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Introduction: Fatigue, brain fog, and sleep disturbance are among the most common symptoms of postacute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality of life in patients with neurologic manifestations of PASC (Neuro-PASC)., Methods: Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH Toolbox cognitive tests, and 7 days of wrist actigraphy., Results: The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p  < 0.001), and later sleep midpoint ( p  = 0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with the severity of fatigue ( p  < 0.001), anxiety ( p  = 0.05), and depression ( p  < 0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency, and latency were associated with decreased performance in attention and processing speed., Conclusion: Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Study Objectives: People with diabetes and prediabetes are more likely to have sleep-disordered breathing (SDB), but few studies examined sleep architecture in people with diabetes or prediabetes in the absence of moderate-severe SDB, which was the aim of our cross-sectional study., Methods: This cross-sectional sample is from the Baependi Heart Study, a family-based cohort of adults in Brazil. About 1074 participants underwent at-home polysomnography (PSG). Diabetes was defined as fasting glucose >125 mg/dL or HbA1c > 6.4 mmol/mol or taking diabetic medication, and prediabetes was defined as HbA1c ≥ 5.7 & <6.5 mmol/mol or fasting glucose ≥ 100 & ≤125 mg/dl. We excluded participants with an apnea-hypopnea index (AHI) ≥ 30 in primary analyses and ≥ 15 in secondary analysis. We compared sleep stages among the 3 diabetes groups (prediabetes, diabetes, neither)., Results: Compared to those without diabetes, we found shorter REM duration for participants with diabetes (-6.7 min, 95%CI -13.2, -0.1) and prediabetes (-5.9 min, 95%CI -10.5, -1.3), even after adjusting for age, gender, BMI, and AHI. Diabetes was also associated with lower total sleep time (-13.7 min, 95%CI -26.8, -0.6), longer slow-wave sleep (N3) duration (+7.6 min, 95%CI 0.6, 14.6) and higher N3 percentage (+2.4%, 95%CI 0.6, 4.2), compared to those without diabetes. Results were similar when restricting to AHI < 15., Conclusions: People with diabetes and prediabetes had less REM sleep than people without either condition. People with diabetes also had more N3 sleep. These results suggest that diabetes and prediabetes are associated with differences in sleep architecture, even in the absence of moderate-severe sleep apnea., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Stress and diabetes coexist in a vicious cycle. Different types of stress lead to diabetes, while diabetes itself is a major life stressor. This was the focus of the Chicago Biomedical Consortium's 19 th annual symposium, "Stress and Human Health: Diabetes," in November 2022. There, researchers primarily from the Chicago area met to explore how different sources of stress - from the cells to the community - impact diabetes outcomes. Presenters discussed the consequences of stress arising from mutant proteins, obesity, sleep disturbances, environmental pollutants, COVID-19, and racial and socioeconomic disparities. This symposium showcased the latest diabetes research and highlighted promising new treatment approaches for mitigating stress in diabetes., Competing Interests: RMS declares that he has received honoraria from CVS/Health and the American Medical Forum; neither of which relate this manuscript. SAO is a co-founder, equity holder, and consultant for OptiKIRA, LLC. All other authors have no competing interests to declare., (© The Author(s) 2023.)

Introduction: Cognitive dysfunction, a leading cause of mortality and morbidity in the USA and globally, has been shown to disproportionately affect the socioeconomically disadvantaged and those who identify as black or Hispanic/Latinx. Poor sleep is strongly associated with the development of vascular and metabolic diseases, which correlate with cognitive dysfunction. Therefore, sleep may contribute to observed disparities in cognitive disorders. The Epidemiologic Study of Disparities in Sleep and Cognition in Older Adults (DISCO) is a longitudinal, observational cohort study that focuses on gathering data to better understand racial/ethnic sleep disparities and illuminate the relationship among sleep, race and ethnicity and changes in cognitive function. This investigation may help inform targeted interventions to minimise disparities in cognitive health among ageing adults., Methods and Analysis: The DISCO study will examine up to 495 individuals aged 55 and older at two time points over 24 months. An equal number of black, white and Hispanic/Latinx individuals will be recruited using methods aimed for adults traditionally under-represented in research. Study procedures at each time point will include cognitive tests, gait speed measurement, wrist actigraphy, a type 2 home polysomnography and a clinical examination. Participants will also complete self-identified assessments and questionnaires on cognitive ability, sleep, medication use, quality of life, sociodemographic characteristics, diet, substance use, and psychological and social health., Ethics and Dissemination: This study was approved by the Northwestern University Feinberg School of Medicine Institutional Review Board. Deidentified datasets will be shared via the BioLINCC repository following the completion of the project. Biospecimen samples from the study that are not being analysed can be made available to qualified investigators on review and approval by study investigators. Requests that do not lead to participant burden or that conflict with the primary aims of the study will be reviewed by the study investigators., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Objectives: The US Preventive Services Task Force recently released guidelines suggesting little evidence of benefit to screening asymptomatic adults for obstructive sleep apnea (OSA). Our goal was to provide important context to this statement. Specifically, we examined associations between common OSA symptoms, excessive daytime sleepiness and snoring, and OSA severity for different racial/ethnic and sex groups., Methods: Analyses were performed on 2 samples. One combined 2 observational studies that included full polysomnography, the Epworth Sleepiness Scale (ESS), and questions about snoring (mean [standard deviation] age 39 [15.2] years). The second sample was the Multi-Ethnic Study of Atherosclerosis study of older adults (mean [standard deviation] age 69 [9.1] years), which also included polysomnography, ESS and a question about snoring. Apnea-hypopnea index represented OSA severity. For each racial/ethnic-sex group we estimated correlations between apnea-hypopnea index and ESS and the sensitivity and specificity of excessive daytime sleepiness (ESS >10) or frequent snoring to predict moderate-to-severe OSA (apnea-hypopnea index >15 events/h)., Results: A weak significant correlation between OSA severity and ESS was found only in White men in the first sample and Black men in the second sample. Screening tool characteristics for ESS and snoring were poor except for moderate specificity in some racial/ethnic-sex groups., Conclusions: Excessive daytime sleepiness and snoring are commonly used to identify symptomatic patients. Our results suggest that the accuracy of these symptoms to identify OSA varies by race/ethnicity and sex. Therefore, focus on common symptoms as an OSA screen could systematically leave out certain patient populations who would benefit from treatment., Citation: Stepney D, Attarian HP, Knutson KL. Association between severity of obstructive sleep apnea and its common symptoms varies by race, ethnicity, and sex. J Clin Sleep Med . 2023;19(10):1727-1733., (© 2023 American Academy of Sleep Medicine.)

