The Association Between Discrimination and Sleep is Exacerbated in Individuals with Comorbid Chronic Health Conditions

Introduction: The consequences of recurrent, stressful daily experiences for sleep health appear intensified in individuals with pre-existing health conditions. Although discrimination has been associated with sleep outcomes, the role of comorbid chronic health conditions (CCHCs), and impact of perceived discrimination, remains unclear. The present study investigated (1) the associations between daily discrimination and sleep and (2) moderating roles of CCHCs and daily life interference and hardship. Methods: The current study utilized archival data from the Midlife in the United States (MIDUS) Study II. Participants, 174 adults (51% female, Mage=57 yrs., SD=11.5 yrs.), completed 7 days of actigraphy, sleep diary, PSQI, and CCHC-reporting measures. Models examined the moderating effects of CCHCs, daily interference, and hardship on the association between discrimination and sleep. Results: Daily discriminatory experiences predicted numerous poor sleep outcomes, exacerbated for persons with higher CCHCs. Higher comorbidity (95% CI=5.40, 68.75) exacerbated the association between discrimination and TSTactigraphy, further strengthened by perceived hardship (95% CI=-3.75, -.40) and interference (95% CI=-3.65, -.30). Number of CCHCs, qualified by perceived hardship (95% CI=.00, .04) and interference (95% CI=.01, .05), predicted diary sleep quality above discrimination. The interaction between CCHCs and hardship predicted global PSQI scores (95% CI=-.91, -.12) beyond discrimination. Conclusion: Daily experiences of discrimination are associated with decreased sleep duration and quality. These associations were stronger for individuals with multiple CCHCs. Exacerbating CCHC effects were perpetuated by perceived interference and hardships, suggesting individual emotion regulation (ER) differences. Future research should attend to sleep-related consequences of differential discrimination-informed ER by persons with CCHCs.https://scholarscompass.vcu.edu/gradposters/1042/thumbnail.jp

Daily Sleep Quality is Associated with Daily Cognition in Late-Life

Background: Older adults often face sleep disturbance or cognitive decline that goes beyond the scope of normal aging. The present study examined the relationship between self-reported sleep quality and self-reported daytime attention in a community-dwelling sample of older men at the between-persons and within-persons levels of association. Methods: Thirty-eight participants (M age =75.36 years, SD age =7.51 years, range=66-90 years) completed a twice-daily sleep diary for one week. Sleep quality and attention were assessed using a single-item 0-10 rating scales from the morning diary (“How was the quality of your sleep last night?”) and from the evening diary (“How was your attention today?”). A two-level multilevel model was parameterized with days nested within individuals to examine whether nightly sleep quality predicts an individual’s daily attention rating. Results: A multilevel model predicting self-reported attention revealed (1) older individuals who reported better sleep quality reported having better daily attention [Beta=0.64, t(248.15)=10.12, p\u3c0.001] and (2) following a day of above-average sleep quality, older individuals experienced above-average attention [Beta=0.16, t(259.79)=2.75, p=.006]. Conclusion: Not only was overall sleep quality associated with self-reported attention, but a good night\u27s sleep was associated with better self-reported next-day attention. Results point to the potential importance of fluctuations in sleep quality for daytime functioning. Interventions aimed at improving nightly sleep consistency may be worth exploring as methods to improve daytime cognitive functioning in older adults. Support: This work was supported by the Sleep Research Society Foundation/Jazz Pharmaceuticals (001JP13, PI: Dzierzewski) and by the National Institute on Aging of the National Institutes of Health under Award Number K23AG049955 (PI: Dzierzewski), and National Heart Lung and Blood Institute at the National Institutes of Health under award number K24HL143055 (PI: Martin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.https://scholarscompass.vcu.edu/gradposters/1089/thumbnail.jp

Self-reported sleep duration mitigates the association between inflammation and cognitive functioning in hospitalized older men

Examination of predictors of late-life cognitive functioning is particularly salient in at-risk older adults, such as those who have been recently hospitalized. Sleep and inflammation are independently related to late-life cognitive functioning. The potential role of sleep as a moderator of the relationship between inflammation and global cognitive functioning has not been adequately addressed. We examined the relationship between self-reported sleep duration, inflammatory markers, and general cognitive functioning in hospitalized older men. Older men (n = 135; Mean age = 72.9 ± 9.7 years) were recruited from inpatient rehabilitation units at a VA Medical Center to participate in a cross-sectional study of sleep. Participants completed the Mini-Mental State Examination and Pittsburgh Sleep Quality Index, and underwent an 8 a.m. blood draw to measure inflammatory markers [i.e., C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble intercellular adhesion molecule-1 (sICAM-1), and interleukin-6 (IL-6)]. Hierarchical regression analyses (controlling for age, education, race, depression, pain, health comorbidity, and BMI) revealed that higher levels of CRP and sICAM are associated with higher global cognitive functioning in older men with sleep duration ≥6 h (β = -0.19, β = -0.18, p's < 0.05, respectively), but not in those with short sleep durations (p's > 0.05). In elderly hospitalized men, sleep duration moderates the association between inflammation and cognitive functioning. These findings have implications for the clinical care of older men within medical settings

