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1.
JAMA Neurol ; 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32628261

RESUMO

Importance: Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality. Objective: To investigate whether REM sleep is associated with greater risk of mortality in 2 independent cohorts and to explore whether another sleep stage could be driving the findings. Design, Setting, and Participants: This multicenter population-based cross-sectional study used data from the Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study and Wisconsin Sleep Cohort (WSC). MrOS participants were recruited from December 2003 to March 2005, and WSC began in 1988. MrOS and WSC participants who had REM sleep and mortality data were included. Analysis began May 2018 and ended December 2019. Main Outcomes and Measures: All-cause and cause-specific mortality confirmed with death certificates. Results: The MrOS cohort included 2675 individuals (2675 men [100%]; mean [SD] age, 76.3 [5.5] years) and was followed up for a median (interquartile range) of 12.1 (7.8-13.2) years. The WSC cohort included 1386 individuals (753 men [54.3%]; mean [SD] age, 51.5 [8.5] years) and was followed up for a median (interquartile range) of 20.8 (17.9-22.4) years. MrOS participants had a 13% higher mortality rate for every 5% reduction in REM sleep (percentage REM sleep SD = 6.6%) after adjusting for multiple demographic, sleep, and health covariates (age-adjusted hazard ratio, 1.12; fully adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19). Results were similar for cardiovascular and other causes of death. Possible threshold effects were seen on the Kaplan-Meier curves, particularly for cancer; individuals with less than 15% REM sleep had a higher mortality rate compared with individuals with 15% or more for each mortality outcome with odds ratios ranging from 1.20 to 1.35. Findings were replicated in the WSC cohort despite younger age, inclusion of women, and longer follow-up (hazard ratio, 1.13; 95% CI, 1.08-1.19). A random forest model identified REM sleep as the most important sleep stage associated with survival. Conclusions and Relevance: Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts.

2.
Am J Hypertens ; 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32492711

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA), nocturnal hypertension, and non-dipping systolic blood pressure (BP) are each highly prevalent among African Americans. However, few data are available on the association between OSA and nighttime BP in this population. METHODS: We examined the association of OSA with nighttime BP among African Americans who completed 24-hour ambulatory BP monitoring at Exam 1 (2000-2004) of the Jackson Heart Study (JHS) and subsequently participated in the JHS Sleep Study (2012-2016). Type 3 home sleep apnea testing was used to assess OSA measures, including respiratory event index (REI4%) and percent sleep time <90% oxygen saturation (nocturnal hypoxemia). Nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. Multivariable linear regression models were fit to estimate the association between each OSA measure and nighttime systolic BP (SBP) and diastolic BP (DBP). RESULTS: Among 206 participants who completed ABPM and participated in the Jackson Heart Sleep Study, 50.5% had nocturnal hypertension and 26.2% had moderate to severe OSA (REI4% ≥15 events/hour). After multivariable adjustment, each standard deviation (SD: 13.3 events/hour) increase in REI4% was associated with 1.75 mm Hg higher nighttime DBP (95% confidence interval [CI]: 0.38, 3.11) and a prevalence ratio of 1.11 (95% CI: 1.00, 1.24) for nocturnal hypertension. Each SD (10.4%) increase in nocturnal hypoxemia was associated with a 1.91 mm Hg higher nighttime SBP (95% CI: 0.15, 3.66). CONCLUSIONS: Severity of OSA and nocturnal hypoxemia were associated with high nighttime BP in African American participants in the JHS.