Previous research has demonstrated that experiences of discrimination contribute to racial disparities in sleep, and that psychological distress mediates these relationships. However, previous research has not included race as part of the mediation pathway and has had limited dimensions of sleep health and psychological mediators. In the current study, we examine serial mediation pathways by which race and sleep health are mediated through discrimination and subsequently through psychological distress (i.e., depressive symptoms, chronic stress, and loneliness). Data were from the 2010 wave of the Health Retirement Study (HRS). The analytic sample (n = 7,749) included Black and White participants who were included in the enhanced face-to-face interview in 2010 and who completed the psychosocial questionnaire. Race was reported as either Black or White. Sleep health was assessed with a 4-item questionnaire. Depressive symptoms were assessed with the shortened CES-D, chronic stress via the ongoing chronic stressor scale, and loneliness via the UCLA loneliness scale. Covariates were included in all serial mediation models. Relative to White participants, Black participants reported increased experiences of discrimination, which was associated with increased psychological distress, and poorer sleep health. Findings demonstrate the significant adverse impact that discrimination has on both psychological well-being and sleep health., (© 2022. W. Montague Cobb-NMA Health Institute.)

Previous research has demonstrated that exposure to light preceding and during sleep is associated with poor sleep, but most research to date has utilized either experimental or cross-sectional designs. The current study expands upon prior studies by using a microlongitudinal design that examines the night-to-night associations between light and sleep health in a diverse sample of adults (pre-registered at osf.io/k5zgv). US adults aged 18-87 years from two parent studies (N = 124) wore an actiwatch for up to 10 nights. Light variables estimated from actigraphy include both average exposure and time above light threshold of 10 (TALT 10 ) and 40 (TALT 40 ) lux both during sleep and for the 1-hr preceding sleep. Actigraphy-based sleep variables included sleep offset, duration, percentage and fragmentation index. Higher average light exposure during sleep was associated with a later sleep-offset time, lower sleep percentage and higher fragmentation index (all p < 0.01). More minutes of TALT 10 during sleep was associated with later sleep timing, lower sleep percentage and higher fragmentation index (all p < 0.01), and greater TALT 40 during sleep was associated with lower sleep percentage. Light exposure was not related to sleep duration. In summary, greater light exposure during sleep was related to poorer sleep continuity and later wake time. The lack of association between light and sleep duration may be the result of compensating for sleep disruption by delaying wake time. Multi-level interventions to consistently reduce light levels during sleep should be considered., (© 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

The human circadian system plays a vital role in many physiological processes, and circadian rhythms are found in virtually all tissues and organs. The disruption of circadian rhythms may lead to adverse health outcomes. Evidence from recent population-based studies was reviewed because they represent real-world behavior and can be useful in developing future studies to reduce the risk of adverse health conditions, including cardiovascular diseases, obesity, and diabetes mellitus, which may occur because of circadian disruption. An electronic search in PubMed and Web of Science (2012-2022) was performed. Selected articles were based on specific inclusion and exclusion criteria. Five factors that may disrupt circadian rhythm alignment are discussed: shift work, late chronotype, late sleep timing, sleep irregularity, and late meal timing. Evidence from observational studies of these circadian disruptors suggests potential detrimental effects on cardiometabolic health, including higher BMI/obesity, higher blood pressure, greater dyslipidemia, greater inflammation, and diabetes. Future research should identify the specific underlying pathways in order to mitigate the health consequences of shift work. Furthermore, optimal sleep and mealtimes for metabolic health can be explored in intervention studies. Lastly, it is important that the timing of external environmental cues (such as light) and behaviors that influence circadian rhythms are managed., (© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Diabetes is highly prevalent and is associated with dietary behaviors. Time-restricted eating, which consolidates caloric intake to a shortened eating duration, has demonstrated improvement in metabolic health. Timing of eating could also impact metabolism. Our objective was to examine whether the timing of eating was associated with metabolic health independently of eating duration. Data (n = 7619) are from four cycles (2005-2012) of the National Health and Nutrition Examination Survey (NHANES), a nationally representative U.S. survey that included surveys, physical examinations, and dietary recalls. The primary exposures are eating duration and eating start time estimated from two non-consecutive dietary recalls. Primary outcomes were fasting glucose and estimated insulin resistance using the homeostatic model assessment method (HOMA-IR). The mean (95% CI) eating duration was 12.0 h (11.9-12.0) and the mean (95% CI) start time was 8:21 (8:15-8:26). Earlier eating start time was significantly associated with lower fasting glucose and estimated insulin resistance but eating interval duration was not. Every hour later that eating commenced was associated with approximately 0.6% higher glucose level and 3% higher HOMA-IR (both p < 0.001). In this cross-sectional study, earlier eating start time was associated with more favorable metabolic measures, indicating that meal timing is another important characteristic of dietary patterns that may influence metabolism.

