Publications by authors named "Adam P Spira"

110 Publications

Later-life sleep, cognition, and neuroimaging research: an update for 2020.

Curr Opin Behav Sci 2020 Jun 11;33:72-77. Epub 2020 Jan 11.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

This review summarizes recent studies of sleep and brain health in later life, focusing on cognitive and magnetic resonance imaging (MRI)-derived outcomes. The majority of older people report sleep problems, and over one-third have sleep-disordered breathing (SDB). The research described herein builds on work demonstrating that abnormal sleep duration, sleep fragmentation, and SDB are associated with memory impairment and executive dysfunction. Self-reported short sleep is linked with greater cortical thinning and lower white matter integrity, and objectively measured fragmentation and SDB are tied to gray matter atrophy and altered connectivity. Results suggest that brain changes mediate previously identified sleep-cognition associations. Additional clinical trials are needed to determine whether treating insomnia or SDB benefits cognition in this population.
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http://dx.doi.org/10.1016/j.cobeha.2019.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095724PMC
June 2020

Personality and Insomnia Symptoms in Older Adults: The Baltimore Longitudinal Study of Aging.

Sleep 2021 Apr 1. Epub 2021 Apr 1.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Study Objective: To examine associations of personality dimensions and facets with insomnia symptoms in a community sample of older adults.

Methods: We studied 1,049 participants aged 60-97 years in the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R), and insomnia symptom severity was measured by the Women's Health Initiative Insomnia Rating Scale (WHIIRS).

Results: Adjusting for demographic characteristics, higher neuroticism, lower conscientiousness, and lower extraversion were associated with greater insomnia symptom severity. These associations remained significant for neuroticism and conscientiousness when further adjusting for depressive symptoms and comorbidities. Higher scores on neuroticism facets Anxiety, Angry Hostility, and Depression, and lower scores on conscientiousness facets Competence, Order, and Achievement-Striving and on agreeableness facet Altruism were associated with greater insomnia symptom severity in fully adjusted models. Results were similar among cognitively normal older adults (N=966), except higher scores on extraversion facets Warmth and Assertiveness associated with lower insomnia symptom severity, and agreeableness facet Altruism was unassociated.

Conclusion: Among older adults, insomnia symptoms appear partially related to personality, with persons higher in neuroticism experiencing greater insomnia symptom severity, and those higher in conscientiousness experiencing lower insomnia symptom severity. Exploring facets of the Big Five dimensions may provide additional insight regarding the etiology and resolution of sleep disturbance, and some of these associations may differ based on cognitive status. Future studies should investigate the hypothesis that sleep impairment mediates part of the association between specific personality traits and health-related outcomes.
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http://dx.doi.org/10.1093/sleep/zsab082DOI Listing
April 2021

Links between parent-reported measures of poor sleep and executive function in childhood autism and attention deficit hyperactivity disorder.

Sleep Health 2021 Jan 15. Epub 2021 Jan 15.

Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Objectives: This study sought to assess whether poor sleep is associated with aspects of executive function (EF) among children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), or typical development (TD), after adjusting for demographic variables, stimulant medications, intelligence, anxiety, inattention, and hyperactivity.

Design: Cross-sectional.

Setting: Children recruited through ongoing studies at the Kennedy Krieger Institute.

Participants: We studied 735 children (323 TD; 177 ASD; 235 ADHD) aged 8 to 12 years.

Measurements: We investigated associations of parent-reported sleep measures from the Children's Sleep Habits Questionnaire (CSHQ) with parent-report measures of EF and performance-based processing speed with each clinical population. EF was measured using 8 clinical T scores that fall under 2 domains (behavioral regulation and metacognition) from the Behavior Rating Inventory of EF (BRIEF) and the processing speed index from the Wechsler Intelligence Scale for Children-IV or -V.

Results: Higher CSHQ scores were associated with poorer EF on all BRIEF scales, across all child groups, after adjustment for demographic factors, stimulant medications, and IQ. Among children with ADHD, these associations largely remained after adjusting for anxiety. Among those ASD, anxiety partially accounted for these associations, especially for behavioral regulation EF outcomes. Co-occurring symptoms of inattention and hyperactivity/impulsivity further accounted for the associations between sleep and EF. Poor sleep was not significantly associated with processing speed.

Conclusions: Strong links exist between parent-reported poor sleep and executive dysfunction in children with typical development. Targeting anxiety may alleviate executive dysfunction, especially among children with ASD.
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http://dx.doi.org/10.1016/j.sleh.2020.12.006DOI Listing
January 2021

Association of Objectively Measured Sleep with Frailty and 5-year Mortality in Community-Dwelling Older Adults.

Sleep 2021 Jan 6. Epub 2021 Jan 6.

Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.

Study Objectives: To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a five-year period among older adults.

Methods: We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N=727 consented and N=615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 hours (2.93±0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset (WASO). Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status were analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase.

Results: After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR=1.70, 95% CI: 1.02-2.84) and mortality (OR=2.12, 95% CI: 1.09-4.09). Greater WASO (OR=1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR=0.41, 95% CI: 0.17-0.97) were associated with mortality.

Conclusions: Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a five-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.
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http://dx.doi.org/10.1093/sleep/zsab003DOI Listing
January 2021

Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults.

Sleep 2021 May;44(5)

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Study Objectives: Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.

Methods: Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits.

Results: Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24-2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01-1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88-3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23-1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02-1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics.

