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Introduction In early childhood, irregular sleep schedules that may promote circadian rhythm misalignment predict greater weight gain. However, circadian rest-activity (CRA) rhythmicity in infancy in relation to growth is understudied. The aim of the present study was to investigate the association between newborn circadian rest-activity rhythmicity and change in weight-for-age from birth to three months. Methods Data were captured as a secondary data analysis from the Snuggle Bug / Acurrucadito Study (see Support). English or Spanish speaking mothers (n=41, age M±SD=33.1±4.6y, 31.7% Hispanic/Latina) and their full-term (≥37wk) infants of normal weight (2.5-4kg; 58.5% female; 25.6% WIC enrolled) were recruited from Phoenix, Arizona. CRA rhythmicity was measured at eight weeks with ankle-worn Micro Motionloggers (Ambulatory Monitoring Inc.) for five 24hr periods at one-minute epochs. CRA metrics assessed included 24hr autocorrelation, mesor, magnitude, acrophase, goodness-of-fit R2, interdaily stability, intradaily variability, and relative amplitude. Birthweight was mother-reported and 3mon infant weight was measured with a Seca scale. Weight-for-age Z-scores (WAZ) by infant sex were computed based upon World Health Organization growth charts and the change difference between timepoints was the primary outcome. Regression models adjusting for birth WAZ examined the relationships between CRA metrics at eight weeks with change in WAZ from birth to 3mo. Results At eight weeks, mean±SD CRA metrics were as follows: 24hr autocorrelation of 0.25±0.03, mesor of 115.6±14.7, amplitude of 68.1±18.3, goodness-of-fit R2 of 0.42±0.10, acrophase of 14:12±1:42, interdaily stability of 0.57±0.12, intradaily variability of 0.93±0.19, and relative amplitude of 0.61±0.11. Mean birth WAZ and change in WAZ from birth to 3mon were 0.39±0.73 and -0.57±0.77, respectively. After adjusting for birth WAZ, in separate models, greater mesor (R2 Change=0.10, β=-0.32, p=0.03), amplitude (R2 Change=0.11, β=-0.34, p=0.03), and goodness-of-fit R2 (R2 Change=0.10, β=-0.32, p=0.04) were significantly associated with less change in WAZ from birth to 3mon. Conclusion Among relatively healthy, full-term infants born of normal weight, greater 24hr circadian rest-activity rhythmicity achieved by 8 weeks was associated with slower rate of weight gain across the newborn stage. Promoting behaviors and environmental cues from parents that strengthen early circadian rhythmicity in their infants may promote healthy weight trajectories. Support (if any) NIH/NHLBI R01HL147931

Introduction Infant sleep is influenced by biopsychosocial factors. However, the influences of early parental sleep quality and parent-infant bonding on infant sleep development are underexplored. This study aimed to examine the relationships between early maternal sleep quality and mother-infant bonding at 8 weeks postpartum, and infant bedtime difficulty at 3 months postpartum. Methods This study is a secondary analysis from the Snuggle Bug/Acurrucadito Study, an observational, longitudinal cohort study investigating the associations between 24-hr sleep-wake patterns, gut microbiome, and weight development among infants. Mothers (n=60, 31.5±5.4y, 66.3% married, 40.8% Hispanic, 41.5% < bachelor’s degree) and their full-term (≥37wk), singleton infants without major complications were recruited from Phoenix, Arizona metropolitan area. At 3 and 8 weeks, and 3 months of infant age, mothers completed the Pittsburgh Sleep Quality Index (PSQI, range:0-21, higher scores indicate worse sleep quality), and reported on infant bedtime difficulty, using a 5-point Likert scale (range:1-5) with higher scores indicating greater bedtime difficulty. Mother-infant bonding was measured by the Postpartum Bonding Questionnaire (PBQ, range:0-125) at 8-week age, with higher scores indicating greater bonding problems. Based on the Transactional Model of Infant Sleep, path analyses were conducted to identify the direct effect of 8-week PSQI scores, and indirect effects of 8-week PBQ total scores and 8-week bedtime difficulty on 3-month bedtime difficulty, using z scores for all variables and the 3-week bedtime difficulty as a covariate. Results At 8 weeks postpartum, the means of PSQI, PBQ, and bedtime difficulty were 5.8±2.6, 5.3±4.7, and 2.4±1.0, respectively. Bedtime difficulty at 3 months was 2.0±1.0. After adjusting for the 3-week bedtime difficulty, the 8-week maternal sleep quality was not directly associated with 8-week (β=.005, 95%CI [-0.31, 0.32]) or 3-month infant bedtime difficulty (β=-0.14, 95%CI [-0.43, 0.14]), whereas 8-week mother-infant bonding significantly mediated the relationship between 8-week maternal sleep quality and 3-month infant bedtime difficulty (β=0.1, 95%CI [0.02, 0.22]). Conclusion This study highlighted that early maternal sleep may disrupt early mother-infant bonding, which, in turn, may increase infant bedtime difficulty later in development. Future research should investigate how best to support healthy family sleep and bonding relationships. Support (if any) NIH/NHLBI R01HL147931

