Rupsha Singh

Background: Complementary and Alternative Medicine (CAM) therapies, such as massage, meditation, and yoga, are widely used to promote wellness, including sleep improvement. Although some CAM therapies may improve sleep through stress reduction, relaxation, and relief of physical discomfort, little is known about associations between individual CAM modalities and sleep health at the population level. Therefore, we investigated the associations between CAM therapies and short sleep duration as well as insomnia symptoms. Methods: Participants from the nationally-representative 2012 National Health Interview Survey (NHIS) self-reported the use of CAM therapies and short sleep duration (<7 hours vs. 7-9 hours) as well as insomnia symptoms (yes vs. no). Poisson regression with robust variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for cross-sectional associations between CAM therapy use and sleep outcomes. Results: Among 30,405 participants, the average age was 46.1 +/- 0.2 years and 51% were women. Adults reporting any vs. no CAM therapy use had a higher prevalence of short sleep duration (aPR: 1.11; 95% CI: 1.05-1.16) and insomnia symptoms (aPR: 1.56; 95% CI: 1.47-1.65) after adjustment for sociodemographic and clinical characteristics. Herbal supplements (aPR: 1.13; 95% CI: 1.07-1.19) and massage (aPR: 1.14; 95% CI: 1.05-1.23) were associated with higher prevalence of short sleep duration. Most CAM therapies were associated with higher prevalence of insomnia symptoms, with the strongest associations observed for meditation/guided imagery/progressive relaxation (aPR: 1.84; 95% CI: 1.68-2.02). Conclusion: The higher prevalence of short sleep duration and insomnia symptoms among CAM users may reflect reverse causation, as adults with more severe or persistent sleep disturbances may be more likely to seek CAM therapies. Longitudinal studies are needed to clarify directionality.

Study Objectives: To investigate associations between religiosity/spirituality (R/S) and sleep along with potential modification by stress among Black/African American (AA) women. Methods: Participants from the Study of Environment, Lifestyle, and Fibroids (2010–2018) reported importance of faith and R/S as a source of strength/comfort (ranging from “very” to “not at all”) as well as frequency of prayer/meditation (ranging from “everyday”, to “<once/month”) at baseline. There were repeated measures of daily stress (“very high/moderate” vs. “low/none”), short sleep duration (<7 hours), non-restorative sleep (NRS, waking rested <4 days/week), and insomnia symptoms (IS; difficulty falling/staying asleep). Adjusted prevalence ratios (aPRs) were estimated with Poisson regression with robust variance, and adjusted risk ratios were estimated by applying generalized estimating equations to models. R/S-by-stress terms were tested. Results: Among 1,693 Black/AA women (mean age ± SD 29.2 ± 3.4 years), 69.3% reported faith as important, 55.6% perceived R/S as a source of strength/comfort, 58.8% prayed/meditated daily, 43.8% reported high/moderate stress, and poor sleep was prevalent (short sleep:58.4%, NRS:62%, and IS:17.9%) at baseline. There were no associations with short sleep and IS. All three R/S measures were each cross-sectionally but not longitudinally associated with lower likelihood of NRS, however, associations differed by stress. R/S as source of strength/comfort and prayer/meditation showed protective associations with NRS prevalence at baseline only among participants with low versus high stress (e.g. prayer everyday vs. <once/month aPRhigh stress = 1.07 [95% CI: 0.91–1.26], aPRlow stress = 0.76 [95% CI: 0.63–0.91], pR/S*stress = 0.03). Conclusions: Higher R/S was associated with lower NRS prevalence, but protective associations were limited to participants with low/no reported stress. Statement of Significance Most Americans identify as religious or spiritual, yet religiosity/spirituality (R/S) remains an understudied determinant of sleep health despite its impact on health and well-being. Using multidimensional measures of R/S, we found that valuing faith, finding strength/comfort in R/S, and prayer/meditation were each associated with restorative sleep, primarily among those reporting low/no daily stress. These findings underscore the importance of incorporating R/S into culturally relevant sleep health research and interventions.

