Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea.

BACKGROUND: There is a dearth of research inclusive of African Americans living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, such as hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers. OBJECTIVE: This longitudinal pilot study aimed to characterize fatigue symptom presentations among African Americans newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension. METHODS: Adult African Americans newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status. RESULTS: Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix-metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first three months after diagnosis. DISCUSSION: Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African Americans. Fatigue in persons with hypertension improved after treatment. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in those with OSA regardless of hypertension status.

Inequality in Physical Activity in Organized Group Settings for Children: A Cross-Sectional Study.

BACKGROUND: Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children. METHODS: PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose. RESULTS: Activity count inequality was lowest (P < .05) during youth club meetings (Gini = 0.17, 95% CI, 0.14-0.20), and inequality in moderate to vigorous PA minutes was greatest (P < .01) during school (Gini = 0.34, 95% CI, 0.30-0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17-0.23) had lower activity count inequality (P < .0001) than academic (Gini = 0.30, 95% CI, 0.27-0.34), enrichment (Gini = 0.31, 95% CI, 0.27-0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25-0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P < .05) in organized PA (Gini = 0.26, 95% CI, 0.20-0.32) and free play (Gini = 0.28, 95% CI, 0.19-0.39) than other sessions. CONCLUSIONS: PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities.

Investigate-Design-Practice-Reflect: An Iterative Community-Engaged Action Process to Improve Population Health.

BACKGROUND: Community-based coalitions are a common strategy for community engagement efforts targeting the improvement of a variety of population health outcomes. The typical processes that coalitions follow to organize efforts include steps that are sequential, slow, and time intensive. These processes also limit local decision-making to the selection of evidence-based policies or programs. METHODS: We present a process control theory-based Community Action Process, Investigate-Design-Practice-Reflect (IDPR), where community hubs (i.e., coalitions) organize agile efforts in a non-sequential, rapid, and efficient manner to harness local assets and data to make decisions regarding the provision and production of population health services. Using qualitative methods, we illustrate and analyze the use of IDPR in a one community case study as part of Wellscapes, a Type 3-hybrid implementation-effectiveness community randomized controlled trial to improve children's population health physical activity. RESULTS: We found community members followed the IDPR Community Action Process to rapidly design, organize, deliver, and receive feedback on a community-based, children's population physical activity prototype, an afterschool Play-in-the-Park opportunity for all children. DISCUSSION: Following IDPR afforded the community coalition timely learning through feedback within a process that coordinated decisions regarding what community services met community needs (provision decisions) and how to organize the production of the population health services (production decisions).

Inequality in Children's Physical Activity Across Time-Segmented Youth Sport Practice.

Purpose: Youth sport (YS) is a community system for promoting children's physical activity (PA). Studies have examined mean PA during YS practices, but few have examined inequalities in the distribution of PA among children during practice time. This study examined PA inequality in time-segmented YS practices and differences in inequality by time segment characteristics. Methods: Children's PA and YS practices were examined using accelerometer and video observation data from a sample of YS teams (n = 36 teams, n = 101 practices) for third- through sixth-grade children (n = 392), approximately eight to 12 years old, in two rural U.S. communities. Practices were time-segmented into smaller units (episodes; n = 991). Episodes were assigned codes for purpose (e.g. warm-up), member arrangement (e.g. whole group), and setting demand (i.e. fosters participation, creates exclusion). Group accelerometer data were paired with episodes, and the Gini coefficient quantified inequality in activity counts and minutes of moderate-to-vigorous PA (MVPA). Beta generalized estimating equations examined the influence of episode structure on PA inequality. Results: Warm-up (Gini = 0.22), fitness (Gini = 0.24), and sport skill (Gini = 0.24) episodes had significantly lower inequality (p < .05) in activity counts than other purpose types. Management (Gini = 0.32) and strategy (Gini = 0.40) episodes had significantly greater inequality (p < .05) in MVPA minutes than other purpose types. Episodes fostering participation (Gini = 0.32) had significantly lower activity count inequality (p < .05) than episodes creating exclusion (Gini = 0.35). Conclusion: PA inequality among children during YS varied by practice structure. Metrics such as the Gini coefficient can illuminate inequalities in PA and may be useful for guiding efforts to improve population PA in children. Trial Registration: This study is registered at www.clinicaltrials.gov (Identifier: NCT03380143).

