Faculty Bibliography

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: 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

Sleep is a fundamental necessity of life. However, sleep health and sleep disorders are not equitably distributed across racial/ethnic groups. In fact, growing research consistently demonstrates that racial/ethnic minorities are more likely to experience, for instance, shorter sleep durations, less deep sleep, inconsistent sleep timing, and lower sleep continuity in comparison to Whites. However, racial/ethnic disparities in reports of sleepiness and sleep complaints are inconsistent. Racial/ethnic groups have significant heterogeneity, yet within-group analyses are limited. Among the few published within-group analyses, there are differences in sleep between non-US-born and US-born racial/ethnic groups, but the group with the more favorable sleep profile is consistent for non-US-born Latinos compared to US-born Latinos and Whites but unclear for other racial/ethnic minority groups. These sleep health disparities are a significant public health problem that should garner support for more observational, experimental, intervention, and policy/implementation research. In this review, we 1) summarize current evidence related to racial/ethnic disparities in sleep health and within-group differences, focusing on the sleep of the following racial/ethnic minority categories that are defined by the United States Office of Management and Budget as: American Indian/Alaska Native, Asian, African American/Black, Hispanic/Latino, and Native Hawaiian/Pacific Islander; 2) discuss measurement challenges related to investigating sleep health disparities; 3) discuss potential contributors to sleep health disparities; 4) present promising interventions to address sleep health disparities; and 5) discuss future research directions on intersectionality and sleep health.

Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites. We searched the literature for studies published between January 1990 to July 2016 that included objective PAP use comparisons between adult US minority individuals and whites. Twenty-two studies met the inclusion criteria. All studies compared the PAP adherence of blacks to whites. Seven studies compared the PAP adherence of additional minority groups to that of whites. Sixteen of the 22 studies (73%) showed worse PAP adherence in blacks compared to whites. Four studies found equivalent PAP use in US Hispanics compared to whites. Little is known about the PAP adherence of other US minority groups. We present a framework and research agenda for understanding PAP use barriers among US minority individuals.

Introduction/UNASSIGNED:Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with metabolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symptoms, in a cohort of adult Black men and women with MetS. Methods/UNASSIGNED:Patients (n=1,013) from the Metabolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program's Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep characteristics, and physician-reported diagnosis of a sleep disorder. Results/UNASSIGNED:Prevalence of the components of MetS included: diabetes (60%); obesity (67%); hypertension (94%); and dyslipidemia (74%). Based on the ARES, 49% were at risk for OSA. Of all study patients, slightly more than half (53%) reported feeling sleepy during the day, and 10% reported an insomnia diagnosis. The most common sleep disturbance reported by 46% of the patients was early morning awakenings (EMA). This was closely followed by 42% who reported difficulty staying asleep (DSA) and 38% reporting difficulty falling asleep (DFA). Seventy percent reported short sleep (≤ 6 hours), whereas a minority (19%) reported long sleep (≥ 9 hours). Only 12% used sleep aids. Women, compared with men, reported greater daytime sleepiness, greater DFA, and greater DSA (57% vs 45%; 41% vs 32.4%; 45% vs 37%), respectively. Conclusion/UNASSIGNED:Blacks with MetS reported insomnia symptoms and insomnia disorder, use of sleep aids, feeling sleepy during the day, and inadequate sleep durations. The presence of these sleep characteristics suggests that patients with MetS should be referred for further sleep assessment.