Gender Differences in the Relationship Between Financial Stress and Metabolic Abnormalities.

BACKGROUND: Financial stress is associated with higher prevalence of metabolic abnormalities and cardiovascular disease, but the extent to which this association differs by type of metabolic abnormalities or gender is unclear. OBJECTIVES: The study aims were (a) to examine the association between financial stress and the prevalence of common metabolic abnormalities and (b) to test the association for gender differences. METHODS: A cross-sectional secondary analysis was conducted using data from the Retirement and Sleep Trajectories study, an ancillary study of the Wisconsin Sleep Cohort study. Composite indicator structural equation alpha modeling with a stacking approach was applied in the data analysis. RESULTS: After controlling for covariates, financial stress was positively associated with the prevalence of abdominal obesity, metabolic syndrome, and dyslipidemia, with significant gender differences. Among men, financial stress was positively associated with the prevalence of hypertriglyceridemia. Among women, financial stress was positively associated with the prevalence of prediabetes, abdominal obesity, metabolic syndrome, and dyslipidemia. CONCLUSION: Men living with financial stress are more likely to have hypertriglyceridemia, a specific metabolic abnormality and risk factor for acute cardiovascular events. However, financial stress in women is associated with a broader array of metabolic abnormalities (e.g., dyslipidemia, prediabetes, abdominal obesity, metabolic syndrome), highlighting a potential risk of multiple chronic conditions later in life.

Relationships between sleep apnea, cardiovascular disease risk factors, and aortic pulse wave velocity over 18 years: the Wisconsin Sleep Cohort.

PURPOSE: The purpose of this study is to determine if apnea-hypopnea index (AHI) severity predicts future aortic pulse wave velocity (PWV) in the Wisconsin Sleep Cohort. METHODS: Applanation tonometry was used to derive carotid-to-femoral PWV a mean of 18 years (standard deviation 4) after overnight polysomnography. Multivariable regression models were created to describe prospective associations between baseline AHI and future PWV. RESULTS: The 618 adults were mean 65 (7) years old (55 % male) with a mean body mass index of 31 (7) kg/m(2) at the tonometry visit. Mean baseline AHI was 4.6 (9.7) events/h. In multiple linear regression models adjusted for age (ß = 0.13/year, standard error [SE] = 0.01, p < 0.001) and sex, higher log10AHI (ß = 0.43/events/h, SE = 0.18, p = 0.02) was associated with PWV. After adjustment for waist circumference (ß = 0.01/cm, SE = 0.01, p = 0.05) and height, the association between baseline log10AHI and future PWV was not statistically significant (p = 0.11), although the association with age persisted unchanged. Addition of covariates such as smoking status (current smoker ß = 0.66, SE = 0.22, p = 0.002), diabetes mellitus status (ß = 2.89, SE = 0.59, p < 0.001), and systolic blood pressure (BP, ß = 0.03/mmHg, SE = 0.01, p < 0.001) did not change the association. AHI did not interact with age or smoking status to predict PWV. A secondary analysis of nocturnal oxygen saturation parameters in 517 participants, 9 (2) years prior also did not show any significant relationships with future PWV. CONCLUSIONS: The prospective association between AHI and PWV is confounded by body size and influenced by smoking, diabetes mellitus, and BP. Weight management, BP control, and smoking cessation may help prevent arterial stiffening associated with obstructive sleep apnea.

Minimal nocturnal oxygen saturation predicts future subclinical carotid atherosclerosis: the Wisconsin sleep cohort.

Previous data on the associations between nocturnal oxygen saturation parameters and carotid atherosclerosis are conflicting. We examined the prospective associations of nocturnal oxygen saturation (SaO2 ) and cardiovascular disease (CVD) risk factors with carotid intima-media thickness (IMT) and plaques. We used data on 689 Wisconsin sleep cohort participants who had baseline overnight polysomnography followed by carotid ultrasonography a mean (SD) of 7.8 (2.5) years later. Far wall common carotid IMT was measured using B-mode ultrasound. Bilateral common, bifurcation and internal carotid artery segments were evaluated for plaque score. Participants (8) were aged 56 years (55% male); 32% had hypertension and mean body mass index (BMI) was 31 (7) kg m(2). Mean and minimum nocturnal SaO2 were 95% (2) and 86% (7), respectively. Mean percentage sleep time with SaO2 < 90% was 2% (8). Both mean (odds ratio [OR]: 0.60 lower plaque count per 5% higher mean SaO2, 95% confidence interval [CI]: 0.38-0.96, P = 0.033) and minimum SaO2 (OR: 0.88 lower plaque count per 5% higher minimum SaO2, 95% CI: 0.80-0.97, P = 0.013) predicted carotid plaque score after adjusting for age, sex and BMI. Minimum SaO2 predicted future plaque score after adding adjustment for traditional CVD risk factors (OR: 0.90 lower plaque count per 5% higher minimum SaO2, 95% CI: 0.81-0.99, P = 0.038). Mean SaO2 was not associated with carotid IMT after CVD risk factor adjustment. We conclude that minimum nocturnal SaO2 is an independent predictor of future carotid plaque burden. Other nocturnal SaO2 parameters are not associated with future carotid IMT or plaques after adjusting for traditional CVD risk factors.

