Faculty Bibliography

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

OBJECTIVES: To reduce respondent burden for future evaluations of the National Heart, Lung, and Blood Institute-supported Programs to Increase Diversity Among Individuals Engaged in Health-Related Research (PRIDE), a mentored-research education program, we sought to shorten the 33-item Ragins and McFarlin Mentor Role Instrument (RMMRI), measuring mentor-role appraisals, and the 69-item Clinical Research Appraisal Inventory (CRAI), measuring research self-efficacy. METHODS: Three nationally recruited, junior-faculty cohorts attended two, annual 2-3 week Summer Institutes (SI-1/SI-2: 2011/2012, 2012/2013, 2013/2014) at one of six PRIDE sites. Mentees completed the RMMRI two months after mentor assignment and the CRAI at baseline (pre-SI-1) and 6-month (mid-year) and 12-month (post-SI-2) follow-up. Publications data obtained from Scopus in October 2015 were verified with mentees' curriculum vitae. The RMMRI and CRAI were shortened using an iterative process of principal-components analysis. The shortened measures were examined in association with each other (multiple linear regression) and with increase in publications (repeated-measures analysis of covariance). RESULTS: PRIDE enrolled 152 mentees (70% women; 60% Black, 35% Hispanic/Latino). Cronbach's alphas for the new 9-item RMMRI, 19-item CRAI, and four CRAI-19 subscales were excellent. Controlling for baseline self-efficacy and cohort, RMMRI-9 scores were independently, positively associated with post-SI-2 scores on the CRAI-19 and three subscales (writing, study design/data analysis, and collaboration/grant preparation). Controlling for cohort, higher RMMRI-9 and post-SI-2 CRAI-19 scores were each associated with greater increase in publications. CONCLUSIONS: The RMMRI-9 and CRAI-19 retained the excellent psychometric properties of the longer measures. Findings support use of the shortened measures in future evaluations of PRIDE.

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

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: Social capital refers to quality of networks of relationships among people who live and work together. Poor social capital predicts adverse outcomes, including cardiovascular disease, diabetes, and increased mortality. Little is known about how social capital relates to sleep health. The current study explored the relationship between social capital and sleep duration, insomnia symptoms, and daytime sleepiness. Methods: A sample of 1,007 participants from the Sleep Health and Activity, Diet and Environment Study (SHADES) was used. Social Capital was assessed as number of group/club memberships, neighborhood helping behavior, willingness to improve their neighborhood, sense of community belongingness, and trust of others in a community. Sleep duration was assessed with the NHANES questionnaire asking participants to report bed/wake time, then categorized as very short (<5hrs), short (5-6hrs), healthy (7-8hrs), and long (>8hrs). Insomnia was assessed with the Insomnia Severity Index and categorized as none, mild, and moderate-severe. Sleepiness was assessed with the Epworth Sleepiness Scale. Logistic regression examined whether sleep variables and social capital measures were associated. Results: Compared with healthy sleepers, decreased likelihood of group membership was seen for very short (OR=0.50;9 5%CI[0.26,0.98];p<0.05) and long (OR=0.41;95%CI[0.18,0.9 3],p<0.05) sleepers. The belief that neighbors rarely/never help each other was more commonly reported by very short (OR=1.9 6;95%CI[1.11,3.46],p<0.05) and short (OR=1.64,95%CI[1.14 ,2.37],p<0.01) sleepers, relative to healthy sleepers, as well as those with moderate-severe insomnia (OR=1.04,95%CI[1.01,1.0 8],p<0.05) and sleepiness (OR=1.04;95%CI[1.01,1.08];p<0.05). A decreased sense of belongingness was felt by very short (OR= 0.57,95%CI[0.35,0.93],p<0.05) and short (OR=0.65;95%CI[0 .49,0.86];p<0.01) sleepers, those with moderate-severe insomnia (OR=0.55,95%CI[0.39,0.78],p<0.01) and sleepiness (OR=0. 95[95%CI[0.93,0.98];p<0.01). Decreased likelihood of trust was reported by short sleepers (OR=0.74,95%CI[0.54,1.00],p<0.05) and those with moderate-severe insomnia (OR=0.57,95%CI[0.40,0 .82],p<0.01) and sleepiness (OR=0.96;95%CI[0.94,0.99];p<0.05). Moderate-severe insomnia was also associated with the belief that neighbors help each other (OR=0.64;95%CI[0.45,0.90];p<0.05). Conclusion: Measures of poor sleep health (short duration, insomnia, sleepiness) are associated with fewer group memberships, low perceived community belongingness, trust, or intention to engage in neighborhood improvement

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

Depression and Obstructive sleep apnea (OSA) are the major associated comorbidities. OSA is a rapidly growing problem in the society that is connected to the rising rates of obesity; at the same time, the depression rate is also increasing day by day. Patients with OSA present with sleep problems, anxiety, and depressive symptoms, depressive patients can also present with the same symptoms. The quality of an individual's health can be improved by the early detection of the symptoms of overlapping OSA and depression. By addressing these issues early, the associated healthcare costs and burden can be reduced simultaneously.