Faculty Bibliography

INTRODUCTION/BACKGROUND:The influence of aging on the clinical presentation of obstructive sleep apnea (OSA) is not well characterized in US veterans. Our aims were to (1) examine age and established predictors of sleepiness and insomnia symptoms in veterans with OSA and (2) determine if the relationship between predictors of the Epworth sleepiness scale (ESS) and insomnia severity index (ISI) depended on age. METHODS:We performed a retrospective analysis of veterans diagnosed with OSA at the Miami VA in 2014. On polysomnography (PSG) night, questionnaires were completed querying socio-demographics, insomnia (ISI), sleepiness (ESS), and self-reported sleep duration. Regression modeling was performed to explore association of variables with (1) ESS and (2) ISI. Analyses were performed in two steps: (1) variables were tested for main effects and (2) product of age and each variable found to have an association at a significance level of p < 0.10 with primary outcome were entered separately to test for interaction. RESULTS:The sample consisted of 483 veterans (93% male, age 52 ± 13 years, 41% black, 34% Hispanic). Having a regular bed partner, higher weighted medical comorbidities, chronic pain diagnosis, and shorter sleep duration were associated with ESS. Age did not moderate the relationship between these variables and ESS. Younger age, Hispanic ethnicity, higher educational level, shorter sleep duration, mood, and pain diagnoses were each associated with the ISI. Furthermore, an age-sleep duration interaction term was associated with the ISI (b = - 0.03; p = 0.005). For all participants, there was an inverse relationship between sleep duration and ISI. However, for any sleep duration, older veterans reported lower levels of insomnia than younger veterans. DISCUSSION/CONCLUSIONS:Older veterans with OSA may report lower ISI scores. Alternative assessment methods for comorbid insomnia among older individuals with OSA may be needed.

Objective/UNASSIGNED:To elucidate women's experiences with opioid medications and their perspectives on provider education regarding opioid use, risks and safety. Methods/UNASSIGNED:Women with a self-reported history of pain who had been prescribed opioids were recruited in 2016 using a convenience sampling approach that included an online social media campaign. Participants (N=154) completed online surveys and open-ended questions regarding their experiences with pain and opioids, and their perspectives on the quality of education they received from their providers. Results/UNASSIGNED:Participants reported receiving insufficient education about opioid-related side effects, as reflected in both ratings for the quantity and quality of education they received from their providers. Non-white participants reported lower quantity and poorer quality of provider education (p<0.05). Themes identified from the qualitative data included frustrations with pain management options, fear of opioids, stigma associated with opioid use, and the need for improved provider education and patient-provider communication. Conclusion/UNASSIGNED:Findings suggest that from a patient's perspective, there is a need for enhanced patient-provider communication and education regarding pain management and potential opioid-related side effects. Improved physician communication and education could promote shared decision-making and result in enhanced satisfaction with care and health outcomes.

Introduction/UNASSIGNED:Mentorship is crucial for academic success. And yet, there are few mentoring programs that address the needs of underrepresented, racially/ethnically diverse junior faculty conducting health-related research in the United States. Methods/UNASSIGNED:To expand mentoring capacity for these racially/ethnically diverse faculty, we developed a Peer Mentor Development Program (PMDP) to prepare near-peers, who have similar characteristics and personal experiences, to provide support to participants in an NIH-PRIDE funded Institute. The PMDP program is designed based on the 8-year experience of the Mentor Development Program of the NYU-Health and Hospitals Clinical Translational Science Institute. Annually, up to six alumni are selected into the PMDP, participate in the 12-hour program over 4 days, are paired with 1 to 3 scholar participants to mentor and join monthly PMDP conference calls during the ensuing year. Results/UNASSIGNED:We describe the program, participant experience and lessons learned from our first 18 peer mentors in three PMDP cohorts. Additionally, all 18 peer mentors completed a post-evaluation survey to assess the program. Overall, peers agreed that participating in the PMDP enhanced most of the specific skills targeted. Participants rated 53%-86% of skills as "more than before" participating in PMDP, demonstrating the appreciation and impact of the program. Conclusions/UNASSIGNED:The PMDP may be a model for higher education and academic medicine programs committed to mentoring and retaining racially/ethnically diverse faculty and ultimately contributing to reducing entrenched health disparities between majority and minority populations.

