The objective of this study is to examine the temporal and bidirectional relationships between accelerometer-derived physical activity estimates and actigraphy-assessed sleep characteristics among ...older women.
A subgroup of participants (N = 143, mean age = 73 yr) enrolled in the Healthy Women Study wore an ActiGraph accelerometer on their waist and an Actiwatch sleep monitor on their wrist concurrently for seven consecutive days. Multilevel models examined whether ActiGraph-assessed daily activity counts (ct·min⁻¹·d⁻¹) and moderate- to vigorous-intensity physical activity (MVPA; min·d⁻¹) predicted Actiwatch-assessed sleep onset latency, total sleep time, sleep efficiency, and sleep fragmentation. Similar models were used to determine whether nighttime sleep characteristics predicted physical activity the following day.
In unadjusted models, greater daily activity counts (B = -0.05, P = 0.005) and more minutes of MVPA (B = -0.03, P = 0.01) were temporally associated with less total sleep time across the week. Greater sleep efficiency was associated with greater daily activity counts (B = 0.37, P = 0.01) and more minutes of MVPA (B = 0.64, P = 0.009) the following day. Less sleep fragmentation was also associated with greater daily activity counts and more MVPA the following day. Findings were similar after adjustment for age, education, body mass index, depressive symptoms, arthritis, and accelerometer wear time.
Few studies have used objective measures to examine the temporal relationships between physical activity and sleep. Notably, these findings suggest that nightly variations in sleep efficiency influence physical activity the following day. Thus, improving overall sleep quality in addition to reducing nightly fluctuations in sleep may be important for encouraging a physically active lifestyle in older women.
To review the recent (1995-2009) literature on psychosocial risk and protective factors for coronary heart disease (CHD) among women, including negative emotions, stress, social relationships, and ...positive psychological factors.
Articles for the review were identified using PubMed and bibliographies of relevant articles. Eligible studies included at least 100 women and either focused on a) exclusively female participants or b) both men and women, conducting either gender-stratified analyses or examining interactions with gender. Sixty-seven published reports were identified that examined prospective associations with incident or recurrent CHD.
In general, evidence suggests that depression, anxiety disorders, anger suppression, and stress associated with relationships or family responsibilities are associated with elevated CHD risk among women, that supportive social relationships and positive psychological factors may be associated with reduced risk, and that general anxiety, hostility, and work-related stress are less consistently associated with CHD among women relative to men.
A growing literature supports the significance of psychosocial factors for the development of CHD among women. Consideration of both traditional psychosocial factors (e.g., depression) and factors that may be especially important for women (e.g., stress associated with responsibilities at home or multiple roles) may improve identification of women at elevated risk as well as the development of effective psychological interventions for women with or at risk for CHD.
Trait optimism (positive future expectations) and cynical, hostile attitudes toward others have not been studied together in relation to incident coronary heart disease (CHD) and mortality in ...postmenopausal women.
Participants were 97 253 women (89 259 white, 7994 black) from the Women's Health Initiative who were free of cancer and cardiovascular disease at study entry. Optimism was assessed by the Life Orientation Test-Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire. Cox proportional hazard models produced adjusted hazard ratios (AHRs) for incident CHD (myocardial infarction, angina, percutaneous coronary angioplasty, or coronary artery bypass surgery) and total mortality (CHD, cardiovascular disease, or cancer related) over approximately 8 years. Optimists (top versus bottom quartile "pessimists") had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). Effects of optimism and cynical hostility were independent.
Optimism and cynical hostility are independently associated with important health outcomes in black and white women. Future research should examine whether interventions designed to change attitudes would lead to altered risk.