Conclusions: Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.
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http://dx.doi.org/10.1093/sleep/zsaa251DOI Listing
May 2021

Association between brain volumes and patterns of physical activity in community-dwelling older adults.

J Gerontol A Biol Sci Med Sci 2020 Nov 24. Epub 2020 Nov 24.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Larger brain volumes are often associated with more free-living physical activity (PA) in cognitively normal older adults. Yet, whether greater brain volumes are associated with more favorable (less fragmented) PA patterns, and whether this association is stronger than with total PA, remains unknown.

Methods: Brain magnetic resonance imaging and wrist-worn accelerometer data were collected in 301 participants (mean age=77[SD=7] years, 59% women) enrolled in the Baltimore Longitudinal Study of Aging. Linear regression models were fit to examine whether brain volumes (cc) were cross-sectionally associated with: 1) total daily PA minutes; and 2) activity fragmentation (mean number of PA bouts / total PA minutes x 100). Sensitivity analyses were conducted by adjusting for counterpart PA variables (e.g., fragmentation covariate included in the PA minutes model).

Results: Greater white matter volumes in the parietal and temporal lobes were associated with higher daily PA minutes (2.6(SE=1.0) and 3.8(0.9)min/day, respectively; p<0.009 for both) after adjusting for demographics, behavioral factors, medical conditions, gait speed, apolipoprotein E e4 status, and intracranial volume. Greater temporal white matter volume was associated with lower fragmentation (-0.16(0.05)%, p=0.003). In sensitivity analyses, observed associations between brain volumes and daily PA minutes remained significant while associations with fragmentation no longer remained significant.

Conclusions: Our results suggest white matter brain structure in cognitively normal older adults is associated with the total amount of PA and, to a lesser extent, the PA accumulation patterns. More work is needed to elucidate the longitudinal relationship between brain structure and function and PA patterns with aging.
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http://dx.doi.org/10.1093/gerona/glaa294DOI Listing
November 2020

Associations of cumulative violence and structural vulnerability with restless sleep among female sex workers in Baltimore, Maryland.

Sleep Health 2021 Feb 19;7(1):10-13. Epub 2020 Nov 19.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objective: To investigate correlates of restless sleep among street-based female sex workers (FSW) in the United States, an understudied population experiencing high rates of structural vulnerabilities (e.g., homelessness, food insecurity) and trauma.

Methods: Using data from a cohort of street-based cisgender FSW (n = 236; median age = 35 years, 68% non-Hispanic White), we examined cross-sectional associations of individual, interpersonal, and structural factors with frequent restless sleep over the past week (5-7 vs. <5 days).

Results: Participants reported a high prevalence of homelessness (62%), food insecurity (61%), daily heroin injection (53%), lifetime sexual or physical violence (81%), and frequent restless sleep (53%). Older age, food insecurity, poor self-rated health, and cumulative violence exposure were independently associated with frequent restless sleep.

Conclusion: Frequent restless sleep was prevalent among FSW with higher odds among those experiencing intersecting vulnerabilities and multiple exposures to violence. Further research on sleep health in this population is needed to understand its role in health risks.
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http://dx.doi.org/10.1016/j.sleh.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925341PMC
February 2021

Impact of exercise on older adults' mood is moderated by sleep and mediated by altered brain connectivity.

Soc Cogn Affect Neurosci 2020 12;15(11):1238-1251

Department of Kinesiology, University of Maryland School of Public Health, College Park, MD 20742, USA.

Older adults comprise the fastest growing global demographic and are at increased risk of poor mental health outcomes. Although aerobic exercise and sleep are critical to the preservation of emotional well-being, few studies have examined their combined mood-enhancing effects, or the potential neural mechanisms underlying these effects. Here, we used a randomized crossover design to test the impact of acute exercise on mood and the intrinsic functional connectivity (iFC) of the cingulo-opercular network in physically healthy older adults. Wrist actigraphy provided objective indices of sleep. Results revealed that 30 min of moderate-intensity aerobic exercise acutely enhanced positive affect (PA) and reduced iFC between the cingulo-opercular network and the hippocampus. Both effects were magnified among older adults with greater sleep disturbance. Exercise-induced changes in hippocampal iFC mediated relations between sleep disturbance and exercise-induced increases in PA. These findings provide evidence that aerobic exercise enhances mood, that it does so by altering connectivity between the anterior insula-a key hub in the cingulo-opercular network-and the hippocampus and that lower sleep quality is a stronger predictor of these effects among older adults. These observations underscore the benefits of moderate-intensity exercise-a safe and scalable behavioral intervention-and provide new clues about the neural circuitry underlying the interactive effects of sleep and exercise on mood.
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http://dx.doi.org/10.1093/scan/nsaa149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745152PMC
December 2020

Long-term Change in Physiological Markers and Cognitive Performance in Type 2 Diabetes: The Look AHEAD Study.

J Clin Endocrinol Metab 2020 12;105(12)

Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Context: The effects of physiological improvements on cognitive function among persons with type 2 diabetes mellitus (T2DM) are not fully understood.

Objective: To determine whether improvements in physiological markers (body weight, blood sugar control, and physical activity) during intensive lifestyle intervention (ILI) are associated with enhancements in cognitive function in older adults with T2DM.

Design: Multisite randomized controlled trial.

Setting: Academic research centers.

Patients Or Other Participants: Participants were aged 45-76 years, with T2DM.

Intervention: The Action for Health in Diabetes (Look AHEAD) study, a randomized, controlled clinical trial of ILI.

