Despite national initiatives to address health disparities, African Americans (AAs) suffer higher rates of cardiovascular disease (CVD), especially stroke, than European Americans (EAs). The Jackson Heart Study (JHS) was established in 2000 with the aim of generating data that would support public health recommendations for reducing CVD disparities in AAs. This landmark study has reported a higher prevalence of diabetes and uncontrolled hypertension in this entirely AA cohort compared to other U.S. mostly EA cohorts. Increased risk factor prevalence is not explained by obesity or other traditional risk factors, suggesting a potential role for additional unmeasured factors in influencing adverse cardio- metabolic outcomes. Although JHS has comprehensively assessed a wide variety of CVD risk factors, a notable gap has been the absences of objective assessment of sleep disordered breathing (SDB) and sleep patterns. The importance of rectifying this gap is underscored by recent research from predominantly EA samples that have demonstrated that SDB and insufficient sleep each are associated with increased incidence of coronary heart disease, diabetes, and stroke. Our preliminary data also indicate that SDB may be more prevalent in the entirely AA JHS cohort than in predominantly white cohorts. Our long-range goal is to ameliorate CVD disparities by identifying ethnicity-specific modifiable risk factors. The proposed study will examine relationships among SDB, insufficient sleep, obesity, psycho- socio-cultural variables, and CVD risk factors in 1,200 members of the JHS cohort. Sleep apnea and sleep patterns will be objectively assessed using low burden but reliable in-home sleep apnea monitoring and wrist actigraphy. To assess intermediate measurements of CVD, particularly related to stroke and diabetes, intimal media thickness (IMT), blood pressure, and biochemical indices of glucose control and inflammation will be obtained using rigorous protocols. These data will be used to achieve three specific aims: (1) Identify risk factors for SDB and insufficient sleep in AAs, including novel measurements of major and minor stress and negative emotions relevant to minority populations;(2) Elucidate relationships between SDB severity, insufficient sleep, and risk for uncontrolled hypertension, stroke and diabetes;and (3) Quantify the extent to which SDB may statistically mediate relationships between obesity and traditional CVD risk factors. Our study will identify the role of sleep disorders as novel modifiabe risk factors for CVD in AAs, provide a basis for promoting better screening for SDB, and enhance scientific understanding of how disparities in stroke and intermediate CVD outcomes such as diabetes, hypertension, and dyslipidemia are impacted by sleep disorders. Finally, the results of our study will serve as the foundation for prospective analyses linking SDB to incident CVD events, morbidity, and mortality in AAs.

Public Health Relevance

The proposed study will help us better understand how sleep disorders and too little sleep contribute to the risk for stroke, diabetes, and cardiovascular disease in African Americans. The data gathered by this study will help researchers develop future targeted health interventions to reduce the public health burden of cardiovascular disease and racial disparities in diabetes, hypertension and stroke.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL110068-03
Application #
8685315
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Twery, Michael
Project Start
2012-06-01
Project End
2016-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
3
Fiscal Year
2014
Total Cost
$686,073
Indirect Cost
$144,050
Name
University of Mississippi Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
928824473
City
Jackson
State
MS
Country
United States
Zip Code
39216
Johnson, Dayna A; Lane, Jacqueline; Wang, Rui et al. (2017) Greater Cognitive Deficits with Sleep-disordered Breathing among Individuals with Genetic Susceptibility to Alzheimer Disease. The Multi-Ethnic Study of Atherosclerosis. Ann Am Thorac Soc 14:1697-1705
Javaheri, Sogol; Sharma, Ravi K; Bluemke, David A et al. (2017) Association between central sleep apnea and left ventricular structure: the Multi-Ethnic Study of Atherosclerosis. J Sleep Res 26:477-480
Johnson, Dayna A; Simonelli, Guido; Moore, Kari et al. (2017) The Neighborhood Social Environment and Objective Measures of Sleep in the Multi-Ethnic Study of Atherosclerosis. Sleep 40:
Jackson, Chandra L; Agénor, Madina; Johnson, Dayna A et al. (2016) Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: a cross-sectional study. BMC Public Health 16:807
Johnson, Dayna A; Simonelli, Guido; Moore, Kari et al. (2016) The Neighborhood Social Environment and Objective Measures of Sleep in the Multi-Ethnic Study of Atherosclerosis. Sleep :
Johnson, Dayna A; Lisabeth, Lynda; Hickson, DeMarc et al. (2016) The Social Patterning of Sleep in African Americans: Associations of Socioeconomic Position and Neighborhood Characteristics with Sleep in the Jackson Heart Study. Sleep 39:1749-59
Chen, Xiaoli; Wang, Rui; Lutsey, Pamela L et al. (2016) Racial/ethnic differences in the associations between obesity measures and severity of sleep-disordered breathing: the Multi-Ethnic Study of Atherosclerosis. Sleep Med 26:46-53
Johnson, Dayna A; Lisabeth, Lynda; Lewis, Tené T et al. (2016) The Contribution of Psychosocial Stressors to Sleep among African Americans in the Jackson Heart Study. Sleep 39:1411-9
Javaheri, Sogol; Sharma, Ravi K; Wang, Rui et al. (2016) Association between Obstructive Sleep Apnea and Left Ventricular Structure by Age and Gender: the Multi-Ethnic Study of Atherosclerosis. Sleep 39:523-9
Koo, Brian B; Sillau, Stefan; Dean 2nd, Dennis A et al. (2015) Periodic limb movements during sleep and prevalent hypertension in the multi-ethnic study of atherosclerosis. Hypertension 65:70-7

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