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Rogers A, Chung A, Seixas A, Chung D, Zizi F, Jean-Louis G. Strategies to Engage Blacks in Sleep Medicine: Lessons Learned from Three Studies Applying Community-Based Participatory Research Principles. J Sleep Disord Ther 2023; 12:425. [PMID: 37425370 PMCID: PMC10327646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Awareness, assessment and treatment of sleep apnea are disproportionately lower among Blacks, compared to other racial/ethnic groups. To address this health disparity gap, communication strategies that connect Blacks to OSA education, detection and treatment adherence interventions are needed. Strategies that engage individuals through communication technologies, community-level social network support, and medical providers in clinical settings are also needed. We present lessons learned from three studies that offer these solutions using a community-engaged research model: The Metabolic Syndrome Outcome Study (MetSO), Peer-enhanced Education to Reduce Sleep Ethnic Disparities (PEERS-ED), and Tailored Approach to Sleep Health Education (TASHE), to capture program effectiveness and lessons learned from project successes and failures. Methods The methods of OSA community-based programs included the application of an OSA community-engaged research model. This model served as a strategic guideline for effective interventions to engage communities in research and ensure cultural appropriateness in OSA interventions. Focus groups, in-depth interviews and community steering committee meetings were conducted with various stakeholders. Delphi surveys were used to identify high priority diseases and conditions. Community barriers and needs were identified through iterative combinations of surveys and focus group meetings. Stakeholder groups participated in all aspects of our studies, including the development, dissemination and implementation phases, reflecting a bi-directional decision-making process that ensures the interests of both parties were considered. The MetSO, PEERS-ED and TASHE studies were reviewed to understand the effectiveness of the programs and to evaluate lessons learned. Results MetSO, PEERS-ED and TASHE interventions revealed that community-engaged strategies are successful in enrolling Black populations into clinical trials. The study teams reached nearly 3,000 Blacks at risk of OSA and screened about 2,000 people in sleep apnea studies in New York City. Sleep brochures were distributed to over 10,000 people. Lessons learned from MetSO, PEERS-ED and TASHE interventions revealed that building relationships, establishing trust, identifying a study champion, learning to adjust and providing participant incentives are key strategic elements for successful recruitment and retention of Blacks participations in clinical trials. Conclusion Strategic application of community-oriented frameworks ensures active community engagement throughout the research process, allowing for greater enrollment of Blacks in clinical studies as well as increased OSA awareness, diagnosis, and treatment.
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Affiliation(s)
- April Rogers
- Department of Health and Human Services, St. John’s University Collins College of Professional Studies, Queens, New York, 11432,USA
| | - Alicia Chung
- Department of Population Health, Center for Early Childhood Health and Development, Division of Health and Behavior, New York University Medical Center, New York, NY 10016, USA
| | - Azizi Seixas
- Department of Informatics and Health Data Science. Center for Translational Sleep and Circadian Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136,USA
- Department of Psychiatry and Behavioral Sciences, Translational Sleep and Circadian Sciences (TSCS), Miami, FL 33136, USA
| | - Debbie Chung
- Department of Psychiatry and Behavioral Sciences, Translational Sleep and Circadian Sciences (TSCS), Miami, FL 33136, USA
| | - Ferdinand Zizi
- Department of Psychiatry and Behavioral Sciences, Translational Sleep and Circadian Sciences (TSCS), Miami, FL 33136, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Translational Sleep and Circadian Sciences (TSCS), Miami, FL 33136, USA
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Pandi-Perumal SR, Vaccarino SR, Chattu VK, Zaki NF, BaHammam AS, Manzar D, Maestroni GJM, Suchecki D, Moscovitch A, Zizi F, Jean-Louis G, Narasimhan M, Ramasubramanian C, Trakht I, Seeman MV, Shneerson JM, Maes M, Reiter RJ, Kennedy SH. 'Distant socializing,' not 'social distancing' as a public health strategy for COVID-19. Pathog Glob Health 2021; 115:357-364. [PMID: 34057046 PMCID: PMC8592617 DOI: 10.1080/20477724.2021.1930713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Social distancing, also referred to as physical distancing, means creating a safe distance of at least two meters (six feet) between yourself and others. This is a term popularized during the COVID-19 pandemic, as it is one of the most important measures to prevent the spread of this virus. However, the term 'social distancing' can be misleading, as it may imply that individuals should stop socializing. However, socializing in a safe context (i.e. over the phone, video-chat, etc.) is especially important during this time of crisis. Therefore, in this narrative review, we suggest the term 'distant socializing' as more apt expression, to promote physical distancing measures while also highlighting the importance of maintaining social bonds. Further, articles discussing the practice, implementation, measurement, and mental health effects of physical distancing are reviewed. Physical distancing is associated with psychiatric symptoms (such as anxiety and depression), suicidal ideation, and domestic violence. Further, unemployment and job insecurity have significantly increased during COVID-19, which may exacerbate these negative mental health effects. Governments, medical institutions, and public health bodies should therefore consider increasing mental health resources both during and after the pandemic, with a specific focus on frontline workers, COVID-19 survivors, and marginalized communities.
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Affiliation(s)
| | - Sophie R. Vaccarino
- Centre for Depression and Suicide Studies, St. Michael’s Hospital, Toronto, Canada
| | | | - Nevin F.W. Zaki
- Department of Psychiatry, Mansoura University, Mansoura, Egypt
| | - Ahmed S. BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Saudi Arabia
| | - Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - G J M Maestroni
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Deborah Suchecki
- Departamento De Psicobiologia, Escola Paulista De Medicina, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Adam Moscovitch
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Meera Narasimhan
- Department of Psychiatry and Behavioral Science, Columbia, University of South Carolina, South Carolina, USA
- Department of Neuropsychiatry and Behavioral Science, Columbia, University of South Carolina, South Carolina, USA
| | | | - Ilya Trakht
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - John M Shneerson
- Respiratory Support & Sleep Center, Royal Papworth Hospital, Cambridge, England, UK
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Russel J Reiter
- Department of Cellular & Structural Biology, UT Health San Antonio, TX, USA
| | - Sidney H. Kennedy
- Centre for Depression and Suicide Studies, St. Michael’s Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Canada
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Aird C, Seixas A, Moore J, Nunes J, Gyamfi L, Garcia J, Blanc J, Williams N, Zizi F, Jean-Louis G. 1189 Recruiting, Training, And Implementing Sleep Health Educators In Community-based Research To Improve Sleep Health. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
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
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Affiliation(s)
- C Aird
- NYU Grossman School of Medicine, New York, NY
| | - A Seixas
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - J Nunes
- City College/ CUNY, New York, NY
| | - L Gyamfi
- NYU Grossman School of Medicine, New York, NY
| | - J Garcia
- NYU Grossman School of Medicine, New York, NY
| | - J Blanc
- NYU Grossman School of Medicine, New York, NY
| | - N Williams
- NYU Grossman School of Medicine, New York, NY
| | - F Zizi
- NYU Grossman School of Medicine, New York, NY
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Rogers A, Seixas A, Moore J, Zizi F, Williams S, Gyamfi L, Pichardo Y, Jean-Louis G. 0621 Utilization of the Ares to Predict OSA Among Blacks Using Home-Based Watchpat Recording. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In two waves of data we collected in Brooklyn New York, we observed blacks were at high risk for obstructive sleep apnea (OSA). In the NIH-funded study ‘Metabolic Syndrome Outcome Study (MetSO), blacks enrolled from primary-care settings had a 59% risk of OSA. Similarly, blacks surveyed in churches and barbershops had a 43% risk of OSA. While these studies showed higher than expected risk as noted in the general population (29%), it remains uncertain how many of those blacks would be diagnosed with OSA in that population. The purpose of this study was to explore the rate of OSA using the WatchPat device in a community-based setting.
Methods
Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks were screened for OSA using the Apnea Risk Evaluation System (ARES) Questionnaire; a score ≥6 denoted moderate-high OSA risk. Individuals were asked to wear the WatchPAT 200 for one night during a week-long sleep assessment. WatchPat 200 measures SaO2 to determine respiratory-related arousals, defined as an Apnea-Hypopnea Index (AHI) ≥5, which is used to identify and diagnose OSA. We used SPSS 25.0 to perform logical regression analysis to assess associations between ARES and WatchPat AHI.
Results
A sample of 111 blacks provided valid ARES and WatchPat data for the present analyses. Of the sample, the mean age was 62.26 (SD=13.52 years; female = 55%); 49% reported annual income >20K and 79.5% reported a high school education. Moreover, 27% reported high blood pressure, 13%, diabetes, and 65% were overweight/obese. Multivariate-adjusted logical regression analyses indicated that blacks at risk for OSA were 66% more likely to receive an OSA diagnosis based on WatchPat AHI data (OR = 1.662, p < 0.01). The model adjusted for age, sex, income, and education.
Conclusion
The present study demonstrated that blacks at risk for OSA at the community level have a significant likelihood of receiving an OSA diagnosis using home-based recordings.
Support
NIH Support (T32HL129953, RO1MD007716, K01HL135452 and K07AG052685).
