Faculty Bibliography

OBJECTIVES: The current study examined the role of emotional distress in explaining racial/ethnic differences in unhealthy sleep duration. DESIGN: Data from the 2004-2013 National Health Interview Survey were analyzed using SPSS 20. SETTING: Data were collected through personal household interviews in the United States. PARTICIPANTS: Of the total 261,686 participants (age>/=18 years), 17.0% were black, 83.0% were white, and the mean age was 48 years (SE=0.04). MEASUREMENTS: To ascertain total sleep duration, participants were asked, "How many hours of sleep do you get on average in a 24-hour period?" Sleep duration was coded as short sleep (<7hours), average sleep (7-8hours), or long sleep (>8hours). Emotional distress-feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period-was measured using Kessler-6, a 6-item screening scale. RESULTS: Of the participants reporting significant emotional distress (4.0% black, 3.5% white), chi2 analyses revealed that a higher percentage of blacks, compared with whites, reported unhealthy sleep durations. Relative to Whites, Blacks had increased prevalence of short sleep (prevalence ratio=1.32, P<.001) or long sleep (odds ratio =1.189, P<.001). The interaction between race/ethnicity and emotional distress was significantly associated with short (prevalence ratio=0.99, P<.001) and long sleep (odds ratio=0.98, P<.001) durations. CONCLUSIONS: Individuals of the black race/ethnicity or those reporting greater levels of emotional distress are more likely to report short or long sleep duration. Emotional distress might partially explain racial/ethnic differences in unhealthy sleep duration between blacks and whites.

BACKGROUND: Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. RESULTS: Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. CONCLUSION: Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.

Introduction: Evidence suggesting that poor sleep is linked to compromised neurocognitive function and poorer quality of life, as well as evidence that stroke survivors suffer from poor sleep have laid the groundwork for the current study. This study investigated the association between sleep and quality of life and neurocognitive characteristics among Blacks and Hispanic stroke survivors. Methods: Using a sample of twenty-three Black and Hispanic stroke survivors, we analyzed associations of sleep parameters (which included sleep duration, sleep quality, insomnia symptoms, being tired, and daytime sleepiness) with quality of life (as measured by the Stroke Specific Quality of Life [SSQOL]) and neurocognitive factors (e.g. working and episodic memory, attention and control, executive function, and processing speed). Additionally, we ascertained whether sleep parameters were associated with SSQOL total score and neurocognitive domains, after adjusting for effects of age and gender. Results: The mean age of the sample was 57 yrs. (S.D.=10.73); 54.5% were female, 59.1% were born in the U.S., 72.7% were primary English speakers, 68.2% were unemployed, 85.7% had at least a Bachelor's degree, 54.5% reported trouble sleeping, and the mean self-reported sleep duration was 6.55 hrs. (S.D.=2.11). Bivariate correlational analyses indicated that individuals who reported "trouble sleeping" (r= -0.47, p<.05), or "being tired" (r= -0.43, p<.05), had lower scores on a Working Memory. Additionally, sleep quality (r= -.61, p<.01) and insomnia (r= -0.49, p<.05) were negatively associated with quality of life. Linear regression analysis indicated that sleep quality was inversely associated with Total SSQOL score (B= -18.84, S.E.= 8.45, p<.05), adjusting for age and gender. Conclusion: We found that sleep quality was associated with poor functional outcomes (quality of life and working memory). Future studies should investigate the long-term consequences of poor sleep on quality of life and neurocognition among stroke survivors

