scholarly journals Self-reported sleep characteristics associated with dementia among rural-dwelling Chinese older adults: a population-based study

BMC Neurology ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui Liu ◽  
Shi Tang ◽  
Yongxiang Wang ◽  
Yi Dong ◽  
Tingting Hou ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Problems ◽  
Population Based ◽  
Sleep Efficiency ◽  
Linear Regression Models ◽  
Short Sleep Duration ◽  
Young Old

Abstract Background Sleep characteristics associated with dementia are poorly defined and whether their associations vary by demographics and APOE genotype among older adults are unclear. Methods This population-based cross-sectional study included 4742 participants (age ≥ 65 years, 57.1% women) living in rural China. Sleep parameters were measured using the self-rated questionnaires of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Global cognitive function was assessed with the Mini-Mental State Examination (MMSE). Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and the National Institute on Aging-Alzheimer’s Association criteria for Alzheimer’s disease (AD). Data were analysed using multiple logistic and general linear regression models. Results Dementia was diagnosed in 173 participants (115 with AD). Multivariable-adjusted odds ratio (OR) of dementia was 1.71 (95%CI, 1.07-2.72) for sleep duration ≤4 h/night (vs. > 6-8 h/night), 0.76 (0.49-1.18) for > 4-6 h/night, 1.63 (1.05-2.55) for > 8 h/night, 1.11 (1.03-1.20) for lower sleep efficiency (per 10% decrease), and 1.85 (1.19-2.89) for excessive daytime sleepiness. Very short sleep duration (≤4 h/night), lower sleep efficiency, and excessive daytime sleepiness were significantly associated with being diagnosed with AD (multivariable-adjusted OR range = 1.12-2.07; p < 0.05). The associations of sleep problems with dementia and AD were evident mainly among young-old adults (65-74 years) or APOE ε4 carriers. Among dementia-free participants, these sleep characteristics were significantly associated with a lower MMSE score. Conclusions Self-reported sleep problems in dementia are characterized by very short or long sleep duration, low sleep efficiency, and excessive daytime sleepiness, especially among young-old people and APOE ε4 carriers. Trial registration ChiCTR1800017758 (Aug 13, 2018).

scholarly journals Short Sleep Duration and Insomnia Symptoms were Associated with Lower Happiness Levels in Chinese Adults in Hong Kong

2019 ◽  
Vol 16 (12) ◽  
pp. 2079 ◽  
Author(s):  
Sheng Zhi Zhao ◽  
Man Ping Wang ◽  
Kasisomayajula Viswanath ◽  
Agnes Lai ◽  
Daniel Yee Tak Fong ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Duration ◽  
Sleep Problems ◽  
Early Morning ◽  
Population Based ◽  
Short Sleep Duration ◽  
Younger Adults ◽  
Study Objective ◽  
Short Sleep ◽  
Insomnia Symptoms

Study objective: To examine the association of sleep duration and insomnia symptoms with happiness. Methods: A random sample of 1691 Chinese adult (mean age 54 ± 20.1, male 51%) were interviewed in a population-based telephone survey. Happiness was measured by the subjective happiness scale (SHS) and the one-item global happiness index (GHI). Information on sleep included mean past seven-day sleep duration (<6 h, ≥6 to <8 h and ≥8 h) and insomnia symptoms: Difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA). Adjusted beta-coefficient (β) of SHS and adjusted odds ratio (aOR) of GHI in relation to sleep problems were calculated. Interaction effects by age (18–65 vs. ≥65) and by sex were assessed. Results: Compared to ≥8 h of sleep, having <6 h of sleep had lower SHS (adjusted β −0.32, 95% CI −0.46 to −0.17) and GHI (aOR 0.54, 95% CI 0.38 to 0.78). The associations were stronger in younger adults and in women (p < 0.05). DIS, DMS, and EMA were associated with lower SHS (adjusted β ranged from −0.20 to −0.06) and GHI (aOR ranged from 0.57 to 0.89). Dose-response association between the number of insomnia symptoms and lower SHS was observed (p < 0.001). These associations were generally stronger in older adults and among women. Conclusions: Lower levels of happiness were observed, particularly in younger adults and females with short sleep duration and older adults and females with insomnia symptoms. Prospective studies are needed to confirm the findings and understand the mechanisms between sleep and happiness.

