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.

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.

The pineal hormone Melatonin plays an important role in the regulation of the circadian sleep/wake cycle, mood, and perhaps immune functions, carcinogensis and reproduction. The human circadian rhythm of melatonin release from the pineal gland is tightly synchronized with the habitual hours of sleep. Peri- and postmenopausal women often complain of difficulties initiating and/or maintaining sleep, with frequent nocturnal and early morning awakenings. In this review we discuss the pathophysiology of melatonin function as it relates to sleep disorders in menopausal women, highlighting the potential use of exogenous melatonin during the menopausal transition and beyond.

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: 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: 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: 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: Fifteen million adults in the U.S. work shift schedules (characterized by work outside the conventional daytime), including on-call, night, and rotating shifts. Shift work is associated with health risks, including Type II Diabetes, hypertension, cardiovascular disease, and obstructive sleep apnea (OSA). Recent media coverage of drowsy driving incidents in transportation workers (bus and train operators) suggest current efforts to promote awareness and treatment for OSA are ineffective. In the current study, we examined sleep among transportation workers and identified avenues for programs to improve sleep health in this high-risk population. Methods: We analyzed data from surveys of employees who work in transportation (truck, snow plough, construction operators) on shift work schedules in the rural Northeast (N = 239). Participants filled out pen-and-paper surveys assessing sleep characteristics including total sleep time, sleep quality, sleep habits (using the Sleep Hygiene Index) daytime sleepiness using the Epworth Sleepiness Scale; sleep apnea risk (according to the Apnea Risk Evaluation System, ARES); and demographic/clinical factors. Results: Among the survey respondents, 42.7% (n=27) reported hypertension, 16.4% (n=18) reported sleep apnea, and 14.5% (n=16) reported diabetes. Overall, 40.5% (n=105) reported short sleep (<6hrs), while 52.1% reported sleep between 6 and 9hrs, and 0.8% reported long sleep (>9hrs). Among respondents, 24.7% (n=64) reported "very bad" or "fairly bad" sleep quality. Responses to sleep hygiene identified prevalent, but modifiable sleep habits; 55.6% (n=144) "think, plan, or worry in bed," and 48.6% (n=126) "use alcohol, tobacco, or caffeine within 4hrs of bedtime." In response to "frequency of snoring", 64.1% (n=166) of participants report "sometimes," "frequently," or "almost always" snoring. Finally, a majority of participants, 54.5% (n=60) were at "moderate" to "high" risk for OSA (>=4 on the ARES). Conclusion: Although sleep health is critical for vigilance and safe driving, individuals in transportation working on shift schedules have poor sleep quality, insufficient sleep, and are at risk for OSA. Future research should use tailored interventions to reduce modifiable barriers (e.g., caffeine close to bedtime) among transportation shift workers to improve sleep health and implement initiatives to improve OSA screening and treatment

Introduction: Obstructive sleep apnea (OSA) and insomnia are two of the most common sleep disorders worldwide. Both conditions are associated with detrimental health consequences. Participation in clinical trials remains essential in understanding screening, diagnosing and treatment. However, the extent to which minority populations are represented in clinical trials that focus on sleep disorders is not yet known. Methods: We queried the Clinicaltrials.gov website, the registry that includes trials conducted in the U.S. and globally to characterize trials (observational and interventional) that focused on OSA and insomnia. All registered trials conducted from 2000 to November 28, 2016 were included. Results: Of the 230,894 trials registered in Clinicaltrials.gov, 826 trials were related to sleep disorders. Of the sleep disorders trials, 34% included drugs, 28% included a device, and 20% were behavioral. Half of the trials were completed (54%) and less than 10% were active, but not yet recruiting or recruiting by invitation only. Eighty percent of the trials were treatment related. Of the 826 sleep trials, 21% reported results, and 12% reported information on race/ethnicity enrollment. Overall, 7,321 of participants in these studies were white followed by 1,461 black, 624 Asian, 551 Hispanic, and 283 'other or unknown'. Conclusion: These results suggest that the number of minority populations in sleep disorders trials are relatively low, specifically compared to the number of trials reported overall. OSA and insomnia treatments are efficacious and effective in the general population. However, the extent to which treatments are effective and utilized by minority populations is not clear; this may in part be related to limited participation in clinical trials. Without appropriate representation in clinical trials, it is difficult to assess which screening, diagnostic, and treatment options work best for minorities, and which factors may influence uptake of treatment. Failure to address this issue may contribute to the increasing disparities in sleep health