Main Outcome Measure: Two to 3 cognitive assessments were collected from 1089 participants, the first and last occurring a mean (standard deviation) of 8.6 (1.0) and 11.5 (0.7) years after enrollment.

Results: Greater improvement in blood sugar control was associated with better cognitive scores (fasting glucose and Rey Auditory Verbal Learning Test [AVLT]: P = 0.0148; fasting glucose and Digit Symbol Coding (DSC): P = 0.0360; HbA1C and DSC: P = 0.0477); but weight loss had mixed associations with cognitive scores (greater body mass index [BMI] reduction and worse AVLT overall: P = 0.0053; and greater BMI reduction and better DSC scores among those overweight but not obese at baseline: P = 0.010). Associations were strongest among those who were overweight (not obese) at baseline, and among those with a history of cardiovascular disease (CVD) at baseline.

Conclusions: Improvements in glycemic control, but not necessarily weight status, during ILI may be associated with better subsequent cognitive performance. These associations may differ by adiposity and CVD history.
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http://dx.doi.org/10.1210/clinem/dgaa591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566388PMC
December 2020

Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study.

Am J Respir Crit Care Med 2021 01;203(2):221-229

Temple University, Philadelphia, Pennsylvania; and.

Weight loss is recommended to treat obstructive sleep apnea (OSA). To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years. Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE). Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group ( values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively ( values ≤ 0.0004), and 4.0 events/h at 10 years ( = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year ( values < 0.0001), and intervention independent of weight change ( = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%). Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.
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http://dx.doi.org/10.1164/rccm.201912-2511OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874414PMC
January 2021

Psychometric and Structural Validity of the Pittsburgh Sleep Quality Index among Filipino Domestic Workers.

Int J Environ Res Public Health 2020 07 20;17(14). Epub 2020 Jul 20.

Global and Community Mental Health Research Group, Department of Psychology, The University of Macau, Macau (SAR) 999078, China.

: Evaluate the psychometric properties and structural validity of the Filipino version of the Pittsburgh Sleep Quality Index (PSQI) among Filipino domestic workers (FDWs). : In Study 1, 131 FDWs completed PSQI and other scales, along with 10-day actigraphic assessment with accompanying electronic daily sleep dairy. A subsample of 61 participants completed follow-up assessment after 10 days. In Study 2, 1363 FDWs were recruited and randomized into two halves. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used in the two halves, respectively. : In Study 1, the Cronbach's alpha of the PSQI was 0.63 at baseline and 0.67 at follow-up. Test-retest reliability for the PSQI global score based on intraclass correlation was 0.63. Convergent validity was supported by the significant associations between the PSQI global score, PSQI components scores, sleep patterns from the daily sleep diary, and measures of depression, anxiety, and rumination. Small correlations between the PSQI global score and measures of daytime sleepiness, social support, and self-reported height, supported discriminant validity. In Study 2, EFA yielded two PSQI factors with acceptable factor loadings. CFA established that this two-factor model, comprised of perceived sleep quality and sleep efficiency, evidenced better model fit than alternative models tested. The Cronbach's alpha of two factors was 0.70 and 0.81, respectively. : The PSQI demonstrated good internal consistency of two factors, and good convergent, and divergent validity. Results can be referenced in future studies to measure and screen sleep dysfunction among clinical and non-clinical populations in the Philippines.
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http://dx.doi.org/10.3390/ijerph17145219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400329PMC
July 2020

Associations of Actigraphic Sleep Parameters With Fatigability in Older Adults.

J Gerontol A Biol Sci Med Sci 2020 09;75(9):e95-e102

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Background: Poor sleep may increase the likelihood of fatigue, and both are common in later life. However, prior studies of the sleep-fatigue relationship used subjective measures or were conducted in clinical populations; thus, the nature of this association in healthier community-dwelling older adults remains unclear. We studied the association of actigraphic sleep parameters with perceived fatigability-fatigue in response to a standardized task-and with conventional fatigue symptoms of low energy or tiredness.

Methods: We studied 382 cognitively normal participants in the Baltimore Longitudinal Study of Aging (aged 73.1 ± 10.3 years, 53.1% women) who completed 6.7 ± 0.9 days of wrist actigraphy and a perceived fatigability assessment, including rating of perceived exertion (RPE) after a 5-minute treadmill walk or the Pittsburgh Fatigability Scale (PFS). Participants also reported non-standardized symptoms of fatigue.

Results: After adjustment for age, sex, race, height, weight, comorbidity index, and depressive symptoms, shorter total sleep time (TST; <6.3 hours vs intermediate TST ≥6.3 to 7.2 hours) was associated with high RPE fatigability (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 1.29, 5.06, p = .007), high PFS physical (OR = 1.88, 95% CI = 1.04, 3.38, p = .035), and high mental fatigability (OR = 2.15, 95% CI = 1.02, 4.50, p = .044), whereas longer TST was also associated with high mental fatigability (OR = 2.19, 95% CI = 1.02, 4.71, p = .043). Additionally, longer wake bout length was associated with high RPE fatigability (OR = 1.53, 95% CI = 1.14, 2.07, p = .005), and greater wake after sleep onset was associated with high mental fatigability (OR = 1.14, 95% CI = 1.01, 1.28, p = .036).

Conclusion: Among well-functioning older adults, abnormal sleep duration and sleep fragmentation are associated with greater perceived fatigability.
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http://dx.doi.org/10.1093/gerona/glaa137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494020PMC
September 2020

Associations of Actigraphic Sleep Parameters With Fatigability in Older Adults.

