (p = .05). Women with insomnia were less likely to have COMISA than men (36% vs. 51%), while 74% of adults with SDB who were depressed had COMISA, compared with 41% of those with insomnia. Conclusion Risk of COMISA is associated with depression and poor sleep among adults with stable HF and SDB. Future study is needed to better understand the risks of COMISA among adults with chronic HF outcomes and to address the need for intervention that addresses it beyond a focus on only SDB or insomnia. Support (if any)