Objective: To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties., Methods: This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity., Results: Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82)., Conclusions: The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In addition to quantity and quality, meal timing and eating duration are additional dietary characteristics that impact cardiometabolic health. Given that cardiometabolic health disparities exist among racial and ethnic groups, we examined whether meal timing and eating duration are additional diet-related differences among racial and ethnic groups. Methods: Participants (n = 13,084) were adults (≥20 years) from the National Health and Nutrition Examination (NHANES, 2011−2018) Survey. Times of first and last meal and the interval between them (eating duration) were derived from two 24-h dietary recalls. Multiple linear regression analyses compared these variables among race and ethnicity after adjusting for potential confounders. Results: Compared to non-Hispanic White adults, the first mealtime was significantly later for Mexican American (23 min), Non-Hispanic Asian (15 min), Non-Hispanic Black (46 min), and Other Hispanic (20 min) and Other Racial (14 min) adults (all p < 0.05). Mexican American and Non-Hispanic Asian adults had a significantly different last mealtime by 13 min earlier and 25 min later, respectively, compared to Non-Hispanic White adults. Compared to Non-Hispanic White adults, the mean eating duration was shorter for other Hispanic (20 min), Mexican American (36 min), and Non-Hispanic Black (49 min) adults. Conclusions: Meal timing and eating duration are additional dietary characteristics that vary significantly among racial and ethnic groups.

Objectives: Prior studies have examined sleep during the coronavirus disease 2019 (COVID-19) pandemic, but have few compared sleep measured both during and prior to COVID. We examined the impact of the COVID-19 pandemic on subjective sleep quality in general and separately by gender and age (<50 vs. ≥50 years). Further, we compared sleep quality between those who did and did not follow quarantine orders., Methods: This sample is from the Baependi Heart Study, a family-based cohort of adults in South-eastern Brazil. Longitudinal data were from 417 individuals who completed the Pittsburgh Sleep Quality Index (PSQI) twice: between January 2010 and September 2014 (pre-COVID) and during the COVID-19 stay-at-home order March-June, 2020. Cross-sectional analysis included 800 participants., Results: Mean (±SD) PSQI scores were significantly higher during than before COVID-19 (5.7 ± 3.8 vs. 5.0 ± 3.3, p < .01). This increase was significant among women and among adults ≥50 years but not in men or younger adults. The significant increase in PSQI was only observed in those who quarantined during COVID-19 (5.9 ±3.7 vs. 5.2 ±3.4, p < .01) and not those who did not quarantine (5.0 ± 3.7 vs. 4.5 ± 3, p = .12). In cross-sectional analyses, individuals who quarantined had higher PSQI scores than nonquarantined individuals (6.1 ± 3.9 vs. 5.0 ± 3.5, p < .01). The quarantine status-dependent differences were significant for women (6.4 ± 4 vs. 5.2 ± 3.7, p < .01) and older adults (6.6 ± 0.1 vs. 5.5 ± 3.3, p = .04). Differences by quarantine status were attenuated after adjusting for age and gender., Conclusions: Subjective sleep quality declined during the COVID-19 pandemic, particularly among women, older adults, and those compliant to quarantine orders., (Copyright © 2021 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy., Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55-86%) and restless legs syndrome (8-45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep-wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA 1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life., (© 2021. The Author(s).)

Circadian disruption is pervasive and can occur at multiple organizational levels, contributing to poor health outcomes at individual and population levels. Evidence points to a bidirectional relationship, in that circadian disruption increases disease severity and many diseases can disrupt circadian rhythms. Importantly, circadian disruption can increase the risk for the expression and development of neurologic, psychiatric, cardiometabolic, and immune disorders. Thus, harnessing the rich findings from preclinical and translational research in circadian biology to enhance health via circadian-based approaches represents a unique opportunity for personalized/precision medicine and overall societal well-being. In this Review, we discuss the implications of circadian disruption for human health using a bench-to-bedside approach. Evidence from preclinical and translational science is applied to a clinical and population-based approach. Given the broad implications of circadian regulation for human health, this Review focuses its discussion on selected examples in neurologic, psychiatric, metabolic, cardiovascular, allergic, and immunologic disorders that highlight the interrelatedness between circadian disruption and human disease and the potential of circadian-based interventions, such as bright light therapy and exogenous melatonin, as well as chronotherapy to improve and/or modify disease outcomes.

