scholarly journals Poor sleep quality is associated with worse self-rated health in long sleep duration but not short sleep duration

2021 ◽  
Author(s):  
Anna Andreasson ◽  
John Axelsson ◽  
Jos A. Bosch ◽  
Leonie JT. Balter
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Self Rated Health ◽  
Long Sleep

Abstract P336: The Association Between Goal-Striving Stress, Sleep Duration and Sleep Quality in the Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Loretta Cain ◽  
LáShauntá Glover ◽  
Dayna Johnson ◽  
Mario Sims
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Poor Sleep ◽  
Jackson Heart Study ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Logistic Regression Models ◽  
Short Sleep ◽  
Goal Striving ◽  
Heart Study

Introduction: Research shows that compared to non-Hispanic whites, African Americans (AAs) have poorer sleep quality, lower mean sleep duration, and a higher prevalence of sleep-disordered breathing. AAs also report more frequent exposures to certain stressors over the life course, which may impact physiological processes that may impair sleep. Goal-striving-stress (GSS), the discrepancy between aspiration and achievement, weighted by the subjective probability of success, and the level of disappointment experienced if goals are not reached, may be an important stressor among AA’s that may influence sleep; however this has yet to be explored. The objective of this study was to assess the relationship between GSS and sleep duration and sleep quality in AAs. Hypothesis: We assessed the hypothesis that high (versus low) GSS would be associated with short or long sleep duration and poor sleep quality. Methods: We utilized data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. There were a total of 5082 participants in the sample; 63.34% female with a mean age of 55.30 (± 12.75) and mean sleep duration of 6.43 hours (±1.51). The sample was categorized into GSS tertiles: low (n=2121), moderate (n=1716), high (n=1296). Participants self-reported sleep duration (hours) and rated their sleep quality. Sleep duration was categorized as short ( < 6 hours), normal (7 or 8 hours) and long ( > 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Logistic regression models were used to obtain odds ratios (OR, 95% confidence interval-CI) to assess the associations of GSS levels with sleep duration and sleep quality categories. Models were adjusted for sex, age, socioeconomic status, health behaviors, discrimination, and health outcomes. Results: Significant results showed that participants who reported high (versus low) GSS had a 29% increased odds [1.29 (1.10, 1.52)] of short (versus normal) sleep after full adjustment. Participants who reported high (versus low) GSS had a 42% increased odds [1.42 (1.20, 1.67)] of low (versus high) sleep quality after full adjustment. Conclusion In conclusion, the deficit between goal aspiration and achievement is associated with short sleep duration and poor sleep quality. Potential interventions should consider the extent to which GSS may contribute to the development of short sleep duration and poor sleep quality.

scholarly journals 0176 Short Sleep Duration and Poor Sleep Quality Predict Blunted Weight Loss in a Behavioral Weight Loss Intervention

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A70-A70
Author(s):  
C E Kline ◽  
M J Lambiase ◽  
M B Conroy ◽  
M M Brooks ◽  
A M Kriska ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Poor Sleep ◽  
Weight Loss Intervention ◽  
Behavioral Weight Loss ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Behavioral Weight Loss Intervention

Abstract Introduction Short sleep duration and poor sleep quality have each been associated with obesity and weight gain. However, less is known regarding how sleep may impact attempted weight loss. The purpose of this study was to investigate the associations between sleep duration and sleep quality, both independently and in combination, with weight loss in a 12-month behavioral weight loss intervention. Methods Young to middle-aged adults who were overweight or obese (N=296) completed a 12-month behavioral weight loss intervention, with weight assessed at baseline, 6 and 12 months. Sleep duration and quality were derived from the Pittsburgh Sleep Quality Index. Analyses examined the change in sleep over time and the association between baseline sleep and changes in sleep with 6- and 12-month weight loss following adjustment for relevant covariates including age, gender, race, education, baseline body mass index, and baseline risk for sleep apnea. Results Participants (with an average baseline weight of 97.0±1.0 kg) lost 6.6±1.1 kg (6.8%) and 6.7±1.2 kg (6.9%) at 6 and 12 months relative to baseline, respectively. Global sleep quality significantly improved over the 12-month intervention (P=.03), but average sleep duration and the prevalence of short sleep duration (&lt;6 h) or poor sleep quality did not change significantly (each P≥.45). Adults with short sleep duration at baseline lost 3.3±0.9% less weight than those with ≥6 h sleep duration (P&lt;.001). Adults with poor sleep quality at baseline lost 1.6±0.8% less weight than those with good sleep quality (P=.04). When considered together, adults with both short sleep duration and poor sleep quality lost at least 5.0% less weight compared with all other sleep duration/quality group combinations (P&lt;.001). Conclusion Our findings highlight the importance of both sleep duration and sleep quality as predictors of behavioral weight loss and suggest that screening for sleep disturbance may be useful to determine who may benefit from additional counseling and resources. Support R01HL077525, K23HL118318

