Association of comorbid obstructive sleep apnea and insomnia with risk of major adverse cardiovascular events in sleep medicine center patients.

OBJECTIVES: To investigate the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events, including myocardial infarction, unstable angina, congestive heart failure, and stroke, in adults with suspected sleep disorders who underwent sleep apnea testing. METHODS: We conducted a retrospective analysis of electronic medical records data from patients with clinical encounters at sleep medicine centers to identify patients with comorbid obstructive sleep apnea and insomnia, obstructive sleep apnea only, insomnia only, and patients without a diagnosis of obstructive sleep apnea or insomnia (i.e., controls). Obstructive sleep apnea, insomnia, comorbidities, and new-onset major adverse cardiovascular events were ascertained by ICD-9-CM and ICD-10-CM codes. Multivariable adjusted Cox proportional regression models evaluated the risk of major adverse cardiovascular events over a 10-year follow-up period. RESULTS: A total of 3951 patients, 226 controls, 2107 with obstructive sleep apnea only, 276 with insomnia only, and 1342 with comorbid obstructive sleep apnea and insomnia, were included in the analysis. Compared to controls, comorbid obstructive sleep apnea and insomnia were associated with a significantly higher risk of developing major adverse cardiovascular events (hazard ratio 3.60, 95 CI%: 2.33-5.91) in unadjusted analyses. The relationship between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events remained after adjustment for demographic and behavioral factors, but not after further adjustment for comorbidities. The greatest risk of major adverse cardiovascular events was found among younger adults with comorbid obstructive sleep apnea and insomnia. Obstructive sleep apnea only was associated with greater risk of major adverse cardiovascular events in unadjusted analyses only (hazard ratio 2.77, 95% CI: 1.80-4.54). Insomnia only was not significantly associated with increased risk of major adverse cardiovascular events. CONCLUSIONS: Comorbid obstructive sleep apnea and insomnia may be a high-risk group for major adverse cardiovascular events, particularly younger adults. Further research is needed to better understand the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events risk.

Characterizing epigenetic aging in an adult sickle cell disease cohort.

ABSTRACT: Sickle cell disease (SCD) affects ∼100 000 predominantly African American individuals in the United States, causing significant cellular damage, increased disease complications, and premature death. However, the contribution of epigenetic factors to SCD pathophysiology remains relatively unexplored. DNA methylation (DNAm), a primary epigenetic mechanism for regulating gene expression in response to the environment, is an important driver of normal cellular aging. Several DNAm epigenetic clocks have been developed to serve as a proxy for cellular aging. We calculated the epigenetic ages of 89 adults with SCD (mean age, 30.64 years; 60.64% female) using 5 published epigenetic clocks: Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE. We hypothesized that in chronic disease, such as SCD, individuals would demonstrate epigenetic age acceleration, but the results differed depending on the clock used. Recently developed clocks more consistently demonstrated acceleration (GrimAge, DunedinPACE). Additional demographic and clinical phenotypes were analyzed to explore their association with epigenetic age estimates. Chronological age was significantly correlated with epigenetic age in all clocks (Horvath, r = 0.88; Hannum, r = 0.89; PhenoAge, r = 0.85; GrimAge, r = 0.88; DunedinPACE, r = 0.34). The SCD genotype was associated with 2 clocks (PhenoAge, P = .02; DunedinPACE, P < .001). Genetic ancestry, biological sex, ß-globin haplotypes, BCL11A rs11886868, and SCD severity were not associated. These findings, among the first to interrogate epigenetic aging in adults with SCD, demonstrate epigenetic age acceleration with recently developed epigenetic clocks but not older-generation clocks. Further development of epigenetic clocks may improve their predictive ability and utility for chronic diseases such as SCD.

Patient-level factors associated with the self-report of trouble sleeping to healthcare providers in adults at high risk for obstructive sleep apnea.

