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Holingue C, Owusu JT, Tzuang M, Nyhuis CC, Yaffe K, Stone KL, Rebok GW, Ancoli-Israel S, Spira AP. Accelerometer-assessed sleep and decline in physical function in older men. Sleep Health 2024; 10:129-136. [PMID: 38143154 PMCID: PMC10922516 DOI: 10.1016/j.sleh.2023.11.004] [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: 01/28/2023] [Revised: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Assess the prospective association of actigraphically measured sleep with self-report and objective measures of physical function among community-dwelling older men. METHODS Participants were (n = 1496) men aged ≥65 years from the Osteoporotic Fractures in Men Study and ancillary sleep study who were followed up at 4 years for physical function outcomes. Sleep predictors included baseline total sleep time (<6, 6-8 hours [reference], >8 hours), sleep efficiency (<80% or ≥80% [reference]), wake after sleep onset (<90 [reference] or ≥90 minutes), and sleep onset latency (<30 [reference] or ≥30 minutes), measured by wrist actigraphy. Outcomes included self-reported difficulties in mobility and instrumental activities of daily living and objective measures of physical performance (time to complete chair stands, gait speed, grip strength, best narrow walk pace). Multivariable regression models estimated associations between the sleep predictors and change in physical function at follow-up, adjusting for demographic and health-related variables. RESULTS Participants with short average baseline total sleep time (<6 hours) had significantly greater slowing in their walking speed from baseline to follow-up. Participants with long baseline sleep onset latency (≥30 minutes) had significant increases in mobility difficulties and time to complete chair stands. Sleep efficiency and wake after sleep onset were not significantly associated with any outcomes. No sleep predictors were associated with change in instrumental activities of daily living. CONCLUSIONS These findings add to the body of evidence showing links between poor sleep and subsequent declines in physical function. Further experimental research is needed to understand the mechanisms at play.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casandra C Nyhuis
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco, California, USA; San Francisco VA Medical Center, San Francisco, California, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
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Owusu JT, Wang P, Wickham RE, Cottonham DP, Varra AA, Chen C, Lungu A. Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups. J Racial Ethn Health Disparities 2023; 10:2731-2743. [PMID: 36459363 PMCID: PMC9717563 DOI: 10.1007/s40615-022-01450-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Studies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity. METHODS Participants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)). RESULTS Participants' self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p's < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude. CONCLUSIONS BCT for anxiety and depression can be effective across diverse racial and ethnic groups.
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Affiliation(s)
| | - Pam Wang
- Lyra Health, Burlingame, CA, USA
| | - Robert E Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
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Silberman J, Wicks P, Patel S, Sarlati S, Park S, Korolev IO, Carl JR, Owusu JT, Mishra V, Kaur M, Willey VJ, Sucala ML, Campellone TR, Geoghegan C, Rodriguez-Chavez IR, Vandendriessche B, Goldsack JC. Rigorous and rapid evidence assessment in digital health with the evidence DEFINED framework. NPJ Digit Med 2023; 6:101. [PMID: 37258851 DOI: 10.1038/s41746-023-00836-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Dozens of frameworks have been proposed to assess evidence for digital health interventions (DHIs), but existing frameworks may not facilitate DHI evidence reviews that meet the needs of stakeholder organizations including payers, health systems, trade organizations, and others. These organizations may benefit from a DHI assessment framework that is both rigorous and rapid. Here we propose a framework to assess Evidence in Digital health for EFfectiveness of INterventions with Evaluative Depth (Evidence DEFINED). Designed for real-world use, the Evidence DEFINED Quick Start Guide may help streamline DHI assessment. A checklist is provided summarizing high-priority evidence considerations in digital health. Evidence-to-recommendation guidelines are proposed, specifying degrees of adoption that may be appropriate for a range of evidence quality levels. Evidence DEFINED differs from prior frameworks in its inclusion of unique elements designed for rigor and speed. Rigor is increased by addressing three gaps in prior frameworks. First, prior frameworks are not adapted adequately to address evidence considerations that are unique to digital health. Second, prior frameworks do not specify evidence quality criteria requiring increased vigilance for DHIs in the current regulatory context. Third, extant frameworks rarely leverage established, robust methodologies that were developed for non-digital interventions. Speed is achieved in the Evidence DEFINED Framework through screening optimization and deprioritization of steps that may have limited value. The primary goals of Evidence DEFINED are to a) facilitate standardized, rapid, rigorous DHI evidence assessment in organizations and b) guide digital health solutions providers who wish to generate evidence that drives DHI adoption.