Obstructive sleep apnea is associated with future subclinical carotid artery disease: thirteen-year follow-up from the Wisconsin sleep cohort.

OBJECTIVE: To determine the longitudinal associations between obstructive sleep apnea, carotid artery intima-media thickness (IMT), and plaque. APPROACH AND RESULTS: This is a population-based, prospective cohort study conducted from July, 1989, to November, 2012, on 790 randomly selected Wisconsin residents who completed a mean of 3.5 (range, 1-6) polysomnograms during the study period. Obstructive sleep apnea was characterized by the apnea-hypopnea index (AHI, events/h). Common carotid artery IMT and plaque were assessed by B-mode ultrasound. The mean (SD) time from the first polysomnograms to carotid ultrasound was 13.5 (3.6) years. Multivariable regression models were created to estimate the independent associations of baseline and cumulative obstructive sleep apnea exposure with subsequent carotid IMT and plaque. At baseline, the mean age of participants was 47.6 (7.7) years (55% men, 97% white). AHI was 4.4 (9.0) events/h (range, 0-97); 7% had AHI >15 events/h. Carotid IMT was 0.755 (0.161) mm; 63% had plaque. Adjusting for age, sex, body mass index, systolic blood pressure, smoking, and use of lipid-lowering, antihypertensive, and antidiabetic medications, baseline AHI independently predicted future carotid IMT (ß=0.027 mm/unit log10[AHI+1]; P=0.049), plaque presence (odds ratio, 1.55 [95% confidence intervals, 1.02-2.35]; P=0.041) and plaque score (odds ratio, 1.30 [1.05-1.61]; P=0.018). In cumulative risk factor-adjusted models, AHI independently predicted future carotid plaque presence (P=0.012) and score (P=0.039), but not IMT (P=0.608). CONCLUSIONS: Prevalent obstructive sleep apnea is independently associated with increased carotid IMT and plaque more than a decade later, indicating increased future cardiovascular disease risk.

Association between asthma and risk of developing obstructive sleep apnea.

IMPORTANCE: Obstructive sleep apnea (OSA) is more common among patients with asthma; whether asthma is associated with the development of OSA is unknown. OBJECTIVE: To examine the prospective relationship of asthma with incident OSA. DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective epidemiologic study (the Wisconsin Sleep Cohort Study) beginning in 1988. Adult participants were recruited from a random sample of Wisconsin state employees to attend overnight polysomnography studies at 4-year intervals. Asthma and covariate information were assessed during polysomnography studies through March 2013. Eligible participants were identified as free of OSA (apnea-hypopnea index [AHI] of <5 events/h and not treated) by 2 baseline polysomnography studies. There were 1105 4-year follow-up intervals provided by 547 participants (52% women; mean [SD] baseline age, 50 [8] years). EXPOSURES: Questionnaire-assessed presence and duration of self-reported physician-diagnosed asthma. MAIN OUTCOMES AND MEASURES: The associations of presence and duration of asthma with 4-year incidences of both OSA (AHI of ≥5 or positive airway pressure treatment) and OSA concomitant with habitual daytime sleepiness were estimated using repeated-measures Poisson regression, adjusting for confounders. RESULTS: Twenty-two of 81 participants (27% [95% CI, 17%-37%]) with asthma experienced incident OSA over their first observed 4-year follow-up interval compared with 75 of 466 participants (16% [95% CI, 13%-19%]) without asthma. Using all 4-year intervals, participants with asthma experienced 45 cases of incident OSA during 167 4-year intervals (27% [95% CI, 20%-34%]) and participants without asthma experienced 160 cases of incident OSA during 938 4-year intervals (17% [95% CI, 15%-19%]); the corresponding adjusted relative risk (RR) was 1.39 (95% CI, 1.06-1.82), controlling for sex, age, baseline and change in body mass index, and other factors. Asthma was also associated with new-onset OSA with habitual sleepiness (RR, 2.72 [95% CI, 1.26-5.89], P = .045). Asthma duration was related to both incident OSA (RR, 1.07 per 5-year increment in asthma duration [95% CI, 1.02-1.13], P = .01) and incident OSA with habitual sleepiness (RR, 1.18 [95% CI, 1.07-1.31], P = .02). CONCLUSIONS AND RELEVANCE: Asthma was associated with an increased risk of new-onset OSA. Studies investigating the mechanisms underlying this association and the value of periodic OSA evaluation in patients with asthma are warranted.

