Faculty Bibliography

Background: In the United States, 40% of African Americans are disproportionately affected by hypertension leading to severe comorbidity and eventual mortality. Ethnic differences in hypertension among the various African American groups are not well documented. We evaluated the blood pressure control rates of Caribbean and West African born African Americans compared to US born African Americans attending New York City Health and Hospitals Corporation (NYC HHC) facilities. Methods: Data from NYC HHC clinical data warehouse were extracted for hypertensive patients seen between January 2004 and December 2009. Ethnic origin was based on self-reported country of birth (United States, the Caribbean, and West Africa). Blood pressure (BP) was scored by taking the average of 3 or more blood pressure measurements over the course of 3 months of HHC data. All BP measurements were made in the clinical setting and uncontrolled hypertension was defined as BP >140/90 mm Hg. All BPs were measured at least 4 months after hypertension diagnosis. We also extracted information regarding comorbid diagnoses, number of prescribed antihypertensive classes, number of medical visits, age, sex, BMI and mortality. We compared the groups using cox proportional hazard regression models. Results: The sample was composed of 25,142 African Americans of whom 13,778 (54.8%) were US born, 10,032 (39.9%) were Caribbean born, and 1,332 (5.3%) were West African born. The mean sample age was 51 (14.2) years, the mean BMI was 32.4 (11.0) and the sample was 61.4% (N=15,449) female. Compared to US born African Americans, Caribbean and West African born African Americans had higher levels of systolic blood pressure (3.8mmHg; p<.001 and 2.4mmHg; p<.001 respectively) and were more likely to have uncontrolled BP (OR=1.40;p<.001 and OR=1.21;p=.002, respectively). These differences were found in unadjusted models and after adjustment for age, sex, BMI, number of classes of antihypertensive medications prescribed, comorbidity, number of BP measurements, and length of HTN diagnosis. However, US born African Americans had higher rates of mortality (11.6%) compared to Caribbean born (6.0%) and West African born (2.5%) African Americans, which was confirmed by unadjusted and fully adjusted cox proportional hazards regression models. Conclusion: Ethnic differences in cardiovascular outcomes and mortality exist among hypertensive African Americans served by NYC HHC. US born African Americans have a lower survival rate despite lower BP and better BP control than Caribbean and West African born African Americans. Future studies on African Americans should take ethnic variations within these populations into account

Uncontrolled blood pressure (BP) is linked to increased risk of obstructive sleep apnea (OSA). However, few studies have assessed the impact of this relationship among blacks with metabolic syndrome (MetS). Data for this study were collected from 1035 blacks (mean age=62+/-13 years) enrolled in the Metabolic Syndrome Outcome study. Patients with a score 6 on the Apnea Risk Evaluation System were considered at risk for OSA. Of the sample, 77.1% were low-to-high OSA risk and 92.3% were hypertensive, of which 16.8% had uncontrolled BP levels. Analysis also showed that 60.4% were diabetic, 8.9% had a stroke history, 74.3% had dyslipidemia, 69.8% were obese and 30.9% had a history of heart disease. Logistic regression analyses were employed to investigate associations between uncontrolled BP and OSA risk, while adjusting for known covariates. Findings showed that uncontrolled BP independently increased the odds of OSA risk twofold (odds ratio=2.02, 95% confidence interval=1.18-3.48, P<0.05). In conclusion, our findings show that uncontrolled BP was associated with a twofold greater risk of OSA among blacks, suggesting that those with MetS and who have uncontrolled BP should be screened for the presence of OSA.Journal of Human Hypertension advance online publication, 6 August 2015; doi:10.1038/jhh.2015.78.

OBJECTIVE: Obstructive sleep apnea (OSA) is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which are disproportionately more prevalent among blacks (ie, peoples of African American, Caribbean, or African descent). METHODS: This article reviews studies conducted in the United States (US) that investigated sleep screenings and adherence to treatment for OSA among blacks. In addition, guidelines are provided for implementing a practical framework to increase OSA screening and management among blacks. RESULTS: Several studies have documented racial/ethnic disparities in adherence to treatment for OSA. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality.

BACKGROUND: The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. METHODS: A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. RESULTS: The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. CONCLUSION: The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.