J Gerontol A Biol Sci Med Sci 2020 09;75(9):e95-e102

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Background: Poor sleep may increase the likelihood of fatigue, and both are common in later life. However, prior studies of the sleep-fatigue relationship used subjective measures or were conducted in clinical populations; thus, the nature of this association in healthier community-dwelling older adults remains unclear. We studied the association of actigraphic sleep parameters with perceived fatigability-fatigue in response to a standardized task-and with conventional fatigue symptoms of low energy or tiredness.

Methods: We studied 382 cognitively normal participants in the Baltimore Longitudinal Study of Aging (aged 73.1 ± 10.3 years, 53.1% women) who completed 6.7 ± 0.9 days of wrist actigraphy and a perceived fatigability assessment, including rating of perceived exertion (RPE) after a 5-minute treadmill walk or the Pittsburgh Fatigability Scale (PFS). Participants also reported non-standardized symptoms of fatigue.

Results: After adjustment for age, sex, race, height, weight, comorbidity index, and depressive symptoms, shorter total sleep time (TST; <6.3 hours vs intermediate TST ≥6.3 to 7.2 hours) was associated with high RPE fatigability (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 1.29, 5.06, p = .007), high PFS physical (OR = 1.88, 95% CI = 1.04, 3.38, p = .035), and high mental fatigability (OR = 2.15, 95% CI = 1.02, 4.50, p = .044), whereas longer TST was also associated with high mental fatigability (OR = 2.19, 95% CI = 1.02, 4.71, p = .043). Additionally, longer wake bout length was associated with high RPE fatigability (OR = 1.53, 95% CI = 1.14, 2.07, p = .005), and greater wake after sleep onset was associated with high mental fatigability (OR = 1.14, 95% CI = 1.01, 1.28, p = .036).

Conclusion: Among well-functioning older adults, abnormal sleep duration and sleep fragmentation are associated with greater perceived fatigability.
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http://dx.doi.org/10.1093/gerona/glaa137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494020PMC
September 2020

Associations of accelerometer-based sleep duration and self-reported sleep difficulties with cognitive function in late mid-life: the Finnish Retirement and Aging Study.

Sleep Med 2020 04 20;68:42-49. Epub 2019 Sep 20.

Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland. Electronic address:

Objectives: Prior evidence suggests that sleep duration and sleep difficulties may be associated with cognitive function in old age, but little is known about the sleep-cognition association in late mid-life. Our aim was to examine the associations of accelerometer-based sleep duration as well as subjective sleep difficulties with different domains of cognitive function among aging workers.

Methods: The study population consisted of 289 participants (mean age 62.4 years, SD 1.02; 83% women) from the Finnish Retirement and Aging Study (FIREA). Sleep difficulties were measured using Jenkins Sleep Problem Scale (difficulties falling asleep, difficulties maintaining sleep, waking up too early in the morning, and nonrestorative sleep). Sleep duration was measured with wrist-worn accelerometer and self-report, and participants were divided into short (<7 h/night), mid-range (7-9 h/night) and long (≥9 h/night) sleepers. Participants underwent extensive cognitive testing covering three domains: (1) memory, (2) executive function, and (3) attention and information processing.

Results: Greater difficulties in waking up too early in the morning were associated with poorer executive function measured with Spatial Working Memory (SWM) test (p = 0.005). Additionally, nonrestorative sleep was associated with poorer executive function measured with Trail Making Test, B-A, (p = 0.036) and borderline significantly with lower SWM (p = 0.056). Compared to mid-range sleepers, long sleepers tended to have poorer cognitive function (all memory function tests and SWM), but the associations were not statistically significant due to small number of long sleepers.

Conclusions: Subjective sleep difficulties may be linked to poorer executive function in a relatively healthy population of older workers in their 60 s. Thus, promoting good sleep quality may translate into better cognitive health in late mid-life.
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http://dx.doi.org/10.1016/j.sleep.2019.08.024DOI Listing
April 2020

Parent-child relationship quality and sleep among adolescents: modification by race/ethnicity.

Sleep Health 2020 04 21;6(2):145-152. Epub 2020 Jan 21.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Center on Aging and Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Background: Both parent-child relationship quality (PCRQ) and sleep are important for health and development, but few studies have examined links between PCRQ and adolescent sleep and potential interactions by race/ethnicity or sex.

Methods: We used cross-sectional data from 6,019 participants (mean = 15.9 years; 50% male; 66% non-Hispanic White, 16% non-Hispanic Black, 5% Hispanic all races) from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of U.S. adolescents. Our exposure was current adolescent-rated PCRQ score. Outcomes were adolescents' reports of chronic insufficient sleep, sleep duration (mins), and frequency of insomnia symptoms (i.e., trouble falling or staying asleep "almost every day"/"every day" versus "never"/"just a few times"/"about once a week").

Results: Adjusting for demographic characteristics, each 1-point increase in PCRQ score was associated with lower odds of insomnia symptoms (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.90, 0.94), chronic insufficient sleep (OR = 0.93, 95% CI: 0.91, 0.95), and longer sleep duration (B = 2.56, 95% CI: 1.90, 3.22). After adjustment for depressive symptoms, the association with insomnia symptoms was no longer statistically significant. Race/ethnicity moderated the association between PCRQ and chronic insufficient sleep such that the magnitude of the association was greater in Hispanics vs. Whites and Blacks. There were no interactions of PCRQ with sex.