Study Objectives: The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa., Methods: Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis., Results: In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses., Conclusions: In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women., (© 2021 American Academy of Sleep Medicine.)

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs)., Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals., Results: Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics., Conclusions: The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Introduction: False beliefs about sleep can persist despite contradicting scientific evidence, potentially impairing population health. Identifying commonly held false beliefs lacking an evidence base ("myths") can inform efforts to promote population sleep health., Method: We compiled a list of potential myths using Internet searches of popular press and scientific literature. We used a Delphi process with sleep experts (n = 10) from the fields of sleep medicine and research. Selection and refinement of myths by sleep experts proceeded in 3 phases, including focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on 2 dimensions, falseness and public health significance, using 5-point Likert scale from 1 ("not at all") to 5 ("extremely false")., Results: The current study identified 20 sleep myths. Mean expert ratings of falseness ranged from 5.00 (SD = 0.00) for the statement "during sleep the brain is not active" to 2.50 (SD = 1.07) for the statement "sleeping in during the weekends is a good way to ensure you get adequate sleep." Mean responses to public health significance ranged from 4.63 (SD = 0.74) for debunking the statement that "many adults need only 5 or less hours of sleep for general health" to 1.71 (SD = 0.49) for the statement that "remembering your dreams is a sign of a good night's sleep.", Conclusion: The current study identified commonly held sleep myths that have a limited or questionable evidence base. Ratings provided by experts suggest areas that may benefit from public health education to correct myths and promote healthy sleep., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Physiological evidence suggests that sleep modulates kidney function. Our objective was to examine the cross-sectional association between kidney function and objectively-estimated habitual sleep duration, quality and timing in a cohort of patients with mild to moderate chronic kidney disease. This study involved two US clinical centers of the Chronic Renal Insufficiency Cohort (CRIC) study, including 432 participants in a CRIC ancillary sleep study. Habitual sleep duration, quality and timing were measured using wrist actigraphy for 5-7 days. Validated sleep questionnaires assessed subjective sleep quality, daytime sleepiness and risk of sleep apnea. Kidney function was assessed with the estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation, and the urinary protein to creatinine ratio. Lower estimated glomerular filtration rate was associated with shorter sleep duration (-1.1 mL min -1  1.73 m -2 per hour less sleep, P = 0.03), greater sleep fragmentation (-2.6 mL min -1  1.73 m -2 per 10% higher fragmentation, P < 0.001) and later timing of sleep (-0.9 mL min -1  1.73 m -2 per hour later, P = 0.05). Higher protein to creatinine ratio was also associated with greater sleep fragmentation (approximately 28% higher per 10% higher fragmentation, P < 0.001). Subjective sleep quality, sleepiness and persistent snoring were not associated with estimated glomerular filtration rate or protein to creatinine ratio. Thus, worse objective sleep quality was associated with lower estimated glomerular filtration rate and higher protein to creatinine ratio. Shorter sleep duration and later sleep timing were also associated with lower estimated glomerular filtration rate. Physicians treating patients with chronic kidney disease should consider inquiring about sleep and possibly sending for clinical sleep assessment. Longitudinal and interventional trials are needed to understand causal direction., (© 2017 European Sleep Research Society.)

Objectives: A validated survey instrument to assess general sleep health would be a useful research tool, particularly when objective measures of sleep are not feasible. Thus, the National Sleep Foundation spearheaded the development of the Sleep Health Index (SHI)., Design: The development of the SHI began with a task force of experts who identified key sleep domains and questions. An initial draft of the survey was created and questions were refined using cognitive testing and pretesting. The resulting 28-question survey was administered via random-sample telephone interviews to nationally representative samples of adults in 2014 (n=1253) and 2015 (n=1250). These data were combined to create the index. A factor analysis linked 14 questions to 3 discrete domains: sleep quality, sleep duration, and disordered sleep. These were assembled as sub-indices, then combined to form the overall SHI, with scores ranging from 0 to 100 (higher score reflects better sleep health)., Results: Americans earned an overall SHI score of 76/100, with sub-index scores of 81/100 in disordered sleep, 79/100 in sleep duration, and 68/100 in sleep quality. In regression analyses, the strongest independent predictors of sleep health were self-reported stress (β=-0.26) and overall health (β=0.26), which were also the strongest predictors of sleep quality (β=-0.32 and β=0.27 respectively)., Conclusions: The current 12-item SHI is a valid, reliable research tool that robustly measures 3 separate but related elements of sleep health-duration, quality, and disorders-and assesses the sleep health status of adults in the United States., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

