Faculty Bibliography

BACKGROUND: The effect of race/ethnicity on the risk of diabetes associated with sleep duration has not been systematically investigated. This study assessed whether blacks reporting short (<6 hours) or long (>8 hours) sleep durations were at greater risk for diabetes than their white counterparts. In addition, this study also examined whether the influence of race/ethnicity on associations between abnormal sleep durations and the presence of diabetes were independent of individuals' sociodemographic and medical characteristics. METHODS: A total of 29,818 Americans (age range: 18-85 years) enrolled in the 2005 National Health Interview Survey, a cross-sectional household interview survey, provided complete data for this analysis. RESULTS: Of the sample, 85% self-ascribed their ethnicity as white and 15% as black. The average age was 47.4 years, and 56% were female. Results of univariate regression analysis adjusting for medical comorbidities showed that black and white participants who reported short sleep duration (<6 hours) were more likely to have diabetes than individuals who reported sleeping 6 to 8 hours (odds ratios 1.66 and 1.87, respectively). Likewise, black and white participants reporting long sleep duration (>8 hours) had a greater likelihood of reporting diabetes compared with those sleeping 6 to 8 hours (odds ratios 1.68 and 2.33, respectively). Significant interactions of short and long sleep with black and white race were observed. Compared with white participants, greater diabetes risk was associated with being short or long sleepers of black race. CONCLUSION: The present findings suggest that American short and long sleepers of black race may be at greater risk for diabetes independently of their sociodemographic profile or the presence of comorbid medical conditions, which have been shown to influence habitual sleep durations. Among black individuals at risk for diabetes, healthcare providers should stress the need for adequate sleep.

OBJECTIVES: This study assessed the prevalence of insomnia symptoms among women with and without HIV-infection and examined factors associated with insomnia. DESIGN: Participants (n = 1682) were enrolled in the Women's Interagency HIV Study (WIHS); 69% were infected with HIV. This was a cross-sectional analysis of data from standardized interviewer-administered instruments and physical/gynecological exams. Analysis focused on sociodemographics, sleep measures, depressive symptoms, drug use, alcohol consumption, medications, and HIV-related clinical variables. Women were classified as having symptoms of insomnia if they reported either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening >/= 3 times a week in the past 2 weeks. RESULTS: Overall, HIV-infected women were 17% more likely to endorse insomnia symptoms than uninfected women (OR = 1.17, 95% CI: 1.04-1.34, P < 0.05). The adjusted prevalence of insomnia symptoms varied by HIV status and age groups. Among women ages 31-40 years, those with HIV infection were 26% more likely to endorse insomnia symptoms than their counterparts (OR = 1.26, 95% CI: 1.01-1.59, P < 0.05). No significant differences were observed in the likelihood of reporting insomnia symptoms based on HIV treatment type. Multivariate-adjusted regression analyses showed that depression was the most consistent and significant independent predictor of the likelihood of reporting insomnia symptoms across all age strata. CONCLUSIONS: Insomnia symptoms are common among both HIV-infected and uninfected women. Prevalence of insomnia did not vary significantly by HIV status, except among younger women. Younger women with HIV infection are at greater risk for experiencing insomnia symptoms.

