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Introduction Adverse childhood experiences can increase likelihood of hyperarousal, especially around periods of vulnerability. Survivors of trauma also experience more nightmares. These data explore whether adverse childhood events are associated with adult insomnia severity and nightmares. Methods Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults 22-60 years recruited from southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Insomnia severity was assessed using the Insomnia severity Index (ISI), evaluated both as a continuous variable and categorical: None (0-7) vs Mild (8-14) or Moderate-Severe (15+). Nightmares were assessed ordinally using the following anchors: Never, Seldom, Sometimes, Often, or Frequently. Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9. Results Child abuse was associated with an additional 2.9 points on the ISI, and parental divorce, death, depression, and anxiety were associated with an additional 1.2, 1.7, 1.8, and 1.8 points, respectively (all p< 0.005). After adjustment for depressed mood, relationships remained for child abuse, parent divorce, and parent death. In evaluating categorical insomnia, child abuse was associated with both mild (RRR=2.64, p< 0.0005) and moderate-severe (RRR=3.37, p< 0.0005) insomnia. Parent death was associated with an increased likelihood of moderate-severe insomnia (RRR=1.94, p=0.007). Parent divorce, depression, and anxiety were all associated with increased mild (RRR=1.44 [p=0.03], RRR=1.85 [p=0.001], and RRR=1.85 [p=0.004], respectively) and moderate-severe (RRR=1.50 [p=0.03], RRR=2.24 [p< 0.0005], and RRR=2.40 [p< 0.0005], respectively) insomnia. More frequent adult nightmares were reported by those who reported a history of child abuse (oOR=1.9, p< 0.0005), parent death (oOR=1.6, p=0.007), parent depression (oOR=1.6, p< 0.0005), and parent anxiety (oOR=1.8, p< 0.0005). After adjustment for depression, relationships with child abuse and parent death were maintained. Child poverty was not associated with insomnia or nightmares. Conclusion Adverse childhood events may contribute to later risk for insomnia and nightmares. Further efforts are needed to establish causality and develop interventions, which may have residual effects on mental and physical health. Support (if any)

Introduction Adverse childhood events have been linked with many mental and physical health risks, but less work has explored nighttime and daytime sleep problems, especially inability to control sleep. Methods Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults aged 22-60 years recruited from communities in southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Habitual sleep duration was assessed in hours, daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS), and control over sleep was assessed with the Brief Index of Sleep Control (BRISC). Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9. Results History of child abuse was associated with 23 fewer minutes of nighttime sleep (p=0.001), and parent anxiety was associated with 15 fewer minutes (p=0.048). When depression was added to the model, the effects for sleep duration were attenuated (15.3 minutes, p=0.03). No other relationships were observed. Regarding control over nighttime sleep, decreased sense of control was reported by those who experienced child abuse (B=-0.4, p< 0.0005), parent divorce (B=-0.1, p=0.035), and parent depression (B=-0.2, p=0.02). After adjusting for depression, the relationship with child abuse was attenuated but maintained (B=-0.2, p< 0.0005). Elevated ESS scores were seen in those who reported child abuse (B=4.7, p< 0.0005), parent depression (B=4.3, p< 0.0005), and parent anxiety (B=3.9, p< 0.0005). After adjusting for depression, relationships were attenuated but maintained for child abuse (B=2.0, p=0.02), parent depression (B=2.2, p=0.004), and parent anxiety (B=2.2, p=0.017). Conclusion Adverse childhood events may lead to sleep/wake dysregulation, including less sleep at night, more sleepiness during the day, and decreased sense of control over sleep ability. Future efforts might focus on increasing control over nighttime sleep and reducing daytime sleepiness. Support (if any)

Introduction Both insomnia and discrimination have been associated with adverse physical and mental health outcomes. Evidence suggests that discrimination may moderate the effects of sleep on telomeres, DNA sequences at the end of chromosomes that protect them from degradation. The purpose of this study was to determine the relationship between insomnia and telomere length among older non-latinx white, black, and latinx individuals and whether discrimination moderated this relationship differently based on race or ethnicity. Methods This study is a secondary analysis from the Health and Retirement Study, a longitudinal project sponsored by the National Institute on Aging. Our analysis consisted of 3,205 US participants who provided information on sleep problems as well as salivary samples from which telomere data were assayed. We computed a linear regression to examine the relationship between insomnia symptoms and telomere length in each racial/ethnic group, including interaction terms to assess moderating effects of discrimination. Results Insomnia symptoms were associated with shortened telomere length among non-latinx white participants (β -0.046, p=0.015, [-0.06, -0.01]). Discrimination had a moderating effect between insomnia symptoms and telomere length among black participants (β -0.28, p=0.045, [-0.33, -0.00]). Analyses remained significant after adjusting for age, medical co-morbidities, smoking status, and a history of depression. Conclusion Our results suggest that symptoms of insomnia may contribute to telomere erosion, with potentially adverse effects on genomic integrity. For black individuals, those who experienced discrimination were at greater risk of telomere damage associated with insomnia. Support (If Any) Funding has been made available by the NIH, granted to UCSF School of Nursing Biobehavioral Research Training Program in Symptom Science (NIH: T32 NRO16920).