In recent years, strong evidence has emerged suggesting that insufficient duration, quality, and/or timing of sleep are associated with cardiovascular disease (CVD), and various mechanisms for this association have been proposed. Such associations may be related to endophenotypic features of the sleep homeostat and the circadian oscillator, or may be state-like effects of the environment. Here, we review recent literature on sleep, circadian rhythms and CVD with a specific emphasis on differences between racial/ethnic groups. We discuss the reported differences, mainly between individuals of European and African descent, in parameters related to sleep (architecture, duration, quality) and circadian rhythms (period length and phase shifting). We further review racial/ethnic differences in cardiovascular disease and its risk factors, and develop the hypothesis that racial/ethnic health disparities may, to a greater or smaller degree, relate to differences in parameters related to sleep and circadian rhythms. When humans left Africa some 100,000 years ago, some genetic differences between different races/ethnicities were acquired. These genetic differences have been proposed as a possible predictor of CVD disparities, but concomitant differences in culture and lifestyle between different groups may equally explain CVD disparities. We discuss the evidence for genetic and environmental causes of these differences in sleep and circadian rhythms, and their usefulness as health intervention targets., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the association of sleep characteristics with prevalent hypertension, diabetes, and obesity in a multiethnic cohort., Design: This study used a population-based cross-sectional study design., Setting: Participants were recruited between 2009 and 2011 from Chicago, Illinois, and the surrounding suburbs., Participants: Participants were 492 adults aged 35 to 64years who self-reported as white, black, Hispanic, or Asian and who had a low likelihood of sleep apnea based on the apnea screening questionnaires and 1 night of apnea screening using an in-home device (apnea hypopnea index <15 or oxygen desaturation index <10)., Measurements: Participants wore a wrist actigraphy monitor (Actiwatch™) for 7days. During a clinical examination, participants completed questionnaires about sleep, other health behaviors, and medical history and had their blood pressure, anthropometric measures, and fasting blood glucose measured; metabolic risk factors were determined based on standard clinical guidelines., Results: The prevalence of hypertension, obesity, and diabetes was 17.1%, 5.5%, and 35.4%, respectively. Sleep duration was not associated with any cardiovascular risk factor. There was a significantly increased odds for hypertension (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08) and obesity (OR, 1.03; 95% CI, 1.00-1.05) associated with higher sleep fragmentation (per 1%). There was also a significantly increased odds for hypertension associated with poorer self-reported sleep quality (OR, 1.14 [95% CI, 1.05-1.24] per 1-unit higher Pittsburgh Sleep Quality Index global score)., Conclusion: Objective and self-reported sleep quality may be more important than duration in relation to prevalent hypertension., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Limited data from former National Football League (NFL) players suggest that obstructive sleep apnea (OSA) may be highly prevalent after retirement. It remains unclear whether the high prevalence of OSA in retired players is comparable to nonathletes. This retrospective analysis compared sleep apnea (SA) risk in retired NFL players to a community cohort (CARDIA Sleep study), and examined associations between SA risk and cardiovascular risk factors, including subclinical atherosclerosis., Materials and Methods: Retired NFL players (n=122) were matched to CARDIA Sleep participants by age ±2 years (range 37-55 years), body mass index ±2 kg/m 2 , race, and male sex. Participants underwent electron-beam computed tomography to measure coronary artery calcium (CAC) and completed the Berlin Questionnaire to determine SA risk. The presence of CAC was defined as an Agatston score >0., Results: Retired NFL players had a greater prevalence of high SA risk than the matched CARDIA Sleep participants (27% vs 11.5%, P =0.002). Compared to the CARDIA Sleep participants, retired players were less likely to smoke, and had higher blood pressure, lower fasting glucose levels, and higher cholesterol levels. However, there was no difference in the prevalence of detectable CAC (30% vs 30%, P =1). In both players and the community cohort, SA risk was not significantly associated with CAC after controlling for age, race, and body mass index., Conclusion: Retired NFL players have a greater prevalence of high SA risk but similar prevalence of CAC compared with a well-matched community cohort., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Study Objectives: Sleep duration has been associated with risk of dementia and stroke, but few studies have investigated the relationship between sleep duration and brain MRI measures, particularly in middle age., Methods: In a prospective cohort of 613 black and white adults (mean age = 45.4 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study, participants reported typical sleep duration, dichotomized into moderate sleep duration (> 6 to ≤ 8 h) and short sleep duration (≤ 6 h) at baseline (2005-2006). Five years later, we obtained brain MRI markers of white matter including fractional anisotropy, mean diffusivity, and white matter hyperintensities., Results: Compared to moderate sleepers, short sleepers had an elevated ratio of white matter hyperintensities to normal tissue in the parietal region (OR = 2.31, 95% CI: 1.47, 3.61) adjusted for age, race/sex, education, hypertension, stroke/TIA, depression, smoking status, and physical activity. White matter diffusivity was also higher, approximately a 0.2 standard deviation difference, in frontal, parietal, and temporal white matter regions, among those reporting shorter sleep duration in (P < 0.05 for all)., Conclusions: Short sleep duration was associated with worse markers of white matter integrity in midlife. These mid-life differences in white matter may underlie the link between poor sleep and risk of dementia and stroke., (© 2016 Associated Professional Sleep Societies, LLC.)

