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provided blood and urine samples for measurement of eGFR and ACR
respectively. OSA severity was established from the oxygen desaturation
index (ODI, 4% desaturation) and the mean nocturnal oxygen saturation
(SaO
2
). CKD progression risk was determined from a heat map incorpo-
rating both eGFR and ACR (KDIGO 2012 Clinical Practice Guideline; normal
values: eGFR90 ml/min/1.73m
2
,ACR<3mg/mmol).
Results: Four hundred and ninety-five patients (306 (62%) male, age:
55±12y, BMI: 35.9±8.6 kg/m
2
) were recruited, of whom 47 (9.5%) reported
a previous CKD diagnosis and 51 (10.3%) reported a history of albuminuria.
Objectively, 313 (63%) had eGFR<90, 58 (11.7%) had eGFR<60, and 94
(19%) had albuminuria (ACR>2.99 mg/mmol). The cohort was divided into
3 groups based on ODI: <15 (no or mild OSA, ODI: 6±5, n¼105), 15-30
(moderate OSA, ODI: 21±4, n¼162), and >30 (severe OSA, ODI: 56±21,
n¼228). Mean SaO
2
fell significantly across the 3 groups (ODI<15: 92.1
(90.6-94.0); ODI 15-30: 90.4 (87.8-91.9); ODI>30: 86.7 (83.0-89.1), p<
0.001). BMI increased significantly across the 3 groups (ODI<15: 32 ±6.8;
ODI 15-30: 33.9±7.8; ODI>30: 39.1±8.9 kg/m
2
,p<0.001). Although the
prevalence of hypertension, diabetes and cardiovascular disease increased
with the severity of OSA, only diabetes reached statistical significance
between the groups (p¼0.03). After stratification by OSA status, 11.4% of
the no or mild OSA group, 31.5% of the moderate OSA group, and 32.5% of
the severe OSA group were considered to be at moderate to high risk of
CKD progression independent of mean SaO
2
, BMI and diabetes (p for
trend<0.001). The risk of CKD progression was maintained when patients
with prior CKD diagnoses were excluded.
Conclusion: Patients with moderate to severe OSA have an increased risk
of CKD progression. Further investigation is required to determine if
treatment of OSA decreases this risk.
Acknowledgements: CIHR CSCN Network Grant.
Insomnia
TOWARDS AN INTEGRATIVE DESIGN-ORIENTED THEORY OF SLEEP-
ONSET AND INSOMNOLENCE FROM WHICH A NEW COGNITIVE
TREATMENT FOR INSOMNOLENCE (SERIAL DIVERSE KINESTHETIC
IMAGINING, A FORM OF COGNITIVE SHUFFLING) IS PROPOSED FOR
EXPERIMENTALLY TESTING THIS AGAINST ALTERNATIVES
L. Beaudoin
1
,
2
,
3
, A. Lemyre
4
, M. Pudlo
5
, C. Bastien
6
.
1
Cognitive Science and
Education, Simon Fraser University, Canada;
2
CogSci Apps Corp., Canada;
3
CogZest, Pitt Meadows, Canada;
4
Psychologie, Universit
e Laval, Laval,
Canada;
5
Department of Psychology, University of Warsaw, Warsaw,
Poland;
6
Psychologie, Universit
e Laval, Lava, Canada
Introduction: We present progress towards an integrative design-ori-
ented (IDO) theory of sleep onset and insomnolence: the somnolent
information-processing theory (SIPt; Beaudoin, 2013, 2014). We define
"insomnolence”as difficulty falling (back) asleep da key feature of
insomnia (DSM-V).
We argue that theories of human sleep onset and propensity require an
IDO approach. By "design-oriented”we mean adopting the design stance
(Dennett, 1982; Poggio, 2012; McCarthy, 20 08) which is universally known
in theoretical Artificial Intelligence and cognitive science but unused in
theories of sleep onset and insomnolence, SIPt aside. Like other cognitive
science, IDO involves interdisciplinary information-processing theories;
but it is also integrative, aiming to specify how requirements of autono-
mous agency (competence) are realized by the interaction of diverse
component processes (subsuming motivational, cognitive, executive and
ancillary functions). The IDO approach requires that any appeal to key
psychological constructs ("consciousness", "arousal", "emotion", "atten-
tion", "goals", "intention", etc.) be grounded in specific IDO theories. This
approach is meant to contribute to a paradigm shift in research in
insomnia, "emotion”and psychology more generally, in response to what
Beaudoin, Hyniewska &Hudlicka (2017) and Muthukrishna &Henrich
(2019) identified as the root of psychologys replication crisis: lack of
rigorous, ambitious, progressive, evolutionarily grounded theoretical
integration. We claim control of human somnolence posed a significant
evolutionary challenge particularly due to their abundant cortex.
