Eileen R. Chasens

Claustrophobia and Adherence to CPAP Treatment

This study evaluated the effect of claustrophobia, an abnormal dread or fear of closed spaces, on adherence to continuous positive airway pressure (CPAP) therapy. The design was a secondary analysis of data from a prospective study of participants (N = 153) that completed 3 months of CPAP therapy from seven sleep disorders centers in the United States and Canada. A 15-item subscale adapted from the Fear and Avoidance Scale measured claustrophobic tendencies pre-CPAP treatment and again after 3 months. An overt monitor attached to the CPAP machines recorded mask-on CPAP adherence. There was a statistically significant difference in claustrophobia scores by adherence group (< 2 hours, 2 to < 5 hours, ≥ 5 hours) and time period (pre-CPAP and after 3 months CPAP). Poor CPAP adherence (< 2 hours per night)was more than two times higher in participants with a claustrophobia score ≥ 25. Identification of persons with increased claustrophobia tendencies and targeted interventions may increase adherence.

Daytime sleepiness, exercise, and physical function in older adults

The purpose of this study was to describe the association between sleepiness, exercise, and physical function in older adults, testing the hypothesis that sleepiness predicts decreased exercise and impaired physical function in this population. We performed a secondary analysis of data from the National Sleep Foundations Sleep in America Poll, comparing frequency of exercise and ability to perform functional tasks between sleepy and non‐sleepy subjects. Trained interviewers administered a scripted telephone survey. Participants (n = 1506) were community‐dwelling older Americans (55–84 years) randomly chosen from geographically representative households with listed telephone numbers. Sleepiness ‘so severe that it interferes with daytime activity’ was dichotomized as ‘daily/frequently’ or ‘never/rare’. Exercise frequency was scored 1–4 (‘less than once a week’ to ‘more than five times a week’). Responses to five questions (walk 0.5 mile, climb stairs, push/pull heavy object, stoop/crouch/or kneel, write, handle small objects), rated 1–5 (‘no difficulty’ to ‘unable to do’), were summed; a mean score of ≥2.5 was considered impaired physical function. Daytime sleepiness predicted low exercise frequency while controlling for age and body mass index (BMI) (OR = 1.40, 95% CI 1.031–1.897, P = 0.031). Frequent daytime sleepiness predicted impaired physical function (OR = 2.76, 95%CI = 0.237–0.553, P = 0.001) after controlling for age, BMI, income and number of co‐morbid conditions. The conclusion was that daytime sleepiness in older adults is associated with physical functional impairments and decreased exercise frequency. The findings suggest that sleepiness in older adults is not benign but has implications for continued physical decline and warrants attention.

Effect of adherence to self-monitoring of diet and physical activity on weight loss in a technology-supported behavioral intervention

Background Examination of mediating behavioral factors could explain how an intervention works and thus provide guidance to optimize behavioral weight-loss programs. This study examined the mediating role of adherence to self-monitoring of diet and physical activity on weight loss in a behavioral weight-loss trial testing the use of personal digital assistants (PDA) for self-monitoring. Methods Mediation analysis was conducted to examine the possible mediating role of adherence to self-monitoring of diet and physical activity between treatments using varying self-monitoring methods (paper record, PDA, and PDA with daily tailored feedback messages) and weight loss. Findings The sample (N = 210) was predominantly white (78%) and female (85%). Compared to a paper record, using a PDA for self-monitoring diet (P = 0.027) and physical activity (P = 0.014) had significant direct effects on weight loss at 12 months, as well as a significant indirect effect on outcomes through improved adherence to self-monitoring (PS < 0.001). Receiving an automated daily feedback message via PDA only had a significant indirect effect on weight through self-monitoring adherence to diet (P = 0.004) and physical activity (P = 0.002). Conclusions Adherence to self-monitoring of diet and physical activity is important as the underlying mechanism in this technology-supported behavioral weight-loss intervention.

Wired at a young age: the effect of caffeine and technology on sleep duration and body mass index in school-aged children

INTRODUCTION Two problems affecting school-aged children in the United States are inadequate sleep and an increased prevalence of obesity. The purpose of this study was to quantify media-related technology use and caffeine consumption in order to assess their potential effects on sleep duration and body mass index (BMI) in children. METHODS The study was a secondary analysis of children 6 to 10 years of age (N = 625) from the National Sleep Foundations Sleep in America Poll. Regression analysis was used to assess the relationship between caffeine and technology use, sleep variables, and BMI, adjusting for age, race, gender, and general health. RESULTS Almost 30% (29.5%) of the children consumed a daily caffeinated beverage, and 42.4% had a television in the bedroom. Children who drank caffeinated beverages had 15 fewer minutes of sleep per night than did children who did not drink such beverages (b = -0.27, p = .002). Children with three technology items in their bedroom received 45 fewer minutes of sleep than did children without these items in their bedroom (b = -0.75, p = .010). Having adjusted for variables, only drinking caffeinated beverages was associated with a BMI z score. DISCUSSION The complex relationships between caffeine intake and the use of technology with shortened periods of sleep and increased BMI need further study. Future research should explore how these risk factors for shortened periods of sleep can be modified in this young population.