INTRODUCTION: In adults at risk for obstructive sleep apnea, it is unclear what patient-level factors and symptoms may influence communication with healthcare providers regarding sleep difficulties. This analysis examined associations between sociodemographic characteristics, comorbidities, and obstructive sleep apnea-related symptoms and whether adults at high risk for obstructive sleep apnea reported trouble sleeping to an healthcare provider. METHODS: The sample included participants from the 2015-2018 National Health and Nutrition Examination Survey determined by a modified STOP-Bang to be at high risk for obstructive sleep apnea (n = 2009). Participants were asked if they had ever reported trouble sleeping to an healthcare provider. Self-reported comorbidities and obstructive sleep apnea-related symptoms (ie, snoring, snorting, gasping, or breathing cessation during sleep, daytime sleepiness, fatigue, insomnia, and nocturia) were assessed. RESULTS: Half of the sample (50.8%) never reported trouble sleeping to an healthcare provider. Factors associated with an increased likelihood of reporting trouble sleeping included female sex, former smoker, and prediabetes or diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and symptoms of snorting, gasping, and/or breathing cessation during sleep. Factors associated with a decreased likelihood of reporting trouble sleeping included Mexican American background or Asian race and having less than a high school education. CONCLUSION: Differences in sex, race, education, comorbidities, and obstructive sleep apnea-related symptoms exist between adults at high risk for obstructive sleep apnea who have and have not reported trouble sleeping to an healthcare provider. It is important for healthcare providers to ask all adults about sleep problems, recognizing that men, minorities, and persons with lower educational attainment may be less likely to report trouble sleeping.

Is insomnia severity a moderator of the associations between obstructive sleep apnea severity with mood and diabetes-related distress?

PURPOSE: This study examined insomnia severity as a moderator of the associations between obstructive sleep apnea (OSA) severity with impaired mood and diabetes-related distress in adults with OSA and type 2 diabetes (T2D). METHODS: This secondary analysis used pooled baseline data from two randomized controlled trials that evaluated the efficacy of treatment of OSA or insomnia in adults with T2D. Participants for this analysis had OSA (Apnea Hypopnea Index [AHI] ≥ five events/hour obtained from an in-home sleep apnea testing device) and completed questionnaires on insomnia, mood, and diabetes-related distress. Hierarchical multiple linear regression and multivariate linear regression analyses were used controlling for demographic characteristics and restless leg syndrome. RESULTS: Of 240 participants, mean age was 57.8 ± 10.17, 50% were female, and 35% were non-White. Participants had poorly controlled diabetes (Mean HbA1C = 7.93 ± 1.62), and moderate OSA (Mean AHI = 19.3 ± 16.2). Insomnia severity significantly moderated the association between OSA severity and mood (b = -0.048, p = .017). Although insomnia severity did not moderate the relationship between OSA severity and diabetes-related distress (b = -0.009, p = .458), insomnia severity was independently associated with greater diabetes-related distress (b = 1.133, p < .001). CONCLUSIONS: In adults with T2D and OSA, as insomnia severity increased, increasing OSA severity was associated with lower level of mood disturbances. Insomnia independently increased the level of diabetes-related distress. These findings suggest that comorbid insomnia may be more impactful than OSA on increasing mood disturbances and diabetes-related distress in adults with T2D.

Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs.

Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.

Shift work organization on nurse injuries: A scoping review.

BACKGROUND: Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety. OBJECTIVE: To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse. METHODS: A scoping review was conducted using search results from five bibliographic databases. RESULTS: Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes. CONCLUSIONS: Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Perioperative management of obstructive sleep apnea in lower extremity orthopedic procedures: A review of evidence to inform the development of a clinical pathway.

Obstructive sleep apnea (OSA) is unrecognized in as high as 80% of patients before surgery. When untreated, OSA increases a surgical patient's propensity for airway collapse and sleep deprivation lending to a higher risk for emergent re-intubation, prolonged recovery time, escalation of care, hospital readmission, and longer length of stay. We have reviewed the evidence regarding diagnostic performance of OSA screening methods and the impact of perioperative management strategies on postoperative complications among patients with diagnosed or suspected OSA who are undergoing orthopedic surgery. We then integrated the data and recommendations from professional society guidelines to develop an evidence-based clinical care pathway to optimize the perioperative management of this surgical population. Successful management of patients with diagnosed or suspected OSA encompass five facets of care: screening, education, airway management, medications, and monitoring. This narrative review revealed two gaps in the evidence to inform management of patients undergoing orthopedic surgery 1) during the perioperative setting to include evidence-based interventions that reduce postoperative complications and 2) after discharge to an unmonitored environment. The clinical care pathway as well as perspectives for future research are discussed.

Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment.

STUDY OBJECTIVES: Upper airway stimulation (UAS) is an alternative treatment for obstructive sleep apnea that must be activated nightly. Although the implanted device offsets the mask- or pressure-related side effects often associated with continuous positive airway pressure therapy, some UAS recipients do not use the therapy consistently. This study qualitatively explored factors associated with UAS usage in obstructive sleep apnea patients. METHODS: Semistructured interviews were conducted with 24 obstructive sleep apnea patients who received UAS treatment. Twelve patients were categorized as high users with mean usage of ≥ 4 hours/night and 12 were categorized as low users with < 4 hours/night or nonuse. Interviews explored patients' experiences regarding barriers and facilitators to UAS use and their advice for new UAS recipients. Demographic and clinical data including the Insomnia Severity Index and Generalized Anxiety Disorder Scale were collected. RESULTS: Compared to high users, low users had higher levels of insomnia (mean Insomnia Severity Index: 3.6 vs 15.2, respectively) and anxiety (mean Generalized Anxiety Disorder Scale: 3.4 vs 6.9). High users reported more positive experiences with UAS treatment, such as improvements in symptoms and convenience of treatment, as facilitators of use. Low users tended to focus on the negative aspects of treatment, particularly stimulation-related discomfort and associated sleep disturbance. CONCLUSIONS: Insomnia with or without anxiety contributes to differing patient-reported experiences in high vs low user groups, with increased insomnia symptoms among low users. Improved understanding of the specific barrier and facilitators of UAS adherence may drive better long-term use and more personalized management strategies, including concomitant insomnia treatment. CLINICAL TRIALS REGISTRATION: Registry: ClinicalTrials.gov; Name: Stimulation Therapy for Apnea: Reporting Thoughts (START); URL: https://clinicaltrials.gov/ct2/show/NCT04768543; Identifier: NCT04768543. CITATION: Luyster FS, Ni Q, Lee K, et al. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med. 2022;18(9):2207-2215.

Sleep problems and associations with cardiovascular disease and all-cause mortality in asthma-chronic obstructive pulmonary disease overlap: analysis of the National Health and Nutrition Examination Survey (2007-2012).

STUDY OBJECTIVES: The impact of sleep problems (ie, sleep duration and presence of sleep disorders) on cardiovascular morbidity and all-cause mortality in adults with asthma-chronic obstructive pulmonary disease overlap (ACO) is unknown. METHODS: Using the National Health and Nutrition Examination Survey database (2007-2012 cycles) and National Death Index data, we identified 398 persons with ACO. Data on self-reported physician-diagnosed sleep disorders and cardiovascular disease were collected. Sleep duration in hours was categorized as short (≤ 5 hours), normal (6-8 hours), and long (≥ 9 hours). Associations between sleep duration and presence of sleep disorders and cardiovascular disease and all-cause mortality were analyzed in regression models adjusted for age, sex, race, smoking status, and body mass index. RESULTS: Presence of sleep disorders was more commonly reported in the ACO group (24.7%) compared to all other groups. The ACO group had a higher proportion of short sleepers (27.6%) compared to controls (11.7%) and chronic obstructive pulmonary disease (19.2%) and a higher proportion of long sleepers (6.9%) compared to chronic obstructive pulmonary disease (5.5%). Presence of sleep disorders was associated with increased risk for cardiovascular disease (odds ratio = 2.48; 95% confidence interval, 1.65-3.73) and death (hazard ratio = 1.44; 95% confidence interval, 1.03-2.02); risk did not vary between groups. A stronger association existed between sleep duration and increased risk for cardiovascular and all-cause mortality in ACO compared to chronic obstructive pulmonary disease and controls. CONCLUSIONS: These results suggest that persons with ACO may represent a high-risk group that should be targeted for more aggressive intervention for sleep problems, a modifiable risk factor. CITATION: Baniak LM, Scott PW, Chasens ER, et al. Sleep problems and associations with cardiovascular disease and all-cause mortality in asthma-chronic obstructive pulmonary disease overlap: analysis of the National Health and Nutrition Examination Survey (2007-2012). J Clin Sleep Med. 2022;18(6):1491-1501.

