Faculty Bibliography

While sleep disturbance has been related to a number of negative health outcomes, few studies have examined the relationship between place of birth and sleep duration among individuals living in the US. Data for 416,152 adult participants in the 2000-2013 National Health Interview Survey (NHIS), who provided self-reported hours of sleep and place of birth were examined. Associations were explored between healthy sleep (7-8 h), referenced to unhealthy sleep (<7 or >8 h), and place of birth using multivariate logistic regression analysis. The mean age of the sample was 47.4 +/- 0.03 years; 56% were female. Of the respondents, 61.5% reported experiencing healthy sleep, 81.5% reported being born in the US and 18.5% were foreign-born adults. Descriptive statistics revealed that Indian Subcontinent-born respondents (71.7%) were more likely to report healthy sleep compared to US-born respondents (OR = 1.53, 95% CI = 1.37-1.71, p < 0.001), whereas African-born respondents (43.5%) were least likely to report healthy sleep (OR = 0.78, 95% CI = 0.70-0.87, p < 0.001). These findings suggest that place of birth should be considered in the assessment of risk factors for unhealthy sleep.

Although sleep apps are among the most popular commercially available health apps, little is known about how well these apps are grounded in behavioral theory. Three-hundred and sixty-nine apps were initially identified using the term "sleep" from the Google play store and Apple iTunes in September 2015. The final sample consisted of 35 apps that met the following inclusion criteria: 1) Stand-alone functionality; 2) Sleep tracker or monitor apps ranked by 100 + users; 3) Sleep Alarm apps ranked by 1000 + users; and 4) English language. A coding instrument was developed to assess the presence of 19 theoretical constructs. All 35 apps were downloaded and coded. The inter-rater reliability between coders was 0.996. A "1" was assigned if a construct was present in the app and "0" if it was not. Mean scores were calculated across all apps, and comparisons were made between total scores and app ratings using R. The mean behavior construct scores (BCS) across all apps was 34% (5% - 84%). Behavioral constructs for realistic goal setting (86%), time management (77%), and self-monitoring (66%) were most common. Although a positive association was observed between BCS and user ratings, this was not found to be statistically significant (p > 0.05). The mean persuasive technology score was 42% (20% to 80%), with higher scores for paid compared to free apps (p < 0.05). While the overall behavior construct scores were low, an opportunity exists to develop or modify existing apps to support sustainable sleep hygiene practices.

This study compared differences in both maladaptive beliefs and attitudes about sleep between African American (heareafter referred to as black) men at risk for obstructive sleep apnea (OSA) and those without OSA risk. METHODS: A convenience sample of 120 community-dwelling men provided sociodemographic, health and sleep data. A validated questionnaire was used to identify men at high risk for OSA and the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale was used to measure endorsed attitudes and beliefs about sleep. RESULTS: The mean age of the sample was 42 +/- 15 years. Men reported difficulty falling asleep (23%), difficulty maintaining sleep (23%), early morning awakening (35%), and use of sleep medicine (6%). 27% were at high risk for OSA. Men at high OSA risk had greater DBAS scores [F1, 92=13.68, p<0.001]; OSA risk was related to greater rate of sleep dissatisfaction overall [46% vs. 13%, Chi2=24.52, p<0.001]. CONCLUSION: The findings suggest that maladaptive beliefs and attitudes about sleep are important characteristics of black men at risk for OSA, and potential screenings around sleep difficulties should also consider these factors.

BACKGROUND: Associations between sleep duration and cardiovascular disease (CVD) risk factors have been demonstrated in past studies. However, previous studies have not investigated these relationships using objective sleep measures in sub-Saharan Africa. Our objective was to investigate the association between sleep duration and cardiovascular risk factors in a sample of community-dwelling Ghanaian adults. METHODS: We used wrist actigraphy along with a seven-day sleep diary to measure sleep duration, wake after sleep onset, sleep latency, and sleep quality. Participants were randomly selected from among those participating in the RODAM study in rural and urban Ghana. Outcome measurements included 10-year risk of CVD events, prevalent CVD, and metabolic syndrome. Additional participant characteristics were assessed using a structured questionnaire. Linear and logistic regression analyses were used to assess the relationships between sleep measures and CVD risk. RESULTS: A total of 263 participants from rural and urban Ghana participated. Total sleep time was positively associated with a 10-year CVD risk; this association remained after adjusting for age, sex, urban vs rural location, socio-economic status, physical activity, and sleep disturbance (beta = 0.990, p = 0.015). Short sleep, defined as sleeping less than seven hours per night on average, was negatively associated with a 10-year CVD risk, and this relationship remained in the fully adjusted model (beta = -2.100, p = 0.011). Sleep duration was not associated with prevalence of CVD or metabolic syndrome. CONCLUSION: Using actigraphy to measure sleep duration among a population of community-dwelling adults in sub-Saharan Africa is feasible. We found a positive association between sleep and CVD risk. No association was found between sleep duration and prevalent CVD or metabolic syndrome. The implications and new directions relating to these findings are stated.

