SLEEP

Zhaoyan, Yu

doi: 10.1093/sleep/zsz067.449pmid: N/A

Abstract Introduction To explore the guiding significance of anesthetic-induced sleep in the clinical diagnosis of obstructive sleep apnea syndrome (OSAS). Methods A total of 124patients with OSAS aged between 18 and 65 years old, who were performed operation in our hospital from October 2016 to July 2018, were enrolled in this study. The upper airway was scanned by computed tomography (CT) while they were awake and during the sleep apnea. Sleep was induced by dexmedetomidine under electrocardiograph and oxyhemoglobin saturation monitoring. Data including cross-sectional area and length of the posterior region of the soft palate, the posterior region of the tongue, and the posterior region of the epiglottis were then collected. Results Of 124 patients, none of them were suffering emergency or dangerous complications during sleep in CT room. 122 patients occurred occlusion or stenosis in upper airway. Among all of those, there were 119 stenosis occurring in oropharynx, accompanied by 5 cases of stenosis or occlusion retroglossal area. Meanwhile, none was found stenosis behind epiglottis. Moreover, we also found 38 (30.67%) cases of deviation of nasal septum with retropalatal problems. Only 2 patients had no changes in upper respiratory tract before and during the sleep. A about 61.33% patients had multi-level obstructions and the most common obstructive site was oropharynx (90.67%), including only retropalatal area stenosis 66 (53.33%) and accompanied tonsillar hypertrophy 46 (37.33%). Conclusion The drug-induced sleep computed tomography (DI-SCT) examination is a safe and non-invasive method for diagnosing the obstructive sites in OSAS patients. The DI-SCT is good for diagnosing multiple obstructions, which occur mostly on severe OSAS patients. The oropharyngeal obstruction usually compares with nasal stenosis, which can be detected by DI-SCT. Support (If Any) This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].

Sahrmann,, Julie;Cheung,, David;Omeni,, Alvan;Espiritu,, Joseph

doi: 10.1093/sleep/zsz067.962pmid: N/A

Abstract Introduction Attendance to sleep clinic appointments is imperative to accurately diagnose sleep-related disorders and offer appropriate treatment. As part of our quality assurance program, we assessed predictors of no-show rates at our sleep clinic. We hypothesize that no-show rates can be predicted by appointment type (new vs. established), insurance status, age, sex, appointment time, day of the week, and season. Methods We performed a 10-month, retrospective chart review of patients scheduled at Saint Louis University’s SLUCare Sleep Disorders Center. Multivariable logistic regression was used to determine which factors were independently associated with no-show rates. Results 2,532 patient charts were reviewed and the overall no-show rate was 21.2%. Factors that were associated with a higher incidence of no-show rates included appointment type (new 39.1% vs. established 28.8%, p<.0001) and insurance status (no insurance 47.5% vs. public 28.3% vs private 24.2%, p<.0001). Multivariable logistic regression confirmed associations between no-show rates and new patient status (adjusted OR=2.96, 95%CI: 2.18-4.03) and the absence of health insurance (adjusted OR=1.74, 95%CI: 1.33, 2.27). Age, sex, appointment time, day of the week, and season did not significantly influence no-show rates. Conclusion Independent predictors of no-show appointments included new patient status and lack of health insurance. Our findings will aid future efforts to identify patients with high predictors of nonadherence. Further studies are needed to develop methods to decrease no-show rates once high risk appointments have been identified. Support (If Any) Other studies have described factors that influence no show rates, although none have specifically addressed no-shows for sleep medicine appointments. Knolhoff et al found that patients with limited health literacy and cigarette smoking had higher no-show rates (1). Drewek et al found that appointments scheduled for 30 days or greater had a higher chance of no-show (2). No-show rates increase the cost of healthcare. Kheirkhah et al analyzed no-show data and found that increased no-show rates occurred at subspecialty clinics, equaling a cost of approximately $196 per no-show (3). Reducing no-show rates can improve quality outcomes by maximizing access to care and reducing overall healthcare spending. This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Bramoweth, Adam D; Lederer, Lisa G; Youk, Ada O; Germain, Anne; Chinman, Matthew J

