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Recent evidence utilizing online samples indicates that sleep patterns were significantly altered during the initial months of the SARS-CoV-2 (COVID-19) pandemic/lockdown. However, it remains less clear how sleep duration changed in population-based samples, in the later months of 2020, and across subpopulations. Here we used a population-based sample to document sleep duration trends for the entire year of 2020, compared these trends to the previous years of 2013, 2014, 2016, and 2018, and systematically analyzed whether self-reported sleep duration patterns in 2020 varied by sex, race/ethnicity, and educational attainment. Data were from the Behavioral Risk Factor Surveillance System (n = 2,203,861) and focused on Americans aged 18 years and older. Respondents self-reported the hours of sleep they got in a 24-h period. We fit multinomial and linear regression models to predict the category of sleep duration (six or fewer hours, seven to eight h (base), and nine or more hours) and the raw reports of sleep duration, net of demographic, socioeconomic, and behavioral health covariates. Results revealed significant increases in sleep duration during the months directly after the COVID-19 lockdown (March and April in particular). However, these increases were short lived; reports of sleep duration reverted to historical levels by the Fall of 2020. We also found that the changes in sleep duration trends in 2020 were similar by sex, race/ethnicity, and educational attainment, cumulatively leading to little impact to disparities in sleep duration. In a dramatic, but brief, alteration of population-level sleep duration patterns, disparities in self-reported sleep duration remained intractable.

Background Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. Methods The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. Discussion Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Short sleep duration and poor dietary habits may contribute to increased adiposity; however, the impact of the interaction between these variables on adiposity is less understood. To evaluate research investigating the combined effects of sleep and diet on adiposity in infants, toddlers, and young children.Systematic searches of electronic databases (PubMed, CINAHL, and Web of Science) from inception through April 2017 were conducted. All studies published in English that had at least 1 sleep (e.g., sleep duration and night awakenings), diet (e.g., 24-hour diet recall and breastfeeding duration), and adiposity (e.g., body mass index z-score and weight-for-length) measure were eligible for inclusion. Abstract and full-text article reviews were conducted by 2 independent reviewers. Data were extracted into a standardized spreadsheet.Of the 17 full-text articles reviewed, 14 studies were included. Mediation (n = 2) and moderation (n = 2) were seldom used. Investigation of the combined effects of sleep and diet on adiposity demonstrated a substantial lack of evidence. Synthesis of articles suggests that the relationship between sleep and diet may be interactive and their effects additive in their impact when targeted simultaneously within interventions.Without consideration of interaction effects among variables of interest, a substantial gap in the literature persists. Both diet and sleep need to be assessed simultaneously and repetitively in future longitudinal research.

Association between COVID-19 Pandemic Related Unemployment and Change in Sedentary Screen Time among Previously Employed Adults Jennifer L. Mattingly, MPH & Megan E. Petrov, PhD Introduction: Worldwide, the COVID-19 pandemic has resulted in widespread job loss and disruptions in daily life. However, the role of job loss during the COVID-19 pandemic on health behaviors such as sedentary screen time (SST) is unknown. The purpose of this study was to determine the association between employment status change during the pandemic and change in SST. Methods: A 25-minute online survey was distributed through local and global social media from 5/21/2020-7/01/2020. A subsample of employed adults (n=417; M =38.45y, range: 18-75; 74.8.% women) provided complete self-reported pre-and during-COVID-19 employment status (categorized as remained employed and became unemployed), pre-and during-COVID-19 hours of daily SST for non-work-related purposes [low: 5]. Change in daily SST was categorized as low-low (ref), low-high, and high-high. The subsample of participants that changed from high to low SST in the sample was low and were removed from subsequent analyses. Multinomial logistic regression models were conducted to examine the association of change in employment status on change in SST while adjusting for age, gender, education level, body mass index, current minutes of physical activity per week, and current typical 24-hour sleep duration. Results: Of the 417 participants who were employed prior to the pandemic, 15.6% (n=675). Became Unemployed. The proportion of participants in the low-low, low-high, and high-high change in SST groups were 46.8% (n=195), 25.4% (n=106), and 27.8% (n=116), respectively. Relative to adults who remained employed, adults who became unemployed had a 3.02 greater odds (95%CI:1.51, 6.02) of being in the high-high change in SST group, and had a 2.54 greater odds (95%CI:1.23,5.25) of being in the low-high change in SST group relative to participants who were consistently low in SST. Conclusion: In this cross-sectional study of an international, online sample of adults, becoming unemployed was associated with a greater odds of both maintaining high levels of sedentary screen time, and increasing sedentary screen time to high levels. Action to protect people in the workforce from job loss and employment disruption in times of global economic upheaval may prevent increased adoption of maladaptive lifestyle behaviors, such as high levels of SST.

Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic & cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.