Recent studies have examined sleep health among men who have sex with men (MSM), but no studies have examined associations of neighborhood characteristics and sleep health among this population. The purpose of this study was to examine associations between perceived neighborhood safety and sleep health among a sample of MSM in Paris, France. We placed broadcast advertisements on a popular smartphone application for MSM in October 2016 to recruit users in the Paris (France) metropolitan area (n = 580). Users were directed to complete a web-based survey, including previously used items measuring perceptions of neighborhood safety, validated measures of sleep health, and socio-demographics. Modified Poisson models were used to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between perceived neighborhood safety and the following outcomes: (1) poor sleep quality, (2) short sleep duration, and (3) self-reported sleep problems. Poor sleep health was common in our sample; e.g., 30.1% reported poor sleep quality and 44.7% reported problems falling asleep. In multivariate regression models, perceived neighborhood safety was associated with poor sleep quality, short sleep duration, and having sleep problems. For example, reporting living in a neighborhood perceived as unsafe during the daytime (vs. safe) was associated with poor sleep quality (aRR, 1.60; 95% CI, 1.01, 2.52), short sleep duration (aRR, 1.92; 95% CI, 1.26, 2.94), problems falling asleep (aRR, 1.57; 95% CI, 1.17, 2.11), and problems staying awake in the daytime (aRR, 2.16; 95% CI, 1.05, 4.43). Interventions to increase neighborhood safety may improve sleep health among MSM.

Sleep apnea is a prevalent sleep disorder that disproportionately affects blacks and has been previously studied among Caribbean-born blacks in Brooklyn, New York, but there has been negligible research in the Caribbean, specifically Haiti, and developing countries on this pressing health issue. A total of 373 medical students (mean age=20.6 years ± 2.3 years) from a medical school in Haiti participated in this study. Participants were administered a questionnaire assessing their sleep health and cardiovascular outcomes. The rate of sleep apnea symptoms was: snoring (13.2%), excessive daytime sleepiness (73.7%), and difficulty maintaining sleep (25.3%). Many reported falling asleep while watching television (68.2%) or while driving (7.8%). Based on logistic regression analysis, reported nocturnal breathing pauses was the most important predictor of the likelihood of reporting a history of cardiac disease (14.96; 95% CI=1.27-76.07). Findings suggest that more aggressive effort should be made to increase screening of sleep apnea among Haitians, thereby increasing the likelihood for early detection and treatment to reduce sleep-related risk of cardiovascular disease.

Neonaticide is the killing of a neonate on the day of its birth by his/her own mother. Neonaticidal women were reported to be predominantly young, unmarried, and primiparous. The motive for murdering the newborn relates to the shame, the fear of rejection, and abandonment by significant others, and the social stigmas associated with an illegitimate birth. The goal of the present study was to conduct a systematic review of the scientific literature and identify population-based studies reporting the incidence of neonaticide in different countries. A total of 485 abstracts were screened. After applying the inclusion/exclusion criteria, 10 studies were selected. Additional searches identified two more articles. Most of these studies were from Europe, where incidence varied from 0.07 (Finland, 1980-2000 period) to 8.5 neonaticides per 100000 births (Austria, 1975-2001 period). More recent studies have indicated that a growing proportion of neonaticidal women are married, multiparous, and suffers from mental disorders. Preventive measures, such as anonymous free delivery, were shown to reduce the incidence of neonaticide, although this effect may be short-lived. Despite social and institutional changes, neonaticide persists even in the most socially advanced, liberal, and prosperous societies in the world.

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.

Study Objectives: To assess effectiveness of a culturally and linguistically tailored telephone-delivered intervention to increase adherence to physician-recommended evaluation and treatment of obstructive sleep apnea (OSA) among blacks. Methods: In a two-arm randomized controlled trial, we evaluated effectiveness of the tailored intervention among blacks with metabolic syndrome, relative to those in an attention control arm (n = 380; mean age = 58 +/- 13; female = 71%). The intervention was designed to enhance adherence using culturally and linguistically tailored OSA health messages delivered by a trained health educator based on patients' readiness to change and unique barriers preventing desired behavior changes. Results: Analysis showed 69.4% of the patients in the intervention arm attended initial consultation with a sleep specialist, compared to 36.7% in the control arm; 74.7% of those in the intervention arm and 66.7% in the control arm completed diagnostic evaluation; and 86.4% in the intervention arm and 88.9% in the control arm adhered to PAP treatment based on subjective report. Logistic regression analyses adjusting for sociodemographic factors indicated patients in the intervention arm were 3.17 times more likely to attend initial consultation, compared to those in the control arm. Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation or treatment. Conclusion: The intervention was successful in promoting importance of sleep consultation and evaluation of OSA among blacks, while there was no significant group difference in laboratory-based evaluation and treatment adherence rates. It seems that the fundamental barrier to OSA care in that population may be the importance of seeking OSA care.