Comorbid obstructive sleep apnea and insomnia and its associations with mood and diabetes-related distress in type 2 diabetes mellitus.

STUDY OBJECTIVES: Previous research suggests that obstructive sleep apnea (OSA) and insomnia frequently coexist and are prevalent in persons with type 2 diabetes mellitus. This study compared mood and diabetes-related distress among OSA, insomnia, and comorbid OSA and insomnia groups in persons with type 2 diabetes mellitus. METHODS: A secondary analysis was conducted with baseline data from 2 independent randomized controlled trials evaluating the efficacy of OSA and insomnia treatment. The pooled sample (n = 224) included participants with OSA only (n = 68 [30.4%]), insomnia only (n = 107 [47.8%]), and OSA and insomnia (OSA+insomnia; n = 49 [21.9%]). OSA was defined as an apnea-hypopnea index ≥ 15 events/h; insomnia was defined as an Insomnia Severity Index score ≥ 15. Mood was measured by the Profile of Mood States total and subscale scores; diabetes-related distress was assessed by the Problem Areas in Diabetes questionnaire. One-way analysis of covariance and multivariate analysis of covariance were conducted, controlling for demographic characteristics and restless legs syndrome. RESULTS: The insomnia group had on average significantly higher scores for total mood disturbance (insomnia vs OSA = 45.32 vs 32.15, P = .049), tension-anxiety (insomnia vs OSA = 12.64 vs 9.47, P = .008), and confusion-bewilderment (insomnia vs OSA = 9.45 vs 7.46, P = .036) than the OSA group. The OSA+insomnia group had on average significantly greater diabetes-related distress than the OSA group (OSA+insomnia vs OSA = 40.61 vs 30.97, P = .036). CONCLUSIONS: Insomnia may have greater impact on mood disturbance and diabetes-related distress than OSA in persons with type 2 diabetes mellitus. In particular, comorbid insomnia may contribute to greater diabetes-related distress in persons with type 2 diabetes mellitus and OSA. CITATION: Jeon B, Luyster FS, Sereika SM, DiNardo MM, Callan JA, Chasens ER. Comorbid obstructive sleep apnea and insomnia and its associations with mood and diabetes-related distress in type 2 diabetes mellitus. J Clin Sleep Med. 2022;18(4):1103-1111.

Covid-19 vaccine confidence and hesitancy in nursing students and faculty at a large academic medical center.

BACKGROUND: Little is known about nursing faculty and nursing student's confidence or potential hesitancy to receive the Covid-19 vaccine once it was available. METHODS: An anonymous electronic survey of nursing students and faculty was conducted at a large academic center in the eastern U.S. FINDINGS: Both students and faculty reported they were fairly or completely confident that the vaccine was safe (n = 235, 89.4%) and that it would effectively mitigate their risk (n = 230, 87.5%). There was a 52.6% decrease in vaccine hesitancy from 6 months prior (p <.01); 22% (n = 58) of those currently willing to receive the vaccine reported moderate to high concern about its side-effects and/or long-term efficacy. Access to vaccine research, vaccine education, and watching others be inoculated, had mitigated their concerns from the previous six months. DISCUSSION: While both nursing students and faculty reported having high confidence in the efficacy and safety of the Covid-19 vaccine, concerns remained.

Obstructive Sleep Apnea Risk Is Associated With Severity of Metabolic Syndrome: A Secondary Analysis of the 2015-2018 National Health and Nutrition Examination Survey.

