Audit of waist measurement methods during statutory diving medical assessments

BACKGROUND

Measurement of waist circumference is used to assess abdominal fat and risk of heart disease, type 2 diabetes, cancer and stroke. It is performed in several clinical settings for health promotion and medical assessment purposes, including statutory medical assessments where results may influence decisions on fitness to work. Under the Diving at Work Regulations 1997, working divers must have an annual assessment of their fitness to dive performed by an approved medical examiner of divers (AMED), appointed by the Health and Safety Executive (HSE). The assessment includes measurement of height, weight and waist circumference, the latter used as an indicator of central adiposity and associated health risks.

AIMS

To establish the practice of AMEDs in measuring waist circumference of working divers undergoing medical assessment to determine their fitness to dive.

METHODS

Ninety-seven AMEDs were sent a questionnaire and asked to describe their current practice in measuring waist circumference. The response rate was 79%. The audit standard used was the consensus document published by the World Health Organization (WHO).

RESULTS

Of the 77 responses, 76 were completed sufficiently to allow analysis. When the waist was measured, there was consistency in the diver's level of clothing, stage of breathing and posture for the procedure but variability in the site of measurement. Only 7/76 (9%) respondents carried out waist measurement fully in line with WHO guidance.

CONCLUSIONS

The audit has identified that there is a need for guidance for AMEDs on measuring waist circumference in the statutory medical assessment of working divers.

O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy

Introduction

Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.

Result

Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.

Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.

Conclusion

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

Take-home Message

Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.

POS1097 TREATMENT KNOWLEDGE AND PREFERENCES FOR BLACK PEOPLE WITH HIP AND KNEE OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS

Background:

Black people are less likely to undergo total joint arthroplasties, despite reporting more severe symptoms. (1) While racial disparities exist in treatment utilization for osteoarthritis, comprehensive studies of the treatment preferences of Black people have not been conducted.

Objectives:

The purpose of this manuscript is to systematically review the literature and identify Black osteoarthritis patients’ treatment preferences to understand how they may contribute to racial differences in the utilization of different treatment options.

Methods:

Searches ran on April 8, 2019 and April 7, 2020 in the following databases: Ovid MEDLINE (ALL - 1946 to Present); Ovid EMBASE (1974 to present); and The Cochrane Library (Wiley). Using the Patient/Population-Intervention-Comparison/Comparator-Outcome (PICO) format, our population of interest was Black people with hip and/or knee osteoarthritis, our intervention was preferences and opinions about treatment options for osteoarthritis, our comparator was white people with hip and/or knee osteoarthritis, and our outcome was preferences of osteoarthritis therapies. The protocol was registered under the PROSPERO international register, and the Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results:

Searches across the chosen databases retrieved 10,894 studies after de-duplication, 182 full text, and 31 selected for inclusion in this review. Black people were less likely to use NSAIDs or narcotic analgesics compared to white people. (Figure 1) Black people were more likely than white people to use spirituality and prayer, as well as topical treatments. Utilization of meditation, supplement/vitamin use, and hot/cold treatments was not significantly different between groups. Black people were less willing than white people to consider or undergo joint replacements, even if the procedure was needed and recommended by a physician.

Conclusion:

Racial differences persist in OA care across the spectrum of options. Future interventions should focus on providing accessible information surrounding treatment options and targeting perceptions of the importance of joint health.

References:

[1]Suarez-Almazor ME, Souchek J, Kelly PA, et al. Ethnic Variation in Knee Replacement: Patient Preferences or Uninformed Disparity? Arch Intern Med. 2005;165(10):1117-1124. doi:10.1001/archinte.165.10.1117

Figure 1.

Meta-analysis describing the odds ratios of Black people using NSAIDs and Narcotic Analgesics compared to white people

Disclosure of Interests:

Collin Brantner: None declared, Diyu Pearce-Fisher: None declared, Carine Moezinia: None declared, Haley Tornberg: None declared, John FitzGerald: None declared, Michael Parks Consultant of: Zimmer Biomet, Peter Sculco Consultant of: EOS Imaging, Intellijoint Surgical, DePuy Synthes, Lima Corporate, Cynthia Kahlenberg: None declared, Curtis Mensah: None declared, Ajay Premkuar: None declared, Nicholas Williams: None declared, Michelle Demetres: None declared, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Horizon Therapeutics.