Community-engaged Systems for Population Health Improvement: A Novel Approach to Improve Diabetes Outcomes in Rural Communities.

BACKGROUND: Approaches to prevent and manage diabetes at a community population level are hindered because current strategies are not aligned with the structure and function of a community system. We describe a community-driven process based on local data and rapid prototyping as an alternative approach to create diabetes prevention and care management solutions appropriate for each community. We report on the process and provide baseline data for a 3-year case study initiative to improve diabetes outcomes in two rural Nebraska communities. METHODS: We developed an iterative design process based on the assumption that decentralized decision-making using local data feedback and monitoring will lead to the innovation of local sustainable solutions. Coalitions act as community innovation hubs and meet monthly to work through a facilitated design process. Six core diabetes measures will be tracked over the course of the project using the electronic health record from community clinics as a proxy for the entire community. RESULTS: Baseline data indicate two-thirds of the population in both communities are at risk for prediabetes based on age and body mass index. However, only a fraction (35% and 12%) of those at risk have been screened. This information led both coalitions to focus on improving screening rates in their communities. DISCUSSION: In order to move a complex system towards an optimal state (e.g., improved diabetes outcomes), stakeholders must have access to continuous feedback of accurate, pertinent information in order to make informed decisions. Conventional approaches of implementing evidence-based interventions do not facilitate this process.

Development of a mindfulness-based intervention for narcolepsy: a feasibility study.

STUDY OBJECTIVES: Mindfulness-based interventions (MBI) have been shown to improve psychosocial functioning in medical populations but have not been studied in narcolepsy. This study examined the feasibility and acceptability of an MBI that was adapted for narcolepsy, including three variations in program length. METHODS: Adults with narcolepsy (N = 60) were randomized to MBI groups of varying durations: brief (4 weeks), standard (8 weeks), or extended (12 weeks). Participants completed assessments at baseline, 4, 8, and 12 weeks. To assess feasibility and acceptability, primary outcomes included attendance, meditation practice, and data completeness. Additionally, participants completed measures of mindfulness, self-compassion, mood, sleep, psychosocial functioning, and cognition. An effect size of Cohen's d ≥ 0.5 was used as the prespecified benchmark for a minimal clinically important difference (MCID). RESULTS: The attendance, meditation, and data completeness benchmarks were met by 71.7%, 61.7%, and 78.3% of participants, respectively. Higher proportions of the brief and extended groups met these benchmarks compared to the standard group. All groups met the MCID for mindfulness, self-compassion, self-efficacy for managing emotions, positive psychosocial impact, global mental health, and fatigue. Standard and extended groups met the MCID for anxiety and depression, and extended groups met the MCID for additional measures including social and cognitive functioning, daytime sleepiness, hypersomnia symptoms, and hypersomnia-related functioning. CONCLUSIONS: Results suggest that the remote delivery and data collection methods are feasible to employ in future clinical trials, and it appears that the extended MBI provides the most favorable clinical impact while maintaining attendance and engagement in meditation practice. CLINICAL TRIAL REGISTRATION: Awareness and Self-Compassion Enhancing Narcolepsy Treatment (ASCENT), NCT04306952, https://clinicaltrials.gov/ct2/show/NCT04306952.

Sociodemographic influences on youth sport participation and physical activity among children living within concentrated Hispanic/Latino rural communities.

