Sleep-disordered breathing symptoms among African-Americans in the Jackson Heart Study

School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, United States.
Sleep Medicine (Impact Factor: 3.15). 07/2012; 13(8):1039-49. DOI: 10.1016/j.sleep.2012.06.005
Source: PubMed


Sleep-disordered breathing (SDB) is an increasingly recognized risk factor for cardiovascular disease (CVD). Limited data are available from large African American cohorts.
We examined the prevalence, burden, and correlates of sleep symptoms suggestive of SDB and risk for obstructive sleep apnea (OSA) in the Jackson Heart Study (JHS), an all-African-American cohort of 5301 adults. Data on selected daytime and nighttime sleep symptoms were collected using a modified Berlin questionnaire during the baseline examination. Risk of OSA was calculated according to published prediction model. Age and multivariable-adjusted logistic regression models were used to examine the associations between potential risk factors and measures of sleep.
Sleep symptoms, burden, and risk of OSA were high among men and women in the JHS and increased with age and obesity. Being married was positively associated with sleep symptoms among women. In men, poor to fair perceived health and increased levels of stress were associated with higher odds of sleep burden, whereas prevalent hypertension and CVD were associated with higher odds of OSA risk. Similar associations were observed among women with slight variations. Sleep duration <7h was associated with increased odds of sleep symptoms among women and increased sleep burden among men. Moderate to severe restless sleep was consistently and positively associated with odds of adverse sleep symptoms, sleep burden, and high risk OSA.
Sleep symptoms in JHS had a strong positive association with features of visceral obesity, stress, and poor perceived health. With increasing obesity among younger African Americans, these findings are likely to have broad public health implications.

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    • "[9]; therefore, ethnic differences may diminish with extreme age. Another study from a large singlesite cohort of black adults found that the risk of obstructive sleep apnea, one of the most common sleep-related breathing disorders, was 3.5% among men and 16.8% among women [10]. This prevalence among black men was comparable to the prevalence rates among white men (4%), whereas the prevalence among black women is substantially larger than that among white women (2%) [11]. "
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    ABSTRACT: Meta-analyses and other previous reviews have identified distinct ethnic/racial differences in the quantity, quality, and propensity for sleep disorders between black and white adults. The present article reviews the meta-analytic evidence along with recent epidemiological, community, and clinical studies to clarify what is known and not known about sleep differences between these two groups. Black individuals tend to have poorer sleep continuity and quality, excessively short or long sleep duration, greater sleep variability, and greater risk of sleep apnea than white individuals. The data suggest that these differences are attenuated yet persist in the face of several relevant confounders such as socioeconomic status, occupational factors, neighborhood context, and comorbidities. However, little is known about the mechanisms that explain ethnic disparities in sleep. We propose a conceptual model of potential mediators for future testing as well as other questions in need of investigation. Copyright © 2015 Elsevier B.V. All rights reserved.
    Sleep Medicine 01/2015; DOI:10.1016/j.sleep.2015.01.011 · 3.15 Impact Factor
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    • "In vivo evidence has shown that hypoxia induces angiogenesis by upregulating connective tissue growth factor in human breast cancer cells [21]. Second, obesity is a risk factor for breast cancer [22], and is highly prevalent in SA patients [23] [24]. An animal study found that both obesity and intermittent hypoxia are associated with increased tumor growth, but no synergistic effect was observed [25]. "
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    ABSTRACT: Background Hypoxia plays an important role in the development of solid tumors. Intermittent hypoxia is the hallmark of sleep apnea (SA). We tested the hypothesis that SA may increase the risk of breast cancer in Taiwan by using a population-based data set. Methods Our study cohort consisted of women diagnosed with SA between January 2003 and December 2005 (n = 846). For each SA patient, five age-matched control women were randomly selected as the comparison cohort (n = 4230). All participant cases were followed for five years from the index date to identify the development of breast cancer. Cox proportional-hazards regression was performed to evaluate the five-year breast-cancer-free survival rates. Results Forty-four women developed breast cancer during the five-year follow-up period, among whom 12 were SA patients and 32 were in the comparison cohort. The adjusted hazard ratio (HR) of breast cancer in patients with SA was higher [HR, 2.09; 95% confidence interval (CI), 1.06–4.12; P < 0.05] than that of the controls during the five-year follow-up. Despite not meeting statistical significance, we found increases in the risk of breast cancer in women aged 30–59 years (HR, 2.06; 95% CI, 0.90–4.70) and ≥60 years (HR, 3.05; 95% CI, 0.90–10.32) compared with those aged 0–29 years. Conclusion The findings of our population-based study suggest an association between SA and an increased risk of breast cancer in women.
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    ABSTRACT: Sleep problems appear to differentially affect racial minorities and people of lower socioeconomic status (SES). These population subgroups also have higher rates of many debilitating diseases such as obesity, type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, stroke, and mortality. Considering the presence of social disparities in sleep and chronic disease, this research aims to assess the role of sleep disparities in the incidence of obesity, T2DM, hypertension, and/or cardiovascular disease (CVD). The Boston Area Community Health (BACH) Survey is a population-based random-sample cohort of 5502 participants aged 30-79. Sleep restriction (< or = 5 hours/night) and restless sleep were assessed at baseline. Health status was ascertained at baseline and approximately 5 years later among 1610 men and 2535 women who completed follow-up. Participants completed an in-person, home visit, interview at baseline (2002-2005) and follow-up (2006-2010). Boston, Massachusetts residents (2301 men, 3201 women) aged 30-79 years from three racial groups (1767 Black, 1876 Hispanic, 1859 White) participated in the BACH Survey. There were significant differences in the prevalence of sleep-related problems at baseline by both race and SES as well as significant disparities in the incidence of T2DM, high blood pressure and cardiovascular disease at follow-up. Restless sleep was associated with an increased risk of obesity, T2DM, and CVD. However, we found that sleep does not mediate social disparities in health outcomes. Results from the BACH Survey confirm large social disparities in health outcomes as well as large social disparities in short sleep duration and restless sleep. However, sleep did not appear to mediate the relationship between race, SES, and health disparities.
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