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Affiliation(s)
- A Rogers
- St. John’s University, Queens, NY
| | - A Seixas
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - F Zizi
- NYU Grossman School of Medicine, New York, NY
| | - S Williams
- NYU Grossman School of Medicine, New York, NY
| | - L Gyamfi
- NYU Grossman School of Medicine, New York, NY
| | - Y Pichardo
- NYU Grossman School of Medicine, New York, NY
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Jehan S, Zizi F, Pandi-Perumal SR, McFarlane SI, Jean-Louis G, Myers AK. Obstructive sleep apnea, hypertension, resistant hypertension and cardiovascular disease. Sleep Med Disord 2020; 4:67-76. [PMID: 33501418 PMCID: PMC7830712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common causes of hypertension (HTN) and cardiovascular disease (CVD). It is also a quite common underlying factor in resistant HTN (RHTN). The main etiological factor of OSA is obesity, which is a rapidly growing global epidemic. To control obesity, patients should be encouraged by health care professionals to lose weight and be educated about weight loss strategies such as lifestyle modifications, which include regular exercise, low-calorie diet, low sodium intake, smoking cessation, and decreased alcohol consumption. This review also emphasizes the importance of screening for OSA as the major underlying cause of essential, and RHTN, which can lead to CVD and can cause end-organ damage. It also stresses the importance of using continuous positive airway pressure (CPAP) and its beneficial effects, along with other antihypertensive regimens, in treating HTN, and RHTN. Treatment with CPAP therapy decreases sympathetic activity, high blood pressure (BP), heart rate, and CVD as well as its associated mortality.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | | | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | - Alyson K Myers
- Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, USA
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Jehan S, Zizi F, Pandi-Perumal SR, McFarlane SI, Jean-Louis G, Myers AK. Energy imbalance: obesity, associated comorbidities, prevention, management and public health implications. Adv Obes Weight Manag Control 2020; 10:146-161. [PMID: 33305001 PMCID: PMC7725222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prevalence of obesity has been continually increasing, as have its associated comorbidities and health care costs. Effective management of obesity and early intervention measures are necessary to overcome this global issue. The responsibility for preventing and managing this global epidemic does not lie solely on an individual, but also on the entire health care system. Policy makers-nationally and globally-must play their roles to solve the issue. In this review article, we examine methods of controlling and managing obesity through interventions, such as a low caloric diet, physical exercise, pharmacological guidance, and bariatric surgical procedures. While health care professionals should educate patients about all available treatment options for severe obesity, bariatric surgical procedures have increased in popularity and are considered very beneficial with outcomes fruitful in managing severe obesity.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, Center for Healthful Behavior Change, USA
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavior Change, USA
| | | | | | | | - Alyson K Myers
- Department of Internal Medicine, Division of Endocrinology, USA
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7
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Bubu OM, Pirraglia E, Andrade AG, Sharma RA, Gimenez-Badia S, Umasabor-Bubu OQ, Hogan MM, Shim AM, Mukhtar F, Sharma N, Mbah AK, Seixas AA, Kam K, Zizi F, Borenstein AR, Mortimer JA, Kip KE, Morgan D, Rosenzweig I, Ayappa I, Rapoport DM, Jean-Louis G, Varga AW, Osorio RS. Obstructive sleep apnea and longitudinal Alzheimer's disease biomarker changes. Sleep 2019; 42:zsz048. [PMID: 30794315 PMCID: PMC6765111 DOI: 10.1093/sleep/zsz048] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/11/2019] [Accepted: 02/19/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To determine the effect of self-reported clinical diagnosis of obstructive sleep apnea (OSA) on longitudinal changes in brain amyloid PET and CSF biomarkers (Aβ42, T-tau, and P-tau) in cognitively normal (NL), mild cognitive impairment (MCI), and Alzheimer's disease (AD) elderly. METHODS Longitudinal study with mean follow-up time of 2.52 ± 0.51 years. Data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Participants included 516 NL, 798 MCI, and 325 AD elderly. Main outcomes were annual rate of change in brain amyloid burden (i.e. longitudinal increases in florbetapir PET uptake or decreases in CSF Aβ42 levels); and tau protein aggregation (i.e. longitudinal increases in CSF total tau [T-tau] and phosphorylated tau [P-tau]). Adjusted multilevel mixed effects linear regression models with randomly varying intercepts and slopes was used to test whether the rate of biomarker change differed between participants with and without OSA. RESULTS In NL and MCI groups, OSA+ subjects experienced faster annual increase in florbetapir uptake (B = .06, 95% CI = .02, .11 and B = .08, 95% CI = .05, .12, respectively) and decrease in CSF Aβ42 levels (B = -2.71, 95% CI = -3.11, -2.35 and B = -2.62, 95% CI = -3.23, -2.03, respectively); as well as increases in CSF T-tau (B = 3.68, 95% CI = 3.31, 4.07 and B = 2.21, 95% CI = 1.58, 2.86, respectively) and P-tau (B = 1.221, 95% CI = 1.02, 1.42 and B = 1.74, 95% CI = 1.22, 2.27, respectively); compared with OSA- participants. No significant variations in the biomarker changes over time were seen in the AD group. CONCLUSIONS In both NL and MCI, elderly, clinical interventions aimed to treat OSA are needed to test if OSA treatment may affect the progression of cognitive impairment due to AD.
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Affiliation(s)
- Omonigho M Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Elizabeth Pirraglia
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Ram A Sharma
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Sandra Gimenez-Badia
- Multidisciplinary Sleep Unit - Respiratory Department, Hospital de la Santa Creu i Sant Pau. IIB Sant Pau Department of Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
| | - Amanda M Shim
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
| | - Fahad Mukhtar
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Nidhi Sharma
- Dipartmento Di Scienze Biochimica A. Rossi Fanelli, University of Rome, Rome, Italy
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Azizi A Seixas
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Amy R Borenstein
- Department of Family Medicine and Public Health, University of California—San Diego, San Diego, CA
| | - James A Mortimer
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Kevin E Kip
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - David Morgan
- Department of Molecular Science and Translational Medicine, Michigan State University, Grand Rapids, MI
- Byrd Alzheimer’s Disease Institute, College of Medicine, Psychiatry and Behavioral Neurosciences, University of South Florida Health, Tampa, FL
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy’s Hospital, Great Maze Pond, London, UK
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King’s College London, London, UK
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
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Robbins R, DiClemente RJ, Troxel A, Rapoport D, Zizi F, Trinh-Shevrin CT, Osorio R, Jean-Louis G. 0706 Examining Sleeping Medication And Insomnia Symptoms By Cognitive Impairment Among Older Americans In The U.S. Using The National Health And Aging Trends Study. Sleep 2019. [DOI: 10.1093/sleep/zsz067.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Andrea Troxel
- New York University School of Medicine, New York, NY, USA
| | | | - Ferdinand Zizi
- New York University School of Medicine, New York, NY, USA
| | | | - Ricardo Osorio
- New York University School of Medicine, New York, NY, USA
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9
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Jehan S, Farag M, Zizi F, Pandi-Perumal SR, Chung A, Truong A, Jean-Louis G, Tello D, McFarlane SI. Obstructive sleep apnea and stroke. Sleep Med Disord 2018; 2:120-125. [PMID: 30680373 PMCID: PMC6340906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a common co-morbid condition in stroke patients. It represents a very important risk factor for stroke in addition to the other established ones such as hypertension, cardiovascular disease (CVD), hyperlipidemia, atrial fibrillation (AF), type 2 diabetes mellitus (T2DM), stress, smoking, and heavy drinking. Although in the United States the prevalence of OSA has somewhat decreased from the previous years, globally its prevalence remains constant, or in some cases, is on the rise. In this review we present the epidemiology for OSA in stroke populations and discuss the risk factors for stroke as well as the underlying pathogenetic mechanisms linking OSA, stroke and CVD. We also emphasize the more thorough evaluation and control of OSA in order to prevent the disabling side effects of a stroke, which not only compromises the physical and mental health of a person and increases the burden on families, but also adds a severe burden to national health economics. OSA should always be considered when assessing a patient with transient ischemic attacks (TIA). Work up and treatment for OSA will not only help prevent stroke with its devastating consequences, but will also help prevent CVD, and ameliorate co-morbid conditions such as diabetes and hypertension in these vulnerable populations.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, New York University School of Medicine, USA
| | - Mahmoud Farag
- Department of Surgery, SUNY Downstate Medical Center, USA
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, USA
| | | | - Alicia Chung
- Department of Population Health, New York University School of Medicine, USA
| | - Anrew Truong
- Department of Medicine, SUNY Downstate Medical Center, USA
| | | | - Daniela Tello
- Department of Medicine, SUNY Downstate Medical Center, USA
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10
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Seixas AA, Gyamfi L, Newsome V, Ranger-Murdock G, Butler M, Rosenthal DM, Zizi F, Youssef I, McFarlane SI, Jean-Louis G. Moderating effects of sleep duration on diabetes risk among cancer survivors: analysis of the National Health Interview Survey in the USA. Cancer Manag Res 2018; 10:4575-4580. [PMID: 30349388 PMCID: PMC6190818 DOI: 10.2147/cmar.s177428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Growing evidence suggests that cancer and diabetes may share common risk factors such as age, race/ethnicity, obesity, insulin resistance, sedentary lifestyle, smoking, and alcohol consumption. However, little is known about how habitual sleep duration (a known cardiometabolic risk factor) may affect the relationship between cancer and diabetes. The aim of this study was to investigate whether sleep duration moderated the relationship between history of cancer and diabetes. Methods Data were extracted from the National Health Interview Survey dataset from 2004 to 2013 containing demographics, chronic diseases, and sleep duration (N=236,406). Data were analyzed to assess the moderating effect of short and long sleep durations on cancer and diabetes mellitus. Results Our findings indicate that short sleep (odds ratio [OR] =1.07, 95% CI =1.03–1.11, P<0.001) and long sleep (OR =1.32, 95% CI =1.26–1.39, P<0.001) were associated with diabetes mellitus in fully adjusted models. However, only long sleep duration significantly moderated the relationship between cancer and diabetes (OR =0.88, 95% CI =0.78–0.98, P<0.05). Conclusion Our findings indicate that for cancer survivors, short sleep was associated with higher self-reported diabetes and long sleep duration may act as a buffer against diabetes mellitus, as the likelihood of self-reported diabetes was lower among cancer survivors who reported long sleep duration. Impact Findings from the current study have clinical and public health implications. Clinically, comprehensive sleep assessments and sleep interventions to improve sleep are needed for cancer survivors who have comorbid diabetes. Our findings can also spur public health reform to make sleep an important component of standard cancer survivorship care, as it reduces other chronic disease like diabetes.