scholarly journals Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study

SLEEP ◽  
2019 ◽  
Vol 43 (3) ◽  
Author(s):  
I Jaussent ◽  
C M Morin ◽  
H Ivers ◽  
Y Dauvilliers
Keyword(s):  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Adult Population ◽  
Population Based ◽  
Normal Weight ◽  
Point Reduction ◽  
Nighttime Sleep ◽  
Over Time

Abstract Study Objectives To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). Methods Participants were recruited in 2007–2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score &gt;10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. Results Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. Conclusions EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.

scholarly journals Sleep Duration and Excessive Daytime Sleepiness Are Associated with Obesity Independent of Diet and Physical Activity

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1219 ◽  
Author(s):  
Andrea Maugeri ◽  
Jose Medina-Inojosa ◽  
Sarka Kunzova ◽  
Antonella Agodi ◽  
Martina Barchitta ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Central Obesity ◽  
Sleep Disturbances ◽  
Short Sleep Duration ◽  
Cross Sectional ◽  
Short Sleep ◽  
Diet And Physical Activity

In the European Union, Czech Republic ranks 3rd and 6th for the incidence of obesity and cardiovascular diseases, respectively. Worldwide, short sleep duration and excessive daytime sleepiness (EDS) characterize obese subjects, which in turn exhibit scarce physical activity and unhealthy diet. We aimed to understand the relationship between irregular sleep patterns, obesity and lifestyle factors, such as diet and physical activity, in a vulnerable Czech population. 1482 members of the Kardiovize cohort, a random sample of the Czech urban population, were included in a cross-sectional study. Exposure variables included self-reported sleep duration and EDS, assessed by the Epworth Sleepiness Scale. Primary outcomes were BMI and waist-to-hip ratio or prevalence of obesity and central obesity. Covariates included physical activity and diet. Associations and interactions between variables were evaluated using logistic regression analyses. After adjustment for covariates, short sleep duration (<7 h) was associated with greater odds of overweight (BMI > 25; OR = 1.42; 95%CI = 1.06–1.90; p = 0.020) and obesity (BMI > 30; OR = 1.40; 95%CI = 1.02–1.94; p = 0.047), while EDS was associated with greater odds of central obesity (OR = 1.72; 95%CI = 1.06–2.79; p = 0.030), independent of diet and physical activity. However, due to the cross-sectional nature of our study, further prospective, large-scale studies are needed to evaluate the etiological link and causality between sleep disturbances and obesity.

scholarly journals Sleep Characteristics and Problems of 2-year-olds with Williams Syndrome: Relations with Language and Behavior

2020 ◽  
Author(s):  
Caroline Greiner de Magalhães ◽  
Louise M. O'Brien ◽  
Carolyn B. Mervis
Keyword(s):  
Behavior Problems ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Externalizing Problems ◽  
Sleep Problems ◽  
Typically Developing ◽  
And Behavior ◽  
Nighttime Sleep ◽  
Nonverbal Reasoning

