Faculty Bibliography

BACKGROUND: Visual impairment (VI) is associated with increased mortality and health factors such as depression and cardiovascular disease. Epidemiologic studies consistently show associations between sleep duration with adverse health outcomes, but these have not systematically considered the influence of VI. The aim of this study was to ascertain the independent association between VI and sleep duration using the National Health Interview Survey (NHIS) data. We also examined whether race/ethnicity influenced these associations independently of sociodemographic and medical characteristics. METHODS: Our analysis was based on the 2009 NHIS, providing valid sleep and vision data for 29,815 participants. The NHIS is a cross-sectional household interview survey utilizing a multistage area probability design. Trained personnel from the US census bureau gathered data during face-to-face interview and obtained socio-demographic, self-reported habitual sleep duration and physician-diagnosed chronic conditions. RESULTS: The mean age of the sample was 48 years and 56% were female. Short sleep and long sleep durations were reported by 49% and 23% of the participants, respectively. Visual impairment was observed in 10%. Multivariate-adjusted logistic regression models showed significant associations between VI and short sleep (OR = 1.6, 95% CI = 1.5-1.9 and long sleep durations (OR = 1.6, 95% CI = 1.3-1.9). These associations persisted in multivariate models stratified by race-ethnic groups. CONCLUSION: Visual impairment was associated with both short and long sleep durations. Analysis of epidemiologic sleep data should consider visual impairment as an important factor likely to influence the amount of sleep experienced habitually.

A growing body of research demonstrates that psychosocial factors play an important role in the development of hypertension. Previous reviews have identified several key factors (i.e., occupational stress) that contribute to the onset of hypertension; however, they are now outdated. In this review, we provide an updated synthesis of the literature from 2010 to April 2014. We identified 21 articles for inclusion in the review, of which there were six categories of psychosocial stressors: occupational stress, personality, mental health, housing instability, social support/isolation, and sleep quality. Sixteen of the studies reported an association between the psychosocial stressor and blood pressure. While several findings were consistent with previous literature, new findings regarding mediating and moderating factors underlying the psychosocial-hypertension association help to untangle inconsistencies reported in the literature. Moreover, sleep quality is a novel additional factor that should undergo further exploration. Areas for future research based on these findings are discussed.

BACKGROUND: Lack of adherence to recommended treatment for obstructive sleep apnea remains an ongoing public health challenge. Despite evidence that continuous positive airway pressure (CPAP) is effective and improves overall quality of life, compliance with the use of CPAP in certain racial/ethnic groups, especially blacks, is suboptimal. Evidence indicates that the incidence and prevalence of obstructive sleep apnea are higher among blacks, relative to whites, and blacks are less likely to adhere to recommended treatment compared with other racial/ethnic groups. METHODS: Using a two-arm randomized controlled design, this study will evaluate the effectiveness of a culturally and linguistically tailored telephone-delivered intervention to promote adherence to physician-recommended sleep apnea assessment and treatment among blacks with metabolic syndrome, versus an attention-control arm. The intervention is designed to foster adherence to recommended sleep apnea care using the stages-of-change model. The intervention will be delivered entirely over the telephone. Participants in the intervention arm will receive 10 phone calls to address challenges and barriers to recommended care. Outcomes will be assessed at baseline, and at 6- and 12-months post-randomization. DISCUSSION: This tailored behavioral intervention will improve adherence to sleep apnea assessment and treatment among blacks with metabolic syndrome. We expect to demonstrate that this intervention modality is feasible in terms of time and cost and can be replicated in populations with similar racial/ethnic backgrounds.Trial registration: The study is registered at clinicaltrials.gov NCT01946659 (February 2013).

BACKGROUND: Epidemiologic studies show a curvilinear relationship between inadequate sleep (< 7 or > 8 hours) and obesity (Body Mass Index > 30 kg/m2), which have enormous public health impact. METHODS: Using data from the National Health Interview Survey, an ongoing nationally representative cross-sectional study of non-institutionalized US adults (>/=18 years) (1977 through 2009), we examined the hypothesis that inadequate sleep is independently related to overweight/obesity, with adjustment for socio-demographic, health risk, and medical factors. Self- reported data on health risks, physician-diagnosed medical conditions, sleep duration, and body weight and height were used. RESULTS: Prevalence of overweight and obesity increased from 31.2% to 36.9% and 10.2% to 27.7%, respectively. Whereas prevalence of very short sleep (<5 hours) and short sleep (5-6 hours) has increased from 1.7% to 2.4% and from 19.7% to 26.7%, it decreased from 11.6% to 7.8% for long sleep. According to multivariate-adjusted multinomial regression analyses, odds of overweight and obesity associated with very short sleep and short sleep increased significantly from 1977 to 2009. Odds of overweight and obesity conferred by long sleep did not show consistent and significant increases over the years. Analyses based on aggregated data showed very short sleepers had 30% greater odds of being overweight or were twice as likely to be obese, relative to 7-8 hour sleepers. Likewise, short sleepers had 20% greater odds of being overweight or 57% greater odds of being obese. Long sleepers had 20% greater odds of being obese, but no greater odds of being overweight. CONCLUSIONS: Our findings support the hypothesis that prevalence of very short and short sleep has gradually increased over the last 32 years. Inadequate sleep was associated with overweight and obesity for each available year.