Abstract 63: Relation between Poor Sleep Quality and Resistant Hypertension

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Rosa Maria Bruno ◽  
Laura Palagini ◽  
Alessia Di Giulio ◽  
Angelo Gemignani ◽  
Stefano Taddei ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Multiple Logistic Regression Analysis ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Short Sleep

Purpose: Insomnia and short sleep duration have been associated with increased incidence of hypertension. However, the relationship between sleep loss and resistant hypertension (RH), has not been ascertained yet. Methods: 270 patients at first access to our Hypertension Outpatient Unit were enrolled. RH was defined according as office BP values >140/90 mmHg with 3 or more antihypertensive drugs, or controlled BP with 4 or more drugs, including a diuretic. Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were assessed. Poor sleep quality was defined as PSQI>5, mild-to-severe depressive symptoms as BDI score >10. Patients with self-reported sleep apneas or snoring were excluded (n=21). Results: Complete data were available for 234 patients (males 51%, mean age 58±13 years, BMI 26±5 kg/mq, antihypertensive treatment 84%, previous CV events 12%, diabetes 8%, smoking 15%, hypercholesterolemia 60%). Mean sleep duration was 6.4±1.6 hours, with a 49% prevalence of short sleep duration (<6 hours) and similar in both sexes. Conversely, women had higher PSQI scores (5.2 vs 3.6, p=0.03) and prevalence of poor sleep quality (46% vs 30% in men, p=0.01). Women showed also higher BDI scores (4.5 vs 1.8, p=0.006) and prevalence of depressive symptoms than men (20% vs 7%, p=0.003). RH patients (15%) had higher PSQI (5.8 vs 4.1, p=0.03), a difference shown in women (6.8 vs 4.8, p=0.04) but not in men (4.7 vs 3.5, p=0.37). The association between BDI score and RH showed a similar behavior (overall 3.6 vs 2.8, p=0.02; women 5.1 vs 3.7, p=0.03; men: 2.0 vs 1.9, p=0.53). In a multiple logistic regression analysis (including age, sex, obesity, diabetes, previous CV events, sleep duration, use of hypnotic drugs) poor sleep quality was independently associated with RH (OR 2.2, CI95% 1.1-5.3). However this relationship lost significance when also depressive symptoms were included in the model (p=0.12). Conclusions: Short sleep duration is highly prevalent in hypertensive patients. This condition is accompanied by poor sleep quality and depressive symptoms in women. Poor sleep quality is associated with a 2-fold higher probability of having RH. This association could be mediated by the presence of depressive symptoms.

Abstract MP073: Sleep Patterns and Depression in a Diverse Sample of Women from the AHA Go Red for Women Strategically Focused Research Network (SFRN)

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Brooke Aggarwal ◽  
Ming Liao
Keyword(s):  
Depressive Symptoms ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Minority Women ◽  
Poor Sleep ◽  
Sleep Patterns ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Long Sleep ◽  
Race Ethnicity