Introduction: Lack of physical activity (PA) among children living in rural communities is a documented public health problem. Although studies have examined community conditions defined by a rural-urban dichotomy, few have investigated rural community conditions with a concentration of Hispanic/Latino people. This cross-sectional study examined sociodemographic characteristics associated with youth sport (YS) participation and daily PA among children living within concentrated Hispanic/Latino rural U.S. Midwest communities. Methods: During spring 2022, 97% of 3rd-6th grade children (n = 281, aged approximately 8-12 years) attending school in rural Midwestern communities (n = 2) with >50% concentration of Hispanic students participated in the Wellscapes Project, a community randomized trial. Participants completed the Youth Activity Profile and supplemental National Survey of Children's Health questions assessing PA behaviors and YS participation. Caregivers of a subsample of children (n = 215; males, n = 93; females, n = 122) consented to pair their child's survey results with school enrollment records (e.g., free/reduced lunch status and race and ethnicity). Mixed models with community as a random effect examined main and interaction effects of grade, sex, ethnoracial status, and family income on YS participation and these sociodemographic characteristics and YS participation on daily moderate-to-vigorous PA (MVPA). Results: Approximately half of children participated in YS. Non-Hispanic White children (n = 82) were over five times more likely to participate in YS than Hispanic peers (n = 133) (OR = 5.54, 95% CI = 2.64-11.61, p < 0.001). YS participants accumulated 8.3 ± 2.3 more minutes of daily MVPA than non-participants (p < 0.001). Sixth graders, females, and Hispanic children reported lower daily MVPA than comparison groups (p < 0.05). Significant interaction effects on daily MVPA between grade and ethnoracial status (F(3, 204) = 3.04, p = 0.030) were also found. Discussion: Disparities in sport participation and PA outcomes based on sociodemographic characteristics exist among children living in ethnoracially diverse rural communities. Strategies to promote YS participation, including community structural changes, may help reduce PA disparities. The research provides valuable insights for policymakers, public health professionals, and community members to address YS participation barriers, not limited to cost, while considering other PA-promotion efforts to improve child population health.

Indicators of community physical activity resources and opportunities and variation by community sociodemographic characteristics: A scoping review.

Objective: This scoping review synthesizes studies examining community-level variability in physical activity resource (assets) and opportunity (organized group physical activity services) availability by community sociodemographic characteristics to describe methodologies for measuring resources/opportunities, indicators characterizing availability, and associations between community-level sociodemographic characteristics and availability. Methods: A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, and Scopus for literature through 2022. Eligible studies quantitatively examined measures of physical activity resource/opportunity availability by community-level racial, ethnic, and/or socioeconomic characteristics within geospatially defined communities. Extracted data included: community geospatial definitions, sociodemographic characteristics assessed, methodologies for measuring and indicators of community physical activity resource/opportunity availability, and study findings. Results: Among the 46 included studies, community geospatial units were defined by 28 different community boundaries (e.g., town), and 13% of studies were conducted in rural areas. Nearly all (98%) studies measured community-level socioeconomic status, and 45% of studies measured race/ethnicity. A total of 41 indicators of physical activity resource/opportunity availability were identified. Most studies (91%) assessed built environment resources (e.g., parks), while 8.7% of studies assessed opportunities (e.g., programs). Of 141 associations/differences between community sociodemographic characteristics and resource/opportunity availability, 29.8% indicated greater availability in communities of higher socioeconomic status or lower prevalence of minority populations. The remaining findings were in the opposite direction (9.2%), non-significant (36.9%), or mixed (24.1%). Conclusions: Variability in physical activity resources/opportunities by community sociodemographic characteristics was not consistently evident. However, the indicators synthesized may be useful for informing population health improvement efforts by illuminating the physical and social conditions impacting population physical activity outcomes.

Performance of PROMIS Measures to Assess Fatigue and Sleep Symptom Severity Among African American Patients Newly Diagnosed With Obstructive Sleep Apnea.

This pilot study examined the concurrent validity of Patient-Reported Outcomes Measurement Information System (PROMIS), Short Form, measures with the longer Multidimensional Fatigue Inventory among patients living with obstructive sleep apnea (OSA). A total of 26 African American patients living with prediabetes and newly diagnosed with OSA completed the six-item short form versions of PROMIS Fatigue and PROMIS Sleep Disturbance, and the longer 20-item Multidimensional Fatigue Inventory. Both PROMIS Fatigue and Sleep Disturbance scales demonstrated high reliability with Cronbach's α of .91 and .92, respectively. PROMIS Fatigue scores were significantly correlated with Multidimensional Fatigue Inventory scores (rs = .53; p = .006) and demonstrated concurrent validity. However, PROMIS Sleep Disturbance scores and Multidimensional Fatigue Inventory scores were not associated with one another. The brief PROMIS Fatigue scale is a useful, succinct approach to assess fatigue severity among diverse patient populations living with OSA. This study is among the first to evaluate the performance of PROMIS Fatigue in a sample living with OSA.

Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector.

BACKGROUND: The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as to their patients/clients and the public. METHODS: This paper has three aims: (1) provide an overview of the burden of shift work, long hours, and related sleep and fatigue problems in this sector; (2) suggest research priorities that would improve these; and (3) discuss potential positive impacts of addressing these research priorities for the health and safety of workers and the public. The authors used a modified Delphi approach to anonymously rank-order priorities for improving HCSA worker health and safety and public safety. Input was also obtained from attendees at the 2019 National Institute for Occupational Safety and Health (NIOSH) Work Hours, Sleep, and Fatigue Forum. RESULTS: The highest rated research priorities were developing better designs for work schedules, and improving the HCSA culture and leadership approaches to shift work and long work hours. Additional priorities are identified. CONCLUSION: Research in these priority areas has the potential to benefit HCSA workers as well as their patients/clients, employers, and society.

Preliminary evidence of insulin resistance in young adults with impaired sleep.

Objective: Impaired sleep is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (T2DM), but is poorly understood in young adults. This cross-sectional study examined sleep characteristics, risk factors for T2DM, and IR in college students. Participants: Thirty-two college students (18-25 years) with either short sleep or poor quality sleep were assessed. Methods: Participants completed self-report measures of sleep and T2DM risk factors. One week of objective sleep was measured with wrist actigraphy. IR was calculated from fasting serum glucose and insulin concentrations. Results: The sample slept on average 6.6 hours/night, and over half had IR. Of those with IR, 44.4% had normal body mass index (BMI), 72% had normal fasting glucose concentrations, and all but one had T2DM risk test score indicating they were not at risk. Conclusions: IR was found in over half of participants; however, many typical T2DM risk factors were not present in those with IR.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT: For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Shiftwork, functional bowel symptoms, and the microbiome.

BACKGROUND: There are about 15 million Americans working full-time on evening, night, or rotating shifts. Between 48% and 81.9% of those working rotating or night shifts report abdominal pain, constipation, diarrhea and other symptoms of functional bowel disorders. The basis for this high prevalence of functional bowel disorders, including irritable bowel syndrome (IBS), among shift workers is unknown. Animal studies, however, suggest that circadian disruption, similar to that in shift workers, may contribute to the development of GI complaints among shift workers by altering the composition and normal diurnal rhythmicity of the resident intestinal microbes. Therefore, the present study was designed to determine if there were differences in (1) composition and diversity of the microbiome of night shift workers compared to day shift workers; and (2) the composition and diversity of the microbiome among shift workers experiencing functional bowel symptoms compared to shift workers who did not experience functional bowel symptoms. METHODS: Fifty-one full time staff nurses who worked either 12-hour day or night shifts completed demographic information, and the Rome III IBS module. They also collected two samples of gut microbiota before the beginning and at the end of their last work shift on day 14, using validated field-tested methods consistent with the Human Microbiome Project. After DNA extraction, 16S rRNA sequencing and assignment to the genus level was completed, samples were then compared to determine if there were (1) differences in the diversity and profile of the microbiome by shift type; (2) if there were differences in the microbiome by time of day for collection; and (3) whether there were differences in the diversity and profile of the microbiome of nurses with IBS and those without IBS. RESULTS: There were no differences in alpha or beta diversity of gut microbiota when specimens from day and night shift nurses were compared. There were however marginal differences in beta diversity when specimens collected at the beginning and end of the shifts were compared, with seven OTUs being differentially abundant when collected from day shift workers in the evening. There were also three OTUs to be differentially abundant in participants reporting IBS symptoms.

Consecutive nursing shifts and the risk of hypoglycemia in critically ill patients who are receiving intravenous insulin: a multicenter study.