Cardiac rehabilitation is associated with lower 1-year all-cause mortality in primary pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Background. Despite introduction of pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains present. Cardiac rehabilitation may be an alternative strategy to improve survival. However, no study directly linked CR to mortality in PH patients. Therefore, adopting a retrospective observational study using a large electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with CR versus a propensity-matched control group of PH without CR.

Methods. The retrospective analysis was conducted on December 14, 2020 using anonymized data within TriNetX, a global federated health research network with access to EMRs from participating academic medical centres, specialty physician practices, and community hospitals, predominantly in the United States. All patients were aged ≥18 years with primary PH recorded in EMRs at least 18-months before the search date to allow for 1-year follow-up from CR. Using logistic regression, patients with PH with an EMR of CR were 1:1 propensity score-matched with PH patients without CR for age, sex, race, diseases of the respiratory system, disease of the circulatory system, hypertensive disease, heart failure, diabetes mellitus, chronic kidney disease, cerebrovascular disease, cardiovascular procedures and cardiovascular medications.

Results. In total, 70,875 patients with primary PH met the inclusion criteria for the control group and 637 patients with primary PH met the inclusion criteria for the CR and exercise cohort (Table 1). Using the propensity score-matched cohort, and excluding patients with outcomes outside the measurement window, mortality at 1-year from CR was proportionally lower with mortality of 13.9% (n = 87 of 628 patients) in the CR and exercise cohort compared to 21.0% (n = 133 of 632 patients) in the controls (OR 0.60, 95% CI 0.45-0.81).

Conclusion. In conclusion, the present study of 1,264 patients with primary PH suggests that CR is associated with 40% lower odds of 1-year mortality, when compared to propensity score-matched patients without CR or exercise programmes.

Abstract Figure.

Location and Setting of the Mars InSight Lander, Instruments, and Landing Site

Knowing precisely where a spacecraft lands on Mars is important for understanding the regional and local context, setting, and the offset between the inertial and cartographic frames. For the InSight spacecraft, the payload of geophysical and environmental sensors also particularly benefits from knowing exactly where the instruments are located. A ~30 cm/pixel image acquired from orbit after landing clearly resolves the lander and the large circular solar panels. This image was carefully georeferenced to a hierarchically generated and coregistered set of decreasing resolution orthoimages and digital elevation models to the established positive east, planetocentric coordinate system. The lander is located at 4.502384°N, 135.623447°E at an elevation of -2,613.426 m with respect to the geoid in Elysium Planitia. Instrument locations (and the magnetometer orientation) are derived by transforming from Instrument Deployment Arm, spacecraft mechanical, and site frames into the cartographic frame. A viewshed created from 1.5 m above the lander and the high-resolution orbital digital elevation model shows the lander is on a shallow regional slope down to the east that reveals crater rims on the east horizon ~400 m and 2.4 km away. A slope up to the north limits the horizon to about 50 m away where three rocks and an eolian bedform are visible on the rim of a degraded crater rim. Azimuths to rocks and craters identified in both surface panoramas and high-resolution orbital images reveal that north in the site frame and the cartographic frame are the same (within 1°).

Assessment of InSight Landing Site Predictions

Comprehensive analysis of remote sensing data used to select the Interior Exploration using Seismic Investigations, Geodesy and Heat Transport (InSight) landing site correctly predicted the atmospheric temperature and pressure profile during entry and descent, the safe landing surface, and the geologic setting of the site. The smooth plains upon which the InSight landing site is located were accurately predicted to be generally similar to the Mars Exploration Rover Spirit landing site with relatively low rock abundance, low slopes, and a moderately dusty surface with a 3-10 m impact fragmented regolith over Hesperian to Early Amazonian basaltic lava flows. The deceleration profile and surface pressure encountered by the spacecraft during entry, descent, and landing compared well (within 1σ) of the envelope of modeled temperature profiles and the expected surface pressure. Orbital estimates of thermal inertia are similar to surface radiometer measurements, and materials at the surface are dominated by poorly consolidated sand as expected. Thin coatings of bright atmospheric dust on the surface were as indicated by orbital albedo and dust cover index measurements. Orbital estimates of rock abundance from shadow measurements in high-resolution images and thermal differencing indicated very low rock abundance and surface counts show 1-4% area covered by rocks. Slopes at 100 to 5 m length scale measured from orbital topographic and radar data correctly indicated a surface comparably smooth and flat as the two smoothest landing sites (Opportunity and Phoenix). Thermal inertia and radar data indicated the surface would be load bearing as found.