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Affiliation(s)
- Jordan Silberman
- Office of Medical Policy and Technology Assessment, Elevance Health, Palo Alto, CA, USA.
| | | | - Smit Patel
- Digital Medicine Society, Boston, MA, USA
| | - Siavash Sarlati
- Office of Medical Policy and Technology Assessment, Elevance Health, Palo Alto, CA, USA
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Siyeon Park
- Geisinger Health System, Danville, PA, USA
- Pharmesol, Inc., Newton, MA, USA
| | | | | | | | - Vimal Mishra
- Department of Medicine and Health Administration, Virginia Commonwealth University, Richmond, VA, USA
- UC Davis Health, Sacramento, CA, USA
| | - Manpreet Kaur
- Office of Medical Policy and Technology Assessment, Elevance Health, Palo Alto, CA, USA
| | | | | | | | - Cindy Geoghegan
- Digital Medicine Society, Boston, MA, USA
- Patients and Partners, LLC, Madison, CT, USA
| | | | - Benjamin Vandendriessche
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
- Byteflies, Antwerp, Belgium
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4
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Owusu JT, Rabinowitz JA, Tzuang M, An Y, Kitner-Triolo M, Zipunnikov V, Wu MN, Wanigatunga SK, Schrack JA, Thorpe RJ, Simonsick EM, Ferrucci L, Resnick SM, Spira AP. Associations Between Objectively Measured Sleep and Cognition: Main Effects and Interactions With Race in Adults Aged ≥50 Years. J Gerontol A Biol Sci Med Sci 2023; 78:454-462. [PMID: 36082967 PMCID: PMC9977252 DOI: 10.1093/gerona/glac180] [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: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined associations of actigraphy-estimated sleep parameters with concurrent and future cognitive performance in adults aged ≥ 50 years and explored interactions with race. METHODS Participants were 435 cognitively normal adults in the Baltimore Longitudinal Study of Aging who completed wrist actigraphy at baseline (mean = 6.6 nights) and underwent longitudinal testing of memory, attention, executive function, language, and visuospatial ability. On average, participants with follow-up data were followed for 3.1 years. Primary predictors were baseline mean total sleep time, sleep onset latency, sleep efficiency (SE), and wake after sleep onset (WASO). Fully adjusted linear mixed-effects models included demographics, baseline health-related characteristics, smoking status, sleep medication use, APOE e4 carrier status, and interactions of each covariate with time. RESULTS In adjusted models, higher SE (per 10%; B = 0.11, p = .012) and lower WASO (per 30 minutes; B = -0.12, p = .007) were associated with better memory cross-sectionally. In contrast, higher SE was associated with greater visuospatial ability decline longitudinally (B = -0.02, p = .004). Greater WASO was associated with poorer visuospatial ability cross-sectionally (B = -0.09, p = .019) but slower declines in visuospatial abilities longitudinally (B = 0.02, p = .002). Several sleep-cognition cross-sectional and longitudinal associations were stronger in, or limited to, Black participants (compared to White participants). CONCLUSIONS This study suggests cross-sectional sleep-cognition associations differ across distinct objective sleep parameters and cognitive domains. This study also provides preliminary evidence for racial differences across some sleep-cognition relationships. Unexpected directions of associations between baseline sleep and cognitive performance over time may be attributable to the significant proportion of participants without follow-up data and require further investigation.
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Affiliation(s)
- Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yang An
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | | | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sarah K Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Susan M Resnick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Owusu JT, Wang P, Wickham RE, Varra AA, Chen C, Lungu A. Real-World Evaluation of a Large-Scale Blended Care-Cognitive Behavioral Therapy Program for Symptoms of Anxiety and Depression. Telemed J E Health 2022; 28:1412-1420. [PMID: 35263185 PMCID: PMC9587796 DOI: 10.1089/tmj.2021.0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited. Objective: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression. Materials and Methods: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes. Results: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01). Conclusions: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.
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Affiliation(s)
| | - Pam Wang
- Lyra Health, Burlingame, California, USA
| | - Robert E Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
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Owusu JT, Sibelli A, Moss-Morris R, van Tilburg MAL, Levy RL, Oser M. A pilot feasibility study of an unguided, internet-delivered cognitive behavioral therapy program for irritable bowel syndrome. Neurogastroenterol Motil 2021; 33:e14108. [PMID: 33745228 DOI: 10.1111/nmo.14108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is linked with lower health-related quality of life. Cognitive behavioral therapy (CBT) designed for IBS management can improve outcomes but further research of more accessible implementations of this treatment approach for IBS is needed. This study assessed the feasibility of a web-delivered CBT program among adults with IBS to apply to a future clinical trial. METHODS Twenty-five participants were randomized to receive an unguided web-based, CBT program for IBS. The primary outcome was changes in IBS symptom severity (IBS Symptom Severity Scale [IBS-SSS]). Secondary outcomes included IBS-specific CBT therapeutic mechanisms of change (GI-specific anxiety, unhelpful IBS behaviors, and GI-focused cognitions) and changes in depressive (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]) symptom severity. KEY RESULTS Among participants randomized to receive web-based CBT, the average baseline IBS-SSS score was 296.3 (SD=100.9). IBS symptom severity significantly improved at 2-month (p < 0.001) and 3-month follow-up (p < 0.0001); the within-group effect size between baseline and 3-month follow-up IBS-SSS scores was large (d = 1.14) and 63.6% experienced a clinically meaningful improvement (ie, ≥50-point IBS-SSS score reduction). GI-specific anxiety symptoms and cognitions significantly improved at 2-month follow-up, as did unhelpful IBS safety behaviors. Additionally, clinically meaningful improvement was observed in depressive and anxiety symptoms at 3-month follow-up among participants with symptoms above the clinical threshold (ie, PHQ-9 ≥ 10 and GAD-7 ≥ 10, respectively) at baseline. CONCLUSIONS & INFERENCES These preliminary findings warrant a larger trial to investigate an unguided, web-based CBT for IBS symptom management that is powered to detect between-group treatment effects.
