Faculty Bibliography

Introduction: Population estimates for sleep duration and quality are inconsistent because they rely on self-report and smaller samples using objective data. Tracking and wearable devices may provide more accurate estimates of sleep duration and quality. In this study, we investigated estimates of sleep duration and quality among 2 million users of a mobile sleep application in an urban city in the United States (U.S.).
Method(s): We examined sleep duration and quality from 2,194,897 users of SleepCycle, a popular sleep tracking app. over a four-year period (2015 to 2018). In this analysis, we specifically explored differences in sleep duration and quality by demographic factors, including age and sex. We utilized graphical matrix representations of data (heat maps) and geospatial analyses to compare sleep duration (in hours) and sleep quality (based on a composite score amalgamating time in bed, deep-sleep time, sleep consistency, and amount of times fully awake), considering potential effects of day of the week and seasonality.
Result(s): Among SleepCycle users, 45.6% (n=1,001,335) were female. The average age of the sample was 31.0 years. The mean sleep duration of the total sample was 7.11 hours; women slept longer than did men (M=7.27 hours vs. M=7.00 hours, p<.001). Increasing age tended to be associated with longer sleep duration and better sleep quality. Results also showed sleep duration was longer on weekends (M=7.19 hours), compared to weeknights (M=7.09 hours). Sleep duration was longest (M=7.18 hours) during the winter, but shortest during the summer (M=7.11 hours). Sleep quality was highest (M=72.75) during the winter, but lowest during the summer (M=71.99).
Conclusion(s): Our findings from big data are consistent with previously reported estimates of sleep duration and quality. Sleep duration varied by age, sex, day of the week, and season. Future studies should determine whether estimates of sleep duration and quality are affected by environmental factors such as geographic location

Introduction: Child fatigue has been associated with behavioral outcomes, including aggression, hyperactivity, and conduct problems, which may affect academic performance. We explored whether fatigue was associated with external behavioral health outcomes in a predominantly Black (Afro-Caribbean and African-American) student population (90%). Ratings of parent and teacher agreement of child fatigue was evaluated. This analysis was part of a larger research program, which included a cluster randomized controlled trial in ten public elementary schools in historically disinvested neighborhoods.
Method(s): A total of 804 first-graders (7+/- 0.6 years old) participated in the study focused on child self-regulation, mental health achievement, parenting and parent involvement. Externalizing behaviors (i.e., conduct problems, aggression, and hyperactivity) were reported by teachers using the Behavior System for Children (BASC-2). A composite score of teacher-perceived child fatigue was created based on ratings of child fatigue, morning alertness, and falling asleep in class. Parent perception of child fatigue was assessed using the Children's Sleep Habits Questionnaire. Regression analysis was conducted to determine the association between teacher's reports of child fatigue and externalizing behavior problems. Cohen's kappa coefficient assessed parent and teacher agreement of child fatigue based on categorical classification of presence of child fatigue.
Result(s): Children who were perceived as fatigued (i.e., tiredness and falling asleep in class) by their teacher were more likely to have a high BASC externalizing composite score (T=60 cut off) (beta = -0.24, p<.001). Cohen's kappa of 0.004 (p<0.05) showed a slight discordance in perception of child fatigue comparing reports from teachers and parents, although results were not significant.
Conclusion(s): Teacher perception of child fatigue was significantly associated with teacher BASC T-score of child externalizing behavior outcomes. Future studies should explore longitudinal relationships between fatigue and mental health

Introduction: Based on principles of community-based participatory research methods (CBPR), a community-oriented framework was applied in three studies that focused on African- Americans/ Blacks (herein referred to as Blacks): The Metabolic Syndrome Outcome Study (MetSO), Tailored Approach to Sleep Health Education (TASHE), and Peer-Based Sleep Health Education and Social Support (PEERS-ED). We describe results of our application of this framework to enroll and study Blacks in these NIHfunded studies of obstructive sleep apnea (OSA).
Method(s): Our community-oriented framework includes strategic guidelines for effective intervention to engage communities in research and ensure cultural and linguistic appropriateness of sleep messages in behavioral interventions. Strategies included: 1) focus groups and in-depth interviews with key stakeholders; 2) establishing a community advisory board; 3) conducting Delphi surveys to identify high-priority diseases and conditions. Community barriers were identified through an iterative process using surveys and focus groups. Stakeholder groups were integral during the development, implementation and dissemination, reflecting a patient-oriented decision-making process with respect to key intervention components.
Result(s): MetSO, TASHE, and PEERS-ED reached nearly 3,000 Blacks at risk of OSA in New York City. Of those, 2,000 were screened for OSA. Sleep brochures were distributed to over 10,000 individuals. The mean age of community participants was 62+/-14 years; 69% were female; 43% had an annual income <$10,000; and 37% had 10); 10% reported an insomnia diagnosis and 12% used sleep medications. Based on WatchPAT data, 24% had moderate OSA and 18%, severe OSA. Compared to blacks receiving standard sleep messages, those exposed to tailored sleep messages in our interventions were nearly 4 times as likely to adhere to OSA care.
Conclusion(s): Community outreach may be an effective strategy in the reach and spread of sleep messages among low-income Blacks at-risk for OSA