Greater levels of socioeconomic position (SEP) are generally associated with better health. However results from previous studies vary across race/ethnicity and health outcomes. Further, the majority ...of previous studies do not account for the effects of life course SEP on health nor the effects of racial discrimination, which could moderate the effects of SEP on health. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we examined the relationship between a life course SEP measure on depressive symptoms and self-rated health. A life course SEP was constructed for each participant, using a framework that included parental education and occupation along with respondents' highest level of education and occupation. Interaction terms were created between life course SEP and racial discrimination to determine whether the association between SEP and health was moderated by experiences of racial discrimination. Analyses revealed that higher levels of life course SEP were inversely related to depressive symptoms. Greater life course SEP was positively associated with favorable self-rated health. Racial discrimination was associated with more depressive symptoms and poorer self-rated health. Analyses indicated a significant interaction between life course SEP and racial discrimination on depressive symptoms in the full sample. This suggested that for respondents with greater levels of SEP, racial discrimination was associated with reports of more depressive symptoms. Future research efforts should be made to examine whether individuals' perceptions and experiences of racial discrimination at the interpersonal and structural levels limits their ability to acquire human capital as well as their advancement in education and occupational status.
•Life course SEP was negatively associated with depressive symptoms.•Life course SEP was positively associated with favorable self-rated health.•Racial discrimination was associated greater depressive symptoms.•Racial discrimination was associated with poorer self-rated health.•Effects of racial discrimination on self-rated health worse for higher SEP whites compared to blacks.
1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were ...associated with distinct demographic, clinical, and sleep characteristics.
The PSQI, ESS, clinical rating scales, sleep diaries, actigraphy, and home polysomnography were collected from 187 community-dwelling adults (mean age 59.5 years, 47.1% women, 41.2% African Americans) as part of a study investigating novel cardiovascular risk factors. Correlations, cluster analysis, principal components analysis, MANOVA, ANOVA, and regressions were used to characterize the relationships between the PSQI, ESS, and other study variables
Mean PSQI score was 6.3 (3.4), and mean ESS score was 8.2 (3.9). PSQI and ESS correlated weakly with each other (r = 0.16, p = 0.03), but segregated from each other on principal components analysis. Groups of participants categorized by either cluster analysis of PSQI and ESS scores, or by scores above or below traditional cut-off values, differed from each other on psychological/stress symptoms and quantitative and qualitative sleep diary measures, but not on actigraphic or polysomnographic measures. Specifically, higher PSQI scores were associated with female sex, greater psychological distress, and greater sleep disturbance on sleep diaries.
The PSQI and ESS measure orthogonal dimensions of sleep-wake symptoms, but neither is related to objective sleep measures. The PSQI is more closely related to psychological symptom ratings and sleep diary measures than the ESS. These instruments are not likely to be useful as screening measures for polysomnographic sleep abnormalities.
Sleep complaints are highly prevalent and associated with cardiovascular disease (CVD) morbidity and mortality. This is the first prospective study to report the association between commonly reported ...sleep symptoms and the development of the metabolic syndrome, a key CVD risk factor.
Participants were from the community-based Heart Strategies Concentrating on Risk Evaluation study. The sample was comprised of 812 participants (36% African American; 67% female) who were free of metabolic syndrome at baseline, had completed a baseline sleep questionnaire, and had metabolic syndrome evaluated 3 years after baseline. Apnea-hypopnea index (AHI) was measured cross-sectionally using a portable monitor in a subset of 290 participants. Logistic regression examined the risk of developing metabolic syndrome and its components according to individual sleep symptoms and insomnia syndrome.
Specific symptoms of insomnia (difficulty falling asleep DFA and "unrefreshing" sleep), but not a syndromal definition of insomnia, were significant predictors of the development of metabolic syndrome. Loud snoring more than doubled the risk of developing the metabolic syndrome and also predicted specific metabolic abnormalities (hyperglycemia and low high-density lipoprotein cholesterol). With further adjustment for AHI or the number of metabolic abnormalities at baseline, loud snoring remained a significant predictor of metabolic syndrome, whereas DFA and unrefreshing sleep were reduced to marginal significance.
Difficulty falling asleep, unrefreshing sleep, and, particularly, loud snoring, predicted the development of metabolic syndrome in community adults. Evaluating sleep symptoms can help identify individuals at risk for developing metabolic syndrome.
Highlights • Sleep problems are highly prevalent in adolescence. • Family factors are important for child and adolescent sleep. • Adolescents from single-parent households had poorer sleep ...efficiency. • Race moderated the effects of family structure on sleep.
