Associations of Infant Feeding, Sleep, and Weight Gain with the Toddler Gut Microbiome.

This study examines how feeding, sleep, and growth during infancy impact the gut microbiome (GM) in toddlers. The research was conducted on toddlers (n = 36), born to Latina women of low-income with obesity. Their mothers completed retrospective feeding and sleeping questionnaires at 1, 6, and 12 months; at 36 months, fecal samples were collected. Sequencing of the 16S rRNA gene (V4 region) revealed that breastfeeding for at least 1 month and the introduction of solids before 6 months differentiated the GM in toddlerhood (Bray-Curtis, pseudo-F = 1.805, p = 0.018, and pseudo-F = 1.651, p = 0.044, respectively). Sleep had an effect across time; at 1 and 6 months of age, a lower proportion of nighttime sleep (relative to 24 h total sleep) was associated with a richer GM at three years of age (Shannon H = 4.395, p = 0.036 and OTU H = 5.559, p = 0.018, respectively). Toddlers experiencing rapid weight gain from birth to 6 months had lower phylogenetic diversity (Faith PD H = 3.633, p = 0.057). These findings suggest that early life nutrition, sleeping patterns, and growth rate in infancy may influence the GM composition. Further verification of these results with objective sleep data and a larger sample is needed.

Actigraphic sleep patterns are associated with bone turnover and bone mineral density among university students.

Poorer sleep is associated with poorer bone health among older adults but the role of sleep in bone health during younger adulthood is understudied. In this observational study, the averages and variability in total sleep time (TST), sleep efficiency (SE), and sleep midpoint of university students were examined in relation to levels of bone turnover markers (BTMs) and bone mineral density (BMD) at the lumbar spine and femur. A sample of healthy, university students (N = 59, aged 18-25 years, 51.8% female, body mass index <30 kg/m2 ), wore a wrist actigraph for 7 days, completed a dual-energy X-ray absorptiometry scan, and underwent blood sampling to assess serum BTM concentrations of osteocalcin (OC) and N-terminal telopeptide of type 1 collagen. A sub-sample (n = 14) completed a one-year follow-up. Multiple regression models examined the associations between each sleep metric and bone health outcome at baseline and 1-year follow-up. At baseline, greater variability in sleep midpoint was cross-sectionally associated with greater OC (ß = 0.21, p = 0.042). In the exploratory, follow-up sub-sample, lower average TST (ß = -0.66, p = 0.013) and SE (ß = -0.68, p = 0.01) at baseline were associated with greater increases in OC at follow-up. Greater delays in mean sleep midpoint over follow-up were significantly associated with decreases in lumbar spine BMD (ß = -0.49, p = 0.03). In a sample of young adults, variable sleep schedules were associated with greater bone turnover suggesting the potential importance of regular sleep for optimising bone health into early adulthood.

Sleep Apnea and Incident Stroke in a National Cohort of Black and White Adults.

BACKGROUND AND OBJECTIVES: Racial/ethnic differences have been documented in the relationship between obstructive sleep apnea (OSA) and stroke incidence, yet racial differences in OSA symptoms or treatment and their relationship with stroke incidence are underexplored and may contribute to stroke disparities. We comprehensively examined OSA symptoms and their relationships to stroke incidence by race/ethnicity. METHODS: Data were collected from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of Black and White individuals in the United States. Participants free from a stroke diagnosis at baseline were included. Participants self-reported the following: (1) snoring; (2) daytime sleepiness; (3) provider-diagnosed sleep apnea (PDSA); and (4) treatment for PDSA using positive airway pressure (PAP). OSA risk was categorized as high or low based on the Berlin Sleep Questionnaire. Incident stroke was defined as first occurrence of stroke over an average of 12 (SD 3.9) years of follow-up. We report the relationships between snoring, OSA risk, PDSA, PAP therapy use, and incident stroke by race/ethnicity using Cox proportional hazards models after adjusting for demographic and socioeconomic factors and stroke risk factors. RESULTS: Among the 22,192 participants (mean age [SD] 64.2[9.1] years), 38.1% identified as Black. Overall, snoring was not associated with incident stroke (hazard ratio [HR] 0.98, 95% CI 0.85-1.13). However, among White individuals but not Black individuals, high OSA risk and PDSA were associated with incident stroke (HR 1.22, 95% CI 1.01-1.47; HR 1.33, 95% CI 1.04-1.70, respectively). PAP therapy use among those with PDSA (compared with non-PDSA) was associated with incident stroke in White individuals (HR 1.38, 95% CI 1.05-1.80). PAP therapy use among those with PDSA (compared with those with PDSA without PAP therapy use) was associated with reduced risk of incident stroke in Black (HR 0.39, 95% CI 0.17-0.91) but not White (HR 0.63, 95% CI 0.37-1.10) individuals. DISCUSSION: White individuals with high OSA risk and those with PDSA with or without PAP therapy use were at increased incident stroke risk, whereas Black individuals reporting PDSA and PAP had reduced incident stroke risk relative to those not using PAP. Future research is needed to understand the mechanisms underlying racial differences in OSA and stroke such as differences in assessment modes and treatment.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking.

