A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia : main outcomes from the MATRICS study

Study Objectives -- To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. Methods -- 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI 7) serving as the clinical endpoints. Results -- No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. Conclusions -- The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP

Association Between Interleukin-6 and Neurocognitive Performance as a Function of Self-Reported Lifetime Marijuana Use in a Community Based Sample of African American Adults

The purpose of the current study was to determine if self-reported lifetime marijuana use moderates the relationship between interleukin-6 (IL-6) and neurocognitive performance. Participants included 161 African American adults (50.3% women), with a mean age of 45.24 (SD = 11.34). Serum was drawn upon entry into the study and participants completed a demographic questionnaire, which included drug use history, and a battery of neuropsychological tests. Using multiple regression analyses and adjusting for demographic covariates, the interaction term comprised of IL-6 and self-reported lifetime marijuana use was significantly associated with poorer performance on the Written (beta = -.116; SE =.059; p = .049) and Oral trials (beta = -.143; SE = .062; p = .022) of the Symbol Digit Modalities Test, as well as the Trail Making Test trial A (beta = .157; SE = .071; p = .028). Current findings support previous literature, which presents the inverse relationship between IL-6 and neurocognitive dysfunction. The potential protective properties of marijuana use in African Americans, who are at increased risk for inflammatory diseases, are discussed. (JINS, 2014, 20, 773-783

Is purpose in life associated with less sleep disturbance in older adults?

Abstract Background Previous work has shown that purpose in life can be protective against numerous negative health outcomes including sleep disturbances. Given that sleep disturbances are common among older adults and African Americans, the aim of the present study was to examine the relationship between purpose in life, overall sleep quality, and the presence of sleep disorders in a community-based bi-racial sample of older adults. Methods Participants were 825 non-demented older African Americans (n = 428) and Whites (n = 397) from two cohort studies, the Minority Aging Research Study (MARS) and the Rush Memory and Aging Project (MAP). Participants completed a 32-item questionnaire assessing sleep quality and symptoms of Sleep Apnea, Restless Leg Syndrome (RLS) and REM Behavior Disorder (RBD). Purpose in life was assessed with a 10-item measure modified from Ryff & Keyes’s scales of Psychological Well Being. Results In a series of hierarchical multiple linear regressions controlling for the demographic covariates of age, sex, race, and education, higher levels of purpose in life were associated with better sleep quality at baseline. Using longitudinal follow-up data, higher levels of purpose in life was associated with lower risk of sleep apnea at baseline, 1-year follow-up, and 2-year follow-up, as well as reduced symptoms of RLS at 1-year and 2-year follow-up. Conclusions These findings provide support for the hypothesis that a higher level of meaning and purpose in life among older adults is related to better sleep quality and appears to be protective against symptoms of sleep apnea and RLS

Marine invertebrate interactions with Harmful Algal Blooms-Implications for One Health

Harmful Algal Blooms (HAB) are natural atypical proliferations of micro or macro algae in either marine or freshwater environments which have significant impacts on human, animal and ecosystem health. The causative HAB organisms are primarily dinoflagellates and diatoms in marine and cyanobacteria within freshwater ecosystems. Several hundred species of HABs, most commonly marine dinoflagellates affect animal and ecosystem health either directly through physical, chemical or biological impacts on surrounding organisms or indirectly through production of algal toxins which transfer through lower-level trophic organisms to higher level predators. Traditionally, a major focus of HABs has concerned their natural production of toxins which bioaccumulate in filter-feeding invertebrates, which with subsequent trophic transfer and biomagnification cause issues throughout the food web, including the human health of seafood consumers. Whilst in many regions of the world, regulations, monitoring and risk management strategies help mitigate against the impacts from HAB/invertebrate toxins upon human health, there is ever-expanding evidence describing enormous impacts upon invertebrate health, as well as the health of higher trophic level organisms and marine ecosystems. This paper provides an overview of HABs and their relationships with aquatic invertebrates, together with a review of their combined impacts on animal, human and ecosystem health. With HAB/invertebrate outbreaks expected in some regions at higher frequency and intensity in the coming decades, we discuss the needs for new science, multi-disciplinary assessment and communication which will be essential for ensuring a continued increasing supply of aquaculture foodstuffs for further generations

