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Wickwire EM. Looking back and looking ahead: advancing understanding of insomnia economics. Sleep 2024; 47:zsae140. [PMID: 38899944 PMCID: PMC11321841 DOI: 10.1093/sleep/zsae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Emerson M Wickwire
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Beydoun MA, Beydoun HA, Ashe J, Georgescu MF, Horvath S, Lu A, Zannas AS, Shadyab AH, Jung SY, Wassertheil-Smoller S, Casanova R, Zonderman AB, Brunner RL. Relationships of depression and antidepressant use with epigenetic age acceleration and all-cause mortality among postmenopausal women. Aging (Albany NY) 2024; 16:8446-8471. [PMID: 38809417 PMCID: PMC11164525 DOI: 10.18632/aging.205868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
We investigated relations of depressive symptoms, antidepressant use, and epigenetic age acceleration with all-cause mortality risk among postmenopausal women. Data were analyzed from ≤1,900 participants in the Women's Health Initiative study testing four-way decomposition models. After a median 20.4y follow-up, 1,161 deaths occurred. Approximately 11% had elevated depressive symptoms (EDS+), 7% were taking antidepressant medication at baseline (ANTIDEP+), while 16.5% fell into either category (EDS_ANTIDEP+). Baseline ANTIDEP+, longitudinal transition into ANTIDEP+ and accelerated epigenetic aging directly predicted increased mortality risk. GrimAge DNA methylation age acceleration (AgeAccelGrim) partially mediated total effects of baseline ANTIDEP+ and EDS_ANTIDEP+ on all-cause mortality risk in socio-demographic factors-adjusted models (Pure Indirect Effect >0, P < 0.05; Total Effect >0, P < 0.05). Thus, higher AgeAccelGrim partially explained the relationship between antidepressant use and increased all-cause mortality risk, though only prior to controlling for lifestyle and health-related factors. Antidepressant use and epigenetic age acceleration independently predicted increased all-cause mortality risk. Further studies are needed in varying populations.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A. Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jason Ashe
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michael F. Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ake Lu
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Anthony S. Zannas
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science and Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Su Yon Jung
- Department of Epidemiology, Fielding School of Public Health, Translational Sciences Section, School of Nursing, University of California, Los Angeles, CA 90095, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Robert L. Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada, Reno, NV 89557, USA
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Wickwire EM, Collen J, Capaldi VF, Williams SG, Assefa SZ, Adornetti JP, Huang K, Venezia JM, Jones RL, Johnston CW, Thomas C, Thomas MA, Mounts C, Drake CL, Businelle MS, Grandner MA, Manber R, Albrecht JS. Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations. JMIR Form Res 2023; 7:e47356. [PMID: 37971788 PMCID: PMC10690521 DOI: 10.2196/47356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. OBJECTIVE The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. METHODS Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. RESULTS In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. CONCLUSIONS Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jacob Collen
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Vincent F Capaldi
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Scott G Williams
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Samson Z Assefa
- Sleep Disorders Center, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States
| | - Julianna P Adornetti
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kathleen Huang
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Janet M Venezia
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Rachell L Jones
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Christine W Johnston
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Connie Thomas
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Mary Ann Thomas
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Charles Mounts
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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Glick DR, Abariga SA, Thomas I, Shipper AG, Gunia BC, Grandner MA, Rosenberg E, Hines SE, Capaldi V, Collen J, Wickwire EM. Economic Impact of Insufficient and Disturbed Sleep in the Workplace. PHARMACOECONOMICS 2023; 41:771-785. [PMID: 36933184 DOI: 10.1007/s40273-023-01249-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Insufficient and disturbed sleep are associated with significant morbidity among working-age adults. Poor sleep results in negative health outcomes and increases economic costs to employers. The current systematic review surveyed the peer-reviewed scientific literature and aggregated scientific evidence of sleep-related economic burdens borne by employers. METHODS A systematic review was performed to identify peer-reviewed, English language studies evaluating the economic impact of insufficient and disturbed sleep among adult employee populations. An exhaustive literature search was performed using keywords related to sleep, economics, and the workplace. Included were scientific studies (randomized controlled trials, cohort and case control studies, cross-sectional and longitudinal studies) examining specific employee populations with relevant sleep and economic outcomes. Each included study was evaluated for risk of bias and relevant data was extracted and summarized. RESULTS Sleep problems among employee populations are associated with worsened workplace outcomes, such as presenteeism, absenteeism, and accidents. Sleep problems also increased costs to employers, ranging from US$322 to US$1967 per employee. Interventions to improve sleep, such as the use of blue-light filtering glasses, strategic shift scheduling, and targeted interventions to treat insomnia, may improve workplace outcomes and reduce costs. CONCLUSIONS This review synthesizes the existing data regarding the negative impacts of insufficient and disturbed sleep on the workplace, suggesting that employers have an economic stake in their employees' sleep. TRIAL REGISTRATION PROSPERO: CRD42021224212.
