Abstract Introduction “Revenge bedtime procrastination”, the intentional delay of bedtime to engage in leisure activities or tasks not accomplished during the day, has been increasingly recognized as a contributor to poor sleep health. However, no studies have examined psychosocial factors associated with bedtime procrastination among Black adults, a population disproportionately exposed to psychosocial stressors and at an increased risk for insufficient sleep. In this study, we examined the association between psychosocial stressors and frequent engagement in revenge bedtime procrastination among Black adults. Methods We analyzed data from the SLUMBR study, a cross-sectional study examining perceptions, attitudes, and beliefs around sleep practices in Black adults (N= 359, 49% women, aged 18-50). Perceived stress was measured via the Global Perceived Stress Scale (GPSS), which assessed stress in the past 12 months across eight domains: job, relationships, neighborhood, caregiving, legal problems, medical problems, racism/discrimination, and meeting basic needs. The total GPSS score was categorized into tertiles (low, medium, high). For analyses examining individual stressors of the GPSS, responses were dichotomized to no/low stress versus moderate/high stress. Participants responded to a single item assessing how often they participated in bedtime procrastination, which we dichotomized as never/rarely/sometimes versus often/always. Poisson regression models with robust estimators examined the association of perceived stress (total stress and eight stressors) and bedtime procrastination, adjusting for age, sex, income, education, employment, and partner status. Results Approximately 34% of participants reported participating in revenge bedtime procrastination often/always. In fully adjusted models, high (vs. low) perceived stress was associated with a greater prevalence of frequent revenge bedtime procrastination (PR: 1.86 CI: 1.16, 2.97). In domain-specific analyses, moderate/high relationship and caregiving stress were associated with increased prevalence of frequent bedtime procrastination (PR: 1.91 CI: [1.30, 2.82]; PR: 1.54 CI: 1.03, 2.30). Conclusion High levels of perceived stress were associated with frequent revenge bedtime procrastination. Individuals experiencing moderate/high levels of relationship and caregiving stress were more likely to engage in revenge bedtime procrastination. While cross-sectional, findings suggest that interventions to address revenge bedtime procrastination should consider addressing stressors that may contribute to delaying bedtime. Support (if any) American Academy of Sleep Medicine Project Number 348-CS-24; NIH 5T32HL130025

OBJECTIVES:We examined the association between sleep duration and quality with cardiometabolic risk factors, assessed whether these associations varied by socioeconomic status, and identified prevalent risk factor combinations in those with poor sleep health. METHODS:We conducted a cross-sectional analysis of 25,433 adults using the 2022 National Health Interview Survey data. Sleep health exposures included self-reported sleep duration (<7, 7-9, >9 h), sleep quality measures (frequency of feeling well rested, difficulty falling asleep, difficulty staying asleep), and a composite sleep health indicator. Cardiometabolic risk factors included overweight/obesity, diabetes, hypertension, and hyperlipidemia. We examined the mean count of cardiometabolic risk factors (individual range: 0-4) and patterns of cardiometabolic risk factor combinations across sleep measures using Poisson regression with marginal standardization for covariates, accounting for the complex survey design. RESULTS:Population-average cardiometabolic risk factor count was 9% higher among short sleepers, 15% to 20% higher across poor sleep quality measures, and 18% higher among those without healthy composite sleep compared with healthy reference groups. Associations between difficulty staying asleep and mean cardiometabolic risk factor count were stronger among those with lower SES (p-interaction ≤0.001) on the ratio scale. Poor sleep quality was associated with more severe CMRF combinations and patterns, while sleep duration showed heterogeneous associations across cardiometabolic outcomes. CONCLUSION:Poor sleep quality and short sleep duration were associated with higher population-level cardiometabolic risk factor burden. Associations for difficulty staying asleep were stronger among individuals with lower socioeconomic status. Poor sleep quality was also associated with more severe cardiometabolic risk factor combinations, suggesting sleep quality may be a potential target for multimorbidity prevention.

OBJECTIVES:The study aimed to examine the association between day-by-day changes in the indoor physical environment and dimensions of sleep health among African American adults. METHODS:A total of 36 African American participants with at least five consecutive days of objective sleep measured by actigraphy (417 person-days) were included in the analysis. Indoor environmental factors, including temperature, carbon dioxide, noise, humidity, and barometric pressure, were objectively measured by an indoor environmental monitor. Linear mixed models were utilized to assess the within-person association between day-by-day changes in indoor environmental factors and sleep efficiency, wakefulness after sleep onset, sleep duration, and linear models for the association with sleep regularity, adjusting for sex, age, educational attainment, and the number of household members. The joint associations of all factors with sleep measures were assessed using quantile g-computation. RESULTS:The participants' mean (standard deviation) age was 55.3 (8.1), and most were female and had a bachelor's degree or higher. In complete case analysis (N = 29, 288 person-days), higher noise levels were associated with lower sleep efficiency (β = -1.81%, 95% CI: -2.00, -0.45), especially among those in the highest quartile vs. the lowest (β = -2.73%, 95% CI: -4.91, -0.54). Higher pressure levels were associated with longer sleep duration (β = 15.22 minutes, 95% CI: 1.11, 28.02) and more irregular sleep (β = 16.07 minutes, 95% CI: 1.40, 30.73). Having higher levels of all environmental factors was associated with lower sleep efficiency (β = -1.38%, 95% CI: -3.01, 0.26). Multiple-imputation analysis yielded consistent results. CONCLUSIONS:Day-by-day changes in indoor physical environment were associated with sleep efficiency, duration, and irregularity among African American adults in the Atlanta Metro area.