Abstract Background Sleep problems have been shown to have a negative impact on language development and behavior for both typically developing children and children with a range of neurodevelopmental disorders. The relation of sleep characteristics and problems to language and behavior for children with Williams syndrome (WS) is unclear. The goal of this study was to address these relations for 2-year-olds with WS. Associations of nonverbal reasoning ability, nighttime sleep duration, and excessive daytime sleepiness with language ability and behavior problems were considered. Method: Ninety-six 2-year-olds with genetically confirmed classic-length WS deletions participated. Parents completed the Pediatric Sleep Questionnaire, which includes a Sleep Related Breathing Disorder (SRBD) scale with a subscale measuring excessive daytime sleepiness, to assess sleep characteristics and problems. Parents also completed the Child Behavior Checklist (CBCL) and the MacArthur-Bates Communicative Development Inventory: Words and Sentences to assess behavior problems and expressive vocabulary, respectively. Children completed the Mullen Scales of Early Learning to measure nonverbal reasoning and language abilities. Results Parents indicated that children slept an average of 10.36 hours per night (SD = 1.09, range: 7.3–13.3), not differing significantly from the mean reported by Bell and Zimmerman (2010) for typically developing toddlers (p = .787). Sixteen percent of participants screened positive for SRBD and 30% for excessive daytime sleepiness. Children who screened positive for SRBD had significantly more behavior problems on all CBCL scales than children who screened negative. Children with daytime sleepiness had significantly more attention/hyperactivity, stress, and externalizing problems than those who did not have daytime sleepiness. Individual differences in parent-reported nighttime sleep duration and directly measured nonverbal reasoning abilities accounted for unique variance in expressive language, receptive language, and internalizing problems. Individual differences in parent-reported daytime sleepiness accounted for unique variance in externalizing problems. Conclusions The relations of nighttime sleep duration, positive screens for SRBD, and excessive daytime sleepiness to language and behavior in toddlers with WS parallel prior findings for typically developing toddlers. These results highlight the importance of screening young children with WS for sleep problems. Studies investigating the efficacy of behavioral strategies for improving sleep in children with WS are warranted.

scholarly journals Sleep characteristics and problems of 2-year-olds with Williams syndrome: relations with language and behavior

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Caroline Greiner de Magalhães ◽  
Louise M. O’Brien ◽  
Carolyn B. Mervis
Keyword(s):  
Behavior Problems ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Externalizing Problems ◽  
Sleep Problems ◽  
Typically Developing ◽  
And Behavior ◽  
Nighttime Sleep ◽  
Nonverbal Reasoning

Abstract Background Sleep problems have been shown to have a negative impact on language development and behavior for both typically developing children and children with a range of neurodevelopmental disorders. The relation of sleep characteristics and problems to language and behavior for children with Williams syndrome (WS) is unclear. The goal of this study was to address these relations for 2-year-olds with WS. Associations of nonverbal reasoning ability, nighttime sleep duration, and excessive daytime sleepiness with language ability and behavior problems were considered. Method Ninety-six 2-year-olds with genetically confirmed classic-length WS deletions participated. Parents completed the Pediatric Sleep Questionnaire, which includes a Sleep-Related Breathing Disorder (SRBD) scale with a subscale measuring excessive daytime sleepiness, to assess sleep characteristics and problems. Parents also completed the Child Behavior Checklist (CBCL) and the MacArthur-Bates Communicative Development Inventory: Words and Sentences to assess behavior problems and expressive vocabulary, respectively. Children completed the Mullen Scales of Early Learning to measure nonverbal reasoning and language abilities. Results Parents indicated that children slept an average of 10.36 h per night (SD = 1.09, range 7.3–13.3), not differing significantly from the mean reported by Bell and Zimmerman (2010) for typically developing toddlers (p = .787). Sixteen percent of participants screened positive for SRBD and 30% for excessive daytime sleepiness. Children who screened positive for SRBD had significantly more behavior problems on all CBCL scales than children who screened negative. Children with excessive daytime sleepiness had significantly more attention/hyperactivity, stress, and externalizing problems than those who did not have daytime sleepiness. Individual differences in parent-reported nighttime sleep duration and directly measured nonverbal reasoning abilities accounted for unique variance in expressive language, receptive language, and internalizing problems. Individual differences in parent-reported daytime sleepiness accounted for unique variance in externalizing problems. Conclusions The relations of nighttime sleep duration, positive screens for SRBD, and excessive daytime sleepiness to language and behavior in toddlers with WS parallel prior findings for typically developing toddlers. These results highlight the importance of screening young children with WS for sleep problems. Studies investigating the efficacy of behavioral strategies for improving sleep in children with WS are warranted.

scholarly journals 1097 Sleep Disturbances, Sleep Burden, And Depressive Symptoms In US Hispanics/Latinos: Results From The HCHS/SOL Sueño Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A417-A418
Author(s):  
C Alcantara ◽  
M Wallace ◽  
D Sotres-Alvarez ◽  
C Vetter ◽  
A J Phillips ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Disturbances ◽  
The United States ◽  
Sleep Efficiency ◽  
Sensitivity Analyses ◽  
Poor Sleep ◽  
Sleep Timing