Objectives: The association between inadequate sleep and type 2 diabetes has garnered much attention, but little is known about sleep and type 1 diabetes (T1D). Our objectives were to conduct a systematic review and meta-analysis comparing sleep in persons with and without T1D, and to explore relationships between sleep and glycemic control in T1D., Methods: Studies were identified from Medline and Scopus. Studies reporting measures of sleep in T1D patients and controls, and/or associations between sleep and glycemic control, were selected., Results: A total of 22 studies were eligible for the meta-analysis. Children with T1D had shorter sleep duration (mean difference [MD] = -26.4 minutes; 95% confidence interval [CI] = -35.4, -17.7) than controls. Adults with T1D reported poorer sleep quality (MD in standardized sleep quality score = 0.51; 95% CI = 0.33, 0.70), with higher scores reflecting worse sleep quality) than controls, but there was no difference in self-reported sleep duration. Adults with TID who reported sleeping >6 hours had lower hemoglobin A1c (HbA1c) levels than those sleeping ≤6 hours (MD = -0.24%; 95% CI = -0.47, -0.02), and participants reporting good sleep quality had lower HbA1c than those with poor sleep quality (MD = -0.19%; 95% CI = -0.30, -0.08). The estimated prevalence of obstructive sleep apnea (OSA) in adults with TID was 51.9% (95% CI = 31.2, 72.6). Patients with moderate-to-severe OSA had a trend toward higher HbA1c (MD = 0.39%, 95% CI = -0.08, 0.87)., Conclusion: T1D was associated with poorer sleep and high prevalence of OSA. Poor sleep quality, shorter sleep duration, and OSA were associated with suboptimal glycemic control in T1D patients., (Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Cardiometabolic diseases, which include obesity, diabetes, hypertension, and cardiovascular disease, are associated with reduced quality of life and reduced life expectancy. Unfortunately, there are racial/ethnic and socioeconomic disparities associated with these diseases such that minority populations, such as African Americans and Hispanics, and those of lower socioeconomic status, experience a greater burden. Several reports have indicated that there are differences in sleep duration and quality that mirror the disparities in cardiometabolic disease. The goal of this paper is to review the association between sleep and cardiometabolic disease risk because of the possibility that suboptimal sleep may partially mediate the cardiometabolic disease disparities., Methods: We review both experimental studies that have restricted sleep duration or impaired sleep quality and examined biomarkers of cardiometabolic disease risk, including glucose metabolism and insulin sensitivity, appetite regulation and food intake, and immune function. We also review observational studies that have examined the association between habitual sleep duration and quality, and the prevalence or risk of obesity, diabetes, hypertension, and cardiovascular disease., Conclusion: Many experimental and observational studies do support an association between suboptimal sleep and increased cardiometabolic disease risk., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Prior studies report less favorable sleep characteristics among non-Whites as compared with non-Hispanic Whites. However, few population-based studies have used objective measures of sleep duration, especially in more than two racial/ethnic groups. We tested whether objectively estimated sleep duration and self-reported sleep quality varied by race and whether differences were at least partially explained by the variability in clinical, psychological, and behavioral covariates., Methods: Adults aged 35-64 years who self-identified as White, Black, Asian, or Hispanic were randomly sampled from Chicago, IL, and the surrounding suburbs. Our analytic sample included adults who had an apnea-hypopnea index <15 after one night of screening and who completed seven nights of wrist actigraphy for determination of sleep duration, sleep percentage, minutes of wake after sleep onset, and sleep fragmentation (n = 495). Daytime sleepiness was estimated using the Epworth Sleepiness Scale (ESS), and sleep quality was estimated from the Pittsburgh Sleep Quality Index (PSQI)., Results: Following statistical adjustment for age, gender, education, work schedule (ie, day vs. night shift), smoking status, depressive symptoms, body mass index (BMI), hypertension, and diabetes, sleep duration (minutes) was significantly (all p < 0.01) shorter in Black (mean = 399.5), Hispanic (mean = 411.7), and Asian (mean = 409.6) participants than in White participants (mean = 447.4). All remaining sleep characteristics were significantly less favorable among Black participants as compared with White participants. Asian participants also reported significantly more daytime sleepiness than did White participants., Conclusions: Differences in sleep characteristics by race/ethnicity are apparent in a sample of adults with a low probability of sleep apnea and following adjustment for known confounders., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Cardiovascular disease, diabetes and obesity are highly prevalent diseases associated with reduced quality of life and life expectancy. We discuss a novel risk factor for these cardiometabolic diseases: circadian disruption. Circadian disruption occurs when the internal circadian (∼24-hour) rhythms are not in synchrony with the environment or each other. This paper reviews (1) cardiometabolic health of shift work, which often leads to circadian disruption, (2) effects of experimentally disrupted circadian rhythms on cardiometabolic function, (3) observational studies of sleep timing and behavioral chronotype, and (4) potential mediators linking chronotype and shift work to circadian disruption and cardiometabolic health., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aims/hypothesis: A normal consequence of increased energy intake and insulin resistance is compensatory hyperinsulinaemia through increased insulin secretion and/or reduced insulin clearance. Failure of compensatory mechanisms plays a central role in the pathogenesis of type 2 diabetes mellitus; consequently, it is critical to identify in vivo signal(s) involved in hyperinsulinaemic compensation. We have previously reported that high-fat feeding leads to an increase in nocturnal NEFA concentration. We therefore designed this study to test the hypothesis that elevated nocturnal NEFA are an early signal for hyperinsulinaemic compensation for insulin resistance., Methods: Blood sampling was conducted in male dogs to determine 24 h profiles of NEFA at baseline and during high-fat feeding with and without acute nocturnal NEFA suppression using a partial A1 adenosine receptor agonist., Results: High-fat feeding increased nocturnal NEFA and reduced insulin sensitivity, effects countered by an increase in acute insulin response to glucose (AIR(g)). Pharmacological NEFA inhibition after 8 weeks of high-fat feeding lowered NEFA to baseline levels and reduced AIR(g) with no effect on insulin sensitivity. A significant relationship emerged between nocturnal NEFA levels and AIR(g). This relationship indicates that the hyperinsulinaemic compensation induced in response to high-fat feeding was prevented when the nocturnal NEFA pattern was returned to baseline., Conclusions/interpretation: Elevated nocturnal NEFA are an important signal for hyperinsulinaemic compensation during diet-induced insulin resistance.

