Orfeu M Buxton

Pennsylvania State University | Penn State · Department of Biobehavioral Health

Background Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality. M...

Background and Objectives Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition, or impaired cognition (mild cognitive impairm...

Aims The role of lay health workers in data collection for clinical and translational research studies is not well described. We explored lay health workers as data collectors in clinical and translational research studies. We also present several methods for examining their work, i.e., qualitative interviews, fidelity checklists, and rates of unus...

Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventio...

Goal and aims: Commonly used actigraphy algorithms are designed to operate within a known in-bed interval. However, in free-living scenarios this interval is often unknown. We trained and evaluated a sleep/wake classifier that operates on actigraphy over ∼24-hour intervals, without knowledge of in-bed timing. Focus technology: Actigraphy counts...

Objective: Research investigating cannabis use and sleep health is limited, and results are mixed. Few studies were nationally representative with racially-ethnically diverse samples or assessed potential modifiers. Our objective was to investigate cross-sectional associations between reported cannabis use and sleep disturbances by potential modif...

Purpose: Poor sleep health is associated with lower positive mood in adolescents, and more variable sleep is associated with more negative mood. There is a lack of research on the associations between sleep variability and positive mood in adolescents. We investigated whether several types of sleep variability, measured with actigraphy, were assoc...

Objective: Sleep restriction alters daytime cardiac activity, including elevating heart rate (HR) and blood pressure (BP). There is minimal research on the cumulative effects of sleep loss and the response after subsequent recovery sleep on HR and BP. This study examined patterns of HR and BP across baseline, sleep restriction, and recovery condit...

A community-based qualitative study identified multilevel influences on sleep duration, quality, and timing in 10 to 12-year-old Latino pre-adolescents via 11 focus groups with 46 children and 15 interviews with parents. An iterative content analysis revealed three themes negatively and positively impacted sleep: (1) Individual-level; (2) Social-le...

Aging populations are at increased risk of sleep deficiencies (e.g., insomnia) that are associated with a variety of chronic health risks, including Alzheimer's Disease and Related Dementias (ADRD). Insomnia medications carry additional risk, including increased drowsiness and falls, as well as polypharmacy risks. The recommended first-line treatme...

Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were a...

Introduction Life’s Simple 7 (LS7), originally proposed as the seven most important predictors of heart health, is associated with negative cognitive outcomes. Recently an updated Life’s Essential 8 (LE8) added sleep as the new eighth component. However, limited research has investigated LE8 and cognitive outcomes. We hypothesize that a higher comp...

Introduction Poor sleep health is associated with increased risk for childhood obesity, but the underlying mechanisms are unclear. Eating behaviors may play a role. We examined the association between appetitive traits and objectively-measured sleep variables in 6-year-old children. We hypothesized that poorer or more variable sleep health measures...

Introduction Adolescents often obtain short sleep duration, which has been linked to poor grades and greater behavioral issues at school. There is limited research on the association between other dimensions of sleep and school-related outcomes, and few studies use objective measures of sleep. The current study examined associations of multiple act...

Introduction The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers resulted in more responsive bedtime parenting and longer infant sleep duration in the first year after birth. The current analysis evaluates intervention effects on parent-reported sleep behavior...

Introduction Daytime video game playing is a sedentary behavior that has been associated with worse adolescent health outcomes, including obesity, mood disorders, and poor sleep. However, few studies have explored the influence of sleep on time spent engaged in screen-based activities. This is the first study to examine whether sleep regularity, a...

Introduction Prior research assessing self-reported or nocturnal sleep suggested that specific sleep traits (sleep restriction in the laboratory; poor sleep quality, sleep disorders) are associated with both pro and anti-inflammatory cytokine and C-Reactive Protein (CRP) levels. To extend prior research, we investigated associations between multipl...

