Faculty Bibliography

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: 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: 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: 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