Conclusions: Among adolescents, better PCRQ was associated with better sleep, and this association varied by race/ethnicity for perceived chronic insufficient sleep. Longitudinal studies with objective and subjective sleep measures are needed to further understand these associations.
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http://dx.doi.org/10.1016/j.sleh.2019.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194447PMC
April 2020

Caudate Volume Mediates the Interaction between Total Sleep Time and Executive Function after Acute Exercise in Healthy Older Adults.

Brain Plast 2019 Dec 26;5(1):69-82. Epub 2019 Dec 26.

Department of Kinesiology, University of Maryland, College Park, MD, USA.

Although both exercise and sleep are significant lifestyle factors in cognitive aging, the interaction of these two factors with respect to cognition remains to be determined. Also, little is known regarding the role of the basal ganglia (BG) in cognitive aging despite its involvement in both sleep and executive function. The primary objective of this study was to investigate the interaction between sleep and acute exercise on executive function performance, and secondarily, to assess if BG volume mediates this interaction. Thirty healthy older adults (65.8±7.3 years) completed 30 minutes of seated rest or moderate-intensity cycling exercise on different days. Structural MRI was used to assess the volumes of BG components including caudate, putamen, and globus pallidus shortly after the experimental conditions. Approximately 90 minutes after each condition, the Stroop task was administered to measure executive function. To examine sleep, participants wore a wrist actigraph for 8.0±3.6 days prior to the first experimental session. Results revealed that while longer total sleep time (TST) was associated with shorter Stroop response time (RT), shorter TST was associated with longer RT after exercise, compared to rest, for both congruent ( = 0.029) and incongruent ( = 0.022) trials. Longer TST was correlated with greater caudate volume, and greater caudate volume was associated with exercise-related improvement in Stroop incongruent RT. Ultimately, we found that the association between longer sleep duration and faster processing speed after acute exercise was mediated by greater caudate volume. These findings suggest that TST is an important factor for acute exercise-induced cognitive improvements in older adults, and that our study is a first step in understanding the interactive effects of these important lifestyle factors in cognitive aging that might simultaneously be addressed to promote healthy cognitive aging. Future studies should examine the interactive effects of sleep and chronic exercise on cognitive function, and whether BG volume might also mediate this interaction.
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http://dx.doi.org/10.3233/BPL-190087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971824PMC
December 2019

E-cigarette use and sleep-related complaints among youth.

J Adolesc 2019 10 20;76:48-54. Epub 2019 Aug 20.

Department of Mental Health, 8th Floor, 624 N Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Sciences, 1800 Orleans Street, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA; Department of Epidemiology, 615 N Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E Monument Street, Johns Hopkins University, Baltimore, MD, 21205, USA.

Introduction: E-cigarette use is highly prevalent among adolescents. However, little research has examined the relationship between e-cigarette use and sleep-related complaints in this population. The objective of this study was to assess whether exclusive e-cigarette, exclusive combusted cigarette, and dual-product use are associated with sleep-related complaints among adolescents.

Methods: Participants were 9,588 U.S. adolescents from the Population Assessment of Tobacco and Health Study, a nationally representative cohort, followed from 2013 through 2015. Using logistic regression, we examined the cross-sectional association between past-year e-cigarette, combusted cigarette, or dual-product use and past-year sleep-related complaints (bad dreams, sleeping restlessly, or falling asleep during the day), both measured at Wave 2. We controlled for Wave 1 demographic characteristics, emotional and behavioral health, and prior history of e-cigarette use, combusted cigarette use, and sleep-related complaints.

Results: In unadjusted analyses, e-cigarette, combusted cigarette, and dual-product use were significantly associated with greater odds of sleep-related complaints, compared to use of neither product (e-cigarettes: OR = 1.61, 95% CI 1.34-1.94; combusted cigarettes: OR = 1.62, 95% CI 1.26-2.09; dual-product use: OR = 2.00, 95% CI 1.63-2.46). Associations between e-cigarette and dual-product use and sleep-related complaints remained significant in fully adjusted analyses (e-cigarettes: aOR = 1.29, 95% CI 1.05-1.59; dual-product use: aOR = 1.57, 95% CI 1.24-1.99), whereas associations with combusted cigarette use were significant in all models except the fully adjusted model (aOR = 1.30, 95% CI 0.98-1.71).

Conclusions: E-cigarette and dual-product use are significantly associated with greater odds of reporting sleep-related complaints among adolescents. Future research should evaluate whether this association may be causal.
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http://dx.doi.org/10.1016/j.adolescence.2019.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803098PMC
October 2019

Sleep Duration and Cognition in a Nationally Representative Sample of U.S. Older Adults.

Am J Geriatr Psychiatry 2019 12 4;27(12):1386-1396. Epub 2019 Jul 4.

Department of Psychiatry and Behavioral Sciences (APS), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Mental Health (APS), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins University Center on Aging and Health (APS), Baltimore, MD.

Objective: Excessive and insufficient sleep have been associated with cognitive dysfunction in older adults in U.S. and non-U.S.

Studies: However, the U.S. studies were not in nationally representative samples. The authors investigated the association between sleep duration and cognitive performance in a nationally representative sample of U.S. older adults.

Participants: The authors studied 1,496 survey participants aged 60 years or older from the National Health and Nutrition Examination Survey 2013-2014 dataset.

