Faculty Bibliography

There are few data on the relationships of anxiety and depression to insomnia among immigrants in the United States. Observations of high rates of symptoms of these associated conditions among older Russians indicate the need to focus clinical attention on this population. Relationships of self-reported depression and anxiety to insomnia complaints were investigated in a community-based sample of older Russian immigrants. Volunteers (N=307) were urban community-residing Russians (ages 50 to 95 years; 54% women). Surveys were conducted in a semistructured environment by bilingual educators in various community centers. 93% reported a major health problem, 83% experienced pain, and 62% had problems engaging in daily activities. Of the sample, 61% reported an insomnia complaint, and 43% considered depression and/or anxiety to be a major impairment. Logistic regression analysis showed that insomnia was the most important predictor of perceived anxiety and depression; the corresponding multivariate-adjusted odds ratio was 4.37. Insomnia complaints and perceptions of depression and anxiety among older Russians may have a synergistic effect. Both patients and primary-care physicians should be better educated regarding the recognition of barriers limiting access to adequate health care among older Russians.

Evidence from well-defined cohort studies has shown that short sleep, through sleep fragmentation caused by obstructive sleep apnea (OSA) or behavioral sleep curtailment because of lifestyle choices, is associated with increased incidence of diabetes. In this report, we review epidemiologic and clinical data suggesting that OSA is involved in the pathogenesis of altered glucose metabolism. Evidence suggesting increased risk of developing diabetes resulting from curtailed sleep duration is also considered. Proposed mechanisms explaining associations between short sleep and diabetes are examined and clinical management of OSA among patients with diabetes is discussed.

BACKGROUND: Anxiety and insomnia are associated with cardiovascular (CV) symptoms. We assessed whether the relation between anxiety and CV symptoms is modulated by insomnia. METHODS: Independently living women (n = 1,440; mean age = 59.36 +/- 6.53 years) were recruited by cluster sampling technique. We obtained data on demographic characteristics, health beliefs, access to health care, CV symptoms, sleep, stress and anxiety levels. RESULTS: Overall, 56% of the sample reported insomnia; 46% reported CV symptoms, and 54% were highly anxious. There was a greater likelihood for highly anxious women and those experiencing insomnia to report CV symptoms (r(s) = 0.31* and r(s) = 0.32*, respectively). In logistic regression analysis, the adjusted odds ratios for reporting CV symptoms were 1.39 for patients with insomnia and 2.79 for those with anxiety. With control for insomnia, we observed a 3-fold reduction in the magnitude of the association between anxiety and CV symptoms (r(p) = 0.09*). Stepwise adjustments for sociodemographic factors, CV risk markers, and factors anchoring health beliefs and access to health care showed lesser impact on the relationships. With simultaneous control for those covariates, the correlation was r(p) = 0.13*; * p < 0.01. CONCLUSION: The association of CV symptoms with anxiety is partly accounted for by insomnia.

A body of epidemiologic and clinical evidence dating back to the early 1960s establishes the relationships between sleep apnea and cardiovascular disease (CVD). Individuals with obstructive sleep apnea, the most common type of sleep-disordered breathing, are at increased risk for coronary artery disease, congestive heart failure, and stroke. Evidence that treatment of sleep apnea with continuous positive airway pressure reduces blood pressure, improves left ventricular systolic function, and diminishes platelet activation further supports linkage between obstructive sleep apnea and CVD. Notwithstanding, complex associations between these two conditions remain largely unexplained due to dearth of systematic experimental studies. Arguably, several intermediary mechanisms including sustained sympathetic activation, intrathoracic pressure changes, and oxidative stress might be involved. Other abnormalities such as dysfunctions in coagulation factors, endothelial damage, platelet activation, and increased systemic inflammation might also play a fundamental role. This review examines evidence for the associations between obstructive sleep apnea and CVD and suggested underlying anatomical and physiological mechanisms. Specific issues pertaining to definition, prevalence, diagnosis, and treatment of sleep apnea are also discussed. Consistent with rising interest in the potential role of the metabolic syndrome, this review explores the hypothesized mediating effects of each of the components of the metabolic syndrome

