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Research ArticleOriginal Research

Elevated Sleep Disturbance among Blacks in an Urban Family Medicine Practice

Wilfred R. Pigeon, Kathi Heffner, Paul Duberstein, Kevin Fiscella, Jan Moynihan and Benjamin P. Chapman
The Journal of the American Board of Family Medicine March 2011, 24 (2) 161-168; DOI: https://doi.org/10.3122/jabfm.2011.02.100028
Wilfred R. Pigeon
PhD
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Kathi Heffner
PhD
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Paul Duberstein
PhD
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Kevin Fiscella
MD, MPH
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Jan Moynihan
PhD
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Benjamin P. Chapman
PhD
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  • Article
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    Table 1.

    Sample Characteristics for Total Sample, Black Participants, and White/Other Participants

    Total SampleBlackWhite/Other
    Race92 (100.0)48 (52.2)44 (48.8)
        Non-Hispanic white40 (43.5)040
        Non-Hispanic black44 (47.8)440
        Hispanic*3 (3.3)21
        American Indian or Alaska Native†4 (4.3)22
        Other1 (1.1)01
    Age (mean yr [range])51.9 (40–80)51.3 (40–80)52.5 (40–79)
    Female sex71 (77.2)39 (81.3)32 (72.7)
    Education
        No high school diploma24 (26.1)16 (33.3)8 (18.2)
        GED or graduated from high school21 (22.8)14 (29.2)7 (14.6)
        Some college8 (8.7)3 (6.3)5 (10.4)
        Associate's degree or 2 years of college23 (25.0)13 (27.1)10 (20.8)
        College graduate10 (10.9)1 (2.1)9 (18.8)
        Graduate degree6 (6.5)1 (2.1)5 (10.4)
    Employment status
        Employed (total)27 (29.3)13 (27.1)14 (31.8)
            Full time17 (18.5)10 (20.8)7 (15.9)
            Part time10 (10.9)3 (6.3)7 (15.9)
        Unemployed (total)‡65 (70.7)35 (72.9)30 (68.2)
            Homemaker2 (2.2)1 (2.1)1 (2.1)
            Retired8 (8.7)3 (6.3)5 (11.4)
            Receiving disability37 (40.2)19 (39.6)18 (40.9)
            Looking for paid work17 (18.5)13 (27.1)4 (9.1)
            Not looking for paid work15 (16.3)7 (14.6)8 (18.2)
    Household income level (per year)
        <$20,00057 (62.0)34 (70.8)23 (52.3)
        ≥$20,00035 (38.0)14 (29.2)21 (47.7)
    • Values provided as n (%) unless otherwise indicated.

    • ↵* Two Hispanic participants also endorsed black; the other endorsed white.

    • ↵† Two American Indian/Native Alaskan participants also endorsed black; one also endorsed white; and the other endorsed only American Indian/Native Alaskan.

    • ↵‡ Some respondents endorsed more than one category of unemployment status.

    • GED, General Educational Development.

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    Table 2.

    Mean (SD) Scores for Sleep Quality Depression and Chronic Illness Morbidity for the Urban Primary Care Patients (n = 92)

    VariableMean (SD)
    PSQI global sleep quality10.00 (4.88)
    PSQI components
        1. Subjective sleep quality1.57 (0.96)
        2. Sleep latency1.70 (1.08)
        3. Sleep duration1.28 (1.14)
        4. Sleep efficiency1.26 (1.23)
        5. Sleep disturbance1.96 (0.80)
        6. Use of sleep medication1.17 (1.34)
        7. Daytime dysfunction1.22 (0.84)
    PSQI items
        Average sleep duration (hr)5.83 (1.77)
        Habitual sleep efficiency (%)75.00 (20.10)
    Depression
        CESD-R17.19 (12.37)
        CESD-R (minus sleep items)14.10 (11.90)
    Morbidity index4.1 (3.1)
    • PSQI, Pittsburgh Sleep Quality Index; CESD-R, Center for Epidemiological Studies Depression Scale, Revised.

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    Table 3.

    Percentages of Selected Characteristics by Sleep Disturbance* and Odds Ratios and Confidence Intervals from Hierarchical Logistic Regression Models Predicting Sleep Disturbance (n = 92)

    CharacteristicPSQI score >6 (%)Model 1Model 2Model 3Model 4Model 5Model 6Model 7Full Model
    Race/ethnicity
        Black81.33.00† (1.17–7.69)2.97† (1.15–7.65)2.92† (1.15–7.86)2.71† (1.04–7.06)2.39‡ (0.89–6.42)2.91† (1.07–7.94)3.15† (1.20–8.26)2.44‡ (0.85–7.01)
        White/other59.1
    Sex
        Male66.7(referent)
        Female71.81.13 (0.38–3.33)
    Employment status
        Employed (full or part time)23.1(referent)
        Unemployed/retired/receiving disability76.92.20 (0.82–5.92)
    Income per year
        <$20,00077.21.93 (0.75–4.97)
        ≥$20,00060.0
    Education level
        No high school diploma or GED83.33.51† (0.98–12.59)2.86 (0.73–11.19)
        High school diploma/GED and some college82.83.63† (1.12–11.73)2.60 (0.74–9.23)
        Associate's degree or higher53.8(referent)‖(referent)‖
    CESD-R§ quartiles
        Lowest quartile45.0(referent)¶(referent)¶
        Second quartile65.22.12 (0.60 to 7.56)1.74 (0.46 to 6.58)
        Third quartile80.84.28† (1.10 to 16.60)3.14 (0.77 to 12.87)
        Highest quartile87.08.38† (1.78 to 39.60)6.37† (1.30 to 31.25)
    Morbidity indexxy6*–1.19‡ (0.99 to 1.42)1.10 (0.89 to 1.36)
    • Model 1 provides the odds ratio (OR) (95% CI) for the unadjusted model of the association between race/ethnicity and sleep disturbance. Models 2 through 7 provide the OR (95% CI) for the adjusted models of the association between race/ethnicity and sleep disturbance (each model's OR is adjusted for a single covariate). The Full Model provides the OR for the fully adjusted model of the association between race/ethnicity and sleep disturbance (after adjusting for all covariates).

    • ↵* Pittsburgh Sleep Quality Index (PSQI) score >6.

    • ↵† Wald statistic, P ≤ .05.

    • ↵‡ Wald statistic, p < .1.

    • ↵§ Center for Epidemiological Studies Depression Scale, Revised (CESD-R) scores exclude sleep items.

    • ↵‖ The OR for education level represents the odds compared with the highest education level (having an Associate's or higher degree).

    • ↵¶ The OR for each CESD-R quartile represents the odds compared to the lowest quartile.

    • ↵** The morbidity index is a continuous variable.

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The Journal of the American Board of Family     Medicine: 24 (2)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 2
March-April 2011
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Elevated Sleep Disturbance among Blacks in an Urban Family Medicine Practice
Wilfred R. Pigeon, Kathi Heffner, Paul Duberstein, Kevin Fiscella, Jan Moynihan, Benjamin P. Chapman
The Journal of the American Board of Family Medicine Mar 2011, 24 (2) 161-168; DOI: 10.3122/jabfm.2011.02.100028

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Elevated Sleep Disturbance among Blacks in an Urban Family Medicine Practice
Wilfred R. Pigeon, Kathi Heffner, Paul Duberstein, Kevin Fiscella, Jan Moynihan, Benjamin P. Chapman
The Journal of the American Board of Family Medicine Mar 2011, 24 (2) 161-168; DOI: 10.3122/jabfm.2011.02.100028
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