Objectively measured daytime sleepiness predicts weight change among adults: Findings from the Wisconsin Sleep Cohort Study.

OBJECTIVE: Body mass index (BMI) trajectories are associated with night-time sleep, but it is not clear how they relate to daytime sleepiness in population data. This study aimed to examine longitudinal associations between levels and changes in daytime sleepiness and BMI trajectories among men and women. METHODS: We estimated growth curve models among 827 participants in the Wisconsin Sleep Cohort Study (mean [sd] age = 55.2 [8.0] years at baseline). The outcome variable was BMI (kg/m2) and the key predictor was daytime sleepiness measured by Multiple Sleep Latency Test (MSLT) scores. Covariates included demographics, health behaviors, retirement status, stimulant use, and depressive symptoms. In sensitivity analyses, we evaluated the potential effects of cardiovascular disease, shift work status, and sleep apnea on the robustness of sleepiness and BMI associations. RESULTS: At the between-person level, men who were sleepier had higher BMI levels. At the within-person level, age moderated the positive association between sleepiness and BMI among women. Specifically, young women who became sleepier over time gained more BMI than older women with comparable increases in sleepiness. Furthermore, while BMI tended to increase with age among women, BMI trajectories were steeper among sleepy women than among well-rested women, who experienced less increase in BMI over time. CONCLUSION: The study suggested that levels and changes in daytime sleepiness as objectively measured by MSLT scores are associated with body mass among adults.

Prevalence and Course of Idiopathic Hypersomnia in the Wisconsin Sleep Cohort Study.

BACKGROUND AND OBJECTIVES: Idiopathic hypersomnia (IH) is a CNS disorder of hypersomnolence of unknown etiology. Due to the requirement for objective sleep testing to diagnose the disorder, there are currently no population-based estimates of the prevalence of IH nor data regarding the longitudinal course of IH in naturalistic settings. METHODS: Subjective and objective data from the Wisconsin Sleep Cohort study were used to identify cases with probable IH from participants with polysomnography and multiple sleep latency test data. Demographic, polysomnographic, and symptom-level data were compared between those with and without IH. Longitudinal trajectories of daytime sleepiness among those with IH were assessed to evaluate symptom persistence or remission over time. RESULTS: From 792 cohort study participants with available polysomnography and multiple sleep latency test data, 12 cases with probable IH were identified resulting in an estimated prevalence of IH of 1.5% (95% CI 0.7-2.5, p < 0.0001). Consistent with inclusion/exclusion criteria, cases with IH had more severe sleepiness and sleep propensity, despite similar or longer sleep times. Longitudinal data (spanning 12.1 ± 4.3 years) demonstrated a chronic course of sleepiness for most of the cases with IH, though pathologic somnolence remitted in roughly 40% of cases. DISCUSSION: These results demonstrate IH is more common in the working population than generally assumed with a prevalence on par with other common neurologic and psychiatric conditions. Further efforts to identify and diagnose those impaired by unexplained daytime somnolence may help clarify the causes of IH and the mechanisms underlying symptomatic remission.

Corrigendum: The effect of low-abundance OTU filtering methods on the reliability and variability of microbial composition assessed by 16S rRNA amplicon sequencing.

[This corrects the article DOI: 10.3389/fcimb.2023.1165295.].

Participant attrition from statewide, population-based Survey of the Health of Wisconsin into the longitudinal SHOW COVID-19 cohort.