The purpose of this prospective study was to investigate whether sedentary screen time (SST) and physical activity in adolescence were related to sleep duration in adulthood and whether these associations varied by sex. We analyzed data from 9279 adolescents who participated in Waves I and V of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. SST was measured by reported hours spent watching television/videos or playing video/computer games per week. Physical activity was measured with participation in school team club sports and frequency (times/week) of moderate to vigorous physical activity (MVPA). Results from multinomial regression models indicated that adolescents with more SST, particularly 15–21 h (Relative Risk Ratio [RRR] = 1.18, 95% CI: 1.02–1.36) or 22 or more hours (RRR = 1.19, 95% CI: 1.06–1.35) compared to 0–7 h per week SST, had significantly higher relative risk of short sleep (six or fewer hours) in adulthood, after controlling for demographic characteristics, socioeconomic status and health behaviors at Waves I and V, sleep duration at Wave I, and SST and MVPA at Wave V. The association between 22 or more hours per week SST in adolescence and later short sleep varied by sex (RRR = 0.75, 95% CI: 0.58–0.95) and was significantly stronger among males. Measures of physical activity in adolescence did not predict sleep duration. Decreasing adolescents' SST to prevent suboptimal sleep later in development may be a target for further investigation, particularly for males.

Objectives To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, and sleep and mental health factors associated with these profiles. Design, setting, and participants A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020. Measurements Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses. Results The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord. Conclusions In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.

OBJECTIVES: Short and long sleep duration are associated with poor health outcomes and are most prevalent among racial/ethnic minorities. Few studies have investigated the intersection of other sociodemographic characteristics with race/ethnicity on sleep duration prevalence. DESIGN: Longitudinal retrospective analysis of continental U.S. cohort, the REasons for Geographic And Racial Differences in Stroke (REGARDS) PARTICIPANTS: Black (n = 7,547) and white (n = 12,341) adults, 56% women, ≥45 years MEASUREMENTS: At baseline (2003–07), participants reported age, sex, race, education, income, marital status, U.S. region, and employment status. The weighted average of reported sleep duration on weekdays and weekends, assessed at follow-up (2008–10), was categorized as

BACKGROUND: Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG. OBJECTIVE: Examine associations between newborn sleep-wake patterns and incident RWG at 6 months of life and OW at 36 months. METHODS: Low-income Mexican/Mexican-American women with OW/obesity and their infants (n = 126) enrolled in a 1-year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire-Revised. Outcome measures included RWG (>0.67 positive change in weight-for-age Z-score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months. RESULTS: By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1-month was significantly associated with decreased odds for RWG compared to napping

Aim: Few studies have examined the association between objective sleep metrics and arterial and echocardiographic (left ventricular systolic/diastolic function) markers of sub-clinical cardiovascular disease (CVD). The present study examined the association of wrist actigraphy-assessed sleep metrics with arterial stiffness, endothelial dysfunction, and left ventricular systolic/diastolic function. Methods: Fifteen young, healthy adults (21-39y; 60% women) with no history of CVD, and no current sleep-disordered breathing (WatchPat200, Itamar Medical) or sleep complaints wore Actiwatch Spectrum Plus actigraphs for eight nights (Philips Respironics, Bend OR) with accompanying sleep logs. Participants underwent fasting vascular testing including central augmented aortic pressure (AP), carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF%), left atrial volume index (LAVI), deceleration time (DT), and mitral valve E/e’ ratio (MVE/e’) using standardized methods. Bivariate correlations investigating the association between mean total sleep time (TST), sleep efficiency % (SE), sleep-onset latency (SOL), and wake after sleep time (WASO) with cardiovascular indices were conducted. Curvilinear regression models examining quadratic relationships between TST and the cardiovascular indices were conducted. Results: On average, participants obtained 6 hrs 44 min of TST (SD=29.1), with 86.0% SE (SD=3.1), 10.6 min SOL (SD=8.5), and 37.0 min WASO (SD=11.6). cfPWV (range: 4.8-7.5), EF% (range: 60.0-72.0), LAVI (range: 15.0-26.7 mL/m 2 ), and MVE/e’ (range: 3.2-7.8) were all within normal ranges according to age and sex normative standards. Mean FMD was 9.2% (SD=4.62, range: 4.3-19.8). Correlations indicated that greater SOL was associated with greater cfPWV (r=.63, p=0.01), and AP (r=.57, p=0.03). Lower SE (r= -.70, p=0.003) and higher WASO (r=.71, p=0.003) were associated with higher MVE/e’. WASO was associated with higher DT (r=.57, p=0.04). Curvilinear regression models revealed a quadratic relationship between TST and cfPWV (F[2,11]=9.78, p=0.004) such that shorter and longer TST were associated with greater cfPWV. No sleep metrics were associated with FMD, EF%, or LAVI. Conclusions: Among normal sleeping, apparently healthy young adults, with no history of CVD, lower levels of objective sleep quality and both shorter and longer sleep duration were associated with greater arterial stiffness, whereas only lower levels of objective sleep quality were related to worsening left ventricular diastolic dysfunction. These data may have implications for CVD risk reduction in young, healthy adults.