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Affiliation(s)
| | | | | | - Miranda A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Megan Oser
- Mahana Therapeutics, Inc, San Francisco, CA, USA
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Tzuang M, Owusu JT, Huang J, Sheehan OC, Rebok GW, Paudel ML, Wickwire EM, Kasper JD, Spira AP. Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults. Sleep 2021; 44:5999485. [PMID: 33231264 DOI: 10.1093/sleep/zsaa251] [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: 05/15/2020] [Revised: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults. METHODS Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits. RESULTS Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24-2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01-1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88-3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23-1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02-1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics. CONCLUSIONS Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.
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Affiliation(s)
- Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Orla C Sheehan
- Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD.,Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Misti L Paudel
- Optum, Health Economics and Outcomes Research, Eden Prairie, MN
| | - Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.,Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Tzuang M, Owusu JT, Huang J, Sheehan OC, Rebok GW, Kasper J, Spira AP. 0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.839] [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
Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults.
Methods
Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency >30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits.
Results
Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p<0.001), all-cause hospitalizations (OR=1.30, p<0.01), preventable hospitalizations (OR=1.83, p<0.05), 30-day readmissions (OR=1.73, p<0.05), and home health care use (OR=1.27, p<0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p<0.05).
Conclusion
Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use.
Support
National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”
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Affiliation(s)
- M Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - J Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - O C Sheehan
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD
| | - G W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - J Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Tzuang M, Owusu JT, Huang J, Sheehan OC, Rebok GW, Kasper J, Spira AP. 0844 Links of Napping With Subsequent All-Cause Hospitalizations and Emergency Department Visits in Older Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.840] [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
Few studies have examined whether napping is associated with objective measures of health services use. We investigated links of napping characteristics with all-cause hospitalizations and emergency department (ED) visits in Medicare claims from a nationally representative sample of older adults.
Methods
Participants were 869 community-dwelling Medicare beneficiaries aged ≥65 years from Round 3 (2013) and Round 4 (2014) of the National Health and Aging Trends Study (NHATS) who had continuous fee-for-service coverage 1 year before and after the NHATS interview. Participants reported past-month napping frequency (re-categorized as non-nappers, infrequent nappers, frequent nappers), napping type (intentional, unintentional), and nap duration. Outcomes were from linked Medicare claims measured after napping assessment: all-cause ED visits and hospitalizations (yes vs. no), and number of hospitalizations and ED visits.
Results
Overall, 45.4% of participants were nappers, and 55.2% of the nappers reported taking unintentional naps. After adjustment for demographics, depressive/anxiety symptoms, medical comorbidities and BMI, compared with non-nappers, infrequent and frequent nappers had a higher odds of hospitalization (odds ratio (OR)=1.65 and 1.73, respectively, both p<0.05), as did unintentional nappers (OR=1.85, p<0.05). We found no significant adjusted associations of napping frequency with ED visits. However, compared with non-nappers, unintentional nappers had a higher odds of visiting the ED (OR=1.94, p<0.01). Additionally, compared to nappers taking short naps (≤30 minutes), those with naps >60 minutes had a greater number of ED visits (Incidence Rate Ratio=1.99, p<0.05).
Conclusion
Among older adults, napping—and particularly unintentional napping—may be a modifiable risk factor for health services use. More studies that consider multiple napping characteristics (e.g., duration, frequency), and using objective measures (e.g., actigraphy), are needed to advance understanding of how napping might influence health services use.
Support
National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”
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Affiliation(s)
- M Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - J Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - O C Sheehan
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD
| | - G W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - J Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Rojo-Wissar DM, Owusu JT, Nyhuis C, Jackson CL, Urbanek JK, Spira AP. Parent-child relationship quality and sleep among adolescents: modification by race/ethnicity. Sleep Health 2020; 6:145-152. [PMID: 31980401 PMCID: PMC7194447 DOI: 10.1016/j.sleh.2019.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Both parent-child relationship quality (PCRQ) and sleep are important for health and development, but few studies have examined links between PCRQ and adolescent sleep and potential interactions by race/ethnicity or sex. METHODS We used cross-sectional data from 6,019 participants (mean = 15.9 years; 50% male; 66% non-Hispanic White, 16% non-Hispanic Black, 5% Hispanic all races) from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of U.S. adolescents. Our exposure was current adolescent-rated PCRQ score. Outcomes were adolescents' reports of chronic insufficient sleep, sleep duration (mins), and frequency of insomnia symptoms (i.e., trouble falling or staying asleep "almost every day"/"every day" versus "never"/"just a few times"/"about once a week"). RESULTS Adjusting for demographic characteristics, each 1-point increase in PCRQ score was associated with lower odds of insomnia symptoms (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.90, 0.94), chronic insufficient sleep (OR = 0.93, 95% CI: 0.91, 0.95), and longer sleep duration (B = 2.56, 95% CI: 1.90, 3.22). After adjustment for depressive symptoms, the association with insomnia symptoms was no longer statistically significant. Race/ethnicity moderated the association between PCRQ and chronic insufficient sleep such that the magnitude of the association was greater in Hispanics vs. Whites and Blacks. There were no interactions of PCRQ with sex. CONCLUSIONS Among adolescents, better PCRQ was associated with better sleep, and this association varied by race/ethnicity for perceived chronic insufficient sleep. Longitudinal studies with objective and subjective sleep measures are needed to further understand these associations.