STUDY OBJECTIVES: Intensive care unit nurses commonly work multiple consecutive 12-hour shifts that leave little time for sleep between work shifts. Working multiple consecutive shifts could compromise vigilance and patient care, especially with respect to managing high-risk medications such as insulin infusions. We hypothesized that as the number of consecutive shifts worked by nurses increases, the rate of hypoglycemia in patients who are receiving an insulin infusion would also increase. METHODS: We identified patients who had hypoglycemia (glucose ≤ 3.5 mmol/L, 63 mg/dL) between December 2008 and December 2009 in 3 intensive care units in Vancouver, British Columbia, Canada. For each hypoglycemic event, we counted the number of shifts worked on consecutive days during the previous 72 hours by the bedside nurse who was caring for the patient at the time of hypoglycemia (case shift). For each case shift, we identified up to 3 control shifts (24, 48, and 72 hours before the hypoglycemic event in the same patient when there were no hypoglycemic events) and counted the number of consecutive shifts worked by those nurses in the previous 72 hours. This analysis allowed us to control for patient-associated confounders. Conditional logistic regression was used to determine the association between number of consecutive shifts worked and occurrence of hypoglycemic events. RESULTS: A total of 282 hypoglycemic events were identified in 259 patients. For 191 events, we were able to identify 1 or more control shifts. Compared with nurses who had not worked a shift in the preceding day, the odds ratio of a hypoglycemic event was 1.68 (95% confidence interval: 1.12-2.52), 2.16 (95% confidence interval:1.25-3.73), and 2.54 (95% confidence interval: 1.28-5.06) for nurses who were working their second, third, or fourth consecutive shift, respectively. CONCLUSIONS: Working multiple consecutive nursing shifts is associated with increased risk of hypoglycemic events in patients in an intensive care unit.

Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study.

The objective of the study was to determine if sleep disorder, depression or anxiety screening status was associated with safety outcomes in a diverse population of hospital workers. A sample of shift workers at four hospitals participated in a prospective cohort study. Participants were screened for five sleep disorders, depression and anxiety at baseline, then completed prospective monthly surveys for the next 6 months to capture motor vehicle crashes, near-miss crashes, occupational exposures and medical errors. We tested the associations between sleep disorders, depression and anxiety and adverse safety outcomes using incidence rate ratios adjusted for potentially confounding factors in a multivariable negative binomial regression model. Of the 416 hospital workers who participated, two in five (40.9%) screened positive for a sleep disorder and 21.6% screened positive for depression or anxiety. After multivariable adjustment, screening positive for a sleep disorder was associated with 83% increased incidence of adverse safety outcomes. Screening positive for depression or anxiety increased the risk by 63%. Sleep disorders and mood disorders were independently associated with adverse outcomes and contributed additively to risk. Our findings suggest that screening for sleep disorders and mental health screening can help identify individuals who are vulnerable to adverse safety outcomes. Future research should evaluate sleep and mental health screening, evaluation and treatment programmes that may improve safety.

Sleep, Lifestyle Behaviors, and Cardiometabolic Health Markers in Overweight/Obese Young Adults: A Pilot Study Using the SenseWear® Armband.

AIM: This pilot study examined associations between sleep quality and metabolic risk profiles, underlying hormones, inflammatory markers, and behaviors in overweight and obese young adults, aged 18-29 years. DESIGN: Cross-sectional, descriptive, correlational study design. METHOD: A partial sample ( n = 29) was re-recruited from a parent study on screening for risk of early-onset diabetes. BodyMedia's SenseWear® armband was used to assess sleep quality. Based on the percentage of consolidated sleep days during the past week, participants were classified as poor, fair, or good sleepers. Multiple multivariate general linear models were used to examine group differences in study variables after adjusting for obesity impact. RESULTS: There were no significant differences among groups in age (mean 23.5 ± 2.9 years) or body mass index (mean 38.0 ± 8.9 kg/m2). Good sleepers ( n = 12, 41.4%) showed the longest nocturnal sleep duration (7:53 ± 1:00 hr), followed by fair ( n = 12, 41.4%, 7:23 ± 1:34 hr) and poor sleepers ( n = 5, 17.2%, 5:34 ± 0:56 hr). Poor sleepers showed the highest plasma resistin (η2 = .103) and ghrelin (η2 = .205) levels and caloric (η2 = .255) and sodium (η2 = .156) intakes. No differences in clinical metabolic markers or serum leptin or adiponectin were observed. CONCLUSIONS: Overweight/obese young adults had irregular sleep schedules and patterns, indicators of poor sleep quality, that were possibly associated with changes in dietary behaviors and underlying plasma hormones. In addition to traditional clinical cardiometabolic markers, plasma resistin and ghrelin may be good predictors of heightened vulnerability to cardiometabolic diseases in overweight/obese young adults with poor-quality sleep.

