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Stone K, Nimon K, Ellinger AD. Examining the predictive validity of a managerial coaching scale: a longitudinal study. Front Psychol 2024; 15:1277422. [PMID: 38629036 PMCID: PMC11020080 DOI: 10.3389/fpsyg.2024.1277422] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/01/2024] [Indexed: 04/19/2024] Open
Abstract
Managerial coaching remains a widespread and popular organizational development intervention applied across numerous industries to enhance critical workplace outcomes and employee attitudes, yet no studies to date have evaluated the temporal precedence within these relationships. This study sought to assess the predictive validity of the widely used Employee Perceptions of Supervisor/Line Manager Coaching Behavior Measure managerial coaching scale (CBI), employing a longitudinal design and following the testing of the causal hypothesized relationship framework. Three hypotheses were evaluated using three commonly associated variables with managerial coaching (role clarity, job satisfaction, and organization commitment), using longitudinal data collected over two waves from full-time US employees (n = 313). The study followed a two-wave design, collecting data over two time points to test for longitudinal measurement invariance and three reciprocal cross-lagged models. Results detected statistically significant cross-lagged and reciprocal cross-lagged effects in the role clarity and organization commitment models, highlighting a reciprocal relationship between managerial coaching behaviors and the two variables. However, only the reciprocal cross-lagged effect was statistically significant in the job satisfaction model. Findings suggest the predictive validity of the CBI scale for role clarity and organization commitment. Moreover, results indicate employee attitudes influenced managerial coaching behaviors over time across all three models, emphasizing the potential impact of employee attitudes on leadership effectiveness. This study highlights the complex relationships between managerial coaching and workplace outcomes, offering nuanced insights for improved understanding.
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Affiliation(s)
- Katie Stone
- Director of Student Wellness and Professional Formation, School of Medicine, The University of Texas at Tyler, Tyler, TX, United States
| | - Kim Nimon
- Department of Human Resource Development, Soules College of Business, The University of Texas at Tyler, Tyler, TX, United States
| | - Andrea D. Ellinger
- Department of Human Resource Development, Soules College of Business, The University of Texas at Tyler, Tyler, TX, United States
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Estaki M, Langsetmo L, Shardell M, Mischel A, Jiang L, Zhong Y, Kaufmann C, Knight R, Stone K, Kado D. Association of Subjective and Objective Measures of Sleep With Gut Microbiota Composition and Diversity in Older Men: The Osteoporotic Fractures in Men Study. J Gerontol A Biol Sci Med Sci 2023; 78:1925-1932. [PMID: 36655399 PMCID: PMC10562887 DOI: 10.1093/gerona/glad011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Growing evidence suggests bidirectional links between gut microbiota and sleep quality as shared contributors to health. Little is known about the relationship between microbiota and sleep among older persons. METHODS We used 16S rRNA sequencing to characterize stool microbiota among men (n = 606, mean [standard deviation] age = 83.9 [3.8]) enrolled in the Osteoporotic Fractures in Men (MrOS) study from 2014 to 2016. Sleep was assessed concurrently by a questionnaire (Pittsburgh Sleep Quality index [PSQI]), and activity monitor to examine timing (acrophase) and regularity of patterns (F-statistic). Alpha diversity was measured using Faith's phylogenetic diversity (PD). Beta diversity was calculated with robust Aitchison distance with matrix completion (RPCA) and phylogenetic-RPCA (PRPCA). Their association with sleep variables was tested with partial distance-based redundancy analysis (dbRDA). Predictive-ratio biomarkers associated with sleep measurements were identified with CoDaCoRe. RESULTS In unadjusted analyses, men with poor sleep (PSQI >5) tended to have lower alpha diversity compared to men with normal sleep (Faith's PD, beta = -0.15; 95% confidence interval [CI]: -0.30 to 0.01, p = .06). Sleep regularity was significantly associated with RPCA and PRPCA, even after adjusting for site, batch, age, ethnicity, body mass index, diabetes, antidepressant and sleep medication use, and health behaviors (RPCA/PRPCA dbRDA; p = .033/.002). In taxonomic analysis, ratios of 7:6 bacteria for better regularity (p = .0004) and 4:7 for worse self-reported sleep (p = .005) were differentially abundant: some butyrate-producing bacteria were associated with better sleep characteristics. CONCLUSIONS Subjective and objective indicators of sleep quality suggest that older men with better sleep patterns are more likely to harbor butyrate-producing bacteria associated with better health.
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Affiliation(s)
- Mehrbod Estaki
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Michelle Shardell
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Mischel
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Lingjing Jiang
- Janssen Research and Development Los Angeles, Los Angeles, California, USA
| | - Yuan Zhong
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Christopher Kaufmann
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rob Knight
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
- UC San Diego Center for Microbiome Innovation, La Jolla, California, USA
- Department of Computer Science and Engineering, UC San Diego, La Jolla, California, USA
- Department of Bioengineering, UC San Diego, La Jolla, California, USA
| | - Katie Stone
- Department of Research, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Deborah Kado
- Geriatrics Section, Stanford University School of Medicine, Palo Alto, California, USA
- Veterans Health Administration, Geriatrics Research Education and Clinical Center, Palo Alto, California, USA
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Stone K, Sullivan L, Korman R. Suspect severe gastroenteritis associated with ingestion of caterpillar setae fragments in a cat. Aust Vet J 2023. [PMID: 37082941 DOI: 10.1111/avj.13247] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
A 6-month-old male neutered Domestic Shorthair cat was assessed for a 24-h history of anorexia, lethargy, depressed mentation, mild abdominal pain and persistent bradycardia. Abdominal ultrasound revealed marked thickening of the gastric wall, gastric distension, free abdominal fluid, distension and corrugation of the small intestine. Full-thickness histopathological biopsy of the gastric wall demonstrated intralesional chitinous structures whose morphology (size and presence of obvious barbs) supports these structures being urticating hairs (setae). A processionary caterpillar is considered most likely as these are the most common urticating caterpillars in Australia. This is the first case of suspected severe gastroenteritis associated with the ingestion of caterpillar setae fragments in a cat.
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Affiliation(s)
- K Stone
- Veterinary Specialist Services, The Centre @ Springwood, Underwood, Queensland, 4119, Australia
| | - L Sullivan
- QML Vetnostics, Murarrie, Queensland, 4172, Australia
| | - R Korman
- Veterinary Specialist Services, The Centre @ Springwood, Underwood, Queensland, 4119, Australia
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Edelson JL, Schneider LD, Amar D, Brink-Kjaer A, Cederberg KL, Kutalik Z, Hagen EW, Peppard PE, Tempaku PF, Tufik S, Evans DS, Stone K, Tranah G, Cade B, Redline S, Haba-Rubio J, Heinzer R, Marques-Vidal P, Vollenweider P, Winkelmann J, Zou J, Mignot E. The genetic etiology of periodic limb movement in sleep. Sleep 2023; 46:zsac121. [PMID: 35670608 PMCID: PMC10091093 DOI: 10.1093/sleep/zsac121] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/12/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Periodic limb movement in sleep is a common sleep phenotype characterized by repetitive leg movements that occur during or before sleep. We conducted a genome-wide association study (GWAS) of periodic limb movements in sleep (PLMS) using a joint analysis (i.e., discovery, replication, and joint meta-analysis) of four cohorts (MrOS, the Wisconsin Sleep Cohort Study, HypnoLaus, and MESA), comprised of 6843 total subjects. METHODS The MrOS study and Wisconsin Sleep Cohort Study (N = 1745 cases) were used for discovery. Replication in the HypnoLaus and MESA cohorts (1002 cases) preceded joint meta-analysis. We also performed LD score regression, estimated heritability, and computed genetic correlations between potentially associated traits such as restless leg syndrome (RLS) and insomnia. The causality and direction of the relationships between PLMS and RLS was evaluated using Mendelian randomization. RESULTS We found 2 independent loci were significantly associated with PLMS: rs113851554 (p = 3.51 × 10-12, β = 0.486), an SNP located in a putative regulatory element of intron eight of MEIS1 (2p14); and rs9369062 (p = 3.06 × 10-22, β = 0.2093), a SNP located in the intron region of BTBD9 (6p12); both of which were also lead signals in RLS GWAS. PLMS is genetically correlated with insomnia, risk of stroke, and RLS, but not with iron deficiency. Pleiotropy adjusted Mendelian randomization analysis identified a causal effect of RLS on PLMS. CONCLUSIONS Because PLMS is more common than RLS, PLMS may have multiple causes and additional studies are needed to further validate these findings.
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Affiliation(s)
- Jacob L Edelson
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Logan D Schneider
- Stanford/VA Alzheimer’s Research Center, Palo Alto, CA 94603, USA
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - David Amar
- Stanford Department of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Andreas Brink-Kjaer
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Katie L Cederberg
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Zoltán Kutalik
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne 1010, Switzerland
- Swiss Institute of Bioinformatics, Lausanne 1015, Switzerland
| | - Erika W Hagen
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI 53726, USA
| | - Paul E Peppard
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI 53726, USA
| | | | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo 04021002, Brazil
| | - Daniel S Evans
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
| | - Katie Stone
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA
| | - Greg Tranah
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
| | - Brian Cade
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 102115, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 102115, USA
| | - Jose Haba-Rubio
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Raphael Heinzer
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Center Munich (HMGU) Technical University of Munich, 81675 Munich, Germany
- School of Medicine, Institute of Human Genetics Synergy, Cluster of Neuroscience Munich, 52246 Munich, Germany
| | - James Zou
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Emmanuel Mignot
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
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Sullivan DR, Wisnivesky JP, Nugent SM, Stone K, Farris MK, Kern JA, Swanson S, Smith CB, Rosenzweig K, Slatore CG. Decision Regret among Patients with Early-stage Lung Cancer Undergoing Radiation Therapy or Surgical Resection. Clin Oncol (R Coll Radiol) 2023; 35:e352-e361. [PMID: 37031075 DOI: 10.1016/j.clon.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/30/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
AIMS Clinical equipoise exists regarding early-stage lung cancer treatment among patients as trials comparing stereotactic body radiation therapy (SBRT) and surgical resection are unavailable. Given the potential differences in treatment effectiveness and side-effects, we sought to determine the associations between treatment type, decision regret and depression. MATERIALS AND METHODS A multicentre, prospective study of patients with stage IA-IIA non-small cell lung cancer (NSCLC) with planned treatment with SBRT or surgical resection was conducted. Decision regret and depression were measured using the Decision Regret Scale (DRS) and Patient Health Questionnaire-4 (PHQ-4) at 3, 6 and 12 months post-treatment, respectively. Mixed linear regression modelling examined associations between treatment and decision regret adjusting for patient sociodemographics. RESULTS Among 211 study participants with early-stage lung cancer, 128 (61%) patients received SBRT and 83 (39%) received surgical resection. The mean age was 73 years (standard deviation = 8); 57% were female; 79% were White non-Hispanic. In the entire cohort at 3 months post-treatment, 72 (34%) and 57 (27%) patients had mild and severe decision regret, respectively. Among patients who received SBRT or surgery, 71% and 46% of patients experienced at least mild decision regret at 3 months, respectively. DRS scores increased at 6 months and decreased slightly at 12 months of follow-up in both groups. Higher DRS scores were associated with SBRT treatment (adjusted mean difference = 4.18, 95% confidence interval 0.82 to 7.54) and depression (adjusted mean difference = 3.49, 95% confidence interval 0.52 to 6.47). Neither patient satisfaction with their provider nor decision-making role concordance was associated with DRS scores. CONCLUSIONS Most early-stage lung cancer patients experienced at least mild decision regret, which was associated with SBRT treatment and depression symptoms. Findings suggest patients with early-stage lung cancer may not be receiving optimal treatment decision-making support. Therefore, opportunities for improved patient-clinician communication probably exist.