Cardiovascular disease (CVD) is associated with increased risk for cognitive decline. Lifestyle behaviors such as moderate to vigorous physical activity (MVPA) and reduced sedentary time (ST) may mitigate this decline, but limited research exists. The aim of the study was to examine the joint association of MVPA and ST on cognitive function by CVD status. Adults (n=2844, ≥60yrs) from the 2011-2014 National Health and Nutrition Examination Survey underwent cognitive testing (Digit Symbol Substitution Test [DSST]; Animal Fluency [AF]). Participants reported minutes of MVPA per week (categorized by U.S. PA Guidelines: ≥ 150min MPA and/or ≥ 75min VPA PA vs 7hrs ) , and reported physician-diagnosed CVD (i.e., myocardial infarction, stroke, coronary heart disease, or heart failure). Weighted linear regression analyses assessed the joint association of MVPA and ST on cognitive function, and tested the modifying effect of CVD status (alpha level for interaction terms set at 0.1) after adjustment for demographics, hypertension, diabetes, body mass index, and depression symptomatology. See Table. There were significant main effects for combined MVPA-ST groups on DSST (Wald F (3,30)=4.92, p =.007) and AF (Wald F (3,30)=5.01, p =.006). Individuals who did not engage in MVPA regardless of ST had significantly worse scores on DSST compared to the reference group. There was a significant main effect for CVD on DSST (Wald F (1,32)=8.82, p =.006). There was a significant interaction between MVPA-ST groups and CVD status on DSST (Wald F (3,30)=3.691, p =.023). Stratified analyses indicated among individuals with CVD, the buffering effect of MVPA was maintained, but the interaction was not significant for those without CVD. In a sample of adults with a history of CVD, meeting recommendations for MVPA appeared to preserve executive functioning regardless of ST. This research highlights the added importance for people with a history of CVD to participate in the recommended amount of MVPA.

Introduction: Evidence suggests there are racial/ethnic differences in lifestyle behaviors that may affect cardiovascular health outcomes such as physical activity engagement, diet, and sleep duration. However, the literature on racial/ethnic differences in sedentary time (ST) and whether these differences may be related differentially to cardiovascular health is limited. The goals of this study are to investigate racial/ethnic differences in self-reported ST, and examine if the modifying effect of ST with race/ethnicity will be associated with hypertension (HTN) prevalence. Methods: Adults (N=15903, age ≥20 yrs) from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 reported their race/ethnicity (Mexican American [MA], Other Hispanic [OH], non-Hispanic White [NHW], non-Hispanic Black [NHB], non-Hispanic Asian, Other or mixed race [OM]), ST on a typical day (median split at 6 hrs: Low vs. High ST), and history of physician diagnosed HTN (yes/no). Weighted logistic regression models were conducted to examine the association between race/ethnic groups and ST, and combined racial/ethnic-ST groups (reference group: NHW with Low ST) on HTN prevalence while controlling for age, sex, education, body mass index, smoking status, moderate-vigorous physical activity min/wk, and history of diabetes, cardiovascular (i.e., heart failure, myocardial infarction, stroke, coronary heart disease) and kidney conditions. Results: There was a significant association between race/ethnic groups and ST (Wald F [5,43]=23.4, p F [11,37] = 9.8, p Conclusion: In a large national cohort, daily ST differed by race/ethnicity, and ST modified the association between race/ethnicity and odds for HTN such that compared to more active NHW, more active Hispanic groups had decreased odds for HTN, but NHB regardless of ST had increased risk for HTN. ST may be a key modifiable risk factor in addressing race/ethnic disparities in cardiovascular health.

ObjectiveTo investigate the association between reported sleep duration and incident stroke in a US cohort of black and white adults, and evaluate race, age, and sex as potential effect modifiers.MethodsFrom 2008 to 2010, 16,733 black and white adults, aged ≥45 years, without a history of stroke or sleep-disordered breathing from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, reported their habitual sleep duration (ResultsThe sample comprised 10.4% (n = 1,747) short sleepers (p= 0.018) and sleep duration and race–sex groups (p= 0.0023) in association with incident stroke. Short sleep duration was significantly associated with decreased risk for stroke among black participants (hazard ratio [HR] 0.49 [95% confidence interval (CI) 0.28–0.85]), particularly black men (HR 0.21 [95% CI 0.07–0.69]), whereas long sleep duration was significantly associated with increased risk for stroke among white men (HR 1.71 [95% CI 1.06–2.76]).ConclusionsThe association of sleep duration with incident stroke differs by race and sex, with short sleep duration among black men associated with decreased risk, whereas long sleep duration among white men associated with increased risk for stroke.

Study Objectives:To examine the cross-sectional association between obstructive sleep apnea (OSA) risk and atrial fibrillation (AF) in the REasons for Geographic And Racial Differences in Stroke (R...

Introduction Infant sleep is influenced by biopsychosocial interactions. However, the influence of an interactive home environment is underexplored. The aim was to examine whether early positive parent-child interactions and an enriched home environment were associated with better infant sleep later. Methods Pregnant, obese, and low-income Latina women were recruited for a RCT delivering a 12-month intervention for infants to prevent overweight (n=129). At 1, 6, and 12 months, mothers reported breastfeeding duration, completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), and underwent the Home Observation for Measurement of the Environment (HOME, range: 0-45) Inventory including subscales of Responsivity, Acceptance, Organization, Learning Materials, Involvement, and Variety. Pearson correlations between HOME and BISQ-R at each visit were conducted. Significant associations (α Results The mean 1-, 6- and 12-month BISQ-R were 84(SD=6.1), 76.4(SD=8.3), and 78.5(SD=8.0), respectively. The 1-month HOME total score (M=21.8[SD=4.4]) significantly correlated with the 6- and 12-month BISQ-R. The regression of 1-month HOME with 6-month BISQ-R indicated greater BISQ-R scores were associated with shorter breastfeeding (β=-0.3, p=0.001), greater HOME total scores (β=0.2, p=0.037), and 1-month BISQ-R scores(β=0.2, p=0.038), which explained 13.1% of the variance (F[3,106]=6.5, p Conclusion Better infant sleep was associated with an early interactive home environment, especially parent’s responsiveness and people/events providing organized variety. Support (if any)