BACKGROUND: Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are associated with increased risk of cardiometabolic disease. The co-occurrence of OSA with MetS is common, but there are limited data on how OSA risk exacerbates the metabolic impairments present in MetS. The purpose of this analysis was to examine in a representative sample of participants in the National Health and Nutrition Examination Survey 2015-2018 cohorts (1) the association of modifiable cardiometabolic risk factors with OSA risk and MetS severity and (2) the influence of OSA risk and lifestyle behaviors on MetS severity. METHODS: Metabolic syndrome severity was assessed using MetS Z score, whereas the risk of OSA was measured via multivariable apnea prediction index. Data analyses were conducted using the sample weights provided by the National Health and Nutrition Examination Survey. RESULTS: The sample (N = 11 288) included adults (>20 years old) who were overweight (mean body mass index, 29.6 ± 0.2 kg/m 2 ), representative by race (36.9% non-White) and gender (51.9% female). Overall, 19.3% of the sample had elevated MetS severity (MetS Z score ≥ 1), and 38.4% were at a high risk of OSA (multivariable apnea prediction score of ≥0.50). High OSA risk was associated with having elevated MetS severity (odds ratio [OR], 4.94; 95% confidence interval [CI], 3.68-6.65). Obstructive sleep apnea risk predicted increased MetS severity (adjusted: B = 0.06, SE = 0.02, P = .013). Physical activity provided the highest protection from increased MetS severity (OR, 0.52; 95% CI, 0.39-0.70) and OSA risk (OR, 0.59; 95% CI, 0.53-0.66). CONCLUSION: Our findings suggest that increased OSA risk exacerbates MetS severity and that greater physical activity may mitigate the risk.

COVID-19 Vaccine Hesitancy and Uptake among Nursing Staff during an Active Vaccine Rollout.

Even with the availability of COVID-19 vaccines, factors associated with vaccine hesitancy and uptake among nurses are unknown. This study evaluated COVID-19 vaccine hesitancy and uptake of nursing staff during one of the first COVID-19 vaccine rollouts in the United States. A cross-sectional survey was conducted during February 2021 among nursing staff working in a large medical center in central United States. There were 276 respondents; 81.9% of participants were willing to receive the vaccine during the initial rollout, 11.2% were hesitant, and only 5.1% were unwilling. The hesitant group was likely to report having inadequate information to make an informed decision about whether to receive the vaccine (45.2%) and about vaccine expectations (32.3%). The majority (83.3%) received at least one dose of the vaccine. Having greater than 10 years' work experience (OR 3.0, 95% CI 1.16-7.9) and confidence in vaccine safety (OR 7.78, 95% CI 4.49-13.5) were significantly associated with vaccine uptake. While our study indicates higher vaccine uptake among nursing staff during an active vaccine rollout, there remains sustained hesitancy and unwillingness to uptake. For those hesitant to receive the COVID-19 vaccine, public health efforts to provide more data on side effects and efficacy may help increase vaccine uptake.

Sleep and Metabolic Syndrome.

Metabolic syndrome (MetS) refers to the clustering of risk factors for cardiovascular disease and diabetes, including central adiposity, hypertension, dyslipidemia, and hyperglycemia. During the past 20 years, there have been parallel and epidemic increases in MetS and impaired sleep. This article describes evidence on the association between MetS and short sleep duration, circadian misalignment, insomnia, and sleep apnea. Potential mechanisms where impaired sleep desynchronizes and worsens metabolic control and interventions to improve sleep and potentially improve MetS are presented.

Depressive Symptoms in Comorbid Obstructive Sleep Apnea and Insomnia: An Integrative Review.