Background: Depression has been linked to increased risk of cardiovascular disease (CVD) through biological mechanisms and altered lifestyle behaviors, possibly including short and/or long sleep duration. However the relation between specific sleep components and depressive symptoms, and interaction by race/ethnicity has not been fully defined. The purpose of this study was to determine if sleep patterns including short sleep duration, poor sleep quality, and insomnia were associated with depressive symptoms in a free-living ethnically diverse population of adult women, and if they varied by racial/ethnic status. Methods: English or Spanish speaking females between the ages of 20-79 y, participating in an observational cohort study as part of the American Heart Association Go Red for Women SFRN, were included (n=50, 56% (28 of 50) non-white, mean age = 41 ±18y). Sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument used to measure the quality and duration of sleep in adults. Presence of insomnia was measured using the Insomnia Severity Index (ISI). Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Linear and logistic regression models were used to evaluate cross-sectional associations between sleep patterns and depression overall, and by race/ethnicity. Results: Overall, nearly one-fifth of participants had depressive symptoms (BDI II score ≤13), 18% (9 of 50) had short sleep duration (<6 hours per night), 38% (19 of 50) had poor quality sleep (PSQI score ≥5), and 40% (20 of 50) had some level of insomnia (ISI score ≥8). Mean BDI-II scores among women who slept <6 versus ≥6 hours were significantly greater (16 versus 5, p=.0003). Higher depression scores were associated with shorter sleep duration (p=.001), poorer sleep quality (p=.03), and higher insomnia severity (p<.0001) overall. There was no association between depression and long sleep (≥8 hours). When stratified by race/ethnicity, depression was significantly associated with poor sleep quality among minority women in multivariable models adjusted for demographic confounders (OR=1.42, 95% CI=1.03-1.95), but not among non-Hispanic white women. Depression was also significantly associated with insomnia severity (p<.001), and sleep duration (p=.03) among minority women only, in multivariable adjusted models stratified by race/ethnicity. Conclusions: In this diverse sample of women, sleep problems were highly prevalent. Poor sleep quality, insomnia, and short sleep duration (but not long sleep) were associated with greater depressive symptoms among minority women but not whites. These preliminary data suggest that minority women with short sleep duration may be at heightened CVD risk from depression. Future research should determine if interventions designed to improve sleep result in decreased depressive symptoms and reduced CVD risk.

scholarly journals Association between Chewing Problems and Sleep among Japanese Adults

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Tetsuji Azuma ◽  
Koichiro Irie ◽  
Kazutoshi Watanabe ◽  
Fumiko Deguchi ◽  
Takao Kojima ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Physical Factor ◽  
Cross Sectional Study ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Cross Sectional ◽  
Short Sleep ◽  
Japanese Adults

An association between physical illness and sleep has been suggested. Disordered chewing might be a physical factor that is associated with sleep issues. This cross-sectional study aimed to determine whether chewing problems are associated with sleep in Japanese adults. Sleep and chewing issues were evaluated in 6,025 community residents using a self-reported questionnaire. The prevalence of poor sleep quality and sleeping for <6 h/day (short duration) were 15.6% and 29.4%, respectively. Multivariate logistic regression analyses showed that prevalence of poor sleep quality was significantly associated with self-reported medical history (odds ratio (OR), 1.30; p<0.001), self-reported symptoms (OR, 4.59; p<0.001), chewing problems (OR, 1.65; p<0.001), and poor glycemic control (OR, 1.43; p=0.035). The prevalence of short sleep duration was also significantly associated with female sex (OR, 1.23; p=0.001), self-reported symptoms (OR, 1.60; p<0.001), chewing problems (OR, 1.30; p=0.001), and being overweight (OR, 1.41; p<0.001). In conclusion, chewing problems were associated with poor sleep quality and short sleep duration among Japanese adults.

scholarly journals Poor Sleep Quality and Sleep Apnea Are Associated with Higher Resting Energy Expenditure in Obese Individuals with Short Sleep Duration

2012 ◽  
Vol 97 (8) ◽  
pp. 2881-2889 ◽  
Author(s):  
Lilian de Jonge ◽  
Xiongce Zhao ◽  
Megan S. Mattingly ◽  
Samuel M. Zuber ◽  
Paolo Piaggi ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Energy Expenditure ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Resting Energy Expenditure ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Resting Energy

scholarly journals Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: a cross-sectional analysis of adults in Jordan