3.
EBioMedicine ; 56: 102803, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32512511

RESUMO

BACKGROUND: Sleep Disordered Breathing (SDB) is associated with a wide range of pathophysiological changes due, in part, to hypoxemia during sleep. We sought to identify gene transcription associations with measures of SDB and hypoxemia during sleep, and study their response to treatment. METHODS: In two discovery cohorts, Framingham Offspring Study (FOS; N = 571) and the Multi-Ethnic Study of Atherosclerosis (MESA; N = 580), we studied gene expression in peripheral blood mononuclear cells in association with three measures of SDB: Apnea Hypopnea Index (AHI); average oxyhemoglobin saturation (avgO2) during sleep; and minimum oxyhemoglobin saturation (minO2) during sleep. Associated genes were used for analysis of gene expression in the blood of 15 participants with moderate or severe obstructive sleep apnea (OSA) from the Heart Biomarkers In Apnea Treatment (HeartBEAT) trial. These genes were studied pre- and post-treatment (three months) with continuous positive airway pressure (CPAP). We also performed Gene Set Enrichment Analysis (GSEA) on all traits and cohort analyses. FINDINGS: Twenty-two genes were associated with SDB traits in both MESA and FOS. Of these, lower expression of CD1D and RAB20 was associated with lower avgO2 in MESA and FOS. CPAP treatment increased the expression of these genes in HeartBEAT participants. Immunity and inflammation pathways were up-regulated in subjects with lower avgO2; i.e., in those with a more severe SDB phenotype (MESA), whereas immuno-inflammatory processes were down-regulated following CPAP treatment (HeartBEAT). INTERPRETATION: Low oxygen saturation during sleep is associated with alterations in gene expression and transcriptional programs that are partially reversed by CPAP treatment.

4.
PLoS Biol ; 18(6): e3000726, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32497046

RESUMO

Why does poor-quality sleep lead to atherosclerosis? In a diverse sample of over 1,600 individuals, we describe a pathway wherein sleep fragmentation raises inflammatory-related white blood cell counts (neutrophils and monocytes), thereby increasing atherosclerosis severity, even when other common risk factors have been accounted for. Improving sleep quality may thus represent one preventive strategy for lowering inflammatory status and thus atherosclerosis risk, reinforcing public health policies focused on sleep health.

5.
Artigo em Inglês | MEDLINE | ID: mdl-32510982

RESUMO

Background - Alcohol intake influences plasma lipid levels and such effects may be moderated by genetic variants. We aimed to characterize the role of aggregated rare and low-frequency protein coding variants in gene by alcohol consumption interactions associated with fasting plasma lipid levels. Methods - In the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, fasting plasma triglycerides (TG), and high- and low-density lipoprotein cholesterol (HDL-C and LDL-C) were measured in 34,153 individuals with European ancestry from five discovery studies and 32,277 individuals from six replication studies. Rare and low-frequency functional protein coding variants (minor allele frequency ≤ 5%) measured by an exome array were aggregated by genes and evaluated by a gene-environment interaction (G×E) test and a joint test of genetic main and G×E interaction effects. Two dichotomous self-reported alcohol consumption variables, current drinker, defined as any recurrent drinking behavior, and regular drinker, defined as the subset of current drinkers who consume at least two drinks per week, were considered. Results - We discovered and replicated 21 gene-lipid associations at 13 known lipid loci through the joint test. Eight loci (PCSK9, LPA, LPL, LIPG, ANGPTL4, APOB, APOC3 and CD300LG) remained significant after conditioning on the common index single nucleotide polymorphism (SNP) identified by previous genome-wide association studies, suggesting an independent role for rare and low-frequency variants at these loci. One significant gene-alcohol interaction on TG in a novel locus was significantly discovered (p-value = 6.65×10-6 for the interaction test) and replicated at nominal significance level (p-value = 0.013) in SMC5. Conclusions - In conclusion, this study applied new gene-based statistical approaches and suggested that rare and low-frequency genetic variants interacted with alcohol consumption on lipid levels.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32452971

