Abstract
BackgroundAfrican Americans (AAs) experience greater sleep quality problems than non-Hispanic Whites (NHWs). Meditation may aid in addressing this disparity, although the dosage levels needed to achieve such benefits have not been adequately studied. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols.ObjectiveThis 6-month dose-response feasibility trial investigated the effects of a breathing awareness meditation (BAM) app, Tension Tamer, on the secondary outcomes of self-reported and actigraphy measures of sleep quality and the modulating effects of ethnicity of AAs and NHWs.MethodsA total of 64 prehypertensive adults (systolic blood pressure <139 mm Hg; 31 AAs and 33 NHWs) were randomized into 3 different Tension Tamer dosage conditions (5,10, or 15 min twice daily). Sleep quality was assessed at baseline and at 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and 1-week bouts of continuous wrist actigraphy monitoring. The study was conducted between August 2014 and October 2016 (IRB #Pro00020894).ResultsAt baseline, PSQI and actigraphy data indicated that AAs had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep (range P=.03 to P<.001). Longitudinal generalized linear mixed modeling revealed a dose effect modulated by ethnicity (P=.01). Multimethod assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses (range P=.04 to P<.001). Actigraphy findings revealed a consistent, but not statistically significant, pattern in the 5-min group, showing lower fragmentation, longer sleep duration, and higher efficiency than the other 2 dosage conditions. Among AAs, actigraphy indicated lower sleep fragmentation with the 5-min dose compared with the 10-min and 15-min doses (P=.03 and P<.001, respectively). The 10-min dose showed longer sleep duration than the 5-min and 15-min doses (P=.02 and P<.001, respectively). The 5-min dose also exhibited significantly longer average sleep than the 15-min dose (P=.03).ConclusionsThese findings indicate the need for further study of the potential modulating influence of ethnicity on the impact of BAM on sleep indices and user-centered exploration to ascertain the potential merits of refining the Tension Tamer app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints.
Highlights
BackgroundObtaining an adequate amount and quality of sleep is essential for optimal health
At baseline, Pittsburgh Sleep Quality Index (PSQI) and actigraphy data indicated that African Americans breathing awareness meditation (BAM) (AA) had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep
Multimethod assessment showed a consistent pattern of non-Hispanic Whites National Institutes of Health (NIH) (NHW) exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses
Summary
BackgroundObtaining an adequate amount and quality of sleep is essential for optimal health. Mind-body strategies addressing stress may aid in the improvement of sleep quality and reduce exacerbation of other chronic conditions such as hypertension, cardiovascular disease, diabetes, and obesity [14,15,16]. There is evidence to show improvements in anxiety, stress [17,18,19], and blood pressure (BP) through the use of these types of meditation techniques [20,21,22,23]. These practices focus on relaxation, self-acceptance, and staying in the present moment through slow, diaphragmatic breathing. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols
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