PURPOSE: Longitudinal studies are essential for examining how social and institutional determinants of health, historical and contemporary, affect disparities in COVID-19 related outcomes. The unequal impacts of COVID-19 likely exacerbated selected attrition in longitudinal research. This study examines attrition and survey mode effects in the SHOW COVID-19 study which recruited from a statewide, representative cohort. MATERIALS & METHODS: Participants were recruited from the Survey of the Health of Wisconsin (SHOW) cohort. Online surveys, or phone interviews, were administered at three timepoints during 2020-2021. The surveys captured social, behavioral, and structural determinants of health and the lived experience. Univariate and multivariate logistic regression was used to examine predictors of participation and survey mode effects. RESULTS: A total of 2304 adults completed at least one COVID-19 online survey. Participants were more educated, older, and more likely to be female, married, non-Hispanic, and White compared to non-participants. Phone participants were older, less educated, and more likely be non-White, food insecure, and have co-morbidities compared to online participants. Mode effects were seen with reporting COVID-19 beliefs, loneliness, and anxiety. CONCLUSION: The SHOW COVID-19 cohort offers unique longitudinal data but suffered from selected attrition. Phone interview is an important mode for retention and representation.

Increased prevalence of sleep-disordered breathing in adults.

Sleep-disordered breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-disordered breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-disordered breathing prevalence require updating. We estimated the prevalence of sleep-disordered breathing in the United States for the periods of 1988-1994 and 2007-2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30-70 years of age had baseline polysomnography studies to assess the presence of sleep-disordered breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-disordered breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-disordered breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30-49-year-old men; 17% (95% CI: 15, 21) among 50-70-year-old men; 3% (95% CI: 2, 4) among 30-49-year-old women; and 9% (95% CI: 7, 11) among 50-70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).

OSA-Onset: An algorithm for predicting the age of OSA onset.

STUDY OBJECTIVES: There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information would allow identification of people who have had an extended exposure period and are therefore at greater risk of other medical disorders; and enable consideration of disease chronicity in the study of OSA pathogenesis/treatment. METHOD: The 'age of OSA Onset' algorithm was developed in the Wisconsin Sleep Cohort (WSC), in participants who had ≥2 sleep studies and not using continuous positive airway pressure (n = 696). The algorithm was tested in a participant subset from the WSC (n = 154) and the Sleep Heart Health Study (SHHS; n = 705), those with an initial sleep study showing no significant OSA (apnea-hypopnea index (AHI) < 15 events/hr) and later sleep study showing moderate to severe OSA (AHI≥15 events/hr). RESULTS: Regression analyses were performed to identify variables that predicted change in AHI over time (BMI, sex, and AHI; beta weights and intercept used in the algorithm). In the WSC and SHHS subsamples, the observed years with OSA was 3.6 ± 2.6 and 2.7 ± 0.6 years, the algorithm estimated years with OSA was 10.6 ± 8.2 and 9.0 ± 6.2 years. CONCLUSIONS: The OSA-Onset algorithm estimated years of exposure to OSA with an accuracy of between 6.6 and 7.8 years (mean absolute error). Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to treatment.

Metabolic health disparities driven by financial stress: Behavioural adaptation or modification?

Financial stress has been linked to an increased risk of metabolic syndrome, yet, it remains unclear whether suboptimal sleep duration and physical inactivity are the adaptive responses to financial stress or effect modifiers in the association between financial stress and metabolic syndrome. Hence, this study aims to examine whether physical activity and sleep duration mediate or moderate the bivariate association between financial stress and metabolic syndrome. A prospective secondary analysis was conducted using data from the Wisconsin Sleep Cohort Study (N = 445, mean [SD] age = 64 [7] years). Baseline moderation effect was examined using subgroup analysis with model constraints; prospective mediation model was examined using bias-corrected bootstrap confidence intervals. Results indicate that participants with higher financial stress were less likely to meet physical activity and sleep recommendations. Baseline moderation analysis indicates that meeting current recommendations of sleep duration and physical activity attenuated the association between financial stress and metabolic syndrome. In the prospective mediation analysis, weekly physical activity levels partially mediated the relationship between financial stress and metabolic syndrome, but sleep duration did not mediate this relationship. In conclusion, the joint effect of optimal sleep duration and physical activity disassociates financial stress from the risk of metabolic syndrome. Future interventions addressing metabolic risk might achieve better outcomes if clinicians and researchers factor in the behavioral adaptation of physical inactivity in financially stressed adults (Clinical Trial Registration: NCT00005557).