Introduction The onset of the COVID-19 pandemic disrupted and changed sleep as well as elevated stress levels worldwide. Previous research has demonstrated a bidirectional relationship between stress and sleep, in that stress contributes to poorer sleep and poor sleep leads to higher stress. It is hypothesized that perseverative cognition (i.e., worry, racing thoughts) is a key cognitive mechanism in this relationship. The goal of our study was to examine the relationships between stress and sleep during a major global stressor, testing key cognitive and behavioral factors that may influence this relationship. Methods Adults aged 18 and above were recruited to complete a text-message survey twice per day for 3 weeks over a 4-month period. Sleep duration and efficiency during the previous night and evening/overnight perseverative cognition was measured in the morning survey, daily stress levels were measured in the evening survey. Physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Results were analyzed using mixed effects models controlling for age, gender and race/ethnicity. Results Participants included 191 adults (91 F, mean age= 43, SD= 16 years). Results demonstrate that stress ratings were associated with higher sleep duration (p= 0.04) but perseverative cognition was associated with lower sleep duration and efficiency (p values Conclusion Results demonstrate that perseverative cognition is a key factor in the daily relationships between stress during the day and sleep at night. Higher physical activity was related to better sleep. These results indicate that interventions to reduce perseverative cognition may improve sleep during times of stress, including reducing the sleep-disrupting effects of the COVID-19 pandemic. Support (If Any) University of Utah i3 COVID-19 pilot grant, UL1TR002538

Introduction There is growing evidence that insufficient sleep can negatively impact the immune system, including vaccination response. Prior laboratory studies have shown that acute sleep restriction can result in impaired antibody resposne to the hepatitis A and influenza vaccine. Similarly, prospective studies have shown that short sleep duration, measured by self-report and wrist actigraphy, is associated with muted antibody responses. These prior findings have critical implications for the COVID-19 pandemic and the efficacy and durability of the COVID-19 vaccines currently available. Whether sleep accounts for variability in response to the COVID-19 vaccination series has not been investigated. Methods We recruited 530 healthy participants (mean age= 52.4, SD=12.1, range: 18-88 years; 64.1% female) who were naive to the COVID-19 vaccination series. Participants completed self-report questionaires (e.g., Pittsburgh Sleep Quality Index) and morning sleep diaries for 7-consecutive days surrounding COVID-19 vaccine administrations. Additionally, 198 participants wore a sleep tracking device (Oura ring) continuously for ~2 months beginning prior to vaccination, which provides behavioral sleep data on days prior to and following the COVID-19 vaccination series. Blood samples were collected prior to vaccination, +1 month after their final vaccine shot (peak response), and +6 months after their final vaccine shot (maintenance); neutralization assays using pseudotype virus will be carried out to quantify antibody titers. Results Data collection concludes December 2021, with antibody assays to be completed February 2022. Initial baseline data indicates that most participants reported poor overall global sleep quality (PSQI mean=6.3, SD=3.6; 52% PSQI>5). Linear mixed models will be conducted to test associations between habitual sleep duration (averaged over the measurement time points), sleep efficiency, and subjective sleep quality with antibody responses over time. Additionally, we will report on the relevance of sleep timing (midpoint) and vaccination timing (receiving the vaccine in the morning vs afternoon vs evening), and the role of self-reported sleep disorders (e.g., obstructive sleep apnea) and shift worker status. Covariates in these analyses will include age, gender, race, body mass index, prior COVID infection, and vaccine type (Moderna, Pfizer, Johnson and Johnson). Conclusion These analyses will provide new knowledge about the role of sleep in mounting and maintaining antibody response to the COVID-19 vaccination series. These findings may provide novel insights into when and for whom improvements in sleep may result in better vaccine efficacy. Support (If Any) R24AG048024

Objectives: Telomeres are the protective caps of chromosomes. They shorten with cell replication, age, and possibly environmental stimuli (e.g., infection and stress). Short telomere length (TL) predicts subsequent worse health. Although venous whole blood (VWB) is most commonly used for TL measurement, other, more minimally-invasive, sampling techniques are becoming increasingly common due to their field-friendliness, allowing for feasible measurement in low-resource contexts. We conducted validation work for measuring TL in dried blood spots (DBS) and incorporated our results into a meta-analysis evaluating minimally-invasive sampling techniques to measure TL.Methods: We isolated DNA extracts from DBS using a modified extraction protocol and tested how they endured different shipping conditions and long-term cryostorage. We then included our in-house DBS TL validation statistics (correlation values with VWB TL and age) in a series of meta-analyses of results from 24 other studies that published similar associations for values between TL measured in DBS, saliva, and buccal cells (BC). Results: Our modified DBS extraction technique produced DNA yields that were roughly twice as large as previously recorded. Partially extracted DBS DNA was stable for seven days at room temperature, and still provided reliable TL measurements, as determined by external validation statistics. In our meta-analysis, DBS TL had the highest external validity (i.e., strongest overall association with both VWB TL and age), followed by saliva, and then BC. Conclusions: Measuring TL using DNA isolated from DBS is the best option for minimally-invasively collected samples, which can be used to expand research to diverse settings and populations.