Middle-aged Community Research Articles

Insulin resistance and white matter microstructural abnormalities in nondiabetic adult: A population-based study.

Insulin resistance (IR) is of growing concern yet its association with white matter integrity remains controversial. We aimed to investigate the association between IR and white matter integrity in nondiabetic adults. This cross-sectional analysis was conducted based on the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. A total of 1709 nondiabetic community-dwelling adults with available diffusion-weighted imaging based on brain magnetic resonance imaging and completed oral glucose tolerance test were included. IR was measured noninvasively by insulin sensitivity indices (ISI), including ISIcomposite and ISI0,120, as well as homeostasis model assessment of insulin resistance (HOMA-IR). White matter microstructure abnormalities were identified by diffusion-weighted imaging along with tract-based spatial statistical analysis to compare diffusion metrics between groups. The multivariable linear regression models were applied to measure the association between white matter microstructure abnormalities and IR. A total of 1709 nondiabetic individuals with a mean age of 60.8 ± 6.4 years and 54.1% female were included. We found that IR was associated with a significant increase in mean diffusivity, axial diffusivity, and radial diffusivity extensively in cerebral white matter in regions such as the anterior corona radiata, superior corona radiata, anterior limb of internal capsule, external capsule, and body of corpus callosum. The pattern of associations was more marked for ISIcomposite and ISI0,120. However, the effect of IR on white matter integrity was attenuated after, in addition, adjustment for history of hypertension and cardiovascular disease and antihypertensive medication use. Our findings indicate a significant association between IR and white matter microstructural abnormalities in nondiabetic middle-aged community residents, while these associations were greatly influenced by the history of hypertension and cardiovascular disease, and antihypertensive medication use. Further investigation is needed to clarify the role of IR in white matter integrity, whereas prophylactic strategies of maintaining a low IR status may ameliorate disturbances in white matter integrity. The data that support the findings of this study are available from the corresponding authors upon reasonable request.

Effects of a complex yoga-based intervention on physical characteristics

Empirical studies on yoga have shown that regular practice can have a beneficial effect on risk factors of cardiovascular diseases; also, it can decrease body weight, body fat and increase muscle mass. Positive effects on balance and flexibility were also reported. This study evaluated the impact of a 3-month complex yoga-based program, including physical exercises, education, and social support, with a quasi-randomized design in a middle-aged community sample. The intervention group consisted of 46 participants while the passive control group was 29 participants. The intervention group showed a significant increase in core muscle strength and hamstring flexibility and a decrease in body fat. No significant changes were found concerning risk factors of cardiovascular diseases, body weight, muscle mass, balancing ability, and dietary habits. A 3-month yoga intervention cannot substantially impact the cardiovascular system and body weight control in middle-aged adults.

The interrelationships between sleep regularity, obstructive sleep apnea, and hypertension in a middle-aged community population.

Little is known about the interrelationships between sleep regularity, obstructive sleep apnea (OSA) and important health markers. This study examined whether irregular sleep is associated with OSA and hypertension, and if this modifies the known association between OSA and hypertension. Six hundred and two adults (age mean(SD) = 56.96(5.51) years, female = 60%) from the Raine Study who were not evening or night shift workers were assessed for OSA (in-laboratory polysomnography; apnea-hypopnea index ≥ 15 events/hour), hypertension (doctor diagnosed, or systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg) and sleep (wrist actigraphy for ≥5 days). A sleep regularity index (SRI) was determined from actigraphy. Participants were categorized by tertiles as severely irregular, mildly irregular, or regular sleepers. Logistic regression models examined the interrelationships between SRI, OSA and hypertension. Covariates included age, sex, body mass index, actigraphy sleep duration, insomnia, depression, activity, alcohol, smoking, and antihypertensive medication. Compared to regular sleepers, participants with mildly irregular (OR 1.97, 95% confidence intervals [CI] 1.20 to 3.27) and severely irregular (OR 2.06, 95% CI: 1.25 to 3.42) sleep had greater odds of OSA. Compared to those with no OSA and regular sleep, OSA and severely irregular sleep combined had the highest odds of hypertension (OR 2.34 95% CI: 1.07 to 5.12; p for interaction = 0.02) while those with OSA and regular/mildly irregular sleep were not at increased risk (p for interaction = 0.20). Sleep irregularity may be an important modifiable target for hypertension among those with OSA.