Highlights • Aerobic physical activity interventions had a large effect on memory. • Aerobic physical activity interventions had a small effect on executive function. • Meeting U.S. physical activity guidelines resulted in a large effect on memory. • Studies with a no treatment control had a large effect on memory., The worldwide population of adults ages 50 and older continues to increase and is projected to reach over 2.3 billion by 2030. Aging is the biggest risk factor for cognitive impairment and dementia. Aerobic physical activity may improve cognitive functioning, thus delaying aging-related cognitive decline. The purpose of this review was to examine the effect of aerobic physical activity on memory and executive function in sedentary adults with no known cognitive impairment. PubMed, CINAHL, Psycinfo, and Cochrane Library databases were systematically searched for peer-reviewed articles up to July 2019. Randomized controlled trials of sedentary adults, aged 50 and older, that compared an aerobic physical activity intervention to either no treatment or alternative active comparator and reported outcome measures of memory and/or executive function were included. A random effects meta-analysis was performed to examine the separate effect sizes for memory and executive function. Nine studies met inclusion criteria and contributed either memory and/or executive function effect sizes (n = 547). Results from the random effects meta-analysis suggested, by post-intervention, a large effect size for the aerobic physical activity interventions on memory (g = 0.80, 95%CI: 0.14–1.47; n = 7; p = 0.02) and a small effect on executive function (g = 0.37, 95%CI: 0.04–0.69; n = 6; p = 0.03). Aerobic physical activity may improve memory and executive function in sedentary adults without cognitive impairment. Policymakers and providers should promote aerobic physical activity in this population, and further research should investigate the most effective ways to promote aerobic physical activity in mid-life to older adults.

Background Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain). Methods In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n = 270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures. Results Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation. Conclusions Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain.

Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined. This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes. A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21–77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol. Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = −2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = −4.11, p

Introduction Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls. Methods Persons with insomnia (met ICSD-III criteria) and good sleeping controls ( Results AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’. Conclusion Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning. Support American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18

Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 &plusmn, 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) &lt, 17 week were randomized to Breezing&trade, (n = 16) or control (n = 12) groups for 13 weeks. REE by Breezing&trade, indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14&ndash, 21 weeks), late (21&ndash, 28 weeks), and overall (14&ndash, 28 weeks) changes in macronutrients and GWG were calculated. The Breezing&trade, group had a significantly greater rate of GWG [F (1,23) = 6.8, p = 0.02] in the latter half of the second trimester. Late (&minus, 155.3 &plusmn, 309.2 vs. 207.1 &plusmn, 416.5 kcal, p = 0.01) and overall (&minus, 143.8 &plusmn, 339.2 vs. 191.8 &plusmn, 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing&trade, and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, p = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.

Older adults experience many physical and health-related changes, including normative changes in sleep patterns characterized by greater fragility of sleep and a tendency toward “lightening” of sleep. This altered sleep patterning combined with an accumulation of other age-related changes (such as illness, polypharmacy, institutionalization, and social role transitions) increases the likelihood of incident sleep complaints and chronic insomnia during older adulthood. This chapter will provide an overview of the foundational research literature on late-life insomnia integrated with up-to-date data on the prevalence and clinical presentation of insomnia symptoms among older adults. Guidelines for the assessment, diagnosis, and treatment of late-life insomnia will also be summarized.

OBJECTIVES: Higher energy intake has been associated with increased gestational weight gain (GWG). However, the effects that individual macronutrients have on GWG remain unclear. We examined the putative mediating effect of macronutrient composition on GWG after an intervention aimed to track prenatal energy needs. METHODS: In this controlled trial, pregnant women aged >18 yr old (X = 29.8 ± 4.9 yr) with a gestational age (GA)

Background Positive airway pressure (PAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), a chronic disorder that affects 6–13% of the adult population. However, adherence to PAP therapy is challenging, and current approaches to improve adherence have limited efficacy and scalability. Methods/design To promote PAP adherence, we developed SleepWell24, a multicomponent, evidence-based smartphone application that delivers objective biofeedback concerning PAP use and sleep/physical activity patterns via cloud-based PAP machine and wearable sensor data, and behavior change strategies and troubleshooting of PAP therapy interface use. This randomized controlled trial will evaluate the feasibility, acceptability, and initial efficacy of SleepWell24 compared to a usual care control condition during the first 60 days of PAP therapy among patients newly diagnosed with OSA. Discussion SleepWell24 is an innovative, multi-component behavior change intervention, designed as a self-management approach to addressing the psychosocial determinants of adherence to PAP therapy among new users. The results will guide lengthier future trials that assess numerous patient-centered and clinical outcomes.