SAT0609-HPR DELPHI CONSENSUS FOR THE OPTIMAL TREATMENT & MANAGEMENT OF COMPLEX RHEUMATOID ARTHRITIS (RA) PATIENTS

Background:

A significant proportion of patients with rheumatoid arthritis (RA) have additional considerations that must be taken into account for managing their disease.1These include; co-morbidities, extra-articular manifestations and poor prognostic factors.2-5Tailored management could reduce the burden on patients, the health system and wider society.

The ‘complex’ RA patient group is ill-defined and no specific recommendations exist for their optimal management and treatment.

Objectives:

A group of UK Rheumatology experts aimed to provide a set of recommendations to support consistent and high quality management, grounded in current evidence, expert opinion and best practice.

Methods:

A steering group meeting identified priority topics associated with complex RA.

Table 1.

Topics for consensus

TopicNo. of statementsDefinition of ‘complex’ RA from a medical perspective19Definition of patient factors that may contribute to ‘complex’ RA3Outcomes for RA patients with co-morbidities and/or extra articular manifestations5Prescribing options for ‘complex’ RA8Evidence vs. best practice requirements4Burden of ‘complex’ RA4TOTAL NUMBER OF STATEMENTS43

For each topic, the group defined statements they all agreed with. Delphi methodology was used to ratify these statements with rheumatology peers.

High levels of agreement (over 70%) were achieved in the first round, the group proceeded to formulate the recommendations.

Figure 1.

Responses received (n=163)

Figure 2.

Consensus Plot (total responses n=163)

Conclusion:

These recommendations are offered:

References:

[1]Uhlig T, Moe RH, Kvien TK. The burden of disease in rheumatoid arthritis. Pharmacoeconomics 2014;32:841–51

[2]Dougados M, et al. Ann Rheum Dis 2014;73:62–68.

[3]Parodi M et al,Rheumatism, 2005, 57(3): 154-60.

[4]Young A & Koduri G. Best Pract Res Clin Rheumatol. 2007 Oct;21(5):907-27.

[5]Holroyd CR, et al. Rheumatology 2019;58:e3-e42

Acknowledgments:

Support for medical writing/editorial assistance, provided by Tim Warren at Triducive was funded by Roche Products Ltd. & Chugai Pharma Ltd. in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Gurdeep Dulay Grant/research support from: Educational grants to attend congress meetings/conferences from Roche, Chugai, UCB, Internis, Pfizer, Lilly, Sandoz, Consultant of: Honoraria for advisory board services from Roche, Chugai, Novartis, Speakers bureau: Speaker fees from Roche, Chugai, Novartis, Amgen, Lilly, Sandoz, Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Theresa Barnes Consultant of: Ad boards for Roche, Actelion and Abbvie, Speakers bureau: Speaker for MSD, UCB, Pfizer, Abbvie, Actelion, Roche and BMS, Debbie Chagadama Consultant of: Roche, Chugai, BI, Speakers bureau: Roche, Chugai, BI, Zoe Cole Consultant of: Consultancy work for Roche, Lilly, Gilead, Abbvie, Pfizer, UCB, Speakers bureau: Lilly, BMS, Abbvie, Pfizer, UCB, Janssen, Anshuman Malaviya Consultant of: Roche, Chugai, MSD, Pfizer, Novartis, Lily, BMS, Speakers bureau: Roche, BMS, Pfizer, MSD, Sandra Robinson Consultant of: Eli Lilly for Education Nurse Meeting, David Walker Grant/research support from: Gilead, Consultant of: Gilead, Lilly, Pfizer, Roche, Speakers bureau: Lilly, Pfizer, Roche, Chris Daly Employee of: Roche, Nicola Savill Employee of: Roche, Tim Warren Consultant of: Roche, Employee of: AstraZeneca, Nick Williams Shareholder of: MSD, Consultant of: Roche, Employee of: MSD

1089 Water Intake Moderates the Relationship Between Sleep Quality and Depressive Symptoms: The Latino Health and Well-Being Study

Introduction

This study examined the relationships between sleep quality and depressive symptoms, and whether this relationship is moderated by frequency of water intake in a sample of Latino adults.