In this registered report, we evaluated how sleep is related to school functioning. Using data from the Future of Families and Child Wellbeing Study ( N = 3002), we evaluated a series of structural equation models evaluating whether sleep at age 5 has a direct or indirect effect on academic achievement, executive function and classroom behaviour at...

Purpose: The goal of this study was to evaluate the relationships of actigraphic nighttime sleep duration and quality with next-day mood among urban adolescents using a micro-longitudinal design. Methods: A subsample (N = 525) of participants from the Fragile Families & Child Wellbeing Study (mean age: 15.4 years; 53% female; 42% Black non-Hispa...

Objectives: The concept of multi-dimensional sleep health, originally based on self-report, was recently extended to actigraphy in older adults, yielding five components, but without a hypothesized rhythmicity factor. The current study extends prior work using a sample of older adults with a longer period of actigraphy follow-up, which may facilit...

Background: Pharmaceutical drug therapy problems (DTPs) are a major public health problem. We examined patient-level risk factors for DTPs among Cambodian Americans. Methods: Community health workers (CHWs) verbally administered surveys and completed a detailed medication review form with participants. A doctoral-level pharmacist reviewed the fo...

Objectives It has been reported that job demands affect sleep, but how different levels of job demands affect sleep remains unclear. We examined whether curvilinear relationships exist between job demands and multiple sleep health outcomes. Design: Cross-sectional analyses with linear and quadratic effects, using self-administered survey data. Sett...

Poor sleep quality is a common problem and has profound physical and mental effects on older adults. Loneliness, another common and harmful condition for older adults, is associated with heightened levels of vigilance and feeling unsafe, which may contribute to poor sleep. Although some studies show that trait loneliness is related to compromised s...

Good sleep is necessary for healthy aging, but it may be threatened by work stress. This study connected midlife job characteristics to trajectories of sleep health profiles (within-person configurations of key self-reported facets: duration, regularity, sleep onset latency or SOL, insomnia symptoms, feeling unrested, and napping) over one decade....

Negative consequences of sleep health problems are common in middle-age but poorly understood. This study investigated multidimensional sleep health in middle adulthood and mortality risk. Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (T1; n=9,640, Mage=52.72) and again in 2013-2016 (T2; n=4,33...

Resting-state functional magnetic resonance imaging (rsfMRI) allows the study of functional brain connectivity based on spatially structured variations in neuronal activity. Proper evaluation of connectivity requires removal of non-neural contributions to the fMRI signal, in particular hemodynamic changes associated with autonomic variability. Regr...

Objectives: Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cogni...

Objectives It has been reported that job demands affect sleep, but how different levels of job demands affect sleep remains unclear. We examined whether curvilinear relationships exist between job demands and multiple sleep health outcomes. Design Cross-sectional analyses with linear and quadratic effects, using self-administered survey data. Set...

Objective Cambodian Americans have complex, interrelated and persistent medical and mental health problems stemming from genocide and the social determinants of health. We examined changes in multiple domains of self-reported health outcomes from a diabetes prevention trial. Methods: Cambodian Americans with depression and high risk for diabetes (n...

The current study included an examination of social factors that mitigate or exacerbate insomnia symptoms among older adults who are married or living with a partner. We first examined the unique effects of spousal support and strain on insomnia symptoms and then evaluated the degree to which extramarital social factors (e.g., friend support) moder...

Machine learning (ML) offers some of the most cost-effective methods for extracting useful insights from large data sets. Availability of large data sets and tools for modular, scalable, reproducible, open, shareable data analytic workflows, allow researchers to rapidly train, rigorously validate and share predictive models in health research. Thes...

Objectives Pain is common among torture survivors and refugees. Clear communication about one’s pain is vital to timely and precise diagnosis and treatment but is rarely recognized as a social determinant of health. We examined whether self-reported difficulty communicating with their health care provider, along with standard social determinants, i...

This paper reports secondary data analysis of associations between psychological distress and health behaviors among Cambodian Americans. Data are from baseline assessments from a diabetes prevention trial. All participants met criteria for depression and were free of diabetes. Participants (n=191) completed surveys, a food frequency assessment, an...