OBJECTIVES: Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG). There is a paucity of research investigating the relationship between REE and GWG. We investigated variations in REE and dietary composition throughout the second trimester and their association with GWG. METHODS: In this controlled trial, pregnant women (N = 16, mean age of 29.9 ± 4.3 years) with a gestational age

Introduction Among persons with mental health conditions, the impact of the COVID-19 pandemic on sleep health is underexplored. The present study investigated whether sleep changes related to the COVID-19 pandemic differed among individuals with mood and/or anxiety disorders compared to individuals without these disorders. Methods A 25-minute online survey, distributed globally to adults aged >18y through social media advertising from 5/28/2020-7/10/2020, examined the association of mental health diagnoses with COVID-19 related sleep changes. Participants reported prior history of mood and anxiety disorders, and pre-COVID-19 and current sleep patterns including bedtime, wake time, total sleep time (TST), sleep efficiency (SE:[TST/time in bed*100%], and nightmare frequency/wk. ANOVA models comparing mental health disorder groups (no diagnoses, mood disorders, anxiety disorders, mood and anxiety disorders) on mean differences in sleep changes were conducted. Results Among 1,048 participants, 71.5% reported no prior mood and/or anxiety disorders9.3% reported anxiety disorders only, 4.3% reported prior mood disorders only, and 14.9% reported both mood and anxiety disorders. There were significant group differences in total sleep time (F (3,670)=4.6, p=0.003) and sleep efficiency (F (3,670) =2.8, p=0.038) such that individuals with both mood and anxiety disorders experienced greater decreases in total sleep time (Mean Difference: 39.0min, SE=13.0) and sleep efficiency (Mean Difference=3.8%, SE=1.6) compared to individuals without any mood or anxiety disorders. In addition, the model for nightmare frequency per week was significant (F(3,654)=5.6, p=0.001) such that individuals with both anxiety and mood disorders (Mean Difference=1.1, SE=0.4) and individuals with mood disorders only (Mean Difference=1.1, SE=0.4) reported greater increases in nightmare frequency compared to participants without any mood or anxiety disorders. There were no group differences in bedtime and wake time. Conclusion Among a global sample, COVID-19 pandemic-related sleep health significantly worsened among individuals with prior mood and anxiety disorders relative to individuals without these disorders. Support (if any)

The indirect association of childhood abuse with prevalent hypertension in adulthood through sleep disturbance and pro-inflammatory biomarkers was investigated in 589 community-dwelling, middle-aged adults. Participants completed the Childhood Trauma Questionnaire and self-reported current sleep disturbance and medical diagnoses including hypertension. Blood pressure was taken and blood samples were analyzed for C-reactive protein, interleukin-6, and fibrinogen. Hypertension was present in 41.3 % of the sample. In the full multiple mediation model, tested using structural equation modeling, all hypothesized pathways were significant (p's

Objective The purpose of this study was to examine the association between self-reported sleep duration and markers of kidney function. Design A cross-sectional survey from the 2009-2012 National Health and Nutrition Examination Survey. Setting and Participants The participants were 8690 adults (≥ 20 years) without a previous sleep disorder diagnosis, end-stage kidney failure, or other kidney or liver problems. Subsamples with pre-diabetes and pre-hypertension were examined. Measurements Participants reported habitual sleep duration, coded as ≤ 5, 6, 7, 8, and ≥ 9 hours per night. Biomarkers of kidney function were determined, including glomerular filtration rate (eGFR) estimated from the Chronic Kidney Disease Epidemiology Collaboration equation, urine albumin-to-creatinine ratio (ACR), microalbuminuria status, and glomerular hyperfiltration status. Weighted and adjusted general linear models assessed associations between sleep duration with eGFR and ACR. Logistic regression analyses evaluated the associations of microalbuminuria and glomerular hyperfiltration status with sleep duration. Results Greater eGFR was related to short sleep duration in the total sample and among participants with pre-diabetes. Greater ACR was associated with short and long sleep duration. Short sleep duration (≤ 5 hours) was associated with an increased odds for glomerular hyperfiltration (OR, 1.41; 95% CI, 0.97-2.06) and microalbuminuria (OR, 1.31; 95% CI, 0.96-1.79). Conclusions In a US representative sample of adults, self-reported short and long sleep duration were related to higher ACR. Short sleep duration was associated with higher eGFR and microalbuminuria. Research is needed to understand whether these associations indicate increased risk for kidney damage and cardiovascular risk.

STUDY OBJECTIVES: We examined the association of sociocultural stress severity (i.e. acculturation stress, ethnic discrimination) and chronic stress burden with multiple dimensions of sleep in a population-based sample of US Hispanics/Latinos. We also explored whether employment status modified stress-sleep associations. METHODS: We conducted survey linear regressions to test the cross-sectional association of sociocultural stress severity and stress burden with sleep dimensions using data collected between 2010 and 2013 from individuals who participated in both the Hispanic Community Health Study/Study of Latinos Sueño and Sociocultural Ancillary studies (N = 1192). RESULTS: Greater acculturation stress (B = 0.75, standard error [SE] = 0.26, p < .01) and chronic psychosocial stress burden (B = 1.04, SE = 0.18, p < .001) were associated with greater insomnia symptoms but were not associated with actigraphic measures of sleep. Ethnic discrimination was not associated with any of the sleep dimensions. The association of acculturation stress with insomnia severity was greater in unemployed (B = 2.06, SE = 0.34) compared to employed (B = 1.01, SE = 0.31) participants (p-interaction = .08). CONCLUSIONS: Acculturation stress severity and chronic stress burden are important and consistent correlates of insomnia, but not actigraphically measured sleep dimensions. If replicated, future research should test whether interventions targeting the resolution of sociocultural stress improve sleep quality in Hispanics/Latinos.