Abstract Introduction While sleep disturbances and depression often co-occur, these associations are understudied among Hispanics/Latinos. We examined the associations of sleep disturbances and sleep burden with depressive symptoms among Hispanic/Latino adults in the United States. Methods We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sueño Ancillary study (2010-2013). The study enrolled 2072 adults (ages 18-64; 51.5% females) who completed one-week wrist-actigraphy and sleep questionnaires. Sleep burden was operationalized as the total count of sleep disturbances across six domains (duration, efficiency, midpoint, variability, insomnia, sleepiness). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale (CESD-10). We used weighted survey linear regressions to evaluate the association of sleep disturbances and sleep burden with elevated depressive symptoms (CESD≥10) in individual models adjusted for age, gender, site, heritage, nativity, education, income, and employment. Sensitivity analyses further adjusted for behavioral health risk factors and apnea-hypopnea index. Results An estimated 28.3% had elevated depressive symptoms, 8.0% had short sleep duration (&lt;6 hours of sleep), 10.9% had long sleep duration (&gt;9 hours), 45.2% exhibited a later sleep midpoint (≥4:00AM), 38.4% had high sleep timing variability (upper third tertile for between day sleep midpoint), 15.3% had insomnia (ISI≥10), 17.3% had excessive daytime sleepiness (ESS ≥10), 21.5% had poor sleep efficiency (&lt;85%), and 77.4% had a total sleep burden count of ≥0. Insomnia (ß=0.49,95%CI:.43,.56), later sleep timing (ß=0.10,95%CI:.04,.16), excessive daytime sleepiness (ß=0.19,95%CI:.11,.27), poor sleep efficiency (ß=0.09,95%CI:.02,.17), high variability (ß=0.07, 95%CI:.01,.12), and sleep burden (ß=0.11,95%CI:.09,.13), were each positively associated with elevated depressive symptoms in individual adjusted models and sensitivity analyses. Extreme sleep durations were not associated with elevated depressive symptoms. Conclusion Multiple inter-related sleep disturbances, particularly those pertaining to sleep quality and timing, are associated with depression and may be targets for future interventions aimed at improving mood among Hispanics/Latinos. Support HL127307, HL098927, HL125748

scholarly journals Sleep Characteristics and Problems of 2-year-olds with Williams Syndrome: Relations with Language and Behavior

2020 ◽  
Author(s):  
Caroline Greiner de Magalhães ◽  
Louise M. O'Brien ◽  
Carolyn B. Mervis
Keyword(s):  
Behavior Problems ◽  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Externalizing Problems ◽  
Sleep Problems ◽  
Typically Developing ◽  
And Behavior ◽  
Nighttime Sleep ◽  
Nonverbal Reasoning

Abstract Background: Sleep problems have been shown to have a negative impact on language development and behavior for both typically developing children and children with a range of neurodevelopmental disorders. The relation of sleep characteristics and problems to language and behavior for children with Williams syndrome (WS) is unclear. The goal of this study was to address these relations for 2-year-olds with WS. Associations of nonverbal reasoning ability, nighttime sleep duration, and excessive daytime sleepiness with language ability and behavior problems were considered. Method: Ninety-six 2-year-olds with genetically confirmed classic-length WS deletions participated. Parents completed the Pediatric Sleep Questionnaire, which includes a Sleep Related Breathing Disorder (SRBD) scale with a subscale measuring excessive daytime sleepiness, to assess sleep characteristics and problems. Parents also completed the Child Behavior Checklist (CBCL) and the MacArthur-Bates Communicative Development Inventory: Words and Sentences to assess behavior problems and expressive vocabulary, respectively. Children completed the Mullen Scales of Early Learning to measure nonverbal reasoning and language abilities. Results: Parents indicated that children slept an average of 10.36 hours per night (SD = 1.09, range: 7.3–13.3), not differing significantly from the mean reported by Bell and Zimmerman (2010) for typically developing toddlers (p = .787). Sixteen percent of participants screened positive for SRBD and 30% for excessive daytime sleepiness. Children who screened positive for SRBD had significantly more behavior problems on all CBCL scales than children who screened negative. Children with excessive daytime sleepiness had significantly more attention/hyperactivity, stress, and externalizing problems than those who did not have daytime sleepiness. Individual differences in parent-reported nighttime sleep duration and directly measured nonverbal reasoning abilities accounted for unique variance in expressive language, receptive language, and internalizing problems. Individual differences in parent-reported daytime sleepiness accounted for unique variance in externalizing problems.Conclusions: The relations of nighttime sleep duration, positive screens for SRBD, and excessive daytime sleepiness to language and behavior in toddlers with WS parallel prior findings for typically developing toddlers. These results highlight the importance of screening young children with WS for sleep problems. Studies investigating the efficacy of behavioral strategies for improving sleep in children with WS are warranted.