Association between stressful life events and non-optimal lipid levels among women with hyperlipidaemia.

AIMS: Psychological stress has been linked to lipid dysregulation with noticeable gender differences, but it remains unclear whether women are more susceptible to non-optimal lipid levels than men, when experiencing stressful life events. This study aims to examine the association between stressful life events and non-optimal lipid levels among persons with hyperlipidaemia and whether the association differs between men and women. METHODS AND RESULTS: A nested case-control study was performed using data from the Wisconsin Sleep Cohort (WSC) Study from 2011 to 2015, including 224 participants with hyperlipidaemia and without a history of myocardial infarction or heart failure. Among them, 63 participants with non-optimal LDL cholesterol or triglyceride levels were identified as cases, and 161 participants with optimal LDL cholesterol and triglyceride levels were identified as controls. Cases and controls were traced back to their self-reported life events collected through the Retirement and Sleep Trajectories study during 2010-11. The association between stressful life events and non-optimal lipid levels was examined using multivariable logistic regression; confounding effects were addressed using propensity score weighting and Mahalanobis distance matching; gender differences were examined using subgroup analysis. Results showed that a higher number of stressful life events during 2010-11 was associated with greater odds of non-optimal lipid levels during 2011-15 (odds ratio = 1.45, P = 0.03) among women with hyperlipidaemia, whereas the association was not significant among men with hyperlipidaemia (P = 0.910). CONCLUSION: Future studies are needed to examine the underlying mechanisms that explain gender differences in the association between stressful life events and non-optimal lipid levels. REGISTRATION: ClinicalTrials.gov NCT00005557.

The effect of low-abundance OTU filtering methods on the reliability and variability of microbial composition assessed by 16S rRNA amplicon sequencing.

PCR amplicon sequencing may lead to detection of spurious operational taxonomic units (OTUs), inflating estimates of gut microbial diversity. There is no consensus in the analytical approach as to what filtering methods should be applied to remove low-abundance OTUs; moreover, few studies have investigated the reliability of OTU detection within replicates. Here, we investigated the reliability of OTU detection (% agreement in detecting OTU in triplicates) and accuracy of their quantification (assessed by coefficient of variation (CV)) in human stool specimens. Stool samples were collected from 12 participants 22-55 years old. We applied several methods for filtering low-abundance OTUs and determined their impact on alpha-diversity and beta-diversity metrics. The reliability of OTU detection without any filtering was only 44.1% (SE=0.9) but increased after filtering low-abundance OTUs. After filtering OTUs with <0.1% abundance in the dataset, the reliability increased to 87.7% (SE=0.6) but at the expense of removing 6.97% reads from the dataset. When filtering was based on individual sample, the reliability increased to 73.1% after filtering OTUs with <10 copies while removing only 1.12% of reads. High abundance OTUs (>10 copies in sample) had lower CV, indicating better accuracy of quantification than low-abundance OTUs. Excluding very low-abundance OTUs had a significant impact on alpha-diversity metrics sensitive to the presence of rare species (observed OTUs, Chao1) but had little impact on relative abundance of major phyla and families and alpha-diversity metrics accounting for both richness and evenness (Shannon, Inverse Simpson). To increase the reliability of microbial composition, we advise removing OTUs with <10 copies in individual samples, particularly in studies where only one subsample per specimen is available for analysis.

Cardiorespiratory Fitness Attenuates the Deleterious Effects of Sleep Apnea on Cerebral Structure and Perfusion in the Wisconsin Sleep Cohort Study.