Socio-psychological factors associated with anticipated stigma toward COVID-19: a cross-sectional study in Japan

BackgroundThe stigmatization against COVID-19 has become a public issue. However, it remains unknown which individual factor contributes to anticipated stigma formation. This study explored socio-psychological factors associated with anticipated stigma toward coronavirus disease 2019 (COVID-19).MethodsWe obtained cross-sectional data regarding 1,638 middle-aged community residents (mean age, 48.5 years) from a population-based survey in metropolitan Tokyo, Japan during the third wave of the COVID-19 pandemic, when a regional public health emergency had been declared in December 2020 and January 2021. We hypothesized that perceived risk of infection, normative beliefs about preventive behaviors, and past experiences of stigmatization unrelated to COVID-19 would be associated with anticipated stigma. Modified Poisson regression was conducted to examine associations after adjustments for demographic and socioeconomic statuses.ResultsHigher perceived risk (adjusted prevalence ratio [APR] = 1.17; 95% confidence interval [CI, 1.08–1.27]), past experiences of stigmatization (APR = 1.09; 95% CI [1.00–1.19]), and higher normative beliefs about preventive behaviors (APR = 1.18; 95% CI [1.11–1.26]) were independently associated with anticipated stigma.ConclusionsThese results suggest that intervention messages to increase risk perception and normative beliefs to enhance protective behaviors may have the unintended effect of increasing anticipated stigma in the context of the COVID-19 pandemic.

Self-Assessment of INTERHEART Risk Stratification among the Middle-Aged Community in Malaysia.

Research background and Objectives: Age is an independent risk factor for cardiovascular disease (CVD), but CVD risk factors are preventable, and lack of awareness of its risk factors is a contributing factor to CVDs. Middle-aged people may be more likely to engage in unhealthy lifestyle behaviours which can increase the risk of CVD. Health self-assessment is crucial for early detection and management of health issues and early lifestyle intervention for better personalised health management. This study aims to determine the self-assessment of INTERHEART risk classification among the middle-aged community in Malaysia. Method: Local community members aged 40-60 years and who are currently residing in Malaysia were recruited via non-randomised sampling. Sociodemographic characteristics and dietary pattern related to salt, fibre, fat (deep fried/snacks), poultry/meat intakes, and other cardiovascular risk factors (waist-hip ratio, medical history related to diabetes/hypertension, history/exposure of tobacco use, psychosocial status, and level of physical activity) were assessed; INTERHEART risk scores were then computed and stratified into low, medium and high risks. Results: Approximately 45% (n = 273/602) of middle-aged respondents in Malaysia are at moderate-to-high risk of cardiovascular events, with men being more likely to develop CVD compared to women. The results of the survey indicated that poultry/meat intake (61%), physical inactivity (59%), and second-hand smoke (SHS) exposure (54%) are the most prevalent risk factors among the respondents. One-third of the respondents consumed excessive salty food and deep fried foods/snacks/fast food, and only one-third of them consumed vegetables/fruits at a recommended level. It is worrying that about a quarter of the respondents felt several periodical/permanent stresses and even felt sad/blue/depressed for two weeks or more in a row. Males, labour workers, and those with lower educational levels are more likely to develop CVD events. Conclusions: This study found that 45% of the middle-aged respondents were having moderate-to-high risk for cardiovascular events with multiple risk factors related to unhealthy lifestyle habits and environmental factors. In addition to non-modifiable factors such as gender and age, sociodemographic factors, i.e., educational level and occupation, are equally important factors to determine CVD risk. Overall, the findings of this study emphasize the clinical relevance of assessing multiple factors in the determination of CVD risks for early prevention and management of cardiovascular diseases.

Different associations of occupational and leisure-time physical activity with the prevalence of hypertension among middle-aged community dwellers in rural Khánh Hòa, Vietnam