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Affiliation(s)
- Darlynn M Rojo-Wissar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Casandra Nyhuis
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Jacek K Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Center on Aging and Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
This review summarizes recent studies of sleep and brain health in later life, focusing on cognitive and magnetic resonance imaging (MRI)-derived outcomes. The majority of older people report sleep problems, and over one-third have sleep-disordered breathing (SDB). The research described herein builds on work demonstrating that abnormal sleep duration, sleep fragmentation, and SDB are associated with memory impairment and executive dysfunction. Self-reported short sleep is linked with greater cortical thinning and lower white matter integrity, and objectively measured fragmentation and SDB are tied to gray matter atrophy and altered connectivity. Results suggest that brain changes mediate previously identified sleep-cognition associations. Additional clinical trials are needed to determine whether treating insomnia or SDB benefits cognition in this population.
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Affiliation(s)
- Alfonso J Alfini
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Owusu JT, Doty SB, Adjaye-Gbewonyo D, Bass JK, Wilcox HC, Gallo JJ, Spira AP. Association of sleep characteristics with suicidal ideation and suicide attempt among adults aged 50 and older with depressive symptoms in low- and middle-income countries. Sleep Health 2019; 6:92-99. [PMID: 31757754 DOI: 10.1016/j.sleh.2019.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Investigate the association of sleep characteristics with suicidal ideation and suicide attempt among middle-aged and older adults with depressive symptoms in five low- and middle-income countries (LMICs). DESIGN Cross-sectional. SETTING China, Ghana, India, Russia, and South Africa. PARTICIPANTS Adults aged ≥50 years with depressive symptoms from the World Health Organization (WHO) Study on Global AGEing and Adult Health (n=2,040). MEASUREMENTS Predictors were self-reported average sleep duration for the past 2 nights (<7 hours (shorter), 7 to <9 hours (reference), ≥9 hours (longer)), sleep quality for the past 2 nights (moderate/good/very good [both nights], poor/very poor [≥1 night]), past-month insomnia symptoms (none/mild, moderate, severe/extreme), and past-day daytime sleepiness. Outcomes were past-year suicidal ideation and suicide attempt. Analyses were adjusted for age, sex, household wealth, marital status, self-rated health, cognitive performance, number of depressive symptoms, and country of residence. RESULTS Participants with poor/very poor sleep quality ≥1 night had greater odds of suicidal ideation (vs. moderate/good/very good sleep quality both nights). Participants with moderate and severe/extreme insomnia symptoms had greater odds of suicidal ideation and suicide attempt (vs. none/mild insomnia symptoms). In moderation analyses, greater insomnia symptoms were associated with higher odds of suicidal ideation among women only and those aged 60-60 years and ≥80 years only. CONCLUSIONS Among middle-aged and older adults with depressive symptoms in LMICs, sleep characteristics are markers of-and potential contributors to-suicidal ideation and suicide attempt, and there was evidence of moderation by age and sex. Interventions aimed at preventing suicide-related outcomes in these populations should consider the role of sleep.
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Affiliation(s)
- J T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - S B Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - H C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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Spira AP, An Y, Wu MN, Owusu JT, Simonsick EM, Bilgel M, Ferrucci L, Wong DF, Resnick SM. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep 2019; 41:5088807. [PMID: 30192978 DOI: 10.1093/sleep/zsy152] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 02/06/2018] [Indexed: 11/14/2022] Open
Abstract
Study Objectives To determine the association of excessive daytime sleepiness (EDS) and napping with subsequent brain β-amyloid (Aβ) deposition in cognitively normal persons. Methods We studied 124 community-dwelling participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-report measures of EDS and napping at our study baseline and underwent [11C] Pittsburgh compound B positron emission tomography (PiB PET) scans of the brain, an average ±standard deviation of 15.7 ± 3.4 years later (range 6.9 to 24.6). Scans with a cortical distribution volume ratio of >1.06 were considered Aβ-positive. Results Participants were aged 60.1 ± 9.8 years (range 36.2 to 82.7) at study baseline; 24.4% had EDS and 28.5% napped. In unadjusted analyses, compared with participants without EDS, those with EDS had more than 3 times the odds of being Aβ+ at follow-up (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.44, 7.90, p = 0.005), and 2.75 times the odds after adjustment for age, age2, sex, education, and body mass index (OR = 2.75, 95% CI: 1.09, 6.95, p = 0.033). There was a trend-level unadjusted association between napping and Aβ status (OR = 2.01, 95% CI: 0.90, 4.50, p = 0.091) that became nonsignificant after adjustment (OR = 1.86, 95% CI: 0.73, 4.75, p = 0.194). Conclusions EDS is associated with more than 2.5 times the odds of Aβ deposition an average of 15.7 years later. If common EDS causes (e.g., sleep-disordered breathing, insufficient sleep) are associated with temporally distal AD biomarkers, this could have important implications for AD prevention.
