Device-estimated sleep metrics do not mediate the relation between race and blood pressure dipping in young black and white women.

Short, disturbed, and irregular sleep may contribute to blunted nocturnal blood pressure (BP) dipping, a predictor of cardiovascular disease. Black women (BLW) demonstrate less BP dipping and poorer sleep health than White women (WHW). However, it remains unclear whether device-estimated sleep health metrics mediate the relation between race and BP dipping in young women. We hypothesized that the relation between race and BP dipping would be partly mediated by sleep health metrics of sleep duration, sleep efficiency, and sleep regularity. Participants (20 BLW, 17 WHW) were 18-29 years old, normotensive, nonobese, and without evidence of sleep disorders. Systolic and diastolic BP dipping were derived from 24-h ambulatory BP monitoring. Habitual sleep duration and sleep efficiency were estimated via 14 days of wrist actigraphy. Sleep duration regularity was calculated as the standard deviation (SD) of nightly sleep duration (SDSD). Sleep timing regularity metrics were calculated as the SD of sleep onset and sleep midpoint (SMSD). Mediation analysis tested the mediating effect of each sleep metric on the relation between race and BP dipping. BLW experienced less systolic (P = .02) and diastolic (P = .01) BP dipping. Sleep duration (P = .14) was not different between groups. BLW had lower sleep efficiency (P < .01) and higher SDSD (P = .02), sleep onset SD (P < .01) and SMSD (P = .01). No sleep metrics mediated the relation between race and BP dipping (all indirect effects P > .38). In conclusion, mediation pathways of sleep health metrics do not explain racial differences in nocturnal BP dipping between young BLW and WHW.

Association between time-of-day for eating, exercise, and sleep with blood pressure in adults with elevated blood pressure or hypertension: a systematic review.

The purpose of this review is to synthesize results from studies examining the association between time-of-day for eating, exercise, and sleep with blood pressure (BP) in adults with elevated BP or hypertension. Six databases were searched for relevant publications from which 789 were identified. Ten studies met inclusion criteria. Four studies examined time-of-day for eating, five examined time-of-day for exercise, and one examined time-of-day for sleep and their associations with BP. Results suggested that later time-of-day for eating ( n  = 2/4) and later sleep mid-point ( n  = 1/1) were significantly related to higher BP in multivariable models, whereas morning ( n  = 3/5) and evening ( n  = 4/5) exercise were associated with significantly lower BP. Although this small body of work is limited by a lack of prospective, randomized controlled study designs and underutilization of 24 h ambulatory BP assessment, these results provide preliminary, hypothesis-generating support for the independent role of time-of-day for eating, exercise, and sleep with lower BP.

Adverse Childhood Experiences May Dampen the Protective Role of Sleep Duration on Adolescent Obesity Risk.

The purpose of this study was to explore Adverse Childhood Experiences (ACEs) as a moderator between sleep duration/irregularity and overweight/obesity in U.S. adolescents. Using the National Survey of Children's Health 2017-2018 cross-sectional dataset, we included adolescents with available sleep and Body Mass Index (BMI) data. In a sample of 24,100 adolescents (mean age = 13.56 years, 49.35% female; 51% White), parents reported adolescent's sleep duration/irregularity, and number of ACEs. Logistic regression estimated the interaction between sleep duration/irregularity and the number of ACEs on overweight/obesity risk (BMI ≥ 85th percentile-for-age) using a stepwise approach and accounting for complex survey design. In the 24,100 adolescents, 33% were overweight/obese, 50% had ≥ 1 ACE, 37% slept < 8-10 h/night, and 14% had irregular sleep. Accounting for covariates and ACEs, every hour increase in sleep duration was associated with 6% decrease in overweight/obesity odds. There was a significant interaction between sleep duration and ACEs; the association between increasing sleep duration and decreasing odds of overweight/obesity was significant only in adolescents without ACEs (OR = 0.87, 95% CI [0.80, 0.95], p < 0.001). Increasing sleep duration is a recognized intervention target to decrease obesity risk, yet in adolescents experiencing ≥ 1 ACE, this protective role may be dampened. Future work may explore mechanisms for overweight/obesity development to inform interventions for adolescents facing adversity.

Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States.

BACKGROUND: Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth. METHODS: This study analyzed data of 32,212 U.S. youth (6-17 years) whose primary caregiver participated in the 2017-2018 National Survey of Children's Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators. RESULTS: Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males. CONCLUSIONS: Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed.