RESUMO

BACKGROUND: We investigate the association of widespread pain with sleep quality among people with HIV (PWH) and HIV-negative controls. SETTING: UK-based cohort. METHODS: Pain information was collected through a pain mannikin identifying affected body sites; pain was classified as widespread if pain was reported in >4 of 5 body regions and in >7 of 15 body sites, and as regional otherwise. Sleep was assessed a median of 3.2 years later though 7-night actigraphy and through self-reported assessments of sleep quality. Chi-squared tests, Kruskal-Wallace tests and linear/logistic regression considered associations between pain extent and sleep quality. RESULTS: Of the 414 participants, 74 (17.9%) reported widespread and 189 (45.7%) regional pain. Whilst there were few clear associations between actigraphy outcomes and pain extent, those with widespread and regional pain consistently reported poorer sleep quality on all self-reported measures than those with no pain. Median (interquartile range) insomnia severity index and Patient-reported Outcomes Measurement Information System (PROMIS) for sleep disturbance and sleep-related impairment scores were 12 (7-16), 55.3 (48.0-58.9) and 57.2 (48.9-61.3) respectively for those with widespread pain, 8 (4-13), 51.2 (45.5-58.3) and 50.3 (43.6-56.1) for those with regional pain, and 5 (2-9), 47.9 (42.9-54.3) and 45.5 (41.4-50.3) for those with no pain (all p-values 0.0001). Associations remained strong after adjustment for HIV status and other confounders, and were reduced but remained significant, after adjustment for depressive symptoms. CONCLUSIONS: Widespread pain was not associated with objective measures of sleep but was strongly associated with self-reported assessments of sleep quality in PWH.

7.
J Sleep Res ; : e13092, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32441843

RESUMO

Obstructive sleep apnea is associated with increased risk of car crashes; however, conventional measures of sleep apnea severity do not clearly identify those individuals who are at greatest risk. Here we tested whether, among individuals with sleep apnea, those with reduced interhemispheric sleep depth coherence, measured by correlation between right and left hemisphere odds ratio product, are at greater risk. The sample was derived from the Sleep Heart Health Study, a prospective observational cohort study, and included 1,378 adults with sleep apnea. The occurrence of a car crash was ascertained by a questionnaire administered 2 years after the sleep study, which asked about the occurrence of crashes during the year prior to questionnaire administration. We computed the sleep depth coherence from electroencephalograms recorded during baseline sleep studies and after 5 years. The weighted kappa coefficient and Bangdiwala's B were 0.34 and 0.59, respectively, indicating a fair to moderate stability over a 5-year interval. Multivariate logistic regression, adjusted for age, sex, race, body mass index and miles driven per year, was used to assess the risk of a car crash. Compared to the lowest quartile of sleep depth coherence (<0.86), individuals in the highest quartile (>0.93) had a 62% (95% confidence interval, 22%-81%) lower risk of an accident. Further adjustments for usual sleep duration and sleepiness did not meaningfully alter these findings. Higher interhemispheric sleep depth coherence is associated with significantly lower risk of motor vehicle crashes in individuals with sleep apnea. This suggests that high interhemispheric sleep depth coherence may be a marker of resistance to sleep apnea-related adverse neurocognitive outcomes.

8.
Circ Cardiovasc Imaging ; 13(5): e009074, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32408831

RESUMO

BACKGROUND: Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. METHODS: We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. RESULTS: Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. CONCLUSIONS: Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.

9.
Complement Ther Clin Pract ; 39: 101121, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379660

RESUMO

BACKGROUND: and purpose: Inadequate sleep is highly prevalent among socioeconomically disadvantaged and racial/ethnic minority communities and is often related to maladaptive sleep behaviors and stress. There is scant research investigating the delivery of these interventions in underserved communities. The purpose of this study was to develop and test the feasibility and acceptability of a sleep education and yoga intervention for socioeconomically disadvantaged and racial/ethnic diverse adults. MATERIALS AND METHODS: We present quantitative and qualitative data from a single-arm sleep education and yoga pilot study (n = 17) conducted in two affordable housing communities, and the multi-modal process we employed to refine the intervention for a future trial. RESULTS: Participants were age 43.6 years on average (±19.3 years) and 88.2% were female. Nearly 56% identified as non-Hispanic Black and 19% as Hispanic/Latino. Results showed significant pre/post-intervention improvements in sleep duration (5.4 ± 1.2 h/night vs 6.9 ± 1.7 h/night; p < 0.01), sleep-related impairment (-8.15; p < 0.01), sleep disturbance (-5.95; p < 0.01), and sleep hygiene behaviors (-5.50; p < 0.01). CONCLUSION: This study indicates intervention acceptability and improvements in sleep and sleep hygiene. Future randomized controlled trials are needed to assess efficacy.