BACKGROUND: Metabolic syndrome poses an increased global burden of disease and causes immense financial burden, warranting heightened public health attention. The present study assessed the prevalence and severity of cardiometabolic risk among foreign-born versus US-born blacks, while exploring potential gender-based effects. METHODS: A total of 1035 patients from the Metabolic Syndrome Outcome Study (Trial registration: NCT01946659) provided sociodemographic, medical history, and clinical data. General Linear Model (GLM) was used to assess the effects of birthplace and gender on cardiometabolic parameters, adjusting for age differences in the sample. 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 HDL-cholesterol levels (50.71 +/- 0.66 vs. 42.77 +/- 0.97; F = 46.01) than did men. CONCLUSIONS: Results showed that birthplace has a significant influence on cardiometabolic profiles of blacks with metabolic syndrome. Patients' gender also had an independent influence on cardiometabolic profile.

Introduction: There is growing evidence suggesting relationships between depression and insomnia symptoms, yet scant evidence indicating directionality of those relationships or potential mediators. Evidence also suggests that social connectedness is a vital, protective factor for depression. Social connectedness may hold promise for helping sleep scientists better understand relationships between disrupted sleep and depression symptomology. Methods: The current study drew on social network analysis, an underexplored approach in sleep medicine, and survey methods to examine social connections, insomnia severity, and depression symptoms. Participants (n = 38) were 44.7% female, with an average age of 56.7 years; 86.8% of the participants self-identified as black. Bivariate correlations and logistic regression were performed to examine relationships between social connectedness, insomnia severity, and depression symptoms. Results: Of the sample, 71.1% reported insomnia and 23.7% reported depression. Participants provided responses to social network items across kin (m = 2.8 people), non-kin (m = 2.4 people), and formal networks (m = 1.6 people). Case by case agreement was strong between kin network size and depression symptomology (chi square < .05), but not between kin network and insomnia (chi square = .658). The logistic regression in the current study showed individuals with depressive symptoms were 6.75 (95% CI 1.45-31.47, p < 0.) times more likely to have severe insomnia versus individuals without clinically significant depression symptoms. There was no significant relationship in the regression between network variables and insomnia or depression symptoms. Conclusion: Our findings are consistent with previous findings and evidence on a strong, positive relationship between depression symptomology and insomnia severity. However, they are not in line with literature suggesting a positive relationship between kin networks and depression symptomology. It is of interest to explore the causal relationship between social connectedness and sleep, and how social networks might serve as a protective (or risk) factor for insomnia, and maybe depression

Introduction: Sleep is an important domain of health. Most data come from US or European samples. This study explored sleep in a university student population in Jamaica. Methods: As part of an ongoing study, N = 361 students were administered the Sleep Practices and Attitudes Questionnaire. To broadly evaluate differences between men and women t-tests for continuous variables and chi-square tests for categorical variables were evaluated. Results: Women reported a greater sleep need on average (7.97h vs 7.57h; p = 0.047). They were also more likely to feel tired (78% vs 67%; p0.019) and share their bed with other family members (19% vs 3%; p < 0.0001). If they felt sleepy, women were more likely to nap (p = 0.002) or exercise (p = 0.028). Women reported worse stimulus control, with greater likelihood of reading (p = 0.0002), worrying (p = 0.0001), arguing (p = 0.0065), and working (p = 0.0086) in bed. Men were more likely to get sleep information from the community (p = 0.022) and trust this information (p = 0.023), as well as information from neighbors (p = 0.007). Men were more likely to consider sleep an important safety issue for pilots (p = 0.0007), drivers (p = 0.013), and less important for police (p = 0.014). Women were more likely to believe that it was important to keep a consistent bedtime (p = 0.030), that st ress affects their sleep (p = 0.006), and that sleep is impor tant for health (p = 0.008). Women were more likely to believe that sleep loss impairs sex drive (p = 0.0008) and makes you tired (p = 0.012). Men were more likely to consider sleep important if it could be shown to be related to driving (p = 0.003), and heart disease (p = 0.0007). Women were more likely to consider sleep important if it could be shown to be related to weight (p = 0.047), hypertension (p = 0.046), missed work (p = 0.019), cognitive performance (p = 0.030), concentration (p = 0.006), and diabetes (p = 0.025). Conclusion: Overall, women reported a greater sleep need and more positive beliefs about sleep, but worse sleep hygiene

