Faculty Bibliography

Introduction: Insomnia is a highly prevalent sleep disorder in the U.S., and it is associated with employment status, gender, income, and education. While low socioeconomic status is linked to complaints of insufficient sleep, little is known, however, about the predictive effect of certain social determinants of insomnia among blacks. Our study examined the relationship between different socioeconomic variables and presence of insomnia among blacks. Methods: The study utilized data from the Metabolic Syndrome Outcome (METSO) study. This is an NIH-funded cohort study, enrolling a sample of 1,035 participants (mean age = 59 +/- 13 years), who provided complete data for the analysis. Of the sample, 69.20 % were male and 30.80 % were female; 42.54% had annual family income < $10K, 64.69% reported High School Education level, and 37.71% indicated a U.S. birthplace. The. Logistic regression analysis was used to assess the relationship between self-reported insomnia (a composite of difficulty falling asleep, difficulty staying asleep, and/or early morning awakening) and socioeconomic factors. Results: Analysis showed that income was the only factor showing significant associations with insomnia after controlling for education level, birthplace, age, and gender. Based on the logistic regression analysis, blacks with annual family income < $10,000 had increased odds of reporting insomnia (OR = 1.685; 95 CL 1.07-2.65, p $10,000. These results remained significant even after controlling for covariates. Conclusion: Consistent with previous studies, blacks reporting lower family income were more likely to report insomnia symptoms. Thus, income may play an important role in understanding higher rates of sleep complaints among blacks

Introduction: Short-term and long-term consequences of insufficient sleep among young adults are well documented in the United States. Insufficient sleep is associated with physical and mental health problems, substance use, injury, loss of productivity and early mortality. However, unlike the U.S., very little has been done to assess effects of insufficient sleep on these outcomes among Caribbean volunteers. This study explored the prevalence and determinants of insufficient sleep in three Caribbean countries. Methods: A total of 1,578 university participants (ages 18-30 years; female = 63.1%) from Jamaica, Barbados, and Grenada provided valid data for the current analysis. In addition to sociodemographic characteristics, participants completed self-reported health-related measures (BMI, health knowledge and physical activity). They also provided psychosocial (PTSD, substance use, social support, LOC and depression) and sleep data. Descriptive, bivariate and multivariate regression analyses were conducted using SAS 9.4. Results: Insufficient sleep (< 7hrs) was reported by 49.10% across the three countries. Barbados reported the highest rate (51.43%), compared with Jamaica (48.78%) and Grenada (45.58%). Analyses showed that males reported a higher rate of insufficient sleep (52.78% vs 47.02%, p < 0.05); 2) t-test revealed a difference in age; the average age of participants who reported insufficient sleep was 21.32 (mean diff = .28, p < .05). Regression for health habits showed exercise was significant; compared to people who report moderate levels of exercise, people with low levels of exercise were less likely to report insufficient sleep (OR = 0.77 95%CI: 0.57-1.04, p < 0.05). Regression for psychosocial factors revealed that PTSD was significant; people with PTSD symptoms are more likely to report < 7 (OR = 1.57, 95%CI: 1.20-2.06, p < .001) Conclusion: A higher rate of insufficient sleep was found in this Caribbean sample than that observed among US samples. This elevated rate has important public health implications with regard to sleep-associated adverse health outcomes and socioeconomic burden