10.
PLoS One ; 15(5): e0230815, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379818

RESUMO

Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D.

11.
Chest ; 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32298733

RESUMO

BACKGROUND: Heart failure (HF) is a leading cause of morbidity and mortality and although it is linked to sleep apnea, which physiological stressors most strongly associate with incident disease is unclear. We tested whether sleep apnea-specific hypoxic burden (SASHB) predicts incident HF in two independent cohort studies. RESEARCH QUESTION: ▪▪▪ STUDY DESIGN AND METHODS: The samples were derived from two cohort studies: The Sleep Heart Health Study (SHHS), which included 4,881 middle-aged and older adults (54.4% women), age 63.6 ± 11.1 years; and the Outcomes of Sleep Disorders in Older Men (MrOS), which included 2,653 men, age 76.2 ± 5.4 years. We computed SASHB as the sleep apnea-specific area under the desaturation curve from pre-event baseline. We used Cox models for incident HF to estimate the adjusted hazard ratios (HRs) for natural log-transformed SASHB and apnea-hypopnea index (AHI) adjusting for multiple confounders. RESULTS: The SASHB predicted incident HF in men in both cohorts, whereas AHI did not. Men in SHHS and MrOS had adjusted HRs (per 1SD increase in SASHB) of 1.18 (95% CI = 1.02-1.37) and 1.22 (95% CI = 1.02-1.45), respectively. Associations with SASHB were observed in men with both low and high AHI levels. Associations were not significant in women. INTERPRETATION: In men, the hypoxic burden of sleep apnea was associated with incident HF after accounting for demographic factors, smoking, and co-morbidities. The findings Suggest that quantification of an easily measured index of sleep apnea-related hypoxias may be useful for identifying individuals at risk for heart disease, while also suggesting targets for intervention.

12.
JAMA Pediatr ; 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32338727

RESUMO

Importance: Sleep is a resource that has been associated with health and well-being; however, sleep insufficiency is common among adolescents. Objective: To examine how delaying school start time is associated with objectively assessed sleep duration, timing, and quality in a cohort of adolescents. Design, Setting, and Participants: This observational cohort study took advantage of district-initiated modifications in the starting times of 5 public high schools in the metropolitan area of Minneapolis and St Paul, Minnesota. A total of 455 students were followed up from grade 9 (May 3 to June 3, 2016) through grade 11 (March 15 to May 21, 2018). Data were analyzed from February 1 to July 24, 2019. Exposures: All 5 participating schools started early (7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), 2 schools delayed their start times by 50 and 65 minutes, whereas 3 comparison schools started at 7:30 am throughout the observation period. Main Outcomes and Measures: Wrist actigraphy was used to derive indices of sleep duration, timing, and quality. With a difference-in-difference design, linear mixed-effects models were used to estimate differences in changes in sleep time between delayed-start and comparison schools. Results: A total of 455 students were included in the analysis (among those identifying sex, 225 girls [49.5%] and 219 boys [48.1%]; mean [SD] age at baseline, 15.2 [0.3] years). Relative to the change observed in the comparison schools, students who attended delayed-start schools had an additional mean 41 (95% CI, 25-57) objectively measured minutes of night sleep at follow-up 1 and 43 (95% CI, 25-61) at follow-up 2. Delayed start times were not associated with falling asleep later on school nights at follow-ups, and students attending these schools had a mean difference-in-differences change in weekend night sleep of -24 (95% CI, -51 to 2) minutes from baseline to follow-up 1 and -34 (95% CI, -65 to -3) minutes from baseline to follow-up 2, relative to comparison school participants. Differences in differences for school night sleep onset, weekend sleep onset latency, sleep midpoints, sleep efficiency, and the sleep fragmentation index between the 2 conditions were minimal. Conclusions and Relevance: This study found that delaying high school start times could extend adolescent school night sleep duration and lessen their need for catch-up sleep on weekends. These findings suggest that later start times could be a durable strategy for addressing population-wide adolescent sleep deficits.