Introduction: rist actigraphy has been used extensively to measure objective sleep duration in sleep-related research. It has been validated against polysomngraphic and self-reported sleep measures. We sought to compare the accuracy of sleep measurements produced by three algorithms developed for wrist actigraphic scoring. Methods: A random sample of 263 participants were selected from among those participating in the Research on Obesity and Type 2 Diabetes among African Migrants (RODAM) study in Kumasi, Ghana. Each participant completed a sleep diary and wore a wrist actigraph for a period of seven days. Actigraphic data were scored using Actilife software, and th ree sepa rate validated algorithms developed separately by Sadeh, Cole-Kripke, and Jean-Louis were applied. SPSS was used to compare actigraphic sleep durations, derived from each algorithm, with self-reported sleep durations. Results: Valid actigraphic data, defined as having data for at least 5 of the 7-day period, were collected from 255 participants. Total sleep time in minutes varied substantially by sleep algorithm. Average sleep time derived from the Sadeh, Cole-Kripke, and Jean-Louis' algorithms were 346.8 (SD 49.3), 320.1 (SD 53.8), and 453.4 (SD 68.1), respectively. Participants self-reported an average of 468.3 (SD 85.7) minutes of sleep per night. The Sadeh and Cole-Kripke algorithms classified only 2.7% and 6.8% of the sample as sleeping the recommended 7 to 8 hours, respectively, whereas Jean-Louis' classified 28.2% in the 7 to 8 hour range. Conclusion: When employing actigraphy for sleep duration measurement, care should be exercised in choosing the most appropriate algorithm for scoring actigraphic data based on specific study populations in order to increase the accuracy of study results. The Jean-Louis' algorithm seems to fare better than other actigraphic scoring algorithms

Introduction: Older age is generally characterized by increased risk for chronic conditions, such as obesity, dyslipidemia, diabetes, and hypertension, and significant changes in sleep patterns. It is unclear whether sleep duration (short or long sleep), contributes to chronic conditions differentially contrasting retirees (> 65 years) and non-retirees (18-65 years). Methods: The study utilized data from the 2004-2013 National Health Interview Survey. NHIS applies a stratified multistage sample survey of the resident civilian non-institutionalized US population. Respondents provided sociodemographic and physician-diagnosed chronic conditions. We defined an unhealthy cohort as a subset of the retired population who reported at least one of four chronic conditions: obesity, dyslipidemia, diabetes, and hypertension. The healthy cohort included individuals who reported none of these conditions. Data was analyzed using SPSS 20. Results: Of the sample, 56.4% of the retirees were female and 81.7% were white. Among non-retirees, 52.0% were female and 76.5% were white. Non-retirees and retirees had an average sleep duration of 7.08 and 7.49, respectively (p < .01). Adjusted logistic regression analysis indicated that overall retirees were less likely to report short sleep (< 7hrs) [OR = .92, 95%CI = .89-.95, p8hrs) [OR = 1.89, 95%CI = 1.801.98, p < .01] compared to non-retirees. Healthy retirees had a 41% greater odds of reporting long sleep, but were no more or less likely to report short sleep, compared to non-retirees. Unhealthy retirees had a two-fold greater odds of reporting long sleep, but 5% lower odds of reporting short sleep, relative to non-retirees. Conclusion: Retirees had a higher mean sleep duration and were characterized by significantly greater odds of long sleep compared to non-retirees regardless of health status. Although retirees overall were more likely to report long sleep, those with 1 or more chronic health conditions had greater odds of reporting long sleep duration compared to healthy retirees

Introduction: Although the association between sleep disturbance and cancer is well documented, there is little evidence regarding how sleep duration among cancer survivors may be associated with other chronic diseases. Growing evidence suggests that cancer and diabetes may share common risk factors such as age, gender, race, being over weight, physical inactivity, smoking and alcohol. However, it is yet unclear how unhealthy sleep duration (a known cardiometabolic risk factor) may affect the relationship between cancer and diabetes. The aim of this study was to investigate whether sleep duration moderated the relationship between physician-diagnosed cancer and diabetes. Methods: Data was extracted from the NHIS dataset (2004-2013), providing demographics, chronic diseases and sleep duration. For the present analysis, we used a subset of individuals providing complete data for the following variables: physician-diagnosed cancer and diabetes and self-reported habitual hours of sleep. Data were analyzed to assess the moderating effect of sleep duration on cancer and diabetes risk. Results: Of the total sample of 283,086 participants, 15.8% were black and 77.2% were white; 55.7% were female and the mean age was 47.7 (18.0) years. In the first adjusted regression model, short sleep duration [< 7 hours] (Beta = 0.15, p < .001) and cancer (Beta = 0.91, p8 hours] (Beta = 0.28, p < .001) and cancer (Beta = 0.14, p < .001) were independently associated with diabetes. However, moderation analysis indicated that only long sleep significantly moderated relationships between cancer and diabetes (Beta = -0.218, S.E. = 0.055, p < .0001, 95% CI = -0.326-0.110). Short sleep did not significantly moderate those relationships. Conclusion: Our findings demonstrate significant associations of short and long sleep with cancer and diabetes. We should note that among people with long sleep, having a cancer diagnosis did not increase diabetes r isk. However, among people with a cancer diag nosis, short sleep seemed to have increased diabetes risk