Measurements: Our primary predictor was weekday (or workday) nighttime sleep duration, categorized as 2-4, 5, 6, 7 (reference), 8, 9, and 10 hours or more. The authors studied five cognitive outcomes: Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL) immediate recall, CERAD-WL delayed recall, Animal Fluency Test (AFT), Digital Symbol Substitution Test (DSST), and subjective cognitive problems (SCP).

Results: After adjusting for age, sex, race, education, depressive symptoms, and sedative-hypnotic use, sleep duration of 10 hours or more was significantly associated with lower scores on CERAD-WL immediate recall, CERAD-WL delayed recall, AFT, and DSST, and greater odds of SCP; sleep duration of 8 hours or more was associated with lower CERAD-WL delayed recall scores: 8, 9, and 10 hours or more. After adjustment, there were no significant associations of shorter sleep duration with cognition.

Conclusion: In U.S. adults aged 60 years or older, long nighttime weekday or workday sleep duration is associated with poorer verbal memory, semantic fluency, working memory, and processing speed in addition to greater odds of self-reported cognitive problems. Long sleep duration may be a marker of fragmented sleep or neurodegeneration in U.S. older adults.
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http://dx.doi.org/10.1016/j.jagp.2019.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842702PMC
December 2019

The Potential of Actigraphy to Assess Agitation in Dementia.

Am J Geriatr Psychiatry 2019 08 20;27(8):870-872. Epub 2019 Mar 20.

Department of Psychiatry and Behavioral Sciences (PBR, APS), Johns Hopkins Bayview Medical Center, Baltimore; Department of Mental Health (SKW, APS), Johns Hopkins Bloomberg School of Public Health, Baltimore; Center on Aging and Health (APS), Johns Hopkins University, Baltimore.

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http://dx.doi.org/10.1016/j.jagp.2019.03.009DOI Listing
August 2019

Stressful life events and cognitive decline: Sex differences in the Baltimore Epidemiologic Catchment Area Follow-Up Study.

Int J Geriatr Psychiatry 2019 07 25;34(7):1008-1017. Epub 2019 Apr 25.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Introduction: The reasons why women are at higher risk than men for developing dementia are unclear. Although studies implicate sex differences in the effect of stress on cognitive functioning, whether stressful life events are associated with subsequent cognitive decline has received scant research attention.

Methods: In Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area study, 337 men and 572 women (mean age = 47 years) reported recent (within the last year) and remote (from 1981 until 1 year ago) traumatic events (eg, combat) and stressful life events (eg, divorce/separation). At Waves 3 and 4 (2004-2005), they completed the Mini Mental State Examination (MMSE) and a word-list memory test. Multivariable models were used to examine the association between traumatic and stressful life events at Wave 3 and cognitive change by Wave 4.

Results: A greater number of recent stressful life events at Wave 3, but not of more remote stressful events, was associated with greater verbal memory decline by Wave 4 in women but not in men. Stressful events were not associated with change in MMSE, and there were no associations between traumatic events occurring at any time and subsequent memory or MMSE decline in either sex.

Conclusions: Unlike men, middle-aged women with a greater number of recent stressful life events demonstrate memory decline over a decade later. Sex differences in cognitive vulnerability to stressful life events may underlie women's increased risk of memory impairment in late life, suggesting that stress reduction interventions may help prevent cognitive decline in women.
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http://dx.doi.org/10.1002/gps.5102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579669PMC
July 2019

Active-to-Sedentary Behavior Transitions, Fatigability, and Physical Functioning in Older Adults.

J Gerontol A Biol Sci Med Sci 2019 03;74(4):560-567

Department of Biostatistics, Baltimore, Maryland.

Background: With aging, daily physical activity (PA) becomes less frequent and more fragmented. Accumulation patterns of daily PA-including transitions from active-to-sedentary behaviors-may provide important insights into functional status in older, less active populations.

Methods: Participants of the Baltimore Longitudinal Study of Aging (n = 680, 50% male, aged 27-94 years) completed a clinical assessment and wore an Actiheart accelerometer. Transitions between active and sedentary states were modeled as a probability (Active-to-Sedentary Transition Probability [ASTP]) defined as the reciprocal of the average PA bout duration. Cross-sectional associations between ASTP and gait speed (m/s), fatigability (rating-of-perceived-exertion [RPE]), 400 m time (seconds), and expanded short physical performance battery score were modeled using linear and logistic regression, adjusted for chronic conditions. Further analyses explored the utility of ASTP over-and-above total daily PA.

Results: In continuous models, each 0.10-unit higher ASTP was associated slower gait (β = -0.06 m/s, SE = 0.01), higher fatigability (β = 0.60 RPE, SE = 0.12), slower 400 m time (β = 16.31 s, SE = 2.70), and lower functioning (β = -0.13 expanded short physical performance battery score, SE = 0.03; p < .001). In categorical analyses, those in the highest tertile of ASTP were >2 times more likely to have high fatigability (rating of perceived exertion ≥10), slow 400 m time (>300 seconds) and reduced functional performance (expanded short physical performance battery score < 3.07) than those in the lowest tertile (p < .01). Further analyses demonstrated ASTP provided additional insight into functional outcomes beyond total daily PA.

Conclusion: Fragmented daily PA-as measured by ASTP-is strongly linked with measures of health and functional status and may identify those at risk of high fatigability and reduced functional performance over and above traditional PA metrics.
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http://dx.doi.org/10.1093/gerona/gly243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417447PMC
March 2019

Job strain and cognitive change: the Baltimore Epidemiologic Catchment Area follow-up study.

