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Discrimination Predicts Suboptimal Adherence to CPAP Treatment and Mediates Black-White Differences in Use

Wallace, Douglas M; Grant, Andrea Barnes; Belisova-Gyure, Zuzana; Ebben, Matthew; Bubu, Omonigho M; Johnson, Dayna A; Jean-Louis, Girardin; Williams, Natasha J
BACKGROUND:Although racial and ethnic differences in CPAP adherence for OSA are widely established, no studies have examined the influence of perceived racial discrimination on CPAP usage, to our knowledge. RESEARCH QUESTION/OBJECTIVE:(1) Do Black adults with OSA report experiencing greater amounts of discrimination than non-Hispanic White adults? (2) Is discrimination associated with poorer CPAP adherence over time, independent of self-identified race? (3) Does discrimination mediate the relationship between self-identified Black race and CPAP usage? STUDY DESIGN AND METHODS/METHODS:/Fisher exact test, as appropriate. A linear regression model was completed with self-identified Black race and EDS total score as the primary independent variables of interest and mean daily CPAP usage at 30 and 90 days serving as the dependent outcomes. This regression modeling was repeated after adjusting for psychosocial variables known to be associated with CPAP usage. EDS total score was explored as a potential mediator of the association between self-identified Black race and mean daily CPAP adherence at 30 and 90 days. RESULTS:The sample for this analysis consisted of 78 participants (31% female, 38% Black) with a mean age of 57 ± 14 years. Sixty percent of the Black adults reported they experienced racial discrimination at least a few times each year. Relative to White adults, Black adults were also more likely to indicate more than one reason for discrimination (27% vs 4%, P = .003). Adjusting for discrimination, self-identified Black race was associated with 1.4 (95% CI, -2.3 to -0.4 h; P = .006) and 1.6 (95% CI, -2.6 to -0.6 h; P = .003) fewer hours of mean daily CPAP usage at 30 and 90 days, respectively. In the fully adjusted model, a 1-unit change in the total discrimination score (more discrimination) was associated with a 0.08-h (95% CI, 0.01-0.15 h; P = .029) and 0.08-h (95% CI, 0.01-0.16 h; P = .045) change in mean daily CPAP usage at 30 and 90 days, respectively. INTERPRETATION/CONCLUSIONS:Adults with OSA who encountered racial discrimination experienced greater decrement in CPAP usage than those who did not experience racial discrimination.
PMID: 37741324
ISSN: 1931-3543
CID: 5632992

The effects of social support and support types on continuous positive airway pressure use after 1month of therapy among adults with obstructive sleep apnea

Williams, Natasha J; Grant, Andrea Barnes; Butler, Mark; Ebben, Matthew; Belisova-Gyure, Zuzana; Bubu, Omonigho M; Jean-Louis, Girardin; Wallace, Douglas M
BACKGROUND:The relationship between perceived social support and continuous positive airway pressure remains understudied among individuals with obstructive sleep apnea. The aim of this prospective cohort study was to determine if baseline perceived social support and subtypes predict regular continuous positive airway pressure use after 1month of therapy. METHODS:Adults with obstructive sleep apnea initiating continuous positive airway pressure therapy were recruited from sleep clinics in New York City. Demographics, medical history, and comorbidities were obtained from patient interview and review of medical records. Objective continuous positive airway pressure adherence data was collected at the first clinical follow-up. RESULTS:Seventy-five participants (32% female; non-Hispanic Black 41%; mean age of 56 ± 14years) provided data. In adjusted analyses, poorer levels of overall social support, and subtypes including informational/emotional support, and positive social interactions were associated with lower continuous positive airway pressure use at 1month. Relative to patients reporting higher levels of support, participants endorsing lower levels of overall social support, positive social interaction and emotional/informational support had 1.6 hours (95% CI: 0.5,2.7, hours; p = .007), 1.3 hours (95% CI: 0.2,2.4; p = .026), and 1.2 hours (95% CI: 0.05,2.4; p = .041) lower mean daily continuous positive airway pressure use at 1month, respectively. CONCLUSION/CONCLUSIONS:Focusing on social support overall and positive social interaction particularly, could be an effective approach to improve continuous positive airway pressure adherence in patients at risk of suboptimal adherence.
PMID: 38007302
ISSN: 2352-7226
CID: 5617532

Obstructive Sleep Apnea and Alzheimer's Disease Pathology: Is Sleep Architecture the Missing Key?

Gills, Joshua L; Bubu, Omonigho M
Impairments of the sleep architecture due to disrupted sleep in individuals with obstructive sleep apnea (OSA) may result in reduced slow wave sleep (SWS), intermittent hypoxemia, and excessive day time sleepiness- all factors that have been shown to impact Alzheimer's disease (AD) risk. In this commentary, we comment on the work by Cavuoto and colleagues in which they examine the associations between nocturnal hypoxemia or sleep disruptions (during SWS) and amyloid-β burden in individuals with OSA. We review the findings in the context of other similar studies and highlight the strengths and weaknesses of these published studies. We note the importance of examining these relationships longitudinally with a large sample size, including considering sleep health disparities, vascular components, and multiple cognitive domain tests.
PMID: 38363613
ISSN: 1875-8908
CID: 5636002

Association Between Documented Severe Pain and Cognitive Impairment in Home Health Care Patients: Results from the National Outcome and Assessment Information Set Data

Osakwe, Zainab Toteh; Calixte, Rose; Bubu, Omonigho Michael; Reckrey, Jennifer M
PMID: 37751588
ISSN: 1557-7740
CID: 5589682

