Faculty Bibliography

INTRODUCTION: The association between sleep disturbances and cardiometabolic diseases has been understudied in blacks with metabolic syndrome. METHODS: This study is a cross-sectional analysis of the Metabolic Syndrome Outcome Study (MetSO) trial. We assessed insomnia symptoms, sleep duration, and risk for sleep apnea. Multivariate logistic regression models evaluated the association between sleep disturbances with diabetes mellitus (DM) and the combined outcomes of DM and hypertension as well as DM and dyslipidemia. RESULTS: The sample consisted of 1,013 participants, mean age of 62 +/- 14 years and 61% female. DM was diagnosed in 60% of the sample. Sleep apnea risk was observed in 48% of the sample, while 10% had insomnia symptoms and 65% reported short sleep duration (< 6 hours). Sleep apnea risk, but not insomnia or sleep duration, was associated with DM (OR 1.66; 95% CI 1.21-2.28), adjusting for age, sex, income, obesity (BMI >/= 30 kg/m2), tobacco use, alcohol use, hypertension, dyslipidemia, and depression. In fully adjusted models, sleep apnea risk was associated with the combined outcome of DM-hypertension (OR 1.95; 95% CI 1.42-2.69), but not with diabetes-dyslipidemia. CONCLUSION: We observed a strong association between sleep apnea risk and diabetes mellitus among blacks with metabolic syndrome.

Purpose: Blacks are less likely to develop metabolic syndrome (MetS), a known cardiovascular risk factor. These findings should be interpreted cautiously because Blacks may not fit into the gold-standard diagnostic criteria and report lower lipid profiles levels. To resolve this issue, we suggest reclassifying the relative weighted effects of each MetS component in a diagnostic risk model. We argue that uncontrolled blood pressure is the strongest predictor of MetS in Blacks, because it causes obstructive sleep apnea (OSA), a known MetS risk factor. Method: Data were collected from 340 participants from the MetS Outcome study, a NIH-funded cohort study of 1,035 Blacks with MetS (mean age=62+/-13 years, 69% female, and 43% with annual family income <$10K). Patients with a BP <140/80 mm/Hg after several antihypertensive medications had uncontrolled BP and a score >6 on the Apnea Risk Evaluation System (ARES+/-) were considered high OSA risk. Results: 77.1% was at risk for OSA and 16.8% had uncontrolled BP. Mean systolic BP was 134.8+/-18.4; diastolic BP was 75.6+/-11.9; LDL cholesterol was 105.6+/-36.9; HDL cholesterol was 48.0+/-17.3; triglycerides were 135.8+/-81.2; glucose was 138.4+/-68.3; and HbA1c was 7.93+/-1.63. Uncontrolled BP increased the odds of OSA risk (OR=1.94, 95% CI=1.12-3.32, p<0.01) and was the strongest predictor of MetS in Blacks. Conclusion: Uncontrolled BP was associated with a twofold greater risk of OSA and the strongest predictor of MetS in Blacks. Blacks, therefore, with uncontrolled BP should be screened for the presence of OSA and MetS

Study Objectives: This study assessed knowledge and attitudes toward obstructive sleep apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation. Methods: Medical students and residents collected data from a convenience sample of 105 physicians practicing at community-based clinics in a large metropolitan area. Average age was 48 +/- 14 years; 68% were male, 70% black, 24% white, and 6% identified as "other." Physicians completed the Obstructive Sleep Apnea Knowledge and Attitudes questionnaire. Results: The average year in physician practice was 18 +/- 19 years. Of the sample, 90% reported providing care to black patients. The overall OSA referral rate made by physicians was 75%. OSA knowledge and attitudes scores ranged from 5 to 18 (mean = 14 +/- 2) and from 7 to 20 (mean = 13 +/- 3), respectively. OSA knowledge was associated with white race/ethnicity (rp = 0.26, p < 0.05), fewer years in practice (rp = -0.38, p < 0.01), patients inquiring about OSA (rp = 0.31, p < 0.01), and number of OSA referrals made for OSA evaluation (rp = 0.30, p < 0.01). Positive attitude toward OSA was associated with patients inquiring about OSA (rp = 0.20, p < 0.05). Adjusting for OSA knowledge and attitudes showed that physicians whose patients inquired about OSA were nearly 10 times as likely to make a referral for OSA evaluation (OR = 9.38, 95% CI: 2.32 - 38.01, p < 0.01). Conclusion: Independent of physicians' knowledge and attitudes toward obstructive sleep apnea, the likelihood of making a referral for obstructive sleep apnea evaluation was influenced by whether patients inquired about the condition.