Introduction: Metabolic syndrome poses an increased burden of disease, warranting heightened public health attention. This study assessed effects of birthplace on cardiometabolic profile among blacks with metabolic syndrome and sleep apnea risk, while exploring potential gender-based effects. Methods: This analysis is based on data from 610 black patients (mean age= 63 +/- 11 years female=65%) with evidence of metabolic syndrome and were at risk for sleep apnea using the ARES. Participants from four community-based clinics in Brooklyn, NY provided sociodemographic, medical, and clinical data. Clinical data included body mass index (BMI), blood pressure (BP), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and fasting plasma glucose (FPG) or hemoglobin (HbA1c) for those who had a diagnosis of diabetes. General Linear Model (GLM) was used to assess effects of birthplace and gender on cardiometabolic parameters, adjusting for age effects. Results: Of the sample, 61.6 % were foreign-born blacks (FBB) and 38.4 % were US-born blacks (USB). FBB had significantly lower BMI compared with USB (32.76 +/- 0.35 vs. 35.41 +/- 0.44, F=22.57), but had significantly higher systolic blood pressure (136.70 +/- 0.77 vs. 132.83 +/- 0.98; F=9.60) and fasting glucose levels than did USB (146.46 +/- 3.37 vs. 135.02 +/- 4.27; F=4.40). Men had higher diastolic BP (76.67 +/- 0.65 vs. 75.05 +/- 0.45; F=4.20), glucose (146.53 +/- 4.48 vs. 134.95 +/- 3.07; F=4.55) and triglyceride levels (148.10 +/- 4.51 vs. 130.60 +/- 3.09; F=10.25) compared with women, but women had higher LDL-cholesterol (109.24 +/- 1.49 vs. 98.49 +/- 2.18; F=16.60) and HDLcholesterol levels (50.71 +/- 0.66 vs. 42.77 +/- 0.97; F=46.01) than did men. Conclusion: FBB have lower levels of obesity, similar rates of hypertension, dyslipidemia, stroke history, but higher rates of diabetes, history of heart disease, and systolic BP compared with USB. Findings may have implications for addressing effects of birthplace and gender on cardiovascular disease outcomes

Introduction: Diabetes is one of the leading causes of health-related morbidity and mortality in the United States. To reduce the burden of diabetes, several behavioral strategies (e.g., healthy diet and increased physical activity) have been implemented. Unfortunately, these strategies have yielded modest improvements, and in some groups (racial/ ethnic minorities) the diabetes burden is mounting yearly. Recent evidence that sleep is associated with increased diabetes risk suggests that sleep may be a novel and potentially impactful target to alleviate this burden. The current study explored the long-term impact of reducing the prevalence of insufficient sleep on diabetes burden in the U.S., relative to potential positive health benefits of physical activity. Methods: Using a representative sample of 100,000 hypothetical participants who do not experience healthy sleep in an Agent-Based Model simulation (a dynamic simulation technique). In this model, we investigated whether reducing the prevalence of insufficient sleep (<=6 hrs.) by 10% or 20% would have a significant impact on attenuating the prevalence of diabetes over a 10-year period. We also explored whether similar observations would be made by increasing the prevalence of individuals engaging in 150 mins/week of moderate physical activity as an alternative to healthy sleep, given the difficulty many have experienced in increasing their habitual sleep time. Results: Based on the simulation model, reducing the prevalence of insufficient sleep by 10% or 20% attenuated the prevalence of diabetes among insufficient sleepers by 1.7% or 2.6%, respectively. By contrast, increasing the prevalence of physical activity by 10% or 20% seemed to be much less impactful. Indeed, the prevalence of diabetes was only reduced by 0.4% or 1.6%, respectively. Conclusion: Despite mixed results shown in experimental and clinical studies, in this particular model, reducing the prevalence of insufficient sleep at the population level could be more impactful in preventing diabetes than increasing physical activity alone in the United States. Future research should determine whether results of our simulated model could be replicated at the population level