doi: 10.1093/sleep/zsz067.382pmid: N/A

Abstract Introduction Insomnia is a prevalent and impactful disorder among Veterans. An evidence-based behavioral intervention, cognitive behavioral therapy for insomnia (CBTI), has strong evidence but its use in the VA is still limited by numerous barriers. An alternative behavioral treatment with comparable evidence and that addresses barriers of CBTI delivery could improve access to care. Methods This randomized trial compares CBTI (5 in-person sessions within 8 weeks) to a newer, brief behavioral treatment for insomnia (BBTI; 2 in-person/2 phone sessions within 5 weeks) to assess non-inferiority. The primary outcome is the Insomnia Severity Index (ISI). To confirm non-inferiority, the 95% confidence interval for the mean ΔISI (pre- to post-treatment) between groups is <5.2, the non-inferiority margin (NIM) determined by the Reliable Change Index. Preliminary analyses, using linear mixed models, were completed on the first 10 participants with baseline and post-treatment assessments in each group. Results The 20 participants were older (61±13), white (90%), and male (90%). At post-treatment, participants in both groups significantly improved (ps <0.001; Glass’ Δs >2.5) and there were no between-group ISI differences. The groups had similar treatment response (ΔISI ≥8: 70%, BBTI; 80% CBTI) and treatment remission (ΔISI ≥8 + ISI post-treatment ≤7: 40%, BBTI; 20%, CBTI). The mean ΔISI pre- to post-treatment between groups was 1.9 (95% CI -2.92, 6.72). Conclusion While ΔISI between BBTI and CBTI was less than the NIM, the confidence interval was too wide to confirm non-inferiority. However, BBTI was effective and can be offered alongside CBTI as a comparable treatment, especially for Veterans who prefer a briefer intervention and varied delivery (in-person + phone). Key limitations of this study include small sample size, single study site, and a large NIM. BBTI shows promise in increasing access to care because it is easier to deliver and attend than CBTI in non-specialty mental health care settings (e.g., primary care). Support (If Any) US Department of Veterans Affairs, HSRD CDA 13-260. The views expressed are the authors and do not necessarily represent those of the US Department of Veterans Affairs or the US Government. This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].

Schwab, Richard; Geng, Eric; Enriquez, Marjon; Blase, Amy; Willes, Leslee; Le, Diana; Benjafield, Adam

doi: 10.1093/sleep/zsz067.507pmid: N/A

Abstract Introduction Sleep disordered breathing (SDB) is associated with cardiac-related morbidity and mortality. Hospitalized patients with heart disease are frequently readmitted. We hypothesized that hospitalized patients with cardiovascular disease and newly diagnosed SDB who used CPAP as an outpatient would show reduced cardiac-related readmissions and ER visit rates compared to patients who did not use CPAP. Methods 127 SDB patients with cardiovascular disease (52 using CPAP, 75 not using CPAP) were followed prospectively in a registry for up to 36 months. CPAP adherence, readmissions/ER visits, mortality, demographic data, LVEF%, pulse oximetry, Epworth Sleepiness Scale (ESS) data were collected. Baseline characteristics were utilized to generate propensity scores, the probability of choosing CPAP treatment, used as weights in statistical comparisons to reduce bias in this non-randomized study. Results The patients choosing CPAP were more likely to be male, had higher BMI and were twice as likely to have LVEF≥40%. 0% (0/52) of CPAP patients had a cardiac readmission or ER visit in the first 90 days. In the untreated group, 4.1% (3/74) had a cardiac readmission and 2.7% (2/74) had a cardiac-related ER visit. Over one year, 3.8% (2/52) of CPAP patients were readmitted compared to 10.8% (8/74) in the untreated group. 1.9% (1/52) and 4.1% (3/74) of CPAP and non-CPAP patients respectively had an ER visit. In adjusted survival analysis, 0.0% of CPAP patients and 13.3% of non-CPAP patients had a cardiac readmission or death in the first 90 days; 12.3% of CPAP patients and 25.9% of non-CPAP patients had a readmission or death by one year (p=0.3408). In unadjusted survival analysis, 12.0% of CPAP patients compared to 29.6% of non-CPAP patients had a cardiac readmission or death in the first year (p=0.0576). Conclusion In this study, SDB patients with CPAP trended towards a lower rate of cardiac-related readmission and ER visits, and/or death than those without CPAP. These data suggest that CPAP may assist in lowering cardiac-related readmissions in patients with SDB and cardiovascular morbidity. Support (If Any) Partial funding by ResMed This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].