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Affiliation(s)
- Azizi A Seixas
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, .,Department of Psychiatry, NYU Langone Health, New York, NY, USA,
| | - Lloyd Gyamfi
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health,
| | - Valerie Newsome
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health,
| | | | - Mark Butler
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health,
| | - Diana Margot Rosenthal
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health,
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health,
| | - Irini Youssef
- Division of Endocrinology, Department of Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, .,Department of Psychiatry, NYU Langone Health, New York, NY, USA,
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Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials 2018; 19:519. [PMID: 30249293 PMCID: PMC6154893 DOI: 10.1186/s13063-018-2835-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, New York School of Medicine, New York, NY USA
- Department of Psychiatry, NYU Langone Health, New York, NY 10016 USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Joseph Ravenell
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Ferdinand Zizi
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Girardin Jean-Louis
- Department of Population Health, New York School of Medicine, New York, NY USA
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12
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Seixas AA, Vallon J, Barnes-Grant A, Butler M, Langford AT, Grandner MA, Schneeberger AR, Huthchinson J, Zizi F, Jean-Louis G. Mediating effects of body mass index, physical activity, and emotional distress on the relationship between short sleep and cardiovascular disease. Medicine (Baltimore) 2018; 97:e11939. [PMID: 30212927 PMCID: PMC6156068 DOI: 10.1097/md.0000000000011939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022] Open
Abstract
The current study investigated the mediating effects of body mass index (BMI), physical activity, and emotional distress on the association between short sleep duration (<7 hours per 24-hour period) and cardiovascular disease (CVD) and risk factors.We used data from the National Health Interview Survey, an ongoing nationally representative cross-sectional study of noninstitutionalized US adults (≥18 years) from 2004 to 2013 (N = 206,049). Participants provided information about anthropometric features (height and weight), sociodemographic factors, health behaviors (smoking and physical activity), emotional distress, and physician-diagnosed health conditions, including hypertension, coronary heart disease, diabetes, heart attack, stroke, kidney disease, and cancer. Structural equation modeling was used to assess the mediating effects of physical activity, BMI, and emotional distress on the relationship between short sleep and CVDs and risk factors (coronary heart disease, hypertension, diabetes, chronic kidney disease, heart attack, and stroke).Of the sample, 54.7% were female, 60.1% identified as white, 17.7% as Hispanic, and 15.4% as black. The mean age of the respondents was 46.75 years (SE = 0.12), with a mean BMI of 27.11 kg/m (SE = 0.02) and approximately 32.5% reported short sleep duration. The main relationship between short sleep and CVD and risk factors was significant (β = 0.08, P < .001), as was the mediated effect via BMI (indirect effect = 0.047, P < .001), emotional distress (indirect effect = 0.022, P < .001), and physical activity (indirect effect = -0.022, P = .035), as well as after adjustment for covariates, including age, race, sex, marital status, and income: short sleep and CVD (B = 0.15; SE = 0.01; P < .001), BMI (B = 0.05; SE = 0.00; P < .001), emotional distress (B = 0.02; SE = 0.00; P < .001), and physical activity (B = 0.01; SE = 0.00; P < .001).Our findings indicate that short sleep is a risk factor for CVD and that the relationship between short sleep and CVD and risk factors may be mediated by emotional distress and obesity, and negatively mediated by physical activity.
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Affiliation(s)
- Azizi A. Seixas
- NYU Langone Health, Department of Population Health, New York
- NYU Langone Health, Department of Psychiatry, New York, NY
| | - Julian Vallon
- NYU Langone Health, Department of Population Health, New York
| | - Andrea Barnes-Grant
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY
| | - Mark Butler
- NYU Langone Health, Department of Population Health, New York
| | | | - Michael A. Grandner
- Departments of Psychiatry, Psychology, and Medicine, Sleep & Health Research Program, University of Arizona College of Medicine, Tucson, AZ
| | - Andres R. Schneeberger
- Universitaere Psychiatrische Kliniken, Universitaet Basel, Basel
- Psychiatrische Dienste Graubuenden, St. Moritz, Switzerland
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx
| | | | - Ferdinand Zizi
- NYU Langone Health, Department of Population Health, New York
| | - Girardin Jean-Louis
- NYU Langone Health, Department of Population Health, New York
- NYU Langone Health, Department of Psychiatry, New York, NY
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13
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Seixas AA, Henclewood DA, Williams SK, Jagannathan R, Ramos A, Zizi F, Jean-Louis G. Sleep Duration and Physical Activity Profiles Associated With Self-Reported Stroke in the United States: Application of Bayesian Belief Network Modeling Techniques. Front Neurol 2018; 9:534. [PMID: 30072944 PMCID: PMC6060565 DOI: 10.3389/fneur.2018.00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 06/18/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction: Physical activity (PA) and sleep are associated with cerebrovascular disease and events like stroke. Though the interrelationships between PA, sleep, and other stroke risk factors have been studied, we are unclear about the associations of different types, frequency and duration of PA, sleep behavioral patterns (short, average and long sleep durations), within the context of stroke-related clinical, behavioral, and socio-demographic risk factors. The current study utilized Bayesian Belief Network analysis (BBN), a type of machine learning analysis, to develop profiles of physical activity (duration, intensity, and frequency) and sleep duration associated with or no history of stroke, given the influence of multiple stroke predictors and correlates. Such a model allowed us to develop a predictive classification model of stroke which can be used in post-stroke risk stratification and developing targeted stroke rehabilitation care based on an individual's profile. Method: Analysis was based on the 2004-2013 National Health Interview Survey (n = 288,888). Bayesian BBN was used to model the omnidirectional relationships of sleep duration and physical activity to history of stroke. Demographic, behavioral, health/medical, and psychosocial factors were considered as well as sleep duration [defined as short < 7 h. and long ≥ 9 h, referenced to healthy sleep (7-8 h)], and intensity (moderate and vigorous) and frequency (times/week) of physical activity. Results: Of the sample, 48.1% were ≤ 45 years; 55.7% female; 77.4% were White; 15.9%, Black/African American; and 45.3% reported an annual income < $35 K. Overall, the model had a precision index of 95.84%. We found that adults who reported 31-60 min of vigorous physical activity six times for the week and average sleep duration (7-8 h) had the lowest stroke prevalence. Of the 36 sleep (short, average, and long sleep) and physical activity profiles we tested, 30 profiles had a self-reported stroke prevalence lower than the US national average of approximately 3.07%. Women, compared to men with the same sleep and physical activity profile, appeared to have higher self-reported stroke prevalence. We also report age differences across three groups 18-45, 46-65, and 66+. Conclusion: Our findings indicate that several profiles of sleep duration and physical activity are associated with low prevalence of self-reported stroke and that there may be sex differences. Overall, our findings indicate that more than 10 min of moderate or vigorous physical activity, about 5-6 times per week and 7-8 h of sleep is associated with lower self-reported stroke prevalence. Results from the current study could lead to more tailored and personalized behavioral secondary stroke prevention strategies.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, NY, United States
| | | | - Stephen K. Williams
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, NY, United States
| | - Ram Jagannathan
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Alberto Ramos
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ferdinand Zizi
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, NY, United States
| | - Girardin Jean-Louis
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, NY, United States
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14
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Seixas A, Henclewood D, Langford A, McFarlane S, Zizi F, Jean-Louis G. 0873 Protective Sleep and Physical Activity Profiles in Diabetes Risk among Blacks and Whites in the United States: A Bayesian Belief Network Machine Learning Model of National Health Interview Survey. Sleep 2018. [DOI: 10.1093/sleep/zsy061.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Seixas
- New York University School of Medicine, New York, NY
| | | | - A Langford
- New York University School of Medicine, New York, NY
| | | | - F Zizi
- New York University School of Medicine, New York, NY
| | - G Jean-Louis
- New York University School of Medicine, New York, NY
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Nwade C, Robbins R, Seixas A, Francis K, Chery K, Champagne K, Roseus J, Madhavaram S, Rogers A, Miller M, Zizi F, Jean-Louis G, Osorio R. 1012 Examining Daytime Sleepiness, Sleep Apnea, and Cognitive Decline in a 2-year Longitudinal Sample of Cognitively Normal Elderly. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Nwade
- Center for Brain health, NYU School of Medicine, New York, NY
| | - R Robbins
- New York University School of Medicine, New York, NY
| | - A Seixas
- New York University School of Medicine, New York, NY
| | - K Francis
- Center for Brain health, NYU School of Medicine, New York, NY
| | - K Chery
- New York University School of Medicine, New York, NY
| | - K Champagne
- New York University School of Medicine, New York, NY
| | - J Roseus
- New York University School of Medicine, New York, NY
| | - S Madhavaram
- New York University School of Medicine, New York, NY
| | - A Rogers
- New York University School of Medicine, New York, NY
| | - M Miller
- New York University School of Medicine, New York, NY
| | - F Zizi
- New York University School of Medicine, New York, NY
| | - G Jean-Louis
- New York University School of Medicine, New York, NY
| | - R Osorio
- Center for Brain health, NYU School of Medicine, New York, NY
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Jehan S, Myers AK, Zizi F, Pandi-Perumal SR, Jean-Louis G, Singh N, Ray J, McFarlane SI. Sleep health disparity: the putative role of race, ethnicity and socioeconomic status. Sleep Med Disord 2018; 2:127-133. [PMID: 31179440 PMCID: PMC6553614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep plays a pivotal role in both physical and mental health. Sleep quality can be affected by many socio demographic factors, such as race and/or ethnicity, as well as socio economic status (SES). Chronic sleep deprivation is associated with unhealthy behaviors such as alcohol abuse and also places individuals at risk for chronic diseases including obesity, cardiovasculardisease (CVD), depression, and/or anxiety. This review explores the common socio demographic factors and SES that can lead to sleep disturbances. Among these factors are shift work, poor dietary habits, smoking and alcohol abuse. Such factors need to be considered by health care providers in the clinical assessment and management plans of patients with sleep disorders.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, New York University School of Medicine, USA
| | - Alyson K Myers
- Department of Medicine, North Shore University Hospital, USA
| | - Ferdinand Zizi
- Department of Medicine, North Shore University Hospital, USA
| | | | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, USA
| | - Navneet Singh
- Department of Medicine, SUNY Downstate Medical Center, USA
| | - Justina Ray
- Department of Medicine, SUNY Downstate Medical Center, USA
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17
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Seixas AA, Henclewood DA, Langford AT, McFarlane SI, Zizi F, Jean-Louis G. Differential and Combined Effects of Physical Activity Profiles and Prohealth Behaviors on Diabetes Prevalence among Blacks and Whites in the US Population: A Novel Bayesian Belief Network Machine Learning Analysis. J Diabetes Res 2017; 2017:5906034. [PMID: 28929121 PMCID: PMC5591986 DOI: 10.1155/2017/5906034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
The current study assessed the prevalence of diabetes across four different physical activity lifestyles and infer through machine learning which combinations of physical activity, sleep, stress, and body mass index yield the lowest prevalence of diabetes in Blacks and Whites. Data were extracted from the National Health Interview Survey (NHIS) dataset from 2004-2013 containing demographics, chronic diseases, and sleep duration (N = 288,888). Of the total sample, 9.34% reported diabetes (where the prevalence of diabetes was 12.92% in Blacks/African Americans and 8.68% in Whites). Over half of the sample reported sedentary lifestyles (Blacks were more sedentary than Whites), approximately 20% reported moderately active lifestyles (Whites more than Blacks), approximately 15% reported active lifestyles (Whites more than Blacks), and approximately 6% reported very active lifestyles (Whites more than Blacks). Across four different physical activity lifestyles, Blacks consistently had a higher diabetes prevalence compared to their White counterparts. Physical activity combined with healthy sleep, low stress, and average body weight reduced the prevalence of diabetes, especially in Blacks. Our study highlights the need to provide alternative and personalized behavioral/lifestyle recommendations to generic national physical activity recommendations, specifically among Blacks, to reduce diabetes and narrow diabetes disparities between Blacks and Whites.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, USA
| | | | - Aisha T. Langford
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, USA
| | - Samy I. McFarlane
- Division of Endocrinology, Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, USA
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18
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Newsome V, Seixas A, Iwelunmor J, Zizi F, Kothare S, Jean-Louis G. Place of Birth and Sleep Duration: Analysis of the National Health Interview Survey (NHIS). Int J Environ Res Public Health 2017; 14:E738. [PMID: 28686184 PMCID: PMC5551176 DOI: 10.3390/ijerph14070738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022]
Abstract
While sleep disturbance has been related to a number of negative health outcomes, few studies have examined the relationship between place of birth and sleep duration among individuals living in the US. Data for 416,152 adult participants in the 2000-2013 National Health Interview Survey (NHIS), who provided self-reported hours of sleep and place of birth were examined. Associations were explored between healthy sleep (7-8 h), referenced to unhealthy sleep (<7 or >8 h), and place of birth using multivariate logistic regression analysis. The mean age of the sample was 47.4 ± 0.03 years; 56% were female. Of the respondents, 61.5% reported experiencing healthy sleep, 81.5% reported being born in the US and 18.5% were foreign-born adults. Descriptive statistics revealed that Indian Subcontinent-born respondents (71.7%) were more likely to report healthy sleep compared to US-born respondents (OR = 1.53, 95% CI = 1.37-1.71, p < 0.001), whereas African-born respondents (43.5%) were least likely to report healthy sleep (OR = 0.78, 95% CI = 0.70-0.87, p < 0.001). These findings suggest that place of birth should be considered in the assessment of risk factors for unhealthy sleep.
