Faculty Bibliography

Introduction: We determined whether the co-occurrence of OSA and hypertension interact synergistically to promote beta-Amyloid burden and cognitive decline in clinically normal older adults Methods: Prospective longitudinal study utilizing NYU cohort of community-dwelling cognitively-normal elderly, with baseline and at least one follow-up of CSF-Abeta42 (measured using ELISA), and neuropsychological visits. OSA was defined using AHI4%. Hypertension diagnosis was according to AHA-guidelines. Cognitive variables assessed included Logic-2, Animal-Fluency [AF], Vegetable-Fluency [VF]), Boston-Naming-Test [BNT], Digit-Symbol-Substitution-Test [DSST], Trails Making Test-A and B [TMT-A and B]). Linear mixed-effects models with random intercept and slope were used to assess associations between OSA, hypertension, and longitudinal changes in CSF-Abeta and cognition, controlling for age-at-baseline, sex, APOE4-status, years-of-education, and their interactions with time.
Result(s): Of the 98 participants, 63 (64.3%) were women. The mean (SD) age was 69.6 (7.3) years and follow-up time was 2.46 (0.64) years. OSA and hypertension were each associated with faster rate-of-change in CSF-Abeta42 (beta = -3.11; 95%CI, -3.71, -2.51; and beta= -2.82, 95% CI -3.29, -2.35, P < .01 for both respectively). The interaction of OSA and hypertension with time was significant (beta= -1.28, 95% CI -1.78 to -0.78, P < .01) suggesting a synergistic effect. No significant associations were seen between annual-changes in CSF-Abeta42 and cognitive-decline. However, faster decline in VF, and DSST were associated with OSA (beta = -0.054; 95%CI, -0.094, -0.013; P = .02; beta = -0.058; 95%CI, -0.084, -0.033; P < .05 for both respectively), and with hypertension (beta = -0.048; 95%CI, -0.079, -0.017; P = .04; beta = -0.078; 95%CI, -0.098, -0.057; P = .002; respectively). The interaction of OSA and hypertension with time was significant for both VF and DSST (beta = -0.033, 95%CI, -0.048, -0.018; P < .001 and beta = -0.040, 95%CI, -0.064, -0.016; P < .001, respectively), suggesting a synergistic effect.
Conclusion(s): In cognitive-normal elderly OSA individuals, vascular risk may complement AD-biomarkers in assessing risk of prospective cognitive-decline in preclinical AD

Introduction: Population estimates for sleep duration and quality are inconsistent because they rely on self-report and smaller samples using objective data. Tracking and wearable devices may provide more accurate estimates of sleep duration and quality. In this study, we investigated estimates of sleep duration and quality among 2 million users of a mobile sleep application in an urban city in the United States (U.S.).
Method(s): We examined sleep duration and quality from 2,194,897 users of SleepCycle, a popular sleep tracking app. over a four-year period (2015 to 2018). In this analysis, we specifically explored differences in sleep duration and quality by demographic factors, including age and sex. We utilized graphical matrix representations of data (heat maps) and geospatial analyses to compare sleep duration (in hours) and sleep quality (based on a composite score amalgamating time in bed, deep-sleep time, sleep consistency, and amount of times fully awake), considering potential effects of day of the week and seasonality.
Result(s): Among SleepCycle users, 45.6% (n=1,001,335) were female. The average age of the sample was 31.0 years. The mean sleep duration of the total sample was 7.11 hours; women slept longer than did men (M=7.27 hours vs. M=7.00 hours, p<.001). Increasing age tended to be associated with longer sleep duration and better sleep quality. Results also showed sleep duration was longer on weekends (M=7.19 hours), compared to weeknights (M=7.09 hours). Sleep duration was longest (M=7.18 hours) during the winter, but shortest during the summer (M=7.11 hours). Sleep quality was highest (M=72.75) during the winter, but lowest during the summer (M=71.99).
Conclusion(s): Our findings from big data are consistent with previously reported estimates of sleep duration and quality. Sleep duration varied by age, sex, day of the week, and season. Future studies should determine whether estimates of sleep duration and quality are affected by environmental factors such as geographic location