Maurer, Leonie, F;Espie, Colin, A;Omlin,, Ximena;Kyle, Simon, D

doi: 10.1093/sleep/zsz067.384pmid: N/A

Abstract Introduction Preliminary work suggests that Sleep Restriction Therapy (SRT) for insomnia may be associated with daytime symptom exacerbation (Kyle, 2011; Miller, 2013), however no study has assessed this possibility within the context of a rigorously-controlled trial. Here we profiled sleepiness and affect on a daily basis pre and post randomisation to either SRT or a specific factors component control arm called Bedtime Consistency Therapy (BCT). Methods Fifty-three participants (16 male, mean age = 41.13 ± 8.95) with insomnia disorder were randomised to SRT (n = 25) or BCT (n = 28). Treatment arms were matched for therapist time and number of sessions. During baseline (2 weeks) and treatment (4 weeks), participants completed daily assessments of sleepiness and positive and negative affect. Linear mixed-model analyses were conducted with fixed effects of time (baseline = week 1-2; early treatment = week 3-4; late treatment = week 5-6) and group (SRT vs. BCT). Random effects were run to account for between-subject variation. Results Significant time x group interaction effects were observed for all measurements (p < .005). In the SRT group, pairwise comparison between time points revealed a significant increase in both evening and morning sleepiness (from baseline to early and late treatment, p < .0001). Moreover, negative affect increased significantly from baseline to late treatment (p < .01), while positive affect decreased from baseline to early and late treatment (p < .0001). In contrast, the BCT group showed no change in evening sleepiness or positive affect, an increase in morning sleepiness (baseline vs early treatment, p < .05) and a decrease in negative affect (baseline vs early treatment, p < .05). Conclusion: Our results show that the introduction of SRT is associated with increased sleepiness and negative affect, and reduced positive affect relative to a robust control arm. This work may have important implications for the clinical implementation of SRT. Support (If Any) N/A This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Arnedt, J, Todd;Conroy, Deirdre, A;Mooney, Ann, J;Dubuc,, Kelley;Yang,, Alexander;Balstad,, Sydney;Pace,, Dari;Sen,, Ananda;Eisenberg,, Daniel

doi: 10.1093/sleep/zsz067.362pmid: N/A

Abstract Introduction CBT for insomnia is highly effective, but few evidence-based modalities exist beyond face-to-face to facilitate dissemination. Telemedicine is increasingly an option, but its efficacy and acceptability for delivering CBT for insomnia is unknown. In an ongoing randomized controlled non-inferiority trial, we are comparing face-to-face with telemedicine (via the AASM SleepTM platform) delivery of CBT for insomnia for improving sleep and daytime functioning. In this study, we compared these modalities on sleep diary and select daytime outcomes for the initial 30 participants. Methods Adults with chronic insomnia (22 women, mean age 51.6 ± 15.4 years) were recruited through advertisement and insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Eligible participants were randomized to 6 sessions of CBT for insomnia delivered face-to-face (n=13) or via AASM SleepTM (n=17). Participants maintained the consensus sleep diary throughout treatment and completed pre- and post-treatment measures of daytime functioning (fatigue, depression, anxiety, and overall functioning). Results Mixed ANOVAs showed no significant Group by Time interactions for any of the sleep diary or daytime functioning variables. However, main effects of Time were evident for all sleep diary measures: sleep latency (F=25.1, df=1,28, p<.001); wake after sleep onset (F=37.0, df=1,28, p<.001); total sleep time (F=7.9, df=1,28, p<.009); and sleep efficiency (F=62.7, df=1,28, p<.001). Similarly, significant pre-to post-treatment improvements were seen in fatigue (MFI-20 General Fatigue: 13.7 ± 4.2 to 10.3 ± 3.5, p<.001), depression symptoms (PHQ-9: 9.2 ± 4.8 to 4.1 ± 3.6, p<001), anxiety symptoms (GAD-7: 4.6 ± 4.0 to 2.3 ± 2.2, p<.001), and overall functioning (WSAS: 11.9 ± 10.8 to 7.1 ± 7.8, p<.001). Conclusion Preliminary findings suggest that CBT for insomnia is equally efficacious when delivered via the AASM SleepTM platform vs. face-to-face. Recruitment is continuing to ensure adequate power for the non-inferiority analyses and to evaluate sustainability of gains over 12 weeks. Support (If Any) American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt) This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Chauhan,, Naresh;Sandhu,, Kanwalpreet;Sood,, Prabhat;Kaur,, Tejinder;Modgil,, Chaitanya;Kalra,, Arjan;Chauhan,, Sachin