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Affiliation(s)
- Valerie Newsome
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
| | - Azizi Seixas
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Champaign, IL 61801, USA.
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
| | - Sanjeev Kothare
- Department of Neurology, School of Medicine, New York University, New York, NY 10016, USA.
| | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
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Rogers A, Ravenell J, Seixas A, Newsome V, Ogedegbe C, Williams N, Zizi F, Casimir G, Jean-Louis G. 1065 EFFECT OF BIRTHPLACE ON CARDIOMETABOLIC PROFILE AMONG BLACKS WITH METABOLIC SYNDROME AND SLEEP APNEA RISK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Richards S, Seixas A, Chung D, Nunes J, Grandner M, Zizi F, Tan N, Jean-Louis G. 1150 SLEEP IMPACTS QUALITY OF LIFE AND NEUROCOGNITIVE CHARACTERISTICS OF BLACK AND HISPANIC STROKE SURVIVORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Seixas A, Li Y, Pagan J, Mcfarlane S, Grandner M, Youngstedt S, Zizi F, Jean-Louis G. 1064 THE ROLE OF SLEEP AND PHYSICAL ACTIVITY IN REDUCING THE PREVALENCE OF DIABETES IN THE UNITED STATES: AN AGENT-BASED SIMULATION MODEL APPROACH. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zizi S, Seixas A, Collado A, Boby A, Camille P, Payano L, Abid A, Gyamfi L, Zizi F, Jean-Louis G. 1020 ASTHMA AND SLEEP AMONG HISPANICS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chung D, Seixas A, Richards SL, Casimir G, Auguste E, Vallon J, Hutchinson J, Zizi F, Jean-Louis G. 1055 THE IMPACT OF SHORT SLEEP DURATION ON INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) AMONG STROKE SURVIVORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seixas A, Kanchi R, Langford A, Rogers A, Williams S, Zizi F, Jean-Louis G. 0756 SHORT SLEEP DURATION DRIVES ACCELERATED AGING IN THE UNITED STATES ESPECIALLY AMONG RACIAL/ETHNIC MINORITIES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rosenthal DM, Conserve DF, Severe D, Gedeon MA, Zizi F, Casimir G, McFarlane SI, Jean-Louis G. Sleep Apnea Symptoms and Cardiovascular Disease Risks among Haitian Medical Students. ACTA ACUST UNITED AC 2017; 6. [PMID: 29142787 PMCID: PMC5683726 DOI: 10.4172/2167-0277.1000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sleep apnea is a prevalent sleep disorder that disproportionately affects blacks and has been previously studied among Caribbean-born blacks in Brooklyn, New York, but there has been negligible research in the Caribbean, specifically Haiti, and developing countries on this pressing health issue. A total of 373 medical students (mean age=20.6 years ± 2.3 years) from a medical school in Haiti participated in this study. Participants were administered a questionnaire assessing their sleep health and cardiovascular outcomes. The rate of sleep apnea symptoms was: snoring (13.2%), excessive daytime sleepiness (73.7%), and difficulty maintaining sleep (25.3%). Many reported falling asleep while watching television (68.2%) or while driving (7.8%). Based on logistic regression analysis, reported nocturnal breathing pauses was the most important predictor of the likelihood of reporting a history of cardiac disease (14.96; 95% CI=1.27–76.07). Findings suggest that more aggressive effort should be made to increase screening of sleep apnea among Haitians, thereby increasing the likelihood for early detection and treatment to reduce sleep-related risk of cardiovascular disease.
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Affiliation(s)
- Diana M Rosenthal
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, NY, USA
| | - Donaldson F Conserve
- Department of Health Promotion, Arnold School of Public Health, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | | | | | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, NY, USA
| | - Georges Casimir
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Samy I McFarlane
- Department of Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, NY, USA
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Iwelunmor J, Gyamfi J, Plange-Rhule J, Blackstone S, Quakyi NK, Ntim M, Zizi F, Yeboah-Awudzi K, Nang-Belfubah A, Ogedegbe G. Exploring stakeholders' perceptions of a task-shifting strategy for hypertension control in Ghana: a qualitative study. BMC Public Health 2017; 17:216. [PMID: 28222754 PMCID: PMC5320716 DOI: 10.1186/s12889-017-4127-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/13/2017] [Indexed: 01/25/2023] Open
Abstract
Background The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. Methods Using focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques. Results Analysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program. Conclusion The findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, College of Applied Health Sciences, Champaign, USA.
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York, USA
| | | | - Sarah Blackstone
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, College of Applied Health Sciences, Champaign, USA
| | - Nana Kofi Quakyi
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Michael Ntim
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, New York, USA
| | | | | | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, USA
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Jean-Louis G, Newsome V, Williams NJ, Zizi F, Ravenell J, Ogedegbe G. Tailored Behavioral Intervention Among Blacks With Metabolic Syndrome and Sleep Apnea: Results of the MetSO Trial. Sleep 2017; 40:2972131. [PMID: 28364475 PMCID: PMC6084749 DOI: 10.1093/sleep/zsw008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Abstract
Study Objectives To assess effectiveness of a culturally and linguistically tailored telephone-delivered intervention to increase adherence to physician-recommended evaluation and treatment of obstructive sleep apnea (OSA) among blacks. Methods In a two-arm randomized controlled trial, we evaluated effectiveness of the tailored intervention among blacks with metabolic syndrome, relative to those in an attention control arm (n = 380; mean age = 58 ± 13; female = 71%). The intervention was designed to enhance adherence using culturally and linguistically tailored OSA health messages delivered by a trained health educator based on patients' readiness to change and unique barriers preventing desired behavior changes. Results Analysis showed 69.4% of the patients in the intervention arm attended initial consultation with a sleep specialist, compared to 36.7% in the control arm; 74.7% of those in the intervention arm and 66.7% in the control arm completed diagnostic evaluation; and 86.4% in the intervention arm and 88.9% in the control arm adhered to PAP treatment based on subjective report. Logistic regression analyses adjusting for sociodemographic factors indicated patients in the intervention arm were 3.17 times more likely to attend initial consultation, compared to those in the control arm. Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation or treatment. Conclusion The intervention was successful in promoting importance of sleep consultation and evaluation of OSA among blacks, while there was no significant group difference in laboratory-based evaluation and treatment adherence rates. It seems that the fundamental barrier to OSA care in that population may be the importance of seeking OSA care.
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Affiliation(s)
- Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Valerie Newsome
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Joseph Ravenell
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
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Jehan S, Jean-Louis G, Zizi F, Auguste E, Pandi-Perumal SR, Gupta R, Attarian H, McFarlane SI, Hardeland R, Brzezinski A. Sleep, melatonin, and the menopausal transition: What are the links? Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jehan S, Jean-Louis G, Zizi F, Auguste E, Pandi-Perumal SR, Gupta R, Attarian H, McFarlane SI, Hardeland R, Brzezinski A. Sleep, Melatonin, and the Menopausal Transition: What Are the Links? ACTA ACUST UNITED AC 2017; 10:11-18. [PMID: 28966733 PMCID: PMC5611767 DOI: 10.5935/1984-0063.20170003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pineal hormone Melatonin plays an important role in the regulation of the
circadian sleep/wake cycle, mood, and perhaps immune functions, carcinogensis
and reproduction. The human circadian rhythm of melatonin release from the
pineal gland is tightly synchronized with the habitual hours of sleep. Peri- and
postmenopausal women often complain of difficulties initiating and/or
maintaining sleep, with frequent nocturnal and early morning awakenings. In this
review we discuss the pathophysiology of melatonin function as it relates to
sleep disorders in menopausal women, highlighting the potential use of exogenous
melatonin during the menopausal transition and beyond.