Prevalence of current smoking and association with meeting 24-h movement guidelines: Results from a national convenience sample of autistic adults.

LAY ABSTRACT: Cigarette smoking is a leading risk behavior for cardiovascular disease; yet its prevalence and determinants are not clear in autistic adults. We examined the prevalence of current smoking and its association between meeting 24-h movement (i.e. sleep, physical activity, and sedentary behavior) guidelines in a self-selecting convenience sample of 259 autistic adults in the United States. We found that current smokers met fewer 24-h movement guidelines. Most significant, those who had insufficient sleep and those with high levels of sedentary behavior were more likely to be current smokers. Therefore, targeting these movement behaviors may be potential intervention targets for smoking cessation.

Feasibility, Acceptability, and Preliminary Effectiveness of a Sleep Intervention in Adults at Risk for Metabolic Syndrome With Short Sleep Duration.

BACKGROUND: The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration. OBJECTIVES: This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration. METHODS: A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t -tests modeled changes in study outcomes. RESULTS: Study participants ( N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable. DISCUSSION: Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.

Primary care outreach and decision counseling for lung cancer screening.

INTRODUCTION: Lung cancer screening rates are very low despite a level B recommendation from the United States Preventive Services Task Force since 2013 and clear evidence that lung cancer screening reduces mortality. The Center for Medicare and Medicaid Services requires shared decision-making (SDM) for lung cancer screening reimbursement. The objective of this study was to determine the effect of an SDM intervention on lung cancer screening in primary care. METHODS: The study design was a single-arm clinical trial design. The intervention included phone contact outside of a primary care visit and the use of the Decision Counseling Program ®, an online interactive decision aid focused on determining the factors which influence patients to screen or not screen, prioritizing those factors, and determining a decision preference score. The primary outcome was the completion of low-dose computed tomography scan (LDCT) 1 year after the SDM session compared in participants versus nonparticipants. RESULTS: From six practices, there were 1359 potentially eligible patients in electronic medical record data, and 336 were reached to assess eligibility criteria. A total of 80 patients consented to be in the study, 64 completed a decision counseling session and 16 did not complete a session. Among the 64 people who agreed to have decision counseling, 45% had LDCT, higher than typically seen in routine clinical practice. Although not a comparable group, among the 16 people who declined decision counseling, none had LDCT. CONCLUSIONS: Decision counseling is a promising intervention that might support SDM in the context of improving uptake of lung cancer screening in primary care. However, further, larger studies are needed.

Sleep Variability, Eating Timing Variability, and Carotid Intima-Media Thickness in Early Adulthood.

Background Day-to-day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross-sectional associations between sleep and eating variability metrics with end-diastolic carotid intima-media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60-minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60-minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.

Daytime Sleepiness in Children With Asthma: Examining Respiratory and Non-respiratory Factors.

Objective Daytime sleepiness is common in youth with asthma (YWA). Treatments designed to mitigate daytime sleepiness in YWA require an understanding of the primary causes of this problem. We examined respiratory- and non-respiratory-related factors associated with daytime sleepiness in YWA. Methods One hundred YWA (eight to 17 years old) were included in a cross-sectional study. Daytime sleepiness, quality of life, anxiety, bedtime cellphone use, and respiratory symptoms were self-reported. Asthma severity, lung function, and the number of prescribed medications were obtained from electronic medical records. Multivariable regression models identifying variables associated with daytime sleepiness were generated. Results Participants were 54% male and 45% Black, with a mean age of 12.1 years. The multivariable regression model showed decreased quality of life (b = -0.328, p = 0.004) and increased bedtime cellphone use (b = 0.300, p = 0.004)were significantly related to daytime sleepiness, while anxiety (b = 0.213, p = 0.05), prescribed asthma medications (b = 0.173, p = 0.05), and worse lung function (b = -0.173, p = 0.05)were marginally related to daytime sleepiness. Conclusions In addition to optimizing asthma control, strategies targeting anxiety, quality of life, and nocturnal cellphone use are important to mitigate daytime sleepiness in YWA.

Temporal associations between nightly sleep with daytime eating and activity levels in free-living young adults.

STUDY OBJECTIVES: This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings. METHODS: Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing. RESULTS: At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008). CONCLUSIONS: These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

Associations between sleep and overweight/obesity in adolescents vary by race/ethnicity and socioeconomic status.