Stress and sleep are related, but the nature and time course of this relation is not well understood. We explored the within-person associations of three components of emotional responses to everyday stressors, indexed by negative affect, reactivity (initial response to a stressor), recovery (persistence of the post-stressor response), and pile-up...

OBJECTIVES The current study examined longitudinal linkages between child sleep duration and children’s socioemotional, learning engagement, executive functioning, and academic outcomes across the full kindergarten (K) year. METHODS A measurement-burst design was employed to examine 3 different measures of child sleep duration in 7-day bursts at p...

Objective/background Night wakings are common during infancy, with variability in infant self-soothing or requiring parent involvement to fall back asleep. Reasons for variable soothing behaviors are unclear and may be influenced by early-life sleep parenting practices. The study applied a novel method using sleep actigraphy in mother-father-infant...

Objectives Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty bo...

Background Poor self-reported sleep health has been linked to not consuming breakfast in adolescents, but it is unknown whether poor sleep measured objectively predicts next-day breakfast consumption within adolescents. We investigated within- and between-person associations of objectively measured sleep dimensions and subjective sleep quality with...

BACKGROUND AND OBJECTIVES The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers improved firstborn infant sleep compared with controls. The goals of this analysis were to test intervention spillover effects on secondborn siblings and examine birth order differen...

Background Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief perform...

Background: Epidemiological data suggest that populations exposed to starvation show increased incidence of type 2 diabetes but these studies are limited by lack of person-level data. Cambodians resettled in the USA survived severe malnutrition during distinct historical eras. We examined the relationship of individual exposure to starvation with...

Introduction The concept of Sleep Health, based on self-reports in the RU-SATED model, has been recently extended using parameters derived from 4 days of actigraphy in a cohort of older adults, yielding a 5-component model. Using a longer actigraphy time series from a separate study, the current factor analysis evaluates and extends a theoretically...

Introduction Poor mental health in adolescents has been linked to more variable sleep. However, most studies use self-reported measures of sleep. There is also a lack of research on sex differences in these associations, which is important given that poor emotional health is more common in female than male adolescents. The current study examined wh...

Introduction Sleep and physical activity are related to psychological trauma. Less is known about how individuals with distinct sleep and activity profiles differ on specific clusters of trauma symptoms. Cambodian-Americans who survived the Pol Pot genocide experienced severe collective trauma. This analysis explored group differences between sleep...

Introduction Wrist-worn research-grade actigraphy devices are commonly used to identify sleep and wakefulness in freely-living people. However, common existing algorithms were developed primarily to classify sleep-wake within a defined in-bed period with PSG, and exhibit relatively high sensitivity (accuracy on sleep epochs) but relatively low spec...

Introduction While sleep health is comprised of multiple dimensions, extant research tends to investigate single elements of sleep, such as sleep duration or sleep quality. The current study aimed to explore whether psychological and behavioral factors were associated with a multidimensional sleep health score as well as if sleep health was related...

Introduction Worse sleep health has been linked with greater substance use among adolescents. However, most studies have only cross-sectionally examined this relationship or examined these longitudinal effects in children with sleep disorders. This study investigates whether childhood sleep is longitudinally associated with adolescent alcohol or ma...

Introduction The majority of adolescents report consuming a caffeinated beverage on a typical day, which has been linked to poor sleep health in cross-sectional studies. However, it is unknown whether poor sleep predicts caffeine consumption, and/or whether caffeine consumption predicts poor sleep, particularly when sleep is measured objectively. T...

New sleep technologies have become pervasive in the consumer space, and are becoming highly common in research and clinical sleep settings. The rapid, widespread use of largely unregulated and unstandardized technology has enabled the quantification of many different facets of sleep health, driving scientific discovery. As sleep scientists, it is o...