Introduction: Sleep disorders are associated with hypertension and cardiovascular diseases (CVD), and treatment of sleep disorders may improve outcomes. To examine burden of sleep disorders, treatment rates, and racial/ethnic differences among patients with hypertension/ CVD, we examined the national burden of sleep disorders, compared with rates of sleep disorder treatments, and evaluated whether racial/ ethnic disparities exist among patients with hypertension/CVD. Methods: We analyzed data from a nationally representative US sample of 417,950 adult ambulatory visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), 2005-2012. We identified visits by adults with hypertension or CVD (coronary artery disease, congestive heart failure, or stroke) in which a diagnosis of sleep disorders or complaints were recorded. Primary measures were provision of a sleep study, medication, or behavioral therapy to improve diet, weight loss, or exercise). We conducted multivariate logistic regression analyses to examine sleep disorder treatment by demographic and clinical risk factors. Results: Sleep apnea was identified in 11.1-per-1,000 visits and insomnia in 10.5-per-1,000 visits, while any sleep disorder was identified in 22.5-per-1,000 visits. Overall, patients with hypertension and a sleep disorder were referred for a sleep study in 7.6% of visits, prescribed sleep medication in 29.7% of visits, and offered behavioral therapy in 31.0% of visits. In adjusted analyses, behavioral therapy was more likely to be provided to patients who were obese compared with those who were normal/overweight (OR=2.89; 95%CI[2.00- 4.17];p<0.001), but less likely to be provided to smokers than nonsmokers (OR=0.61; 95%CI[0.38-0.99];p<0.05). Non-hispanic blacks were less likely to receive medications than were non-Hispanic whites (OR=0.44; 95%CI[0.21-0.92];p<0.05). There were no differences in sleep study by race/ethnicity, but patients with insomnia were less likely to be referred for a sleep study compared with patients with sleep apnea (OR=0.07; 95%CI[0.03-0.18];p<.001). Conclusion: Although sleep disorders were observed in a small proportion of patients with hypertension/CVD, the prevalence rates were relatively lower than those reported for the general population. Behavioral therapy was provided in a small number of visits, and non-Hispanic Blacks were less likely to receive medications than non-Hispanic Whites

Introduction: According to the Center for Disease Control and Prevention (CDC), 3 out of 4 Americans have a heart age (age, sex, systolic blood pressure, treatment for hypertension, smoking, diabetes, HDL cholesterol, total cholesterol and 10-year cardiovascular risk) that is five times greater than their chronological age. Non-Hispanic blacks and Hispanics are even at greater risk with an average heart age 11 times greater than their chronological age. Evidence linking short sleep duration with cardiovascular disease (CVD) may inform future behavioral strategies to reduce CVD risk, heart age, and accelerated aging (heart age greater than chronological age), especially among racial/ethnic minorities who are at greater risk of poor sleep and CVD. Methods: Using data from 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey (NHANES), we investigated whether short sleep duration (<7 hrs/24 hr. period) was associated with accelerated aging and whether this association differed across race/ethnicity. Heart age was calculated based on the Framingham Study Heart Age Calculator, a well-established composite CVD risk predictor. Results: The majority of the population were women (52%) with a high school degree or more (63%). Sixty-six percent were Non- Hispanic (NH)-white, 12% were NH-black, and 15% were Hispanic. NH white adults were more likely than non-Hispanic black and Hispanic adults to sleep at least 7 hours everyday (67.6% vs 50.3% and 63.1%, respectively p<0.05). NH- white adults had lower mean accelerated age (7.2 years) than NH- black adults (8.8 years) and Hispanic adults (10 years) (p<0.05). Regression models showed: a) accelerated aging was significantly associated with race/ethnicity; b) short sleep duration explained 14% of the association between race and accelerated aging; c) accelerated aging was significantly associated with short sleep; and d) race explained 14% of the association between short sleep and accelerated aging. Conclusion: Compared with non-Hispanic Whites, non-Hispanic black and Hispanic adults have greater levels of heart age and accelerated aging, and short sleep duration significantly contributes to this difference. Future studies should investigate the longitudinal effects of improved sleep on heart age and accelerated aging