OBJECTIVES/OBJECTIVE:Determine the current rate of patient-provider sleep discussions and identify factors associated with occurrence of these discussions. DESIGN/METHODS:Secondary cross-sectional analysis of self-report data collected during the Sleep and Healthy Activity Diet Environment and Socialization study. Logistic regressions were used. SETTING/METHODS:Urban and suburban Southeastern Pennsylvania PARTICIPANTS: A total of n = 998 adults (aged 22-60), 38.6% female, racially and socioeconomically diverse, from urban and suburban Southeastern Pennsylvania. MEASUREMENTS/METHODS:Outcome measures were responses to 3 questions: (1) ever discussed sleep with a provider, (2) a provider ever discussed importance of sleep schedule, and (3) a provider ever discussed importance of enough sleep. Descriptive/independent variables included demographic factors and a wide range of patient-reported measures of health and sleep habits. RESULTS:About a third of individuals have ever discussed sleep with a provider. Factors associated with higher odds of sleep-related discussions included sleep medication use, worse insomnia severity, race (Black/African American, Hispanic, Latino, other/multiracial), female sex, higher education, higher body mass index, and worse depression severity. Factors associated with lower odds were Asian race and low income. Sleep discussions were not associated with certain factors indicative of sleep disorders: sleep duration, snoring, shift work schedule, not working, and anxiety. CONCLUSIONS:Low rates of patient-provider sleep discussions and factors associated (or not) with their occurrence indicate missed opportunities for improved health outcomes.

Blacks are at greater risk for lower sleep quality and higher risk for obstructive sleep apnea (OSA) than other racial groups. In this study, we summarize the development of a tailored website including visuals, key messages, and video narratives, to promote awareness about sleep apnea among community-dwelling blacks. We utilized mixed methods, including in-depth interviews, usability-testing procedures, and brief surveys (n = 9, 55% female, 100% black, average age 38.5 years). Themes from the qualitative analysis illuminated varied knowledge regarding OSA symptoms and prevalent self-reported experience with sleep disturbance and OSA symptoms (e.g., snoring). On a scale from 1 (not at all) to 5 (very high), participants provided favorable ratings of website usefulness (mean = 4.9), user friendliness (mean = 4.9) and attractiveness (mean = 4.3). Our findings suggest although tailored health communication has potential for serving as a tool for advancing health equity, usability-testing of health materials is critical to ensure that culturally and linguistically tailored messages are acceptable and actionable in the intended population.

Introduction: Sleep health is associated with many domains of functioning. Yet, changing behaviors linked to improved sleep health is difficult. Beliefs about the health impact of sleep may motivate behavior change. This analysis examined which beliefs about sleep might motivate sleep behavior change.
Method(s): Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study, consisting of N=1007 community-dwelling adults age 22-60. Participants were asked, regarding "the single most important thing you personally could do to improve your sleep," whether participants were in the stage of precontemplation (not considered change), contemplation (considered but not decided), preparation (decided but not acting), and action stages of change from the transtheoretical model. They were also asked items from the Sleep Practices and Attitudes Questionnaire (SPAQ) regarding the degree to which they agree with whether "not getting enough sleep" can cause sleepiness, drowsy driving, weight gain, heart disease, high cholesterol, hypertension, moodiness, lower energy, decreased sex drive, missed days at work, decreased performance, memory/concentration problems, diabetes, and/or tiredness. Ordinal logistic regressions evaluated increased likelihood of stage of change, based on degree of agreement with those statements, adjusted for age, sex, race/ethnicity, and education. Post-hoc analyses also examined sleep duration as an additional covariate.
Result(s): In adjusted analyses, stage of change was associated with degree of agreement that insufficient sleep can cause sleepiness (OR=1.17, p=0.035), weight gain (OR=1.20, p<0.0005), heart disease (OR=1.21, p=0.001), cholesterol (OR=1.13, p=0.047), hypertension (OR=1.16, p=0.014), moodiness (OR=1.42, p<0.0005), decreased energy (OR=1.30, p=0.002), absenteeism (OR=1.13, p=0.007), decreased performance (OR=1.20, p=0.003), concentration/ memory problems (OR=1.23, p=0.004), diabetes (OR=1.14, p=0.042), and feeling tired (OR=1.39, p<0.0005). When sleep duration was added to the model, significant relationships remained for weight, heart, hypertension, moodiness, energy, absenteeism, performance, memory, diabetes, and tiredness.
Conclusion(s): Degree of belief that insufficient sleep can cause outcomes such as moodiness, occupational problems, and health problems may impact whether an individual is contemplating/ attempting to improve their sleep. This may guide education/outreach efforts

