Faculty Bibliography

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.

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.

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.

OBJECTIVE: To report baseline characteristics of junior-level faculty participants in the Summer Institute Programs to Increase Diversity (SIPID) and the Programs to Increase Diversity among individuals engaged in Health-Related Research (PRIDE), which aim to facilitate participants' career development as independent investigators in heart, lung, blood, and sleep research. DESIGN AND SETTING: Junior faculty from groups underrepresented in the biomedical-research workforce attended two, 2-3 week, annual summer research-education programs at one of six sites. Programs provided didactic and/or laboratory courses, workshops to develop research, writing and career-development skills, as well as a mentoring component, with regular contact maintained via phone, email and webinar conferences. Between summer institutes, trainees participated in a short mid-year meeting and an annual scientific meeting. Participants were surveyed during and after SIPID/PRIDE to evaluate program components. PARTICIPANTS: Junior faculty from underrepresented populations across the United States and Puerto Rico participated in one of three SIPID (2007-2010) or six PRIDE programs (2011-2014). RESULTS: Of 204 SIPID/PRIDE participants, 68% were female; 67% African American and 27% Hispanic/Latino; at enrollment, 75% were assistant professors and 15% instructors, with most (96%) on non-tenure track. Fifty-eight percent had research doctorates (PhD, ScD) and 42% had medical (MD, DO) degrees. Mentees' feedback about the program indicated skills development (eg, manuscript and grant writing), access to networking, and mentoring were the most beneficial elements of SIPID and PRIDE programs. Grant awards shifted from primarily mentored research mechanisms to primarily independent investigator awards after training. CONCLUSIONS: Mentees reported their career development benefited from SIPID and PRIDE participation.

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.

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: 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

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