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Affiliation(s)
- D R Sullivan
- Division of Pulmonary & Critical Care Medicine (PCCM), OHSU, Portland, OR, USA; Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA.
| | - J P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Division of PCCM Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S M Nugent
- Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA
| | - K Stone
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Division of PCCM Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - M K Farris
- Department of Radiation Oncology, Wake Forest Baptist Atrium Health, Winston-Salem, NC, USA
| | - J A Kern
- Division of Oncology, National Jewish Health, Denver, CO, USA
| | - S Swanson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Division of Surgical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C B Smith
- Division of Hematology and Medical Oncology, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - K Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - C G Slatore
- Division of Pulmonary & Critical Care Medicine (PCCM), OHSU, Portland, OR, USA; Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA; Section of PCCM, VAPORHCS, Portland, OR, USA
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Haghayegh S, Hu K, Stone K, Redline S, Schernhammer E. Automated Sleep Stages Classification Using Convolutional Neural Network From Raw and Time-Frequency Electroencephalogram Signals: Systematic Evaluation Study. J Med Internet Res 2023; 25:e40211. [PMID: 36763454 PMCID: PMC9960035 DOI: 10.2196/40211] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Most existing automated sleep staging methods rely on multimodal data, and scoring a specific epoch requires not only the current epoch but also a sequence of consecutive epochs that precede and follow the epoch. OBJECTIVE We proposed and tested a convolutional neural network called SleepInceptionNet, which allows sleep classification of a single epoch using a single-channel electroencephalogram (EEG). METHODS SleepInceptionNet is based on our systematic evaluation of the effects of different EEG preprocessing methods, EEG channels, and convolutional neural networks on automatic sleep staging performance. The evaluation was performed using polysomnography data of 883 participants (937,975 thirty-second epochs). Raw data of individual EEG channels (ie, frontal, central, and occipital) and 3 specific transformations of the data, including power spectral density, continuous wavelet transform, and short-time Fourier transform, were used separately as the inputs of the convolutional neural network models. To classify sleep stages, 7 sequential deep neural networks were tested for the 1D data (ie, raw EEG and power spectral density), and 16 image classifier convolutional neural networks were tested for the 2D data (ie, continuous wavelet transform and short-time Fourier transform time-frequency images). RESULTS The best model, SleepInceptionNet, which uses time-frequency images developed by the continuous wavelet transform method from central single-channel EEG data as input to the InceptionV3 image classifier algorithm, achieved a Cohen κ agreement of 0.705 (SD 0.077) in reference to the gold standard polysomnography. CONCLUSIONS SleepInceptionNet may allow real-time automated sleep staging in free-living conditions using a single-channel EEG, which may be useful for on-demand intervention or treatment during specific sleep stages.
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Affiliation(s)
- Shahab Haghayegh
- Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Kun Hu
- Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Susan Redline
- Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Eva Schernhammer
- Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
- Medical University of Vienna, Vienna, Austria
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Brady PD, Six-Means A, Sood A, Durante J, Day P, Gimpel N, Stone K. Empowering youth aging out of foster care: a needs assessment to improve transitions to independent living. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00527-x] [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: 01/28/2023]
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Heckler B, Lee M, Stone K, Bauer C, Xiao Q. Cross-sectional and Prospective Associations of Rest-Activity Rhythms With Body Mass Index in Older Men: A Novel Analysis Using Harmonic Hidden Markov Models. J Biol Rhythms 2023; 38:87-97. [PMID: 36416436 PMCID: PMC10074583 DOI: 10.1177/07487304221134163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Growing evidence supports a role for rest-activity rhythms (RARs) in metabolic health. Epidemiological studies in adolescents and young adults showed that RAR characteristics consistent with weakened rhythmicity were associated with obesity. However, studies in older adults are lacking. The objective of this study was to examine the cross-sectional and prospective associations between RAR and obesity in older men using the Harmonic Hidden Markov Model (HHMM), a novel analytical approach with several advantages over conventional methods for characterizing RAR. The analysis included nearly 3,000 participants in the Osteoporotic Fractures in Men study with 5-day 24-h actigraphy data. The strength of RAR was measured by rhythmic index (RI), a scaled value between 0 and 1 with higher values indicating better RAR. Multiple linear and logistic regression adjusting for multiple confounders were performed to examine the RI in relation to body mass index (BMI) and obesity status at baseline and after ~3.5 years of follow-up. We showed that the HHMM can derive both meaningful visual profile and quantifier of RAR. A lower RI was associated with higher BMI and obesity at baseline, and an elevated likelihood for developing obesity over follow-up. Specifically, when compared with men in the highest quartile of RI, those in the lowest quartile on average had a higher BMI (β [95% confidence interval (CI)], 1.76 [1.39, 2.13]) and were more likely to be obese at baseline (odds ratio (OR) [95% CI], 2.63 [2.03, 3.43]). Moreover, among nonobese men at baseline, those in the lowest quartile of RI were 2.06 times (OR [95% CI], 2.06 [1.02, 4.27]) more likely to develop obesity over follow-up when compared with those in the highest quartile. In conclusion, our study demonstrated the utility of HHMM in characterizing RAR and showed that rhythmicity strength was associated with BMI and risk of obesity in older men.
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Affiliation(s)
- Brian Heckler
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Miryoung Lee
- Department of Epidemiology, Human Genetics and Environmental Science, University of Texas Health Science Center at Houston School of Public Health, Brownsville, Texas
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Cici Bauer
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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Shahrbabaki SS, Linz D, Redline S, Stone K, Ensrud K, Baumert M. Sleep Arousal-Related Ventricular Repolarization Lability Is Associated With Cardiovascular Mortality in Older Community-Dwelling Men. Chest 2023; 163:419-432. [PMID: 36244405 PMCID: PMC9899642 DOI: 10.1016/j.chest.2022.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/16/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sleep is fragmented by brief arousals, and excessive arousal burden has been linked to increased cardiovascular (CV) risk, but mechanisms are poorly understood. RESEARCH QUESTION Do arousals trigger cardiac ventricular repolarization lability that may predispose people to long-term cardiovascular mortality? STUDY DESIGN AND METHODS This study analyzed 407,541 arousals in the overnight polysomnograms of 2,558 older men in the Osteoporotic Fractures in Men sleep study. QT and RR intervals were measured beat-to-beat starting 15 s prior to arousal onset until 15 s past onset. Ventricular repolarization lability was quantified by using the QT variability index (QTVi). RESULTS During 10.1 ± 2.5 years of follow-up, 1,000 men died of any cause, including 348 CV deaths. During arousals, QT and RR variability increased on average by 5 and 55 ms, respectively, resulting in a paradoxical transient decrease in QTVi from 0.07 ± 1.68 to -1.00 ± 1.68. Multivariable Cox proportional hazards analysis adjusted for age, BMI, cardiovascular and respiratory risk factors, sleep-disordered breathing and arousal, diabetes, and Parkinson disease indicated that excessive QTVi during arousal was independently associated with all-cause and CV mortality (all-cause hazard ratio, 1.20 [95% CI, 1.04-1.38; P = .012]; CV hazard ratio, 1.29 [95% CI, 1.01 -1.65; P = .043]). INTERPRETATION Arousals affect ventricular repolarization. A disproportionate increase in QT variability during arousal is associated with an increased all-cause and CV mortality and may reflect ventricular repolarization maladaptation to the arousal stimulus. Whether arousal-related QTVi can be used for more tailored risk stratification warrants further study, including evaluating whether arousal suppression attenuates ventricular repolarization lability and reduces subsequent mortality. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT00070681; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Susan Redline
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Kristine Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
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Cavaillès C, Yaffe K, Blackwell T, Buysse D, Stone K, Leng Y. Multidimensional Sleep Health and Long-Term Cognitive Decline in Community-Dwelling Older Men. J Alzheimers Dis 2023; 96:65-71. [PMID: 37742655 PMCID: PMC11021854 DOI: 10.3233/jad-230737] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Specific sleep characteristics have been associated with cognitive decline, Alzheimer's disease, and related dementias; however, studies examining the association between multidimensional sleep (a more comprehensive integration of sleep parameters) and cognitive decline are lacking. Among 2,811 older men without dementia, those with none, 1-2, and 3-5 "poor" self-reported sleep health dimensions had an adjusted 10-year change score of global cognition (3MS) of 2.9, 4.0 and 3.5 points (p-trend = 0.05), and in executive function (Trails B) completion time of 36.7, 42.7, and 46.7 seconds (p-trend < 0.01), respectively. In conclusion, a multidimensional measure of sleep health was associated with greater cognitive decline.
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Affiliation(s)
- Clémence Cavaillès
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Neurology and Epidemiology, University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Terri Blackwell
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Daniel Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Katie Stone
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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11
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Cauley J, Harrison S, Cawthon P, Kubala A, Ensrud K, Crandall C, Buysse D, Stone K. MULTIDIMENSIONAL SLEEP HEALTH AND RECURRENT FALLS: THE OSTEOPOROTIC FRACTURES IN MEN STUDY (MROS). Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1175] [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: 12/24/2022] Open
Abstract
Abstract
Prospective studies have reported associations between individual dimensions of sleep and subsequent falls. Considering sleep as a multidimensional construct may provide a more comprehensive assessment. Using data from the MrOS Sleep study, we calculated a multidimensional index of sleep, operationalized as the number of disturbances in 5 dimensions of sleep (self-reported “poor”: satisfaction, duration, daytime sleepiness, latency and sleep midpoint) and categorized as: 0, 1-2, >=3. A total of 3111 men, mean age 76.4 years, were studied. Logistic regression generalized estimating equations were used to model repeated measures of annually self-reported recurrent falls (≥2 falls) over 4 years of follow-up. Compared to men with no poor sleep dimensions, the Odds Ratio (OR) of recurrent falls in men with scores of 1 or 2 was 1.13 (95% Confidence Intervals, 0.96, 1.34), and in men with scores >3, the OR was 1.46(1.15, 1.84). Worse multidimensional sleep health was associated with recurrent falls.
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Affiliation(s)
- Jane Cauley
- University of Pittsburgh , Pittsburgh, Pennsylvania , United States
| | - Stephanie Harrison
- California Pacific Medical Center, Research Institute , San Francisco, California , United States
| | - Peggy Cawthon
- California Pacific Medical Center Research Institute , San Francisco, California , United States
| | - Andrew Kubala
- Sleep, Tactical Efficiency, and Endurance Lab (STEEL) Research Group , San Diego, California , United States
| | - Kristine Ensrud
- University of Minnesota Medical School and Minneapolis VA Health Care System , Minneapolis, Minnesota , United States
| | - Carolyn Crandall
- University of California, Los Angeles , Los Angeles, California , United States
| | | | - Katie Stone
- University of California, San Francisco , Castro Valley, California , United States
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12
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Mu C, Jester D, Cawthon P, Stone K, Lane N, Lee S. SUBJECTIVE SOCIAL STATUS MODERATES BACK PAIN AND MENTAL HEALTH: A LONGITUDINAL ANALYSIS OF OLDER MEN. Innov Aging 2022. [PMCID: PMC9766402 DOI: 10.1093/geroni/igac059.1933] [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: 12/24/2022] Open
Abstract
Objectives. This study tested the longitudinal relationship between back pain and mental health and examined the moderating role of subjective social status (SSS). Method. Community-dwelling older men from the MrOS Study provided four study visits of data collected between 2000-2016 (15,975 observations nested within 5,979 participants). Back pain frequency and severity were assessed at visits 1-4. General mental health was measured at each visit by the 12-item Short Form Survey Mental Component Score (SF-12 MCS; higher scores representing better mental health). National and community SSS were assessed at visits 1 and 3 with the MacArthur Scale. Growth curve models tested longitudinal within-person change associations after accounting for the repeated measures within each person. Age was used as the primary time variable. Results. At baseline, those with higher back pain-frequency/severity reported lower SF-12 MCS. After accounting for this between-person difference, there were bidirectional within-person associations between back pain frequency/severity and SF-12 MCS. On follow-up visits when back pain frequency/severity increased from baseline, participants reported lower SF-12 MCS (p<.001). On follow-up visits when SF-12 MCS decreased from baseline, participants also reported higher back pain frequency/severity (p<.001). Higher national and community SSS at baseline and having increases or consistently higher SSS over time attenuated the negative relationships between back pain frequency/severity and SF-12 MCS. Results were consistent after controlling for an extensive list of baseline health covariates and pain medications. Discussion. These findings highlight how self-perceived social status may buffer the relationship between greater back pain frequency/severity and lower mental health.