Study objectives To identify weekly sleep trajectories (sleep pattern changing by day over a course of week) of specific characteristics and examine the associations between trajectory classes and obesity and hypertension. Methods A total of 2043 participants (mean age 46.9, 65.5% female) completed at least 7 days of actigraphy aged 18-64 from the Sueno ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Weekly sleep trajectories for three daily level measures (wake after sleep onset [WASO], daytime napping duration, and intranight instability index) were identified using latent class growth models. The outcomes were obesity and hypertension. Results Using the trajectory with low-stable WASO as reference, the trajectory classes with increasing and high-concave patterns had significantly higher odds for obesity (OR 3.64 [1.23-10.84]) and hypertension (OR 5.25 [1.33, 20.82]), respectively. Compared with individuals with a low-stable napping duration trajectory, those with the high-concave pattern class were associated with hypertension (OR 2.27 [1.10-4.67]), and the association was mediated in part by obesity (OR 1.11 [1.00-1.22]). Individuals in the high intranight instability index trajectory had significantly larger likelihood for both obesity (OR 1.90 [1.26-2.86]) and hypertension (OR 1.86 [1.13-3.06]) compared with those in the low intranight instability index trajectory. Conclusions Weekly trajectories varied for WASO, daytime napping duration, and intranight instability index. The trajectories with relatively larger values for these three measures were associated with greater risk for obesity and hypertension. These findings suggest that a stable pattern with relatively small weekly and nightly variability may be beneficial for cardiovascular health.

OBJECTIVE: To compare therapeutic response to behavioral therapy for insomnia (BT-I) among hypnotic-dependent insomnia (HDI) patients with and without Cluster C personality disorders. PARTICIPANTS: Twenty-three adults with HDI (17 females), aged between 33 and 68 (M = 53; SD = 9.9) were included in the study. METHODS: Participants completed a personality disorder assessment (baseline), as well as sleep diaries, polysomnography (PSG), and an insomnia severity assessment (baseline, post-treatment, and one-year follow-up). Treatment consisted of eight weeks of individual BT-I and gradual hypnotic medication withdrawal. Multilevel mixed-effects linear regression models examined the interaction between study visit and Cluster C personality disorders status on treatment response to BT-I. RESULTS: Obsessive-compulsive personality disorder (OCPD) was the most prevalent of the Cluster C personality disorders with 38% (n=8) of participants meeting criteria. There were no significant treatment differences by OCPD status across time as measured by sleep diaries and insomnia severity status. However, there were significant treatment differences by OCPD status by one-year follow-up on PSG outcomes indicating patients with OCPD status had shorter and more disrupted sleep than patients without OCPD status. CONCLUSIONS: Based on self-reported sleep measures, patients with insomnia and features of OCPD responded equivalently to BT-I at one-year follow-up compared to patients without features of OCPD. However, polysomnography outcomes indicated objective sleep deteriorated in these patients, which may suggest greater vulnerability to relapse.

Introduction: Hypertension is associated with increased risk for cognitive decline. Lifestyle behaviors such as moderate physical activity (MPA) and adequate sleep duration may mitigate this decline, though limited research exists. The aim of the study was to examine the joint association of MPA and sleep duration on cognitive function by hypertension status. Methods: Adults (n=2976, ≥60yrs) from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were assessed for their habitual sleep duration (≥9hr) , self-reported participation in regular MPA (yes/no), reported physician-diagnosed hypertension (yes/no), and cognitive function (Digit Symbol Substitution Test [DSST]; Animal Fluency test). Weighted linear regression analyses were conducted to assess joint association of sleep duration and MPA on cognitive function, and test the modifying effect of hypertension status (alpha level set at 0.1) after adjustment for demographics. Results: See Table. There were significant main effects for combined MPA and sleep duration on DSST (Wald F (5,28)=5.33, p =.001) and Animal Fluency (Wald F (5,28)=2.58, p =.05). Participants who did not engage in MPA regardless of sleep duration had significantly worse cognitive function compared to participants who engaged in MPA and obtained 7-8.9hr sleep. There was a significant interaction between MPA-sleep duration groups and hypertension status on DSST (Wald F (5,28)=2.42, p =.06), but not on Animal Fluency. Stratified analyses indicated among individuals with hypertension the buffering effect of MPA regardless of sleep duration was maintained, but not for individuals without hypertension. Conclusions: In a sample of adults, regular MPA predicted better cognitive outcomes regardless of sleep duration. Among individuals with hypertension regular MPA regardless of sleep duration was significantly associated with better executive function, but no such association was found among individuals without hypertension.