Cardiovascular-Kidney-Metabolic Syndrome (CKM), a condition characterized by the comorbid occurrence of metabolic conditions, chronic kidney disease, and cardiovascular disease, can significantly increase the risk for early mortality. Sex, racial, and ethnic differences have been found, with men (compared to women) and Black individuals (compared to White individuals) being more likely to have advanced stage CKM (stages 3 and 4), suggesting the need to examine factors that may be contributing to advanced stage CKM. Poor sleep may be a determinant of CKM, given its link to cardiovascular, chronic kidney, and metabolic conditions independently. We examined associations of objective sleep duration and the occurrence of advanced-stage CKM, and whether the associations differed by sex and race and ethnicity. We analyzed cross-sectional data from two cycles (2011-2012 & 2013-2014) of the NHANES study. Individuals were classified into five stages (0-4) of CKM. For the current analyses, individuals were further classified as having advanced CKM (stages 3-4) vs no advanced CKM (stages 0-2). Sleep duration was obtained via actigraphy across a nine day period and coded as short (< 7 hours), recommended (> 7 and < 9 hours), and long (> 9 hours) sleep. Sex and race and ethnicity stratified logistic regressions were fit to determine the association of sleep duration and CKM adjusting for sociodemographic factors, smoking, alcohol use, and depressive symptoms. The sample (n=4510; Mage = 48.9) was 50% female, 22% Latinx, 42% White, 21% Black, and 13% Asian. Approximately 37% had short sleep duration, 13% had long sleep duration, and 17% had advanced CKM. In fully adjusted models, long compared to recommended sleep duration was associated with an increased odds of advanced CKM for men (aOR: 1.84 CI: [1.05, 3.24]) and Latinx individuals (aOR: 4.64 CI:[2.07, 10.40]). Sleep duration was not associated with advanced CKM in women, or White, Black, or Asian individuals. Long sleep duration was associated with higher odds of advanced stage CKM among men and Latinx individuals. While cross-sectional, findings may suggest that interventions to improve sleep may reduce the burden of CKM among these populations. NIH 5T32HL130025-09.

Abstract Introduction Adverse housing conditions are associated with cognitive impairment; however, the mechanism is not fully understood. Adverse housing can affect sleep – an essential physiologic activity for cognitive function, yet this pathway is understudied. We tested associations between housing condition, sleep disturbances, and cognitive impairment. Methods This study utilized data from the Health and Retirement Study, a longitudinal panel study among adults (2020). Participants (n=2,346) completed questionnaires on housing, sleep disturbances, and cognition. Housing was measured by self-reported ratings of their homes physical condition (1-excellent to 5-poor), and further categorized as poor/fair vs. excellent/very good/good. Sleep disturbances were self-reported as trouble falling asleep, trouble waking up during the night, and trouble with waking up too early and not being able fall asleep again, and each item was scored from 0 (rarely/never) to 2 (most of the time). Subjective and objective cognitive impairment was defined as a participant rating of fair or poor regarding their memory at the present time and by diagnostic classification, respectively. Logistic regression models were fit to test associations between housing and sleep and cognitive impairment after adjustment for covariates. A bootstrapped, model based, causal mediation analysis was conducted to calculate the effect of sleep on housing and cognition. Results The sample had a mean age of 66.5 + 0.21 years, and 56% were female, 10% Black, 80% White, and 10% other racial group. There was a high prevalence of cognitive impairment (subjective: 25%, objective: 34%) and sleep disturbance (38%). Individuals living in fair/poor vs. excellent/very good/good housing conditions had higher odds of sleep disturbances [Adjusted Odds Ratio (aOR)=3.72, 95% confidence interval (1.89, 7.36)] and cognitive impairment [Subjective aOR=3.74 (1.73, 8.06) and Objective aOR=4.71 (2.07, 10.70)], respectively. Sleep disturbances were associated with higher odds of cognitive impairment [Subjective aOR=2.42(1.51, 3.88) and Objective aOR=1.72 (1.04, 2.87)]. The formal mediation results showed that sleep partially mediated the association between housing and cognitive decline (15% subjective and 9% objective). Conclusion Results suggest that sleep may explain a portion of the association between housing conditions and cognitive impairment. Targeting sleep and determinants of sleep (i.e., housing), may reduce cognitive impairment. Support (if any) NHLBI R01HL157954

Purpose To investigate intraoperative stress levels using heart rate monitoring during each step of cataract surgery. Setting Single tertiary hospital. Design Observational study recording resident heart rate as a measure of acute stress level during cataract surgeries. Methods Emory ophthalmology postgraduate year (PGY) 3 and PGY-4 residents operating at Grady Memorial Hospital during the time period of the study were eligible to participate. Chest-strapped Bluetooth devices recorded heart rate during the surgeries. The mean, maximum, and minimum heart rates were then analyzed individually for the following steps of surgery: incisions, continuous curvilinear capsulorhexis, hydrodissection, nucleus disassembly, quadrant removal, cortical cleanup, intraocular lens insertion, and closure. Data collection started in April 2017 and ended in February 2018. Results Out of the 549 surgeries recorded, 427 yielded viable data. Across that dataset, quadrant removal had the highest adjusted mean heart rate value (90.3; 95% confidence interval [CI]: 82.9–97.7; p < 0.0001), highest adjusted maximum heart rate value (97.3; 95% CI: 89.5–105.3; p < 0.0001), and highest adjusted minimum heart rate value (82.1; 95% CI: 75.2–89; p < 0.0001). Nuclear disassembly and incisions were second and third highest, respectively. Conclusions Quadrant removal, nucleus disassembly, and incisions are the three most stressful steps for resident surgeons. This knowledge should be applied to enhance the resident experience by emphasizing these steps during surgical preparation and training. Future studies using intraoperative heart rate monitoring may be warranted to better understand the resident and attending experience and ultimately improve surgical outcomes.