AIM: To examine the interaction between sleep and social determinants of health (SDOH) [race/ethnicity and socioeconomic status (SES)] on overweight/obesity in adolescents. DESIGN: Cross-sectional. METHODS: We conducted a secondary analysis using the 2017-2018 National Survey of Children's Health data. We included adolescents (10-17 years old) who had sleep and body mass index (BMI) data available (n = 24,337) in analyses (samples with BMI <5th percentile excluded). Parents reported children's sleep duration and regularity. High BMI (≥85th percentile) for age defines overweight/obesity. We selected SDOH (race/ethnicity, family income, primary caregiver education and neighbourhood condition) and covariates (age, sex, smoking, exercise and depression) using a hierarchical model-building approach. Accounting for complex survey design, logistic regression estimated the interaction between sleep and SDOH. RESULTS: There were significant interactions between sleep duration and SDOH. The association between increasing sleep and decreasing odds of overweight/obesity only showed in the following subgroups: White, family income ≥400% federal poverty level (FPL) or primary caregiver' education ≥ high school. Compared with these subgroups, Hispanic adolescents and adolescents whose family income was below 100% FPL and whose caregiver education was below high school had weakened and reversed associations. Sleep regularity was not associated with overweight/obesity. CONCLUSIONS: Increasing sleep duration was associated with a decreased risk of overweight/obesity, but the association was not present in adolescents from racial/ethnic minority groups (i.e. Hispanic) and those with low SES. IMPACT: The study findings suggest that associations between sleep and overweight/obesity vary by race and SES. Identification of additional mechanisms for obesity is needed for racial/ethnic minority groups and those from families with low SES. Also, the complexity of these relationships underscores the importance of community-based needs assessment in the design of targeted and meaningful interventions to address complex health conditions such as poor sleep and obesity.

Factors Related to Physical Activity in Adults With Intellectual Disabilities in Group Home Settings: A Systematic Literature Review.

This systematic review of literature aimed to synthesize the multilevel factors related to physical activity (PA) among adults (age 18-65) with intellectual disability living in group homes. Keyword searches were used to identify articles from electronic databases, resulting in the inclusion of 10 articles for full-text review. Data were extracted relating to study and sample characteristics and study findings. Methodological quality of the studies was also evaluated. Factors related to PA in group homes were identified at all levels of the social-ecological model. Intrapersonal factors (e.g., health and functional status, attitude to PA), interpersonal factors (e.g., staff attitude, encouragement for PA, and coparticipation in PA), and organizational factors (e.g., program offerings, staff education, and staff-client ratios) were prominent findings in the reviewed studies. The findings support a social-ecological approach for PA promotion in group homes that target intrapersonal, interpersonal, and organizational factors.

Identifying the most proximal multi-level factors associated with meeting each of the 24-h movement behavior recommendations in a sample of autistic adults.

BACKGROUND: Autistic adults have poorer 24-h movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-h movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-h movement behavior guidelines among autistic adults. OBJECTIVE: This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-h movement behaviors of aerobic physical activity, sedentary behavior, and sleep. METHODS: We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs >0 indicate predictive variables/domains. RESULTS: A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep. CONCLUSIONS: These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.

Subjective sleep score is associated with central and peripheral blood pressure values in children aged 7-12 years.

Shortened and poor-quality sleep have emerged as non-traditional risk factors for the development of hypertension in adults, and it is likely these relations extend to paediatric populations when evaluating sleep subjectively. Therefore, we aimed to evaluate subjective sleep metrics and their associations with central and peripheral blood pressure (BP) values in children. We hypothesized that poor-quality sleep and short sleep duration would be associated with elevated pressures in healthy children. Subjective sleep habits and sleep duration were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) in 29 children aged 7-12 years (13 male/16 female). A total sleep score was generated by summing subscale scores: a higher score indicates poorer sleep habits. Peripheral BP was measured, and central pressures were estimated using pulse wave analysis. Pearson's r correlations were used to assess relations between total sleep score, sleep duration, and sleep score subscales with BP values. Sleep score was positively associated with central and peripheral systolic pressure (r = 0.43, p = 0.02 and r = 0.41, p = 0.03, respectively), diastolic pressure (r = 0.42, p = 0.02 and r = 0.36, p = 0.05, respectively) and mean arterial pressure (r = 0.40, p = 0.03 and r = 0.36, p = 0.03, respectively). Sleep duration was negatively associated with central and peripheral diastolic pressure (r = -0.40, p = 0.03 and r = -0.41, p = 0.03, respectively). Regarding the CSHQ subscales, daytime sleepiness and parasomnias were consistently positively associated with BP values. These findings support sleep as a primordial prevention target for hypertension and the maintenance of cardiovascular health during childhood. Consideration of a variety of sleep habits using tools such as the CSHQ may provide important insights into early-life cardiovascular risk.