Introduction Exclusively breastfed (EBF) newborns wake more often at night than partially breastfed, or exclusively formula fed (EFF) newborns. Contextual factors during the first weeks of life related to these associations are understudied. We examined relationships among post-birth experiences, objectively-estimated sleep-wake patterns, and feeding practices through three weeks post-delivery. Methods English or Spanish speaking mothers (n=20) and their full-term (≥37wk), singleton infants were recruited from Phoenix, Arizona. Mothers were 32.7±5.1y, 30.0% identified as Hispanic, 20.0% with < high school degree, and 15.0% were enrolled in the federal Women, Infants, and Children program. Infants were born normal weight (2500-4000g) and without major complications. At three weeks post-delivery, infants wore a Micro Motionlogger (Ambulatory Monitoring Inc.) on their left ankle for five 24hr periods at three weeks of age. Mothers completed an accompanying sleep diary and an adapted Infant Feeding Practices Study-II questionnaire. Pearson correlations and t-tests examined relationships between nocturnal sleep-wake patterns and feeding practices at birth and 3-weeks post-delivery. Results At birth, all mothers attempted breastfeeding, 40.0% of infants received formula, and mean time for milk to come in was 2.7 days (range: 1-4). At three weeks, one mother was EFF, 55.5% (n=11) were EBF, and 40.0% (n=8) were mixed feeding. Infant sleep-wake patterns included midpoint of 2:40±1:01, long wake episode (≥5min) frequency of 5.8±2.3, longest sleep bout duration of 127.2±34.9min, WASO of 124.1±54.3min, and TST of 434.7±79.7min. Breastmilk feeding frequency was positively related to long wake episode frequency (r=.49, p=0.03) and WASO (r=.47, p=0.04), and negatively related to longest sleep bout (r=-.59, p=0.006). Formula feeding frequency was positively related to longest sleep bout (r=.58, p=0.007). Greater time for milk to come in was positively related to long wake episode frequency (r=.53, p=0.02) and WASO (r=.56, p=0.01), and negatively related to longest sleep bout (r=-.47, p=0.04). Receiving formula in the hospital was associated with later sleep midpoint (t[18]=3.2, p=0.005), regardless of current formula feeding. Conclusion Feeding experiences and ability to breastfeed during the first few days of life may play a role in the quality and patterning of actigraphy-estimated sleep among newborns. Future research should investigate whether these associations persist into later infancy. Support (If Any) National Institutes of Health / National Heart, Lung, and Blood Institute R01 HL147931

Introduction Increased sleep problems in adults have been repeatedly reported during the COVID-19 pandemic. However, infant sleep was understudied. We aimed to examine the relationships between the impact of the COVID-19 pandemic, parent insomnia, infant temperament, and infant sleep during the COVID-19 pandemic. Methods Parents from the Phoenix metropolitan area with a full-term healthy infant ( Results The parent sample was predominantly female (94.3%), identified as White (72.9%), had obtained a bachelor’s degree or above (71.5%), was married or in a domestic partnership (98.6%), and had household incomes > US$70,000 (57.1%). More than one third (35.7%) experienced insomnia symptoms. The means of CEFIS, ISI, IBQ-R subscale Negative Affect, and BISQ-R scores were 29.3±9.5, 8.7±5.2, 4.1±1.1, and 68.8±12.7, respectively. After adjusting for infant age, the COVID-19 related family impact was not directly associated with BISQ-R scores, whereas parent ISI scores (β=-0.11, 95%CI [-.25, -.01]) and infant IBQ-R Negative Affect scores (β=-0.10, 95%CI [-.25, -.002]) significantly mediated the relationship. Conclusion The study highlighted the indirect effects of parent insomnia symptom severity and infant negative affect on infant sleep from the family impact of the COVID-19 pandemic. Future research should investigate how best to support healthy sleep for families during global crises. Support (If Any)

Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic & cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.