Introduction: Many risk factors have been implicated in the pathophysiology of obstructive sleep apnea (OSA). Recent evidence suggests that medical risk factors, such as uncontrolled/high blood pressure (BP), high cholesterol, triglycerides, high body mass index, diabetes, and dyslipidemia (all indicators of metabolic syndrome) are highly comorbid with OSA. However, data on the relationships between these risk factors and OSA among blacks with metabolic syndrome are lacking. Methods: Data for the present study were collected from 340 participants from the Metabolic Syndrome Outcome (MetSO) study, a NIHfunded cohort study of 1,035 blacks with metabolic syndrome (mean age = 62 + 13 years, 69% female, and 43% with annual family income < $10K). During initial interviews, patients provided sociodemographic, health risks, and history of chronic diseases. Patients with a score > 6 on the Apnea Risk Evaluation System (ARES) were considered at high OSA risk. Logistic regression analyses were employed to investigate whether metabolic syndrome indicators, particularly uncontrolled blood pressure, increased the odds of OSA. Results: Of the sample, 77.1% was at risk for OSA and 16.8% had uncontrolled BP. Analysis also showed 60.4% were diabetic, 8.9% had a stroke history, 74.3% had dyslipidemia, 91.1% were either overweight or obese and 30.9% had heart disease. 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 was 135.8 + 81.2; glucose was 138.4 + 68.3; and HbA1c was 7.93 + 1.63. Logistic regression analysis showed that uncontrolled BP independently increased the odds of OSA risk (OR = 1.94, 95% CI = 1.12-3.32, p < 0.01). Conclusion: Our indings suggest that uncontrolled BP was associated with a twofold greater risk of OSA in blacks. The clinical implication of this inding is that blacks with metabolic syndrome and who have uncontrolled BP should be screened for the presence of OSA

BACKGROUND: Excessive daytime sleepiness (EDS) often occurs as a result of insufficient sleep, sleep apnea, illicit substance use, and other medical and psychiatric conditions. This study tested the hypothesis that blacks exhibiting EDS would have poorer self-reported adherence to hypertensive medication using cross-sectional data from the Counseling African-Americans to Control Hypertension (CAATCH) trial. METHODS: A total of 1,058 hypertensive blacks (average age 57+/-12 years) participated in CAATCH, a randomized controlled trial evaluating the effectiveness of a multilevel intervention for participants who receive care from community health centers in New York City. Data analyzed in this study included baseline sociodemographics, medical history, EDS, and medication adherence. We used the Epworth Sleepiness Scale, with a cutoff score of >/=10, to define EDS. Medication adherence was measured using an abbreviated Morisky Medication Adherence scale, with a score >0 indicating nonadherence. RESULTS: Of the sample, 71% were female, 72% received at least a high school education, 51% reported a history of smoking, and 33% had a history of alcohol consumption. Overall, 27% of the participants exhibited EDS, and 44% of those who exhibited EDS were classified as adherent to prescribed antihypertensive medications. Multivariable logistic regression analysis, adjusting for effects of age, body mass index, sex, education, and smoking and drinking history indicated that participants who exhibited EDS were more than twice as likely to be nonadherent (odds ratio 2.28, 95% confidence interval 1.42-3.67, P<0.001). CONCLUSION: Analysis of the CAATCH data showed a high prevalence of EDS among hypertensive blacks. EDS is a significant predictor of nonadherence to prescribed medications for hypertension. These findings point to a modifiable variable that can be targeted in future interventions focusing on medication adherence.

Introduction: Emerging empirical evidence suggests exposure to natural amenities (e.g., green-space, oceanfront) may improve health behaviors and mental health outcomes such as increased levels of physical activity and lower levels of depression associated with sleep quality. Little is known about the relationship between self-reported suficient sleep and natural amenities. Methods: A subsample (n = 253,550) of the US 2010 Behavioral Risk Factor Surveillance System, a randomized survey of risk factors among US adults > 18 years of age, was used to examine the association between self-reported sleep suficiency (the number of days individuals indicated as having suficient sleep in the past month) and access to natural amenities. Participants with geographically referenced data were assigned an amenity score based on an index developed by the United States Department of Agriculture to relect the natural landscape of counties including varied topography such as lakes, ponds, oceanfront, and climate to encompass all four seasons in the US (i.e., winter, spring, summer, fall). Multiple linear regression was performed in STATA 12 to explore the relationship between subjective sleep suficiency and natural amenities. Results: Higher number of days with suficient sleep were positively associated with higher scores for natural amenities (beta = 0.112, P = 0.05), controlling for age, gender, race, marital status, education, employment status, income level, physical activity, body mass index and asthma. Days with suficient sleep were negatively associated with Hispanic ethnicity (beta = -1.418), increased age (beta = -0.081), higher levels of education (beta = -0.411) and a propensity to snore (beta = -0.388) (all P < 0.00). Conclusion: In a nationally representative sample of US adults, access to natural amenities was shown to attenuate the risk for insuficient sleep. Additional studies may be needed to determine whether this relationship holds at smaller levels of geography and to disentangle whether spec!