Introduction: Sleep is an important domain of health. Most data come from US or European samples. This study explored sleep in a university student population in Jamaica Methods: As part of an ongoing study, N = 361 students were administered the Sleep Practices and Attitudes Question nai re. Sleep duration was assessed separately for typical workday/weekday sleep and weekend/vacation time over the past week, combined with a 5/2 weighted average for weekday/weekend sleep, and dichotomized at < 7 (74% of sample) and > 7 hours. To broadly evaluate differences between men and women t-tests for continuous variables and chi-square tests for categorical variables were evaluated. Results: Short sleepers were younger (p = 0.045), had worse sleep quality (p < 0.0001), reported greater sleep debt (p < 0.0001) despite less sleep need (p < 0.0001). Short sleepers were less likely to wake up refreshed (p = 0.002). If they had difficulty sleeping, they were more likely to report just getting up and starting their day (p = 0.007). If they were having trouble sleeping over a period of time, they were less likely to try to make more time for sleep (p = 0.014). Short sleepers were more likely to argue in bed (p-0.035). Short sleepers were less likely to report that medical conditions affect their sleep (p = 0.014), that they make enough time for sleep (p = 0.007), that it is important to keep a healthy bedtime (p = 0.001), and that sleep was important for health (p = 0.027). Short sleepers were more likely to report that lying in bed with eyes closed was as good as sleep (p = 0.039) and that turning up the volume while driving was an effective countermeasure to sleepiness (p = 0.035). Conclusion: Overall, short sleepers reported worse quality sleep and greater sleep debt despite reduced sleep need. They also reported more unhealthy sleep-related beliefs and practices

Introduction: Past research indicates that insomnia symptoms, defined as an inability to initiate or maintain sleep, may be associated with cardiovascular disease (CVD). In many low- and middle-income countries, urbanization and changing lifestyles have contributed to a rapidly growing burden of non-communicable disease, such as CVD. The present study assessed whether insomnia symptoms were associated with CVD in a sample of community-dwelling Ghanaian adults. Methods: Data were collected by structured questionnaires from a community-based sample of 263 participants (> 25 years) in Ghana, randomly selected from among participants in the Research on Obesity and Type 2 Diabetes among African Migrants (RODAM) study. Insomnia symptoms were assessed with three items: 1) having difficulty falling asleep, 2) having difficulty staying asleep, and 3) having problems waking up too early. Insomnia was coded as experiencing one or more of these symptoms. Incident CVD was measured using the Rose questionnaire. We used multiple logistic regression to test the association between insomnia and CVD, adjusting for age and sex. Results: The mean age of the sample was 47.3 years +/- 11.5, 41.1% were men, 44.9% had never been to school or attended only elementary school. Over 59% of the sample reported having one or more insomnia symptoms and 24% had CVD. After adjusting for age and sex, having insomnia symptoms was positively associated with having CVD, and this association approached significance (adjusted OR = 1.78, p = 0.063). This relationship was reduced after adjusting for comorbid conditions (adjusted OR = 1.66, p = 0.110). Conclusion: Our results indicate that insomnia may be related to having incident CVD, and that this relationship may be accounted for by comorbid conditions, which might confound the relationship between sleep and CVD. Nevertheless, assessing and treating insomnia may have important implications for managing CVD. This may be particularly important given the growing burden of chronic diseases in subSaharan Africa

Introduction: Sleep apnea severity, characterized by an increasing Apnea-Hypopnea-Index (AHI), correlates with increased incidence of cardiovascular morbidity. A subgroup of patients with obstructive sleep apnea (OSA) has respiratory events predominantly during REM sleep. Given the relatively low proportion of REM sleep to total sleep time, these patients often have low overall AHIs. It remains unclear whether exclusively REM-related OSA is associated with increased incidence of cardiovascular complications despite a low overall AHI. This study assesses the cardiovascular risk in patients with exclusively REM-related OSA. Methods: Data was obtained on 4455 adults enrolled in the Sleep Heart Health Study who had previously undergone polysomnography and been prospectively followed for cardiovascular complications such as coronary artery disease, myocardial infarction, or stroke up to ten years after the initial sleep study. OSA was defined by AHI4% overall and in REM and NREM sleep periods. The participants were classified into 4 groups based on the presence or absence of sleepdisordered breathing during REM versus NREM sleep as follows: 1. REM-related OSA (AHI4%-REM > 5/h and AHI4%-NREM 5/h and AHI4%-NREM > 5/h, n = 1326), and 4. no OSA (AHI4%-REM < 5/h and AHI4%-NREM < 5/h, n = 1614). Results: The mean AHI4% was 1.1/h in participants without OSA, 4.8/h in participants with REM-related OSA, 9.5/h in participants with NREM-related OSA, and 20.6/h in participants with overall OSA (p < 0.001). Of the participants without OSA, 16.7% had at least one new cardiovascular event, compared to 22.7% of participants with REM-related OSA, 28.5% of participants with NREM-related OSA, and 28.8% of participants with overall OSA (p < 0.001). Conclusion: REM-related sleep apnea is associated with an increased risk of cardiovascular complications despite an overall low AHI that might not prompt treatment consideration