Introduction: Child fatigue has been associated with behavioral outcomes, including aggression, hyperactivity, and conduct problems, which may affect academic performance. We explored whether fatigue was associated with external behavioral health outcomes in a predominantly Black (Afro-Caribbean and African-American) student population (90%). Ratings of parent and teacher agreement of child fatigue was evaluated. This analysis was part of a larger research program, which included a cluster randomized controlled trial in ten public elementary schools in historically disinvested neighborhoods.
Method(s): A total of 804 first-graders (7+/- 0.6 years old) participated in the study focused on child self-regulation, mental health achievement, parenting and parent involvement. Externalizing behaviors (i.e., conduct problems, aggression, and hyperactivity) were reported by teachers using the Behavior System for Children (BASC-2). A composite score of teacher-perceived child fatigue was created based on ratings of child fatigue, morning alertness, and falling asleep in class. Parent perception of child fatigue was assessed using the Children's Sleep Habits Questionnaire. Regression analysis was conducted to determine the association between teacher's reports of child fatigue and externalizing behavior problems. Cohen's kappa coefficient assessed parent and teacher agreement of child fatigue based on categorical classification of presence of child fatigue.
Result(s): Children who were perceived as fatigued (i.e., tiredness and falling asleep in class) by their teacher were more likely to have a high BASC externalizing composite score (T=60 cut off) (beta = -0.24, p<.001). Cohen's kappa of 0.004 (p<0.05) showed a slight discordance in perception of child fatigue comparing reports from teachers and parents, although results were not significant.
Conclusion(s): Teacher perception of child fatigue was significantly associated with teacher BASC T-score of child externalizing behavior outcomes. Future studies should explore longitudinal relationships between fatigue and mental health

Introduction: The American Heart Association (AHA) suggests "Life's Simple 7" guidelines to improve overall health. The aim of this study was to test the hypothesis that sleep duration would be associated with each of the Simple 7 metrics and would provide additional information to overall health over and above that of the Simple-7.
Method(s): Data were from the 2011-2014 NHANES (N=8,113). Habitual sleep duration was assessed by self-report and divided into very short(<=4h), short(5-6h), normal(7-8h) and long(>=9h). Overall health was self-rated as "Good" or "Poor." The components of the Simple-7 were assessed as high blood pressure (history, hypertensive medications, or >=140/90mmHg), high cholesterol (history, statin use, or >=240mg/dl), diabetes (history or fasting glucose >=100mg/dl), unhealthy diet (fast food >=7 meals in past week), obesity (BMI>=30kg/m2), inactivity (<30mins/day moderate/vigorous), and smoking (current). Covariates included age, sex, education, race/ethnicity and (in analyses without obesity) BMI.
Result(s): In logistic regression analyses, poor overall health was associated with very short (OR=3.0,P<0.0005), short (OR=1.4,p<0.0005), and long (OR=1.7,p<0.0005) sleep. Variance explained for health by sleep (R-squared=0.02) was of similar magnitude to Simple-7 components (R-squared=0.0001[diet], 0.01[smoking, cholesterol), 0.02[obesity, sedentary], 0.04[hypertension, diabetes]). Sleep duration was associated with six of the Simple-7 (blood pressure, diabetes, diet, obesity, physical activity, and smoking). Sleep duration continues to be associated with overall health after controlling for all of the Simple-7 (very short OR=2.9,p<0.0005; short OR=1.3,p<0.0005; long OR=1.6,p<0.0005). Adding sleep to a model that contained covariates and the Simple-7 explained an additional 0.85% of the variance in health (retaining 46% of the variance explained in the outcome) without the Simple-7.
Conclusion(s): Sleep is related to nearly all of the components of the Simple-7, is related to health even after accounting for the Simple-7, and explains variance in overall health above that explained by the Simple-7. These data/analyses suggest that a sleep assessment should be added to the Simple-7, given the observed increment in predictive value

BACKGROUND:African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. OBJECTIVE:This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. METHODS:Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. RESULTS:A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. CONCLUSIONS:Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.

Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants.

BACKGROUND:Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. OBJECTIVE:This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. METHODS:Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. RESULTS:Approximately 1460 (37.6% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55% vs 66%, P=.001, and 86% vs 68%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16% vs 9%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45% vs 30%, P<.001) and report that mobile devices helped them achieve a health-related goal (72% vs 63%, P=.01). CONCLUSIONS:Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension.

Objective/UNASSIGNED:Stroke survivors generally have problems completing instrumental activities of daily living (IADL; eg, preparing meals, chores, taking a bath, and managing finances). However, it is unclear how stroke survivors might stave off IADL issues. Studies indicating that sleep has restorative neurological effects provide potential mechanisms to address issues with IADL. The aim of this study was to ascertain the association between sleep duration (short or long sleep duration) and IADL among stroke survivors and those without a stroke history. Methods/UNASSIGNED:Data of 486,619 participants were analyzed from the 2000 to 2015 National Health Interview Survey (NHIS), a nationally representative sample. Measures of self-reported stroke, sociodemographic variables, sleep duration, and IADL problems were collected. Binary logistic regression was utilized to analyze the relationship of short (≤6 hours) and long (≥9 hours) sleep duration with limitations to IADL. Results/UNASSIGNED:<0.001) adjusting for age, sex, race, marital status, poverty, and health. Conclusion/UNASSIGNED:Findings from our study indicate that, among stroke survivors, long sleepers were more likely to report IADL problems compared to average sleepers (7-8 hours). Future studies should investigate other potential mediators such as severity of stroke, medication, comorbidities, level of impairment, and whether improving sleep among stroke survivors may improve IADL.