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Affiliation(s)
- Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center on Aging and Health, Baltimore, MD
| | - Yang An
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Solomon Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Murat Bilgel
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Luigi Ferrucci
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Dean F Wong
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Solomon Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Russell H Morgan Department of Radiology, Division of Nuclear Medicine and Molecular Imaging/High Resolution Brain PET, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan M Resnick
- National Institute on Aging Intramural Research Program, Baltimore, MD
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Tzuang M, Owusu JT, Spira AP, Albert MS, Rebok GW. Cognitive Training for Ethnic Minority Older Adults in the United States: A Review. Gerontologist 2019; 58:e311-e324. [PMID: 28575230 DOI: 10.1093/geront/gnw260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Interest in cognitive training for healthy older adults to reduce cognitive decline has grown considerably over the past few decades. Given the shift toward a more diverse society, the purpose of this review is to examine the extent of race/ethnic minority participation in cognitive training studies and characteristics of studies that included race/ethnic minority participants. Design and Methods This review considered peer-reviewed studies reporting cognitive training studies for cognitively healthy, community-dwelling older adults (age 55+) in the United States published in English before December 31, 2015. A total of 31 articles published between 1986 and 2015 meeting inclusion criteria were identified and included in the review. Results A total of 6,432 participants were recruited across all of the studies, and ranged in age from 55 to 99 years. Across all studies examined, 39% reported racial/ethnic background information. Only 3 of these studies included a substantial number of minorities (26.7% in the ACTIVE study; 28.4% in the SeniorWISE study; 22.7% in the TEAM study). Race/ethnic minority older adults were disproportionately underrepresented in cognitive training studies. Implications Further research should aim to enroll participants representative of various race/ethnic minority populations. Strategies for recruitment and retention of ethnic minority participants in cognitive training research are discussed, which could lead to the development of more culturally appropriate and perhaps more effective cognitive interventions.
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Affiliation(s)
- Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
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Owusu JT, Wennberg AMV, Holingue CB, Tzuang M, Abeson KD, Spira AP. Napping characteristics and cognitive performance in older adults. Int J Geriatr Psychiatry 2019; 34:87-96. [PMID: 30311961 PMCID: PMC6445640 DOI: 10.1002/gps.4991] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/21/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine the association of napping intention, frequency, and duration with cognition in a nationally-representative sample of US older adults. METHODS We performed a cross-sectional analysis of community-dwelling Medicare beneficiaries aged ≥65 years from Rounds 3 or 4 (2013-2014) of the National Health and Aging Trends Study (N = 2549). Participants reported past-month napping intention (intentional/unintentional), napping frequency (rarely/never [non-nappers], some days [infrequent nappers], most days/every day [frequent nappers]), and average nap duration (we categorized as ≤30 minutes [short]; 31-60 minutes [moderate]; and > 60 minutes [long]). Cognitive outcomes were performance on immediate and delayed word recall tests (IWR and DWR, respectively), the Clock Drawing Test (CDT), and self-rated memory (score: 1[excellent]-5[very poor]). RESULTS After adjustment for potential confounders, unintentional nappers had poorer immediate word recall test performance than non-nappers (B = -0.23, P < 0.01) and intentional nappers (B = -0.26, P < 0.01). After further adjustment for daytime sleepiness, frequent nappers reported poorer self-rated memory than non-nappers (B = 0.14, P < 0.05). Compared with short nappers, long nappers had poorer IWR (B = -0.26, P < 0.05) and CDT scores (B = -0.17, P < 0.05). Except for the association of nap duration with IWR and CDT, these associations remained after excluding participants with dementia and/or proxy respondents. Among participants undiagnosed with dementia or proxies, moderate-duration naps were associated with better DWR than short naps (B = 0.24, P < 0.05). Neither napping intentionality nor frequency was associated with CDT performance. CONCLUSIONS Among older adults, distinct aspects of napping are associated with cognitive performance. Prospective research, with objective measures of napping, is needed to elucidate the link between napping and cognitive trajectories.