Introduction: Sleep health encompasses a number of concepts, including "satisfaction," timing, efficiency, duration, and absence of disorders, and is related to mental/physical health. This analysis aims to explore the idea of "sleep satisfaction" and how it relates to these concepts.
Method(s): Data were from N=1,003 working-age adults age 22-60 in the Philadelphia area. Participants were asked to rate their satisfaction with sleep on a scale of 0-100 (100=max). Participants also completed the Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Brief Inventory of Sleep Control, sleep duration (categorized as <=4h, 5-6h, 7-8h[ref], and >=9h), habitual bedtime, Patient Health Questionnaire (for depression), GAD7 anxiety scale, Perceived Stress Scale, and an overall indicator of health (Excellent, Very Good, Good, Fair, or Poor). Linear regression analyses examined whether each of these individually and/or uniquely contributed variance to sleep satisfaction after adjustment for age, sex, race/ethnicity, education, and income.
Result(s): The following significantly predicted worse sleep satisfaction (in order of decreasing magnitude): insomnia symptoms (B=- 2.99, p<0.0005), sleep duration in the <=4h (B=-38.57, p<0.0005), 5-6h (B=-19.03, p<0.0005), and >=9h (B=-8.15, p=0.032) ranges vs 7-8h, lack of sleep control (B=3.42, p<0.0005), later bedtime (B=-2.83, p<0.0005), sleepiness (-1.82, p<0.0005), fatigue (B=-0.86, p<0.0005), depression (B=-2.38, p<0.0005), anxiety (B=-2.16, p<0.0005), stress (B=-1.32, p<0.0005), and overall health rated as good (B=-15.29, p<0.0005), fair (B=-27.22, p<0.0005), and poor (B=-38.79, p<0.0005), vs excellent. In a model with all variables combined, unique variance was contributed only by insomnia, sleep duration, sleep control, and depression; other variables were non-significant.
Conclusion(s): Sleep satisfaction, as a concept, is related to nighttime sleep experiences, daytime impairment experiences, and overall mental and physical health. However, some of these relationships overlap and a combined model suggests that sleep satisfaction mostly represents a combination of nighttime sleep duration/ quality, perceived control, and daytime mood

Introduction: While there is epidemiologic evidence that racial/ ethnic minorities report shorter sleep duration and poorer sleep quality than whites, few studies have assessed sleep continuity (SC), variable by variable (e.g., SL, NWAK, WASO, EMA, & TST). The present analysis assesses in a quantitative way whether insomnia symptom severity varies by race/ethnicity.
Method(s): An archival analysis was conducted on an existing database of 4,206 individuals who completed a screening survey on-line at https://urldefense.proofpoint.com/v2/url?u=http- 3A__www.sleeplessinphilly.com&d=DwIBAg&c=j5oPpO0eBH1iio48DtsedeElZfc04rx3ExJHeIIZuCs&r=CY_ mkeBghQnUPnp2mckgsNSbUXISJaiBQUhM-Uz9W58&m=_icVcFoc7ulJmPF3ojT4VQ- keh3a2N4OhtHGRLx7AN4&s=GRc5DD1Hlq9WkqeVHjBH7X9hXNa8mcKsHyVAl9iK8QI&e=. Variables collected included estimates for: sleep latency (SL), number of awakenings (NWAK), wake after sleep onset (WASO), early morning awakenings (EMA) and total sleep time (TST).
Result(s): The sample for the present analysis was comprised of 2,049 whites (63.4%), 1,007 blacks (31.2%), and 175 Hispanics (5.4%). The overall mean age was 39.0+/-14.7, 60.4% of the sample was female, and the average BMI was 28.0+/-7.1. For all SC variables, blacks significantly differed from whites: SL (49.2+/-38.3 vs. 42.8+/-30.5; p<.001); NWAK (2.64+/-1.7 vs. 2.50+/-1.6; p<.001); WASO (47.3+/-43.4 vs. 29.9+/-30.5; p<.000); EMA (63.4+/-41.8 vs. 57.2+/-33.0; p<.000); Hispanics did not significantly differ from whites with respect to the above measures. For self-reported TST, blacks and Hispanics significantly differed from whites (316.4+/-85.1; 356.2+/-73.7; 365.8+/-80.6, respectively; p<0.000).
Conclusion(s): Our results suggest that blacks exhibit marginally worse sleep continuity (statistically significant owing to the large sample sizes) and shorter TSTs. Analysis is ongoing to evaluate Time in Bed [TIB], calculated TST, SE%, sleep period, sleep schedule differences, and percentage of group with Insufficient Sleep Disorder by race, in matched samples