BACKGROUND: Emerging evidence suggests that age-related changes in cerebral health may be sensitive to vascular risk modifiers, such as physical activity and sleep. OBJECTIVE: We examine whether cardiorespiratory fitness modifies the association of obstructive sleep apnea (OSA) severity with MRI-assessed measures of cerebral structure and perfusion. METHODS: Using data from a cross-sectional sample of participants (n = 129, 51% female, age range 49.6-85.3 years) in the Wisconsin Sleep Cohort study, we estimated linear models of MRI-assessed total and regional gray matter (GM) and white matter (WM) volumes, WM hyperintensity (WMH:ICV ratio), total lesion volume, and arterial spin labeling (ASL) cerebral blood flow (CBF), using an estimated measure of cardiorespiratory fitness (CRF) and OSA severity as predictors. Participants' sleep was assessed using overnight in-laboratory polysomnography, and OSA severity was measured using the apnea-hypopnea index (AHI), or the mean number of recorded apnea and hypopnea events per hour of sleep. The mean±SD time difference between PSG data collection and MRI data collection was 1.7±1.5 years (range: [0, 4.9 years]). RESULTS: OSA severity was associated with reduced total GM volume (ß=-0.064; SE = 0.023; p = 0.007), greater total WM lesion volume (interaction p = 0.023), and greater WMHs (interaction p = 0.017) in less-fit subjects. Perfusion models revealed significant differences in the association of AHI and regional CBF between fitness groups (interaction ps < 0.05). CONCLUSION: This work provides new evidence for the protective role of cardiorespiratory fitness against the deleterious effects of OSA on brain aging in late-middle age to older adults.

Polysomnographic indicators of restorative sleep and body mass trajectories in the Wisconsin Sleep Cohort Study.

STUDY OBJECTIVES: Previous research suggests that reductions in restorative, slow-wave (N3), and rapid eye movement (REM) sleep are associated with weight gain and obesity in mid-to-late life. We extend prior work by examining how within-person (WP) changes and between-person (BP) differences in restorative sleep over several years are associated with body mass trajectories among participants in the Wisconsin Sleep Cohort Study (WSCS). METHODS: We used data from 4,862 polysomnographic (PSG) sleep studies and physical exams collected from 1,187 WSCS participants over an average duration of 14.9 years. Primary measures of interest included body mass index (BMI = kg/m2) and the percentages of time spent in N3 and REM sleep. We estimated a series of linear mixed regression models to examine how WP changes and BP differences in N3 and REM sleep affected BMI trajectories, controlling for other sleep measures, demographic characteristics, and health behaviors as potential confounders. RESULTS: Women in the WSCS experienced more rapid BMI gain than men. With some variation by sex, we found that (1) below-average N3 and REM sleep is associated with above-average BMI, and (2) within-person decreases in N3 and REM sleep over time are associated with gains in BMI. These findings persisted after adjustment for sleep duration and other potential confounders. CONCLUSIONS: Our findings highlight the importance of PSG indices of restorative sleep in mid-to-late life, suggesting that future clinical treatments and public health policies will benefit from heightened attention to sleep quality.

Assessing the impact of storage time on the stability of stool microbiota richness, diversity, and composition.

BACKGROUND: New technologies like next-generation sequencing have led to a proliferation of studies investigating the role of the gut microbiome in human health, particularly population-based studies that rely upon participant self-collection of samples. However, the impact of methodological differences in sample shipping, storage, and processing are not well-characterized for these types of studies, especially when transit times may exceed 24 h. The aim of this study was to experimentally assess microbiota stability in stool samples stored at 4 °C for durations of 6, 24, 48, 72, and 96 h with no additives to better understand effects of variable shipping times in population-based studies. These data were compared to a baseline sample that was immediately stored at - 80 °C after stool production. RESULTS: Compared to the baseline sample, we found that the alpha-diversity metrics Shannon's and Inverse Simpson's had excellent intra-class correlations (ICC) for all storage durations. Chao1 richness had good to excellent ICC. We found that the relative abundances of bacteria in the phyla Verrucomicrobia, Actinobacteria, and Proteobacteria had excellent ICC with baseline for all storage durations, while Firmicutes and Bacteroidetes ranged from moderate to good. We interpreted the ICCs as follows: poor: ICC < 0.50, moderate: 0.50 < ICC < 0.75, good: 0.75 < ICC < 0.90, and excellent: ICC > 0.90. Using the Bray-Curtis dissimilarity index, we found that the greatest change in community composition occurred between 0 and 24 h of storage, while community composition remained relatively stable for subsequent storage durations. Samples showed strong clustering by individual, indicating that inter-individual variability was greater than the variability associated with storage time. CONCLUSIONS: The results of this analysis suggest that several measures of alpha diversity, relative abundance, and overall community composition are robust to storage at 4 °C for up to 96 h. We found that the overall community richness was influenced by storage duration in addition to the relative abundances of sequences within the Firmicutes and Bacteroidetes phyla. Finally, we demonstrate that inter-individual variability in microbiota composition was greater than the variability due to changing storage durations.

Habitual sleep, sleep duration differential, and weight change among adults: Findings from the Wisconsin Sleep Cohort Study.