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Affiliation(s)
- Shazia Jehan
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | - Giardin Jean-Louis
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | - Evan Auguste
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | | | - Ravi Gupta
- Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun-248016, INDIA
| | - Hrayr Attarian
- Circadian Rhythms and Sleep Research Lab, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, 11203 Brooklyn, NY, USA
| | - Rüdiger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology, University of Göttingen, D-37073 Göttingen, Germany
| | - Amnon Brzezinski
- Department of Obstetrics & Gynecology, the Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Seixas AA, Auguste E, Butler M, James C, Newsome V, Auguste E, da Silva Fonseca VA, Schneeberger A, Zizi F, Jean-Louis G. Differences in short and long sleep durations between blacks and whites attributed to emotional distress: analysis of the National Health Interview Survey in the United States. Sleep Health 2016; 3:28-34. [PMID: 28346147 DOI: 10.1016/j.sleh.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The current study examined the role of emotional distress in explaining racial/ethnic differences in unhealthy sleep duration. DESIGN Data from the 2004-2013 National Health Interview Survey were analyzed using SPSS 20. SETTING Data were collected through personal household interviews in the United States. PARTICIPANTS Of the total 261,686 participants (age≥18 years), 17.0% were black, 83.0% were white, and the mean age was 48 years (SE=0.04). MEASUREMENTS To ascertain total sleep duration, participants were asked, "How many hours of sleep do you get on average in a 24-hour period?" Sleep duration was coded as short sleep (<7hours), average sleep (7-8hours), or long sleep (>8hours). Emotional distress-feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period-was measured using Kessler-6, a 6-item screening scale. RESULTS Of the participants reporting significant emotional distress (4.0% black, 3.5% white), χ2 analyses revealed that a higher percentage of blacks, compared with whites, reported unhealthy sleep durations. Relative to Whites, Blacks had increased prevalence of short sleep (prevalence ratio=1.32, P<.001) or long sleep (odds ratio =1.189, P<.001). The interaction between race/ethnicity and emotional distress was significantly associated with short (prevalence ratio=0.99, P<.001) and long sleep (odds ratio=0.98, P<.001) durations. CONCLUSIONS Individuals of the black race/ethnicity or those reporting greater levels of emotional distress are more likely to report short or long sleep duration. Emotional distress might partially explain racial/ethnic differences in unhealthy sleep duration between blacks and whites.
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Affiliation(s)
- Azizi A Seixas
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change.
| | - Emmanuella Auguste
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
| | - Mark Butler
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
| | - Caryl James
- The University of the West Indies, Mona, Jamaica
| | - Valerie Newsome
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
| | - Evan Auguste
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
| | | | - Andres Schneeberger
- Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Psychiatrische Dienste Graubuenden (PDGR), Plazza Paracelsus 2, 7500 St Moritz, Switzerland; Universitaere Psychiatrische Kliniken Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; Albert Einstein College of Medicine (AECOM), Department of Psychiatry and Behavioral Sciences, 3331 Bainbridge Ave, Bronx, NY 10467, USA
| | - Ferdinand Zizi
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
| | - Girardin Jean-Louis
- NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change
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Jehan S, Auguste E, Zizi F, Pandi-Perumal SR, Gupta R, Attarian H, Jean-Louis G, McFarlane SI. Obstructive Sleep Apnea: Women's Perspective. J Sleep Med Disord 2016; 3:1064. [PMID: 28239685 PMCID: PMC5323064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The main characteristics of sleep-disordered breathing (SDB) are airflow limitation, chronic intermittent hypoxia, or apnea; which may lead to tissue hypoperfusion and recurrent arousal from sleep. These episodes of hypoxia or apnea can lead to tissue inflammation, and are causal factors of disturbed sleep in both men and women. Several lines of evidence suggest that sleep patterns differ along the lifespan in both male and female subjects, and this may result from the influence of female gonadotropic hormones on sleep. Compared to men, women have more sleep complaints, as women's sleep is not only influenced by gonadotropins, but also by conditions related to these hormones, such as pregnancy. It is therefore not surprising that sleep disturbances are seen during menopause, too. Factors that may play a role in this type of SDB in women include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle factors.
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Affiliation(s)
- Shazia Jehan
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Evan Auguste
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Ferdinand Zizi
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | | | - Ravi Gupta
- Department of Psychiatry, Sleep Clinic, Himalayan Institute of Medical Sciences, India
| | - Hrayr Attarian
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Giradin Jean-Louis
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Samy I. McFarlane
- Division of Endocrinology and Medicine, SUNY Downstate Medical Center, USA
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Ojike N, Sowers JR, Seixas A, Ravenell J, Rodriguez-Figueroa G, Awadallah M, Zizi F, Jean-Louis G, Ogedegbe O, McFarlane SI. Psychological Distress and Hypertension: Results from the National Health Interview Survey for 2004-2013. Cardiorenal Med 2016; 6:198-208. [PMID: 27275156 DOI: 10.1159/000443933] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Psychological conditions are increasingly linked with cardiovascular disorders. We aimed to examine the association between psychological distress and hypertension. METHODS We used data from the National Health Interview Survey for 2004-2013. Hypertension was self-reported and the 6-item Kessler Psychological Distress Scale was used to assess psychological distress (a score ≥13 indicated distress). We used a logistic regression model to test the assumption that hypertension was associated with psychological distress. RESULTS Among the study participants completing the survey (n = 288,784), 51% were female; the overall mean age (±SEM) was 35.3 ± 0.02 years and the mean body mass index was 27.5 ± 0.01. In the entire sample, the prevalence of psychological distress was 3.2%. The adjusted odds of reporting hypertension in psychologically distressed individuals was 1.53 (95% CI = 1.31-1.80, p = 0.01). CONCLUSION The findings suggest that psychological distress is associated with higher odds of hypertension after adjusting for other risk factors for high blood pressure. Further studies are needed to confirm these findings and to elucidate the mechanisms by which stress increases hypertension risk.
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Affiliation(s)
- Nwakile Ojike
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - James R Sowers
- Division of Endocrinology, Department of Medicine, University of Missouri, Columbia, Mo., USA
| | - Azizi Seixas
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - Joseph Ravenell
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - G Rodriguez-Figueroa
- Division of Endocrinology, Department of Medicine, SUNY-Downstate/Kings County Hospital Center, Brooklyn, N.Y., USA
| | - M Awadallah
- Division of Endocrinology, Department of Medicine, SUNY-Downstate/Kings County Hospital Center, Brooklyn, N.Y., USA
| | - F Zizi
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - Olugbenga Ogedegbe
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, N.Y., USA
| | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, SUNY-Downstate/Kings County Hospital Center, Brooklyn, N.Y., USA
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Jean-Louis G, Ayappa I, Rapoport D, Zizi F, Airhihenbuwa C, Okuyemi K, Ogedegbe G. Mentoring junior URM scientists to engage in sleep health disparities research: experience of the NYU PRIDE Institute. Sleep Med 2016; 18:108-17. [PMID: 26631970 PMCID: PMC4762758 DOI: 10.1016/j.sleep.2015.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/10/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022]
Abstract
AIM The aim of this study was to evaluate the National Institute of Health (NIH)-funded PRIDE Institute in Behavioral Medicine and Sleep Disorders Research at New York University (NYU) Langone Medical Center. The NYU PRIDE Institute provides intensive didactic and mentored research training to junior underrepresented minority (URM) faculty. METHOD The Kirkpatrick model, a mixed-methods program evaluation tool, was used to gather data on participant's satisfaction and program outcomes. Quantitative evaluation data were obtained from all 29 mentees using the PRIDE REDcap-based evaluation tool. In addition, in-depth interviews and focus groups were conducted with 17 mentees to learn about their experiences at the institute and their professional development activities. Quantitative data were examined, and emerging themes from in-depth interviews and focus groups were studied for patterns of connection and grouped into broader categories based on grounded theory. RESULTS Overall, mentees rated all programmatic and mentoring aspects of the NYU PRIDE Institute very highly (80-100%). They identified the following areas as critical to their development: research and professional skills, mentorship, structured support and accountability, peer support, and continuous career development beyond the summer institute. Indicators of academic self-efficacy showed substantial improvement over time. Areas for improvement included tailoring programmatic activities to individual needs, greater assistance with publications, and identifying local mentors when K awards are sought. CONCLUSIONS In order to promote career development, numerous factors that uniquely influence URM investigators' ability to succeed should be addressed. The NYU PRIDE Institute, which provides exposure to a well-resourced academic environment, leadership, didactic skills building, and intensive individualized mentorship proved successful in enabling URM mentees to excel in the academic environment. Overall, the institute accomplished its goals: to build an infrastructure enabling junior URM faculty to network with one another as well as with senior investigators, serving as a role model, in a supportive academic environment.
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Affiliation(s)
- Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, USA.
| | - Indu Ayappa
- Department of Pulmonology and Critical Care, NYU School of Medicine, New York, NY, USA
| | - David Rapoport
- Department of Pulmonology and Critical Care, NYU School of Medicine, New York, NY, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Collins Airhihenbuwa
- Department of Biobehavioral Health, Penn State University, University Park, State College, PA, USA
| | - Kola Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, USA
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Akinseye O, Williams SK, Ojike NI, Seixas A, Zizi F, Jean-Louis G, Ogedegbe OG. Abstract TP188: Black-White Differences in Susceptibility to Stroke Secondary to Abnormal Sleep Duration. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
A strong predictor of stroke is abnormal sleep duration with both short and long sleep associated with increased stroke risk.
Hypothesis:
We tested the hypothesis that the stroke-sleep association differs based on race and age.
Methods:
Using a hypertensive subset from the NHIS dataset (2004-2013), we assessed the association between stroke prevalence and self-reported sleep duration, stratifying for race and age. Diagnosis of hypertension and stroke was based on self-report. Sleep duration was also self-reported and categorized as short (6 or fewer hours), normal/referent (7-8 h) or long (9 or more hours per day). Race was self-reported and categorized as White or Black. Age at screening was grouped into categories of 18-34, 45-64, and those 65 years and older.