Introduction: Several studies have demonstrated that insomnia symptoms negatively impact adherence to Continuous Positive Airway Pressure (CPAP). Yet, little is known about psychosocial factors that may buffer the associated negative effects. The present study explored the role of resilience, the ability to function in the face of or following adversity, on reducing the negative effects of insomnia on CPAP adherence.
Method(s): The study sample included volunteers from a large sleep center enrolling individuals newly diagnosed with Obstructive Sleep Apnea (OSA). For this analysis, we examined volunteers with complete data (n=45) on insomnia severity (based on the Insomnia Severity Index (ISI)), resilience (based on the Connor Davidson Resiliency Scale (CD-RISC)), and objective median hours of CPAP use over the first 30 days of treatment.
Result(s): The mean age was 55.4 years (SD=15.7); 62.2% male, and 33% black. The mean ISI score was 13.0 (SD=6.3), mean CD-RISC was 30.7 (SD=5.7) and mean CPA use over the first 30 days was 5.9 (SD=1.9). In the linear regression, ISI was positively correlated with increased hours of CPAP use (r=-0.305, p=.047). Resilience was not significantly correlated with CPAP use (r=0.216, p=.163), likely attributable to the sample size. ISI correlated with CPAP use among those with low resilience (r=-0.461, p=.027), but not among those with high resilience (r=-0.039, p=.870). There was a significant interaction (B(SE)=0.22 (0.08); p=.005) between ISI and resilience on median hours of CPAP use, indicating that resilience may moderate the association between ISI and hours of CPAP use.
Conclusion(s): Results of our study indicated that resilience is an important factor and may reduce the negative effects of insomnia on CPAP adherence. Notably, the high resilience score in this sample could signal an important target for tailoring CPAP adherence interventions to address unique characteristics of each subgroup

Introduction: The influence of aging on the symptomatic presentation of obstructive sleep apnea (OSA) is not well-characterized in US veterans. Our aims were to 1) examine age and established predictors of sleepiness and insomnia symptoms in US veterans with OSA and 2) determine if the relationship between predictors and sleepiness and insomnia depended on age.
Method(s): We performed a retrospective analysis of US veterans newly-diagnosed with OSA at the Miami VA in 2015. On diagnostic PSG night (76% attended studies), questionnaires were completed querying demographics, social characteristics, insomnia symptoms (Insomnia severity index [ISI]), sleepiness (Epworth sleepiness scale [ESS]) and self-reported sleep duration. Medical and psychiatric comorbidities were assessed with electronic medical record review. Linear regression modeling was used to explore the association of variables with 1) ESS and 2) ISI. Regression analyses were performed in two steps: 1) all variables were entered simultaneously testing for main effects, 2) the product of age and each variable found to have an association at a significance level of p < 0.10 with the primary outcome was entered separately to test for interaction.
Result(s): The sample consisted of 483 veterans (93% male, age 52 +/- 13 yrs, 41% black, 34% Hispanic) diagnosed with OSA (AHI 36 +/- 28 events/hr of sleep). Having a regular bed partner, higher weighted medical comorbidities, chronic pain diagnosis, and shorter sleep duration were associated with ESS. Age did not moderate the relationship between these variables and the ESS. Younger age, Hispanic ethnicity, higher educational level, shorter sleep duration, mood and pain diagnoses were each associated with the ISI. Furthermore, an age-sleep duration interaction term was associated with the ISI (b = -0.03; p=0.005). For all participants, there was an inverse relationship between sleep duration and ISI scores. However, for any sleep duration, older veterans reported a lower level of insomnia symptoms than younger veterans.
Conclusion(s): Older veterans with OSA may report less sleep complaints. Personalized screening methods for older individuals with OSA may be needed