Methods

Participants in this community-based study were 574 Latino adults from Lawrence, Massachusetts. Assessments included surveys and anthropological measures. Variables in this study included sleep quality (Pittsburgh Sleep Quality Index- PSQI), depressive symptoms (Center for Epidemiologic Studies Depression Scale -CES-D) and frequency of water intake in the previous three months (investigator-developed question). Covariates included demographics, stress (Perceived Stress Scale-PSS), and body mass index (BMI). Multiple linear regression analyses were conducted to explore associations between sleep and depressive symptoms. Potential moderating effect of frequency of water intake was assessed using hierarchical, moderated, multiple regression analysis.

Results

The sample was 51.2% female, with a mean age of 46.6 years (SD=15.4) and mean BMI of 29.6 (SD=5.9); 31% of the sample had CES-D scores > 22 (cut off for elevated depressive symptoms), the mean PSQI score was 13.11(SD=3.4) and 92% reported water intake two or more times daily. Sleep quality correlated positively with depression (r=.558; p=.000). After adjusting for covariates, sleep quality was strongly associated with depression (B = .417; SE=13; p =.000). The relationship between sleep quality and depressive symptoms was moderated by frequency of water intake (B= -.186, SE =1.107; p= 0.11).

Conclusion

This study is among the first to examine the association between sleep quality and depressive symptoms among Latino adults, and to show that frequency of water intake may moderate this association in this population.

Support

This study was supported by funding from the NIH: R01 MH085653; 1U48DP006381; and T32HL129953.

1108 Associations Between Insomnia And Anxiety Symptoms: Which Elements Of Insomnia Are Associated With Which Elements Of Anxiety?

Introduction

It is still not clear which aspects of insomnia are associated with various aspects of anxiety problems. Knowing this could better guide treatment of insomnia comorbid with anxiety.

Methods

Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 adults age 22-60. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty sleeping), DAYTIME symptoms (difficulty functioning), and PERCEPTION symptoms (dissatisfaction). GAD7 items included anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and fear. Logistic regression analyses examined each symptom, with each component of the ISI as predictor, as well as age, sex, race/ethnicity and education as covariates.

Results

SLEEP symptoms were independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were independently associated with anxiety level (OR=1.3, p<0.0005), control (OR=1.2, p<0.0005), many worries (OR=1.3, p<0.0005), difficulty relaxing (OR=1.2, p=0.004), restlessness (OR=1.3, p=0.001), and irritability (OR=1.2, p<0.0005). PERCEPTION symptoms were uniquely, independently associated with anxiety level (OR=1.1, p=0.03), control (OR=1.2, p=0.001), many worries (OR=1.2, p=0.001), difficulty relaxing (OR=1.4, p<0.0005), irritability (OR=1.2, p=0.018), and feelings of fear (OR=1.2, p=0.002).

Conclusion

The DAYTIME and PERCEPTION symptoms of insomnia were strongly related to anxiety symptoms. Current treatments for insomnia focus mainly on improving sleep. Future research should test the hypothesis that treating daytime symptoms of insomnia may aid patients with comorbid anxiety.

Support

The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.

1175 Sleep Disorders Screening in Primary Care: Prevalence of Diagnosis and Treatment in the EMR

Introduction

Undetected and untreated sleep disorders likely precipitate or exacerbate medical and/or psychiatric illnesses. Given this, primary care is an ideal point for managing sleep disorders, yet prior research shows that PCPs diagnose and/or treat sleep disorders at rates far below population prevalences. The purpose of this study was to determine the current rate of detection and treatment of sleep disorders within primary care settings.

Methods

EMR data from two health care systems was analyzed. The proportion of PCPs diagnosing and treating one or more sleep disorders was calculated (per year) for 5 years (2014-2018). Also calculated was the percent of PCP caseload diagnosed and/or treated for sleep disorders.

Results

The two systems comprised n=1021 PCPs. From 2014-2018, the proportion of PCPs diagnosing patients with sleep disorders fluctuated between 58-89%. The proportion treating sleep disorders fluctuated between 50-91%. Non-parametric one-sample run tests (SPSS) indicate these are random distributions (p>0.05). PCPs’ use of medications to treat sleep disorders is trending downward over time within one system (per linear regression, p=0.03, R-squared=0.8). Other temporal trends were not evidenced. The average percentage of diagnosed and treated patients per PCP was around 2.5% of their caseloads. Between-system differences were observed.

