Faculty Bibliography

Introduction: Sleep disturbance is a common complaint in the general population. Studies have shown that there are substantial differences between and within racial/ethnic groups with respect to reporting sleep problems, with blacks being less likely to report such problems. Previous studies, however, have not speciically examined black patients with symptoms of obstructive sleep apnea (OSA). This study sought to investigate further whether blacks at risk for OSA are likely to report sleep problems, which would suggest no bias in reporting. Methods: We analyzed data from the Metabolic Syndrome Outcome (MetSO) study, an NIH-funded cohort study of 1,035 blacks (mean age: 62.3 + 13.5 years, women = 69%) with metabolic syndrome. Metabolic syndrome was diagnosed using criteria articulated in the joint interim statement for harmonizing the metabolic syndrome. Patients with a score > 6 on the Apnea Risk Evaluation System (ARES) were considered at high OSA risk. To assess sleep habits and problems, we administered the Sleep Disorders Screening questionnaire. The data was coded and analyzed using SPSS 19.0. Results: Of the sample, 60.4% had diabetes; 92.3%, hypertension; 74%, dyslipidemia; and 66.9%, obesity. Overall, 48.9% of the patients were at high OSA risk. Patients at OSA risk were more likely to report having trouble falling asleep (58.3% vs. 43.7%, p < 0.001), trouble staying asleep (60.5% vs. 41.2%, p < 0.001), complaint of early morning awakenings (58.4% vs. 42.2%, p < 0.001), daytime naps (53.4% vs. 44.4%, p < 0.001), excessive daytime sleepiness (56.8% vs. 40.2%, p < 0.001), and being diagnosed with insomnia (63.7% vs. 47.9, p < 0.001). Conclusion: Nearly half of the blacks with metabolic syndrome were at risk for OSA. Those at OSA risk were more likely to report sleep problems. Compared with previous studies, our analysis does not show a reporting bias among blacks, at least among those at risk for OSA

Epidemiologic studies have consistently shown that sleeping <7h and >/=8h is associated with increased mortality and morbidity. The risks of short sleep may be consistent with results from experimental sleep deprivation studies. However, there has been little study of chronic moderate sleep restriction and little evaluation of older adults who might be more vulnerable to negative effects of sleep restriction, given their age-related morbidities. Moreover, the risks of long sleep have scarcely been examined experimentally. Moderate sleep restriction might benefit older long sleepers who often spend excessive time in bed (TIB) in contrast to older adults with average sleep patterns. Our aims are: (1) to examine the ability of older long sleepers and older average sleepers to adhere to 60min TIB restriction; and (2) to contrast effects of chronic TIB restriction in older long vs. average sleepers. Older adults (n=100) (60-80years) who sleep 8-9h per night and 100 older adults who sleep 6-7.25h per night will be examined at 4 sites over 5years. Following a 2-week baseline, participants will be randomized to one of two 12-week treatments: (1) a sleep restriction involving a fixed sleep-wake schedule, in which TIB is reduced 60min below each participant's baseline TIB; and (2) a control treatment involving no sleep restriction, but a fixed sleep schedule. Sleep will be assessed with actigraphy and a diary. Measures will include glucose tolerance, sleepiness, depressive symptoms, quality of life, cognitive performance, incidence of illness or accident, and inflammation.

AIMS: The effect of race/ethnicity on the risk of obesity associated with short or long sleep durations is largely unknown. This study assessed whether the sleep-obesity link differentially affects black and whites. METHODS: Analysis was based on data obtained from 29,818 adult American respondents from the 2005 National Health Interview Survey, a cross-sectional household interview survey. RESULTS: Multivariate-adjusted odds ratios for obesity associated with short sleep (/=9 h) for blacks and whites were 1.48 (95% CI: 1.14-1.93) and 0.77 (95% CI: 0.67-0.89), respectively (all p < 0.001). CONCLUSION: Race/ethnicity may have significantly influenced the likelihood of reporting obesity associated with short and long sleep durations. Relative to white respondents, an excess of 78% of black respondents showed increased obesity odds associated with short sleep. Black long sleepers also showed increased odds for obesity, but white long sleepers may be at a reduced obesity risk.

