Faculty Bibliography

Objective. The purpose of this study was to investigate whether short sleepers (<6 hrs) who worked the non-day-shift were at greater likelihood of reporting hypertension and if these associations varied by individuals' ethnicity. Methods. Analysis was based on the 2010 National Health Interview Survey (NHIS). A total of 59,199 American adults provided valid data for the present analyses (mean age = 46.2 +/- 17.7 years; 51.5% were female). Respondents provided work schedule and estimated habitual sleep durations as well as self-report of chronic conditions. Results. Of the sample, 30.8% reported a diagnosis of hypertension, 79.1% reported daytime shift work, 11.0% reported rotating shift work, and 4.0% reported night shift work. Logistic regression analysis showed that shift work was significantly associated with hypertension among Blacks [OR = 1.35, CI: 1.06-1.72. P < 0.05], but not among Whites [OR = 1.01, CI: 0.85-1.20, NS]. Black shift workers sleeping less than 6 hours had significantly increased odds of reporting hypertension [OR = 1.81, CI: 1.29-2.54, P < 0.01], while their White counterparts did not [OR = 1.17, CI: 0.90-1.52, NS]. Conclusions. Findings suggest that Black Americans working the non-day-shift especially with short sleep duration have increased odds of reporting hypertension.

INTRODUCTION: This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study. METHOD: A total of 1,035 patients participated. ARESTM score >/=6 defined high OSA risk. Moderate depression was defined by a CES-D score >/=16. Moderate anxiety was measured by a BAI score >/=16. RESULTS: The mean age was 62 +/- 14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02-2.98, p < 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11-5.15, p < 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04-1.09, p < 0.05), but depression was no longer significant. CONCLUSION: Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA. Key messages This study assessed associations of moderate to severe depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks with metabolic syndrome. Patients with depression had nearly two-fold increased odds of being at risk for OSA. Patients with anxiety had three-fold increased odds of being at risk for OSA.

INTRODUCTION: Identification of risk factors for obstructive sleep apnea (OSA) is important to enable comprehensive intervention to reduce OSA-related cardiovascular disease (CVD). The metabolic syndrome outcome study (MetSO) provides a unique opportunity to address these factors. This study investigated risk of OSA among blacks with metabolic syndrome. METHODS: The present study utilized data from MetSO, an NIH-funded cohort study of blacks with metabolic syndrome. A total of 1,035 patients provided data for the analysis. These included sociodemographic factors, health risks, and medical history. Physician-diagnosed conditions were obtained using an electronic medical record system (Allscripts, Sunrise Enterprise). Patients were diagnosed with metabolic syndrome using criteria articulated in the joint interim statement for harmonizing the metabolic syndrome. Patients with a score >/=6 on the Apnea Risk Evaluation System (ARES) questionnaire were considered at risk for OSA. Obesity is defined by body mass index (BMI >/= 30 kg/m2). RESULTS: Of the 1,035 patients screened in the MetSO cohort, 48.9% were at high risk for OSA. Using multivariate-adjusted logistic regression analysis, we observed that obesity was the strongest predictor of OSA risk (OR=1.59, 95%CI=1.24-2.04, p<0.0001). This finding remained significant even after adjustment for known covariates including blood pressure, low-density lipoprotein, high-density lipoprotein, and glucose levels (OR=1.44, 95%CI=1.11-1.86, p<0.001). CONCLUSION: Blacks in the MetSO cohort are at greater OSA risk, relative to the adult population in developed countries. Consistent with previous observations, obesity proved the strongest independent predictor of OSA risk among blacks with metabolic syndrome.

BACKGROUND: Patients with chronic kidney disease (CKD) have a high prevalence of sleep disorders. The association between sleep duration and self-reported CKD was examined in a population of Americans who participated in a national survey over a 3-year period. STUDY DESIGN: A cross-sectional study using survey data from the National Health Interview Survey (NHIS) from the year 2004-2006 was carried out. A retrospective examination of data from a community-based survey of 128,486 noninstitutionalized US civilian residents over the age of 18 years was conducted. Self-reported CKD was defined as having 'weak or failing kidneys'. The sleep duration was defined by a self-reported estimate of habitual sleep duration. RESULTS: The prevalence of participants self-reporting kidney disease was higher in those with short (/=8 h per night) sleep durations when compared to those sleeping 7 h per night. Self-reported information about sleep, demographic information, and information on comorbidities were assessed using standardized validated questionnaires which reported no kidney disease. A multivariate logistic regression analysis showed increased odds of self-reported kidney disease in study participants with both short and long sleep durations compared to healthy sleepers (sleeping >7-8 h per night). Observational data do not permit examination of causality, although possible confounders in observations of interest can be adjusted. CONCLUSION: Among Americans surveyed in the NHIS (2004-2006), those with short or long sleep duration had higher odds of reporting that they had CKD.