OBJECTIVES Osteoarthritis (OA) is associated with inflammation, chronic pain, functional limitations, and psychosocial distress. High omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with lower levels of inflammatory mediators, anti-nociception, and adaptive cognitive/emotional functioning. High omega-6 (n-6) PUFAs are associated with inflammation, nociception, and psychological distress. While findings related to n-3 supplementation in knee OA are mixed, consideration of the n-6:n-3 ratio and additional outcome measures may provide improved understanding of the potential relevance of these fatty acids in OA. On the basis of recommended and typical ranges of the n-6:n-3 ratio, we hypothesized that in adults with knee pain, those with a high n-6:n-3 ratio would have greater pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared with those with a low n-6:n-3 ratio. MATERIALS AND METHODS A cross-sectional investigation of clinical and experimental pain and physical and psychosocial functioning was completed in 167 adults ages 45 to 85 meeting knee OA screening criteria. Blood samples were collected and the plasma n-6:n-3 PUFA ratio determined. Quartile splits were computed and low (n=42) and high (n=41) ratio groups were compared. RESULTS The high ratio group reported greater pain and functional limitations, (all Ps

Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis, but it is unclear if this association extends to experimentally induced pain responses. A community-based sample of 88 African American and 52 non-Hispanic white adults (45–76 years) with knee osteoarthritis completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing, including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee osteoarthritis. Perspective This article presents the association between insomnia severity, maladaptive sleep behaviors, and experimentally induced pain responses among people with knee osteoarthritis. Disrupted sleep was associated with altered pain processing by sex and ethnicity/race. Offering sleep interventions may help ameliorate pain, but treatment may need to be tailored by sex and ethnicity/race.

Introduction Commute time is associated with reduced sleep time, but previous studies have relied on self-reported sleep assessment. The present study investigated the relationships between commute time for employment and objective sleep patterns among non-shift working U.S. Hispanic/Latino adults. Methods From 2010 to 2013, Hispanic/Latino employed, non-shift–working adults (n=760, aged 18–64 years) from the Sueno study, ancillary to the Hispanic Community Health Study/Study of Latinos, reported their total daily commute time to and from work, completed questionnaires on sleep and other health behaviors, and wore wrist actigraphs to record sleep duration, continuity, and variability for 1 week. Survey linear regression models of the actigraphic and self-reported sleep measures regressed on categorized commute time (short: 1–44 minutes; moderate: 45–89 minutes; long: ≥90 minutes) were built adjusting for relevant covariates. For associations that suggested a linear relationship, continuous commute time was modeled as the exposure. Moderation effects by age, sex, income, and depressive symptoms also were explored. Results Commute time was linearly related to sleep duration on work days such that each additional hour of commute time conferred 15 minutes of sleep loss (p=0.01). Compared with short commutes, individuals with moderate commutes had greater sleep duration variability (p=0.04) and lower interdaily stability (p=0.046, a measure of sleep/wake schedule regularity). No significant associations were detected for self-reported sleep measures. Conclusions Commute time is significantly associated with actigraphy-measured sleep duration and regularity among Hispanic/Latino adults. Interventions to shorten commute times should be evaluated to help improve sleep habits in this minority population.

Introduction: Sedentary behavior and short sleep duration are independently associated with cardiovascular disease (CVD), but there is limited research on the interaction between sedentary behavior and sleep duration on CVD. Hypothesis: Short sleep duration combined with greater sedentary behavior will be significantly associated with CVD. Methods: Middle-aged (40-65), community-dwelling adults were recruited to participate in a healthy aging study. Participants completed questionnaires on demographics, medical history, and habitual sleep duration. Sleep duration was categorized as < 6 vs. ≥ 6 hours. Sedentary behavior, measured with the International Physical Activity Questionnaire, was defined as sitting in hours/day dichotomized at the 75 th percentile (< 9 vs. ≥ 9 hrs). CVD was defined as reported diagnosis of one or more of five conditions including coronary artery disease, congestive heart failure, myocardial infarction, arrhythmias, and stroke. Of the total sample of 770 individuals, 731 who had complete data on sleep, sitting, and CVD were included in the analysis. We conducted logistic regression models predicting CVD from sleep duration and sitting time groups adjusting sequentially for demographics (age, sex, education level) and CVD risk factors (reported high blood pressure and diabetes) (see Table). Results: CVD was present in 21% of the sample (n = 162). Participants who reported < 6 hrs sleep duration and sitting < 9 hrs/day were at significantly greater risk for CVD events compared to participants obtaining ≥ 6 hrs sleep duration and sitting < 9 hrs/day in the demographic model (see Table). Adjustment for CVD risk factors attenuated the relationship to borderline significance. Conclusions: Contrary to prediction, short sleep duration combined with short to moderate sitting time was associated with CVD events. Interpretation of the results should be done cautiously given our analysis was limited by a small sample size and a lack of adjustment for other potential CVD risk factors.

Introduction: Insomnia symptoms are associated with cardiovascular disease and multiple metabolic syndrome components, yet few studies have investigated their association with metabolic syndrome. Hypothesis: Insomnia symptoms will be significantly associated with prevalent metabolic syndrome. Methods: Middle-aged, community-dwelling adults, ages 40-65 yrs, were recruited to participate in a study on healthy aging. All participants completed questionnaires on demographics, medical history, and sleep patterns in the past month including estimated sleep-onset latency, frequency of difficulty falling asleep, and severity of difficulty falling asleep, difficulty maintaining sleep, and early morning awakenings. Measurements for metabolic syndrome were collected at a home health visit. All metabolic syndrome criteria consisting of waist circumference, triglyceride level, HDL cholesterol level, blood pressure, and fasting glucose were identified using the American Heart Association definitions. Participants with three or more positive criteria were considered to have metabolic syndrome. Of a total sample of 770 individuals, 557 participants who did not have a history of cardiovascular events (n = 62), and had complete sleep and metabolic syndrome data were included in the analysis. We conducted logistic regression models predicting presence of metabolic syndrome from the sleep measures adjusting for age, sex, race, education level, smoking status, alcohol consumption, moderate physical activity minutes per week, and current major depression diagnosis. Results: Metabolic syndrome was prevalent in 24.2% of the sample (n = 135). Sleep onset latency of greater than 30 minutes and difficulty falling asleep three or more nights per week were significantly related to metabolic syndrome, but no other insomnia symptoms were related (see Table). Conclusions: Difficulty falling asleep, a marker of physiological and emotional hyperarousal, may be a modifiable risk factor for metabolic syndrome.