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Affiliation(s)
- Christina Mu
- University of South Florida, Tampa, Florida, United States
| | - Dylan Jester
- University of California San Diego, La Jolla, California, United States
| | - Peggy Cawthon
- California Pacific Medical Center Research Institute, San Francisco, California, United States
| | - Katie Stone
- University of California, San Francisco, Castro Valley, California, United States
| | - Nancy Lane
- University of California, Davis Health, Davis, California, United States
| | - Soomi Lee
- University of South Florida, Tampa, Florida, United States
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13
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Xiao Q, Sampson J, Shadyab A, LaCroix A, Yaffe K, Stone K. ASSOCIATIONS BETWEEN SLEEP AND REST: ACTIVITY CHARACTERISTICS AND METABOLOMIC PROFILES IN OLDER MEN. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1437] [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: 12/24/2022] Open
Abstract
Abstract
The association of sleep and rest-activity rhythms (RAR) with metabolic health is not fully understood. Previous studies have identified multiple metabolite markers in amino acid and lipid pathways associated with various characteristics of sleep. However, most of the studies used self-reported sleep, and limited studies have examined 24-hour RAR profiles, a more complete picture of activity. We studied 950 older men and measured metabolomics from fasting blood samples. We identified numerous metabolomic markers that were cross-sectionally associated with actigraphy-based measures of sleep (total sleep time, sleep efficiency, sleep timing) and RAR (amplitude, acrophase, mesor and overall rhythmicity). The majority of the associated metabolites were amino acids and lipids from a wide range of pathways, including metabolism pathways of branched chain amino acid metabolism, fatty acids, and gamma-glutamyl amino acids. Our preliminary findings suggest that sleep and RAR are widely involved in human metabolism.
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Affiliation(s)
- Qian Xiao
- The University of Texas Health Science Center at Houston , Houston, Texas , United States
| | | | - Aladdin Shadyab
- University of California, San Diego , La Jolla, California , United States , 4 , San Francisco, California , United States
- University of California, San Francisco , La Jolla, California , United States , 4 , San Francisco, California , United States
| | - Andrea LaCroix
- University of California, San Diego , La Jolla, California , United States , 4 , San Francisco, California , United States
- University of California, San Francisco , La Jolla, California , United States , 4 , San Francisco, California , United States
| | - Kristine Yaffe
- University of California, San Francisco, San Francisco, California, United States
| | - Katie Stone
- University of California, San Francisco, San Francisco, California, United States
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14
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Allen HL, Gmelin T, Moored KD, Boudreau RM, Smagula SF, Cohen RW, Katz R, Stone K, Cauley JA, Glynn NW. Relationship Between Personality Measures and Perceived Mental Fatigability. J Aging Health 2022; 34:750-760. [PMID: 34821521 PMCID: PMC9130341 DOI: 10.1177/08982643211055032] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Examine the association between personality measures and perceived mental fatigability. METHODS We performed a cross-sectional analysis in N=1670 men, age 84.3±4.1 years. Multivariable linear regression models were used to examine the covariate adjusted association between personality measures (conscientiousness, optimism, goal reengagement, and goal disengagement) and perceived mental fatigability (measured with the validated 10-item Pittsburgh Fatigability Scale, PFS). RESULTS One standard deviation lower conscientiousness (β=-0.91, p<.0001) and optimism (β=-0.63, p<.0001), and higher goal reengagement (β=0.51, p=.01) scores were independently associated with higher PFS Mental scores adjusted for age, cognitive function, self-reported health status, depressive symptoms, sleep disturbance, physical activity, and goal disengagement. DISCUSSION Lower conscientiousness, optimism, and higher goal reengagement were linked with more severe perceived mental fatigability in older men. Personality traits may potentially contribute to early risk assessment for fatigability in later life. Future work should be longitudinal in nature and include personality assessments to confirm the temporality of the relationships observed.
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Affiliation(s)
- Hannah L. Allen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Kyle D. Moored
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen F. Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rebecca W. Cohen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Rain Katz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nancy W. Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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15
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Wallace M, Lee S, Stone K, Hall M, Smagula S, Redline S, Ensrud K, Ancoli-Israel S, Buysse D. 0316 Actigraphy-Derived Sleep Health Profiles and Mortality in Older Men and Women. Sleep 2022. [DOI: 10.1093/sleep/zsac079.314] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
To identify actigraphy sleep health profiles in older men (Osteoporotic Fractures in Men Study; N=2,640) and women (Study of Osteoporotic Fractures; N=2.430), and to determine whether the identified profiles predict mortality.
Methods
We applied a novel and flexible clustering approach (Multiple Coalesced Generalized Hyperbolic mixture modeling) to identify sleep health profiles based on actigraphy midpoint timing, midpoint variability, sleep interval length, continuity, and napping/inactivity. Adjusted Cox models were used to determine whether profile membership predicts time to all-cause mortality.
Results
We identified similar profiles with different prevalences in men and women: High Sleep Propensity [HSP] (20% of women; 39% of men; high napping and high continuity); Adequate Sleep [AS] (74% of women; 31% of men; average actigraphy levels); and Abnormal Continuity/Timing [ACT] (6% of women; 30% of men; low continuity and late/variable midpoint). In women, ACT was associated with increased mortality risk (Hazard Ratio [HR]=1.59 for ACT vs. AS; 1.75 for IS vs. HSP). In men, ACT and AS were associated with increased mortality risk relative to HSP (1.19 for IS vs. HSP; 1.22 for AS vs. HSP).
Conclusion
These findings suggest several considerations for sleep-related interventions in older adults. For instance, interventions may be developed to target the combination of low continuity with late/variable midpoint. Findings also indicate that high napping/inactivity co-occurs with high sleep continuity in some older adults. Although high napping/inactivity is typically considered a risk factor for deleterious health outcomes, our findings suggest that it may not be inherently problematic when occurring in combination with high sleep continuity.
Support (If Any)
The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH grants U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, UL1 TR000128, R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Study of Osteoporotic Fractures (SOF) is supported by NIH grants R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576, and R01 AG026720. This study is also supported by NIH grants R01AG056331 and RF1AG056331 (PI: Wallace), R56AG065251 (PI: Lee), K01MH112683 (PI: Smagula), and R35HL135815 (PI: Redline).
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Affiliation(s)
| | | | | | - Martica Hall
- Department of Psychiatry, University of Pittsburgh
| | | | - Susan Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kristine Ensrud
- Division of Epidemiology and Community Health, University of Minnesota
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16
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Leng Y, Johnson L, Stone K, Redline S, O'Bryant S, Yaffe K. 0332 Objective and subjective sleep quality in Mexican Americans and non-Hispanic Whites: the HABLE-Dormir Study. Sleep 2022. [DOI: 10.1093/sleep/zsac079.330] [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
The ongoing prospective Health & Aging Brain among Latino Elders (HABLE)-Dormir Study is designed to investigate the association between objective and subjective sleep quality and cognitive impairment among Mexican Americans and non-Hispanic Whites (NHWs).
Methods
We plan to recruit 1000 community-dwelling Mexican Americans and NHWs and elders (age 50 and above). Objective sleep duration and fragmentation were assessed by 7-day wrist actigraphy; presence of sleep disordered breathing (SDB) was determined using WatchPAT; and subjective sleep quality and excessive daytime sleepiness (EDS) were examined by Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.
Results
To date, 367 participants have been enrolled (62% women, 45% Mexican Americans, mean age 67.3±8.4 years); 296 (81%) of the participants had normal cognition, 56 (15%) had mild cognitive impairment (MCI), and 15 (4%) had dementia. On average, participants had a mean sleep duration of 7.3±1.1 hours, sleep efficiency of 88.3±5.3%, and wake after sleep onset (WASO) of 55.2±29.3 minutes. Almost half (51%) of the participants had moderate to severe SDB defined by WatchPAT-derived respiratory event index (REI) >=15, 54% had self-reported poor sleep quality (PSQI>5), and 10% reported EDS (ESS>=11). After adjustment for age, Mexican Americans had lower sleep efficiency (86.5% vs. 89.5%, p<0.001) and greater WASO (63.6 vs. 48.9 minutes, p<0.001), compared to NHWs. Sleep duration did not differ significantly among NHWs (7.2 hours) and Mexican Americans (7.4 hours); p=0.20. The prevalence of moderate to severe SDB was similar in NHWs (51.2%) and Mexican Americans (50.0%); p=0.84. Besides, NHWs and Mexican Americans had similar PSQI and prevalence of EDS.
Conclusion
In this initial analysis, Mexican Americans have worse objective sleep quality, but similar sleep duration, prevalence of SDB and subjective sleep quality as compared to NHWs. Continued investigations are needed to explore potential racial/ethnic disparities in sleep health and how differences in objective and subjective measurements vary by race and ethnicity.
Support (If Any)
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Affiliation(s)
- Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Leigh Johnson
- Institute for Translational Research University of North Texas Health Science Center at Fort Worth
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA; Department of Epidemiology and Biostatsitcs, University of California, San Francisco
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital; Harvard Medical School
| | - Sid O'Bryant
- Institute for Translational Research University of North Texas Health Science Center at Fort Worth
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Neurology, and Epidemiology, University of California, San Francisco, San Francisco VA Medical Center
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Haghayegh S, Hu K, Stone K, Redline S, Schernhammer E. 0085 SleepInceptionNet: A Deep Learning Algorithm for Real-Time Sleep Stages Scoring Using Single-channel EEG. Sleep 2022. [DOI: 10.1093/sleep/zsac079.083] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Most of the current automatic polysomnography sleep staging methods use multi-signal data and require a sequence of preceding and following epochs to score the stage of a specific epoch, which may not be desirable for analysis in real-time and/or in free-living conditions. We developed a deep learning-based sleep staging algorithm, namely SleepInceptionNet, that is designed to score each epoch using only single-channel electroencephalogram (EEG) data within that specific epoch.
Methods
Polysomnography data of 883 participants (937,975 thirty-second epochs) in the Multi-Ethnic Study of Atherosclerosis (MESA) obtained from the National Sleep Research Resource (NSRR) were randomly divided into a separate training/validation set of 194 participants and a test set of 689 participants. Each 30-second raw central EEG channel signal was transformed to time-frequency domain images using continuous wavelet transform method. Sleep stage in each epoch was obtained using SleepInceptionNet, in which the InceptionV3 convolutional neural network structure was trained and tuned on the time-frequency images of the training set to classify each epoch into one of the five stages of Wake, N1, N2, N3, or rapid eye movement (REM) sleep.
