Introduction:Awareness, assessment and treatment of sleep apnea are disproportionately lower among Blacks, compared to other racial/ethnic groups. To address this health disparity gap, communication strategies that connect Blacks to OSA education, detection and treatment adherence interventions are needed. Strategies that engage individuals through communication technologies, community-level social network support, and medical providers in clinical settings are also needed. We present lessons learned from three studies that offer these solutions using a community-engaged research model: The Metabolic Syndrome Outcome Study (MetSO), Peer-enhanced Education to Reduce Sleep Ethnic Disparities (PEERS-ED), and Tailored Approach to Sleep Health Education (TASHE), to capture program effectiveness and lessons learned from project successes and failures.Methods:The methods of OSA community-based programs included the application of an OSA community-engaged research model. This model served as a strategic guideline for effective interventions to engage communities in research and ensure cultural appropriateness in OSA interventions. Focus groups, in-depth interviews and community steering committee meetings were conducted with various stakeholders. Delphi surveys were used to identify high priority diseases and conditions. Community barriers and needs were identified through iterative combinations of surveys and focus group meetings. Stakeholder groups participated in all aspects of our studies, including the development, dissemination and implementation phases, reflecting a bi-directional decision-making process that ensures the interests of both parties were considered. The MetSO, PEERS-ED and TASHE studies were reviewed to understand the effectiveness of the programs and to evaluate lessons learned.Results:MetSO, PEERS-ED and TASHE interventions revealed that community-engaged strategies are successful in enrolling Black populations into clinical trials. The study teams reached nearly 3,000 Blacks at risk of OSA and screened about 2,000 people in sleep apnea studies in New York City. Sleep brochures were distributed to over 10,000 people. Lessons learned from MetSO, PEERS-ED and TASHE interventions revealed that building relationships, establishing trust, identifying a study champion, learning to adjust and providing participant incentives are key strategic elements for successful recruitment and retention of Blacks participations in clinical trials.Conclusion:Strategic application of community-oriented frameworks ensures active community engagement throughout the research process, allowing for greater enrollment of Blacks in clinical studies as well as increased OSA awareness, diagnosis, and treatment.
Objectives: To compare whether nonapnea sleep disorders (NASDs) or obstructive sleep apnea (OSA)are associated with an increased risk of obesity. Methods: From January 1, 2000, to December 31, 2015, we identified 24 363 patients with obesity from the 2005 Longitudinal Health Insurance Database, which is part of Taiwan’s National Health Insurance Research Database; 97 452 patients without obesity were also identified from the same database. The age, sex, and index date were matched. Multiple logistic regression was used to analyze the previous exposure risk of patients with obesity and NASD or OSA. A P value of <.05 was considered significant. Results: Patients with obesity were more likely to be exposed to OSA than did those with NASD (OSA adjusted OR [AOR] = 2.927, 95% CI=1.878-4.194, P < .001; NASD adjusted OR [AOR]=1.693, 95% CI=1.575-1.821, P< .001). Furthermore, the closeness of the exposure period to the index time was positively associated with the severity of obesity, with a dose– response effect (OSA exposure <1 year, AOR=3.895; OSA exposure ≥ 1 year and <5 years, AOR=2.933; OSA exposure ≥5 years, AOR=2.486 ; NASD exposure <1 year, AOR=2.386; NASD exposure ≥1 year and <5 years, AOR=1.725; NASD exposure ≥5 years, AOR=1.422). The exposure duration of OSA in patients with obesity was 2.927 times than that of NASD was 1.693 times. Longer exposure durations were associated with more severe obesity with a dose–response effect (OSA exposure <1 year, AOR = 2.251; OSA exposure ≥1 year and <5 years, AOR=2.986; OSA exposure ≥5 years, AOR=3.452; NASD exposure <1 year, AOR=1.420; NASD exposure ≥1 year and <5 years, AOR=2.240; NASD exposure ≥5 years, AOR=2.863). Conclusions: The risk of obesity was determined to be significantly higher in patients with OSA than that of NASD in this nested case-control study. Longer exposure to OSA or NASD was associated with a higher likelihood of obesity, with a dose-response effect.
The relationship between poor sleep quality and fibromyalgia is bidirectional; both processes constantly feed into each other. A treatment that improves both processes could be very useful. This study investigates the effectiveness of applying a very lowfield transcranial magnetic stimulation treatment on patients with fibromyalgia, and to know what changes are produced in the quality of sleep of the patients, compared to two control groups. Methods: a total of 27 patients with fibromyalgia were recruited, all of them adult women. The treatment of magnetic stimulation was applied to them, 4 or 6 weekly sessions, and the results were compared against a group of 52 patients with fibromyalgia to whom no treatment was applied, along with another group of 52 women with the same bio demographic characteristics, but without any pathology. The results were compared in terms of pain improvement using clinical global impression scales, and in terms of sleep quality using the Pittsburgh scale. Results: an improvement in the parameters studied was obtained in 82% of the subjects to whom the treatment was applied, with a mean reduction in the total score of the sleep scale from 16 to 8 points. This improvement is close to the rates observed in healthy subjects. Conclusion: very low intensity transcranial magnetic stimulation in this group of patients with fibromyalgia produced a clinical improvement and an improvement in sleep quality, reaching levels similar to those of healthy subjects.
Background: Some patients with periodic limb movement in sleep (PLMS) have disrupted sleep and excessive daytime sleepiness (EDS). The clinical characteristics of patients with PLMS and EDS remain to be elucidated. Objective: To address the clinical characteristics of patients with PLMS affected by EDS, we assessed the clinical variables in patients with and without EDS and determined the influencing factors using polysomnography (PSG). Methods: This retrospective study included 306 patients with PLMS who did not take drugs. They visited our clinic between March 2015 and February 2021. Their sleep was recorded using PSG. PLMS was defined as having brief (0.5-5 seconds) repetitive limb movements, with a frequency of 15 or more times per hour. The Epworth Sleepiness Scale (ESS) was used as a subjective sleepiness indicator. Using the ESS, EDS was defined as a score ≧11. Multivariable logistic regression analysis was performed to determine the factors influencing EDS in patients with PLMS. Results: Of the 306 patients, 43 had PLMS. EDS was detected in 23 patients with PLMS. Logistic regression analyses revealed lower odds of EDS in men (odds ratio［OR］0.187, 95% confidence interval ［CI］ 0.041-0.856, P = 0.0307) and older individuals (OR 0.92, 95% CI 0.862-0.982, P = 0.0119) among patients with PLMS. Conclusions: Older male patients with PLMS were less likely to have EDS. To our knowledge, this is the first study to demonstrate that men and older individuals had a lower likelihood of experiencing EDS among patients with PLMS.