Background Preliminary evidence suggests sleep medications are associated with risk of vascular events; however, the long-term vascular consequences are understudied. This study investigated the relation between sleep medication use and incident stroke. Methods Within the REasons for Geographic And Racial Differences in Stroke study, 21,678 black participants and white participants (≥45 years) with no history of stroke were studied. Participants were recruited from 2003 to 2007. From 2008 to 2010, participants self reported their prescription and over-the-counter sleep medication use over the past month. Suspected stroke events were identified by telephone contact at 6-month intervals and associated medical records were retrieved and physician-adjudicated. Proportional hazards analysis was used to estimate hazard ratios for incident stroke associated with sleep medication use (0, 1-14, and 15+ days per month) controlling for sociodemographics, stroke risk factors, mental health symptoms, and sleep apnea risk. Results At the sleep assessment, 9.6% of the sample used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3 ± 1.0 years, 297 stroke events occurred. Over-the-counter sleep medication use was associated with increased risk of incident stroke in a frequency-response relationship ( P = .014), with a 46% increased risk for 1-14 days of use per month (hazards ratio [HR] = 1.46; 95% confidence interval [CI], .99-2.15) and a 65% increased risk for 15+ days (HR = 1.65; 95% CI, .96-2.85). There was no significant association with prescription sleep medications ( P = .80). Conclusions Over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.

The aim of the study was to determine the prospective association between baseline benzodiazepine use and mobility, functioning, and pain among urban and rural African-American and non-Hispanic white community-dwelling older adults. From 1999 to 2001, a cohort of 1,000 community-dwelling adults, aged ≥65 years, representing a random sample of Medicare beneficiaries, stratified by ethnicity, sex, and urban/rural residence were recruited. Benzodiazepine use was assessed at an in-home visit. Every six months thereafter, study outcomes were assessed via telephone for 8.5-years. Mobility was assessed with the Life-Space Assessment. Functioning was quantified with level of difficulty in five basic activities of daily living (ADL: bathing, dressing, transferring, toileting, eating), and six instrumental activities of daily living (shopping, managing money, preparing meals, light and heavy housework, telephone use). Pain was measured by frequency per week and the magnitude of interference with daily tasks. All analytic models were adjusted for relevant covariates and mental health symptoms. After multivariable adjustment, baseline benzodiazepine use was significantly associated with greater difficulty with basic ADL (Estimate = 0.39, 95%CI: 0.04–0.74), and more frequent pain (Estimate = 0.41, 95%CI: 0.09–0.74) in the total sample and declines in mobility among rural residents (Estimate = −0.67, t(5,902)= −1.98, p= .048), over 8.5 years. Benzodiazepine use was prospectively associated with greater risk for basic ADL difficulties and frequent pain among African-American and non-Hispanic white community-dwelling older adults, and life-space mobility declines among rural-dwellers, independently of relevant covariates. These findings highlight the potential long-term negative impact of benzodiazepine use among community-dwelling older adults.

Objective Knee osteoarthritis (OA) contributes significantly to disability in older individuals, and racial/ethnic minorities are disproportionately affected. The present study aimed to characterize differences in clinical and experimental pain, including pain inhibition, among older African American (AA) and non-Hispanic white (NHW) subjects with knee OA. Methods AA and NHW subjects with knee OA (n = 267) completed clinical and functional pain assessments, including quantitative sensory testing (QST). We hypothesized that, when compared to NHW subjects, AA subjects would display 1) lower pain tolerance and higher ratings of heat-, mechanical-, and cold-induced pain, 2) greater temporal summation of pain, 3) reduced pain inhibition, and 4) greater clinical pain and poorer function. In addition, we hypothesized that the findings from QST would significantly predict the severity of clinical pain within each race/ethnicity. Results AA subjects with knee OA displayed increased pain sensitivity, greater temporal summation, and reduced pain inhibition when compared to NHW subjects with knee OA. Moreover, AA subjects reported greater clinical pain and poorer function. Racial/ethnic differences in clinical pain became nonsignificant when the analyses were controlled for education and annual income, whereas differences in QST findings remained highly significant. Although the extent of pain inhibition predicted the severity of clinical pain in both groups, different QST measures were additionally predictive of clinical pain within each group. Conclusion The results of this study establish that there are racial/ethnic differences in experimental and clinical pain and function in older individuals with knee OA. Our findings indicating that different QST measures were associated with clinical pain within the 2 racial/ethnic groups, whereas reduced pain inhibition was important in all participants, warrant further study in order to elucidate the common and group-specific pathophysiologic mechanisms contributing to clinical pain in OA.