BACKGROUND: Visual impairment (VI) is associated with increased mortality and health factors such as depression and cardiovascular disease. Epidemiologic studies consistently show associations between sleep duration with adverse health outcomes, but these have not systematically considered the influence of VI. The aim of this study was to ascertain the independent association between VI and sleep duration using the National Health Interview Survey (NHIS) data. We also examined whether race/ethnicity influenced these associations independently of sociodemographic and medical characteristics. METHODS: Our analysis was based on the 2009 NHIS, providing valid sleep and vision data for 29,815 participants. The NHIS is a cross-sectional household interview survey utilizing a multistage area probability design. Trained personnel from the US census bureau gathered data during face-to-face interview and obtained socio-demographic, self-reported habitual sleep duration and physician-diagnosed chronic conditions. RESULTS: The mean age of the sample was 48 years and 56% were female. Short sleep and long sleep durations were reported by 49% and 23% of the participants, respectively. Visual impairment was observed in 10%. Multivariate-adjusted logistic regression models showed significant associations between VI and short sleep (OR = 1.6, 95% CI = 1.5-1.9 and long sleep durations (OR = 1.6, 95% CI = 1.3-1.9). These associations persisted in multivariate models stratified by race-ethnic groups. CONCLUSION: Visual impairment was associated with both short and long sleep durations. Analysis of epidemiologic sleep data should consider visual impairment as an important factor likely to influence the amount of sleep experienced habitually.

The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions.

BACKGROUND: We investigated ethnic differences in sleep duration, and the contribution of socio-economic status (SES) to the observed differences in Amsterdam, the Netherlands. METHODS: 6959 participants (aged 18-71 years) from the multi-ethnic HELIUS cohort were studied. Outcome variables were short sleep (<7 h/night) and long sleep (>/=9 h/night). Comparisons among groups were made using Prevalence Ratios (PRs). RESULTS: Ethnic minority groups were more likely than ethnic-Dutch to report short sleep, with prevalence ranging from 15.1% to 49.7% in men and 16.3% to 41.4% in women. Among men, the age-adjusted PRs ranged from 2.15 (95% CI 1.72-2.69) in Turkish to 3.31 (2.75-3.99) in Ghanaians; and among women, from 1.62 (1.30-2.01) in Turkish to 2.52 (2.15-2.95) in African-Surinamese, respectively. The prevalence of long sleep was significantly higher only in Moroccan men and all the ethnic minority women than in ethnic-Dutch women except for African-Surinamese. Adjustment for SES explains the ethnic difference in long sleep, but not for short sleep. CONCLUSION: Ethnic minority groups reported more short sleep than ethnic-Dutch, while there were no ethnic differences in long sleep. Further study is needed to investigate how this finding on short sleep may contribute to ethnic differences in health outcomes.

BACKGROUND: Lack of adherence to recommended treatment for obstructive sleep apnea remains an ongoing public health challenge. Despite evidence that continuous positive airway pressure (CPAP) is effective and improves overall quality of life, compliance with the use of CPAP in certain racial/ethnic groups, especially blacks, is suboptimal. Evidence indicates that the incidence and prevalence of obstructive sleep apnea are higher among blacks, relative to whites, and blacks are less likely to adhere to recommended treatment compared with other racial/ethnic groups. METHODS: Using a two-arm randomized controlled design, this study will evaluate the effectiveness of a culturally and linguistically tailored telephone-delivered intervention to promote adherence to physician-recommended sleep apnea assessment and treatment among blacks with metabolic syndrome, versus an attention-control arm. The intervention is designed to foster adherence to recommended sleep apnea care using the stages-of-change model. The intervention will be delivered entirely over the telephone. Participants in the intervention arm will receive 10 phone calls to address challenges and barriers to recommended care. Outcomes will be assessed at baseline, and at 6- and 12-months post-randomization. DISCUSSION: This tailored behavioral intervention will improve adherence to sleep apnea assessment and treatment among blacks with metabolic syndrome. We expect to demonstrate that this intervention modality is feasible in terms of time and cost and can be replicated in populations with similar racial/ethnic backgrounds.Trial registration: The study is registered at clinicaltrials.gov NCT01946659 (February 2013).

OBJECTIVE: Improving and validating sleep scoring algorithms for actigraphs enhances their usefulness in clinical and research applications. The MTI(R) device (ActiGraph, Pensacola, FL) had not been previously validated for sleep. The aims were to (1) compare the accuracy of sleep metrics obtained via wrist- and hip-mounted MTI(R) actigraphs with polysomnographic (PSG) recordings in a sample that included both normal sleepers and individuals with presumed sleep disorders; and (2) develop a novel sleep scoring algorithm using spline regression to improve the correspondence between the actigraphs and PSG. METHODS: Original actigraphy data were amplified and their pattern was estimated using a penalized spline. The magnitude of amplification and the spline were estimated by minimizing the difference in sleep efficiency between wrist- (hip-) actigraphs and PSG recordings. Sleep measures using both the original and spline-modified actigraphy data were compared to PSG using the following: mean sleep summary measures; Spearman rank-order correlations of summary measures; percent of minute-by-minute agreement; sensitivity and specificity; and Bland-Altman plots. RESULTS: The original wrist actigraphy data showed modest correspondence with PSG, and much less correspondence was found between hip actigraphy and PSG. The spline-modified wrist actigraphy produced better approximations of interclass correlations, sensitivity, and mean sleep summary measures relative to PSG than the original wrist actigraphy data. The spline-modified hip actigraphy provided improved correspondence, but sleep measures were still not representative of PSG. DISCUSSION: The results indicate that with some refinement, the spline regression method has the potential to improve sleep estimates obtained using wrist actigraphy.