Psychological and behavioral moderators of physical health among caregivers and non-caregivers.

The current study sought to evaluate whether psychological and/or behavioral health moderate the relationship between caregiving and physical health. MATERIALS AND METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) survey (2017-2018), separate composite scores were created for psychological and behavioral health. Self-reported physical health was the primary outcome. The sample was 1,387 non-caregivers and 266 caregivers. RESULTS: The psychological, behavioral, and self-reported physical health did not significantly differ between caregivers and non-caregivers, but psychological and behavioral health were shown to differentially affect self-reported health outcomes among caregivers, compared to non-caregivers. Caregivers with worse psychological health had higher odds of experiencing poor physical health versus non-caregivers, while caregivers with better behavioral health had lower odds of having better general health versus non-caregivers. DISCUSSION: These data extend our understanding on how to consider the impact of psychological and behavioral health as a caregiver and opportunities to develop targeted interventions.

Brief Report: Perceived Barriers to Physical Activity Among a National Sample of Autistic Adults.

Improving physical activity (PA) levels in autistic adults is an important population health goal. Limiting efforts to achieve this goal is an incomplete understanding of the barriers to PA in this high-risk group. This study utilized cross-sectional data collected via an electronic survey from 253 autistic adults aged 18-50 years to examine their perceived barriers to PA, how PA barriers differed by demographic factors, and the relationship between PA barriers and meeting PA guidelines. The Barriers to Physical Activity scale assessed the independent variable. Lack of motivation to exercise, perceiving exercise as boring, and lack of transportation were the most strongly endorsed barriers to PA. Participants who reported these barriers were significantly less likely (≤ 50%) to meet PA guidelines.

Examining fruit and vegetable intake in low-income older adults using the Veggie Meter®.

BACKGROUND: Older adults report low fruit and vegetable (FV) intake. The lack of objective, field-based assessments of FV intake is a limitation when assessing the effectiveness of interventions. AIM: To examine if self-reported FV intake was correlated with Veggie Meter® scores among low-income older adults. The Veggie Meter® is a portable tool that uses pressure-mediated reflection spectroscopy to estimate skin carotenoid measurements. METHODS: A cross-sectional assessment of FV intake, food security, and Veggie Meter® score in low-income older adults was conducted. Bivariate analyses quantified the association between FV intake and Veggie Meter® score. RESULTS: Participants (n = 154) were mostly female (69.3%), non-white (66.2%) and at risk for food insecurity (65.6%). Mean Veggie Meter® score was 172.3 ± 77.2 and had a small significant positive correlation with FV intake (r= 0.192, p = 0.018). CONCLUSION: The Veggie Meter® may objectively indicate FV intake. Research to validate the Veggie Meter® in older, diverse populations is needed.

Quantifying Benefits and Harms of Lung Cancer Screening in an Underserved Population: Results From a Prospective Study.

Lung cancer screening with annual low-dose computed tomography reduces lung cancer death by 20-26%. However, potential harms of screening include false-positive results, procedures from false positives, procedural complications and failure to adhere to follow-up recommendations. In diverse, underserved populations, it is unknown if benefits of early lung cancer detection outweigh harms. We conducted a prospective observational study of lung cancer screening participants in an urban, safety-net institution from September 2014 to June 2020. We measured benefits of screening in terms of cancer diagnosis, stage, and treatment. We measured harms of screening by calculating false-positive rate, procedures as a result of false positive screens, procedural complications, and failure to follow-up with recommended care. Of patients with 3-year follow up, we measured these same outcomes in addition to compliance with annual screening. Of 1509 participants, 55.6% were African American, 35.2% White, 8.1% Hispanic, and 0.5% Asian. Screening resulted in cancer detection and treatment in 2.8%. False positive and procedure as a result of a false positive occurred in 9.2% and 0.8% of participants, respectively with no major complications from diagnostic procedures or treatment. Adherence to annual screening was low, 18.7%, 3.7%, and 0.4% at 1, 2, and 3 years after baseline screening respectively. Multidisciplinary lung cancer screening in a safety-net institution can successfully detect and treat lung cancer with few harms of false-positive screens, procedure after false-positive screens and major complications. However, adherence to annual screening is poor.