doi: 10.1093/sleep/zsz067.812pmid: N/A

Abstract Introduction Sleep disorders in children and adolescents are associated with significant adverse daytime consequences on mood and behavior. The aim of this study is to assess the psychological issues prevalent in children with a single parent. A secondary aim is to evaluate the prevalence of sleep problems in this high risk group. Methods 180 children with a single parent were identified in Block Khamanon in District Fatehgarh sahib, Punjab in the age range of 5-16 years through purposive sampling. The study is cross sectional in nature and makes use of mixed design technique aimed to identify the psychological issues in terms of cognitive, emotional, behavioral and social issues in children. Before the baseline data collection, informed consent was taken from the parents regarding their and their children's participation. Different scales to assess psychological issues related to intelligence, emotional, behavioral and social aspects were used. Strengths and difficulties questionnaire in which the Punjabi version of the test was used for parents of children aged 5-10 years and the Hindi version will be translated into Punjabi was used for children above 10 years, Peabody reading test, child behavior checklist and adjustment questionnaire were used. The enrolled participants were assessed for their nutritional status by using dietary survey and anthropometric measurements. Hemoglobin estimation was done for checking anemia among children. Presence of sleep problems was assessed by questionnaire. Results Preliminary data on 129 children is presented here. Median age of children was 11years and 52% were male. Prevalence of pyschological problems necessitating counseling was identified in 26 children (20%). Anemia was diagnosed in 71 children (55%). Frequent snoring was report by 5 children (4%) and talking during sleep was reported by 2 children (1.5%). Conclusion Data presented above demonstrate the high prevalence of psychological issues and anemia in children of single parents. Future studies assessing RLS and PLMD in anemic children in this cohort are planned. Support (If Any) Sai Eye Care Society This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Forbes,, Alison;Saini,, Prabhjyot;Rye, David, B

doi: 10.1093/sleep/zsz067.661pmid: N/A

Abstract Introduction Schedule II opioids are often the final medication class prescribed for refractory RLS,but use is limited by concerns over tolerance,dependence,respiratory depression,prescription monitoring and dispensing. Buprenorphine (B) is a Schedule III partial mu-opioid receptor agonist,with a 24-48 hr half-life,often formulated with the antagonist naloxone (N) to manage opioid dependence. We report our open label experience with B/N. Methods Seven subjects (5 men) were prescribed B/N. Average age was 68 ± 2.5 (SD),BMI 31.3 (± 7.7),and RLS disease duration 30.7 ± 18.9 yrs. Over their 10.7 ± 7.5 yr treatment courses,9.3 ± 1.1 medications (2.4 ± 0.5 of which were opioids) had been tried,and 3 had received iv iron. Dopamine agonist therapy was limited by augmentation (N=6) and impulse control disorders (N=3). OSA was mild (N=2),moderate (N=2),or severe (N=3). Mobilizable iron stores were normal in six. Results Treatment inadequacy contributed to loss of employment (N=2),diminished work productivity (N=3),CPAP non-adherence (N=3 of 4),and MVAs (N=2). Opioid therapy was limited by insomnia (N=2),sleepiness (N=2),anxiety (N=2),pruritis (N=1),lack of efficacy (N=1),or waning in dose duration benefit (N=3) manifesting as “withdrawal myoclonus”/waking periodic leg movements (PLM) (N=2). After discontinuing opioids,2.0/0.5mg sublingual B/N was prescribed each twelve hours (N=1),or each evening (N=6) concurrent with other RLS medications. One subject discontinued B/N secondary to anxiety/insomnia.RLS symptoms and signs (i.e.,PLM) were promptly eliminated in two subjects. Dizziness/sleepiness/gait instability necessitated discontinuation or ongoing downwards dose titration. Four subjects (2 retirees) realized a profound,immediate benefit free of AEs for 2-6 months. IRLSSG rating scale severity decreased from 31.3 ± 6.7 to 4 ± 8 and insomnia severity index from 19.8 ± 6.1 to 1.3 ± 1.9. CPAP usage ≥ 4 hr/night increased from 39 to 68%,and 72 to 82%,and by 65 and 45 min/night,respectively,in two subjects). Employment (N=1) and premorbid work productivity (N=1) were regained. Conclusion Sleep,CPAP adherence,and quality of life in chronic RLS patients experiencing augmentation,treatment refractoriness,or side effects with traditional opioids,can benefit from B/N. Incorporation into treatment algorithms warrants further investigation given B/Ns unique pharmacology and DEA schedule status. Support (If Any) Arthur L.Williams Jr.Foundation and grateful patients This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Ward, Charles; Beneat, Amanda; Johnston, Douglas; Billings, Kathleen; Maddalozzo, John; Thompson, Dana M; Giancola, Nicholas; Bhushan, Bharat