Results:
Of the 403, 621 patients in the NHIS dataset (2004-2013), 50.5 % (n=203794) had a diagnosis of hypertension. The average age of the cohort was 58.1 years (95% CI=57.8-58.4), 50.2% female; 15.4 % of the cohort was Black. The prevalence of abnormally short and long sleep duration was 31.3 % and 11%, respectively. The age-standardized prevalence of stroke amongst the hypertensive population for normal, short and long sleep duration was 3.5%, 4.9%, and 7.6%, respectively. Both short and long sleep duration were significant predictors of stroke (1.17; 95% confidence interval (CI) 1.06 - 1.31 and 2.51; 95% CI 2.44-2.58, respectively). An interaction term added to the model suggested that race and age modified the relationship between sleep duration and stroke (p=0.01). Long sleep was a significant predictor of stroke in all age groups, regardless of race. Short sleep was not a significant predictor of stroke in Whites. Short sleep predicted stroke in the youngest age group of Blacks (1.95; 95% CI 1.01 - 3.74). Conversely, short sleep duration was associated with a lower risk of stroke in the oldest age group of Blacks (0.78; 95% CI 0.58- 1.05).
Conclusions:
Risk of stroke is predicted by abnormal sleep duration. The novel finding is that in this hypertensive cohort, the association between stroke and abnormal sleep duration differs by race and age.
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Affiliation(s)
- Oluwaseun Akinseye
- Dept of Medicine, Icahn Sch of Medicine at Mount Sinai, Queens Hosp Cntr, Queens, NY
| | | | | | - Azizi Seixas
- Dept of Population Health, NYU Sch of Medicine, NY, NY
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Seixas A, Henclewood D, Williams S, Zizi F, Williams O, Ogedegbe G, Jean-Louis G. Abstract TMP85: The Protective Roles of Sleep Duration and Physical Activity on Stroke Risk: Analysis of the 2004-2013 National Health Interview Survey using Machine Learning. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tmp85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Health behavior profiles to reduce stroke risk are limited methodologically and hard to apply at the population level. Big data and machine learning was used to quantify dynamic omnidirectional interactions between physical activity, sleep, and stroke risk in the context of multiple socio-demographic, clinical, behavioral, and psychosocial factors.
Hypothesis:
Average sleep duration and moderate-vigorous physical activity will reduce stroke risk.
Method:
Analysis was based on the 2004-2013 National Health Interview Survey (N=288,888). We employed a machine-learning Bayesian Belief Network (BBN) to model the probabilistic relationships (independent and additive) of sleep duration and physical activity to stroke risk. Factors considered included demographic, behavioral, health/medical, and psychosocial as well as sleep duration (short, average, and long), and physical activity (leisurely walking/bicycling, slow swimming/dancing, and simple gardening activities).
Results:
Of the sample, 48.1% were ≤45 years; 77.4% were White; 15.9%, Black/African American; and 45.1% reported less than $35K annually. Overall, the model had a precision index of 95.84%. Average sleepers (7-8hours) were 25% (2.3% to 3%) less likely to experience a stroke. Respectively, long sleepers (>8hours) were 146% (3% to 7.5%) and short sleepers (<7 hours) 22% (3%-3.74%) more likely to report a stroke. A model-based adaptive method evidenced that the combined effect of health status, hypertension, heart condition, income, and alcohol consumption increased the likelihood of stroke from 3% to 90%. Healthy sleep (7-8 hours) and vigorous leisurely activity (30-60 minutes) three to six times per week significantly decreased stroke risk. Using the observational inference technique, we developed idiosyncratic profiles of protective behaviors (i.e. minutes and frequency of moderate or vigorous exercise per week and short, average or long sleep) that reduced stroke risk.
Conclusion:
Utilization of BBN analysis is important, as it provides a more dynamic risk stratification system. Healthy sleep and exercise routines reduced stroke risk, based on systematic iterations.
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Affiliation(s)
- Azizi Seixas
- Population Health, NYU Sch of Medicine, New York, NY
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James C, Seixas AA, Harrison A, Jean-Louis G, Butler M, Zizi F, Samuels A. Childhood Physical and Sexual Abuse in Caribbean Young Adults and Its Association with Depression, Post-Traumatic Stress, and Skin Bleaching. ACTA ACUST UNITED AC 2015; 5. [PMID: 27019771 PMCID: PMC4807863 DOI: 10.4172/2167-1044.1000214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. METHODS A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. RESULTS The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. CONCLUSION The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.
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Affiliation(s)
- Caryl James
- Corresponding author: Caryl James, PhD, CEDS, Lecturer, Department of Sociology, Psychology, and Social Work, Faculty of Social Sciences, The University of the West Indies, Mona, Kingston, 6, Jamaica, West Indies, Tel: 876-927-1660; . Azizi Seixas, PhD, Postodoctoral Fellow, NYU Langone School of Medicine, Center for Healthful Behavior Change, 227 East 30th St, 6th Floor, New York NY 10016, USA, Tel: 646-501-2672;
| | - Azizi A Seixas
- Corresponding author: Caryl James, PhD, CEDS, Lecturer, Department of Sociology, Psychology, and Social Work, Faculty of Social Sciences, The University of the West Indies, Mona, Kingston, 6, Jamaica, West Indies, Tel: 876-927-1660; . Azizi Seixas, PhD, Postodoctoral Fellow, NYU Langone School of Medicine, Center for Healthful Behavior Change, 227 East 30th St, 6th Floor, New York NY 10016, USA, Tel: 646-501-2672;
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Jean-Louis G, Grandner MA, Youngstedt SD, Williams NJ, Zizi F, Sarpong DF, Ogedegbe GG. Differential increase in prevalence estimates of inadequate sleep among black and white Americans. BMC Public Health 2015; 15:1185. [PMID: 26611643 PMCID: PMC4661980 DOI: 10.1186/s12889-015-2500-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/17/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The National Health Interview Survey (NHIS) was used to ascertain whether increases in inadequate sleep differentially affected black and white Americans. We tested the hypothesis that prevalence estimates of inadequate sleep were consistently greater among blacks, and that temporal changes have affected these two strata differentially. METHODS NHIS is an ongoing cross-sectional study of non-institutionalized US adults (≥18 years) providing socio-demographic, health risk, and medical factors. Sleep duration was coded as very short sleep [VSS] (<5 h), short sleep [SS] (5-6 h), or long sleep [LS] (>8 h), referenced to 7-8 h sleepers. Analyses adjusted for NHIS' complex sampling design using SAS-callable SUDAAN. RESULTS Among whites, the prevalence of VSS increased by 53% (1.5% to 2.3%) from 1977 to 2009 and the prevalence of SS increased by 32% (19.3% to 25.4 %); prevalence of LS decreased by 30% (11.2% to 7.8%). Among blacks, the prevalence of VSS increased by 21% (3.3% to 4.0%) and the prevalence of SS increased by 37% (24.6 % to 33.7%); prevalence of LS decreased by 42% (16.1% to 9.4%). Adjusted multinomial regression analysis showed that odds of reporting inadequate sleep for whites were: VSS (OR = 1.40, 95% CI = 1.13-1.74, p < 0.001), SS (OR = 1.34, 95 % CI = 1.25-1.44, p < 0.001), and LS (OR = 0.94, 95% CI = 0.85-1.05, NS). For blacks, estimates were: VSS (OR = 0.83, 95% CI = 0.60-1.40, NS), SS (OR = 1.21, 95% CI = 1.05-1.50, p < 0.001), and LS (OR = 0.84, 95% CI = 0.64-1.08, NS). CONCLUSIONS Blacks and whites are characteristically different regarding the prevalence of inadequate sleep over the years. Temporal changes in estimates of inadequate sleep seem dependent upon individuals' race/ethnicity.
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Affiliation(s)
- Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
| | - Michael A Grandner
- Department of Psychiatry at the University of Arizona College of Medicine, 550 East Van Buren, Tucson, AZ, 85004, USA.
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA.
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
| | - Daniel F Sarpong
- Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, LA, USA.
| | - Gbenga G Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY, 10016, USA.
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Jean-Louis G, Youngstedt S, Grandner M, Williams NJ, Sarpong D, Zizi F, Ogedegbe G. Unequal burden of sleep-related obesity among black and white Americans. Sleep Health 2015; 1:169-176. [PMID: 26937487 DOI: 10.1016/j.sleh.2015.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study ascertained whether individuals of the black race/ethnicity are unequally burdened by sleep-related overweight/obesity. METHODS Analysis was based on data obtained from Americans (ages, 18-85 years) in the National Health Interview Survey (1977-2009). Sleep duration was coded as either very short sleep (VSS) (≤5 hours), short sleep (SS) (5-6 hours), or long sleep (>8 hours), referenced to 7-8-hour sleepers. Overweight was defined as body mass index (BMI) ≥25.0 and ≤29.9 kg/m2 and obesity, BMI ≥30 kg/m2, referenced to normal weight (BMI = 18.5-24.9 kg/m2). RESULTS Multivariate-adjusted regression analyses indicated that, among whites, VSS was associated with a 10% increased likelihood of being overweight and 51% increased likelihood of being obese, relative to 7-8-hour sleepers. Short sleep was associated with a 13% increased likelihood of being overweight and 45% increased likelihood of being obese. Long sleep was associated with 21% increased likelihood of being obese. Among blacks, VSS was associated with a 76% increased likelihood of being overweight and 81% increased likelihood of being obese. Short sleep was associated with a 16% increased likelihood of being overweight and 32% increased likelihood of being obese. As for the white stratum, long sleep was associated with a 25% increased likelihood of being obese. CONCLUSION Our investigation demonstrates strong linkages between inadequate sleep and overweight/ obesity among black and white Americans. Although it cannot be said that insufficient sleep causes overweight/obesity, individuals of the black race/ethnicity sleeping ≤5 hours may be unequally burdened by sleep-related overweight/obesity.