OBJECTIVES: Assess longitudinal associations between diary-measured sleep duration and clinically assessed body mass index (BMI). DESIGN: Multilevel growth curve analyses examined how within-person changes and between-person differences in habitual sleep duration were associated with BMI trajectories. SETTING: Sleep diaries across 2-6 consecutive weekday and weekend nights at each data collection point, repeatedly collected at approximate 4-year intervals, for an average of 9.2 (standard deviation [SD] = 3.6) years between 1989 and 2011. PARTICIPANTS: About 784 participants (47% women) enrolled in the Wisconsin Sleep Cohort Study (mean [SD] age = 51.1 [8.0] years at baseline). MEASUREMENTS: The outcome variable was BMI (kg/m2). Key predictors were habitual sleep duration (defined as average weekday nighttime sleep duration) and sleep duration differential (defined as the difference between average weekday and average weekend nighttime sleep duration) at each data collection wave. RESULTS: Men with shorter habitual sleep duration on weekdays had higher BMI than men with longer habitual sleep duration on weekdays (ß = -0.90 kg/m2/hour, se = 0.34, p = .008). Participants with larger differentials between weekday and weekend sleep duration experienced more rapid BMI gain over time for both men (ß = 0.033 kg/m2/year per hour differential, se = 0.017, p = .044) and women (ß = 0.057 kg/m2/year per hour differential, se = 0.027, p = .036). CONCLUSION: This study suggests that habitual short sleep is associated with higher BMI levels in men and that a larger weekday-weekend sleep differential is associated with increasing BMI trajectories among both men and women in mid-to-late life.

Prescribed Opioid Use in Wisconsin 2008-2016: Findings From the Survey of the Health of Wisconsin.

BACKGROUND: The opioid epidemic is a national crisis. The objectives of this report were to describe prescription opioid use in Wisconsin from 2008 through 2016 using unique populationrepresentative data and to assess which demographic, health, and behavioral health characteristics were related to past 30-day prescribed opioid use. METHODS: Data were obtained from the Survey of the Health of Wisconsin (SHOW), a statewide representative sample of 4,487 adults. Prescription medication use was ascertained via in-person interviews that included an inventory of all prescription medications used by the respondent in the past 30 days. The data were weighted to represent the adult population of Wisconsin, aged 21 to 74. Chi-square, logistic regression, and descriptive statistics were used to analyze data. RESULTS: From 2008 to 2016, 6.4% (95% CI, 5.5-7.3) of adults age 21 years or older reported using a prescribed opioid in the past 30 days. Hydrocodone was the most prescribed opioid class followed by oxycodone. People 50 years of age and older, self-identified black or Hispanic, urban dwellers, those with a high school education or less, and those having incomes below 200% of the federal poverty level (FPL) reported significantly higher rates of prescribed opioid use relative to others. Participants reporting physician-diagnosed drug or alcohol abuse, current smokers, and those currently suffering from depression also reported significantly higher use. CONCLUSION: These data from 2008-2016 demonstrate concerning levels of prescription opioid use and provide data on which population groups may be most vulnerable. While policies and clinical practice have changed since 2016, ongoing evaluation of prescribing practices, including consideration of behavioral health issues when prescribing opioids, is called for.

Reasons Behind Preferences for Community-Based Continence Promotion.

OBJECTIVES: This study aimed to understand the potential reach of continence promotion intervention formats among incontinent women. METHODS: The Survey of the Health of Wisconsin conducts household interviews on a population-based sample. In 2016, 399 adult women were asked about incontinence and likelihood of participation in continence promotion via 3 formats: single lecture, interactive 3-session workshop, or online. Descriptive analyses compared women likely versus unlikely to participate in continence promotion. To understand format preferences, modified grounded theory was used to conduct and analyze telephone interviews. RESULTS: One hundred eighty-seven (76%) of 246 incontinent women reported being likely to attend continence promotion: 111 (45%) for a single lecture, 43 (17%) for an interactive 3-session workshop, and 156 (64%) for an online program. Obesity, older age, nonwhite race, prior health program participation, and Internet use for health information were associated with reported continence promotion participation. Cited advantages of a single lecture included convenience and ability to ask questions. A workshop offered accountability, hands-on learning, and opportunity to learn from others; online format offered privacy, convenience, and self-directed learning. CONCLUSIONS: Most incontinent women are willing to participate in continence promotion, especially online.