Conclusion

There is a profound mismatch between percentage of PCPs identifying patients with sleep disorders (60-90%) and the percentage of patient caseload diagnosed and/or treated for sleep disorders (2.5%). This suggests that the majority of PCPs are willing to assess for sleep health but do so in only a small minority of patients. These data, along with our survey data (elsewhere in this volume) suggest that the intention-action gap could be closed if PCPs were appropriately resourced.

Support

There was no funding for this study.

1113 Physical Activity Moderates The Sleep-emotional Distress Relationship, But Less So Among Blacks Vs. Whites

Introduction

Emotional distress (ED) is associated with poor sleep. Research shows that minority populations experience greater vulnerabilities to both ED and poor sleep. Interventions such as relaxation training and behavioral therapy address this relationship but are not always successful. Research shows that physical activity (PA) is negatively associated with ED and positively associated with sleep duration. However, it is unclear whether PA attenuates the relationship between ED and sleep, and if this relationship differs by race/ethnicity.

Methods

We analyzed data from the 2005-2015 National Health Interview Survey (NHIS), a nationally representative dataset of 416,152 participants. ED, hours of PA per day, and average sleep duration were collected. Regression models with covariates (age, sex, employment status, BMI) were used to analyze the moderation effect of PA within sleep and ED. Regression models were stratified by race/ethnicity.

Results

261,686 participants (45,926 blacks, 17.55%, and 215,760 whites, 82.45%) responded with the required variables for analysis. 63% of participants reported at least some physical activity. The results of the regression showed that a significant amount of variance in ED stemmed from sleep duration; F (7, 121088) = 1,619.72, p < 0.001. PA was found to have a significant main effect, t(121,088) = 9.01, p= <0.001. There was a significant moderation effect of PA, t(121088) =7.26, p < 0.001. Stratification showed that the moderation effect of PA was not significant among blacks t(121,088) = -1.45, p=0.149 and significant among whites b = -.08, t(101,754) = -7.82, p < 0.001.

Conclusion

The present study found support for moderation of PA in the sleep-ED relationship. However, it found that blacks do not experience the same benefits of PA in this relationship as whites. Further research should be performed to understand the connection of PA to sleep duration and ED.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685

1189 Recruiting, Training, And Implementing Sleep Health Educators In Community-based Research To Improve Sleep Health

Introduction

Adherence to OSA assessment and treatment is low among racial/ethnic minorities, particularly among blacks. Navigating patients along the continuum of care from assessment to treatment adherence requires motivation, social support, and self-efficacy. Previous studies indicate that community health educators can provide motivation, social support, and skills to patients to better navigate the complex OSA care continuum. However, recruiting, training, and implementing sleep health educators in clinical or research settings is complex. For the current study, we describe how we recruit, train, and implement sleep health educators in research and clinical settings and assess what makes a sleep health educator successful.

Methods

We recruited and trained twenty-five self-identified black sleep health educators for a randomized clinical trial (R01MD007716) focused on increasing OSA assessment and treatment adherence among blacks. During recruitment, we assessed key personality attributes that translate to being an effective sleep health educator, via behavioral and personality surveys, focused groups, and process forms filled out by educators. Sleep health educators underwent an 8-week training program on sleep health and motivational interviewing. In order to be certified, sleep health educators had to pass a written and scenario-based assessment. During the implementation phase of the trial, we assessed how many interviews each health educator conducted and whether individual characteristics were related to how many interviews.

Results

Of the trained educators, 80% were female, ranging from 25 to 58 years old. They all completed at least high school. All educators rated the program highly and were very satisfied with dispensing tailored sleep health education. Educators who displayed the highest knowledge about sleep health, provided frequent emotional and strategic support, committed to helping their assigned participants, and who rated their rapport highly with their assigned participants were most effective in getting their participant to adhere to OSA assessment and treatment.

Conclusion

Sleep health educators can be vital to increasing OSA assessment and treatment adherence among blacks. In order to ensure success, sleep health educators must undergo a thorough recruitment, training, and implementation and dissemination process.