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Affiliation(s)
- Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Shawn Youngstedt
- College of Nursing and Health Innovation, College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Michael Grandner
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Daniel Sarpong
- Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans, LA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY
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Seixas A, Ravenell J, Williams NJ, Williams SK, Zizi F, Ogedegbe G, Jean-Louis G. Uncontrolled blood pressure and risk of sleep apnea among blacks: findings from the Metabolic Syndrome Outcome (MetSO) study. J Hum Hypertens 2015; 30:149-52. [PMID: 26246311 PMCID: PMC4744577 DOI: 10.1038/jhh.2015.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/30/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023]
Abstract
Uncontrolled blood pressure (BP) is linked to increased risk of obstructive sleep apnea (OSA). However, few studies have assessed the impact of this relationship among blacks with metabolic syndrome (MetS). Data for this study were collected from 1035 blacks (mean age=62±13 years) enrolled in the Metabolic Syndrome Outcome study. Patients with a score ⩾6 on the Apnea Risk Evaluation System were considered at risk for OSA. Of the sample, 77.1% were low-to-high OSA risk and 92.3% were hypertensive, of which 16.8% had uncontrolled BP levels. Analysis also showed that 60.4% were diabetic, 8.9% had a stroke history, 74.3% had dyslipidemia, 69.8% were obese and 30.9% had a history of heart disease. Logistic regression analyses were employed to investigate associations between uncontrolled BP and OSA risk, while adjusting for known covariates. Findings showed that uncontrolled BP independently increased the odds of OSA risk twofold (odds ratio=2.02, 95% confidence interval=1.18-3.48, P<0.05). In conclusion, our findings show that uncontrolled BP was associated with a twofold greater risk of OSA among blacks, suggesting that those with MetS and who have uncontrolled BP should be screened for the presence of OSA.
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Affiliation(s)
- A Seixas
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - J Ravenell
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - N J Williams
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - S K Williams
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - F Zizi
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - G Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - G Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
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Jehan S, Masters-Isarilov A, Salifu I, Zizi F, Jean-Louis G, Pandi-Perumal SR, Gupta R, Brzezinski A, McFarlane SI. Sleep Disorders in Postmenopausal Women. J Sleep Disord Ther 2015; 4:212. [PMID: 26512337 PMCID: PMC4621258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Factors that may play a role in this type of insomnia include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle. Other common sleep problems in this age group, such as obstructive sleep apnea and restless leg syndrome, can also worsen the sleep quality. Exogenous melatonin use reportedly induces drowsiness and sleep and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age and the menopausal transition. Recently, more potent melatonin analogs (selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonists) with prolonged effects and slow-release melatonin preparations have been developed. They were found effective in increasing total sleep time and sleep efficiency as well as in reducing sleep latency in insomnia patients. The purpose of this review is to give an overview on the changes in hormonal status to sleep problems among menopausal and postmenopausal women.
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Affiliation(s)
- Shazia Jehan
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | | | - Idoko Salifu
- Department of Obstetrics and Gynecology, Lutheran Medical center, Brooklyn, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, New York University School of Medicine, New York, USA
| | | | - Ravi Gupta
- Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun, India
| | - Amnon Brzezinski
- Department of Obstetrics & Gynecology, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, USA
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Seixas AA, James C, Jean-Louis G, Butler M, Zizi F, Gardner A. The Mediating Effects of Social Support and Locus of Control on the Relationship between Post-Traumatic Stress and Depressive Symptoms in a Jamaican University Sample. J Depress Anxiety 2015; 4:194. [PMID: 26798566 PMCID: PMC4718585 DOI: 10.4172/2167-1044.1000194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The increasing rate of comorbid posttraumatic stress and depressive symptoms among young adults presents a unique symptom presentation and challenges to treatment. The current study examined psychosocial barriers--external locus of control-- and facilitators-- social support-- in the posttraumatic stress and depressive symptoms association. METHODS The current cross-sectional study was conducted among 701 Jamaican university participants, ages 18-30 years. Participants completed self-report measures of general demographic information as well as target variables which include the CES-D-10, Sense of control (external and internal locus of control), Short screening scale for DSM-IV posttraumatic stress disorder and social support measures. RESULTS Majority of the sample was female (76.2%; n=534); and slightly more than half of the sample self-identified as Black/African ancestry (59.7%). External locus of control (LOC) partially mediated the relationship between posttraumatic stress and depressive symptoms, external locus of control (LOC) had a greater mediation magnitude than social support in the posttraumatic stress-depressive symptoms association (Indirect Effect=0.133, 95% CI-0.075-0.211). In post-hoc analyses women appeared more highly traumatized than their male counterparts (14.3%, χ2 =8.032, p=0.005). The sub-sample of highly traumatized individuals reported higher levels of depression, posttraumatic stress symptoms, external LOC, and lower levels of social support and internal LOC than did individuals with lower levels of trauma. CONCLUSION Contrary to previous research, our findings indicate that external LOC partially mediated the relationship between posttraumatic stress and depressive symptoms among a Jamaica university sample more so than social support. These findings therefore suggest that psychosocial treatments should consider locus of control focused interventions or skill building for young adults who suffer from posttraumatic stress and depressive symptoms.
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Affiliation(s)
- Azizi A. Seixas
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Caryl James
- The University of the West Indies, Mona, Jamaica
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Mark Butler
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, NY, USA
| | - Alex Gardner
- The University of the West Indies, Mona, Jamaica
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Williams NJ, Nunes JV, Zizi F, Okuyemi K, Airhihenbuwa CO, Ogedegbe G, Jean-Louis G. Factors associated with referrals for obstructive sleep apnea evaluation among community physicians. J Clin Sleep Med 2015; 11:23-6. [PMID: 25325590 DOI: 10.5664/jcsm.4356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/21/2014] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES This study assessed knowledge and attitudes toward obstructive sleep apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation. METHODS Medical students and residents collected data from a convenience sample of 105 physicians practicing at community-based clinics in a large metropolitan area. Average age was 48 ± 14 years; 68% were male, 70% black, 24% white, and 6% identified as "other." Physicians completed the Obstructive Sleep Apnea Knowledge and Attitudes questionnaire. RESULTS The average year in physician practice was 18 ± 19 years. Of the sample, 90% reported providing care to black patients. The overall OSA referral rate made by physicians was 75%. OSA knowledge and attitudes scores ranged from 5 to 18 (mean = 14 ± 2) and from 7 to 20 (mean = 13 ± 3), respectively. OSA knowledge was associated with white race/ ethnicity (rp = 0.26, p < 0.05), fewer years in practice (rp = -0.38, p < 0.01), patients inquiring about OSA (rp = 0.31, p < 0.01), and number of OSA referrals made for OSA evaluation (rp = 0.30, p < 0.01). Positive attitude toward OSA was associated with patients inquiring about OSA (rp = 0.20, p < 0.05). Adjusting for OSA knowledge and attitudes showed that physicians whose patients inquired about OSA were nearly 10 times as likely to make a referral for OSA evaluation (OR = 9.38, 95% CI: 2.32-38.01, p < 0.01). CONCLUSION Independent of physicians' knowledge and attitudes toward obstructive sleep apnea, the likelihood of making a referral for obstructive sleep apnea evaluation was influenced by whether patients inquired about the condition.
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Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - João V Nunes
- Department of Physiology, Pharmacology and Neuroscience, The Sophie Davis School of Biomedical Education, The City College of New York, New York, NY
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - Kola Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
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Ramos AR, Wallace DM, Williams NJ, Spence DW, Pandi-Perumal SR, Zizi F, Jean-Louis G. Association between visual impairment and sleep duration: analysis of the 2009 National Health Interview Survey (NHIS). BMC Ophthalmol 2014; 14:115. [PMID: 25274449 PMCID: PMC4192766 DOI: 10.1186/1471-2415-14-115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Visual impairment (VI) is associated with increased mortality and health factors such as depression and cardiovascular disease. Epidemiologic studies consistently show associations between sleep duration with adverse health outcomes, but these have not systematically considered the influence of VI. The aim of this study was to ascertain the independent association between VI and sleep duration using the National Health Interview Survey (NHIS) data. We also examined whether race/ethnicity influenced these associations independently of sociodemographic and medical characteristics. Methods Our analysis was based on the 2009 NHIS, providing valid sleep and vision data for 29,815 participants. The NHIS is a cross-sectional household interview survey utilizing a multistage area probability design. Trained personnel from the US census bureau gathered data during face-to-face interview and obtained socio-demographic, self-reported habitual sleep duration and physician-diagnosed chronic conditions. Results The mean age of the sample was 48 years and 56% were female. Short sleep and long sleep durations were reported by 49% and 23% of the participants, respectively. Visual impairment was observed in 10%. Multivariate-adjusted logistic regression models showed significant associations between VI and short sleep (OR = 1.6, 95% CI = 1.5-1.9 and long sleep durations (OR = 1.6, 95% CI = 1.3-1.9). These associations persisted in multivariate models stratified by race-ethnic groups. Conclusion Visual impairment was associated with both short and long sleep durations. Analysis of epidemiologic sleep data should consider visual impairment as an important factor likely to influence the amount of sleep experienced habitually.
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Affiliation(s)
| | | | | | | | | | | | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, NYU Langone Medical Center, 227 East 30th Street, Floor # 6-615, New York, NY 10016, USA.
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Jean-Louis G, Williams NJ, Sarpong D, Pandey A, Youngstedt S, Zizi F, Ogedegbe G. Associations between inadequate sleep and obesity in the US adult population: analysis of the national health interview survey (1977-2009). BMC Public Health 2014; 14:290. [PMID: 24678583 PMCID: PMC3999886 DOI: 10.1186/1471-2458-14-290] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epidemiologic studies show a curvilinear relationship between inadequate sleep (< 7 or > 8 hours) and obesity (Body Mass Index > 30 kg/m2), which have enormous public health impact. METHODS Using data from the National Health Interview Survey, an ongoing nationally representative cross-sectional study of non-institutionalized US adults (≥18 years) (1977 through 2009), we examined the hypothesis that inadequate sleep is independently related to overweight/obesity, with adjustment for socio-demographic, health risk, and medical factors. Self- reported data on health risks, physician-diagnosed medical conditions, sleep duration, and body weight and height were used. RESULTS Prevalence of overweight and obesity increased from 31.2% to 36.9% and 10.2% to 27.7%, respectively. Whereas prevalence of very short sleep (<5 hours) and short sleep (5-6 hours) has increased from 1.7% to 2.4% and from 19.7% to 26.7%, it decreased from 11.6% to 7.8% for long sleep. According to multivariate-adjusted multinomial regression analyses, odds of overweight and obesity associated with very short sleep and short sleep increased significantly from 1977 to 2009. Odds of overweight and obesity conferred by long sleep did not show consistent and significant increases over the years. Analyses based on aggregated data showed very short sleepers had 30% greater odds of being overweight or were twice as likely to be obese, relative to 7-8 hour sleepers. Likewise, short sleepers had 20% greater odds of being overweight or 57% greater odds of being obese. Long sleepers had 20% greater odds of being obese, but no greater odds of being overweight. CONCLUSIONS Our findings support the hypothesis that prevalence of very short and short sleep has gradually increased over the last 32 years. Inadequate sleep was associated with overweight and obesity for each available year.