13.
Sleep Health ; 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32335037

RESUMO

OBJECTIVE: We investigated associations of sleep duration and social jetlag with cardiometabolic outcomes. PARTICIPANTS: Boys and girls aged 8-16 years from the Hispanic Community Health Study/Study of Latino Youth. MEASUREMENTS: Participants (n = 1,208) completed a clinical examination where anthropometric characteristics, health behaviors, and health history were measured. Sleep duration was calculated as the weighted average of self-reported weekday and weekend bedtimes and wake times and categorized into age-specific cutoffs for short vs. normal sleep. "Social jetlag" was defined as the absolute difference in the midpoint of the sleep period between weekdays and weekends, measured continuously and dichotomized (≥2 hours), with higher values indicating more displacement of sleep timing across the week. Regression models tested the associations between sleep measures (separately) and cardiometabolic outcomes (e.g., healthy eating index [0-100], physical activity-minutes per week, obesity, diabetes, hypertension) after adjustment for covariates. RESULTS: The average sleep duration was 9.5 hours (95% confidence interval: 9.3, 9.6) and the mean social jetlag was 2.5 (2.4, 2.7) hours. Participants with social jetlag reported more physical activity (ß = 34.8 [13.14], P < .01), had a higher healthy eating index (ß = 1.77 [0.87], P < .05] and lower odds of being overweight [OR = 0.66, (95% confidence interval 0.44, 0.99)]. Short sleep duration was associated with less physical activity but did not relate to other cardiometabolic outcomes. CONCLUSIONS: Social jetlag was associated with healthier behaviors and a lower odds of being overweight. Given these mixed findings, future research should further evaluate how to best characterize sleep timing differences in youth to identify health consequences.

14.
Res Synth Methods ; 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32270909

RESUMO

Meta-analyses of clinical trials typically focus on one outcome at a time. However, treatment decision-making depends on an overall assessment of outcomes balancing benefit in various domains and potential risks. This calls for meta-analysis methods for combined outcomes that encompass information from different domains. When individual patient data (IPD) are available from all studies, combined outcomes can be calculated for each individual and standard meta-analysis methods would apply. However, IPD are usually difficult to obtain. We propose a method to estimate the overall treatment effect for combined outcomes based on first reconstructing pseudo IPD from available summary statistics and then pooling estimates from multiple reconstructed datasets. We focus on combined outcomes constructed from two continuous original outcomes. The reconstruction step requires the specification of the joint distribution of these two original outcomes, including the correlation which is often unknown. For outcomes that are combined in a linear fashion, misspecifications of this correlation affect efficiency, but not consistency, of the resulting treatment effect estimator. For other combined outcomes, an accurate estimate of the correlation is necessary to ensure the consistency of treatment effect estimates. To this end, we propose several ways to estimate this correlation under different data availability scenarios. We evaluate the performance of the proposed methods through simulation studies and apply these to two examples: (a) a meta-analysis of dipeptidyl peptidase-4 inhibitors vs control on treating type 2 diabetes; and (b) a meta-analysis of positive airway pressure therapy vs control on lowering blood pressure among patients with obstructive sleep apnea.

