Faculty Bibliography

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: 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: 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: 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

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.

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.

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.

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.