doi: 10.1093/sleep/zsz067.739pmid: N/A

Abstract Introduction Higher rates of childhood obesity have been reported in Hispanic children in the United States. Obesity puts children at an increased risk for Obstructive Sleep Apnea (OSA). Both obesity and OSA are known to be associated with metabolic syndrome and insulin resistance. The objective of this study was to evaluate the association between OSA, metabolic variables, and insulin resistance in obese Hispanic children. Methods The study was conducted at a tertiary care children’s hospital. Data were obtained from obese Hispanic children aged 2-12 years-old. Patients underwent a routine overnight polysomnography (PSG) and a routine laboratory testing for lipid levels, fasting glucose, and insulin levels within 3 months of their PSG. Results A total of 90 patients were included in the analysis. Fifty-nine (65.5%) were Male and the mean age of patients was 7.9±2.9 years. All patients were obese with Body Mass Index (BMI)z-score>95th percentile. 30 patients (33.3%) had Mild-OSA, 15 patients (16.7%) had Moderate-OSA, 20 patients (22.2%) had Severe-OSA, and 25 patients (27.8%) had No-OSA. Fasting insulin, serum glucose, and homeostasis model assessment of Homeostatic Model Assessment Insulin Resistance (HOMA-IR) were significantly higher in patients with OSA compared to those with No-OSA (p<0.01). There was no significant difference in total cholesterol, triglycerides, high and low density lipoproteincholesterol (LDL-c) levels between those patients with or without OSA. Apnea Hypopnea Index (AHI) correlated to BMI z-score as well as increased HOMA-IR on multivariate analysis. Results from logistic regression analysis showed that HOMA-IR predicted OSA severity independently of age, gender, and BMI z-score in these patients. Conclusion OSA severity is associated with an increase in fasting insulin, blood glucose, and HOMA-IR even after controlling for age and gender in Hispanic children. Support (If Any) The study was supported by the Faculty Practice Plan Grant (F931179. PI-Bhushan B). This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].

Chapagain,, Nikita;Gao,, Chenlu;Scullin,, Michael

doi: 10.1093/sleep/zsz067.281pmid: N/A

Abstract Introduction Caregiving may have negative consequences for the individual providing care (typically, the spouse). For example, spousal caregivers of dementia patients show decreased cognitive functioning (relative to non-caregivers) that is concomitant with the level of caregiving burden. One possibility is that cognitive impairments in caregivers could be due to impaired sleep quantity or quality. To determine whether, and how, sleep is impaired in caregivers we conducted a meta-analysis. Methods Cohort studies using self-report or objective sleep measures, and studies employing sleep interventions in dementia caregivers were eligible. We identified 34 eligible studies using the Pubmed and Scopus databases; 17 studies reported total sleep time, 25 studies reported caregivers’ sleep quality, and 11 studies reported sleep interventions’ impact on caregiver sleep. The studies were inclusive of 3,071 dementia caregivers and 1,219 control adults. We used NHLBI tools to systematically assess study quality. Results Caregivers reported total sleep times of 6.61(±1.18) hours/night; compared to non-caregiver controls, caregivers lose 0.29 hours/night of sleep (overall effect size = -0.25, 95% CI: -0.47, -0.03, p = .03). Caregivers scored 5.56 (±3.20) on the Pittsburgh sleep quality index (PSQI), which is significantly worse than non-caregiver control adults (overall effect size = 0.64, 95% CI: 0.38, 0.90, p < .001). Our pooled analysis suggested that caregivers’ sleep quality was compromised in the sleep latency (d=0.42), habitual sleep efficiency (d=0.59), and sleep disturbances (d=0.59) domains. Furthermore, we found that sleep intervention studies improved caregiver sleep quality by 0.84 points on the PSQI scale (0.26 (95% CI: 0.09, 0.43), p = .002). Medications and electrical brain stimulation did not improve sleep quality in caregivers, but non-invasive behavioral therapies (e.g., physical exercise, light therapy) did significantly improve caregiver sleep quality. Conclusion Sleep quality should be considered in clinical guidelines for caregivers and should be discussed at the time of dementia diagnosis. Future research should investigate whether correcting for sleep disturbances in caregivers promotes better cognition and overall health for both the patient and the caregiver. Support (If Any) N/A This content is only available as a PDF. © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)