INTRODUCTION: This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females. METHOD: Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests. RESULTS: Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05). DISCUSSION: Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

SleepWell24, a Smartphone Application to Promote Adherence to Positive Airway Pressure Therapy: Feasibility and Acceptability in a Randomized Controlled Trial.

OBJECTIVE: To investigate the feasibility and acceptability of SleepWell24, a multicomponent, evidence-based smartphone application, to improve positive airway pressure therapy (PAP) adherence, among patients with obstructive sleep apnea (OSA) naive to PAP. METHODS: In a single-blind randomized controlled trial, SleepWell24, with a companion activity monitor was compared to usual care plus the activity monitor and its associated app. SleepWell24 provides objective feedback on PAP usage and sleep/physical activity patterns, and chronic disease management. Patients were recruited from two sleep medicine centers and followed over the first 60 days of PAP. Feasibility and acceptability were measured by recruitment/retention rates, app usage, differences in post-trial Treatment Evaluation Questionnaire (TEQ) scores, and patient interviews. Exploratory, intent-to-treat logistic and linear mixed models estimated PAP adherence and clinical outcomes. RESULTS: Of 103 eligible participants, 87 were enrolled (SleepWell24 n = 40, control n = 47; mean 57.6y [SD = 12.3], 44.8% female). Retention was ≥95% across arms. There were no significant differences in TEQ scores. SleepWell24 participants engaged with the app on 62.9% of trial days. PAP use was high across both arms (SleepWell24 vs. Control: mean hours 5.98 vs. 5.86). There were no differences in PAP adherence or clinical outcomes. CONCLUSIONS: SleepWell24 was feasible and acceptable among PAP-naive patients with OSA. CLINICAL TRIAL REGISTRATION: NCT03156283https://www.clinicaltrials.gov/study/NCT03156283.

History of obstructive sleep apnea associated with incident cognitive impairment in white but not black individuals in a US national cohort study.

BACKGROUND: We sought to determine if risk for obstructive sleep apnea (OSA), a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals. METHODS: To determine whether the risk for OSA, a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals; data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) was used. Participants that completed the sleep questionnaire module, had baseline cognitive assessment, and at least one cognitive assessment during follow-up were included. Risk of OSA was determined based on Berlin Sleep Questionnaire. History of sleep apnea was determined based on structured interview questions. Optimally treated OSA was defined as treated sleep apnea as at least 4 h of continuous positive airway pressure use per night for ≥5 nights per week. RESULTS: In 19,017 participants stratified by race, White participants with history of OSA were 1.62 times more likely to have incident cognitive impairment compared to White participants without history of OSA after adjusting for demographic characteristics, history, and lifestyle factors (OR = 1.62, 95% CI = 1.05-2.50, p-value = 0.03). This relationship was not seen in Black participants (OR = 0.92, 95% CI = 0.60-1.43, p-value = 0.72). DISCUSSION: A previous diagnosis of OSA is associated with incident cognitive impairment in White Americans but not Black Americans. Further investigations are required to determine the mechanism for this difference.

Breastfeeding Practices and Associated Factors among Immigrant Muslim Arab Women Living in a Metropolitan Area of the Southwest of United States.