Occup Environ Med 2018 12 15;75(12):856-862. Epub 2018 Oct 15.

Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objectives: To investigate the association between job strain and subsequent cognitive change over approximately 11 years, using data from the population-based Baltimore Epidemiologic Catchment Area follow-up study.

Methods: The sample ranged from 555 to 563 participants, depending on the outcome, who reported psychosocial characteristics corresponding to the full-time job they held at baseline (1993-1996). Overall cognitive performance was measured by the Mini-Mental State Examination (MMSE), and verbal memory was measured by the ImmediateWord Recall Task and Delayed Word Recall Task at baseline and follow-up (2004-2005). Multiple linear regression was used to examine the association between job strain and cognitive change, and inverse probability weighting was used to account for differential attrition.

Results: Participants with high job demands (psychological or physical demands) and/or low job control had greater decrease in the MMSE and memory scores than those with low job demands and high job control. After adjustment for baseline outcome scores, age and sex, the greatest decrease was observed in participants with high job demands and low job control (MMSE: -0.24, 95% CI -0.36 to -0.11; verbal memory scores: -0.26, 95% CI -0.44 to -0.07). The differences were partially explained by sociodemographic characteristics, occupational prestige and health factors.

Conclusions: Findings from this prospective study suggest that job strain is associated with and may be a potential modifiable risk factor for adverse cognitive outcomes.
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http://dx.doi.org/10.1136/oemed-2018-105213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476297PMC
December 2018

Napping characteristics and cognitive performance in older adults.

Int J Geriatr Psychiatry 2019 01 12;34(1):87-96. Epub 2018 Oct 12.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Objectives: To determine the association of napping intention, frequency, and duration with cognition in a nationally-representative sample of US older adults.

Methods: We performed a cross-sectional analysis of community-dwelling Medicare beneficiaries aged ≥65 years from Rounds 3 or 4 (2013-2014) of the National Health and Aging Trends Study (N = 2549). Participants reported past-month napping intention (intentional/unintentional), napping frequency (rarely/never [non-nappers], some days [infrequent nappers], most days/every day [frequent nappers]), and average nap duration (we categorized as ≤30 minutes [short]; 31-60 minutes [moderate]; and > 60 minutes [long]). Cognitive outcomes were performance on immediate and delayed word recall tests (IWR and DWR, respectively), the Clock Drawing Test (CDT), and self-rated memory (score: 1[excellent]-5[very poor]).

Results: After adjustment for potential confounders, unintentional nappers had poorer immediate word recall test performance than non-nappers (B = -0.23, P < 0.01) and intentional nappers (B = -0.26, P < 0.01). After further adjustment for daytime sleepiness, frequent nappers reported poorer self-rated memory than non-nappers (B = 0.14, P < 0.05). Compared with short nappers, long nappers had poorer IWR (B = -0.26, P < 0.05) and CDT scores (B = -0.17, P < 0.05). Except for the association of nap duration with IWR and CDT, these associations remained after excluding participants with dementia and/or proxy respondents. Among participants undiagnosed with dementia or proxies, moderate-duration naps were associated with better DWR than short naps (B = 0.24, P < 0.05). Neither napping intentionality nor frequency was associated with CDT performance.

Conclusions: Among older adults, distinct aspects of napping are associated with cognitive performance. Prospective research, with objective measures of napping, is needed to elucidate the link between napping and cognitive trajectories.
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http://dx.doi.org/10.1002/gps.4991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445640PMC
January 2019

Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET.

Sleep 2018 10;41(10)

National Institute on Aging Intramural Research Program, Baltimore, MD.

Study Objectives: To determine the association of excessive daytime sleepiness (EDS) and napping with subsequent brain β-amyloid (Aβ) deposition in cognitively normal persons.

Methods: We studied 124 community-dwelling participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-report measures of EDS and napping at our study baseline and underwent [11C] Pittsburgh compound B positron emission tomography (PiB PET) scans of the brain, an average ±standard deviation of 15.7 ± 3.4 years later (range 6.9 to 24.6). Scans with a cortical distribution volume ratio of >1.06 were considered Aβ-positive.

Results: Participants were aged 60.1 ± 9.8 years (range 36.2 to 82.7) at study baseline; 24.4% had EDS and 28.5% napped. In unadjusted analyses, compared with participants without EDS, those with EDS had more than 3 times the odds of being Aβ+ at follow-up (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.44, 7.90, p = 0.005), and 2.75 times the odds after adjustment for age, age2, sex, education, and body mass index (OR = 2.75, 95% CI: 1.09, 6.95, p = 0.033). There was a trend-level unadjusted association between napping and Aβ status (OR = 2.01, 95% CI: 0.90, 4.50, p = 0.091) that became nonsignificant after adjustment (OR = 1.86, 95% CI: 0.73, 4.75, p = 0.194).

Conclusions: EDS is associated with more than 2.5 times the odds of Aβ deposition an average of 15.7 years later. If common EDS causes (e.g., sleep-disordered breathing, insufficient sleep) are associated with temporally distal AD biomarkers, this could have important implications for AD prevention.
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http://dx.doi.org/10.1093/sleep/zsy152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6187104PMC
October 2018

Sleep duration and C-reactive protein: Associations among pregnant and non-pregnant women.