Support

K01HL135452, R01MD007716, R01HL142066, K01HL135452,and K07AG052685

0226 Sleep Duration and Symptoms Associated with Race/Ethnicity in Elite Collegiate Athletes

Introduction

Previous studies have documented sleep disparities in the general population. Given the increased interest in sleep among athletes, and the degree to which demographics and schedules among athletes differ from the general population, this analysis aims to examine the relationship between race/ethnicity and sleep duration and symptoms among elite college athletes.

Methods

Data were obtained from N=189 Division-1 collegiate athletes across a wide range of sports played. Race/ethnicity was self-reported and categorized as Non-Hispanic White, Black/African-American, Hispanic/Latino, Asian, and American Indian/Alaskan Native. Outcomes of interest included self-reported typical sleep duration (in hours), CESD depression score, and frequency of sleep symptoms, assessed using items from the Sleep Disorders Symptom Check List (difficulty falling asleep, difficulty staying asleep, early morning awakenings, tiredness, sleepiness, loud snoring, choking/gasping, fragmentation, hypnogogic/pompic hallucinations, sleep paralysis, and nightmares). Sleep duration and depression were evaluated with linear regression, and symptoms were evaluated as ordinal. Covariates included age and sex.

Results

Compared to Non-Hispanic Whites, Blacks/African-Americans reported less sleep (B=-0.80, p<0.0005), more depression (B=2.85, p=0.046), more difficulty maintaining sleep (oOR=2.12, p=0.034), early morning awakenings (oOR=3.15, p=0.001), and sleepiness (oOR=2.11, p=0.048); Hispanic/Latinos reported more hypnogogic/pompic hallucinations (oOR=2.90, p=0.007), sleep paralysis (oOR=2.72, p=0.026), and nightmares (oOR=2.22, p=0.035); Asians reported more depression (B=4.46, p=0.028), sleepiness (oOR=5.06, p=0.003), loud snoring (oOR=4.71, p=0.018), and sleep paralysis (oOR=3.57, p=0.031); and American Indians/Alaskan Natives reported less sleep (B=-1.00, p=0.018).

Conclusion

Racial/ethnic differences in sleep duration and sleep symptoms were seen among athletes. Future studies will be needed to replicate and further explain these findings.

Support

The REST study was funded by an NCAA Innovations grant. Dr. Grandner is supported by R01MD011600

1082 Offsprings Autistic Behaviors Modify The Relationships Between Maternal Peritraumatic Distress And Sleep Disturbance Following Trauma Exposure

Introduction

Neurodevelopmental impairments may alter parents’ sleep and add tremendous stress to their families’ routine. This study examined the relationship between peritraumatic distress, and sleep disturbances among mothers who were exposed to the 2010 Haitian earthquake during pregnancy and whether this relationship is moderated by offspring‘s autistic behaviors.

Methods

Sample includes 361 mother-offspring dyads [mean (SD) age= 27.31 (5.93); 3.1/2(3.88)] who survived the 2010 earthquake in Haiti. Maternal data were collected 3 years following the event via the Earthquake Experience Questionnaire (EEQ), the Peritraumatic Distress Inventory (PDI), and the sleep items of the PTSD Checklist (PCL-S) (such as trouble falling or staying asleep, and repeated disturbed dreams in response to the disaster exposure). Child-related data were obtained from maternal completion of the Echelle d’Evaluation des Comportements Autistiques Revisee (ECAR) (Autistic Behaviors Scale Revised). Pearson Correlations, multilinear regression and interaction effect analyses were conducted to explore the association between peritraumatic distress, offspring’s autistic behaviors and sleep disturbance among the participants.

Results

10.7% of mothers were caught under rubble or were seriously injured during the event. Three years later, 56.83% and 52.9% of them had consequent disturbed sleep and nightmares, respectively. Maternal sleep disturbance correlated positively with peritraumatic distress (r=.38, p=.01) and offspring autistic behaviors (r=.13, p=.05). As hypothesized, adjusting for covariates, peritramatic distress was the strongest predictor of maternal sleep disturbance (B=.310, p<.001). The relationship between maternal peritraumatic distress and sleep disturbance was modified by offspring autistic behaviors (B=.138, p= .015).

Conclusion

This is the first study to document the prolonged effect of peritraumatic distress during the 2010 Haitian earthquake on mother’s sleep disturbance and whether this relationship is moderated by offspring autistic behaviors. The findings support the importance of a sleep component in maternal and child health in disaster preparedness program.

