A link between nurses’ nightmares and high levels of perceived work stress, efficacy of lemborexant for insomnia with short sleep, hypersomnolence among people with depression, and a correlation between sleep disturbances and ADHD symptoms in young children were among the many study findings reported at the 36th Annual Meeting SLEEP 2022, held June 4 to 8, 2022, in Charlotte, North Carolina.
Nurses Increased Social Vigilance = Nightmares
Exposure and reactivity to stressors during the day have the potential to increase nightmare frequency and severity. Nurses are a population who have high exposure to social vigilance, or the monitoring of their social environment for potential threats, which may also increase the risk for nightmares.
Nurses (N=464; 91% women; mean age 39 years) from 2 hospitals in the Dallas area were evaluated using the Social Vigilance Questionnaire (SVQ), Nightmare Disorder Index (NDI), and Challenge- and Hindrance-Related Self-Reported Stress Scale (CHRSS), and were asked to keep a dream diary for 14 days.
Both greater hindrance stress (β, 0.13; P =.031) and social vigilance (β, 0.10; P =.041) predicted more nightmare symptoms, as assessed by the NDI. Hindrance stress is stressors that interfere with performance or goals. Nightmare frequency was associated with greater hindrance stress (β, 0.14; P =.015) but not social vigilance, according to data from sleep diaries.
Lemborexant Shows Promise for Insomnia With Short Sleep
Older adults experiencing insomnia with short sleep achieved clinically meaningful improvement with lemborexant, with nearly 30% considered remitters and greater than 50% considered treatment responders after 1 month of treatment, according to study findings reported by Edinger et al.2
Lemborexant was approved in December, 2019 by the US Food and Drug Administration for the treatment of adult patients with insomnia. The study data were derived from a larger phase 3 trial (Study 304; N=1006) that found lemborexant to be more effective than placebo in patients with insomnia based on polysomnography and sleep diary-based sleep onset and maintenance outcomes seen over 1 month. The trial included women 55 years and older and men 65 years and older.
The current study aimed to assess rates of response and remission with lemborexant in the subgroup of 535 patients with insomnia short sleep (total sleep time <6 hours), who may have may have limited response to cognitive behavioral therapy for insomnia, according to the study authors.
Treatment response (ie, decrease from baseline on Insomnia Severity Index [ISI] ≥7) was found in 56% of patients who received lemborexant 5 mg and 54% of patients who received lemborexant 10 mg. The rate of remission (ISI total score <8 points) was 28% for both the 5-mg and 10-mg dose groups. The response and remission rates for both doses were significantly greater than those for placebo (42% and 15%, respectively; P <0.05).
Excessive Sleepiness Linked to Major Depressive Disorder
Excessive sleepiness is significantly associated with major depressive disorder (MDD) according to findings from a longitudinal analysis of data from 10,931 participants from 8 states conducted by Ohayon et al.3
These participants completed 2 rounds of telephone interviews conducted 3 years apart. Symptoms of hypersomnolence include:
- Recurrent periods of sleep or lapses into sleep within the same day
- A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (ie, unrefreshing).
- Difficulty being fully awake after abrupt awakening
Approximately one-quarter of participants at both time points reported at least 1 hypersomnolence symptom at least 3 times per week. The prevalence of MDD at both time points was approximately 5%, and over half (51%-54%) of the respondents with MDD reported hypersomnolence symptoms. Persistent hypersomnolence (ie, present at both time points) predicted new-onset MDD (relative risk [RR], 2.0) and persistent MDD (RR, 3.8), after adjusting for age, gender, and medical conditions.
After adjusting for the presence of insomnia, hypersomnolence remained a predictor of persistent MDD (RR, 2.4) but not new-onset MDD.
Sleep Disturbances Correlate With ADHD Symptoms in Children
Sleep disturbances are bidirectionally associated with attention-deficit/hyperactivity disorder (ADHD) symptoms, according to findings from a longitudinal study by Davis et al.4
The researchers recruited pediatric patients from an academic medical center’s primary care clinics and asked caregivers to complete sleep and ADHD scales when the children were at a mean age of 20 months (T1; n=1806) and 37 months (T2; n=646).
Sleep problems were associated with increased ADHD symptoms at both time points (T1, r=.40; P <.001; T2, r=.49; P <.001). Increased sleep problems at T2 were associated with increased ADHD scale scores (r=.44 P <.001) as well as inattention (r=.41), and hyperactivity/impulsivity (r=.43) subscale scores.
“Incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms,” Davis et al concluded.
More coverage of SLEEP 2022 presentations is available here.
Disclosure: The lemborexant research was supported by Eisai Inc. Please see the original reference for a full list of disclosures.
1. Jordan S, Slavish D, Dietch J, et al. The role of social vigilance and hindrance-challenge stress in predicting nightmares among nurses. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 497.
2. Edinger J, Krystal A, Kumar D, Pappadopulos E, Malhotra M, Moline M. Lemborexant treatment of older adults with insomnia and objective short sleep: rates of response and remission. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 451.
3. Ohayon, M, Pakpour A, Cote LM. The role of hypersomnolence in depression: results from a longitudinal study of the American general population. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 669.
4. Davis N, Lunsford-Avery J, Compton S. Dawson, G. Associations between sleep problems and ADHD symptoms in early childhood: a longitudinal primary-care based study. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 497.