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Affiliation(s)
- Jocelynn T. Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | | | - Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Kylie D. Abeson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
- Center on Aging and Health, Johns Hopkins University
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Holingue C, T Owusu J, Tzuang M, Yaffe K, Stone KL, W Rebok G, Ancoli-Israel S, P Spira A. OBJECTIVELY MEASURED SLEEP AND DECLINE IN PERFORMANCE-BASED PHYSICAL FUNCTION IN OLDER MEN. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Holingue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - J T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Yaffe
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - K L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - G W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - S Ancoli-Israel
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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Spira AP, An Y, Wu MN, Owusu JT, Simonsick EM, Bilgel M, Ferrucci L, Wong DF, Resnick SM. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep 2018; 41:5106760. [PMID: 30257013 DOI: 10.1093/sleep/zsy184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Holingue C, Owusu JT, Feder KA, Spira AP. Sleep duration and C-reactive protein: Associations among pregnant and non-pregnant women. J Reprod Immunol 2018; 128:9-15. [PMID: 29803192 DOI: 10.1016/j.jri.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/01/2018] [Revised: 04/27/2018] [Accepted: 05/09/2018] [Indexed: 12/30/2022]
Abstract
Pregnant women experience more sleep disturbances and greater systemic inflammation than non-pregnant women. However, the few studies that have examined the links between sleep and inflammation in pregnant women have been in clinical samples. We examined whether sleep duration is associated with C-reactive protein (CRP) levels, a marker of inflammation, in pregnant and non-pregnant women in a population-based sample of US women. Participants were 2865 women of reproductive age (aged 20-44 years) in the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of Americans. Sleeping <5 h on weeknights or workdays was significantly associated with increased CRP levels among both pregnant and non-pregnant women in unadjusted analyses; however, after adjustment for demographic, and health-related variables (depressive symptoms, self-rated health status, body mass index (BMI), diabetes), sleeping <5 h was no longer significantly related to CRP levels. Pregnant women had significantly higher CRP levels, after adjusting for sleep duration, demographic, and health-related variables. Our findings suggest that pregnancy is associated with increased peripheral CRP, after adjustment for sleep duration, demographic, and health factors. Further, in both pregnant and non-pregnant U.S. women of reproductive age, short sleep duration is associated with higher CRP levels, but this link is explained by self-rated health, BMI, and diabetes. Further studies are needed to investigate links of other sleep parameters (e.g., sleep fragmentation) with CRP in these populations.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kenneth A Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States.
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Holingue C, Owusu JT, Yaffe K, Stone KL, Rebok GW, Ancoli-Israel S, Spira AP. 0698 Actigraphic Sleep and Functional Decline in Older Men. Sleep 2018. [DOI: 10.1093/sleep/zsy061.697] [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)
- C Holingue
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - J T Owusu
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - K Yaffe
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California San Francisco & San Francisco VA Medical Center, San Francsico, CA
| | - K L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - G W Rebok
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - S Ancoli-Israel
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - A P Spira
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Owusu JT, Doty SB, Bass JK, Wilcox HC, Gallo JJ, Spira AP. 0987 Sleep Characteristics, Suicidal Ideation, and Attempts among Adults Aged 50+ with Depressive Symptoms in Five Middle-Income Countries. Sleep 2018. [DOI: 10.1093/sleep/zsy061.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - S B Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD
| | - H C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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Owusu JT, Ramsey CM, Tzuang M, Kaufmann CN, Parisi JM, Spira AP. Napping Characteristics and Restricted Participation in Valued Activities Among Older Adults. J Gerontol A Biol Sci Med Sci 2018; 73:367-373. [PMID: 28958012 PMCID: PMC5861910 DOI: 10.1093/gerona/glx166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022] Open
Abstract
Background Napping is associated with both positive and negative health outcomes among older adults. However, the association between particular napping characteristics (eg, frequency, duration, and whether naps were intentional) and daytime function is unclear. Methods Participants were 2,739 community-dwelling Medicare beneficiaries aged ≥65 years from the nationally representative National Health and Aging Trends Study. Participants reported napping frequency, duration, and whether naps were intentional versus unintentional. Restricted participation in valued activities was measured by self-report. Results After adjusting for potential confounders and nighttime sleep duration, those who took intentional and unintentional naps had a greater odds of any valued activity restriction (ie, ≥1 valued activity restriction), compared to those who rarely/never napped (unintentional odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.01, 1.79, intentional OR = 1.49, 95% CI 1.09, 2.04). There was no difference between unintentional napping and intentional napping with respect to any valued activity restriction after adjustment for demographics. Compared to participants napping "some days," those napping most days/every day had a greater odds of any valued activity restriction (OR = 1.68, 95% CI 1.30, 2.16). Moreover, each 30-minute increase in average nap duration was associated with a 25% greater odds of any valued activity restriction (OR = 1.25, 95% CI 1.10, 1.43). Conclusion Older adults who took more frequent or longer naps were more likely to report activity restrictions, as were those who took intentional or unintentional naps. Additional longitudinal studies with objective measures of sleep are needed to further our understanding of associations between napping characteristics and daytime dysfunction.