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Affiliation(s)
- Girardin Jean-Louis
- Division of Internal Medicine, Center for Healthful Behavior Change, NYU Medical Center, New York, NY, USA.
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Seixas A, Ramos AR, Gordon-Strachan GM, Fonseca VADS, Zizi F, Jean-Louis G. Relationship between Visual Impairment, Insomnia, Anxiety/Depressive Symptoms among Russian Immigrants. J Sleep Med Disord 2014; 1:1009. [PMID: 26015992 PMCID: PMC4442088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Little is known about the association between visual impairment and insomnia symptoms in elderly populations. The purpose of this study was to ascertain associations between self-reported visual impairments and insomnia symptoms in a community-based sample of Russian immigrants. METHOD Sample consisted of 307 community-residing Russians (ages: 25-95 years, mean=72.64 ± 9.62; women=54% and men=46%). Semi-structured interviews assessed health-care needs and physical health characteristics. Collected demographic and health-related data were analyzed using SPSS 19.0. RESULTS Overall, 93% reported at least one of several major health problems: visual impairment (48.4%), hypertension (53%), diabetes (25.7%), arthritis (52.8%), cancer (10.5%), weight problems (34.1%), and anxiety/depressive symptoms (43%), 62% had an insomnia diagnosis. Unadjusted logistic regression analysis showed that individuals with visual impairment were nearly three times as likely as those without to report insomnia symptoms [OR = 2.73, p < 0.01; 95% CI = 1.68-4.48]. Adjusting for the presence of socio demographic variables reduced the odds to 2.68; further adjustment for social isolation and anxiety and depressed symptoms reduced the odds to 2.20.Anxiety/depression mediated the relationship between visual impairment and insomnia. CONCLUSION Individuals with visual impairment have twice the odds of reporting insomnia independent of anxiety/depression and social isolation, two common problems affecting quality of life in that population.
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Affiliation(s)
- Azizi Seixas
- Department of Population Health, New York University School of Medicine, USA
| | | | | | | | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, USA
| | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, USA
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Adenekan B, Pandey A, McKenzie S, Zizi F, Casimir GJ, Jean-Louis G. Sleep in America: role of racial/ethnic differences. Sleep Med Rev 2013; 17:255-62. [PMID: 23348004 PMCID: PMC3644542 DOI: 10.1016/j.smrv.2012.07.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 07/20/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting that the population's current average sleep duration is approximately 6 h. In this paper, we examine epidemiologic and community-based data on sleep complaints reported by American adults, specifically addressing the role of race/ethnicity in the subjective report of sleep problems. Subjective and objective findings indicate that black (throughout the text, we use the term black in lieu of African American for there are instances where we refer to individuals with self-ascribed race/ethnicity as black, African American, African, or Caribbean American; the term white is used to denote individuals of European descent). Americans have higher rates of long (≥9 h) and short (≤5 h) sleep than their white counterparts, and this may mediate a higher risk of cardiovascular disease, obesity and diabetes among blacks. In addition, studies show mixed results on sleep complaints among blacks compared to those among other ethnicities. This paper explores factors that may contribute to racial/ethnic differences in sleep including intra-ethnic variation, cultural biases, genetics and psychosocial factors.
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Affiliation(s)
- Bosede Adenekan
- Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, NY 11203-2098, USA
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Abstract
Introduction This study explored the associations between sleep duration and emotion regulation among urban black women (mean age=59 ± 7 yrs). Method Eligible women (n=523) provided sociodemographic data during face-to-face interviews. We used the Comprehensive Assessment and Referral Examination Physical to measure health status; women also estimated their habitual sleep duration. We utilized a modified version of Weinberger’s conceptual model of repression, the Index of Self-Regulation (ISE) to measure emotion regulation. ISE scores were derived by amalgamating the defensive subscale from the Social Desirability Scale and the anxiety subscale from the State-Trait Anxiety Inventory. Results The median habitual sleep duration was 7 hours; 20% of the women were short sleepers (<6 hours) and 6% were long sleepers (>8 hours). Short sleepers, rather than long sleepers, had a greater likelihood of reporting insomnia symptoms than those sleeping 6–8 hours [63.4% vs. 28.1%; Χ2 = 41.87, p<0.001]. In the first logistic regression model, the odds of being a short sleeper for low regulators were 3 times greater than for high regulators [OR = 3.22 95% CI: 2.05–5.06; p<0.0001]. In multivariate-adjusted analysis, OR was reduced to 2.06, but remained significant. In the second logistic model, the likelihood of being a long sleeper among low regulators were 37% greater than for high regulators, but results were not significant [OR=1.37, 95% CI: 0.62–3.01; NS]. Discussion Short and long sleep duration are associated with reduced ability for emotion regulation. Women sleeping 6–8 hrs might be more adept at regulating emotions in their daily lives. Insomnia symptoms might mediate associations between emotion regulations and sleep durations.
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Affiliation(s)
- Christie Racine
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Kaushal Kalra
- Department of Family Practice, SUNY Downstate Medical Centre, NY, USA
| | - Mirnova Ceide
- Albert Einstein College of Medicine of Yeshiva University, Department of Psychiatry and Behavioural Sciences, NY, USA
| | - Natasha J Williams
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, NY, USA ; Institute of Psychiatry, Universidade Federal do Rio de Janeiro, NY, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Medical Centre, NY, USA
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Roberts CB, Browne R, Wilson TE, Rashied-Henry K, Primus N, Shaw R, Brown H, Zizi F, Jean-Louis G, Brown C, Graham Y, Fraser-White M. Lessons learned from building an infrastructure for community-engaged research. Int Public Health J 2013; 5:7-16. [PMID: 26753057 PMCID: PMC4704865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Before community-based participatory research (CBPR) can commence an infrastructure needs to be established whereby both academic researchers and community members can participate in CBPR as equitable partners throughout the research process. OBJECTIVES We describe the key principles of the Brooklyn Health Disparities Center (BHDC), a community-academic-government partnership, to guide the development for an infrastructure to support, increase, and sustain the capacity of academics and community members to engage in CBPR to address cardiovascular health disparities in Brooklyn, New York. METHODS The guiding principles of the BHDC consist of 1) promoting equitable and collaborative partnerships 2) enhancing research capacity and 3) building/sustaining trust. Delphi survey, youth summer internship programs, and workshops were among the tools utilized in enhancing community capacity. RESULTS Several lessons were gleaned: design programs that are capable of building trust, skills, capacity, and interest of community members concomitantly; be flexible in terms of the priorities and objectives that the partners seek to focus on as these may change over time; and build a groundswell of local advocates to embrace the research and policy agenda of the BHDC.
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Affiliation(s)
| | - Ruth Browne
- Arthur Ashe Institute for Urban Health, Brooklyn, New York
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | | | - Nicole Primus
- Brooklyn Health Disparities Center, Brooklyn, New York
| | - Raphael Shaw
- Brooklyn Health Disparities Center, Brooklyn, New York
| | - Humberto Brown
- Arthur Ashe Institute for Urban Health, Brooklyn, New York
| | - Ferdinand Zizi
- Department of Health Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Girardin Jean-Louis
- Department of Health Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Clinton Brown
- Department of Health Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Yvonne Graham
- Office of the Brooklyn Borough President, Brooklyn, New York, United States of America
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McFarlane SI, Jean-Louis G, Zizi F, Whaley-Connell AT, Ogedegbe O, Makaryus AN, Maraj I. Hypertension in the high-cardiovascular-risk populations. Int J Hypertens 2012; 2011:746369. [PMID: 22778912 PMCID: PMC3388432 DOI: 10.4061/2011/746369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/01/2012] [Indexed: 11/20/2022] Open
Affiliation(s)
- Samy I McFarlane
- Division of Endocrinology, State University of New York-Downstate Medical Center, Kings County Hospital Center, 450 Clarkson Avenue, Box 50, Brooklyn, NY 11203, USA
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50
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Olafiranye O, Jean-Louis G, Antwi M, Zizi F, Shaw R, Brimah P, Ogedegbe G. Functional capacity is a better predictor of coronary heart disease than depression or abnormal sleep duration in Black and White Americans. Sleep Med 2012; 13:728-31. [PMID: 22465451 DOI: 10.1016/j.sleep.2012.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 12/26/2011] [Accepted: 01/31/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess whether functional capacity is a better predictor of coronary heart disease (CHD) than depression or abnormal sleep duration. METHODS Adult civilians in the USA (n=29,818, mean age 48 ± 18 years, range 18-85 years) were recruited by a cross-sectional household interview survey using multistage area probability sampling. Data on chronic conditions, estimated habitual sleep duration, functional capacity, depressed moods, and sociodemographic characteristics were obtained. RESULTS Thirty-five percent of participants reported reduced functional capacity. The CHD rates among White and Black Americans were 5.2% and 4%, respectively. Individuals with CHD were more likely to report extreme sleep durations (short sleep [≤ 5h] or long sleep [≥ 9 h]; odds ratio [OR] 1.65, 95% confidence interval [CI] 1.38-1.97; P<0.0001), less likely to be functionally active (anchored by the ability to walk one-quarter of a mile without assistance [OR 6.27, 95% CI 5.64-6.98; P<0.0001]) and more likely to be depressed (OR 1.78, 95% CI 1.60-1.99; P<0.0001) than their counterparts. On multivariate regression analysis adjusting for sociodemographic factors and health characteristics, only functional capacity remained an independent predictor of CHD (OR 1.81, 95% CI 1.42-2.31; P<0.0001). CONCLUSION Functional capacity was an independent predictor of CHD in the study population, whereas depression and sleep duration were not independent predictors.
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Affiliation(s)
- Oladipupo Olafiranye
- Brooklyn Health Disparities Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
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