Introduction: Stroke survivors have a heightened risk of having problems with daily functioning. However, it is unclear what behavioral factors increase the likelihood of problems with daily functioning among stroke survivors. Hence, the purpose of this study is to investigate the association between short sleep duration and daily functioning, among stroke survivors. Methods: For analysis, we used data from the National Health Interview Survey (NHIS) 2000-2015 dataset which contained sociodemographic variables, self-reported stroke, problems with instrumental activities of daily living (IADL), and sleep duration. Data were analyzed to investigate the association between IADL and short sleep duration among stroke survivors. Results: Of the sample of 1,108,043 individuals (mean age was 45.73 yrs.; S.D.=141.48), 52.7% were female, 77.4% identified as White, 14.2% as Black, 41.3% were married, 62.7% were currently working, 31.1% had families earning less than $35,000 annually, and 87% reported their general health status as Excellent to Good. Thirty percent of stroke survivors reported problems with IADL and 34.4% of respondents who reported problems with IADL were short sleepers. Results from the Binary Logistic regression indicated that stroke survivors (N=14, 350) who are short sleepers were 35% more likely to report problems with activities of daily living, as compared to stroke survivors who did not report short sleep (OR=1.355, 95% CI=1.23- 1.49, p<.001), adjusting for the effects of age, sex, race, marital status, health status, and income. Conclusion: Findings from our study indicate that stroke survivors who experience less than seven hours of sleep per day on average are at increased risk of IADL problems. Future studies should investigate whether improving sleep would improve IADL functioning in stroke survivors

Introduction: Latinos experience higher asthma disease burden than do Whites. The literature suggests that this disease burden may be due to problems with asthma management and control. Higher disease burden in Latinos may explain why studies show strong associations between sleep and asthma morbidity in Latino children compared with non-Latino white children. The current study investigated the association between asthma and short sleep duration among Latinos. Methods: We used data from the National Health Interview Survey (NHIS)-2000-2015, which provided demographics, chronic diseases, self-report asthma, and sleep duration. Data were analyzed to assess the prevalence of short sleep duration and asthma among Latinos, as well as the association between short sleep duration and asthma. Results: Of the total sample of 227,869 Latinos (mean age= 39.91 S.D.=15.65 yrs.), 51.7% were female, 64.2% were currently employed, 19.9% were overweight/obese, 36.8% reported an annual family income less than $35,000, 14% reported their general health to be fair-poor, 27.9% were short sleepers (<7 hrs.) and 9.4% had asthma. We found that 28.9% of Latinos who reported a diagnosis of asthma were short sleepers, which was significantly greater than those without asthma (p<.001). Latinos with asthma were 68% more likely to report short sleep duration compared with those without asthma (OR=1.68, 95% CI=1.60-1.78, p<.001). Conclusion: Our findings indicate that Latinos with asthma are at significant risk of reporting short sleep duration, which may increase their risk for sleep-related comorbidities such as cardiovascular disease. Future studies should investigate environmental and social factors likely to influence associations between short sleep and asthma among Latinos

The current study assessed the prevalence of diabetes across four different physical activity lifestyles and infer through machine learning which combinations of physical activity, sleep, stress, and body mass index yield the lowest prevalence of diabetes in Blacks and Whites. Data were extracted from the National Health Interview Survey (NHIS) dataset from 2004-2013 containing demographics, chronic diseases, and sleep duration (N = 288,888). Of the total sample, 9.34% reported diabetes (where the prevalence of diabetes was 12.92% in Blacks/African Americans and 8.68% in Whites). Over half of the sample reported sedentary lifestyles (Blacks were more sedentary than Whites), approximately 20% reported moderately active lifestyles (Whites more than Blacks), approximately 15% reported active lifestyles (Whites more than Blacks), and approximately 6% reported very active lifestyles (Whites more than Blacks). Across four different physical activity lifestyles, Blacks consistently had a higher diabetes prevalence compared to their White counterparts. Physical activity combined with healthy sleep, low stress, and average body weight reduced the prevalence of diabetes, especially in Blacks. Our study highlights the need to provide alternative and personalized behavioral/lifestyle recommendations to generic national physical activity recommendations, specifically among Blacks, to reduce diabetes and narrow diabetes disparities between Blacks and Whites.