Leading theories of insomnia tend to explain insomnolence in terms of
cognitive and/or physiological activity (Perlis, 2011) or "arousal”(Harvey,
2005). Cognitive theories of insomnia assume that attention, intention and
effort to sleep are insomnolent (e.g., inhibiting "de-arousal", Espie, 2006).
Rejecting these assumptions, we argue that arousal is a problematically
polymorphic concept unsuitable for IDO explanations of somnolence.
In contrast, SIPt grounds its major concepts in specific IDO theories. In
accordance with Moors(2017) skepticism, SIPt replaces "emotion”with
computational architectures of motivation. More precisely, we leverage the
H-CogAff (Sloman, 2003) and LIDA (Franklin et al, 2013) architectures. We
replace the concept of "emotion”and "arousal”with IDO concepts of
perturbance and alarms. Perturbance is an emergent state in which an
insistent motivator tends to control executive functions (Beaudoin, 1994;
Wright, Sloman &Beaudoin, 1996). Perturbance is theoretical grounding
for repetitive thought (Watkins, 20 08). Alarms (Oatley, 1992; Sloman,
2003; Baars &Franklin, 2009) are urgent global control signals which, we
claim, also underlie the alarm reaction (Selye 1936).
SIPt postulates that (1) chronobiological processes (Borb
ely, 2016) are the
principal contributors to somnolence; (2) sleep-onset-like information-
processing is pro-somnolent (increases sleep propensity); (3) perturbance
is insomnolent; (4) alarms are insomnolent; (5) some perceptual states
affect sleep propensity: sensing supineness, rocking (Bayer et al, 2011) or
skin temperature, Romeijn et al (2011).
We describe an effortful form of cognitive shuffling, serial diverse kines-
thetic imagining (SDKI). It is suitable for an experiment pitting SIPt against
other theories (eg, Espie, 2006 and Havey, 2005) since only according to
SIPt should SDKI be both counter-insomnolent (per postulates 3 and 4) and
pro-somnolent (per postulates 2 and 5).
Yet more theoretical work is required towards an IDO theory of somno-
lence.
Insomnia
PRE-SLEEP COGNITIVE ACTIVITY IN ADULTS: A SYSTEMATIC REVIEW
A. Lemyre
1
, F. Belzile-Marsolais
1
,M.Landry
1
,C.Bastien
1
,L.
Beaudoin
2
.
1
Universit
eLaval,Qu
ebec, Canada;
2
Simon Fraser
University, Vancouver, Canada
Introduction: Cognitive activity during the pre-sleep period has long been
hypothesized to be a critical determinant for insomnia. Unfortunately,
there is no comprehensive review of the literature on this topic. The pre-
sent study aims to fill this gap in the literature. More precisely, this sys-
tematic review focuses on three themes: 1) the nature of pre-sleep
cognitive activity in good sleepers and individuals with insomnia, 2) the
links between measures of pre-sleep cognitive activity and sleep onset
latency (SOL) or insomnia, and 3) the effect of manipulating pre-sleep
cognitive activity on SOL or insomnia.
Materials and methods: For each theme, a systematic search was con-
ducted in PsycInfo. In total, 1730 articles were sorted. The sorting pro-
cessed comprised four steps. In step-1, two authors independently sorted
the documents based on the titles and abstracts. In step-2, all disagree-
ments resulting from step-1 were resolved by mean of consensus between
the two authors and the main author. In step-3, the two authors inde-
pendently sorted the remaining documents after reading them in full. In
step-4, all disagreements resulting from step-3 were, again, resolved by
mean of consensus.
Results: Regarding the first theme, mentation reports have been collected
in a sleep laboratory, with an ambulatory monitoring device, or using a
voice-activated tape-recorder. Normal transition to sleep is characterized
by sensorial imagery, inhibition of higher cognitive processes, hallucina-
tions, and changes in agency. Moreover, pre-sleep thoughts in individuals
with insomnia frequently relate to planning or problem-solving, and are
more unpleasant than in good sleepers. Regarding the second theme, ten
questionnaires and three interviews were identified. Insomnia is associ-
ated with more thoughts interfering with sleep, counterfactual processing,
worries, maladaptive thought control strategies, covert monitoring, and
cognitive arousal. Regarding the third theme, several strategies have been
tested: mental imagery, hypnosis, paradoxical intention, articulatory
suppression, ordinary suppression, and distraction. Their effect on sleep
onset is either beneficial, negligible, or detrimental.
Conclusions: In conclusion, our understanding of the links between pre-
sleep cognitive activity and insomnia might be improved based on new
psychological theories explaining normal sleep onset. Such theories would
help in interpreting available data, in developing new measures of pre-
sleep cognitive activity, and in creating novel treatment strategies.
Abstracts / Sleep Medicine 64 (2019) S1eS359 S29