Introduction: Sleep apnea is an impor tant medical condition, which is associated with adverse health outcomes and socioeconomic costs. As novel approaches to promoting awareness about sleep apnea symptoms and treatment emerge, there is a compelling need to develop a valid tool to assess sleep apnea health literacy in at-risk populations. The goal of this study was to develop a scale to assess sleep apnea literacy at the population level. Methods: Using a multi-phase design, we developed a scale for measuring sleep apnea health literacy. This included 1) devising a list of relevant sleep apnea-related questions in consultation with several established sleep investigators, 2) collecting preliminary data, 3) exploring natural component str uct ure, 4) selecting items compr ising the final scale using standardized procedures, 5) collecting additional data, and 6) generating construct validity of the scale. The final scale was approved by an independent expert in sleep medicine and an expert in scale design. Results: Data were collected using Amazon Mechanical Turk (MTurk) to gather data from 91 participants (mean age = 38yrs; 48% were White and 27%, African American). Analyses were conducted using exploratory and confirmatory factor analyses (SPSS version 20). The scale includes 26 items across three sub-domains, including sleep apnea health literacy (component alpha = 0.74), sleep apnea self-efficacy (component alpha = 0.76), and sleep apnea clinical management (component alpha = 0.65). Analysis showed that the concurrent scale validity was = 0.85. Conclusion: This is the first scale to feature characteristics that assess sleep apnea health literacy at the population level. This scale can be useful in designing and evaluating sleep apnea health education programs. It will also enable adequate tailoring of future interventions to ascertain specific areas of knowledge about sleep apnea

Introduction: General health consequences of co-occurring obstructive sleep apnea (OSA) and insomnia have been well documented. However, little is known about the emotional/psychological consequences of comorbid OSA and insomnia symptoms. The current study investigated emotional/psychological and physical health of blacks with co-morbid OSA and insomnia symptoms and explored whether insufficient sleep duration influences this relationship. Methods: Data collected from individuals belonging to faith-based organizations participating in the Peer Enhanced Education to Reduce Sleep Ethnic Disparities Study, a NIMHD-funded clinical trial looking at effectiveness of peer-delivered sleep health education in minority communities. A sample of 201 individuals (mean age = 47.83 years; female = 70.15%) were screened for high OSA risk (score > 6) using the ARES Questionnaire. A Sleep Disorders Questionnaire was used to assess insufficient sleep duration (< 7 hours) and prevalence of insomnia based on the three common symptoms: trouble falling asleep, difficulty staying asleep and waking up early in the morning. Physical composite score (SF-12PCS) and mental composite score (SF-12MCS) were determined using the Short Form 12 Health Survey. Results: 70.56% of the participants reported insufficient sleep; of those, 36.69% were at high OSA risk and endorsed insomnia symptoms. Bivariate logistic regression indicated significant association between mental health and likelihood of reporting OSA and insomnia (OR = 0.92, 95% Cl = 0.87-0.97, p < 0.01). Bivariate logistic regression analysis revealed no significant association of comorbid OSA risk and insomnia symptoms with physical health. Backward stepwise regression models adjusted for effects of BMI, age, sex, and sleep duration. People who reported both OSA and Insomnia were less likely to report sufficient sleep (> 7 hours) (OR = 0.35, 95% Cl = 0.14-0.85, p = 0.02) and higher mental health scores (OR = 0.93, 95% Cl = 0.88-0.99, p = 0.02). Conclusion: Results demonstrate that individuals with comorbid OSA and insomnia are more likely to endorse lower mental health. Presence of insomnia symptoms and OSA risk were not related to physical health as herein defined