Racial/ethnic sleep disparities in US school-aged children and adolescents: a review of the literature.

Sleep is essential for optimal health, well-being, and cognitive functioning, and yet nationwide, youth are not obtaining consistent, adequate, or high-quality sleep. In fact, more than two-thirds of US adolescents are sleeping less than 8 hours nightly on school nights. Racial and ethnic minority children and adolescents are at an increased risk of having shorter sleep duration and poorer sleep quality than their white peers. In this review, we critically examined and compared results from 23 studies that have investigated racial/ethnic sleep disparities in American school-aged children and adolescents ages 6-19 years. We found that White youth generally had more sufficient sleep than minority youth, Hispanics had more than Blacks, and there was inconclusive evidence for Asians and other minorities. Recommendations for researchers include the following: (1) explore underlying causes of the disparities of these subpopulations, with a particular interest in identifying modifiable causes; (2) examine factors that may be impacted by racial/ethnic sleep disparities; (3) use a multidimensional approach to measuring sleep disparities; and (4) examine how beliefs about sleep are patterned by race/ethnicity. Understanding sleep disparities can inform interventions, policies, and educational programs to minimize sleep disparities and their impact on health, psychological, and educational outcomes.

Insomnia Symptoms Are Associated With Abnormal Endothelial Function.

BACKGROUND: Insomnia is a prevalent sleep disorder, and it has been increasingly associated with cardiovascular morbidity and mortality. The reasons for this relationship are not completely understood but may involve endothelial dysfunction. In this study, we hypothesized that insomnia symptoms would be associated with reduced endothelial function. METHODS: Working adults (n = 496, 67.5% female, 78.6% white, mean age 48.7 [SD, 10.8] years, body mass index 28.2 [SD, 6.7] kg/m, diabetes 5.8%, hypertension 20.0%, hyperlipidemia 17.9%, heart disease 2.6%) enrolled in the Emory-Georgia Tech Predictive Health Institute study completed baseline demographic, clinical, depression (Beck Depression Inventory II), anxiety (General Anxiety Disorder 7), sleep (Pittsburg Sleep Quality Index), and noninvasive endothelial function (brachial artery flow-mediated dilation [FMD]) measures. Insomnia symptoms were defined as subjective sleep latency of 30 minutes or longer, nighttime or early morning awakenings, and/or sleep medication use occurring 3 times or more per week in the past month. RESULTS: Insomnia symptoms were reported by 39.5% of participants. Multivariable regression models showed that insomnia symptoms, age, baseline artery diameter, and dyslipidemia were inversely related to FMD. After adjusting for age, baseline artery diameter, and dyslipidemia, participants reporting insomnia symptoms had lower FMD than did participants reporting better sleep (adjusted FMD mean, 6.13% [SD, 0.28%] vs 6.83% [SD, 0.26%], P = .035). CONCLUSION: In this study, insomnia symptoms were associated with reduced FMD. Research examining the therapeutic benefits of treating insomnia on endothelial function and future cardiovascular risk is warranted.

Impact of work schedules on sleep duration of critical care nurses.

BACKGROUND: Sleep deprivation leads to reduced vigilance and potentially impairs work performance. Nurses may work long shifts that may contribute to sleep deprivation. OBJECTIVE: To assess how nurses' sleep patterns are affected by work schedules and other factors. METHODS: Between October 2009 and June 2010, a total of 20 critical care nurses completed daily sleep and activity logs and a demographic survey and wore an actigraph to objectively measure sleep time for 14 days. RESULTS: In a multivariate model with controls for repeated measures, mean sleep time between consecutive work shifts was short: 6.79 hours between 2 day shifts and 5.68 hours between 2 night shifts (P = .01). Sleep time was much greater between days when no shifts were worked (8.53 hours), consistent with catch-up sleep during these times. Every minute of 1-way commuting time was associated with a reduction of sleep time by 0.84 minutes. CONCLUSION: Critical care nurses obtain reduced amounts of sleep between consecutive work shifts, particularly between consecutive night shifts. Whether this degree of sleep deprivation adversely affects patients' safety needs further study.