The purpose of this integrative review was to synthesize evidence concerning the relationship between comorbid obstructive sleep apnea and insomnia (OSA+I), and depressive symptoms. OSA and insomnia are common sleep disorders, recently comorbid OSA+I has been recognized as prevalent in adults. Although each sleep disorder increases the risk and severity of depressive symptoms, the effect of comorbid OSA+I on depressive symptoms remains unclear. A systematic search of PubMed, CINAHL, and PsycINFO identified 15 data-based studies. All the studies were observational with either a cross-sectional (n = 14) or a case-control design (n = 1). Study quality was assessed. Most of the studies (n = 14) indicated that comorbid OSA+I had an additive role on depressive symptoms. Insomnia appeared to have a more important role than OSA in increasing the severity of depressive symptoms in persons with comorbid OSA+I.

Insomnia and Daily Function in Older Adults With Asthma.

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].

Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia.

PURPOSE: The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. METHODS: This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. RESULTS: Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood (b = 2.59, P < .001) and diabetes-related distress (b = 1.40, P < .001) and lower functional outcome (b = -0.22, P < .001). Older age was associated with lower diabetes-related distress (b = -0.44, P = .040). CONCLUSION: Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.

Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma.

BACKGROUND: Asthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. OBJECTIVE: To examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. METHODS: Cross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. RESULTS: Of the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). CONCLUSION: Compared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.

Internet-Based Cognitive-Behavioral Therapy for Insomnia in Adults With Asthma: A Pilot Study.

Background/Objective: Insomnia is common among adults with asthma and is associated with worse asthma control. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia with medical comorbidities, but it has not been tested in asthma. The purpose of this study was to assess the feasibility and acceptability of an Internet-based CBT-I intervention, called Sleep Healthy Using the Internet (SHUTi), among adults with asthma and comorbid insomnia, and to gather preliminary efficacy data on changes in insomnia severity, sleep quality, asthma control, and asthma-related quality of life. Methods: A single-group, pretest-posttest design was employed, where all participants completed the SHUTi program. Online questionnaires were completed pre- and postintervention. Individual telephone interviews were conducted after posttreatment data collection to obtain participants' experiences with SHUTi and suggestions for improvement. Results: The sample (N = 23) comprised men and women aged 18-75 years with moderate to severe, not well-controlled asthma, and comorbid insomnia. Nineteen (83%) completed postintervention assessments. Improvements on the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Asthma Control Test, and Asthma Quality of Life Questionnair-Marks were observed at postintervention. Data from the telephone interviews suggest that most participants had a positive experience with SHUTi. Participants suggested incorporating asthma-specific content into future versions of the intervention. Conclusions: Internet-based CBT-I is a potential treatment option for adults with asthma and comorbid insomnia.

Solving insomnia electronically: Sleep treatment for asthma (SIESTA): A study protocol for a randomized controlled trial.

BACKGROUND: Chronic insomnia is associated with poor asthma control. Cognitive-behavioral treatment for insomnia (CBT-I) is an efficacious and durable treatment for comorbid insomnia in medical and psychiatric disorders. However, the efficacy and potential accompanying mechanisms of CBT-I have not been examined in asthma. The purpose of this study is to test the efficacy of a CBT-I intervention on sleep and asthma control in adults with insomnia and asthma. We will also explore airway inflammation (i.e., exhaled nitric oxide, blood eosinophils) as a potential biological mechanism linking improvements in sleep with improvements in asthma control. METHODS: The study is a single center, parallel group, randomized controlled trial. Two hundred and ten adults with insomnia and asthma that is not well-controlled will be randomized to either a 9-week Internet-based CBT-I program (Sleep Healthy Using the Internet (SHUTi)) or an enhanced usual care condition which utilizes an online educational video about insomnia. The primary sleep outcome is insomnia severity measured by the Insomnia Severity Index. Secondary sleep outcomes are sleep quality and wrist actigraph-recorded sleep parameters. Asthma control will be assessed by the Asthma Control Test, Asthma Quality of Life Questionnaire, pulmonary function testing, and self-report of asthma exacerbations and asthma-related healthcare utilization. Treatment outcomes will be measured at baseline, 9 weeks, and 6 months. DISCUSSION: This trial has the potential to identify a novel strategy for improving asthma control. Findings may advocate for the inclusion of treatment of comorbid insomnia into current asthma management practice guidelines.