Importance Sleep-disordered breathing (SDB) is preventable but underdiagnosed, with disparities among sociodemographic groups with limited material and social resources, partly driven by community-level environmental and social conditions along with healthcare-related factors. Objectives We sought to investigate associations between multifactorial community-level environmental, social, and health burdens and SDB prevalence. We also determined effect modification by age, sex, race, and ethnicity. Design, Setting, and Participants Cross-sectional analysis of electronic health records (EHR) data collected in 2022 from 1,957,775 adult patients in the OCHIN network (>2,000 community health centers across 40 U.S. states). Exposures Patients’ 2022 residential addresses were linked to a census tract-level environmental, social, and health burden (ESHB) index created by the Centers for Disease Control and Prevention and the Agency for Toxic Substances Disease Registry. The ESHB comprises 36 indicators that capture and rank community-level social (e.g., socioeconomic status), environmental (e.g., air pollution), and health (e.g., hypertension) vulnerability. Higher percentile ranks of ESHB (range: 0-1) indicated higher vulnerability. Main Outcomes and Measures SDB was identified via diagnostic and procedural codes, and subtypes were categorized as obstructive (OSA), central (CSA), other/unspecified (OUSA), multiple apneas, and procedure-based cases. Log-binomial regression estimated prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for age, sex, race, and ethnicity. We assessed effect modification by testing cross-product terms. Results Among 1,957,775 patients (median age was 43.0 years [IQR: 30.0–58.0]; 40.6% men), SDB prevalence was 5.5%, with CSA at 0.03%, OSA at 3.8%, OUSA at 1.4%, multiple sleep apneas at 0.03%, and procedure-based cases at 0.21%. Each 0.1-unit increase in ESHB percentile rank was associated with higher prevalence of SDB (PR=1.01 [1.01–1.01]), OUSA (PR=1.01 [1.01–1.02]), and procedure-based cases (PR=1.05 [1.03–1.06]). The ESHB-SDB association was elevated among adults aged 18-49 years, women, American Indian/Alaska Native and White, and non-Hispanic. ESHB was not associated with CSA. Conclusions and Relevance Higher community-level environmental, social, and health vulnerabilities were associated with higher SDB prevalence (although future prospective studies are warranted). Our findings underscore the need to address community-level factors with potential tailoring of interventions across sociodemographic groups. Question Are community-level environmental, social, and health burdens associated with the prevalence of sleep-disordered breathing (SDB) among medically underserved patients in United States (U.S.) community health centers? If so, to what extent? Findings This cross-sectional study included electronic health records data from 1,957,775 patients of 2,000 community-based health centers in 40 states linked to the 2022 census tract-level environmental, social, and health burden (ESHB) index. Higher ESHB was associated with a higher prevalence of SDB and its subtypes (e.g., obstructive sleep apnea [OSA] and central sleep apnea [CSA]). Elevated associations were observed among adults aged 18-49 years, women, American Indian/Alaska Native and White, and non-Hispanic. Meaning Multifactorial community adversity was associated with SDB prevalence. Our findings underscore the need for future intervention studies to address environmental, social, and health burdens at the community level to reduce SDB prevalence in medically underserved populations. Prospective studies are needed.