Background: Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices in this population. objectives: The objective of this study was to describe infant feeding practices and factors associated with these practices among immigrant Muslim Arab women. design: A nonexperimental-one group, cross-sectional, descriptive, prospective design was used to identify infant feeding practices among immigrant Muslim Arab women. methods: A convenience sample of one hundred sixteen immigrant Muslim Arab women with at least one child five years or younger was recruited from a large metropolitan area in the Southwestern region. Participants completed the social ecological model of health promotion self-reported questionnaire. Descriptive statistics were performed to identify infant feeding practices and logistic regression was used to identify factors associated with these practices. results: Immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%) and lengthy breastfeeding duration (M = 11.86, SD = 8.04), but low rates of exclusive breastfeeding at six months (21.6%). The most frequent reasons for early termination of breastfeeding were perceived insufficient milk (44.4%), child was still hungry after breastfeeding (37.5%), and the belief that the child was old enough to stop breastfeeding (32.9%). conclusion: Development of educational interventions are needed to improve breastfeeding exclusivity and raise women's awareness of the importance of exclusive breastfeeding. Healthcare providers should help women gain confidence in their ability to produce enough milk to successfully continue breastfeeding.

How did trends in sleep duration in 2020 compare to previous years and how did they vary by sex, race/ethnicity, and educational attainment?

Recent evidence utilizing online samples indicates that sleep patterns were significantly altered during the initial months of the SARS-CoV-2 (COVID-19) pandemic/lockdown. However, it remains less clear how sleep duration changed in population-based samples, in the later months of 2020, and across subpopulations. Here we used a population-based sample to document sleep duration trends for the entire year of 2020, compared these trends to the previous years of 2013, 2014, 2016, and 2018, and systematically analyzed whether self-reported sleep duration patterns in 2020 varied by sex, race/ethnicity, and educational attainment. Data were from the Behavioral Risk Factor Surveillance System (n = 2,203,861) and focused on Americans aged 18 years and older. Respondents self-reported the hours of sleep they got in a 24-h period. We fit multinomial and linear regression models to predict the category of sleep duration (six or fewer hours, seven to eight h (base), and nine or more hours) and the raw reports of sleep duration, net of demographic, socioeconomic, and behavioral health covariates. Results revealed significant increases in sleep duration during the months directly after the COVID-19 lockdown (March and April in particular). However, these increases were short lived; reports of sleep duration reverted to historical levels by the Fall of 2020. We also found that the changes in sleep duration trends in 2020 were similar by sex, race/ethnicity, and educational attainment, cumulatively leading to little impact to disparities in sleep duration. In a dramatic, but brief, alteration of population-level sleep duration patterns, disparities in self-reported sleep duration remained intractable.

Protocol of the Snuggle Bug/Acurrucadito Study: a longitudinal study investigating the influences of sleep-wake patterns and gut microbiome development in infancy on rapid weight gain, an early risk factor for obesity.

BACKGROUND: Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. METHODS: The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. DISCUSSION: Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

Prospective associations between sedentary behavior and physical activity in adolescence and sleep duration in adulthood.

The purpose of this prospective study was to investigate whether sedentary screen time (SST) and physical activity in adolescence were related to sleep duration in adulthood and whether these associations varied by sex. We analyzed data from 9279 adolescents who participated in Waves I and V of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. SST was measured by reported hours spent watching television/videos or playing video/computer games per week. Physical activity was measured with participation in school team club sports and frequency (times/week) of moderate to vigorous physical activity (MVPA). Results from multinomial regression models indicated that adolescents with more SST, particularly 15-21 h (Relative Risk Ratio [RRR] = 1.18, 95% CI: 1.02-1.36) or 22 or more hours (RRR = 1.19, 95% CI: 1.06-1.35) compared to 0-7 h per week SST, had significantly higher relative risk of short sleep (six or fewer hours) in adulthood, after controlling for demographic characteristics, socioeconomic status and health behaviors at Waves I and V, sleep duration at Wave I, and SST and MVPA at Wave V. The association between 22 or more hours per week SST in adolescence and later short sleep varied by sex (RRR = 0.75, 95% CI: 0.58-0.95) and was significantly stronger among males. Measures of physical activity in adolescence did not predict sleep duration. Decreasing adolescents' SST to prevent suboptimal sleep later in development may be a target for further investigation, particularly for males.

Aerobic physical activity to improve memory and executive function in sedentary adults without cognitive impairment: A systematic review and meta-analysis.