Differences in internalizing symptoms between those with and without Cannabis Use Disorder among HBCU undergraduate students

Objective To determine the differences in internalizing symptoms between those who met criteria for Cannabis Use Disorder (CUD) and those who did not in young adults attending a Historically Black College or University (HBCU). Participants The sample included 619 undergraduate students, with 110 (18%) who met criteria for CUD. Methods Participants completed an online survey, which included demographic, anxious and depressive symptomatology, and substance use assessment. Results Those who met CUD criteria reported more depressive symptoms (M = 22.83 +/- 10.74) and anxiety symptoms (M = 45.70 +/- 12.82) than their non-CUD counterparts (M = 19.17 +/- 10.58; M = 40.57 +/- 14.11, respectively). Conclusion Differences between those who met criteria for CUD and those who did not are consistent with previous literature and may aid in characterizing internalizing behaviors in HBCU students with CUD. Future research should examine the subgroups that may cycle through withdrawal symptoms, despite not having severe CUD. This subgroup may be at higher risk for psychopathology than their severe counterparts

Cannabis use disorder severity and sleep quality among undergraduates attending a Historically Black University

•Moderate CUD has significantly poorer sleep quality compared to non-CUD group.•Severe CUD and Non-CUD groups reported similar sleep quality levels.•First study of CUD and sleep quality in a Historically Black College or University sample.•Sleep latency, duration, and disturbances were higher in mild and moderate CUD groups. Nearly one third of Americans experience poor sleep, which is associated with numerous deleterious health outcomes. Poor sleep may be exacerbated when an individual attends college, as they experience drastic shifts in lifestyle and sleep patterns. Previous research suggests cannabis has therapeutic potential for sleep disorders but may also impair sleep quality long-term. However, no study has examined the differences in sleep quality within individuals who meet criteria for Cannabis Use Disorder (CUD). The purpose of the current study was to determine differences in sleep quality among undergraduate students who met criteria for mild CUD (n = 18), moderate CUD (n = 22), severe CUD (n = 16) and students who did not meet criteria for CUD (n = 244). Participants included 300 predominantly Black/African American undergraduate students (79% female), aged between 18 and 25 years. Each participant completed an online survey that included measures assessing sleep quality and CUD criteria. Employing analysis of covariance, the moderate CUD subgroup (M = 9.00, SD = 3.32) reported poorer sleep quality than individuals who did not meet criteria for CUD (M = 6.93, SD = 3.03). Interestingly, the severe CUD subgroup (M = 6.75, SD = 2.52) reported similar sleep quality to individuals who did not meet criteria for CUD (M = 6.93, SD = 3.03). Individuals meeting criteria for mild and moderate CUD reported the poorest sleep quality among the groups, suggesting a differentiation within CUD severity. Future research should assess withdrawal and cannabis use frequency among individuals who meet criteria for CUD to further elucidate disturbances in sleep quality among those with CUD

The Psychoneuroimmunological Influences of Recreational Marijuana

Background: Marijuana is the most widely used illicit substance in the USA and self-reported use has remained steady over the past decade. Numerous publications examine the influence of marijuana use on various facets of human physiology including neurocognitive function, immune function, and illness symptom control, each discussing marijuana's influence in a narrow or compartmentalized fashion. However, there is a scant literature discussing the empirical and clinical implications of the intersection of these constructs. The primary objective of this review is to review and synthesize this disparate literature and propose future research directions. Thus, this review examines the literature that relates the influence of marijuana to: (1) neurocognitive function; (2) immune function; (3) treatment uses; and (4) propose future directions. Methods: Clinical and nonclinical empirical studies were collected and utilized to inform this review. The authors used PubMed search engine as the primary mechanism used to identify relevant articles. Conclusion: Given the legalization efforts of recreational marijuana use, there is a need to discuss health and treatment effects of marijuana use from a more comprehensive, psychoneuroimmunological or biopsychosocial framework. We will discuss the need for an interdisciplinary research and future steps regarding the examination of marijuana use

Characterization of older, cognitively normal obstructive sleep apnea patients at risk of prospective cognitive decline using the NIA‐AA Research Framework