Chronic sleep restriction (CSR) has been associated with adverse effects including cognitive impairment and increased risk of diabetes and cardiovascular disease. Yet, sleep restriction therapy is an essential component of most behavioral treatments for insomnia. Moreover, little is known about the impact of CSR on sleep continuity and structure in...

Study Objectives Sleep is a modifiable risk factor for cardiovascular conditions. Holistic examination of within-person, multidimensional sleep patterns may offer more detailed information about the sleep-cardiovascular condition link, including who is more vulnerable to both. This study aimed to identify common sleep phenotypes in adulthood, estab...

Background: Nearly 14% of Americans experience chronic circadian disruption due to shift work, increasing their risk of obesity, diabetes, and other cardiometabolic disorders. These disorders are also exacerbated by modern eating habits such as frequent snacking and consumption of high-fat foods. Methods: We investigated the effects of recurrent...

Resting-state functional magnetic resonance imaging (rsfMRI) allows the study of functional brain connectivity based on spatially structured variations in neuronal activity. Proper evaluation of connectivity requires removal of non-neural contributions to the fMRI signal, in particular hemodynamic changes associated with autonomic variability. Regr...

We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history. A smaller sample (n = 663) provided actigraphy sleep data. We tested two sleep...

Differential social and contextual environments may contribute to adolescent sleep disparities, yet most prior studies are limited to self-reported sleep data and have not been conducted at a national level, limiting the variation in neighborhood contexts. This study examined the association between neighborhood disadvantage and objective measures...

This chapter describes the specific ways in which the family unit influences the development of infant, child, and adolescent sleep patterns. Sleep health is discussed in the context of both parent practices and quality, as well as family, sociodemographic, contextual, and structural factors. In particular, factors relevant for infant sleep develop...

Caffeine consumption has been linked to poor sleep health in adolescents, but it is unknown whether poor sleep predicts caffeine consumption, and/or whether caffeine consumption predicts poor sleep, particularly when sleep is measured objectively. Data were collected from a micro-longitudinal sub-study of the age 15 wave of the Fragile Families and...

Pathways through which spousal support and strain influence older adults’ well-being are poorly understood. We examined sleep quality and loneliness as mechanisms through which support and strain predict depressive symptoms across ten years utilizing National Social Life, Health, and Aging Project data. Our sample included partnered participants at...

Alzheimer’s disease (AD) is the most common cause of dementia in the old adult population. AD pathogenesis has been linked to the aggregation of toxic proteins, e.g., amyloid-β and tau. The glymphatic system may play an important role in clearing out these proteins via cerebrospinal fluid (CSF) flows through perivascular and interstitial spaces. Re...

Since the early 2000s, it is increasingly common that people have short sleep durations (<=6 per 24-hour), making this a high-prevalence public health issue, especially among Black individuals. We investigate how trends in short sleep duration are influenced by changes in population aging, socioeconomic factors (e.g., education, labor force partici...

Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty and examined...

Objective To better understand the short-term impact of family interactions on adolescent sleep, this study examined daily associations between family interaction quality and sleep duration, sleep maintenance efficiency, and subjective sleep quality. Methods Participants were 517 diverse youth (Mage = 15.4 years, Range = 15-18) in the Fragile Fami...

Insufficient sleep, which has been shown to adversely affect metabolism, is generally associated with prolonged exposure to artificial light at night, a known circadian disruptor. There is growing evidence suggesting that circadian disruption adversely affects metabolism, yet few studies have attempted to evaluate the adverse metabolic effects of i...

Background Cambodian Americans have high rates of cardiometabolic and psychiatric disorders and disadvantaged social determinants of health (SDOH). These factors can make it challenging to resolve drug therapy problems (DTPs) and improve medication-related outcomes. This manuscript reports planned analyses from a randomized controlled trial in whic...