Results
Compared to the ground truth manually scored polysomnography sleep stages, SleepInceptionNet achieved an overall kappa agreement of 0.690 and overall weighted accuracy of 0.897. The model showed accuracy (mean±SD across the test set participants) of 0.940±0.067 in detecting Wake, 0.883±0.047 in detecting N1, 0.845±0.055 in detecting N2, 0.939±0.038 in detecting N3, and 0.930±0.038 in detecting REM epochs, in reference to manually scored polysomnography.
Conclusion
SleepInceptionNet showed a high agreement with manually scored polysomnography in epoch-by-epoch classification of sleep stages. This study demonstrates the viability of real-time, accurate sleep staging using a single-channel EEG, which could have a variety of applications such as delivery of on-demand interventions during specific sleep stages in free-living conditions.
Support (If Any)
MESA Sleep Ancillary study was funded by NIH-NHLBI Association of Sleep Disorders with Cardiovascular Health Across Ethnic Groups (RO1 HL098433). MESA is supported by NHLBI (HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01- HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169) and NCATS (UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420). NSRR was supported by NHLBI (R24 HL114473, 75N92019R002).
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Affiliation(s)
| | - Kun Hu
- Harvard Medical School/Brigham and Women's Hospital
| | - Katie Stone
- California Pacific Medical Center Research Institute
| | | | - Eva Schernhammer
- Harvard Medical School/Brigham and Women's Hospital/Harvard School of Public Health/Medical University of Vienna
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18
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Miner B, Yaggi H, Gill T, Doyle M, Stone K, Redline S, Ensrud K, Blackwell T, Knauert M. 0321 Poor Agreement Among Self-Reported and Objective Sleep Deficiency Assessments in Older Persons. Sleep 2022. [DOI: 10.1093/sleep/zsac079.319] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Many traditional sleep questionnaires were developed in younger populations and may have poor sensitivity to detect objective sleep deficiency in older persons due to atypical presentations, aging-related decreases in symptom awareness, and different expectations about health.
Methods
In a secondary analysis of data from the Osteoporotic Fractures in Men (MrOS; Sleep Visit 1) and the Study of Osteoporotic Fractures (SOF Visit 9), we evaluated the prevalence of objective sleep deficiency among persons with scores in the normal range on traditional sleep questionnaires (Pittsburgh Sleep Quality Index [PSQI] <6 and Epworth Sleepiness Scale [ESS] <11). Objective sleep deficiency was established based on presence of sleep-disordered breathing (SDB; apnea hypopnea index [at >4% desaturation] per hour of sleep ≥15 on polysomnography), insufficient sleep duration (average sleep duration <6 hours on actigraphy), or impairment in daytime sustained attention/alertness (falling in the worst quartile of Digit Vigilance Test scores for the sex-specific cohort).
Results
Average ages were 76±6 and 84±4 years in men and women, respectively. Among men with normal scores on the PSQI and ESS, 359/1527 (25%) had SDB, 428/1519 (28%) had insufficient sleep duration, and 346/1527 (23%) had impaired daytime attention/alertness. Among women with normal scores on both the PSQI and ESS, 72/185 (40%) had SDB, 318/1332 (24%) had insufficient sleep duration, and 140/546 (26%) had impaired daytime attention/alertness.
Conclusion
A substantial proportion of older men and women with normal scores on traditional sleep questionnaires have objective sleep deficits, suggesting a need to develop instruments to improve detection of sleep deficiency in this population.
Support (If Any)
American Academy of Sleep Medicine Foundation, Yale Claude D. Pepper Older Americans Independence Center, Patterson Trust, National Institute on Aging
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Affiliation(s)
| | | | | | | | - Katie Stone
- California Pacific Medical Center Research Institute
| | | | - Kristine Ensrud
- University of Minnesota and Veterans Affairs Health Care System
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19
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Brink-Kjaer A, Leary E, Sun H, Westover MB, Stone K, Peppard P, Lane N, Cawthon P, Redline S, Jennum P, Mignot E, Sorensen H. 0319 Age Estimation from Sleep using Deep Learning Predicts Life Expectancy. Sleep 2022. [DOI: 10.1093/sleep/zsac079.317] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep disturbances increase with age and are predictors of mortality. However, summary metrics typically derived in sleep clinics from gold standard clinical analysis of polysomnograms (PSGs) only represent a very small fraction of data collected. In this study, we designed deep neural networks that estimate age as a proxy for overall health using full PSG signals. Age estimation was next used to evaluate association to mortality risk.
Methods
Aging was modeled using 2,500 PSGs and tested in 10,808 PSGs from men and women in 7 different cohorts aged between 20 and 90. The deep neural network was trained using as a regression model of age in the 2,500 PSGs roughly uniformly distributed across 6 to 90 years. The estimates of the network were interpreted using Gradient SHAP, which attributes relevance scores to the input in terms of the age estimate. The association between age estimate error (AEE), which is the residual of the estimate, and mortality risk was investigated with Cox proportional hazards models that adjusted for demographics, sleep, and health covariates.
Results
Ages were estimated with a mean absolute error of 5.81 ± 1.18 years, while a linear regression model using basic sleep scoring measures had an error of 15.10 ± 6.48 years. Interpretation of the network revealed that patterns such as arousal, sleep apnea, and sleep stage transitions contribute to the age estimate. Each 10-year increment in AEE was associated with increased all-cause mortality rate of 28 % (95% confidence interval: 19–38 %) and cardiovascular mortality rate of 38 % (95% confidence interval: 19 – 59 %). An increase from -10 to +10 years in AEE translates to an estimated decreased life expectancy of 6.21 years (95% confidence interval: 4.31–8.21 years).
Conclusion
Greater AEE was mostly reflected in increased sleep fragmentation, suggesting this is an important biomarker of future health independent of sleep apnea.
Support (If Any)
The Klarman Family Foundation and grants HL46380, M01 RR00080-39, T32-HL07567, RO1-46380, U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL64360, U01HL53938, U01HL53940, U01HL53941, U01HL63463, 38-PM-07, R01HL62252, R01AG036838, R01AG058680, 1UL1RR025011, U01AG027810, U01AG042124, U01AG042139, U01AG042140, U01AG042143, U01AG042145, U01AG042168, U01AR066160, UL1TR000128, R01HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, R01HL070839, R24HL114473, and 75N92019R002.
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20
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Chen D, Tranah G, Bradshaw P, Blackwell-Hoge T, Zeitzer J, Ancoli-Israel S, Yaffe K, Stone K. Rest-Activity Rhythm Patterns and Physical Functional Performance in Community-Dwelling Older Men. Innov Aging 2021. [PMCID: PMC8680485 DOI: 10.1093/geroni/igab046.1305] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Sleep and activity patterns have been linked to physical performance in older adults. Traditional parametric models of 24-hour activity rhythms fail to adequately capture specific diurnal sleep and wake patterns; functional principal components analysis (fPCA) is a non-parametric approach that addresses this limitation. Using fPCA, we modeled accelerometry data from n = 2,960 participants in the Osteoporotic Fractures in Men (MrOS) ancillary sleep study (mean age 77y) and examined cross-sectional associations with gait speed and grip strength measurements. Lower daytime activity (expected difference = -0.049 [-0.072, -0.028] m/s), increased sleep duration and a reduced midday dip in activity (-0.015 [-0.035, 0.006] m/s) were modestly associated with worsening gait speed. A modest association between both later sleep and wake times and increased sleep duration with worsening grip strength outcomes was observed (-1.11 [-1.90, -0.32] kg). Specific daily activity patterns may serve as predictive biomarkers for changing physical function in aging populations.
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Affiliation(s)
- Dorothy Chen
- Sutter Health, SAN FRANCISCO, California, United States
| | | | | | | | - Jamie Zeitzer
- Stanford University, Palo Alto, California, United States
| | | | | | - Katie Stone
- University of California, Berkley, San Francisco, California, United States
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21
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Roe LS, Harrison S, Cawthon P, Moored K, Ensrud K, Stone K, Gabriel KP, Cauley J. Association of Sedentary and Active Bout Frequency With Mortality in Older Men Using Accelerometry. Innov Aging 2021. [PMCID: PMC8681899 DOI: 10.1093/geroni/igab046.3467] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Time spent sedentary increases with age and has several negative health consequences. We sought to examine associations between daily sedentary and active bout frequency with all-cause mortality. METHODS: Data are from 2,918 men in the Osteoporotic Fractures in Men (MrOS) study (mean age at Visit 3±SD: 79.0±5.1 years) with valid activity monitor data (5.1±0.3 days worn>90%) at Year 7 visit (Visit 3, 2007-2009). Sedentary and active bout frequencies are defined as the daily transition frequency from a sedentary bout lasting 5+ minutes to activity of any intensity, and the transition frequency from an active bout lasting 5+ minutes to sedentary. Deaths were centrally adjudicated using death certificates. Cox proportional hazard models were used to examine associations between quartiles of sedentary (Q1 referent, <13.6 bouts/day) or active (Q1 referent, <5 bouts/day) bout frequency and mortality. Models were repeated, stratifying by median daily total time spent sedentary and active. RESULTS: After 9.4±3.7 years of follow-up, 1,487 (51.0%) men died. Men averaged 16.9±5.1 and 8.2±4.2 sedentary and active bouts/day, respectively. After full covariate adjustment, each quartile reflecting a higher sedentary (Q4 vs Q1 HR: 0.68, 95%CI: 0.58-0.81, p-trend<0.001) and active bout (Q4 vs Q1 HR: 0.57, 95%CI: 0.48-0.68, p-trend<0.001) frequency was associated with lower mortality risk. There was no evidence that effects differed by total sedentary time (p-interaction for sedentary bout frequency and total sedentary time>0.05). CONCLUSIONS: More frequent, prolonged sedentary and active bouts are associated with a lower mortality risk in older men and is not moderated by total sedentary time.
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Affiliation(s)
- Lauren S Roe
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Stephanie Harrison
- California Pacific Medical Center, Research Institute, San Francisco, California, United States
| | - Peggy Cawthon
- California Pacific Medical Center, Research Institute, San Francisco, California, United States
| | - Kyle Moored
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kristine Ensrud
- University of Minnesota, Minneapolis, Minnesota, United States
| | - Katie Stone
- University of California, Berkley, San Francisco, California, United States
| | | | - Jane Cauley
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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22
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Smail E, Maher B, Moore A, Kuo PL, Wu M, Low D, Stone K, Spira A. Links of Sleep Duration with Biomarkers of Accelerated Aging: the Baltimore Longitudinal Study of Aging. Innov Aging 2021. [PMCID: PMC8681407 DOI: 10.1093/geroni/igab046.2512] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Sleep disorders and sleep deprivation have been linked to markers of biological aging, including methylation change and increases in white blood cell and neutrophil counts. However, little is known regarding the association of sleep duration with biological markers of aging. We investigated links of self-reported sleep duration with biological aging markers in 615 participants in the Baltimore Longitudinal Study of Aging (BLSA) aged ≥50 years (mean = 71.0 ± 11.2, 49.6% women, 68.8% white) with data on self-reported sleep duration in hours (i.e., ≤6 (n=131), >6 to 7 (n=234), >7 (n=250)), demographics, and genetic and methylation data (mDNA). Our aging biomarker outcomes were four epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge), mDNA-estimated PAI1, and estimated granulocyte count. After adjustment for age, sex, and race, compared to those sleeping ≤6 hours, those reporting >7 hours of sleep had faster biological aging according to Hannum age-acceleration, PhenoAge, GrimAge, mDNA-estimated PAI1, and granulocyte count. In addition, sleep duration interacted with age, such that compared to individuals reporting ≤6 hours of sleep, individuals reporting >6 to 7 hours showed lower GrimAge with increasing age, and with sex, such that males with longer sleep duration (>6 to 7 and >7 hours) showed a lower granulocyte count compared to females. Findings suggest that both short and long sleep duration are associated with and may contribute to accelerated aging. Prospective studies in larger samples are needed to examine whether changes in sleep duration precede changes in aging biomarkers.