J Reprod Immunol 2018 08 24;128:9-15. Epub 2018 May 24.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States. Electronic address:

Pregnant women experience more sleep disturbances and greater systemic inflammation than non-pregnant women. However, the few studies that have examined the links between sleep and inflammation in pregnant women have been in clinical samples. We examined whether sleep duration is associated with C-reactive protein (CRP) levels, a marker of inflammation, in pregnant and non-pregnant women in a population-based sample of US women. Participants were 2865 women of reproductive age (aged 20-44 years) in the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of Americans. Sleeping <5 h on weeknights or workdays was significantly associated with increased CRP levels among both pregnant and non-pregnant women in unadjusted analyses; however, after adjustment for demographic, and health-related variables (depressive symptoms, self-rated health status, body mass index (BMI), diabetes), sleeping <5 h was no longer significantly related to CRP levels. Pregnant women had significantly higher CRP levels, after adjusting for sleep duration, demographic, and health-related variables. Our findings suggest that pregnancy is associated with increased peripheral CRP, after adjustment for sleep duration, demographic, and health factors. Further, in both pregnant and non-pregnant U.S. women of reproductive age, short sleep duration is associated with higher CRP levels, but this link is explained by self-rated health, BMI, and diabetes. Further studies are needed to investigate links of other sleep parameters (e.g., sleep fragmentation) with CRP in these populations.
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http://dx.doi.org/10.1016/j.jri.2018.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424128PMC
August 2018

Disturbed sleep and diabetes: A potential nexus of dementia risk.

Metabolism 2018 07 1;84:85-93. Epub 2018 Feb 1.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States; Johns Hopkins Center on Aging and Health, United States. Electronic address:

Type 2 diabetes (T2D) and sleep disturbance (e.g., insomnia, sleep-disordered breathing) are prevalent conditions among older adults that are associated with cognitive decline and dementia, including Alzheimer's disease (AD). Importantly, disturbed sleep is associated with alterations in insulin sensitivity and glucose metabolism, and may increase the risk of T2D, and T2D-related complications (e.g., pain, nocturia) can negatively affect sleep. Despite these associations, little is known about how interactions between T2D and sleep disturbance might alter cognitive trajectories or the pathological changes that underlie dementia. Here, we review links among T2D, sleep disturbance, cognitive decline and dementia-including preclinical and clinical AD-and identify gaps in the literature, that if addressed, could have significant implications for the prevention of poor cognitive outcomes.
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http://dx.doi.org/10.1016/j.metabol.2018.01.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995651PMC
July 2018

Incorrect Wave 4 Reporting.

JAMA Psychiatry 2018 03;75(3):303

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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http://dx.doi.org/10.1001/jamapsychiatry.2017.4368DOI Listing
March 2018

Sleep and Health in Older Adulthood: Recent Advances and the Path Forward.

Authors:
Adam P Spira

J Gerontol A Biol Sci Med Sci 2018 03;73(3):357-359

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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http://dx.doi.org/10.1093/gerona/glx263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861917PMC
March 2018

Epidemiology of objectively measured bedtime and chronotype in US adolescents and adults: NHANES 2003-2006.

Chronobiol Int 2018 03 28;35(3):416-434. Epub 2017 Dec 28.

d Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , US.

Background: We propose a method for estimating the timing of in-bed intervals using objective data in a large representative US sample, and quantify the association between these intervals and age, sex, and day of the week.

Methods: The study included 11,951 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2003-2006, who wore accelerometers to measure physical activity for seven consecutive days. Participants were instructed to remove the device just before the nighttime sleep period and put it back on immediately after. This nighttime period of non-wear was defined in this paper as the objective bedtime (OBT), an objectively estimated record of the in-bed interval. For each night of the week, we estimated two measures: the duration of the OBT (OBT-D) and, as a measure of the chronotype, the midpoint of the OBT (OBT-M). We estimated day-of-the-week-specific OBT-D and OBT-M using gender-specific population percentile curves. Differences in OBT-M (chronotype) and OBT-D (the amount of time spent in bed) by age and sex were estimated using regression models.

Results: The estimates of OBT-M and their differences among age groups were consistent with the estimates of chronotype obtained via self-report in European populations. The average OBT-M varied significantly by age, while OBT-D was less variable with age. In the reference group (females, aged 17-22 years), the average OBT-M across 7 days was 4:19 AM (SD = 30 min) and the average OBT-D was 9 h 19 min (SD = 12 min). In the same age group the average OBT-D was 18 minutes shorter for males than for females, while the average OBT-M was not significantly different between males and females. The most pronounced differences were observed between OBT-M of weekday and weekend nights. In the reference group, compared to the average OBT-M of 3:50 am on Monday through Thursday nights, there was a 57-minute delay in OBT-M on Friday nights (entering the weekend), a 69-minute delay on Saturday nights (staying in the weekend), and a 23-minute delay on Sunday night (leaving the weekend). For both OBT-M and OBT-D, in most age groups and for most days of the week, there were no statistically significant differences between males and females, except for OBT-D on Wednesdays and Thursdays, with males having 31 (p-value < 0.05) and 45 (p-value < 0.05) minutes shorter OBT-D, respectively.

Conclusions: The proposed measures, OBT-D and OBT-M, provide useful information of time in bed and chronotype in NHANES 2003-2006. They identify within-week patterns of bedtime and can be used to study associations between the bedtime and the large number of health outcomes collected in NHANES 2003-2006.
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http://dx.doi.org/10.1080/07420528.2017.1411359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862775PMC
March 2018