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Introduction Several studies have shown that the insomnia with objective short sleep duration (ISSD) phenotype is associated with stage 2 hypertension and type 2 diabetes. We aimed to determine if there is an association between ISSD and metabolic syndrome (MetS). Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority) who underwent a 1-night polysomnographic (PSG) evaluation, clinical history, and physical examination. Insomnia was defined as a complaint of insomnia with a duration ≥ 1 year, while poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, nonrestorative sleep or early morning awakening. Objective short sleep duration was defined as < 6-hours. MetS was defined by the presence of 3 or more of: BMI≥30 kg/m2, elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), fasting glucose (≥100 mg/dL), or treatment, and blood pressure (≥130/85 mm Hg) or treatment. Logistic regression models examined the odds of developing MetS, while simultaneously adjusting for sex, race, age, alcohol, smoking, sleep-disordered breathing, mental and physical problems, and sampling weight. Results Compared to normal sleepers with normal sleep duration, ISSD was associated with a significantly increased risk of MetS (OR=2.04, 95%CI=1.13-3.70), while insomnia with normal sleep duration (INSD) was not (OR=1.03, 95%CI=0.53-1.99). Neither normal sleepers with short sleep duration nor poor sleeper with normal or short sleep duration were associated with increased risk of MetS. Further analysis of the clustering of the cardiometabolic risk factors revealed that in the ISSD group who had MetS, 94% had elevated blood pressure, 78% had elevated cholesterol, 72% had insulin resistance, 53% had elevated triglycerides, and 53% had BMI≥30 kg/m2. Conclusion These data indicate that hypercholesterolemia, but not hypertriglyceridemia or obesity, contributes to the association of ISSD with MetS. These data suggest that in addition to the previously-identified elevated blood pressure and insulin resistance, treatment of hypercholesterolemia in patients with ISSD may prevent the development of cardiovascular and cerebrovascular disease. Support (if any)

Introduction Insomnia with objective short sleep duration (ISSD) has been associated with adverse cardiometabolic outcomes, including hypertension and diabetes. However, data on the association between ISSD and the development of cardiovascular and/or cerebrovascular disease (CBVD) are limited. We aimed to examine whether ISSD is associated with incident CBVD. Methods 1,211 men and women from the Penn State Adult Cohort (56.9% women, 51.82±12.85 years) without CBVD at baseline were followed up for 9.21±4.08 years. Based upon clinical history and physical examination, we defined the presence of CBVD as a history of diagnosis or treatment of heart disease and/or stroke. Insomnia was defined as a complaint of insomnia with a duration ≥ 1 year. Poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, nonrestorative sleep or early morning awakening. Objective short sleep duration was defined as < 6-hours sleep based on a 1-night, 8-hours, in-lab polysomnography. Logistic regression models examined the odds of incident CBVD, while simultaneously adjusting for race, sex, age, BMI, smoking, alcohol use, physical and mental health problems, sleep-disordered breathing and follow-up duration. Results Compared to normal sleepers with normal sleep duration, the highest risk of incident CBVD was in the ISSD group (OR=2.68, 95%CI=1.17-6.14), and the second highest in normal sleepers with short sleep duration (OR=1.65, 95%CI=1.10-2.49). The risk for incident CBVD was not significantly increased, in poor sleepers or those with insomnia with normal sleep duration (INSD). Conclusion Our findings indicate that the combination of short sleep duration with the complaint of chronic insomnia (ISSD) is associated with an additive effect on incident heart disease and stroke. These data add to the cumulative evidence supporting the existence of two insomnia phenotypes and that ISSD is the more severe biological phenotype of the disorder associated with physiologic hyperarousal and cardiovascular morbidity. The diagnostic and treatment implications of insomnia phenotyping based on objective sleep duration will be discussed. Support (if any)

Introduction Mild-to-moderate obstructive sleep apnea (OSA) affects 15-40% of the adult general population and is associated with incident hypertension, particularly in young and middle-aged adults. We examined whether visceral adiposity, a key predictor of OSA, and excessive daytime sleepiness (EDS), a cardinal symptom of OSA, are associated with hypertension in middle-aged and older adult patients with mild-to-moderate OSA. Methods A clinical sample of 148 adults (53.79±12.45y, 36.5% female) with mild-to-moderate OSA (5≤AHI Results VAI (OR=1.64, 95%CI=1.23-2.20, p=0.001) and EDS (OR=2.73, 95%CI=1.04-7.17, p=0.042), but not AHI (OR=1.05, 95%CI=0.98-1.13, p=0.165), were associated with significantly increased odds of hypertension in adults aged Conclusion These data indicate that the combination of visceral adiposity and subjective sleepiness improves markedly the ability for clinicians to detect cases of mild-to-moderate OSA with increased cardiovascular risk, an association that is strongest in young and middle-aged adults. These findings also further support that OSA in older subjects is a distinctly different phenotype than in young and middle-aged adults. Support (If Any)

Introduction Several studies have shown that the association of obstructive sleep apnea (OSA) with clinical outcomes, such as hypertension, weakens in older adults. An apnea hypopnea index (AHI) ≥5 is recommended as the cut-off for initiating treatment without any consideration of possible age differences. We aimed to examine at which cut-off point of AHI, OSA is associated with cardiovascular and/or cerebrovascular diseases (CBVD) in middle-aged adults and in older adults. Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority), who underwent a 1-night sleep laboratory evaluation, clinical history and physical examination. Hypertension was defined as a diastolic blood pressure ≥90 mmHg or a systolic blood pressure ≥140 mmHg or the use of anti-hypertensive medication. CBVD was defined based on a self-report of a physician diagnosis of heart disease and/or stroke. Logistic regression models examined the odds of having hypertension or CBVD in a step-wise manner starting from an AHI ≥5 up to AHI ≥30 by increments of 5 events, while simultaneously adjusting for sex, race and BMI and stratifying by age. Results The odds of hypertension were significantly increased in adults aged Conclusion These data suggest that AHI cut-offs warranting treatment of OSA should be adjusted based on age and prevalent clinical disorders, consistent with the concept of personalized medicine. These findings are also consistent with the notion that OSA in older adults is a distinctly different phenotype than in young and middle-aged adults. Support (If Any)

Introduction Visceral adiposity is a key predictor of both metabolic syndrome and obstructive sleep apnea (OSA). Both metabolic syndrome and OSA are associated with cardiometabolic disorders, however, the association of OSA with these disorders weakens in older adults. We compared the relative strength of the association between visceral adiposity vs. OSA with hypertension and diabetes and whether this association is stronger in middle-aged vs. older adults. Methods A clinical sample of 148 adults (53.79±12.45y, 36,5% female) with mild-to-moderate OSA (5≤AHI Results VAI was associated with greater odds of having hypertension (OR=1.57, 95%CI=1.20-2.06, P=0.001) and diabetes (OR=1.27, 95%CI=1.02-1.57, p=0.031) compared to AHI (OR=1.05, 95%CI=0.98-1.13, p=0.185; and OR=1.07, 95% CI=1.00-1.14, p=0.690, respectively) in adults aged Conclusion These data indicate that visceral adiposity, but not AHI, is associated with cardiometabolic disorders in patients with mild-to-moderate OSA, an association that is stronger in middle-aged adults. Visceral obesity should be a priority in preventive/therapeutic interventions in young and middle-aged patients with OSA. These findings also further support that OSA in older adults is a distinctly different phenotype. Support (If Any)