INTRODUCTION: This study explored the associations between sleep duration and emotion regulation among urban black women (mean age=59 +/- 7 yrs). METHOD: Eligible women (n=523) provided sociodemographic data during face-to-face interviews. We used the Comprehensive Assessment and Referral Examination Physical to measure health status; women also estimated their habitual sleep duration. We utilized a modified version of Weinberger's conceptual model of repression, the Index of Self-Regulation (ISE) to measure emotion regulation. ISE scores were derived by amalgamating the defensive subscale from the Social Desirability Scale and the anxiety subscale from the State-Trait Anxiety Inventory. RESULTS: The median habitual sleep duration was 7 hours; 20% of the women were short sleepers (<6 hours) and 6% were long sleepers (>8 hours). Short sleepers, rather than long sleepers, had a greater likelihood of reporting insomnia symptoms than those sleeping 6-8 hours [63.4% vs. 28.1%; Chi2 = 41.87, p<0.001]. In the first logistic regression model, the odds of being a short sleeper for low regulators were 3 times greater than for high regulators [OR = 3.22 95% CI: 2.05-5.06; p<0.0001]. In multivariate-adjusted analysis, OR was reduced to 2.06, but remained significant. In the second logistic model, the likelihood of being a long sleeper among low regulators were 37% greater than for high regulators, but results were not significant [OR=1.37, 95% CI: 0.62-3.01; NS]. DISCUSSION: Short and long sleep duration are associated with reduced ability for emotion regulation. Women sleeping 6-8 hrs might be more adept at regulating emotions in their daily lives. Insomnia symptoms might mediate associations between emotion regulations and sleep durations.

Background. Evidence shows that blacks exhibit greater daytime sleepiness compared with whites, based on the Epworth Sleepiness Scale. In addition, sleep complaints might differ based on individuals' country of origin. However, it is not clear whether individuals' country of origin has any influence on excessive daytime sleepiness (EDS). Study Objectives. We tested the hypothesis that US-born blacks would show a greater level of EDS compared with foreign-born blacks. The potential effects of sociodemographic and medical risk were also determined. Design. We used the Counseling African-Americans to Control Hypertension (CAATCH) data. CAATCH is a group randomized clinical trial that was conducted among 30 community healthcare centers in New York, yielding baseline data for 1,058 hypertensive black patients. Results. Results of univariate logistic regression analysis indicated that US-born blacks were nearly twice as likely as their foreign-born black counterparts to exhibit EDS (OR = 1.87, 95% CI: 1.30-2.68, P < 0.001). After adjusting for effects of age, sex, education, employment, body mass index, alcohol consumption, and smoking habit, US-born blacks were 69% more likely than their counterparts to exhibit EDS (OR = 1.69, 95% CI: 1.11-2.57, P < 0.01). Conclusion. Findings demonstrate the importance of considering individuals' country of origin, in addition to their race and ethnicity, when analyzing epidemiologic sleep data.

Background. Evidence suggests that insufficient sleep duration is associated with an increased likelihood for hypertension. Both short (<6 hours) and long (>8 hour) sleep durations as well as hypertension are more prevalent among blacks than among whites. This study examined associations between sleep duration and hypertension, considering differential effects of race and ethnicity among black and white Americans. Methods. Data came from a cross-sectional household interview with 25,352 Americans (age range: 18-85 years). Results. Both white and black short sleepers had a greater likelihood of reporting hypertension than those who reported sleeping 6 to 8 hours. Unadjusted logistic regression analysis exploring the race/ethnicity interactions between insufficient sleep and hypertension indicated that black short (<6 hours) and long (>8 hours) sleepers were more likely to report hypertension than their white counterparts (OR = 1.34 and 1.37, resp.; P < 0.01). Significant interactions of insufficient sleep with race/ethnicity were observed even after adjusting to effects of age, sex, income, education, body mass index, alcohol use, smoking, emotional distress, diabetes, coronary heart disease, and stroke. Conclusion. Results suggest that the race/ethnicity interaction is a significant mediator in the relationship between insufficient sleep and likelihood of having a diagnosis of hypertension.