Background The association between Obstructive Sleep Apnea (OSA) and cognition in older‐adults is conflicting. We determined to characterize older OSA‐patients using the NIA‐AA Research Framework and test whether OSA accelerates cognitive decline in preclinical Alzheimer’s disease (AD) Method Community‐dwelling cognitively normal elderly participating on a study on memory, sleep and aging, with baseline AD biomarker data and both baseline and follow‐up neuropsychological data were included. OSA was defined using AHI4%. Data‐driven, clinically relevant thresholds for CSF‐Aβ42 (≤375pg/ml), and CSF P‐tau (≥53.7pg/ml) indicated OSA participants AT(N) status using the NIA‐AA Research Framework. Twenty‐four participants with non‐AD pathologic change defined as A‐T+ were excluded leaving 127 for the analysis. Main outcome was the annual rate‐of‐change in global cognition (calculated as an average composite Z‐score of episodic memory, language and executive function cognitive tests domains). Linear mixed‐effects models with random intercept and slope were used to assess associations between AT(N) characterized OSA subjects, and longitudinal changes in global cognition, controlling for age‐at‐baseline, sex, APOE4‐status, years‐of‐education, and their interactions with time. Result Of the 127 participants, 81 (63.8%) were women. The mean (SD) age was 69.6 (7.3) years and follow‐up time was 2.46 (0.64) years. Eight (6.3%) met biomarker criteria for AD (OSA+/A+/T+ [n=4] and OSA‐/A+/T+ [n=4]). Forty‐four participants (34.6%) were amyloid positive (OSA+/A+ [n=20] and OSA‐/A+ [n=24]). Sixteen (12.6%) were OSA+/A+/T‐, and 20 (15.7%) were OSA‐/A+/T‐. Eighty‐three (63.4%) had normal AD biomarkers (OSA+/A‐/T‐ [n=40] and OSA‐/A‐/T‐ [N=43]). Regardless of OSA status, relative to normal AD biomarkers, amyloid positive participants i.e. AD pathologic change, showed significant faster rate‐of‐decline in global cognition (β = −0.066, 95%CI, −0.088, −0.046; P < .001). However, OSA+/A+/T‐ participants showed even more significantly faster rate‐of‐decline in global cognition compared to OSA‐/A+/T‐ participants (β = −0.042, 95%CI, −0.063, −0.019; P < .001), suggesting an OSA/Aβ42 synergism independent of PTau. OSA+/A‐/T‐ or OSA‐/A‐/T‐ participants (normal AD biomarkers) did not show any significant cognitive change over time. Conclusion Among amyloid positive healthy‐elderly, OSA and Aβ demonstrate synergism related to cognitive decline that might be independent of tau deposition. Clinical trials in a population of elderly OSA cognitive‐normal individuals should target at minimum persons with Alzheimer’s pathologic change

Perceived Stress and Cognitive Decline in Different Cognitive Domains in a Cohort of Older African Americans

Background: Research indicates that stress is linked to cognitive dysfunction. However, few community-based studies have explored the relationship between perceived stress and cognitive decline, and fewer still have utilized cognitive domains rather than a global measure of cognition. Objective: We examined the relation between perceived stress and the rate of decline in different cognitive domains. Methods: Participants were older African Americans without dementia from the Minority Aging Research Study (MARS; N = 467, mean age: 73 years, SD: 6.1 years). A battery of 19 cognitive tests was administered at baseline and at annual intervals for up to 9 years (mean follow-up: 4 years), from which composite measures of global cognitive function and five specific cognitive domains were derived. The four-item Cohen's Perceived Stress Scale (PSS) was also administered at baseline. Results: In linear mixed-effects models adjusted for age, sex, education, and vascular risk factors, higher perceived stress was related to faster declines in global cognition (beta = -0.019; SE: 0.008; t(1951) = -2.46), episodic memory (beta = -0.022; SE: 0.011; t(1954) = -1.99), and visuospatial ability (beta = -0.021; SE: 0.009; t(1939) = -2.38) all p < 0.05. Findings were similar in subsequent models adjusted for demographics, vascular diseases, and depressive symptoms. Conclusions: Results indicate that older African Americans with higher levels of perceived stress have more rapid declines in global cognition than those with lower levels, most notably for episodic memory and visuospatial ability