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Affiliation(s)
- Emily Smail
- University of Florida, Baltimore, Maryland, United States
| | - Brion Maher
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Ann Moore
- National Institute on Aging, Baltimore, Maryland, United States
| | - Pei-Lun Kuo
- National Institute on Aging, Baltimore, Maryland, United States
| | - Mark Wu
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Dominique Low
- University of California, Berkley, San Francisco, California, United States
| | - Katie Stone
- Stanford University School of Medicine, Stanford, California, United States
| | - Adam Spira
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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23
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Xiao Q, Sampson JN, LaCroix AZ, Shadyab AH, Zeitzer JM, Ancoli-Israel S, Yaffe K, Stone K. Nonparametric parameters of 24-hour rest-activity rhythms and long-term cognitive decline and incident cognitive impairment in older men. J Gerontol A Biol Sci Med Sci 2021; 77:250-258. [PMID: 34558603 DOI: 10.1093/gerona/glab275] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Altered 24-hour rest-activity rhythms may be associated with cognitive impairment in older adults, but evidence from prospective studies is limited. Non-parametric methods were used to assess actigraphy-based activity patterns in 2,496 older men. Incident cognitive impairment was assessed four times over 12 years using the Modified Mini Mental State Examination (3MS) and Trails B tests, self-reported medication use, and clinical diagnosis. The highest quartile (vs. the lowest) of intradaily variability and the lowest quartiles (vs. the highest) of interdaily stability and relative amplitude were associated with incident cognitive impairment ((Hazard ratio (95% confidence interval): 1.82 (1.31, 2.53)), 1.36 (0.99, 1.86), and 1.85 (1.33, 2.56), respectively). A larger increase in intradaily variability over 7.5 years was associated with a greater subsequent decline in 3MS scores but not in Trails B performance. In conclusion, less stable and more variable rest-activity rhythms may represent early biomarkers of cognitive impairment in older men.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua N Sampson
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, Center for Circadian Biology, University of California, San Diego, La Jolla, CA
| | - Kristin Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
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Haines A, Shadyab A, Saquib N, Stone K, Wassertheil-smoller SW. Abstract 030: The Association Of Hypnotics With Incident Cardiovascular Disease And Mortality Among Post-menopausal Women With Sleep Disturbances. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Chronic insomnia is common in post-menopausal women and is associated with higher cardiovascular disease (CVD) risk. Hypnotics are a second-line therapy after cognitive behavioral therapy for management of chronic insomnia. Among the hypnotics, nonbenzodiazepine GABA agonists (Z-drugs) are commonly prescribed. However, it is unclear whether Z-drug use and other hypnotic use is associated with risk of incident CVD and mortality in older people with sleep disturbances.
Objectives:
Among post-menopausal women with sleep disturbances, to evaluate the association of Z-drug use compared with use of other prescription hypnotics, and with non-use of any prescription hypnotics with CVD and mortality.
Methods:
The population studied were post-menopausal women from the Women’s Health Initiative (WHI) Observational Study and Clinical Trials who, at baseline, scored >=9 with the WHI Insomnia Rating Scale (N=40,728). Hypnotic use was ascertained from prescription medications scanned into the Medi-Span database at baseline and first follow-up clinic visit. Frequency of use was ascertained from self-report. Participants were categorized as users of Z-drugs, users of other prescription hypnotics or non-users. Outcomes were composite CVD (congestive heart failure, stroke, and fatal/non-fatal myocardial infarction) and mortality, centrally adjudicated with review of medical records and death certificates. Hazard ratios were estimated from Cox proportional hazards regression models adjusted for demographic, medical history, and sleep measures. To address potential confounding by indication, we also adjusted for propensity to be prescribed hypnotics.
Results:
At the first follow-up visit 1.1% (424 of 38,979) of participants were users of Z-drugs, 4.2% (1,653 of 38,979) were users of other prescription hypnotics, 3.1% (1,187 of 38,979) had discontinued prescription hypnotic use, and 91.6% (35,715 of 38,979) were non-users at both baseline and first follow-up visit. The mean age of our cohort was 63.6 years (SD = 7.2) and mean follow-up time after the initial follow-up visit was 14.0 years (SD = 6.3). Z-drug use was significantly associated with an increased risk of composite CVD (HR= 1.35, 95%CI: 1.02-1.79) and all-cause mortality (HR= 1.38, 95%CI: 1.13-1.69). Use of other prescription hypnotics and casual use (<=2 times a week) of any hypnotic were not associated with either cardiovascular disease or mortality.
Conclusion:
Use of Z-drugs three or more times a week was associated with an increased risk of death and cardiovascular disease in post-menopausal women being treated for insomnia. Additional research is needed to evaluate association between frequency of hypnotic use and these outcomes and to investigate possible mechanisms.
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Affiliation(s)
- Adam Haines
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Katie Stone
- Univ of California San Francisco, San Francisco, CA
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25
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Haines A, Shadyab AH, Saquib N, Kamensky V, Stone K, Wassertheil-Smoller S. The association of hypnotics with incident cardiovascular disease and mortality in older women with sleep disturbances. Sleep Med 2021; 83:304-310. [PMID: 34087626 DOI: 10.1016/j.sleep.2021.04.032] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE Insomnia is common in older women and is associated with higher cardiovascular disease (CVD) risk. Nonbenzodiazepine GABA agonists (Z-drugs) are the most commonly prescribed sleep aids. The study objective was to determine whether the use of Z-drugs is associated with the risk of developing CVD and mortality in older women with sleep disturbances. PATIENTS/METHODS The study cohort included post-menopausal women who, at baseline, scored ≥9 with the Women's Health Initiative Insomnia Rating Scale (N = 40,728). Members of the cohort were categorized as users of Z-drugs, users of other prescription hypnotics, or non-users. Outcomes were composite CVD (congestive heart failure, stroke, and fatal/non-fatal myocardial infarction) and mortality. Hazard ratios were estimated from Cox proportional hazards regression models adjusted for demographics, medical history, and sleep measures. To address potential confounding by indication, we also adjusted for propensity to be prescribed hypnotics. RESULTS The mean age of our cohort was 63.57 years (SD = 7.23) and mean follow-up time after the initial follow-up visit was 14.0 years (SD = 6.3). Z-drug use was significantly associated with an increased risk of composite CVD (HR = 1.35, 95%CI: 1.02-1.79) and all-cause mortality (HR = 1.38, 95%CI: 1.13-1.69). When groups were divided by heavy and casual use, only heavy users (≥3 times per week) had an increased risk of mortality. CONCLUSIONS Z-drugs use was associated with an increased risk for death and CVD in post-menopausal women being treated for sleep disturbances. Additional research is needed to evaluate both frequency and duration of Z-drug use.
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Affiliation(s)
- Adam Haines
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. adam.haines#@einsteinmed.org
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Nazmus Saquib
- Department of Research, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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26
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Xiao Q, Qian J, Evans DS, Redline S, Lane NE, Ancoli-Israel S, Scheer FAJL, Stone K. Cross-Sectional and Prospective Associations of Rest-Activity Rhythms with Circulating Inflammatory Markers in Older Men. J Gerontol A Biol Sci Med Sci 2021; 77:55-65. [PMID: 33822930 DOI: 10.1093/gerona/glab095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/23/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic increases in pro-inflammatory cytokines in older adults, known as inflammaging, is an important risk factor for morbidity and mortality in the aging population. It has been suggested that circadian disruption may play a role in chronic inflammation, but there has been limited study that investigated the overall profile of 24-hour rest-activity rhythms in relation to inflammation using longitudinal data. In the Outcomes of Sleep Disorders in Older Men Study, we applied the extended cosine model to derive multiple rest-activity rhythm characteristics using multi-day actigraphy, and examined their associations with six inflammatory markers (i.e., CRP, IL-6, TNF-α, TNF-α-sRII, IL-1 β, IFN-γ) measured from fasting blood. We assessed both the cross-sectional association between rest-activity rhythms and inflammatory markers measured at baseline, and the prospective association between baseline rest-activity rhythms and changes in in inflammatory markers over 3.5 years of follow up. We found that multiple rest-activity characteristics, including lower amplitude and relative amplitude, and decreased overall rhythmicity, were associated with higher levels of CRP, IL-6, TNF-α, and TNF-α-sRII, but not IL-1β and IFN-γ at baseline. Moreover, the lowest quartile of these three rest-activity characteristics was associated with an approximately two-fold increase in the odds of having elevated inflammation (i.e. having three or more markers in the highest quartile) at baseline. However, we found little evidence supporting a relationship between rest-activity rhythm characteristics and changes in inflammatory markers. Future studies should clarify the dynamic relationship between rest-activity rhythms and inflammation in different populations, and evaluate the effects of improving rest-activity profiles on inflammation and related disease outcomes.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Jingyi Qian
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | - Daniel S Evans
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA
| | - Nancy E Lane
- Department of Medicine and Rheumatology, University of California at Davis School of Medicine, Sacramento, CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, Center for Circadian Biology, University of California San Diego
| | - Frank A J L Scheer
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
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Mu C, Jester D, Cawthon P, Stone K, Lee S. The Effects of Severe and Frequent Back Pain on Mental Health: Does Perceived Socioeconomic Status Matter? Innov Aging 2020. [PMCID: PMC7741933 DOI: 10.1093/geroni/igaa057.1285] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Back pain and mental health are related. The relationship may differ by socioeconomic status (SES); yet, research has not examined the moderating role of perceived SES. We examined if the association between back pain and poor mental health is more pronounced for older men with lower perceived SES. We used a sample of community-dwelling older men (>65yrs) with back pain from the Osteoporotic Fractures in Men Study (n=4,035). Participants reported their perceived SES in comparison to others in the community and in the nation (1=lowest—10=highest), back pain severity (mild—severe), and frequency (rarely—all of the time). Mental health was assessed with the 12-item Short Form Health Survey. Analyses were adjusted for sociodemographic and health covariates. Greater pain severity and higher pain frequency were associated with poorer mental health (p<.001). Only severe pain was associated with poorer mental health (p<.001). Pain ‘some of the time’ (p=.02), ‘most of the time’ (p=.02), and ‘all of the time’ (p=.001) were associated with poorer mental health. Adverse effects of pain were reduced with greater community SES (p<.001 for severe pain; p=.02 for ‘all of the time’ pain frequency) and greater national SES (p=.01 for severe pain; frequency n.s.). Reports of pain were worse for individuals with lower SES. Adverse associations of severe and high frequency back pain with poor mental health are more apparent in older men with lower perceived SES. Where one ranks oneself within their community or nation can influence the pain and mental health link.