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041995
Author(s):  
Yazan A Al-Ajlouni ◽  
Su Hyun Park ◽  
Jude Alawa ◽  
Ghaith Shamaileh ◽  
Aziz Bawab ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Quality ◽  
Health Outcomes ◽  
Sleep Duration ◽  
Sleep Problem ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Sleep Health ◽  
Short Sleep

Background Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19-induced nationwide lockdown. Methods Using Facebook, participants (n=1240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive symptoms (items from Center for Epidemiologic Studies Depression Scale), sleep health (items from the Pittsburgh Sleep Quality Index) and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated to examine how anxiety and depressive symptoms may affect different dimensions of sleep health: (1) poor sleep quality, (2) short sleep duration, (3) encountering sleep problems. Results The majority of participants reported having experienced mild (33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during lockdown, and nearly half of respondents reported depressive symptoms during lockdown. Similarly, over 60% of participants reported having experienced at least one sleep problem in the last week, and nearly half reported having had short sleep duration. Importantly, anxiety was associated with poor sleep health outcomes. For example, corresponding to the dose–response relationship between anxiety and sleep health outcomes, those reporting severe anxiety were the most likely to experience poor sleep quality (aPR =8.95; 95% CI=6.12 to 13.08), short sleep duration (aPR =2.23; 95% CI=1.91 to 2.61) and at least one problem sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared with scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04), short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18). Conclusions Increased levels of anxiety and depressive symptoms can negatively influence sleep health among a sample of Jordanian adults living in a state of COVID-19-induced nationwide lockdown.

Abstract P080: Associations of Poor Sleep Quality and Quantity and Subclinical Atherosclerosis in Older Age - The Chicago Healthy Aging Study (CHAS)

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Thanh Huyen T Vu ◽  
Norrina B Allen ◽  
Kathryn J Reid ◽  
Kiang Liu ◽  
Daniel B Garside ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Subclinical Atherosclerosis ◽  
Older Age ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Sleep Quantity ◽  
Short Sleep ◽  
Increased Risk

Background: Previous studies have demonstrated a link between both sleep quantity and quality and an increased risk of CVD, stroke, and diabetes. However only a few population-based studies have information on the association of sleep quantity and quality and subclinical atherosclerosis as measured by coronary artery calcium (CAC) and ankle brachial index (ABI) -- a marker for peripheral arterial disease. Methods: CHAS data were used to investigate cross-sectional associations of short sleep duration and poor sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) (see Table Footnote for definition of poor sleep quality and quantity) and prevalence of having CAC (score > 0) or low ABI (<0.99). CAC, assessed by multi-detector computed tomography, was quantified by the Agatston’s method. ABI was calculated as the ratio of Doppler recorded systolic pressures in the lower and upper extremities (ABI >1.4 was excluded). Results: The study sample consists of 1,005 men and 390 women ages 65-84 (mean age 71) in 2007-10; 9% were African American. There are no differences in CAC prevalence among participants with or without short sleep duration (11.2% vs. 11.0%). For low ABI, these figures are 20% and10.8%, respectively. With multiple adjustments (see Table Footnote), there are no significant associations of short sleep duration or poor sleep total score with prevalent CAC. However, participants with short sleep duration are more likely to have low ABI, i.e., the odds (95% confidence interval) of having ABI <0.99 with sleep duration of <6hrs was almost two fold (1.02-3.13) compared to others (see Table). Conclusion: In older age, shorter sleep duration is associated with peripheral vascular disease. Sleep may represent a modifiable risk factor for CVD.

Abstract P109: The Cross-sectional and Longitudinal Association of Dispositional Optimism with Sleep Duration and Quality: Findings form the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Rosalba Hernandez ◽  
Thanh-Huyen T Vu ◽  
Kiarri N Kershaw ◽  
Mercedes Carnethon ◽  
Kristen L Knutson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Cross Sectional ◽  
Lower Odds ◽  
Short Sleep ◽  
Long Sleep