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Affiliation(s)
- Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christine M Ramsey
- Program on Aging, Yale School of Medicine, New Haven, CT
- Department of Medical Informatics, Yale School of Medicine, New Haven, CT
| | - Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher N Kaufmann
- Department of Psychiatry, University of California, San Diego
- Stein Institute for Research on Aging, University of California, San Diego
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Praphasiri P, Owusu JT, Thammathitiwat S, Ditsungnoen D, Boonmongkon P, Sangwichian O, Prasert K, Srihapanya S, Sornwong K, Kerdsin A, Dejsirilert S, Baggett HC, Olsen SJ. Streptococcus suis infection in hospitalized patients, Nakhon Phanom Province, Thailand. Emerg Infect Dis 2015; 21:345-8. [PMID: 25625540 PMCID: PMC4313644 DOI: 10.3201/eid2102.140961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Nakhon Phanom, Thailand, we identified 38 hospitalized patients with Streptococcus suis infection during 2006-2012. Deafness developed in 12 patients; none died. Thirty-five reported recent exposure to pigs/pork. Annual incidence was 0.1-2.2 cases/100,000 population (0.2-3.2 in persons ≥20 years of age). Clinicians should consider S. suis infection in areas where pig exposure is common.
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Prapasiri P, Owusu JT, Thammathitiwat S, Ditsungnoen D, Boonmongkon P, Sangwichian O, Prasert K, Srihapanya S, Sornwong K, Kerdsin A, Dejsirilert S, Baggett HC, Olsen SJ. Streptococcus suisInfection in Hospitalized Patients, Nakhon Phanom Province, Thailand. Emerg Infect Dis 2015. [DOI: 10.3201/eid2102.14-0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Owusu JT, Prapasiri P, Ditsungnoen D, Leetongin G, Yoocharoen P, Rattanayot J, Olsen SJ, Muangchana C. Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012. Vaccine 2014; 33:742-7. [PMID: 25454853 PMCID: PMC4610807 DOI: 10.1016/j.vaccine.2014.10.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/29/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
Background The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months–2 years, persons ≥65 years, persons with chronic diseases, obese persons), and health-care personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. Methods National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. Results From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37–3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months–2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p < 0.01) and persons ≥65 years (12%, versus 20%; p < 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p < 0.01), children 6 months–2 years (2.3% versus 0.9%; p < 0.01), pregnant women (1.1% versus 0.9%; p < 0.01), and obese persons (0.2% versus 0.1%; p < 0.01). Conclusions From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand.
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Affiliation(s)
- Jocelynn T Owusu
- ASPPH/CDC Allan Rosenfield Global Health Fellow, Atlanta, GA, USA; Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Prabda Prapasiri
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Pornsak Yoocharoen
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Sonja J Olsen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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O'Brien LM, Bullough AS, Owusu JT, Tremblay KA, Brincat CA, Chames MC, Kalbfleisch JD, Chervin RD. Snoring during pregnancy and delivery outcomes: a cohort study. Sleep 2013; 36:1625-32. [PMID: 24179294 DOI: 10.5665/sleep.3112] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 01/07/2023] Open
Abstract
STUDY OBJECTIVE This cohort study examined the impact of maternal snoring on key delivery outcomes such as mode of delivery, infant birth centile, and small-for-gestational age. DESIGN Cohort study. SETTING A large tertiary medical center. PATIENTS OR PARTICIPANTS Pregnant women in their third trimester were recruited between March 2007 and December 2010. MEASUREMENTS AND RESULTS Women were screened for habitual snoring, as a known marker for sleep disordered breathing. Outcome data were obtained from medical records following delivery and birth centiles were calculated. Of 1,673 women, a total of 35% reported habitual snoring (26% with pregnancy-onset snoring and 9% with chronic snoring). After adjusting for confounders, chronic snoring was associated with small-forgestational age (OR 1.65, 95%CI 1.02-2.66, P = 0.041) and elective cesarean delivery (OR 2.25, 95%CI 1.22-4.18, P = 0.008). Pregnancy-onset snoring was associated with emergency cesarean delivery (OR 1.68, 95%CI 1.22-2.30, P = 0.001). CONCLUSION Maternal snoring during pregnancy is a risk factor for adverse delivery outcomes including cesarean delivery and small-for-gestational age. Screening pregnant women for symptoms of SDB may provide an early opportunity to identify women at risk of poor delivery outcomes. CLINICAL TRIALS REGISTRATION IDENTIFIER: NCT01030003.
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Affiliation(s)
- Louise M O'Brien
- Sleep Disorders Center, Department of Neurology ; Department of Oral and Maxillofacial Surgery ; Department of Obstetrics and Gynecology
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O'Brien LM, Owusu JT, Swanson LM. Habitual snoring and depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2013; 13:113. [PMID: 23679132 PMCID: PMC3660222 DOI: 10.1186/1471-2393-13-113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/13/2013] [Indexed: 01/02/2023] Open
Abstract
Background Depression is frequently observed in patients with untreated sleep-disordered breathing (SDB) in the general population. Pregnant women are particularly vulnerable since pregnancy increases the risk of both SDB and depressive symptoms. However, no study has investigated whether SDB symptoms prior to or in early pregnancy are associated with such mood problems. Methods A retrospective chart review of pregnant women. Women were included if they attended prenatal clinics between June 2007 and July 2010, were ≥18 years old, pregnant with a single fetus, and had been screened for habitual snoring as well as depressive symptoms using the Edinburgh Postnatal Depression Scales (EPDS). Results In total, 362 women were included and 32.3% reported habitual snoring. Twenty-nine percent of women had an EPDS score ≥10. Significantly more snoring women, compared to non-snorers, had an EPDS score ≥10 (42.7% vs. 22.9%, p < 0.001) despite the mean EPDS values not reaching statistical significance (6.1 ± 4.9 vs. 5.4 ± 5.0, p = 0.2). In a logistic regression model controlling for parity, the presence of pre-pregnancy obesity, presence of a partner, sleep quality, African American race, maternal educational level, pre-eclampsia, and diabetes, snoring was independently associated with a prenatal EPDS score ≥10 (O.R. 2.0, 95%CI 1.13-3.46; p = 0.023). Conclusion Maternal snoring may be a risk factor for prenatal depressive symptoms. Further investigation of the temporal relationship between maternal snoring and depressive symptoms is warranted.