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Affiliation(s)
- Christina Mu
- University of South Florida, Tampa, Florida, United States
| | - Dylan Jester
- University of South Florida, Tampa, Florida, United States
| | - Peggy Cawthon
- California Pacific Medical Center, San Francisco, California, United States
| | - Katie Stone
- California Pacific Medical Center, San Francisco, California, United States
| | - Soomi Lee
- University of South Florida, Tampa, Florida, United States
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28
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Xiao Q, Qian J, Evans DS, Redline S, Lane NE, Ancoli-Israel S, Scheer FAJL, Stone K. Cross-sectional and Prospective Associations of Rest-Activity Rhythms With Metabolic Markers and Type 2 Diabetes in Older Men. Diabetes Care 2020; 43:2702-2712. [PMID: 32887712 PMCID: PMC7576417 DOI: 10.2337/dc20-0557] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/18/2020] [Accepted: 08/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Disruption of rest-activity rhythms is cross-sectionally associated with metabolic disorders, including type 2 diabetes, yet it remains unclear whether it predicts impaired glucose metabolism and homeostasis. The aim of this study is to examine the cross-sectional and prospective associations between rest-activity rhythm characteristics and glycemic measures in a cohort of older men. RESEARCH DESIGN AND METHODS Baseline rest-activity rhythms were derived from actigraphy with use of extended cosine model analysis. With subjects fasting, glucose, insulin, and HOMA of insulin resistance (HOMA-IR) were measured from blood at baseline and after ∼3.5 years. Type 2 diabetes was defined based on self-report, medication use, and fasting glucose. RESULTS In the cross-sectional analysis (n = 2,450), lower 24-h amplitude-to-mesor ratio (i.e., mean activity-adjusted rhythm amplitude) and reduced overall rhythmicity were associated with higher fasting insulin and HOMA-IR (all P trend < 0.0001), indicating increased insulin resistance. The odds of baseline type 2 diabetes were significantly higher among those in the lowest quartile of amplitude (Q1) (odds ratio [OR]Q1 vs. Q4 1.63 [95% CI 1.14, 2.30]) and late acrophase group (ORlate vs. normal 1.46 [95% CI 1.04, 2.04]). In the prospective analysis (n = 861), multiple rest-activity characteristics predicted a two- to threefold increase in type 2 diabetes risk, including a lower amplitude (ORQ1 vs. Q4 3.81 [95% CI 1.45, 10.00]) and amplitude-to-mesor ratio (OR 2.79 [95% CI 1.10, 7.07]), reduced overall rhythmicity (OR 3.49 [95% CI 1.34, 9.10]), and a late acrophase (OR 2.44 [1.09, 5.47]). CONCLUSIONS Rest-activity rhythm characteristics are associated with impaired glycemic metabolism and homeostasis and higher risk of incident type 2 diabetes.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Jingyi Qian
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA .,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | - Daniel S Evans
- Research Institute, California Pacific Medical Center Research Institute, San Francisco, CA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA
| | - Nancy E Lane
- Center for Musculoskeletal Health, Medicine and Rheumatology, University of California at Davis School of Medicine, Sacramento, CA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA.,Department of Veterans Affairs San Diego Center of Excellence for Stress and Mental Health, La Jolla, CA
| | - Frank A J L Scheer
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
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30
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Evans CJ, Yorganci E, Lewis P, Koffman J, Stone K, Tunnard I, Wee B, Bernal W, Hotopf M, Higginson IJ. Processes of consent in research for adults with impaired mental capacity nearing the end of life: systematic review and transparent expert consultation (MORECare_Capacity statement). BMC Med 2020; 18:221. [PMID: 32693800 PMCID: PMC7374835 DOI: 10.1186/s12916-020-01654-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Received: 12/12/2019] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Involving adults lacking capacity (ALC) in research on end of life care (EoLC) or serious illness is important, but often omitted. We aimed to develop evidence-based guidance on how best to include individuals with impaired capacity nearing the end of life in research, by identifying the challenges and solutions for processes of consent across the capacity spectrum. METHODS Methods Of Researching End of Life Care_Capacity (MORECare_C) furthers the MORECare statement on research evaluating EoLC. We used simultaneous methods of systematic review and transparent expert consultation (TEC). The systematic review involved four electronic databases searches. The eligibility criteria identified studies involving adults with serious illness and impaired capacity, and methods for recruitment in research, implementing the research methods, and exploring public attitudes. The TEC involved stakeholder consultation to discuss and generate recommendations, and a Delphi survey and an expert 'think-tank' to explore consensus. We narratively synthesised the literature mapping processes of consent with recruitment outcomes, solutions, and challenges. We explored recommendation consensus using descriptive statistics. Synthesis of all the findings informed the guidance statement. RESULTS Of the 5539 articles identified, 91 met eligibility. The studies encompassed people with dementia (27%) and in palliative care (18%). Seventy-five percent used observational designs. Studies on research methods (37 studies) focused on processes of proxy decision-making, advance consent, and deferred consent. Studies implementing research methods (30 studies) demonstrated the role of family members as both proxy decision-makers and supporting decision-making for the person with impaired capacity. The TEC involved 43 participants who generated 29 recommendations, with consensus that indicated. Key areas were the timeliness of the consent process and maximising an individual's decisional capacity. The think-tank (n = 19) refined equivocal recommendations including supporting proxy decision-makers, training practitioners, and incorporating legislative frameworks. CONCLUSIONS The MORECare_C statement details 20 solutions to recruit ALC nearing the EoL in research. The statement provides much needed guidance to enrol individuals with serious illness in research. Key is involving family members early and designing study procedures to accommodate variable and changeable levels of capacity. The statement demonstrates the ethical imperative and processes of recruiting adults across the capacity spectrum in varying populations and settings.
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Affiliation(s)
- C J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK.
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK.
| | - E Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - P Lewis
- Centre of Medical Law and Ethics, The Dickson Poon School of Law, King's College London, London, UK
| | - J Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - K Stone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - I Tunnard
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - B Wee
- Oxford University Hospitals NHS Foundation Trust and Harris Manchester College, University of Oxford, Oxford, UK
| | - W Bernal
- King's College Hospital, London, UK
| | - M Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - I J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
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Leng Y, Blackwell T, Cawthon PM, Ancoli-Israel S, Stone K, Yaffe K. 1145 Longitudinal Association Between Circadian Activity Rhythms And Risk Of Incident Parkinson’s Disease In Older Men. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1139] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Disruption in circadian activity rhythms are very common in older adults, particularly among those with neurodegenerative diseases. However, the longitudinal association between circadian disruption and subsequent risk of developing neurodegenerative diseases, including Parkinson’s disease (PD), is unclear.
Methods
We examined rest-activity rhythms in 2930 community-dwelling older men (mean age 76.3 ± 5.5 years) without PD and followed them for incident PD over the next 11 years. 24-h rest-activity rhythm parameters (amplitude, mesor, robustness, acrophase) were generated by wrist actigraphy-extended cosinor analysis. Incident PD cases were identified based on physician-diagnosed PD between 2005 and 2016. Logistic regression was used to determine the association between quartiles of rest-activity parameters and risk of incident PD.
Results
78 (2.7%) men developed PD during 11 years of follow-up. The risk of PD increased with decreasing circadian amplitude (strength of the rhythm), mesor (mean level of activity) or robustness (how closely activity follows a cosine 24h pattern); p for trend across quartiles <0.05. After accounting for demographics, clinic site, education, depressive symptoms, body mass index, physical activity, benzodiazepine use, alcohol, caffeine, smoking, comorbidities and baseline cognition, those in the lowest quartile of amplitude, mesor or robustness had approximately three times the risk of developing PD compared to those in the highest quartile of amplitude [ORs (95% CI)= 3.11 (1.54-6.29)], mesor [3.04 (1.54-6.01)] and robustness [2.65 (1.24-5.66)]. The association remained after further adjustment for nighttime sleep disturbances and sleep duration. These associations were somewhat attenuated, but the pattern remained similar after excluding PD cases developed within 2 years after baseline. Acrophase was not significantly associated with risk of PD.
Conclusion
Older men with reduced circadian rhythmicity had an increased risk of incident PD over 11 years. Circadian disruption in the elderly may represent an important prodrome or risk factor for PD. Randomized trials should evaluate whether strategies to improve circadian function impact risk of PD.
Support
This work was supported by the NIA, NIAMS, NCATS, NIH Roadmap for Medical Research and the NHLBI under the grant numbers: U01AG027810, U01AG042124, U01AG042139, U01AG042140, U01AG042143, U01AG042145, U01AG042168, U01AR066160, UL1TR000128, R01HL071194, R01HL070848, R01HL070847, R01HL070842, R01HL070841, R01HL070837, R01HL070838, and R01HL070839.
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Affiliation(s)
- Y Leng
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - T Blackwell
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA
| | - P M Cawthon
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA
| | - S Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - K Stone
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA
| | - K Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, San Francisco, CA
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Vo T, Blackwell T, Kats A, Langsetmo L, Taylor B, Schousboe J, Redline S, Stone K, Smagula S, Chu H, Rodriguez R, Schommer J, Carlson A, Ensrud K. 0388 Predictors of Incident Reduced Sleep Efficiency in Community-Dwelling Older Women. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.385] [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
There is a paucity of longitudinal studies with sleep efficiency (SE) as an outcome measure. Our objective was to examine potential risk factors for incident reduced SE among community-dwelling women in late life.
Methods
We studied 700 women (mean age 82.5 [SD=3.0] years) with a SE ≥70% at the Year 16 (2002-04) visit of the Study of Osteoporotic Fractures with a follow-up measure of SE at the Year 20 (2006-08) visit. SE (percentage of time sleeping while in bed) at both visits was measured using a wrist actigraph with data collected for an average of four 24-hour periods. Women were classified as having incident reduced SE if they had SE <70% at Year 20. Logistic regression was used to estimate the associations between potential risk factors (demographics, lifestyle, use of medications, self-reported medical conditions, functional impairment, frailty, mental and physical health) at Year 16 and reduced SE at Year 20. The association of each candidate risk factor with reduced SE at Year 20 was examined in models adjusted for age, clinical site and continuous SE at Year 16. Candidate risk factors with Benjamin Hochberg false-discovery rate q-values <0.10 were included in a final multivariate model.
Results
Among the 700 eligible women, 62 (8.9%) developed incident reduced SE between the Year 16 and Year 20 visits. After adjusting for age, site and baseline SE, antidepressant use [OR=3.06; 95% CI: 1.50-6.25], benzodiazepine use [OR=2.97; 95% CI: 1.30-6.80] and the presence of hypertension [OR=2.83; 95% CI: 1.47-5.45] at Year 16 were independently associated with a higher odds of having reduced SE at follow-up.
Conclusion
These findings suggest that antidepressant use, benzodiazepine use and hypertension are risk factors or markers for the development of reduced sleep efficiency in older women. Future studies are warranted to examine the underlying mechanisms for these associations.
Support
The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576.
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Affiliation(s)
- T Vo
- University of Minnesota, Minneapolis, MN
| | - T Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - A Kats
- University of Minnesota, Minneapolis, MN
| | | | - B Taylor
- University of Minnesota, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
| | - J Schousboe
- University of Minnesota, Minneapolis, MN
- HealthPartners Institute, Bloomington, MN
| | - S Redline
- Brigham and Women’s Hospital, Boston, MA
| | - K Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - S Smagula
- University of Pittsburgh, Pittsburgh, PA
| | - H Chu
- University of Minnesota, Minneapolis, MN
| | | | - J Schommer
- University of Minnesota, Minneapolis, MN
| | - A Carlson
- University of Minnesota, Minneapolis, MN
| | - K Ensrud
- University of Minnesota, Minneapolis, MN
- Minneapolis VA Health Care System, Minneapolis, MN
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Abstract
Despite the fact that a large portion of the prison population is made up of people who use and inject drugs, harm reduction continues to be extremely limited in prison settings. This article begins with a review of drug-related incarceration, drug use in prisons, and HIV and hepatitis C (HCV) prevalence among prisoners globally. It presents the scientific evidence, alongside legal and economic arguments supporting the provision of harm reduction to people who use drugs, both inside and outside of prisons. The article then provides a global overview of the availability, accessibility, and quality of harm reduction services in prisons-specifically needle and syringe programs; opioid substitution therapy; provision of the opioid agonist naloxone; and diagnosis, treatment, and care for HIV, HCV, and tuberculosis.