16.
Sleep Health ; 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32331867

RESUMO

OBJECTIVE: To examine the association of maternal lifetime experiences of racial discrimination with infant sleep duration over the first 2 years of life. DESIGN: Prebirth cohort study. SETTING: Massachusetts, USA (baseline: 1999-2002). PARTICIPANTS: 552 mother-infant dyads in Project Viva, for whom the mother self-identified as being a woman of color. MEASUREMENTS: During pregnancy, mothers completed the Experiences of Discrimination survey that measured lifetime experiences of racial discrimination in eight domains. The main outcome was a weighted average of their infants' 24-hour sleep duration from 6 months to 2 years. RESULTS: 30% reported 0 domains of racial discrimination, 35% 1-2 domains, and 34% ≥3 domains. Any racial discrimination (≥1 vs. 0 domains) was higher among black (80%) versus Hispanic (58%) or Asian (53%) mothers and the United States versus foreign-born mothers (79% vs. 58%) and was associated with higher mean prepregnancy BMI (26.8 vs. 24.5 kg/m2). Children whose mothers reported ≥3 domains versus 0 domains had shorter sleep duration from 6 months to 2 years in unadjusted analysis (ß -18.6 min/d; 95% CI -37.3, 0.0), which was attenuated after adjusting for maternal race/ethnicity and nativity (-13.6 min/d; -33.7, 6.5). We found stronger associations of racial discrimination with offspring sleep at 6 months (-49.3 min/d; -85.3, -13.2) than for sleep at 1 year (-13.5 min/d; -47.2, 20.3) or 2 years (4.2 min/d; -21.5, 29.9). CONCLUSIONS: Maternal lifetime experiences of racial discrimination was associated with shorter offspring sleep duration at 6 months, but not with infant's sleep at 1 and 2 years of age.

17.
J Clin Sleep Med ; 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32248895

RESUMO

STUDY OBJECTIVES: African Americans have a high prevalence of severe sleep apnea which is often undiagnosed. We developed a prediction model for sleep apnea and compared the predictive values of that model to other prediction models among African Americans in the Jackson Heart Sleep Study (JHSS). METHODS: JHSS participants underwent a Type 3 home sleep apnea study and completed standardized measurements and questionnaires. We identified 26 candidate predictors from 17 preselected measures capturing information on demographics, anthropometry, sleep, and comorbidities. To develop the optimal prediction model, we fit logistic regression models using all possible combinations of candidate predictors. We then implemented a series of steps: comparisons of equivalent models based on the C-statistics, bootstrap to evaluate the finite sample properties of the C-statistics between models, and 5-fold cross-validation to prevent overfitting. RESULTS: Of 719 participants, 38% had moderate or severe sleep apnea, 34% were male and 38% reported habitual snoring. The average age and BMI were 63.2 (SD:10.7) years and 32.2 (SD: 7.0) kg/m². The final prediction model included: age, sex, BMI, neck circumference, depressive symptoms, snoring, restless sleep, and witnessed apneas. The final model has an equal sensitivity and specificity of 0.72, and better predictive properties than commonly used prediction models. CONCLUSIONS: In comparing a prediction model developed for African Americans in the JHSS to widely used screening tools, we found a model that included measures of demographics, anthropometry, depressive symptoms, and sleep patterns and symptoms better predicted sleep apnea.

18.
J Am Heart Assoc ; 9(9): e013209, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32342760

RESUMO

Background Characterizing associations of sleep characteristics with blood-glucose-level factors among blacks may clarify the underlying mechanisms of impaired glucose metabolism and help identify treatment targets to prevent diabetes mellitus in blacks. Methods and Results Cross-sectional analyses were conducted in 789 blacks who completed home sleep apnea testing and 7-day wrist actigraphy in 2012-2016. Sleep-disordered breathing measurements included respiratory event index associated with 4% oxygen desaturation and minimum oxygen saturation. Sleep patterns on actigraphy included fragmented sleep indices. Associations between sleep characteristics (8 exposures) and measures of glucose metabolism (3 outcomes) were determined using multivariable linear regression. Mean (SD) age of the participants was 63 (11) years; 581 (74%) were women; 198 (25%) were diabetes mellitus, and 158 (20%) were taking antihyperglycemic medication. After multivariable adjustment, including antihyperglycemic medication use, the betas (95% CI) for fasting glucose and hemoglobin A1c, respectively, for each SD higher level were 0.13 (0.02, 0.24) mmol/L and 1.11 (0.42, 1.79) mmol/mol for respiratory event index associated with 4% oxygen desaturation and 0.16 (0.05, 0.27) mmol/L and 0.77 (0.10, 1.43) mmol/mol for fragmented sleep indices. Among 589 participants without diabetes mellitus, the betas (95% CI) for homeostatic model assessment of insulin resistance for each SD higher level were 1.09 (1.03, 1.16) for respiratory event index associated with 4% oxygen desaturation, 0.90 (0.85, 0.96) for minimum oxygen saturation, and 1.07 (1.01, 1.13) for fragmented sleep indices. Conclusions Sleep-disordered breathing, overnight hypoxemia, and sleep fragmentation were associated with higher blood glucose levels among blacks.