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Owusu JT, Anderson FJ, Coleman J, Oppong S, Seffah JD, Aikins A, O'Brien LM. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women. Int J Gynaecol Obstet 2013; 121:261-5. [PMID: 23507553 DOI: 10.1016/j.ijgo.2013.01.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [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: 11/07/2012] [Revised: 01/10/2013] [Accepted: 02/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess sleep practices, and investigate their relationship with maternal and fetal outcomes, among pregnant Ghanaian women. METHODS In a cross-sectional study conducted at Korle Bu Teaching Hospital, Accra, Ghana, between June and July 2011, postpartum women were interviewed within 48hours of delivery about sleep quality and practices during pregnancy. Interviews were coupled with a systematic review of participants' medical charts for key outcomes including maternal hypertension, pre-eclampsia, premature delivery, low birth weight, and stillbirth. RESULTS Most women reported poor sleep quality during pregnancy. Snoring during pregnancy was independently associated with pre-eclampsia (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4-8.5; P=0.007). The newborns of women who reported supine sleep during pregnancy were at increased risk of low birth weight (OR, 5.0; 95% CI, 1.2-20.2; P=0.025) and stillbirth (OR, 8.0; 95% CI, 1.5-43.2; P=0.016). Low birth weight was found to mediate the relationship between supine sleep and stillbirth. CONCLUSION The present findings in an African population demonstrate that maternal sleep, a modifiable risk factor, has a significant role in pre-eclampsia, low birth weight, and subsequently stillbirth.
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Affiliation(s)
- Jocelynn T Owusu
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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O'Brien LM, Koo J, Fan L, Owusu JT, Chotinaiwattarakul W, Felt BT, Chervin RD. Iron Stores, Periodic Leg Movements, and Sleepiness in Obstructive Sleep Apnea. J Clin Sleep Med 2009. [DOI: 10.5664/jcsm.27652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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]
Affiliation(s)
- Louise M. O'Brien
- Sleep Disorders Center and Department of Neurology
- Department of Oral and Maxillofacial Surgery
| | - Julie Koo
- Sleep Disorders Center and Department of Neurology
| | - Ludi Fan
- Department of Biostatistics, Center for Human Growth and Development and Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | | | | | - Barbara T. Felt
- Center for Human Growth and Development and Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
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O'Brien LM, Koo J, Fan L, Owusu JT, Chotinaiwattarakul W, Felt BT, Chervin RD. Iron stores, periodic leg movements, and sleepiness in obstructive sleep apnea. J Clin Sleep Med 2009; 5:525-31. [PMID: 20465018 PMCID: PMC2792967] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
STUDY OBJECTIVES Most clinical sleep studies are performed for suspected obstructive sleep apnea (OSA), yet one-quarter to one-half show periodic leg movements (PLMs), for reasons that remain unknown. Several other disparate sleep disorders also increase the risk for PLMs. We examined the novel hypotheses that OSA as a representative sleep disorder could promote lower body iron stores, as reflected by serum ferritin levels, and, through downstream effects on dopaminergic transmission, increase PLMs and daytime sleepiness. METHODS Subjects were recruited as they underwent laboratory-based polysomnography for suspected OSA. Serum ferritin levels were measured the next morning. Each subject completed an Epworth Sleepiness Scale and a brief questionnaire to assess for restless legs syndrome (RLS). RESULTS The frequency of apneic events showed no association with serum ferritin levels, before or after adjustment for age, sex, body mass index, and likely RLS (each p value > 0.3). Serum ferritin levels did not predict the frequency of PLMs (p = 0.7) or Epworth scores (p = 0.8). Iron deficiency as a dichotomous variable, determined by ferritin levels less than < 50 microg/L or in combination with low transferrin saturation or mean corpuscular volume, showed similar results. In exploratory analyses, contrary to expectations, lower minimum oxygen saturation and increased sleep-stage shifts predicted increased rather than decreased ferritin levels (p = 0.03 and p = 0.02, respectively). CONCLUSIONS Results of this study, powered to detect small to moderate effect sizes, strongly suggest that OSA does not cause lower serum ferritin levels, which, in turn, cannot explain PLMs or daytime sleepiness in these patients.
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Affiliation(s)
- Louise M O'Brien
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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