Effect of Poor Sleep Quality and Excessive Daytime Sleepiness on Factors Associated With Diabetes Self-Management

Purpose The purpose of this study is to investigate the association of impaired sleep quality and daytime sleepiness on self-reported diabetes control and psychological and social factors that affect diabetes self-management. Methods Participants were 107 adults with type 2 diabetes (T2DM) with self-reported daytime sleepiness. Subjective sleepiness was assessed using the Epworth Sleepiness Scale (ESS); sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) Global score and its 3 factors of Perceived Sleep Quality, Sleep Efficiency, and Daily Disturbances. The Diabetes Care Profile (DCP) scales (Control Problems, Social and Personal Factors, Positive Attitude, Negative Attitude, Self-Care Adherence, and Diet Adherence) were used to measure difficulty in maintaining glycemic control and factors important for diabetes control. Results Poor sleep quality was associated with significantly worse scores on the DCP scales, with lower diabetes control, negative attitude, decreased positive attitude, lower self-care adherence, and decreased adherence to dietary adherence. Hierarchal linear regression modeling revealed no significant associations between diabetes control problems and age, education, gender, and daytime sleepiness. Being married or partnered significantly decreased glycemic control problems, whereas poor sleep quality increased diabetes control problems. Further examination of PSQI factors (perceived sleep quality, sleep efficiency, and daily disturbances) found that being married or partnered significantly decreased diabetes control problems, whereas of the 3 factors of the PSQI, only the Daily Disturbances factor was significantly associated with increased diabetes control problems. Conclusions Impaired sleep quality and daytime sleepiness are associated with decreased diabetes self-management in adults with T2DM.

Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea

Objective. This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity. Setting. Subjects (N = 37) being evaluated for OSA were recruited from a sleep clinic. Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD = 7.35; median BMI = 32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr). Measurements. Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity. Results. Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patients age, sex, and ESS. Conclusion. Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

The 2007 Sleep in America™ poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchal regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.

Obstructive Sleep Apnea, Daytime Sleepiness, and Type 2 Diabetes

PURPOSE The purpose of this article is to review the literature on obstructive sleep apnea, resultant daytime sleepiness, and type 2 diabetes mellitus, as the state of evidence exists. METHODS A search was conducted on Medline and CINAHL using the search terms sleep apnea syndromes, obstructive sleep apnea, disorders of excessive somnolence, type 2 diabetes mellitus, and insulin resistance. This review includes only published research studies in English, in adults aged 19 years or older. There were 109 citations when the terms were combined, 36 citations that were identified as research studies, no randomized clinical trials, and only 1 qualitative study. RESULTS Obstructive sleep apnea and type 2 diabetes share the risk factors of age and central abdominal obesity. Recent studies suggest that obstructive sleep apnea and type 2 diabetes not only frequently coexist but also have a bidirectional association wherein each condition exacerbates the other. The mechanism whereby obstructive sleep apnea affects glucose metabolism is likely repetitive hypoxia and sleep fragmentation, which cause a stress response with increased sympathetic nervous system activity, increased fatigue-causing cytokines, and altered leptin levels that result in weight gain. In addition, daytime sleepiness results in an impaired mood state that may impede diabetes management. CONCLUSIONS Type 2 diabetes is prevalent in persons with obstructive sleep apnea, although the direction of causality is unknown. More research, including randomized clinical trials, is needed to determine how obstructive sleep apnea and daytime sleepiness affect persons with type 2 diabetes.

Insulin resistance and obstructive sleep apnea: is increased sympathetic stimulation the link?

The science of sleep is in early stages of development, and the biochemical consequences of obstructive sleep apnea (OSA) are slowly being identified. Only recently have investigators begun to identify the commonalities and interaction between OSA and insulin resistance, the underlying pathology of type 2 diabetes. Obesity and increasing age play important parts in the natural history of both conditions, which frequently coexist. The purpose of this article is, first, to examine the extent and strength of studies that have investigated the association between OSA and increased insulin resistance or type 2 diabetes and, second, to propose a model that explains the association and cyclical interaction between OSA, obesity, and insulin resistance.

Daytime Sleepiness and Functional Outcomes in Older Adults With Diabetes

Purpose This secondary analysis examined the effect of excessive sleepiness on daytime function in older adults with diabetes from the National Sleep Foundations Sleep and Aging poll. Methods Respondents were older adults (N = 1506; age range, 55-84 years) evaluated by telephone survey on their sleep duration, sleep disturbances, daytime functional outcomes, and self-reported height, weight, and comorbidities. Results Approximately 16% (n = 244) of the sample acknowledged a diagnosis of diabetes; they were older, had more comorbidities, had a higher body mass index (BMI), and were more likely to be sleepy during the daytime than nondiabetic respondents (all P < .05). Respondents with diabetes who reported frequent daytime sleepiness (n = 50; 20%) had significantly (P < .05) higher BMI, lower self-rated health, and more sleep disturbances than those who were not sleepy (n = 194). Sleepy respondents with diabetes also reported more frequent feelings of depression, decreased pleasure in life, naps, feeling drowsy, or dozing off while driving (all P < .05). Excessive sleepiness was significantly associated (P < .001) with an increased risk for depressive symptoms while controlling for BMI, age, and number of comorbidities. Conclusions These results indicate that sleep disturbances affect not only sleep quality but also daytime function in older adults with diabetes.