We investigated whether interindividual attentional vulnerability moderates performance on domain-specific cognitive tasks during sleep restriction (SR) and subsequent recovery sleep. Fifteen healthy men (M ± SD, 22.3 ± 2.8 years) were exposed to three nights of baseline, five nights of 5-h time in bed SR, and two nights of recovery sleep. Particip...

Background: Shift work is associated with long-term health risks. Workplace-based health interventions hold promise for improving or maintaining the health of shift workers; yet, the impact of workplace-based interventions on shift worker sleep duration has not been assessed. We conducted a systematic review of workplace interventions on shift wor...

Purpose: The effects of sleep restriction on subjective alertness, motivation, and effort vary among individuals and may explain interindividual differences in attention during sleep restriction. We investigated whether individuals with a greater decrease in subjective alertness or motivation, or a greater increase in subjective effort (versus oth...

Objectives We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food insecurity and HbA1c among Cambodian Americans with depression enrolled in a diabetes prevention trial. Methods Community health workers assessed household food insecurity and SNAP participation. HbA1c wa...

Objectives We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food security status and HbA1c, the gold standard measure of glycemic control, among Cambodian Americans with depression enrolled in a diabetes prevention trial. Methods Participants had elevated risk factors...

The glymphatic system plays an important role in clearing the amyloid-β (Aβ) and tau proteins that are closely linked to Alzheimer disease (AD) pathology. Glymphatic clearance, as well as Aβ accumulation, is highly dependent on sleep, but the sleep-dependent driving forces behind cerebrospinal fluid (CSF) movements essential to the glymphatic flux...

Introduction The prevalence of obesity among U.S. Latinx children is nearly 10% higher than in their white counterparts. Long-term success of diet and activity level-focused interventions has been limited. Poor sleep is associated with increased obesity risk in youth. Application of social ecological models of behavior change to identify influences...

Introduction Experiences of discrimination attributed to a range of individual characteristics (race, skin color, age, sex, etc.) may influence the extent to which sleep impacts cognitive functioning in order adults, particularly within older minorities. Thus, we investigated the effect of discrimination on the relationship between actigraphic slee...

Introduction Sleep health is linked to dietary choices, and skipping breakfast is associated with risk of negative health outcomes in adolescents. However, there is a lack of research on whether dimensions of sleep at night predict adolescents eating breakfast the next day. We investigated within- and between-person associations of multiple aspects...

Introduction Daytime and evening screen use have been associated with poor sleep health among adolescents, especially delayed sleep timing. However, most studies only investigate associations between adolescents rather than within the same person across multiple nights. Our multilevel modeling approach allows for assessment of connection between sc...

Introduction Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep for health among this group. Methods Data were collected from N=100 adults (age 18-60, 47% female) of...

Background Depression and antidepressant medications are associated with increased risk for type 2 diabetes. It is not known if diabetes can be prevented in the setting of depression. Cambodian Americans have high rates of both depression and diabetes. This paper reports intervention development, experimental design, baseline characteristics, and p...

Background Sleep is a robust determinant of next-day emotions, but people vary in the extent that their emotions fluctuate on days following short sleep duration. These individual differences in day-to-day sleep and emotion dynamics may have long-term health implications. Purpose To evaluate emotional vulnerability to short sleep (within-person as...

Aims Migrants experience social disconnection and also have high risk for metabolic syndrome (MetS). This study explored associations of social alienation, social isolation, and social support with MetS among Cambodian Americans. Methods We conducted secondary data analysis on baseline assessments from a diabetes prevention trial for Cambodian Ame...

Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating b...

Objective We and others have found that couples’ sleep is a shared and dyadic process. Couples’ sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples’ relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose o...

We examined daily affective vulnerability to short sleep (i.e., individual differences in the extent that sleeping ≤6h predicts next-day affect) as a risk factor for developing chronic conditions 10 years later. Participants (N=1945, ages 35-85, 57% women) from the National Study of Daily Experiences reported sleep duration and affect in daily diar...