Introduction: Social influence is a strong predictor of health behavior in college. This research extends these findings to college students' sleep, exploring how social influence is exerted on their sleep intentions. Exploring social factors that predict uptake of healthful sleep practices in college will illuminate directions for future sleep education programs on college campuses. Methods: Data were collected from a random sample of students at Cornell University (N = 157; mean age = 20 +/- 1.4 years; 78%, female; and 56%, white). Online surveys assessed self-reported sleep behavior, intention, social norm beliefs (e.g., "People important to me would be supportive of me sleeping 7 to 8 hours at night"), and sleep-related conversation (e.g., about healthful sleep practices, "Getting adequate sleep," and unhealthful practices, "Staying up late"). Regression analysis was used to assess relationships between social variables and intentions. Results: Insufficient sleep (< 7hrs) is common on weeknights (48.4% agreed with statement "I sleep 7 to 8 hours on most weeknights"), yet sufficient sleep (7-8hrs) is common on weekends (73.0% agreed with statement "I sleep 7 to 8 hours on most weekend nights"). Students repor ted intention to sleep (M = 1.1, range -3 to +3), and positive nor ms (M = 1.8, same range). Conversations about healthful sleep (M = 6.3, range 1 to 14) were less com mon than un healthfu l sleep (M = 7.2, same range). Regression analysis also showed significant relationships between conversation and social norm beliefs (healthful sleep conversation (b = .43, p < .01, r2 =), unhealthful sleep conversation (b = -.44, p < .01; r2 = .11). Analysis also showed a strong positive relationship between social norm and intention (b = .3, p < .001; r2 = .12). Conclusion: Our findings are consistent with previous research on relationships between social norm and sleep behavior. They extend this literature, documenting negative relationships between unhealthy sleep-related conversation and social norm beliefs. These suggest these undesirable conversations may be important to target in interventions

Introduction: Previous studies have indicated that race/ethnicity predicts insufficient sleep duration and that blacks bear a greater associated burden than individuals of other racial/ethnic group. We hypothesized that this disparity is likely due to greater poverty levels rather than race/ethnicity itself. Methods: Data for the present analysis came from the National Health Interview Survey [2004-2013], (N = 911,773). The survey applies a multi-stage sample survey of the resident civilian non-institutionalized US population. Respondents provided sociodemographic and physician-diagnosed chronic conditions. Self-reported sleep data was used to determine insufficient sleep status (< 6 hours/night) as well as poverty status. Poisson regression and logistic regression analyses were used to analyze the NHIS data. Results: A nalysis showe d that 54.7% of the sample were female; 77.8% were white and 15.6% black, (mean age = 46.68 +/- 17.38) years. Blacks consistently had a significantly higher prevalence of insufficient sleep compared to whites for all years included in the analysis (36.35% (p < .001) versus 27.4% (p < .001). Prevalence estimates of insufficient sleepers living below the poverty level was consistently higher than those living above poverty line (OR = 1.28, 95% CI = 1.25-1.32) (p < .001). After adjusting for race/ethnicity, poverty index was found to be a more significant indicator of likelihood of reporting for insufficient sleep than was race/ethnicity. Conclusion: Results support our hypothesis that poverty level was a stronger indicator of insufficient sleep than was race/ethnicity. Our findings confirm the importance for advocating for mitigation of the negative aspects of poverty such as poor housing and neighborhood quality and food deserts, all of which affecting sleep health, quality of life and eventually chronic disease risks

Introduction: Associations between place of birth and various health outcomes have been explored in recent studies. 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 United States. Methods: We examined 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. NHIS data emanated from face-to-face interviews with trained interviewers from the U.S. Census Bureau. We explored associations between healthy sleep (7-8hrs.), referenced to unhealthy sleep (8 hrs.), and place of birth among US adults using multivariate logistic regression analysis, adjusting for effects of socio-demographic factors, health risks, and physician-diagnosed medical conditions. We used SPSS 20.0 to conduct descriptive and inferential analyses. Results: 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 United States and 18.5% were foreign-born adults. Descriptive statistics revealed that Indian Subcontinent-bor n 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). Conclusion: These findings suggest that place of birth should be considered in the assessment of risk factors for unhealthy sleep. They add to the literature on sleep duration among racial and ethnic minorities in the U.S. This is useful when attempting to elucidate differences in sleep based on race/ethnicity and immigrant status