scholarly journals 1120 Inverse U-Curve Association Between Sleep Duration and Cognitive Performance Among Patients with Dementia: Findings From the Cretan Aging Cohort

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A426-A427
Author(s):  
M Basta ◽  
P Simos ◽  
E Koutentaki ◽  
I Zaganas ◽  
S Tziraki ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Sleep Duration ◽  
Large Population ◽  
Sleep Time ◽  
Population Based ◽  
Community Dwelling ◽  
Linear Regression Models ◽  
Short Sleep Duration ◽  
Visuomotor Coordination ◽  
Non Linear

Abstract Introduction Previous research reports an inverse U-curve association between subjective sleep duration and cognition in elderly, while findings on objective sleep duration are inconsistent. Only one study found weak association between objective short sleep duration and cognition, mainly driven by demented elders. Our aim was to examine the non-linear associations between objective sleep duration and cognitive performance among community-dwelling patients with dementia. Methods A sub-sample of 46 patients with mild-to-moderate dementia(AD) [mean age: 80.3 (SD=5.6) years, 40% males] and 85 cognitively intact controls(NI) [mean age: 73.0 (SD=7.4) years, 37% males], were recruited from a large, population-based cohort [Cretan Aging Cohort] in the island of Crete, Greece of 3,140 older adults (≥60yrs). All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, and 3-day 24-h actigraphy. Comparisons between AD and NI participants on sleep parameters and neuropsychological performance were made using ANOVA controlling for demographics. Associations between 24-TST, and age- and education-adjusted cognitive scores and Independent Activity of Daily Living Scale (IADL) scores were assessed using hierarchical, non-linear, regression models, controlling for confounders. Results Dementia patients had significantly longer 24-h total sleep time (24h-TST) (491.2±107.1 min vs. 444.6±88.5 min, respectively, p=0.027), as well as lower cognitive/IADL sores as compared to the NI group. Significant associations between objective sleep and various cognitive /IADL scores were found only among patients with dementia. Specifically, we found a negative curvilinear association between 24-h TST and IADL, episodic memory indices (AVLT Retention, autobiographic memory) and visuomotor coordination speed (Trail Making Test, Part A). Conclusion Our study showed an inverse U-curve association between objective sleep duration and daily function, memory, and executive function in patients with dementia. Possibly, sleep loss may lead to cognitive impairment, whereas, prolonged sleep may be an indicator of worse cognitive performance among patients with dementia. Support National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant: MIS 377299).

Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording

SLEEP ◽  
2020 ◽  
Author(s):  
E Evangelista ◽  
A L Rassu ◽  
L Barateau ◽  
R Lopez ◽  
S Chenini ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Bed Rest ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Idiopathic Hypersomnia ◽  
Normal Sleep ◽  
Nighttime Sleep

Abstract Study Objectives Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording. Methods Two hundred and sixty-six drug-free subjects (201 women; mean age: 26.5 years [16.08;60.87]) underwent 32-hour bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score &gt;10) and EQS (≥9 hours/24h per week). Results Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, ESS, EQS and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder. Conclusion Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.

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