Background Cardiovascular disease (CVD) in women has unique features, including associations with reproductive factors that are incompletely understood. Vasomotor symptoms (VMS), the classic ...menopausal symptom, are linked to CVD risk factors and subclinical CVD. Evidence linking VMS to CVD events is limited. We tested whether frequent and/or persistent VMS were associated with increased risk for fatal and nonfatal CVD events in SWAN (Study of Women's Health Across the Nation). Methods and Results A total of 3083 women, aged 42 to 52 years at baseline, underwent up to 16 in-person visits over 22 years. Assessments included questionnaires on VMS frequency (0, 1-5, or ≥6 days/2 weeks), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). A subset of events was adjudicated via medical record. Death certificates were obtained. Relationships between baseline VMS or persistent VMS over the follow-up (proportion of visits with frequent VMS) with combined incident nonfatal and fatal CVD were tested in Cox proportional hazards models adjusted for demographics, medication use, and CVD risk factors. Participants experienced 231 CVD events over the follow-up. Women with frequent baseline VMS had an elevated risk of subsequent CVD events (relative to no VMS; ≥6 days: hazard ratio HR 95% CI, 1.51 1.05-2.17,
=0.03; 1-5 days: HR 95% CI, 1.02 0.75-1.39,
=0.89, multivariable). Women with frequent VMS that persisted over time also had an increased CVD event risk (>33% versus ≤33% of visits: HR 95% CI, 1.77 1.33-2.35,
<0.0001, multivariable). Conclusions Frequent and persistent VMS were associated with increased risk of later CVD events. VMS may represent a novel female-specific CVD risk factor.
Neighborhood socioeconomic status (NSES) is associated with cognitive function, independently of individual demographic, health, and socioeconomic characteristics. However, research has been largely ...cross-sectional, and mechanisms of the association are unknown. In 1992-1993, Cardiovascular Health Study participants (n = 3,595; mean age = 74.8 years; 15.7% black) underwent cognitive testing and magnetic resonance imaging of white matter hyperintensities (WMH), and their addresses were geocoded. NSES was calculated using 1990 US Census data (block groups; 6 measures of wealth, education, and occupation). The Modified Mini-Mental State Examination (3MS) was used to assess general cognition, and the Digit Symbol Substitution Test (DSST) was used to assess speed of processing annually for 6 years. Associations of race-specific NSES tertiles with 3MS, DSST, and WMH were estimated using linear mixed-effects models accounting for geographic clustering, stratified by race, and adjusted for demographic, health, and individual socioeconomic status (education, income, lifetime occupational status) variables. In fully adjusted models, higher NSES was associated with higher 3MS scores in blacks (mean difference between highest and lowest NSES = 2.4 points; P = 0.004) and whites (mean difference = 0.7 points; P = 0.02) at baseline but not with changes in 3MS over time. NSES was marginally associated with DSST and was not associated with WMH. Adjustment for WMH did not attenuate NSES-3MS associations. Associations of NSES with cognition in late adulthood differ by race, are not explained by WMH, and are evident only at baseline.
We evaluate the evidence that depression, anger, hostility, and anxiety are related to risk for the metabolic syndrome, focusing as well on its components of central adiposity and insulin resistance. ...In addition, we identify possible moderators of these associations and summarize plausible underlying biobehavioral pathways.
Medline, PsycINFO, PubMed, and Web of Science searches were conducted using the keywords metabolic syndrome, syndrome x, central adiposity/obesity, visceral adiposity/obesity, body fat distribution, waist circumference, waist hip ratio, insulin resistance/sensitivity, glucose tolerance, psychological, depression, hostility, anger, cynicism, and anxiety.
The current literature provides cross-sectional evidence for an association between psychological characteristics and the metabolic syndrome. Prospective data, though limited, suggest that depression, hostility, and anger predict increased risk for the metabolic syndrome. Data on modifiers are too limited to permit definitive conclusions. Negative health behaviors and hypothalamic and sympathetic dysregulation are identified as plausible underlying pathways.
More prospective studies, conducted with diverse samples, are needed to delineate the direction of this relationship and the proposed biobehavioral mechanisms; experimental investigations are needed to test for causality. Nevertheless, findings suggest that psychological characteristics, especially depression, hostility, and anger, may increase risk for the metabolic syndrome, providing a novel direction for prevention and treatment interventions.
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