Guido Simonelli

Neighborhood factors as predictors of poor sleep in the sueno ancillary study of the hispanic community health study/study of latinos

Study Objectives To evaluate whether an adverse neighborhood environment has higher prevalence of poor sleep in a US Hispanic/Latino population. Methods A cross-sectional analysis was performed in 2156 US Hispanic/Latino participants aged 18-64 years from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Participants completed surveys of neighborhood environment including perceived safety, violence and noise, the Insomnia Severity Index (ISI), and 7 days of wrist actigraphy. Results In age and sex-adjusted analyses, short sleep, low sleep efficiency, and late sleep midpoint were all more prevalent among those living in an unsafe neighborhood. After adjustment for background, site, nativity, income, employment, depressive symptoms, and sleep apnea, the absolute risk of sleeping <6 hours was 7.7 (95% CI [0.9, 14.6]) percentage points greater in those living in an unsafe compared to a safe neighborhood. There were no differences in the prevalence of insomnia by level of safety or violence. Insomnia was more prevalent among those living in a noisy neighborhood. In adjusted analysis, the absolute risk of insomnia was 4.4 (95% CI [0.4, 8.4]) percentage points greater in those living in noisy compared to non-noisy neighborhoods. Conclusion Using validated measures of sleep duration and insomnia, we have demonstrated the existence of a higher prevalence of short sleep and insomnia by adverse neighborhood factors. An adverse neighborhood environment is an established risk factor for a variety of poor health outcomes. Our findings suggest negative effects on sleep may represent one pathway by which neighborhood environment influences health.

Actigraphic Sleep Patterns of U.S. Hispanics: The Hispanic Community Health Study/Study of Latinos

Study objective: To assess the extent to which objective sleep patterns vary among U.S. Hispanics/Latinos. Methods: We assessed objective sleep patterns in 2087 participants of the Hispanic Community Health Study/Study of Latinos from 6 Hispanic/Latino subgroups aged 18‐64 years who underwent 7 days of wrist actigraphy. Results: The age‐ and sex‐standardized mean (SE) sleep duration was 6.82 (0.05), 6.72 (0.07), 6.61 (0.07), 6.59 (0.06), 6.57 (0.10), and 6.44 (0.09) hr among individuals of Mexican, Cuban, Dominican, Central American, Puerto Rican, and South American heritage, respectively. Sleep maintenance efficiency ranged from 89.2 (0.2)% in Mexicans to 86.5 (0.4)% in Puerto Ricans, while the sleep fragmentation index ranged from 19.7 (0.3)% in Mexicans to 24.2 (0.7)% in Puerto Ricans. In multivariable models adjusted for age, sex, season, socioeconomic status, lifestyle habits, and comorbidities, these differences persisted. Conclusions: There are important differences in actigraphically measured sleep across U.S. Hispanic/Latino heritages. Individuals of Mexican heritage have longer and more consolidated sleep, while those of Puerto Rican heritage have shorter and more fragmented sleep. These differences may have clinically important effects on health outcomes.

A systematic review and meta-analysis of sleep architecture and chronic traumatic brain injury

Sleep quality appears to be altered by traumatic brain injury (TBI). However, whether persistent post-injury changes in sleep architecture are present is unknown and relatively unexplored. We conducted a systematic review and meta-analysis to assess the extent to which chronic TBI (>6 months since injury) is characterized by changes to sleep architecture. We also explored the relationship between sleep architecture and TBI severity. In the fourteen included studies, sleep was assessed with at least one night of polysomnography in both chronic TBI participants and controls. Statistical analyses, performed using Comprehensive Meta-Analysis software, revealed that chronic TBI is characterized by relatively increased slow wave sleep (SWS). A meta-regression showed moderate-severe TBI is associated with elevated SWS, reduced stage 2, and reduced sleep efficiency. In contrast, mild TBI was not associated with any significant alteration of sleep architecture. The present findings are consistent with the hypothesis that increased SWS after moderate-severe TBI reflects post-injury cortical reorganization and restructuring. Suggestions for future research are discussed, including adoption of common data elements in future studies to facilitate cross-study comparability, reliability, and replicability, thereby increasing the likelihood that meaningful sleep (and other) biomarkers of TBI will be identified.

Perceived neighborhood safety and sleep, commentary on “The association of neighborhood characteristics with sleep duration and daytime sleepiness”☆☆☆