Study Objectives: The overall objective of the 2014 National Sleep Foundation Sleep in America Poll "Sleep in the Modern Family" was to obtain a current picture of sleep in families with at least 1 school-aged child., Design: Cross-sectional poll., Setting: Internet-based interview., Participants: Nationally representative Internet panel of US households with a child 6-17 years., Measurements and Results: Primary measures included parental perception of the importance of sleep, parental and child sleep quality, child sleep duration and habits, technology in bedroom, and family rules. Parents/guardians (n= 1103; mean age, 42; 54% female) completed the survey. Although the majority of parents endorsed the importance of sleep, 90% of children obtain less sleep than recommended. Significant predictors of age-adjusted sufficient sleep duration (estimated conservatively as ≥9 hours for ages 6-11 years and ≥8 hours for ages 12-17 years) included parent education, regular enforcement of rules about caffeine, and whether children left technology on in their bedroom overnight. Significant predictors of excellent sleep quality included whether a bedtime was always enforced and whether children left technology on overnight., Conclusions: Children generally have better age-appropriate sleep in the presence of household rules and regular sleep-wake routines. Sufficient sleep quantity and adequate sleep quality were protected by well-established rules of sleep hygiene (limited caffeine and regular bedtime). In contrast, sleep deficiency was more likely to be present when parents and children had electronic devices on in the bedroom after bedtime. Public health intervention goals for sleep health might focus on reducing the encroachment of technology and media into time for sleep and supporting well-known sleep hygiene principles.

Objective: To determine the association between objectively measured sleep and 10-year changes in estimated glomerular filtration rate (eGFR)., Methods: From 2003 to 2005, an ancillary sleep study was conducted at the Chicago site of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Community-based black and white adults (aged 32-51 years) wore a wrist actigraph for up to six nights to record sleep duration and fragmentation. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Participants without history of cardiovascular or chronic kidney diseases, proteinuria, or hypertension at the 2000-2001 CARDIA examination were followed over 10 years (n = 463). eGFR was estimated from serum creatinine (eGFRCr) at the 2000-2001, 2005-2006, and 2010-2011 CARDIA examinations, whereas cystatin-C-estimated eGFR (eGFRCys) was measured at the 2000-2001 and 2005-2006 examinations. Generalized estimating equation regression and linear models estimated the associations of each sleep parameter with changes in eGFRCr and eGFRCys, controlling for cardiovascular and renal risk., Results: Sleep parameters were not related to 5-year change in eGFRCys. However, each 1 h decrease in sleep duration was significantly associated with a 1.5 mL/min/1.73 m2 higher eGFRCr [95% confidence interval (CI), 0.2-2.7], and each one-point increase in PSQI was significantly associated with a 0.5 mL/min/1.73 m2 higher eGFRCr (95% CI, 0.04-0.9) over 10 years., Conclusion: In this community-based sample, shorter sleep and poorer sleep quality were related to higher kidney filtration rates over 10 years., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background and Aim: Short sleep duration and poor quality sleep are associated with coronary heart disease (CHD) mortality; however, the underlying pathophysiologic process remains unclear. Sleep apnea may confound the association because of its relationship with formation of thrombi, the vascular occlusive process in CHD. We tested whether sleep duration and quality were associated with prothrombotic biomarkers in adults with a low probability of apnea., Methods: We included adults aged 35-64 years recruited from the community and who had an apnea hypopnea index <15 after one night of screening (n=506). Sleep duration and maintenance were determined from 7 days of wrist actigraphy; daytime sleepiness was estimated using the Epworth Sleepiness Scale. Factor VIII (FVIII), von Willebrand factor (vWF), thrombin antithrombin (TAT) complexes, and plasminogen activator inhibitor-1 (PAI-1) were measured in fasting blood., Results: Sleep duration, maintenance, and daytime sleepiness were not associated with FVIII, vWf, or TAT. Sleep maintenance was modestly inversely associated with higher levels of log-transformed PAI-1 (β = -0.07, standard error (SE)=0.03 per 4.8%, p=0.04) following adjustment for demographic characteristics, cardiovascular risk factors, and body mass index (BMI)., Conclusions: Mild impairment in sleep was modestly associated with activation of coagulation; further study is needed to evaluate the role of fibrinolytic factors in sleep-mediated coronary thrombosis., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Short sleep duration is associated with weight gain and obesity, diabetes, cardiovascular disease, psychiatric illness, and performance deficits. Likewise, long sleep duration is also associated with poor physical and mental health. The role of a healthy diet in habitual sleep duration represents a largely unexplored pathway linking sleep and health. This study evaluated associations between habitual sleep parameters and dietary/nutritional variables obtained via the National Health and Nutrition Examination Survey (NHANES), 2007-2008. We hypothesized that habitual very short (<5h) short (5-6h) and long (9+h) sleep durations are associated with intake of a number of dietary nutrient variables. Overall, energy intake varied across very short (2036kcal), short (2201kcal), and long (1926kcal) sleep duration, relative to normal (2151kcal) sleep duration (p=0.001). Normal sleep duration was associated with the greatest food variety (17.8), compared to very short (14.0), short (16.5) and