BACKGROUND: African American and African Caribbeans have high cardiovascular morbidity/mortality. Increased arterial stiffness is a marker of subclinical atherosclerosis, predicts higher cardiovascular risk, and causes isolated systolic hypertension. The objectives of the study were to compare arterial stiffness indices in African Americans and African Caribbeans and obtain reference values. METHODS/RESULTS: We prospectively studied 449 African Americans and 454 African Caribbeans. Using applanation tonometry, mean augmentation index and carotid-to-radial pulse-swave velocity were similar between the 2 groups (23 +/- 15 vs 24 +/- 14%, p = .20) and (9.0 +/- 1.9 vs 9.0 +/- 2.0 m/s, p = .86). On multivariate analysis, age, weight, gender, mean arterial pressure, heart rate, and family history of coronary artery disease were independently associated with augmentation index in African Americans (R2, 0.46) and African Caribbeans (R2, 0.49). Among 94 African American and 98 African Caribbean healthy subjects without cardiovascular risk factors/disease, augmentation index (20 +/- 14 vs 18 +/- 16%, p = .43) and pulse-wave velocity (8.9 +/- 1.9 vs 9.0 +/- 1.5 m/s, p = .92) were similar. Age-based normative values were determined. CONCLUSION: Augmentation index and pulse-wave velocity and their related clinical factors are similar between African Americans and African Caribbeans. Age, weight, female gender, mean arterial pressure, heart rate, and family history of coronary artery disease are independent predictors of higher augmentation index in African Americans and African Caribbeans. Whether increased arterial stiffness improves risk stratification in these populations merits further study.

Diabetes is a major public health problem that is reaching epidemic proportions in the United States and worldwide. Over 22 million Americans currently have diabetes and it is forecast that over 350 million people worldwide will be affected by 2030. Furthermore, the economic cost of diabetes care is enormous. Despite current efforts on the part of health care providers and their patients, outcomes of care remain largely suboptimal, with only 3% to 7% of the entire diabetes population meeting recommended treatment goals for glycemic, blood pressure, and lipid control. Therefore, alternative approaches to diabetes care are desperately needed. Group visits may provide a viable option for patients and health care providers, with the potential to improve outcomes and cost effectiveness. In this review, we highlight the magnitude of the diabetes epidemic, the barriers to optimal diabetes care, and the utility of the concept of group visits as a chronic disease management strategy for diabetes care

BACKGROUND: Measures of attachment style are often used to appraise social and emotional health. In developmental literature, the concept of attachment is used to explain relationships between children and their adult caregivers. While both attachment styles and sleep patterns are conceived as developmentally organized systems, very few studies have explored the link between the two. The present study examined whether attachment styles and sleep measures are associated among older adults. METHODS: Relationships between attachment styles (i.e., secure, fearful, preoccupied, and dismissive) and subjective sleep measures were assessed utilizing data from 70 older participants (mean age: 68+/-6 years; Blacks: 59% and Whites: 41%) in a community-based study assessing subjective health characteristics. After obtaining informed consent, each participant provided demographic and socioeconomic data, as well as relevant medical and subjective data. RESULTS: Independent of participants' demographic and subjective factors, significant correlations were found between the preoccupied attachment dimension and sleep measures. Specifically, individuals scoring high on the preoccupied attachment dimension were more likely to report daytime napping (r(p)=0.31, p<0.01) and to use sleep-inducing medications (r(p)=0.37, p<0.05). No significant correlations were found among sleep measures and the secure, dismissive, and fearful dimensions. CONCLUSIONS: Important relations have been observed between specific attachment styles and subjective sleep factors in our data. Although only one-dimension (preoccupied) demonstrated statistical significance, a trend was observed, suggesting possible associations between the secure attachment style dimension and subjective sleep measures. Future studies are needed to broaden our understanding of the relationship between attachment styles and sleep patterns.