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Affiliation(s)
- Gen Sander
- 1 Harm Reduction International, London, UK
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Langsetmo L, Harrison S, Jonnalagadda S, Pereira SL, Shikany JM, Farsijani S, Lane NE, Cauley JA, Stone K, Cawthon PM. Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-dwelling Men. J Nutr Health Aging 2020; 24:900-905. [PMID: 33009543 PMCID: PMC7734969 DOI: 10.1007/s12603-020-1422-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men. DESIGN Prospective cohort study. SETTING 5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study. MEASUREMENTS Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables. RESULTS The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18). CONCLUSIONS Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.
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Affiliation(s)
- L Langsetmo
- Lisa Langsetmo, Ph.D., Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, USA, 55454. E-mail:
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Wakerley B, Warner R, Cole M, Stone K, Foy C, Sittampalam M. Cerebrospinal fluid opening pressure: The effect of body mass index and body composition. Clin Neurol Neurosurg 2020; 188:105597. [DOI: 10.1016/j.clineuro.2019.105597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
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Xiao Q, Evans D, Redline S, Lane N, Ancoli-Israel S, Stone K. Cross-sectional and longitudinal relationships between rest-activity rhythms and circulating inflammatory markers in older men: the osteoporotic fractures in men sleep study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Leng Y, Blackwell T, Cawthon P, Ancoli-Israel S, Stone K, Yaffe K. Longitudinal association between circadian activity rhythms and risk of incident parkinson's disease in older men. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.620] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Stone K, Blackwell T, Yaffe K, Zeitzer J, Ancoli-Israel S, Redline S, Leng Y, Tranah G. Non-parametric analysis of rest-activity rhythms and risk of incident mild cognitive impairment and dementia in older women. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Fajgenbaum DC, Langan RA, Japp AS, Partridge HL, Pierson SK, Singh A, Arenas DJ, Ruth JR, Nabel CS, Stone K, Okumura M, Schwarer A, Jose FF, Hamerschlak N, Wertheim GB, Jordan MB, Cohen AD, Krymskaya V, Rubenstein A, Betts MR, Kambayashi T, van Rhee F, Uldrick TS. Identifying and targeting pathogenic PI3K/AKT/mTOR signaling in IL-6-blockade-refractory idiopathic multicentric Castleman disease. J Clin Invest 2019; 129:4451-4463. [PMID: 31408438 DOI: 10.1172/jci126091] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Idiopathic multicentric Castleman disease (iMCD) is a hematologic illness involving cytokine-induced lymphoproliferation, systemic inflammation, cytopenias, and life-threatening multi-organ dysfunction. The molecular underpinnings of interleukin-6(IL-6)-blockade refractory patients remain unknown; no targeted therapies exist. In this study, we searched for therapeutic targets in IL-6-blockade refractory iMCD patients with the thrombocytopenia, anasarca, fever/elevated C-reactive protein, reticulin myelofibrosis, renal dysfunction, organomegaly (TAFRO) clinical subtype. METHODS We analyzed tissues and blood samples from three IL-6-blockade refractory iMCD-TAFRO patients. Cytokine panels, quantitative serum proteomics, flow cytometry of PBMCs, and pathway analyses were employed to identify novel therapeutic targets. To confirm elevated mTOR signaling, a candidate therapeutic target from the above assays, immunohistochemistry was performed for phosphorylated S6, a read-out of mTOR activation, in three iMCD lymph node tissue samples and controls. Proteomic, immunophenotypic, and clinical response assessments were performed to quantify the effects of administration of the mTOR inhibitor, sirolimus. RESULTS Studies of three IL-6-blockade refractory iMCD cases revealed increased CD8+ T cell activation, VEGF-A, and PI3K/Akt/mTOR pathway activity. Administration of sirolimus significantly attenuated CD8+ T cell activation and decreased VEGF-A levels. Sirolimus induced clinical benefit responses in all three patients with durable and ongoing remissions of 66, 19, and 19 months. CONCLUSION This precision medicine approach identifies PI3K/Akt/mTOR signaling as the first pharmacologically-targetable pathogenic process in IL-6-blockade refractory iMCD. Prospective evaluation of sirolimus in treatment-refractory iMCD is planned (NCT03933904). FUNDING Castleman's Awareness & Research Effort/Castleman Disease Collaborative Network, Penn Center for Precision Medicine, University Research Foundation, Intramural NIH funding, and National Heart Lung and Blood Institute.
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Affiliation(s)
| | | | - Alberto Sada Japp
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Amrit Singh
- Prevention of Organ Failure (PROOF) Centre of Excellence, Vancouver, British Columbia, Canada
| | | | - Jason R Ruth
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, USA
| | | | - Katie Stone
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mariko Okumura
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anthony Schwarer
- Department of Haematology and Oncology, Eastern Health Monash University Clinical School, Melbourne, Victoria, Australia
| | | | - Nelson Hamerschlak
- Department of Hematology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Gerald B Wertheim
- Department of Pathology & Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael B Jordan
- Division of Immunobiology, Department of Pediatrics, Cincinnati Children's Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam D Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Michael R Betts
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Taku Kambayashi
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frits van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thomas S Uldrick
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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40
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Baumert M, Linz D, Stone K, McEvoy RD, Cummings S, Redline S, Mehra R, Immanuel S. Mean nocturnal respiratory rate predicts cardiovascular and all-cause mortality in community-dwelling older men and women. Eur Respir J 2019; 54:13993003.02175-2018. [PMID: 31151958 DOI: 10.1183/13993003.02175-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/21/2019] [Indexed: 11/05/2022]
Abstract
Respiratory frequency (f R) predicts in-hospital and short-term mortality in patients with a variety of pathophysiological conditions, but its predictive value for long-term cardiovascular and all-cause mortality in the general population is unknown. Here, we investigated the relationship between mean nocturnal f R and mortality in community-dwelling older men and women.We measured mean nocturnal f R during sleep from overnight polysomnography in 2686 men participating in the Osteoporotic Fractures in Men Study (MrOS) Sleep study and 406 women participating in the Study of Osteoporotic Fractures (SOF) to investigate the relationship between mean nocturnal f R and long-term cardiovascular and all-cause mortality.166 (6.1%) men in the MrOS cohort (8.9±2.6 years' follow-up) and 46 (11.2%) women in the SOF cohort (6.4±1.6 years' follow-up) died from cardiovascular disease. All-cause mortality was 51.2% and 26.1% during 13.7±3.7 and 6.4±1.6 years' follow-up in the MrOS Sleep study and the SOF cohorts, respectively. Multivariable Cox regression analysis adjusted for significant covariates demonstrated that f R dichotomised at 16 breaths·min-1 was independently associated with cardiovascular mortality (MrOS: hazard ratio (HR) 1.57, 95% CI 1.14-2.15; p=0.005; SOF: HR 2.58, 95% CI 1.41-4.76; p=0.002) and all-cause mortality (MrOS: HR 1.18, 95% CI 1.04-1.32; p=0.007; SOF: HR 1.50, 95% CI 1.02-2.20; p=0.04).In community-dwelling older men and women, polysomnography-derived mean nocturnal f R ≥16 breaths·min-1 is an independent predictor of long-term cardiovascular and all-cause mortality. Whether nocturnal mean f R can be used as a risk marker warrants further prospective studies.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
| | - Dominik Linz
- Center for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Steve Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Dept of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Reena Mehra
- Center of Sleep Disorders, Neurologic Institute, Respiratory Institute, Heart and Vascular Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Immanuel
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.,College of Medicine and Public Health and Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
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Nabel CS, Sameroff S, Shilling D, Alapat D, Ruth JR, Kawano M, Sato Y, Stone K, Spetalen S, Valdivieso F, Feldman MD, Chadburn A, Fosså A, van Rhee F, Lipkin WI, Fajgenbaum DC. Virome capture sequencing does not identify active viral infection in unicentric and idiopathic multicentric Castleman disease. PLoS One 2019; 14:e0218660. [PMID: 31242229 PMCID: PMC6594611 DOI: 10.1371/journal.pone.0218660] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/06/2019] [Indexed: 01/09/2023] Open
Abstract
Castleman disease (CD) describes a spectrum of heterogeneous disorders defined by characteristic lymph node histopathology. Enlarged lymph nodes demonstrating CD histopathology can occur in isolation (unicentric CD; UCD) sometimes accompanied by mild symptoms, or at multiple sites (multicentric CD, MCD) with systemic inflammation and cytokine-driven multi-organ dysfunction. The discovery that Kaposi sarcoma herpesvirus/human herpesvirus (HHV)-8 drives MCD in a subset of patients has led to the hypotheses that UCD and MCD patients with negative HHV-8 testing by conventional methods may represent false negatives, or that these cases are driven by another virus, known or unknown. To investigate these hypotheses, the virome capture sequencing for vertebrate viruses (VirCapSeq-VERT) platform was employed to detect RNA transcripts from known and novel viruses in fresh frozen lymph node tissue from CD patients (12 UCD, 11 HHV-8-negative MCD [idiopathic MCD; iMCD], and two HHV-8-positive MCD) and related diseases (three T cell lymphoma and three Hodgkin lymphoma). This assay detected HHV-8 in both HHV-8-positive cases; however, HHV-8 was not found in clinically HHV-8-negative iMCD or UCD cases. Additionally, no novel viruses were discovered, and no single known virus was detected with apparent association to HHV-8-negative CD cases. Herpesviridae family members, notably including Epstein-Barr virus (EBV), were detected in 7 out of 12 UCD and 5 of 11 iMCD cases with apparent correlations with markers of disease severity in iMCD. Analysis of a separate cohort of archival formalin-fixed, paraffin-embedded lymph node tissue by In situ hybridization revealed significantly fewer EBV-positive cells in UCD and iMCD compared to tissue from HHV-8-positive MCD and EBV-associated lymphoproliferative disorder. In an additional cohort, quantitative testing for EBV by PCR in peripheral blood during disease flare did not detect systemic EBV viremia, suggesting detection lymph node tissue is due to occult, local reactivation in UCD and iMCD. This study confirms that HHV-8 is not present in UCD and iMCD patients. Further, it fails to establish a clear association between any single virus, novel or known, and CD in HHV-8-negative cases. Given that distinct forms of CD exist with viral and non-viral etiological drivers, CD should be considered a group of distinct and separate diseases with heterogeneous causes worthy of further study.