long (16.3) sleep duration (p<0.001). Associations between sleep duration were found across nutrient categories, with significant associations between habitual sleep duration and proteins, carbohydrates, vitamins and minerals. In stepwise analyses, significant contributors of unique variance included theobromine (long sleep RR=0.910, p<0.05), vitamin C (short sleep RR=0.890, p<0.05), tap water (short sleep RR=0.952, p<0.001; very short (<5h) sleep RR=0.941, p<0.05), lutein+zeaxanthin (short sleep RR=1.123, p<0.05), dodecanoic acid (long sleep RR=0.812, p<0.05), choline (long sleep RR=0.450, p=0.001), lycopene (very short (<5h) sleep RR=0.950, p<0.05), total carbohydrate (very short (<5h) sleep RR=0.494, p<0.05; long sleep RR=0.509, p<0.05), selenium (short sleep RR=0.670, p<0.01) and alcohol (long sleep RR=1.172, p<0.01). Overall, many nutrient variables were associated with short and/or long sleep duration, which may be explained by differences in food variety. Future studies should assess whether these associations are due to appetite dysregulation, due to short/long sleep and/or whether these nutrients have physiologic effects on sleep regulation. In addition, these data may help us better understand the complex relationship between diet and sleep and the potential role of diet in the relationship between sleep and obesity and other cardiometabolic risks., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Sleep is a biological imperative associated with cardiometabolic disease risk. As such, a thorough discussion of the sociocultural and demographic determinants of sleep is warranted, if not overdue. This paper begins with a brief review of the laboratory and epidemiologic evidence linking sleep deficiency, which includes insufficient sleep and poor sleep quality, with increased risk of chronic cardiometabolic diseases such as obesity, diabetes and hypertension. Identification of the determinants of sleep deficiency is the critical next step to understanding the role sleep plays in human variation in health and disease. Therefore, the majority of this paper describes the different biopsychosocial determinants of sleep, including age, gender, psychosocial factors (depression, stress and loneliness), socioeconomic position and race/ethnicity. In addition, because sleep duration is partly determined by behavior, it will be shaped by cultural values, beliefs and practices. Therefore, possible cultural differences that may impact sleep are discussed. If certain cultural, ethnic or social groups are more likely to experience sleep deficiency, then these differences in sleep could increase their risk of cardiometabolic diseases. Furthermore, if the mechanisms underlying the increased risk of sleep deficiency in certain populations can be identified, interventions could be developed to target these mechanisms, reduce sleep differences and potentially reduce cardiometabolic disease risk., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Sleep disordered breathing (SDB) is common in obese adults, but not all obese adults have SDB. The aim of these analyses was to determine what predicted SDB in a sample of obese adults., Methods: We conducted cross-sectional analysis of 139 obese men and women aged 18-50 years who are chronic short sleepers. Habitual sleep duration and sleep efficiency were estimated using two weeks of wrist actigraphy. Respiratory disturbance index (RDI) was assessed by a portable screening device. SDB was defined as RDI ≥15 events h(-1). Subjective sleep quality, sleepiness, and sociodemographic characteristics were evaluated by questionnaires., Results: Increased sleep duration from actigraphy was associated with reduced odds of SDB (OR 0.44 per hour, p=0.043). Neither subjective sleep quality nor sleepiness was associated with SDB. Male sex, older age, and increased waist circumference were associated with increased odds of SDB., Conclusions: In this sample of obese adults, subjective measures of sleep quality and sleepiness were not indicators of SDB. These results suggest that, in obese patients, physicians should not rely on subjective measures to determine who should be referred for a clinical sleep study. A wider use of portable apnea screening devices should be considered in nonsymptomatic, non-Hispanic white males., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Polysomnograms (PSGs) are routinely ordered by nonsleep specialists. However, it is unknown whether a sleep specialist consultation prior to a diagnostic PSG influences adherence to continuous positive airway pressure (CPAP) therapy., Methods: This study was done at the University of Chicago Sleep Disorders Center and included 403 patients with obstructive sleep apnea who had CPAP adherence data available. CPAP was set up at home, and objective adherence was remotely monitored during the first 30 days of therapy. Physicians who ordered PSGs were divided into two groups: sleep specialists and nonsleep specialists., Results: Patients were aged 52.5 ± 14 years, 47% were men, and 54% were African American. Mean daily CPAP use was greater in patients who were referred by sleep specialists (n = 105, 279 ± 179 min/d) than in patients referred by nonsleep specialists (n = 298, 219 ± 152 min/d, P = .005). In the linear regression model adjusting for several covariates, only two predictors were significantly associated with CPAP adherence. A sleep specialist consultation prior to the diagnostic PSG was associated with 58.2 min more per day (P = .002), and African American race was associated with 56.0 min less per day (P = .002) of CPAP use., Conclusions: In this cohort study, CPAP adherence was significantly higher with a sleep specialist consultation prior to the diagnostic PSG. In addition, African American race was associated with worse adherence to therapy. A better understanding of predictors of CPAP adherence may be useful in identifying patients who may benefit from a sleep specialist consultation prior to ordering a diagnostic PSG.