Self-reported Physical Activity and Objective Aerobic Fitness: Differential Associations with Gray Matter Density in Healthy Aging

Aerobic fitness (AF) and self-reported physical activity (srPA) do not represent the same construct. However, many exercise and brain aging studies interchangeably use AF and srPA measures, which may be problematic with regards to how these metrics are associated with brain outcomes, such as morphology. If AF and PA measures captured the same phenomena, regional brain volumes associated with these measures should directly overlap. This study employed the general linear model to examine the differential association between objectively-measured AF (treadmill assessment) and srPA (questionnaire) with gray matter density (GMd) in 29 cognitively unimpaired community- dwelling older adults using voxel based morphometry. The results show significant regional variance in terms of GMd when comparing AF and srPA as predictors. Higher AF was associated with greater GMd in the cerebellum only, while srPA displayed positive associations with GMd in occipito-temporal, left perisylvian, and frontal regions after correcting for age. Importantly, only AF level, and not srPA, modified the relationship between age and GMd, such that higher levels of AF were associated with increased GMd in older age, while decreased GMd was seen in those with lower AF as a function of age. These results support existing literature suggesting that both AF and PA exert beneficial effects on GMd, but only AF served as a buffer against age-related GMd loss. Furthermore, these results highlight the need for use of objective PA measurement and comparability of tools across studies, since results vary dependent upon the measures used and whether these are objective or subjective in nature

A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes.

OBJECTIVE: Insomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBTI) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined. METHODS: Data consisted of a secondary analysis from a randomized comparative effectiveness trial of CBT-I and ABC-I among women veterans with insomnia and comorbid pain. Pain outcomes, beliefs about sleep, and psychological flexibility were assessed at baseline, post-treatment, and at three-months follow-up. RESULTS: At baseline, 93 women veterans reported comorbid insomnia and pain (mean age = 46.7; 33.3% Black, 24.7% Hispanic/Latina). Both CBT-I (n = 48) and ABC-I (n = 45) were associated with decreased pain intensity (p < .001, Cohens d = 0.41-0.67) and pain interference (p < .001, Cohens d = 0.71-0.77) at post-treatment and three-months follow-up, with results indicating that ABC-I was non-inferior to CBT-I for pain improvement. Both conditions were associated with greater psychological flexibility post-treatment, and CBT-I resulted in larger reductions in dysfunctional beliefs about sleep (p = .01, Cohens d = 0.59). CONCLUSION: CBT-I and ABC-I both had positive secondary effects on pain with ABC-I being non-inferior to CBT-I with respect to its impact on pain. The mechanisms of change associated with these treatments may differ with CBT-I leading to greater reductions in dysfunctional beliefs. Hybrid treatments which incorporate an acceptance and commitment approach to both insomnia and pain warrant further examination

Pain in your day? Get sleep treatment anyway! The role of pain in insomnia treatment efficacy in women veterans.

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research

Cognitive functioning throughout the treatment history of clinical late‐life depression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113769/1/gps4264.pd

Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder

AimAmong individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment.MethodsThis is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18–45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data.ResultsParticipants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency.ConclusionsMany women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population

Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity

We examined whether baseline self-reported physical activity is associated with the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older veterans. Community-dwelling veterans aged 60 years and older with insomnia received CBT-I in a randomized controlled trial. Participants who received active treatment were divided into low and high physical activity based on self-report. Sleep outcomes were measured by sleep diary, questionnaire and wrist actigraphy; collected at baseline, post-treatment, 6-month and 12-month follow-up. Mixed-effects models compared differences between physical activity groups in change in sleep outcome from baseline to each follow-up, and equivalence tests examined if physical activity groups were clinically equal. There were no significant differences in sleep outcomes between physical activity groups. Equivalence tests suggested possible equality in physical activity groups for five of seven sleep outcomes. Efficacy of CBT-I in older veterans was not associated with self-reported physical activity at baseline. Older adults with insomnia who report low levels of physical activity can benefit from CBT-I