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Whibley D, Guyer HM, Swanson LM, Braley TJ, Kratz AL, Dunietz GL. Sleep disturbance as a moderator of the association between physical activity and later pain onset among American adults aged 50 and over: evidence from the Health and Retirement Study. BMJ Open 2020; 10:e036219. [PMID: 32513889 PMCID: PMC7282328 DOI: 10.1136/bmjopen-2019-036219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To examine whether sleep disturbance modifies the association between physical activity and incident pain. DESIGN Prospective population-based study. SETTING Health and Retirement Study. PARTICIPANTS American adults aged ≥50 years who reported no troublesome pain in 2014 were re-assessed for pain in 2016. Of 9828 eligible baseline respondents, 8036 (82%) had complete follow-up data for adjusted analyses (weighted analysis population N=42 407 222). EXPOSURES Physical activity was assessed via interview with questions about time spent in moderate and vigorous physical activity. Sleep disturbance, assessed using a modified form of the Jenkins Sleep Scale, was examined as a potential moderator. MAIN OUTCOME MEASURE Troublesome pain. RESULTS In weighted analyses, 37.9% of the 2014 baseline pain-free sample participated in moderate or vigorous physical activity once a week or less, with an overall mean Physical Activity Index Score of 9.0 (SE=0.12). 18.6% went on to report troublesome pain in 2016. Each one-point higher on the Physical Activity Index Score was associated with a reduced odds ratio (OR) of incident pain for those who endorsed sleep disturbance never/rarely (OR=0.97, 95% CI 0.94 to 0.99), but not for those who endorsed sleep disturbance sometimes (OR=0.99, 95% CI 0.97 to 1.01) or most of the time (OR=1.01, 95% CI 0.99 to 1.03). The analysis of possible interaction demonstrated that frequency of sleep disturbance moderated the physical activity and incident pain association (Wald test: p=0.02). CONCLUSIONS The beneficial association of physical activity on reduced likelihood of later pain was only observed in persons who endorsed low levels of sleep disturbance.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, United States
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Heidi M Guyer
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States
- RTI International, North Carolina, United States
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Tiffany J Braley
- Department of Neurology, Division of Multiple Sclerosis and Neuroimmunology, University of Michigan, Ann Arbor, Michigan, United States
- Department of Neurology, Division of Sleep Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, United States
| | - Galit Levi Dunietz
- Department of Neurology, Division of Sleep Medicine, University of Michigan, Ann Arbor, Michigan, United States
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Saxon DT, Kennel PJ, Guyer HM, Goyal P, Hummel SL, Konerman MC. Specialty-Based Variability in Diagnosing and Managing Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2020; 95:669-675. [PMID: 32247341 DOI: 10.1016/j.mayocp.2019.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To quantify differences in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF) between cardiologists and noncardiologists, who often diagnose and manage HFpEF. METHODS Cardiologists and noncardiologists (internal medicine, medicine/pediatrics, family medicine, geriatrics) were anonymously surveyed between January 16, 2018, and March 2, 2018, regarding practices related to diagnosing and managing HFpEF at the University of Michigan and Weill Cornell Medical Center. Response data were compared using χ2 analysis. RESULTS Of 1010 physicians surveyed, 211 completed a significant portion of the survey: 32 cardiologists and 179 noncardiologists. Most noncardiologists were unaware of HFpEF diagnostic guidelines and commonly used left ventricular diastolic dysfunction and natriuretic peptides to diagnose HFpEF. Noncardiologists (32.3%, n=52) were less likely than cardiologists (64.5%, n= 20) to prescribe an aldosterone antagonist for HFpEF (P=.001). Both groups reported similar use of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and exercise programs. Noncardiologists were more likely to refer patients with HFrEF to cardiology (63.1%, n=111) compared with patients with HFpEF (33.5%, n=59; P<.001). Noncardiologists were more likely to discuss prognosis and goals of care with patients with HFrEF (84.4%, n=151) than with patients with HFpEF (65.9%, n=118; P<.001). CONCLUSION Cardiologists and noncardiologists vary significantly in their HFpEF diagnosis and treatment practices. As diagnostic criteria continue to be evaluated for HFpEF, dissemination of these guidelines to noncardiologists, with an emphasis on the morbidity and mortality associated with HFpEF, is imperative.
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Affiliation(s)
- David T Saxon
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Peter J Kennel
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Heidi M Guyer
- Survey Research Center, University of Michigan, Ann Arbor, MI; RTI International, Durham, NC
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
| | - Matthew C Konerman
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
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Jansen EC, Dunietz GL, Tsimpanouli ME, Guyer HM, Shannon C, Hershner SD, O'Brien LM, Baylin A. Sleep, Diet, and Cardiometabolic Health Investigations: a Systematic Review of Analytic Strategies. Curr Nutr Rep 2019; 7:235-258. [PMID: 30187293 DOI: 10.1007/s13668-018-0240-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/28/2022]
Abstract
PURPOSE OF REVIEW Poor sleep is a risk factor for cardiometabolic morbidity. The relationship of sleep and cardiometabolic health could be confounded, mediated, or modified by diet, yet the incorporation of diet in sleep-cardiometabolic health studies is inconsistent. This rapid systematic literature review evaluates the conceptualization of diet as a confounder, mediator, or effect modifier within sleep-cardiometabolic health investigations, and the statistical approaches utilized. RECENT FINDINGS Of 4692 studies identified, 60 were retained (28 adult, 32 pediatric). Most studies included diet patterns, quality, or energy intake as confounders, while a few examined these dietary variables as mediators or effect modifiers. There was some evidence, mostly in pediatric studies, that inclusion of diet altered sleep-cardiometabolic health associations. Diet plays a diverse role within sleep-cardiometabolic health associations. Investigators should carefully consider the conceptualization of diet variables in these relationships and utilize contemporary statistical approaches when applicable.
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Affiliation(s)
- Erica C Jansen
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA.
| | - Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Maria-Efstratia Tsimpanouli
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Heidi M Guyer
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Shelley D Hershner
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, C728 Med Inn Building, Ann Arbor, MI, 48109, USA.,Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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