19.
Physiol Meas ; 41(6): 065004, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32344384

RESUMO

OBJECTIVES: Lung-to-finger circulation time (LFCT) measured from sleep studies may reflect underlying cardiac dysfunction. We aimed to examine the distribution of LFCT in community-dwelling men and women in order to better understand the factors determining LFCT between and within subjects. APPROACH: We included participants of the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep with polysomnography-based evidence of sleep apnea (defined by apnea hypopnea index >15 hr-1). In a randomly selected subset of the analytical dataset, we tested an automated LFCT measurement method against the visual method. Using the automated method we then scored LFCTs from all eligible respiratory events for all included participants. A multiple regression model was constructed to determine factors independently associated with average LFCT across subjects. We also explored factors that are associated with LFCT within subjects using linear mixed-effect models. MAIN RESULTS: In a subset of the cohort (N = 39) there was a high correlation in average LFCT obtained by automated and visual methods (r = 0.96). In the analysis of 596 participants, men [19.6 (2.8)] (vs. women [17.9 (2.7) s], p < 0.0001) and older age (> 69 (vs. ≤ 69) had longer average LFCT (19.4 [2.8] vs. 18.5 [2.9] s, p < 0.0001). These associations persisted in multivariable analysis. No association was found with body habitus. Within subject analysis revealed trivial associations between apnea/hypopnea duration, apnea (vs. hypopnea), nadir O2 saturation and sleep stages (NREM vs. REM) and individual LFCT. SIGNIFICANCE: Automated LFCT measurement was highly correlated with visual-based LFCT measurement. In this group of community-dwelling adults, male sex and older age were associated with higher average LFCT.

20.
J Sleep Res ; : e13033, 2020 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-32198950

RESUMO

Discrepancies between actigraphic and self-reported sleep measures are common. Studies of people with insomnia, in whom both sleep disturbances and discrepancy are common, suggest disturbances and discrepancy reflect differences in the sleeping brain's activity measurable using spectral electroencephalogram (EEG). Disentangling effects of discrepancy and disturbance on sleep EEG could help target research on the consequences and treatments of different sleep phenotypes. We therefore categorized participants in a cohort study including 2,850 men (average age = 76 years, standard deviation = 5.5) into four groups using median splits on actigraphic and self-reported sleep efficiency (SE). We compared spectral power between these groups in 1-Hz bins up to 24 Hz. Compared with the concordant-high SE group: (a) the group with high actigraphic and low self-reported SE had higher spectral power from 11-15 Hz across the night; (b) both groups with low actigraphic SE had higher power across the 15-24 Hz range, predominantly in early cycles, and greater slow frequency power in later cycles. These findings suggest that perceived wakefulness undetected by actigraphy may result from or drive activity corresponding to spindles. We also found, consistent with hyperarousal models, that low SE detectable via actigraphy was related to higher frequency power in the beta range; actigraph-measured inefficiency was also associated with later slow oscillations, potentially representing attempts to dissipate homeostatic drive elevated from earlier hyperarousal. These distinct spectral EEG markers (of low SE measured with actigraphy vs. low perceived SE that is not captured by actigraphy) may have different causes or consequences.

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