Neighborhood context undoubtedly affects the health andbehavior of its residents. Some authors believe that elements of the social environment, such as fear of crime aswell as crime itself, may bemediators between the effects of the physical environment (eg, litter, abandoned buildings, broken windows, etc) on public health. In their article in this issue of Sleep Health, Johnson et al reported novel findings on the association between neighborhood environment and sleep. This study adds to an increasing number of studies that have examined this topic in the past couple of years . Studies exploring the neighborhood social environment on health have varied in terms of their use of different modes of assessing the social environment, often using one the following 3 constructs: perception of neighborhood safety, exposure to neighborhood violence, or actual measures of crime or disorder (police data reports or neighborhood observations).When reviewing the sleep literature, it is worth noting that the range of differentmetrics used to assess perceived neighborhood safety and different conceptualizations and measurements of safety, may partially explain the large variability in findings among these studies. Johnson et al found that women who experienced exposure to high neighborhood violence had greater odds of reporting less than 7 hours of sleep per night but found no association between perceived safety and short sleep duration. In this study, “perceived safety” was assessed based on the sum of the level of agreement with the following 2 questions: “I feel safe walking alone during the day” and “I feel safe moving alone during the night.” The study of Johnson et al used a similar construct that was based on the

Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration

Sleep research has been dominated by high income countries (HIC). Sleep may be different in low and middle income countries (LMIC) due to cultural, demographic, geographical and health factors. We systematically reviewed the epidemiological literature reporting sleep parameters in the adult population in LMIC and meta-analyzed the prevalence of subjective poor sleep quality and sleep duration. We identified 45 publications; over 50% of which came from China and Brazil. Of the 45 identified studies, 32 contained data on sleep quality and 17 on self-reported sleep duration. Only one study utilized polysomnography and only one study utilized actigraphy. This review provides evidence that sleep parameters in LMIC appear to be similar to those in HIC but the variability and bias found suggests any attempt to extract a universal prevalence estimate or average sleep duration from the current data is very likely flawed and should be taken with caution. In our meta-analysis we found an enormous variability that was not explicable by regional, rurality, gender, age group or sleep assessment method. Further, there was a suggestion of significant small study effect, with smaller studies reporting worse sleep. There is surprisingly little consistent high-quality data that could be used for policy, planning, or scientific purposes at a global level in low and middle-income countries about what humans spend a third of their lives doing. High-quality epidemiological research about basic sleep health parameters is needed that focuses on the whole-population in LMIC, and that uses standardized, well-validated and culturally applicable measures.

Hours of service regulations for professional drivers in continental Latin America

Objectives: To describe the hours of service provisions in continental Latin America. Design: Information on regulations of service hours was extracted from either the national transportation authorities or ministries of transportation (or the equivalent institution) from each country. Setting: Seventeen sovereign countries in continental Latin America (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela). Participants: N/A Intervention (if any): N/A Measurement: Data on (a) limit on work hours, (b) mandatory daily time off (or rest), (c) overall schedule (mandatory weekly time off), and (d) daily breaks were extracted and summarized. Results: Of the 17 countries surveyed, 9 countries have provisions limiting the daily amount of hours of service for professional drivers. Ten have provisions for mandatory daily rest, but only 5 have explicit provisions limiting the number of continuous working days, with mandatory uninterrupted time off >35 hours. Eight countries have provisions for mandatory breaks that limit the hours of continuous driving (ranging from 3 to 5:30 hours). Conclusion: Regulations that govern a population with 6 million injuries and over 100,000 deaths per year due to motor vehicle accidents leave important gaps. A minority, 6, of the countries regulated all 3 aspects; daily hours, breaks, and time off, and 3 regulate none of these. The regulations are less precise and restrictive than those in high‐income countries, despite the doubled road injury mortality, and likely expose professional drivers and other road users to an increased risk of fatigue‐related accidents.

Agreement between subjective and objective measures of sleep duration in a low-middle income country setting

Objectives: Describe sleep duration in adult Sri Lankans and determine the bias and agreement of self‐report and actigraphic assessments. Design: Validation sub‐study nested within the Colombo Twin and Singleton Study (2012‐2015). Setting: Colombo, Sri Lanka. Participants: 175 adults with actigraphy, randomly selected from 3497 participants with self‐reported sleep assessed in a population‐based cohort. Measurements: Self‐reported sleep duration, ascertained by the Pittsburgh Sleep Quality Index (PSQI), was compared to a minimum of four days of actigraphy. Bias and agreement were assessed using the Bland‐Altman method and a novel application of criterion cut‐point analysis. Objective measurements of wake after sleep onset (WASO) and sleep efficiency were evaluated. Results: Sri Lankans have short sleep duration; averaging 6.4h (SD 1.5) self‐reported and 6.0h (SD 0.9) actigraphically. Poor sleep quality was prevalent with an average WASO of 49 min., and sleep efficiency <85%. Bias was observed, with self‐report consistently over‐reporting sleep on average by 27.6 min (95% CI: ‐0.68, ‐0.24) compared to objective measures, but wide individual variation in disagreement, ranging from over‐reporting by 3.34h to under‐reporting by 2.42h. A criterion cut‐point method also failed to define agreed definitions of short and long sleep duration. Conclusions: Sleep in Sri Lankan adults, whether measured subjectively or objectively, is of short duration and suboptimal objective quality by High Income Country consensus standards. Given the high cardiometabolic morbidity in Sri Lanka and poor measurement agreement observed, this warrants further investigation and supports the need for culturally appropriate, reliable, and valid assessment for analytic epidemiology in non‐Western settings.