Faculty Bibliography

Introduction: Although the relationship between sleep duration and body mass index (BMI) has been well-characterized, the underlying mechanisms have not. Understanding which factors explain this relationship would provide important insights in developing effective public health interventions to reduce associated cardiometabolic risks. The present study investigated 5 potential mediators of the relationship between sleep duration and BMI. Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) was used in our analysis. BRFSS is a CDC-sponsored project representing the world's largest ongoing, state-speciic, randomized telephone survey that measures behavioral risk factors among U.S. adults [mean age = 56 + 16 years, female = 63%]. Analysis focused on interviews conducted in six representative states, soliciting sociodemographic, medical, sleep, and health-risk data, yielding observations for n = 35,895 respondents. A bootstrapping method was employed to generate conidence intervals (BCCI) ascertaining total and unique mediation across all 5 hypothesized mediators simultaneously (using 1,000 bootstrap samples) of the sleep duration and BMI relationship. The hypothesized mediators included: alcohol use, diet, physical activity, general health status, and life satisfaction. Age and sex were adjusted in all tested models. Results: Analysis showed that for each additional hour of sleep BMI decreases by 0.15 unit. Evidence of unique mediation was noted for: physical activity (BCCI = 0.0017 to 0.0102; SE = 0.0022), diet (BCCI =-0.0138 to-0.0052; SE = 0.0022), and general health status (BCCI =-0.0379 to-0.0079; SE = 0.0423). However, there was no evidence of unique mediation for: alcohol use (BCCI =-0.0013 to 0.0019; SE = 0.0008) or life satisfaction (BCCI =-0.0057 to 0.0057; SE = 0.0028). Conclusion: These indings suggest that the sleep and BMI relationship may be partially mediated by physical activity, diet, and general health. This is consistent with previous hypotheses regard!

Introduction: Blacks are less likely to adhere to sleep apnea treatment compared with whites. This study explored the unique perspectives of blacks with metabolic syndrome who were referred for treatment of obstructive sleep apnea (OSA) at local sleep clinics. Methods: A total of 340 adults from the Metabolic Syndrome Outcome Study (MetSO), an NIH-funded cohort study of blacks, were randomly assigned to receive either Tailored-Telephone Intervention or regular standard of care. Prior to randomization, participants provided a detailed sleep history assessing sleep habits and OSA risk. The qualitative study involved 4 focus groups (mean age = years; 4 Males, 22 Females). A focus group guide was used to elicit responses from participants. Interviews were audio-taped and transcribed verbatim. Initial a priori codes were developed to guide initial coding. Analysis was guided by grounded theory. We explored 3 important questions: Q1) What are the potential barriers and facilitators of OSA evaluation? Q2) What are the potential barriers and facilitators of CPAP adherence? Q3) What are the experiences of blacks who participated in the intervention? Results: Themes for each question were as follows: Q1 a) general sleep disturbances, b) presence of other health conditions, c) encouragement from loved ones and d) rapport with medical provider plays a key role in adhering to OSA evaluation. Q2 a) improvement in sleep apnea, b) CPAP side effects, c) mistrust of the medical system, d) socio-economic factors limiting ability to participate and e) perception that CPAP device is not necessary were barriers and facilitators of CPAP adherence. Q3 a) having received meaningful information about sleep disorders, sleep hygiene b) increase in health information and c) rapport with the health educator were the experiences of participants in the intervention. Conclusion: To our knowledge, this is the irst study to describe qualitative indings of blacks with metabolic syndrome that participated in an OSA-related interve!

Introduction: Sleep disturbance is a common complaint in the general population. Studies have shown that there are substantial differences between and within racial/ethnic groups with respect to reporting sleep problems, with blacks being less likely to report such problems. Previous studies, however, have not speciically examined black patients with symptoms of obstructive sleep apnea (OSA). This study sought to investigate further whether blacks at risk for OSA are likely to report sleep problems, which would suggest no bias in reporting. Methods: We analyzed data from the Metabolic Syndrome Outcome (MetSO) study, an NIH-funded cohort study of 1,035 blacks (mean age: 62.3 + 13.5 years, women = 69%) with metabolic syndrome. Metabolic syndrome was diagnosed 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) were considered at high OSA risk. To assess sleep habits and problems, we administered the Sleep Disorders Screening questionnaire. The data was coded and analyzed using SPSS 19.0. Results: Of the sample, 60.4% had diabetes; 92.3%, hypertension; 74%, dyslipidemia; and 66.9%, obesity. Overall, 48.9% of the patients were at high OSA risk. Patients at OSA risk were more likely to report having trouble falling asleep (58.3% vs. 43.7%, p < 0.001), trouble staying asleep (60.5% vs. 41.2%, p < 0.001), complaint of early morning awakenings (58.4% vs. 42.2%, p < 0.001), daytime naps (53.4% vs. 44.4%, p < 0.001), excessive daytime sleepiness (56.8% vs. 40.2%, p < 0.001), and being diagnosed with insomnia (63.7% vs. 47.9, p < 0.001). Conclusion: Nearly half of the blacks with metabolic syndrome were at risk for OSA. Those at OSA risk were more likely to report sleep problems. Compared with previous studies, our analysis does not show a reporting bias among blacks, at least among those at risk for OSA