Aim: Few studies have examined the association between objective sleep metrics and arterial and echocardiographic (left ventricular systolic/diastolic function) markers of sub-clinical cardiovascular disease (CVD). The present study examined the association of wrist actigraphy-assessed sleep metrics with arterial stiffness, endothelial dysfunction, and left ventricular systolic/diastolic function. Methods: Fifteen young, healthy adults (21-39y; 60% women) with no history of CVD, and no current sleep-disordered breathing (WatchPat200, Itamar Medical) or sleep complaints wore Actiwatch Spectrum Plus actigraphs for eight nights (Philips Respironics, Bend OR) with accompanying sleep logs. Participants underwent fasting vascular testing including central augmented aortic pressure (AP), carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF%), left atrial volume index (LAVI), deceleration time (DT), and mitral valve E/e’ ratio (MVE/e’) using standardized methods. Bivariate correlations investigating the association between mean total sleep time (TST), sleep efficiency % (SE), sleep-onset latency (SOL), and wake after sleep time (WASO) with cardiovascular indices were conducted. Curvilinear regression models examining quadratic relationships between TST and the cardiovascular indices were conducted. Results: On average, participants obtained 6 hrs 44 min of TST (SD=29.1), with 86.0% SE (SD=3.1), 10.6 min SOL (SD=8.5), and 37.0 min WASO (SD=11.6). cfPWV (range: 4.8-7.5), EF% (range: 60.0-72.0), LAVI (range: 15.0-26.7 mL/m 2 ), and MVE/e’ (range: 3.2-7.8) were all within normal ranges according to age and sex normative standards. Mean FMD was 9.2% (SD=4.62, range: 4.3-19.8). Correlations indicated that greater SOL was associated with greater cfPWV (r=.63, p=0.01), and AP (r=.57, p=0.03). Lower SE (r= -.70, p=0.003) and higher WASO (r=.71, p=0.003) were associated with higher MVE/e’. WASO was associated with higher DT (r=.57, p=0.04). Curvilinear regression models revealed a quadratic relationship between TST and cfPWV (F[2,11]=9.78, p=0.004) such that shorter and longer TST were associated with greater cfPWV. No sleep metrics were associated with FMD, EF%, or LAVI. Conclusions: Among normal sleeping, apparently healthy young adults, with no history of CVD, lower levels of objective sleep quality and both shorter and longer sleep duration were associated with greater arterial stiffness, whereas only lower levels of objective sleep quality were related to worsening left ventricular diastolic dysfunction. These data may have implications for CVD risk reduction in young, healthy adults.

Introduction Infant sleep is influenced by biopsychosocial interactions. However, the influence of an interactive home environment is underexplored. The aim was to examine whether early positive parent-child interactions and an enriched home environment were associated with better infant sleep later. Methods Pregnant, obese, and low-income Latina women were recruited for a RCT delivering a 12-month intervention for infants to prevent overweight (n=129). At 1, 6, and 12 months, mothers reported breastfeeding duration, completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), and underwent the Home Observation for Measurement of the Environment (HOME, range: 0-45) Inventory including subscales of Responsivity, Acceptance, Organization, Learning Materials, Involvement, and Variety. Pearson correlations between HOME and BISQ-R at each visit were conducted. Significant associations (α Results The mean 1-, 6- and 12-month BISQ-R were 84(SD=6.1), 76.4(SD=8.3), and 78.5(SD=8.0), respectively. The 1-month HOME total score (M=21.8[SD=4.4]) significantly correlated with the 6- and 12-month BISQ-R. The regression of 1-month HOME with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.3, p=0.001), greater HOME total scores (β=0.2, p=0.037), and 1-month BISQ-R scores(β=0.2, p=0.038), which explained 13.1% of the variance (F[3,106]=6.5, p Conclusion Better infant sleep was associated with an early interactive home environment, especially parent’s responsiveness and people/events providing organized variety. Support (if any)

Introduction Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls. Methods Persons with insomnia (met ICSD-III criteria) and good sleeping controls ( Results AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’. Conclusion Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning. Support American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18