BACKGROUND: Over the last thirty years, Akiskal and collaborators have described and developed operationalized diagnostic criteria for five types of affective temperaments - cyclothymic, irritable, hyperthymic, depressive, and anxious. A 110-item, yes-or-no questionnaire, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), was specifically developed for measuring temperamental variation. The TEMPS-A was translated into more than 25 languages and cross-culturally valid versions are now available in Italian, French, German, Japanese, Turkish, Arabic, Polish, Hungarian, Spanish and Portuguese. Recent studies in the US and in Europe, however, have suggested that shorter versions of TEMPS-A can be just as efficient as the full ones while potentially enhancing the compliance of respondents. The main objective of the present study was to validate a brief Brazilian Portuguese version of TEMPS-A (brief TEMPS-Rio de Janeiro). METHODS: Our main sample consisted of 997 undergraduate students (female = 72.6%) from seven different universities located in the city of Rio de Janeiro, Brazil. An additional group of 167 healthy senior citizens (women = 83.8%) was recruited in senior community centers in the city of Rio de Janeiro, Brazil. All participants were asked to complete the 110-item, Brazilian translation of the full version of the TEMPS-A. RESULTS: An exploratory factor analysis (PCA type 2, Varimax rotation) vying for a five-factor solution yielded mixed results, with cyclothymic traits, physical symptoms of anxiety and preoccupation with the well-being of a family member loading together on the first factor. When a forced six-factor solution was attempted, cyclothymic, irritable, hyperthymic, and depressive were delineated as predicted by the theory. The original generalized anxious temperament was split into two sharply delimited components, a "worrying" subscale and an abbreviated anxious subscale, which included physical symptoms of anxiety and concerns with the well-being of relatives. Based on the tripartite model of anxiety and depression, we proposed that the abridged anxious subscale, which includes physical symptoms of anxiety, represents the "true" generalized anxious temperament, while the "worrying" subscale corresponds to the "general distress factor". The internal consistency of the six subscales thus identified was generally good, ranging from 0.67 (anxious subscale) to 0.81 (worrying subscale), with cyclothymic, irritable, depressive, and hyperthymic subscales exhibiting intermediate values (0.74, 0.74, 0.72, and 0.7, respectively). LIMITATIONS: The present study was based on a non-clinical sample that does not reflect accurately the characteristics of the Brazilian population. The relative uniformity of the sample in terms of age and education precluded a more in-depth analysis of the influence of these highly relevant factors. Further, we did not assess convergent, divergent or test-retest validity. CONCLUSIONS: We believe that the brief Brazilian version of the TEMPS-A auto-questionnaire will provide Brazilian researchers and clinicians with a psychometrically sound instrument and thus contribute toward the creation of a worldwide research network dedicated to the investigation of affective temperaments.

An increasing body of evidence suggests that anxiety is an independent predictor of adverse cardiovascular (CV) events. Individuals with high levels of anxiety are at increased risk of coronary heart disease, congestive heart failure, stroke, fatal ventricular arrhythmias, and sudden cardiac death. Anxiety following a major cardiac event can impede recovery, and is associated with a higher morbidity and mortality. This linkage between anxiety and CV disease is further corroborated by evidence suggesting that treatment of anxiety may improve cardiac symptoms. However, the mechanisms underlying the observed associations are not entirely delineated. Several intermediary mechanisms have been suggested, including sympathetic activation, impaired vagal control, reduced heart rate variability, stimulation of the hypothalamic-pituitary axis, hyperventilation-induced coronary spasm, oxidative stress, increased inflammatory mediators, and unhealthy lifestyle. There is a need for several clinical trials to explicate the complex associations between anxiety and CV disease, which may be compounded by the involvement of other psychosocial factors. In this review, we examine the epidemiological evidence for the association between anxiety and CV disease, and discuss the proposed mechanisms that may be responsible for this association.

Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea-associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered

The rampant diabetes pandemic over the past few decades has been associated with an increased rise in cardiovascular events and deaths. Risk factors such as obesity, family history of diabetes, decreased physical activity, and aging are among the most common in the development of diabetes. Emerging evidence in the past 10 years has suggested that sleep apnea is a novel risk factor in the development of diabetes. Associations between diabetes and sleep apnea are supported by both epidemiologic and clinical sleep apnea studies. In this report, we discuss epidemiologic and clinical evidence suggesting that sleep apnea is involved in the pathogenesis of altered glucose metabolism. In light of current evidence, sleep apnea treatment should be incorporated into existing pharmacotherapeutic regimens for optimal management of diabetes among diabetic patients with sleep apnea to reduce associated cardiovascular risk. Suggestions to improve practice guidelines in the management of diabetic patients with sleep apnea are provided.