PURPOSE: To assess associations among chronic obstructive pulmonary disease (COPD), disability as measured by activities of daily living (ADL) and instrumental ADL (IADL), engagement in social activities, and death among elderly noninstitutionalized US residents. MATERIALS AND METHODS: A nationally representative sample of 9,415 adults who were aged ≥70 years and responded to the Second Supplement on Aging survey in 1994-1996 and mortality follow-up study through 2006 were assessed. Multiple logistic regression analyses were performed to assess the risk of all-cause mortality in participants with COPD after accounting for age, sex, race/ethnicity, and smoking status. RESULTS: At baseline, approximately 9.6% of study participants reported having COPD. Compared with participants without COPD, those with COPD were significantly more likely (P<0.05) to have difficulty with at least one ADL (44.3% versus [vs] 27.5%) and with at least one IADL (59.9% vs 40.2%), significantly less likely to be engaged in social activities (32.6% vs 26.3%), and significantly more likely to die by 2006 (70.7% vs 60.4%; adjusted risk ratio 1.15, P<0.05). The association between COPD and risk for death was moderately attenuated by disability status. CONCLUSION: COPD is positively associated with disability and mortality risk among US adults aged ≥70 years. The significant relationship between COPD and mortality risk was moderately attenuated, but was not completely explained by stages of ADL and IADL limitations and social activities.

OBJECTIVE: This investigation examined the association of anxiety or depressive disorder and frequent insufficient sleep. METHODS: Data were obtained from a 2010 telephone survey of a population-based sample of 113,936 adults in 20 states. Respondents were asked how often they did not get enough rest or sleep and if they had ever received a diagnosis of an anxiety or depressive disorder. Frequent insufficient sleep was defined as insufficient rest or sleep during ≥ 14 of the past 30 days. RESULTS: Frequent insufficient sleep was reported by 27.0% of the sample and was significantly more common (p<.05) among respondents who reported both anxiety and depressive disorders (48.6%), depressive disorders only (39.0%), or anxiety only (37.5%) than among adults who reported neither disorder (23.1%). CONCLUSIONS: Frequent insufficient sleep is associated with depressive and anxiety disorders, and the odds of the sleep disorder are increased when both classes of psychiatric disorders are diagnosed.

OBJECTIVE: Frequent insufficient sleep, defined as ≥14 days/past 30 days in which an adult did not get enough rest or sleep, is associated with adverse mental and physical health outcomes. Little is known about the prevalence of frequent insufficient sleep among American Indians/Alaska Natives (AI/AN). METHODS: We assessed racial/ethnic differences in the prevalence of frequent insufficient sleep from the combined 2009-2010 Behavioral Risk Factor Surveillance Survey among 810,168 respondents who self-identified as non-Hispanic white (NHW, n = 671,448), non-Hispanic black (NHB, n = 67,685), Hispanic (n = 59,528), or AI/AN (n = 11,507). RESULTS: We found significantly higher unadjusted prevalences (95% CI) of frequent insufficient sleep among AI/AN (34.2% [32.1-36.4]) compared to NHW (27.4% [27.1-27.6]). However, the age-adjusted excess prevalence of frequent insufficient sleep in AI/AN compared to NHW was decreased but remained significant with the addition of sex, education, and employment status; this latter relationship was further attenuated by the separate additions of obesity and lifestyle indicators, but was no longer significant with the addition of frequent mental distress to the model (PR = 1.05; 95% CI : 0.99-1.13). This is the first report of a high prevalence of frequent insufficient sleep among AI/AN. These results further suggest that investigation of sleep health interventions addressing frequent mental distress may benefit AI/AN populations.

BACKGROUND: Although adverse childhood experiences (ACEs) have previously been demonstrated to be adversely associated with a variety of health outcomes in adulthood, their specific association with sleep among adults has not been examined. To better address this issue, this study examines the relationship between eight self-reported ACEs and frequent insufficient sleep among community-dwelling adults residing in 5 U.S. states in 2009. METHODS: To assess whether ACEs were associated with frequent insufficient sleep (respondent did not get sufficient rest or sleep ≥14 days in past 30 days) in adulthood, we analyzed ACE data collected in the 2009 Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey in Arkansas, Louisiana, New Mexico, Tennessee, and Washington. ACEs included physical abuse, sexual abuse, verbal abuse, household mental illness, incarcerated household members, household substance abuse, parental separation/divorce, and witnessing domestic violence before age 18. Smoking status and frequent mental distress (FMD) (≥14 days in past 30 days when self-perceived mental health was not good) were assessed as potential mediators in multivariate logistic regression analyses of frequent insufficient sleep by ACEs adjusted for race/ethnicity, gender, education, and body mass index. RESULTS: Overall, 28.8% of 25,810 respondents reported frequent insufficient sleep, 18.8% were current smokers, 10.8% reported frequent mental distress, 59.5% percent reported ≥1 ACE, and 8.7% reported ≥ 5 ACEs. Each ACE was associated with frequent insufficient sleep in multivariate analyses. Odds of frequent insufficient sleep were 2.5 (95% CI, 2.1-3.1) times higher in persons with ≥5 ACEs compared to those with no ACEs. Most relationships were modestly attenuated by smoking and FMD, but remained significant. CONCLUSIONS: Childhood exposures to eight indicators of child maltreatment and household dysfunction were significantly associated with frequent insufficient sleep during adulthood in this population. ACEs could be potential indicators promoting further investigation of sleep insufficiency, along with consideration of FMD and smoking.

BACKGROUND: Over the past 50 years, the average sleep duration for adults in the United States has decreased while the prevalence of obesity and associated outcomes has increased. The objective of this study was to determine whether perceived insufficient sleep was associated with body mass index (BMI) in a national sample. METHODS: We analyzed data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey (N = 384,541) in which respondents were asked, "During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?" We divided respondents into six BMI categories and used multivariable linear regression and logistic regression analyses to assess the association between BMI categories and days of insufficient sleep after adjusting for sociodemographic variables, smoking, physical activity, and frequent mental distress. RESULTS: Adjusted mean days of insufficient sleep ranged from 7.9 (95% confidence interval [CI]: 7.8, 8.0) days for people of normal weight to 10.5 (95% CI: 10.2, 10.9) days for those in the highest weight category (BMI ≥ 40). Days of perceived insufficient sleep followed a linear trend across BMI categories. The likelihood of reporting ≥14 days of insufficient sleep in the previous 30 days was higher for respondents in the highest weight category than for those who were normal weight (34.9% vs. 25.2%; adjusted odds ratio = 1.7 (95% CI: 1.5, 1.8]). CONCLUSION: Among U.S. adults, days of insufficient rest or sleep strongly correlated with BMI. Sleep sufficiency should be an important consideration in the assessment of the health of overweight and obese people and should be considered by developers of weight-reduction programs.

The World Health Organization (WHO) defines mental health as “not just the absence of mental disorder” but “as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1(p2) Mental illness, on the other hand, is the “term that refers collectively to all diagnosable mental disorders” that are “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”2(p5) | Further, WHO has long defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity.”3(p100) Given these definitions, it should be clear that there is no health without mental health.