Sleep duration, quality, or stability and obesity in an urban family medicine center.

PURPOSE: Inadequate sleep has negative metabolic consequences that may contribute to obesity. A priori hypotheses posit relationships between sleep characteristics, carbohydrate and lipid metabolism, appetite, fatigue, and obesity in laboratory, clinical, and population settings. There are few reports from primary care; and none that address sleep duration, quality, and stability. This study examines the relationship between three sleep characteristics-duration, quality, or stability-and obesity in our urban hospital affiliated family medicine center in Akron, Ohio. METHODS: A systematic sampling process yielded 225 representative patients who completed the Pittsburgh Sleep Quality Index, the Berlin Apnea Questionnaire, and the Sleep Timing Questionnaire. Demographic, body mass, hypertension, and insurance data were obtained from the electronic medical record. Associations between self-reported sleep characteristics and obesity were examined via contingency tables and regression models. RESULTS: Seventy-eight percent (78%) reported poor quality sleep, 59% had elevated Berlin apnea-risk scores, 12% reported restless legs symptoms, and 9% reported a prior diagnosis of sleep apnea; 62% were obese. We found significant (p < 0.05) associations between sleep quality, duration or bedtime stability, and obesity. The association between sleep quality and obesity was negative and linear (69%, 72%, 56%, 43%), while the association between sleep duration and obesity was U-shaped (74%, 53%, 53%, 62%; linear term p = 0.02 and quadratic term p = 0.03). Less stable bedtimes during the week (OR = 2.3, p = 0.008) or on the weekend (OR = 1.8, p = 0.04) were also associated with obesity. The association between sleep quality and obesity was not explained by patient demographics or snoring (ORadj = 2.2; p = 0.008). CONCLUSION: This study adds to the sparse literature on the relationship between three self-reported sleep characteristics and obesity in urban primary care settings which typically differ from both general population and specialty outpatient settings.

The better weight-better sleep study: a pilot intervention in primary care.

OBJECTIVE: To explore the feasibility of integrating sleep management interventions with dietary and exercise interventions for obesity in a 12-week randomized trial. METHODS: We randomized 49 overweight or obese adult patients either to a better weight (BW) cognitive behavioral intervention, or to a combination of the BW intervention and a better sleep intervention, better weight-better sleep (BWBS). RESULTS: The BWBS group lost weight faster (P=.04), and coping self-efficacy accelerated (P=.01). CONCLUSIONS: These preliminary results merit replication in a larger primary care-based trial with a longer continuous intervention and follow-up period.

A method for obtaining an unbiased sample of family medicine patients for research purposes.

INTRODUCTION: Obtaining a representative patient sample for research purposes can be challenging. Classic probability sampling can be trusted, but these approaches are not always feasible; yet alternatives may introduce bias. We summarize relevant literature, the need for new approaches, and illustrate a practical hybrid approach that could consistently produce representative patient samples. METHODS: Valid approaches shift sampling decisions from fallible interviewers to less fallible reproducible processes. In lieu of the interviewer's inclination to select particular patients, we used the day of the week, the appointment time, and the sequence of the patient's last name in the alphabet to select a sample for a consent process and a survey. ILLUSTRATIVE USE: Characteristics of the study sample (n = 225) were compared with the characteristics of the population (N = 1964) that had an office visit during the recruiting period. The data suggested that the study sample was highly representative of the population in this illustrative case. DISCUSSION: A hybrid sampling approach, in the context of a brief consent process, and a nonthreatening interview produced a representative study sample, but formal evaluation via simulation is needed to validate the hybrid approach. Convenience samples of consecutive patients should be avoided to minimize bias.

Longitudinal relationship between elapsed time in the action stages of change and weight loss.

OBJECTIVE: The objective of this study was to examine the longitudinal relationship between the elapsed time in the action and maintenance stages of change for multiple target behaviors and weight loss or gain. RESEARCH METHODS AND PROCEDURES: The research design was a prospective cohort study of overweight and obese primary care patients randomized to an obesity management intervention based on the Transtheoretical Model and a chronic disease paradigm. The target behaviors included increased planned exercise and usual physical activity, decreased dietary fat, increased fruit and vegetable consumption, and increased dietary portion control. The participants were 329 middle-aged men and women with elevated body mass indices recruited from 15 primary care practices in Northeastern Ohio; 28% of the participants were African Americans. The main outcomes were weight loss (5% or more) or weight gain (5% or more) after 18 or 24 months of follow-up. RESULTS: There were significant (p < 0.05) longitudinal relationships between the number of periods (0 to 4) in action or maintenance for each of the five target behaviors, or a composite score taken across the five target behaviors, and weight loss. In all cases, there was a significant (p < 0.05) stepped (graded) relationship between the time in action or maintenance and weight loss (or gain). DISCUSSION: The data support the concept of applying the Transtheoretical Model to the problem of managing obesity in primary care settings. The remaining challenge is to identify those factors that reliably move patients into the action and maintenance stages for long periods.