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Affiliation(s)
- Danielle R Glick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sleep Disorders Center, University of Maryland School of Medicine, 100 N Greene St, 2nd Floor, Baltimore, MD, 21201, USA.
| | - Samuel A Abariga
- Department of Epidemiology & Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Irine Thomas
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea G Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA
- Charles Library, Temple University, Philadelphia, PA, USA
| | - Brian C Gunia
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
| | | | - Stella E Hines
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vincent Capaldi
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Emerson M Wickwire
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sleep Disorders Center, University of Maryland School of Medicine, 100 N Greene St, 2nd Floor, Baltimore, MD, 21201, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Wickwire EM, Abdelwadoud M, Collen J, Edwards H, Labra C, Capaldi VF, Williams SG, Manber R, Assefa SZ, Drake CL, Albrecht JS, Bevan J, Mahoney A, Tatum ED, Pierre E, Mantua J, Grandner MA, Mullins CD. Active Duty Service Members, Primary Managers, and Administrators' Perspectives on a Novel Sleep Telehealth Management Platform in the U.S. Military Healthcare System. Mil Med 2022; 187:e1201-e1208. [PMID: 35089344 DOI: 10.1093/milmed/usac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Sleep disorders are common in the military, and there is a gross shortage of sleep specialists in the military health system. The purposes of the present study were to (1) understand perceptions and expectations surrounding sleep telehealth approaches and (2) solicit feedback to optimize and refine a proposed novel sleep telehealth management platform. To accomplish these objectives, we investigated the perceptions, expectations, and preferences of active duty service members (ADSMs) with sleep disorders, primary care managers (PCMs), and administrative stakeholders regarding sleep telehealth management. MATERIALS AND METHODS Using convenience sampling, we conducted five focus groups with 26 ADSMs and 11 individual interviews with PCMs from two military treatment facilities in the U.S National Capital Region and 11 individual interviews with administrative sleep stakeholders (9 military and 2 civilian). RESULTS Active duty service members, PCMs, and administrative stakeholders provided insight regarding expectations for sleep telehealth as well as suggestions to optimize the novel sleep telehealth platform. In terms of outcomes, ADSMs expected sleep telehealth to improve sleep and convenience. Primary care managers expected improved sleep and other comorbidities, enhanced operational readiness, and reduced mortalities among their patients. Administrators expected increased access to care, optimized utilization of health services, realized cost savings, reduced accidents and errors, and improved military performance. In terms of the platform, for ADSMs, desired characteristics included delivery of timely clinical reports, improved patient-provider communication, and enhanced continuity of care. For PCMs and administrators,an ideal sleep telehealth solution will improve the diagnosis and triage of sleep patients, save PCM time, be easy to use, and integrate with the electronic health record system. CONCLUSION The proposed sleep telehealth platform appealed to nearly all participants as a significant force multiplier to enhance sleep disorder management in the military. Stakeholders offered valuable recommendations to optimize the platform to ensure its successful real-world implementation.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Walter Reed National Military Medical Center, Sleep Disorders Center, Silver Spring, MD 20814, USA
| | - Hillary Edwards
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Christian Labra
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Vincent F Capaldi
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Scott G Williams
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Samson Z Assefa
- Sleep Medicine Clinic, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | | | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Jeffrey Bevan
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Alexandra Mahoney
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Eileen D Tatum
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Elysse Pierre
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Janna Mantua
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
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