Support

This study was supported by funding from the NIH: T32HL129953

0235 Sleep Duration and Timing Associated with Eating Behaviors: Data from NHANES 2015–2016

Introduction

Previous studies have shown that, in the laboratory, sleep deprivation leads to unhealthy eating patterns. In real-world samples, lack of sleep is associated with obesity. Few real-world studies of sleep and food intake patterns exist, especially from nationally-representative samples.

Methods

Data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) were used. NHANES is a national-representative survey collected by the CDC. N=6,291 participants provided data about dietary behaviors and sleep timing. Dietary behaviors included the number of meals not made at home in the past 7 days (NOTHOME), number of fast food/pizza meals in the past 7 days (FASTFOOD), number of pre-made meals in the past 30 days (PREMADE), and number of frozen meals in the past 30 days (FROZEN). Linear regression models examined these as outcomes and predictors including bedtime (minutes), waketime (minutes), sleep duration (hours), and daytime tiredness/fatigue (never, rarely, sometimes, often). Covariates included age, sex, education, income/poverty ratio, race/ethnicity, and body mass index.

Results

Number of meals not made at home (NOTHOME) was associated with a later bedtime (B=2.25, p=0.01) and shorter sleep duration (B=-0.12, p=0.01). FASTFOOD was associated with shorter sleep (B=-0.13,p=0.003) and tiredness/sleepiness sometimes (B=0.77, p=0.007) and often (B=0.55, p=0.03). FROZEN meals were associated with a later waketime (B=3.31, p=0.003) and tiredness/sleepiness sometime (B=1.20, p=0.025) and often (B=1.60, p=0.04). A sleep duration by bedtime interaction was not significant for any outcomes. In models that included overall levels of anxiety, these relationships were maintained.

Conclusion

This is one of the largest studies to show that habitual sleep patterns are associated with real-world food choices. In particular, shorter sleep duration and tiredness/sleepiness are associated with more ready-made and fast food meals. It is possible that lack of sleep leads to worse food choices, or that stress leads to both lack of sleep and easier food options. Given the often poor nutritive value of foods consumed outside the home and pre-prepared foods, these associations may in part explain the influence of sleep on cardiometabolic risk factors.

Support

Dr. Grandner is supported by R01MD011600

1174 Assessing Sleep Disorders in Primary Care: A Provider Survey About the Importance of Sleep Health

Introduction

Conditions commonly managed by primary care providers (PCPs) such as depression, diabetes, and heart disease, commonly co-occur with sleep disorders. If PCPs could readily identify comorbid sleep disorders in this context, it may provide a pathway to more effective management of both types of disorders. Currently, it is unknown what might encourage or discourage PCPs from routinely screening their patients for sleep disorders.

Methods

PCPs from UPENN and GHS completed surveys regarding sleep health. The 30-item instrument comprised demographic, 14 VAS (0%-100%=strongly disagree-strongly agree), 4 open-ended, 3 yes/no, and 2 multiple-choice questions.

Results

Ninety-nine PCPs responded and were predominately female (61% F, 37%M, 2% other), Caucasian (81%), on-average 45yrs old (25-70) and in primary care for 16yrs (1-43). Fifty-six percent were MDs, 21%DOs, 17%PAs, and 6%NPs. PCPs rated sleep disorders as highly important for cardiopulmonary, mental, and general health (85, 84, & 83%), with no difference (per linear regression, p>0.05) according to system or provider characteristics. PCPs reported high importance for knowing about and diagnosing sleep disorders (88% & 82%) within their practices. Lower comfort levels were reported for discussing (78%) sleep disorders, overseeing/following (62%), diagnosing (60%), or treating (48%) patients. Eighty percent of PCPs stated an efficient sleep disorders screener would be useful for their practice; this perception varied (per logistic regression) according to provider credentials (Wald=0.037) and Hispanic/Latino ethnicity (Wald=0.025). PCPs reported time constraints limit their responsiveness to sleep disorders

Conclusion

A large disparity exists between the importance PCPs place on sleep disorders and their low comfort levels with following, diagnosing, and treating sleep disorders. PCPs endorsed the need to have available an efficient sleep disorders screener to use in their practice.

Support

No funding was received for this study.