Objective: To investigate associations between religiosity/spirituality and sleep and potential modification by stress among Black/African American (AA) women. Methods: Using data from the Study of Environment, Lifestyle, & Fibroids at enrollment (2010– 2012) and three follow-up periods (2012–2018), we estimated prevalence ratios (PRs), risk ratios, and 95% confidence intervals (CIs) for the following sleep dimensions: short sleep duration (<7 hours), nonrestorative sleep (NRS, waking rested <4 days/week), and insomnia symptoms (difficulty falling/staying asleep). At baseline, participants reported: importance of faith, religion/spirituality as a source of strength/comfort (‘very-to-somewhat’ vs. ‘not at all’), and prayer/meditation frequency (‘everyday,’ ‘every week,’ or ‘≥once/month’ vs. ‘<once/month’). Day-to-day stress was dichotomized as ‘very high/moderate’ vs. ‘mild/not at all.’ PRs were estimated using adjusted Poisson regression with robust variance, and longitudinal models used generalized estimating equations. Interactions between religiosity/spirituality and stress were tested. Results: Among 1,693 Black/AA women (mean age ± SD 29.2 ± 3.4 years), 69.3% reported faith as important, 55.6% perceived religion/spirituality as a source of strength/comfort, 58.8% prayed/meditated daily, and 43.8% reported high/moderate stress. Short sleep affected 58.4% of participants, NRS 9.5%, and insomnia symptoms 17.9%. Everyday vs. <once/month prayer/meditation was associated with NRS (aPR=3.16 [95% CI:1.16-8.56]). Among women experiencing daily life stress vs. no daily life stress, those who reported religion/spirituality as “very much” a source of strength/comfort had significantly lower prevalence of NRS compared to those who did not (aPR = 0.37, 95% CI: 0.14–0.98, p = 0.05). Religiosity/spirituality was not longitudinally associated with sleep. Conclusion: Daily prayer/meditation was associated with NRS. Religion/spirituality as a source of strength was associated with restorative sleep among highly stressed women. Future research should address potential reverse causation for both negative and positive effects.

Study Objectives: To examine differences in the longitudinal prevalence of childhood insomnia symptoms across black/African American, Hispanic/Latinx, and non-Hispanic white groups. Methods: Participants were 519 children from the Penn State Child Cohort (baseline [V1] from 2000–2005) who were followed up 8 years later as adolescents (V2) and 15 years later as young adults (S3). Mean age at S3 was 24.1 ± 2.7 years. Approximately, 76.5% identified as non-Hispanic white, 12.9% as black/African American, 7.1% as Hispanic/Latinx, and 3.5% as “other” race/ethnicity. Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence and young adulthood) moderate-to-severe difficulties initiating/maintaining sleep. Longitudinal trajectories of insomnia symptoms were identified across three-time points and the odds of each trajectory were compared between racial/ethnic groups, adjusting for sex, age, overweight, sleep apnea, periodic limb movements, psychiatric/behavioral disorders, and psychotropic medication use. Results: Black/African Americans compared to non-Hispanic whites were at significantly higher odds of having a childhood-onset persistent trajectory through young adulthood (OR = 2.58, 95% CI [1.29, 5.14]), while Hispanics/Latinx were at nonsignificantly higher odds to have the same trajectory (OR = 1.81, 95% CI [0.77, 4.25]). No significant racial/ethnic differences were observed for remitted and waxing-and-waning trajectories since childhood or incident/new-onset trajectories in young adulthood. Conclusions: The results indicate that disparities in insomnia symptoms among black/African American and, to a lesser extent, Hispanic/Latinx groups start early in childhood and persist into young adulthood. Identifying and intervening upon upstream determinants of racial/ethnic insomnia disparities are warranted to directly address these disparities and to prevent their adverse health sequelae. Clinical Trial Information: N/A; Not a clinical trial.

The event centrality model indicates that the development and maintenance of posttraumatic stress symptoms (PTSSs) occurs when a traumatic event becomes central to one's identity, marking a key turning point in one's life narrative and influencing the meaning assigned to subsequent posttrauma events. Previous research has shown that event centrality is associated with PTSSs among survivors of intimate partner violence (IPV). However, research has not yet determined whether event centrality may explain associations between trauma exposure and IPV among perpetrators of IPV. Trauma and PTSSs are key risk factors for IPV perpetration, but many questions remain about the mechanisms that explain these associations. Study participants came from a sample of 134 men presenting for treatment at a community-based relationship violence intervention program in the Baltimore-Washington, DC metro area between July 2013 and July 2015 during routine program intake. In the hypothesized serial model, exposure to potentially traumatic events predicted event centrality, which predicted PTSSs, which predicted IPV perpetration and relationship problems. The serial mediation model was significant for physical assault, psychological aggression, emotional abuse, and relationship problems, but not for sexual coercion. The results indicate that the extent to which a trauma becomes central to one's identity is important in understanding the links between trauma exposure, PTSSs, and IPV perpetration. These findings support the development and application of trauma-informed interventions to reduce IPV perpetration and reduce event centrality in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).