Introduction: There is evidence indicating that Latinos in the U.S. experience short sleep duration. Socioeconomic and cultural factors may provide an explanation for why Latinos experience insuficient sleep. Insuficient sleep has negative physiologic and metal consequences. Because of the multiple life demands, such as childcare and work, and environmental factors, such as noise and light pollution, low-income Latino women experience insuficient sleep. However, few studies have examined the perceptions of sleep in this population. The purpose of this study was to describe the perceptions of sleep and its beneits, and the consequences of insuficient sleep among low-income Latino women of child-bearing age living in the U.S. Methods: Thirty-four low-income Latino women, between the ages of 21-35, responded in writing to ive semi-structured interview questions that elicited their perceptions of the importance of sleep and the impact of insuficient sleep on their health and daily lives. Responses to the ive interview questions were coded and collated into themes. The themes that emerged from the data analysis were used during four dissemination focus groups to validate results with the study participants. Results: The themes that emerged were "Sleep is the food for the body" where women explained how sleep was crucial to maintain and protect health. The second theme that emerged was "No sleep means I can't function." In this theme participants described how insuficient sleep affects their day-to-day activities and family duties. Conclusion: Understanding how this group of Latino women perceives sleep and the impact of sleep deprivation in their lives will facilitate the creation of culturally sensitive programs that promote sleep in this undeserved population

Introduction: Inadequate sleep duration is an important public health burden in the United States. However, there is a paucity of information on the relationships between psychological health and inadequate sleep. Our study examined the relationships between emotional distress and inadequate sleep. Methods: Data from the 2009 National Health Interview Survey (NHIS), N = 27,731 participants 18 years and older, were analyzed to investigate the associations of emotional distress with inadequate sleep duration, adjusting for socio-demographic factors, health risks, and chronic diseases. We deine inadequate sleep as less than 7 or greater than 8 hours sleep durations; compared to healthy sleep (7-8 hours). We measured emotional distress, based on Kessler's 6 scale, which assesses the frequency of feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period. Responses were used to generate a score ranging from 0 to 24. Scores of > 13 are considered likely to indicate serious mental illness. Results: Of the sample, 52% were female, 80% were white, 12% black, and 8% other; 30% hold a HS diploma and 31% reported a family income below 31K. Analysis also showed that 10.9% reported emotional distress and 37.2% reported inadequate sleep. Results of our logistic regression analysis revealed that individuals with emotional distress had 57% greater odd of reporting inadequate sleep (OR = 1.5795% C.I. 1.54, 1.61, p < 0.001); the model adjusted for age, sex, race/ethnicity, marital status, education, combined family income, body mass index, history of alcohol consumption, smoking status, and chronic diseases including, arthritis, hypertension, diabetes, cancer, coronary heart disease and heart conditions. Conclusion: Our indings showed that emotional distress, an important proxy for psychological health, was the strongest predictor of inadequate sleep. Other factors associated with inadequate sleep include demographic (age, education, sex, race/ethnicity, combined family income), health!

Introduction: Sleep among blacks with metabolic syndrome is not well characterized. Our study examined sleep characteristics of black men and women with a diagnosis of metabolic syndrome. Methods: The present study utilized data from the Metabolic Syndrome Outcome Study (MetSO), an NIH-funded cohort study of blacks with metabolic syndrome (N = 1,035). Patients [mean age = 62 + 14 years; female = 71%] were diagnosed with metabolic syndrome using criteria articulated in the joint interim statement for harmonizing the metabolic syndrome. They provided self-reported data including sleep habits and insomnia symptoms. They were administered the Apnea Risk Evaluation System (ARES) to ascertain risk of obstructive sleep apnea (OSA). Patients with a score of > 6 on the ARES scale were considered at high OSA risk, based on validation studies. Results: Of the sample, 60% were diagnosed with diabetes; stroke, 10%; heart disease, 31%; hypertension, 93%; overweight/obese, 90%. Based on ARES data, 48% were at risk for OSA. Analysis also showed that 53% reported feeling sleepy during the day, and 10% had an insomnia diagnosis. Speciic insomnia symptoms included dificulty falling asleep (38%), dificulty maintaining sleep (42%), early morning awakening (46%); 53% reported daytime naps, and 12% used sleep medication. Prevalence of short sleepers (< 6 hrs) and long sleepers (> 9 hrs), referenced to healthy sleepers (7-8 hrs), was 70% and 19%, respectively. Based on chi-squared analysis, there was signiicant difference between males and females in regard to reported daytime sleepiness (41% vs. 56%; x2 = 7.736, p < 0.05), dificulty falling asleep (34% vs. 41%; x2 = 5.252, p < 0.05), and daytime naps (60% vs. 50%, x2 = 8.338, p < 0.05). No other signiicant gender differences were observed. Conclusion: Our indings suggest that a large number of blacks with metabolic syndrome experience insomnia symptoms, use sleep aids, and are both short and long sleepers. These sleep-related problems are associated with a myriad of !