Introduction: Short and long sleep duration are an important public health burden in the United States. They are influenced by race/ethnicity and socioeconomic status. Little is known about the relationships between psychological health and short and long sleep across race/ethnicity. Our study examined the racial/ethnic influence on the relationship between psychological distress and sleep duration. Methods: Data from the 2009 National Health Interview Survey (NHIS), N = 27,731 participants ages > 18 years, were analyzed to investigate the associations of psychological distress with inadequate sleep duration, adjusting for socio-demographic factors, health risk behaviors, and chronic diseases. Short sleep was coded as 8 hours. Psychological distress (PD), based on Kessler's 6 scale, assessed the frequency of feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period. Scores range from 0 to 24 and scores > 13 likely indicate serious mental illness. Results: Of the sample, 51.6% were female; 76.2%, White and 15.6%, Black/African-American, with a mean age of 35.79 +/- 22.4 yrs. Of the sample, 8.1%) of Blacks vs. 7.1% of Whites reported PD. Logistic regression analysis indicated that blacks and whites with PD have similar odds of reporting short sleep (Blacks: OR = 2.33, p < 0.05 and Whites: OR = 2.36, p < 0.05). However, different odds for long sleep were observed (Blacks: OR = 1.23, p < 0.05 and Whites: OR = 1.63, p < 0.05). These analyses adjusted for demographic, health risk behaviors, and chronic diseases. We also found discrepancies in the predictive model. For Whites, gender, marital status, family income, body mass index, arthritis, diabetes, hypertension, heart condition and PD predicted short sleep. For Blacks, only age, family income, hypertension and PD predicted short sleep. Conclusion: Psychological distress was the strongest predictor of short and long sleep for both groups. PD and short and long sleep were more prevalent among blacks than among whites. Our study underscored the significant role of PD in racial/ethnic sleep disparities

Introduction: We assessed associations of sleep duration and socio-demographic factors with severe headaches/migraine. Methods: National Health Interview Survey (NHIS) data collected from 1997-2013 was utilized. NHIS applied a multistage area probability sampling design. Descriptive statistics were used to characterize the sample, and multivariate logistic regression model was used to test associations of sleep duration and socioeconomic factors with severe headaches/migraine. Results: Of 515,456 adults surveyed, the mean (+/- SEM) age was 54.3 +/- 0.016 ranging from 18 to 85 years; the mean body mass index (BMI) in kg/m² was 26.8 +/- 0.007 A greater proportion of women reported headaches compared to men (20.1% vs 9.5%, p < 0.001). Individuals with headaches were younger (42.2 +/- 0.05 vs. 48.1 +/- 0.02, p < 0.01) and had higher BMI (27.3 +/- 0.02 vs. 26.7 +/- 0.01, p < 0.01). Headaches were more common among short sleepers, < 7 hours (21.5%) and long sleepers, > 8 hours (15.7%), compared to those averaging 7-8 hours (12%), p < 0.01. Headaches were more common among blacks, compared to whites and Asians (16.5%, 15.4% and 10.9%, respectively), p < 0.01. Headaches were reported by individuals who were separated (23.1%), divorced (18.3%), never married individuals (16.8%,) married (14.6%) or 9 widowed (6%), p < 0.01. After adjusting for age, BMI and sleep duration, the odds ratio (OR) for headaches for married was 1.126 (95% CI = 1.093-1.159), p < 0.01; for widowed: OR was 1.28 (95% CI = 1.207-1.36), p < 0.01; for divorced: OR was 1.57 (95% CI = 1.52-1.63), p < 0.01 and for separated: OR was 1.85 (95% CI = 1.75-1.95), p < 0.01, using never married as a referent. Headaches were more common among individuals below (23.0%), compared to those above (14.8%) poverty level, p < 0.01. Conclusion: Both short and long sleep durations were associated with higher frequency of headaches. Female sex, increasing BMI and younger age were also associated with increased headaches. Compared to individuals who were never married, those of other marital status had increased odds of having headaches. Poverty level was significantly associated with increased headaches