Background: Sleep disturbance is associated with multiple adverse cardiovascular-related health outcomes. Little is known about the relationship between psychological well-being, an independent modifiable risk factor for cardiovascular disease, and sleep disruptions. This study examines cross-sectional and longitudinal associations of optimism with sleep duration and quality. Methods: Data were collected from 3,549 Black and White adults aged 33-45 years who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study during follow-up years 15 (2000-2001) and 20 (2005-2006). Optimism was assessed in 2000-2001 using the Life-Orientation Test—Revised, with possible scores ranging from 6 (least optimistic) to 30 (most optimistic). Single-item questions on sleep quality and duration in the past month were assessed during 2000-2001 and 2005-2006. Cross-sectional analyses considered optimism and sleep measures at follow-up year 15. Longitudinal analyses considered 5-year incidence of poor sleep quality (fairly/very bad) and duration (short/long sleep) in 2005-2006 by optimism in 2000-2001 (participants with poor sleep quality and duration in 2000-2001 were excluded). Results: Among 3,549 participants (56% female, 46% Black) with complete data on optimism in 2000-2001, 15.9% reported fairly/very bad sleep quality. Sleep duration was distributed as follows: short-sleep (47.9%), sufficient sleep (31.6%), and long-sleep (20.5%). In unadjusted and fully adjusted models, a 1-unit higher optimism score was cross-sectionally associated with 11% lower odds of having fairly/very bad sleep quality and 3-5% lower odds of having short-sleep duration (Table 1). Cross-sectional associations were attenuated after adjustment for depressive symptoms (not shown). Incidence of poor sleep quality in 2005-2006 was 7% lower with each unit higher optimism score, after full adjustment. Conclusion: Optimism is associated with lower incidence of poor self-reported sleep quality over a 5-year period.

scholarly journals 0852 Geriatric Health Conditions And The Combined Outcome Of Poor Sleep Quality With Objective Short Sleep Duration

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A324-A325
Author(s):  
B Miner ◽  
C A Vaz Fragoso ◽  
L Han ◽  
H K Yaggi ◽  
N S Redeker ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Osteoporotic Fractures ◽  
Sleep Medicine ◽  
Health Conditions ◽  
Physical Impairment ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Short Sleep Duration ◽  
Short Sleep

Abstract Introduction Poor sleep quality with objective short sleep duration (≤6 hours) is a high-risk phenotype. The associations of geriatric health conditions with this sleep phenotype have not been described. Methods Using data on 3,127 older women from the Study of Osteoporotic Fractures (SOF), mean age 84 years, and 3,058 older men from the Osteoporotic Fractures in Men Sleep Study (MrOS), mean age 76 years, we evaluated cross-sectional associations between geriatric health conditions and the combined outcome of poor sleep quality with actigraphic short sleep duration. Geriatric health conditions included cognitive impairment (modified MMSE score 1.5SD below the cohort mean value), physical impairment (inability to do a chair stand), falls (≥2 in past year), and vision impairment (acuity ≤20/40). Poor sleep quality was defined by Pittsburgh Sleep Quality Index (PSQI) score &gt;5 and short sleep duration by average total sleep time ≤6 hours from wrist actigraphy (averaged over ~5 days). Women (SOF) and men (MrOS) were evaluated separately and multivariate logistic regression models also included age, race, education, comorbidities (medical, psychiatric, and primary sleep disorders), and medication use. Results Poor sleep quality with actigraphic short sleep duration was present in 475 (15.6%) men and 400 (13.1%) women. In men, the unadjusted odds of having combined poor sleep quality with actigraphic short sleep duration were statistically higher with cognitive impairment (OR=1.45 [CI 1.05, 1.98]), physical impairment (2.90 [1.87, 4.51]), and falls (1.97 [1.48, 2.62]). In women, the unadjusted odds of having combined poor sleep quality with actigraphic short sleep duration were statistically higher with physical impairment (1.54 [1.16, 2.04]) and falls (1.63 [1.21, 2.20]). However, these associations were no longer statistically significant in adjusted models (men and women). Conclusion Older persons with geriatric health conditions are more likely to have the combined phenotype of poor sleep quality with actigraphic short sleep duration, but this association is likely explained by comorbidity and medication use. Support Dr. Miner is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine, and the National Institute on Aging T32AG019134.

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