Melatonin is a hormone secreted by the enigmatic pineal gland in response to darkness, hence the name hormone of darkness. It has generated a great deal of interest as a therapeutic modality for various diseases particularly sleep disorders. This pleiotropic molecule has anti-inflammatory, antioxidant and anticoagulopathic properties in addition to its endothelial protective effects. In this article we discuss melatonin secretion and mechanisms of action as well as therapeutic rationale. We also highlight the potential utility of melatonin in the deadly modern-day Ebola epidemic.

BACKGROUND: Little is known about the association between visual impairment and insomnia symptoms in elderly populations. The purpose of this study was to ascertain associations between self-reported visual impairments and insomnia symptoms in a community-based sample of Russian immigrants. METHOD: Sample consisted of 307 community-residing Russians (ages: 25-95 years, mean=72.64 +/- 9.62; women=54% and men=46%). Semi-structured interviews assessed health-care needs and physical health characteristics. Collected demographic and health-related data were analyzed using SPSS 19.0. RESULTS: Overall, 93% reported at least one of several major health problems: visual impairment (48.4%), hypertension (53%), diabetes (25.7%), arthritis (52.8%), cancer (10.5%), weight problems (34.1%), and anxiety/depressive symptoms (43%), 62% had an insomnia diagnosis. Unadjusted logistic regression analysis showed that individuals with visual impairment were nearly three times as likely as those without to report insomnia symptoms [OR = 2.73, p < 0.01; 95% CI = 1.68-4.48]. Adjusting for the presence of socio demographic variables reduced the odds to 2.68; further adjustment for social isolation and anxiety and depressed symptoms reduced the odds to 2.20.Anxiety/depression mediated the relationship between visual impairment and insomnia. CONCLUSION: Individuals with visual impairment have twice the odds of reporting insomnia independent of anxiety/depression and social isolation, two common problems affecting quality of life in that population.

Epidemiologic studies have consistently shown that sleeping <7h and >/=8h is associated with increased mortality and morbidity. The risks of short sleep may be consistent with results from experimental sleep deprivation studies. However, there has been little study of chronic moderate sleep restriction and little evaluation of older adults who might be more vulnerable to negative effects of sleep restriction, given their age-related morbidities. Moreover, the risks of long sleep have scarcely been examined experimentally. Moderate sleep restriction might benefit older long sleepers who often spend excessive time in bed (TIB) in contrast to older adults with average sleep patterns. Our aims are: (1) to examine the ability of older long sleepers and older average sleepers to adhere to 60min TIB restriction; and (2) to contrast effects of chronic TIB restriction in older long vs. average sleepers. Older adults (n=100) (60-80years) who sleep 8-9h per night and 100 older adults who sleep 6-7.25h per night will be examined at 4 sites over 5years. Following a 2-week baseline, participants will be randomized to one of two 12-week treatments: (1) a sleep restriction involving a fixed sleep-wake schedule, in which TIB is reduced 60min below each participant's baseline TIB; and (2) a control treatment involving no sleep restriction, but a fixed sleep schedule. Sleep will be assessed with actigraphy and a diary. Measures will include glucose tolerance, sleepiness, depressive symptoms, quality of life, cognitive performance, incidence of illness or accident, and inflammation.

AIMS: The effect of race/ethnicity on the risk of obesity associated with short or long sleep durations is largely unknown. This study assessed whether the sleep-obesity link differentially affects black and whites. METHODS: Analysis was based on data obtained from 29,818 adult American respondents from the 2005 National Health Interview Survey, a cross-sectional household interview survey. RESULTS: Multivariate-adjusted odds ratios for obesity associated with short sleep (/=9 h) for blacks and whites were 1.48 (95% CI: 1.14-1.93) and 0.77 (95% CI: 0.67-0.89), respectively (all p < 0.001). CONCLUSION: Race/ethnicity may have significantly influenced the likelihood of reporting obesity associated with short and long sleep durations. Relative to white respondents, an excess of 78% of black respondents showed increased obesity odds associated with short sleep. Black long sleepers also showed increased odds for obesity, but white long sleepers may be at a reduced obesity risk.

Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting that the population's current average sleep duration is approximately 6 h. In this paper, we examine epidemiologic and community-based data on sleep complaints reported by American adults, specifically addressing the role of race/ethnicity in the subjective report of sleep problems. Subjective and objective findings indicate that black (throughout the text, we use the term black in lieu of African American for there are instances where we refer to individuals with self-ascribed race/ethnicity as black, African American, African, or Caribbean American; the term white is used to denote individuals of European descent). Americans have higher rates of long (>/=9 h) and short (</=5 h) sleep than their white counterparts, and this may mediate a higher risk of cardiovascular disease, obesity and diabetes among blacks. In addition, studies show mixed results on sleep complaints among blacks compared to those among other ethnicities. This paper explores factors that may contribute to racial/ethnic differences in sleep including intra-ethnic variation, cultural biases, genetics and psychosocial factors.

INTRODUCTION: This study explored the associations between sleep duration and emotion regulation among urban black women (mean age=59 +/- 7 yrs). METHOD: Eligible women (n=523) provided sociodemographic data during face-to-face interviews. We used the Comprehensive Assessment and Referral Examination Physical to measure health status; women also estimated their habitual sleep duration. We utilized a modified version of Weinberger's conceptual model of repression, the Index of Self-Regulation (ISE) to measure emotion regulation. ISE scores were derived by amalgamating the defensive subscale from the Social Desirability Scale and the anxiety subscale from the State-Trait Anxiety Inventory. RESULTS: The median habitual sleep duration was 7 hours; 20% of the women were short sleepers (<6 hours) and 6% were long sleepers (>8 hours). Short sleepers, rather than long sleepers, had a greater likelihood of reporting insomnia symptoms than those sleeping 6-8 hours [63.4% vs. 28.1%; Chi2 = 41.87, p<0.001]. In the first logistic regression model, the odds of being a short sleeper for low regulators were 3 times greater than for high regulators [OR = 3.22 95% CI: 2.05-5.06; p<0.0001]. In multivariate-adjusted analysis, OR was reduced to 2.06, but remained significant. In the second logistic model, the likelihood of being a long sleeper among low regulators were 37% greater than for high regulators, but results were not significant [OR=1.37, 95% CI: 0.62-3.01; NS]. DISCUSSION: Short and long sleep duration are associated with reduced ability for emotion regulation. Women sleeping 6-8 hrs might be more adept at regulating emotions in their daily lives. Insomnia symptoms might mediate associations between emotion regulations and sleep durations.

OBJECTIVE: Evidence suggests that individuals reporting sleeping below or above the population's modal sleep duration are at risk for diabetes, hypertension, and other cardiovascular diseases. Evidence also indicates that individuals with these conditions have reduced functional capacity. We assessed whether reported sleep duration and functional capacity are independently associated and whether individuals' race/ethnicity has an effect on this association. METHOD: Data were obtained from 29,818 black and white Americans (age range: 18-85 years) who participated in the 2005 National Health Interview Survey (NHIS). The NHIS uses a multistage area probability design sampling of non-institutionalized representatives of the US civilian population. Of the sample, 85% were white and 56% were women. RESULTS: Univariate logistic regression analysis showed that individuals sleeping < 6 h were 3.55 times more likely than those sleeping 6-8 h to be functionally impaired (34% vs 13%; p < 0.001). Likewise, those sleeping > 8 h were 3.77 times more likely to be functionally impaired (36% vs 13%; p < 0.001). Individuals of the black race/ethnicity were more likely to be functionally impaired than their white counterparts (23% vs 19%; p < 0.001). Multivariate-adjusted regression analyses showed significant interactions between individuals' race/ethnicity and short sleep with respect to functional capacity (black: OR = 2.78, p < 0.0001; white: OR = 2.30, p < 0.0001). Signifi-cant interactions between race/ethnicity and long sleep were also observed (black: OR = 2.43, p < 0.001; white: OR = 2.63, p < 0.001). CONCLUSION: Our findings suggest that individuals' habitual sleep duration and their race/ethnicity are significant predictors of their functional capacity. CITATION: Brimah P; Oulds F; Olafiranye O; Ceide M; Dillon S; Awoniyi O; Nunes J; Jean-Louis G. Sleep duration and reported functional capacity among black and white US adults. J Clin Sleep Med 2013;9(6):605-609.