The worldwide population of adults ages 50 and older continues to increase and is projected to reach over 2.3 billion by 2030. Aging is the biggest risk factor for cognitive impairment and dementia. Aerobic physical activity may improve cognitive functioning, thus delaying aging-related cognitive decline. The purpose of this review was to examine the effect of aerobic physical activity on memory and executive function in sedentary adults with no known cognitive impairment. PubMed, CINAHL, Psycinfo, and Cochrane Library databases were systematically searched for peer-reviewed articles up to July 2019. Randomized controlled trials of sedentary adults, aged 50 and older, that compared an aerobic physical activity intervention to either no treatment or alternative active comparator and reported outcome measures of memory and/or executive function were included. A random effects meta-analysis was performed to examine the separate effect sizes for memory and executive function. Nine studies met inclusion criteria and contributed either memory and/or executive function effect sizes (n = 547). Results from the random effects meta-analysis suggested, by post-intervention, a large effect size for the aerobic physical activity interventions on memory (g = 0.80, 95%CI: 0.14-1.47; n = 7; p = 0.02) and a small effect on executive function (g = 0.37, 95%CI: 0.04-0.69; n = 6; p = 0.03). Aerobic physical activity may improve memory and executive function in sedentary adults without cognitive impairment. Policymakers and providers should promote aerobic physical activity in this population, and further research should investigate the most effective ways to promote aerobic physical activity in mid-life to older adults.

Recruitment and retention of underrepresented and vulnerable populations to research.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Impact of the COVID-19 pandemic on change in sleep patterns in an exploratory, cross-sectional online sample of 79 countries.

OBJECTIVES: To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, and sleep and mental health factors associated with these profiles. DESIGN, SETTING, AND PARTICIPANTS: A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020. MEASUREMENTS: Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses. RESULTS: The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord. CONCLUSIONS: In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.

Sleep-wake patterns in newborns are associated with infant rapid weight gain and incident adiposity in toddlerhood.

BACKGROUND: Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG. OBJECTIVE: Examine associations between newborn sleep-wake patterns and incident RWG at 6 months of life and OW at 36 months. METHODS: Low-income Mexican/Mexican-American women with OW/obesity and their infants (n = 126) enrolled in a 1-year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire-Revised. Outcome measures included RWG (>0.67 positive change in weight-for-age Z-score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months. RESULTS: By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1-month was significantly associated with decreased odds for RWG compared to napping <5x (OR = 0.11, 95%CI:0.02, 0.63). Each 1-hour increase in nocturnal vs diurnal sleep was associated with greater odds of incident OW at 36 mos (OR = 1.51, 95%CI:1.13, 2.03). CONCLUSIONS: Early-life sleep patterns related to infant nap frequency and nocturnal vs diurnal sleep distribution were associated with obesity outcomes and may be important intervention targets to prevent lasting consequences on infant growth.

Racial differences in sleep duration intersect with sex, socioeconomic status, and U.S. geographic region: The REGARDS study.

OBJECTIVES: Short and long sleep duration are associated with poor health outcomes and are most prevalent among racial/ethnic minorities. Few studies have investigated the intersection of other sociodemographic characteristics with race/ethnicity on sleep duration prevalence. DESIGN: Longitudinal retrospective analysis of continental U.S. cohort, the REasons for Geographic And Racial Differences in Stroke (REGARDS) PARTICIPANTS: Black (n = 7,547) and white (n = 12,341) adults, 56% women, ≥45 years MEASUREMENTS: At baseline (2003-07), participants reported age, sex, race, education, income, marital status, U.S. region, and employment status. The weighted average of reported sleep duration on weekdays and weekends, assessed at follow-up (2008-10), was categorized as <6, 6.0-6.99, 7.0-7.99 [reference], 8.0-8.99, and ≥9 h. Multinomial logistic regression models examined the independent and multivariable associations of sociodemographic factors with sleep duration. Interactions terms between race with education, income, region, and sex were examined. RESULTS: Average sleep duration was 7.0 h (SD=1.3). Prevalence of short (<6 h) and long (≥9 h) sleep duration was 11.4% (n = 2,260) and 7.0% (n = 1,395), respectively. In the multivariable model, interactions terms race*income, race*sex, and race*region were significant (P < .05). Relative to white adults, black adults, were most likely to have short sleep duration. The magnitude of that likelihood increased across greater levels of household income, but with greatest odds among black adults living outside of the Southeast and Appalachian United States, particularly for men (≥$75k; black men OR = 5.47, 95%CI: 3.94,7.54; black women OR = 4.28, 95%CI: 3.08, 5.96). CONCLUSIONS: Race in the context of socioeconomic, sex, and regional factors should be examined as key modifiers of sleep duration.

Resting Energy Expenditure Relationship with Macronutrients and Gestational Weight Gain: A Pilot Study.

Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 ± 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) < 17 week were randomized to Breezing™ (n = 16) or control (n = 12) groups for 13 weeks. REE by Breezing™ indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14-21 weeks), late (21-28 weeks), and overall (14-28 weeks) changes in macronutrients and GWG were calculated. The Breezing™ group had a significantly greater rate of GWG [F (1,23) = 6.8, p = 0.02] in the latter half of the second trimester. Late (-155.3 ± 309.2 vs. 207.1 ± 416.5 kcal, p = 0.01) and overall (-143.8 ± 339.2 vs. 191.8 ± 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing™ and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, p = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.

Rationale, design, and development of SleepWell24: A smartphone application to promote adherence to positive airway pressure therapy among patients with obstructive sleep apnea.

BACKGROUND: Positive airway pressure (PAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), a chronic disorder that affects 6-13% of the adult population. However, adherence to PAP therapy is challenging, and current approaches to improve adherence have limited efficacy and scalability. METHODS/DESIGN: To promote PAP adherence, we developed SleepWell24, a multicomponent, evidence-based smartphone application that delivers objective biofeedback concerning PAP use and sleep/physical activity patterns via cloud-based PAP machine and wearable sensor data, and behavior change strategies and troubleshooting of PAP therapy interface use. This randomized controlled trial will evaluate the feasibility, acceptability, and initial efficacy of SleepWell24 compared to a usual care control condition during the first 60 days of PAP therapy among patients newly diagnosed with OSA. DISCUSSION: SleepWell24 is an innovative, multi-component behavior change intervention, designed as a self-management approach to addressing the psychosocial determinants of adherence to PAP therapy among new users. The results will guide lengthier future trials that assess numerous patient-centered and clinical outcomes.

The Combined Impact of Sleep and Diet on Adiposity in Infants, Toddlers, and Young Children: A Systematic Review.

OBJECTIVE: Short sleep duration and poor dietary habits may contribute to increased adiposity; however, the impact of the interaction between these variables on adiposity is less understood. To evaluate research investigating the combined effects of sleep and diet on adiposity in infants, toddlers, and young children. METHODS: Systematic searches of electronic databases (PubMed, CINAHL, and Web of Science) from inception through April 2017 were conducted. All studies published in English that had at least 1 sleep (e.g., sleep duration and night awakenings), diet (e.g., 24-hour diet recall and breastfeeding duration), and adiposity (e.g., body mass index z-score and weight-for-length) measure were eligible for inclusion. Abstract and full-text article reviews were conducted by 2 independent reviewers. Data were extracted into a standardized spreadsheet. RESULTS: Of the 17 full-text articles reviewed, 14 studies were included. Mediation (n = 2) and moderation (n = 2) were seldom used. Investigation of the combined effects of sleep and diet on adiposity demonstrated a substantial lack of evidence. Synthesis of articles suggests that the relationship between sleep and diet may be interactive and their effects additive in their impact when targeted simultaneously within interventions. CONCLUSION: Without consideration of interaction effects among variables of interest, a substantial gap in the literature persists. Both diet and sleep need to be assessed simultaneously and repetitively in future longitudinal research.

Employment status and the association of sociocultural stress with sleep in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

STUDY OBJECTIVES: We examined the association of sociocultural stress severity (i.e. acculturation stress, ethnic discrimination) and chronic stress burden with multiple dimensions of sleep in a population-based sample of US Hispanics/Latinos. We also explored whether employment status modified stress-sleep associations. METHODS: We conducted survey linear regressions to test the cross-sectional association of sociocultural stress severity and stress burden with sleep dimensions using data collected between 2010 and 2013 from individuals who participated in both the Hispanic Community Health Study/Study of Latinos Sueño and Sociocultural Ancillary studies (N = 1192). RESULTS: Greater acculturation stress (B = 0.75, standard error [SE] = 0.26, p < .01) and chronic psychosocial stress burden (B = 1.04, SE = 0.18, p < .001) were associated with greater insomnia symptoms but were not associated with actigraphic measures of sleep. Ethnic discrimination was not associated with any of the sleep dimensions. The association of acculturation stress with insomnia severity was greater in unemployed (B = 2.06, SE = 0.34) compared to employed (B = 1.01, SE = 0.31) participants (p-interaction = .08). CONCLUSIONS: Acculturation stress severity and chronic stress burden are important and consistent correlates of insomnia, but not actigraphically measured sleep dimensions. If replicated, future research should test whether interventions targeting the resolution of sociocultural stress improve sleep quality in Hispanics/Latinos.