The structural and social determinants of Alzheimer's disease related dementias

Adkins-Jackson, Paris B; George, Kristen M; Besser, Lilah M; Hyun, Jinshil; Lamar, Melissa; Hill-Jarrett, Tanisha G; Bubu, Omonigho M; Flatt, Jason D; Heyn, Patricia C; Cicero, Ethan C; Zarina Kraal, A; Pushpalata Zanwar, Preeti; Peterson, Rachel; Kim, Boeun; Turner, Robert W; Viswanathan, Jaya; Kulick, Erin R; Zuelsdorff, Megan; Stites, Shana D; Arce Rentería, Miguel; Tsoy, Elena; Seblova, Dominika; Ng, Ted K S; Manly, Jennifer J; Babulal, Ganesh
INTRODUCTION/BACKGROUND:The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. METHODS:In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. RESULTS:Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. DISCUSSION/CONCLUSIONS:Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. HIGHLIGHTS/CONCLUSIONS:Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.
PMID: 37074203
ISSN: 1552-5279
CID: 5464452

Exploring the combined effects of sleep apnea and APOE-e4 on biomarkers of Alzheimer's disease

Turner, Arlener D.; Locklear, Clarence E.; Oruru, Daisha; Briggs, Anthony Q.; Bubu, Omonigho M.; Seixas, Azizi
Objective: We determined the interactive associations of apolipoprotein e4 (APOE-e4), and obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease and examined for racial/ethnic differences of this association. Methods: We used data from the National Alzheimer's Coordinating Center Uniform Dataset (NACC UDS). All participants undergo annual observations, including demographic survey, battery of neuropsychological tests, blood draw (with genotyping), and a clinical evaluation with medical and cognitive/dementia status assessment, while a subset of participants have cerebrospinal fluid (CSF) biomarkers and neuroimaging data. Biomarkers of AD were characterized as the presence of abnormally low amyloid in CSF, via validated Aβ42 cut off protocols, and total segmented hippocampal volume, and volume of white matter hyper intensities (WMH). While clinical markers (to preview cognitive relationships) were characterized via the Montreal Cognitive Assessment (MOCA). Results: Biomarker and clinical marker data were derived from 1,387 participants at baseline (mean age = 69.73 � 8.32; 58.6% female; 13.7% Black/African American), 18.4% of the sample had sleep apnea, and 37.9% were APOE-e4 carriers. Our results confirmed previous reports that OSA and APOE-e4 were independently associated with AD through abnormal levels of amyloid (F(1,306) = 4.27; p = 0.040; F(1,285) = 60.88; p < 0.000, respectively), WMH volume (F(1,306) = 4.27; p = 0.040; F(1,285) = 60.88; p < 0.000, respectively), and MOCA scores (F(1,306) = 4.27; p = 0.040; F(1,285) = 60.88; p < 0.000, respectively). No significant interaction between OSA and APOE-e4 relative to amyloid emerged, however, race stratified analyses indicated the interaction of OSA and APOE-e4 and was significantly associated with WMH and hippocampal volume in Black/African American, but not white participants. Conclusion: OSA and APOE-e4 are interactively associated with WHM in Black/African Americans. This interaction may partially explicate increased levels of risk in this population.
ISSN: 1663-4365
CID: 5423842

Editorial: Additive or synergistic impacts of sleep, circadian rhythm disturbances and other modifiable risk factors on established and novel plasma biomarkers of Alzheimer's disease pathology

Bubu, Omonigho M.; Kam, Korey; Parekh, Ankit; Ayappa, Indu
ISSN: 1663-4365
CID: 5460032

Discrimination and Hypertension Among Older African Americans and Caribbean Blacks: The Moderating Effects of John Henryism

Nguyen, Ann W; Miller, David; Bubu, Omonigho M; Taylor, Harry O; Cobb, Ryon; Trammell, Antoine R; Mitchell, Uchechi A
OBJECTIVES/OBJECTIVE:Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination-health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks. METHODS:The analytic sample was drawn from the National Survey of American Life-Reinterview, which was conducted 2001-2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim. RESULTS:Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension. DISCUSSION/CONCLUSIONS:The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations.
PMID: 34978323
ISSN: 1758-5368
CID: 5106862

Acute OSA Impacts Diurnal Alzheimer's Biomarkers Through Nocturnal Hypoxemia and State Transitions

Kam, Korey; Jun, Jonathan; Parekh, Ankit; Bubu, Omonigho M; Mullins, Anna E; Gu, Chenjuan; Pham, Luu; Wisniewski, Thomas M; Rapoport, David M; Ayappa, Indu; Osorio, Ricardo S; Varga, Andrew W
PMID: 35696622
ISSN: 1535-4970
CID: 5282532

Obstructive Sleep Apnea and Hypertension with Longitudinal β-Amyloid Burden and Cognitive Changes

Bubu, Omonigho M; Kaur, Sonya S; Mbah, Alfred K; Umasabor-Bubu, Ogie Q; Ramos-Cejudo, Jaime; Debure, Ludovic; Mullins, Anna E; Parekh, Ankit; Kam, Korey; Osakwe, Zainab T; Williams, Ellita T; Turner, Arlener D; Glodzik, Lidia; Rapoport, David M; Ogedegbe, Gbenga; Fieremans, Els; de Leon, Mony J; Ayappa, Indu; Jean-Louis, Girardin; Masurkar, Arjun V; Varga, Andrew W; Osorio, Ricardo S
PMID: 35550019
ISSN: 1535-4970
CID: 5213082