Introduction: Using the National Health and Aging Trends Study (NHATS), we examined use of sleeping medication, difficulty falling asleep, and trouble falling back asleep among individuals with and without cognitive impairment.
Method(s): Binomial logistic regression examined sleep medication use and insomnia symptoms (difficulty falling asleep or falling back asleep after awakening) by cognitive impairment (no dementia and possible or probable dementia). Sleep-related variables were collected on frequency scales ranging from 1 (every day) to 5 (never). Of the sample, 71.1% were White (n=3,369), 20.7% were Black (n=982), 5.0% were Hispanic (n=235), and 2.4% other (n=113); 60.4% were female (n=2,662) and 39.6% were male (n=1,875).
Result(s): Respondents were classified as having no dementia (63.7%), possible dementia (8.5%), or probable dementia (12.9%). Of the sample, 10.7% reported medication use every night, 2.5% 5-6 nights/week, 5.7% 2-4 nights/week, 6.6% once/week and 59.4% reported no use. Of the respondents, 8.3% reported difficulty sleeping every night, 8.0% reported 5-6 nights/week, 21.4% reported 2-4 nights/week, 22.9% reported rarely, and 23.5% reported never experiencing difficulty sleeping. Regarding difficulty falling back asleep, 4.9% reported difficulty every night, 7.4% reported 5-6 nights/week, 26.0% reported 2-4 nights/week, 20.4% reported rarely, and 24.3% reported never. Compared to individuals who reported never using sleep medications, those reporting nightly use were significantly more likely to be cognitively impaired (OR=1.44,95%CI: 1.14-1.82). Compared to individuals reporting never having difficulty falling asleep, those reporting difficulty falling asleep nightly were not more likely to have cognitive impairment (OR=0.74 95%CI: 0.67 to 1.19). Compared to individuals reporting never having difficulty falling back asleep after awakening, those frequently reporting difficulty falling back asleep were less likely to be cognitively impaired (OR=0.44,95%CI:0.22 to 0.64).
Conclusion(s): Cognitive impairment was positively associated with sleep medication use in adjusted models, but not with trouble falling asleep or difficulty falling back asleep after awakening. Our findings are consistent with the literature on deleterious consequences of sleep medications

BACKGROUND:African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. OBJECTIVE:This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. METHODS:Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. RESULTS:A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. CONCLUSIONS:Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.

Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants.

Objective/UNASSIGNED:Stroke survivors generally have problems completing instrumental activities of daily living (IADL; eg, preparing meals, chores, taking a bath, and managing finances). However, it is unclear how stroke survivors might stave off IADL issues. Studies indicating that sleep has restorative neurological effects provide potential mechanisms to address issues with IADL. The aim of this study was to ascertain the association between sleep duration (short or long sleep duration) and IADL among stroke survivors and those without a stroke history. Methods/UNASSIGNED:Data of 486,619 participants were analyzed from the 2000 to 2015 National Health Interview Survey (NHIS), a nationally representative sample. Measures of self-reported stroke, sociodemographic variables, sleep duration, and IADL problems were collected. Binary logistic regression was utilized to analyze the relationship of short (≤6 hours) and long (≥9 hours) sleep duration with limitations to IADL. Results/UNASSIGNED:<0.001) adjusting for age, sex, race, marital status, poverty, and health. Conclusion/UNASSIGNED:Findings from our study indicate that, among stroke survivors, long sleepers were more likely to report IADL problems compared to average sleepers (7-8 hours). Future studies should investigate other potential mediators such as severity of stroke, medication, comorbidities, level of impairment, and whether improving sleep among stroke survivors may improve IADL.

Purpose of review/UNASSIGNED:To systematically review the available research studies that characterize the benefits, uncertainty, or weaknesses of commercially-available sleep tracking technology. Recent findings/UNASSIGNED:Sleep is a vital component of health and well-being. Research shows that tracking sleep using commercially available sleep tracking technology (e.g., wearable or smartphone-based) is increasingly popular in the general population. Methods/UNASSIGNED:Systematic literature searches were conducted using PubMed/Medline, Embase (Ovid) the Cochrane Library, PsycINFO (Ovid), CINAHL, and Web of Science Plus (which included results from Biosis Citation Index, INSPEC, and Food, Science & Technology Abstracts) (n=842). Study Inclusion and Exclusion Criteria/UNASSIGNED:Three independent reviewers reviewed eligible articles that administered a commercially-available sleep tracker to participants and reported on sleep parameters as captured by the tracker, including either sleep duration or quality. Eligible articles had to include sleep data from users for >=4 nights.