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Affiliation(s)
- Christopher S. Nabel
- Dana-Farber Cancer Institute, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, United States of America
| | - Stephen Sameroff
- Columbia University, New York, New York, United States of America
| | - Dustin Shilling
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
| | - Daisy Alapat
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jason R. Ruth
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
| | | | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Katie Stone
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | | | - Federico Valdivieso
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michael D. Feldman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | | | - Frits van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - W. Ian Lipkin
- Columbia University, New York, New York, United States of America
| | - David C. Fajgenbaum
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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42
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Zeitzer JM, Blackwell T, Hoffman AR, Cummings S, Ancoli-Israel S, Stone K. Daily Patterns of Accelerometer Activity Predict Changes in Sleep, Cognition, and Mortality in Older Men. J Gerontol A Biol Sci Med Sci 2019; 73:682-687. [PMID: 28158467 DOI: 10.1093/gerona/glw250] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/02/2016] [Indexed: 01/23/2023] Open
Abstract
Background There is growing interest in the area of "wearable tech" and its relationship to health. A common element of many of these devices is a triaxial accelerometer that can yield continuous information on gross motor activity levels; how such data might predict changes in health is less clear. Methods We examined accelerometry data from 2,976 older men who were part of the Osteoporotic Fractures in Men (MrOS) study. Using a shape-naive technique, functional principal component analysis, we examined the patterns of motor activity over the course of 4-7 days and determined whether these patterns were associated with changes in polysomnographic-determined sleep and cognitive function (Trail Making Test-Part B [Trails B], Modified Mini-Mental State Examination [3MS]), as well as mortality over 6.5-8 years of follow-up. Results In comparing baseline to 6.5 years later, multivariate modeling indicated that low daytime activity at baseline was associated with worsening of sleep efficiency (p < .05), more wake after sleep onset (p < .05), and a decrease in cognition (Trails B; p < .001), as well as a 1.6-fold higher rate of all-cause mortality (hazard ratio = 1.64 [1.34-2.00]). Earlier wake and bed times were associated with a decrease in cognition (3MS; p < .05). Having a late afternoon peak in activity was associated with a 1.4-fold higher rate of all-cause mortality (hazard ratio = 1.46 [1.21-1.77]). Those having a longer duration of their daytime activity with a bimodal activity pattern also had over a 1.4-fold higher rate of cardiovascular-related mortality (hazard ratio = 1.42 [1.02-1.98]). Conclusions Patterns of daily activity may be useful as predictive biomarkers for changes in clinically relevant outcomes, including mortality and changes in sleep and cognition in older men.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, California.,Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, California.,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco
| | | | - Steve Cummings
- California Pacific Medical Center Research Institute, San Francisco
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla.,Department of Medicine, University of California, San Diego, La Jolla
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco
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43
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Landrigan CP, Rahman SA, Sullivan JP, Blackwell T, Vittinghoff E, Barger LK, Sanderson AP, Wright KP, O'Brien CS, Poynter SE, Lockley SW, Stone K, Czeisler CA. 0995 Schedule Re-design and Patient Safety: the Randomized Order Safety Trial Evaluating Resident-Physician Schedules (ROSTERS). Sleep 2019. [DOI: 10.1093/sleep/zsz067.992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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)
| | | | | | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | | | | | | | | | | | - Sue E Poynter
- Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | | | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
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44
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Miner B, MHS MD, Stone K, Hajduk A, Yaggi HK, Redeker N, Fragoso CV. 0709 Self-Reported and Actigraphic Short Sleep Duration in Older Persons. Sleep 2019. [DOI: 10.1093/sleep/zsz067.707] [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: 11/13/2022] Open
Affiliation(s)
| | - M D MHS
- Yale University, New Haven, CT, USA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
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Wallace M, Buysse DJ, Stone K, Redline S, Leng Y, Ensrud K, Ancoli-Israel S, Hall MH. 0289 Sleep and Mortality in Older Adults: A Machine-Learning-Based Comparison with Other Risk Factors. Sleep 2019. [DOI: 10.1093/sleep/zsz067.288] [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: 11/13/2022] Open
Affiliation(s)
| | | | - Katie Stone
- California Pacific Medical Center, San Francisco, CA, USA
| | - Susan Redline
- 2Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yue Leng
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Leng Y, Stone K, Ancoli-Israel S, Covinsky K, Yaffe K. Who Take Naps? Self-Reported and Objectively Measured Napping in Very Old Women. J Gerontol A Biol Sci Med Sci 2019; 73:374-379. [PMID: 28329031 DOI: 10.1093/gerona/glx014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Indexed: 11/14/2022] Open
Abstract
Background Despite the widespread belief that napping is common among older adults, little is known about the correlates of napping. We examined the prevalence and correlates of self-reported and objectively measured napping among very old women. Methods We studied 2,675 community-dwelling women (mean age 84.5 ± 3.7 years; range 79-96). Self-reported napping was defined as a report of regular napping for ≥1 hour per day. Individual objective naps were defined as ≥5 consecutive minutes of inactivity as measured by actigraphy and women were characterized as "objective nappers" if they had at least 60 minutes of naps per day. Results Seven percent of the women only had self-reported napping, 29% only had objective napping, and 14% met the criteria for both. Multinomial logistic regression showed that the independent correlates of "both subjective and objective napping" were age (per 5 year odds ratio [OR] = 1.59; 95% CI: 1.31-1.93), depressive symptoms (per SD of score, OR = 1.53; 1.32-1.77), obesity (OR =1.93; 1.42-2.61), current smoking (OR = 3.37; 1.56-7.30), heavier alcohol drinking (OR = 0.49; 0.34-0.71), history of stroke (OR = 1.56; 1.08-2.26), diabetes (OR = 2.40; 1.61-3.57), dementia (OR = 3.31; 1.27-8.62), and Parkinson's disease (OR = 7.43; 1.87-29.50). Besides, having objective napping alone was associated with age and diabetes, whereas subjective napping was associated with stroke and myocardial infarction. These associations were independent of nighttime sleep duration and fragmentation. Conclusions Daytime napping is very common in women living in their ninth decade and both subjective and objective napping were significantly related to age and comorbidities. Future studies are needed to better understand napping and its health implications.
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Affiliation(s)
- Yue Leng
- Department of Psychiatry, University of California, San Francisco
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco
| | | | - Kenneth Covinsky
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, San Francisco VA Medical Center.,Department of Neurology, University of California, San Francisco, San Francisco VA Medical Center.,Department of Epidemiology, University of California, San Francisco, San Francisco VA Medical Center
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Fryer S, Stone K, Dickson T, Wilhelmsen A, Cowen D, Faulkner J, Lambrick D, Stoner L. The effects of 4 weeks normobaric hypoxia training on microvascular responses in the forearm flexor. J Sports Sci 2018; 37:1235-1241. [PMID: 30558476 DOI: 10.1080/02640414.2018.1554177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/30/2023]
Abstract
Intermittent exposure to hypoxia can lead to improved endurance performance. Currently, it is unclear whether peripheral adaptions play a role in improving oxygen delivery and utilization following both training and detraining. This study aimed to characterize skeletal muscle blood flow (mBF), oxygen consumption (mV̇O2), and perfusion adaptations to i) 4-weeks handgrip training in hypoxic and normoxic conditions, and ii) following 4-weeks detraining. Using a randomised crossover design, 9 males completed 30-min handgrip training four times a week in hypoxic (14% FiO2 ~ 3250m altitude) and normoxic conditions. mBF, mV̇O2 and perfusion were assessed pre, post 4-weeks training, and following 4-weeks detraining. Hierarchical linear modelling found that mV̇O2 increased at a significantly faster rate (58%) with hypoxic training (0.09 mlO2·min-1 · 100g-1 per week); perfusion increased at a significantly (69%) faster rate with hypoxic training (3.72 μM per week). mBF did not significantly change for the normoxic condition, but there was a significant increase of 0.38 ml· min-1 · 100ml-1 per week (95% CI: 0.35, 0.40) for the hypoxic condition. During 4-weeks detraining, mV̇O2 and perfusion significantly declined at similar rates for both conditions, whereas mBF decreased significantly faster following hypoxic training. Four weeks hypoxic training increases the delivery and utilisation of oxygen in the periphery.
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Affiliation(s)
- S Fryer
- a School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - K Stone
- a School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - T Dickson
- a School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - A Wilhelmsen
- b School of Life Sciences, Metabolic and Molecular Physiology Research Group , University of Nottingham , UK
| | - D Cowen
- a School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - J Faulkner
- c Faculty of Business, Law and Sport , University of Winchester , Winchester , UK
| | - D Lambrick
- d Faculty of Health Sciences , University of Southampton , Southampton , UK
| | - L Stoner
- e Department of Sport and Exercise , University of North Carolina , Chapel Hill , NC , USA
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Abstract
Currently, there are approximately 10.8 million child refugees worldwide. Youth living in refugee camps face a wide range of difficulties placing them at risk for trauma exposure and negative mental health outcomes. However, little is known about the mental health functioning of these youth. The present review provides a systematic review of mental health outcomes for refugee/displaced youth residing in refugee camps. Twenty studies were included in the present review. Among these studies, the prevalence of mental health disorders varied greatly with some studies reporting null effects for disorders like posttraumatic stress disorder and others reporting prevalence as high as 87%. Levels of anxiety, somatic symptoms, depression, and aggression also varied across studies. The results point to the significant need for more research on the mental health of youth residing in refugee camps. Despite the wide range of measurement approaches, the evidence points to a fairly consistent finding of a range of maladjustment problems for youth living in refugee camps. Implications for improving the methodology for investigating mental health are discussed.
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Affiliation(s)
| | - Yo Jackson
- 1 University of Kansas, Lawrence, KS, USA
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Tranah G, Blackwell T, Zeitzer J, Lane N, Cawthon P, Redline S, Mariani S, Stone K. ASSOCIATIONS OF REST-ACTIVITY RHYTHMS WITH FUNCTIONAL LIMITATIONS IN OLDER ADULTS: THE SOF AND MROS STUDIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.363] [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)
| | | | - J Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | | | - P Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute and Associate Adjunct Professor Department of Epidemiology and Biostatistics University of California, San Francisco
| | - S Redline
- Brigham & Women’s Hospital; Harvard Medical School
| | - S Mariani
- Brigham & Women’s Hospital; Harvard Medical School
| | - K Stone
- California Pacific Medical Center
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Delaney M, Roberts J, Mazor R, Townsend-McCall D, Saifee NH, Pagano MB, Matthews DC, Stone K. Bleeding emergencies in neonatal and paediatric patients: improving the quality of care using simulation. Transfus Med 2018; 28:405-412. [PMID: 30325081 DOI: 10.1111/tme.12562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Using a multidisciplinary approach and simulation, a massive transfusion process (MTP) was developed to care for patients in need of emergency transfusion. It was then assessed for effectiveness. BACKGROUND After a series of sentinel emergency bleeding events, a reliable process for hospital staff to deliver appropriate blood products and obtain relevant laboratory tests to guide therapy for patients with emergency bleeding was needed. METHODS To determine the feasibility of the new MTP, multidisciplinary teams participated in simulation events. Each simulation event helped refine the MTP. A special laboratory testing panel was devised. To judge the effectiveness and timeliness of the MTP, process measures and patient survival was retrospectively evaluated during the time period before and after MTP implementation. RESULTS A new emergency bleeding panel of laboratory tests significantly decreased the turn-around time for fibrinogen, haematocrit, International normalised ratio (INR) and platelet count. The speed of commencing the first red blood cells transfusion was also improved (2:00 h vs 0:20 min, P = 0·001). Of 78 patients, there was no change in survival before (n = 31, 48·4%) and after (n = 47, 42·6%; P = 0·6478) MTP implementation. However, there was significant improvement in survival associated with MTP events on the weekdays. CONCLUSIONS A reliable emergency transfusion process consists of an automatic chain of events that keeps decision-making to a minimum and leads to the fast procurement of blood products and salient test results. This work shows that a multidisciplinary iterative process using simulation increases the efficiency of clinical care delivery for bleeding paediatric and neonatal patients.
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Affiliation(s)
- M Delaney
- Laboratory Division, Seattle Children's Hospital, Seattle, Washington, USA.,Bloodworks NW, Seattle, Washington, USA.,Children's National Medical Center, Washington DC, USA
| | - J Roberts
- Critical Care, Department of Paediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - R Mazor
- Critical Care, Department of Paediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - D Townsend-McCall
- Laboratory Division, Seattle Children's Hospital, Seattle, Washington, USA
| | - N H Saifee
- Laboratory Division, Seattle Children's Hospital, Seattle, Washington, USA.,Bloodworks NW, Seattle, Washington, USA
| | - M B Pagano
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - D C Matthews
- Center for Cancer and Blood Disorders, Seattle Children's Hospital, Seattle, Washington, USA
| | - K Stone
- Division of Emergency Medicine, Department of Paediatrics, Seattle Children's Hospital, Seattle, Washington, USA
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