BackgroundIn contrast to high-income countries where physical activity (PA), particularly leisure-time PA, has been shown to be protective against hypertension, few studies have been conducted in low- and middle-income countries. We examined the cross-sectional association between PA and hypertension prevalence among rural residents in Vietnam.MethodsWe used data collected in the baseline survey of a prospective cohort study, among 3000 people aged 40–60 years old residing in rural Khánh Hòa, Vietnam. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or the use of antihypertensive medication. We assessed occupational PA and leisure-time PA using the Global Physical Activity Questionnaire. A robust Poisson regression model was used to investigate the associations, with adjustment for covariates.ResultsThe prevalence of hypertension was 39.6%. After adjusting for socio-demographic and lifestyle-related variables, leisure-time PA was positively associated with hypertension prevalence (prevalence ratio [PR]: 1.03 per 10 MET-hour/week, 95% confidence interval [CI] 1.01–1.06). Occupational PA was inversely associated with hypertension prevalence (PR: 0.98 per 50 MET-hour/week, 95% CI = 0.96–0.996). After adjusting for BMI and other health-related variables, the association related to occupational PA became statistically non-significant, while the association related to leisure-time PA remained statistically significant.ConclusionIn contrast to previous studies in high-income countries, we found that leisure-time PA was positively associated with hypertension prevalence and occupational PA was associated with a lower hypertension prevalence. This suggests that the association between PA and hypertension might differ depending on the context.

Brain effective connectivity and functional connectivity as markers of lifespan vascular exposures in middle-aged adults: The Bogalusa Heart Study.

Effective connectivity (EC), the causal influence that functional activity in a source brain location exerts over functional activity in a target brain location, has the potential to provide different information about brain network dynamics than functional connectivity (FC), which quantifies activity synchrony between locations. However, head-to-head comparisons between EC and FC from either task-based or resting-state functional MRI (fMRI) data are rare, especially in terms of how they associate with salient aspects of brain health. In this study, 100 cognitively-healthy participants in the Bogalusa Heart Study aged 54.2 ± 4.3years completed Stroop task-based fMRI, resting-state fMRI. EC and FC among 24 regions of interest (ROIs) previously identified as involved in Stroop task execution (EC-task and FC-task) and among 33 default mode network ROIs (EC-rest and FC-rest) were calculated from task-based and resting-state fMRI using deep stacking networks and Pearson correlation. The EC and FC measures were thresholded to generate directed and undirected graphs, from which standard graph metrics were calculated. Linear regression models related graph metrics to demographic, cardiometabolic risk factors, and cognitive function measures. Women and whites (compared to men and African Americans) had better EC-task metrics, and better EC-task metrics associated with lower blood pressure, white matter hyperintensity volume, and higher vocabulary score (maximum value of p = 0.043). Women had better FC-task metrics, and better FC-task metrics associated with APOE-ε4 3-3 genotype and better hemoglobin-A1c, white matter hyperintensity volume and digit span backwards score (maximum value of p = 0.047). Better EC rest metrics associated with lower age, non-drinker status, and better BMI, white matter hyperintensity volume, logical memory II total score, and word reading score (maximum value of p = 0.044). Women and non-drinkers had better FC-rest metrics (value of p = 0.004). In a diverse, cognitively healthy, middle-aged community sample, EC and FC based graph metrics from task-based fMRI data, and EC based graph metrics from resting-state fMRI data, were associated with recognized indicators of brain health in differing ways. Future studies of brain health should consider taking both task-based and resting-state fMRI scans and measuring both EC and FC analyses to get a more complete picture of functional networks relevant to brain health.

Insomnia Symptoms and Biomarkers of Alzheimer's Disease in the Community.

Insomnia is one of the most common sleep disorders yet its relationship to the biology of Alzheimer's disease remains equivocal. We investigated the cross-sectional relationship between insomnia symptom severity and cerebrospinal fluid (CSF) concentrations of Alzheimer's disease biomarkers in a cognitively unimpaired middle-aged community sample. A total of 63 participants from the Healthy Brain Project (age = 59±7 years; 67% women) completed a lumbar puncture and two weeks of actigraphy to measure two of insomnia's core features: difficulty initiating sleep (prolonged sleep onset latency) and difficulty maintaining sleep (wake after sleep onset [WASO] and number of awakenings). Additionally, the Insomnia Severity Index (ISI) was completed by 58 participants. Linear and Tobit regression were used to estimate the associations between each insomnia variable and CSF Aβ42, phosphorylated tau 181 (p-tau181), total-tau, and neurofilament light chain protein (NfL), adjusting for age, sex, and APOEɛ4 genotype. Higher ISI score was associated with greater average levels of CSF Aβ42 (per point: 30.7 pg/mL, 95% CI: 4.17-57.3, p = 0.023), as was higher WASO (per 10 min: 136 pg/mL, 95% CI: 48-223, p = 0.002) and more awakenings (per 5:123 pg/mL, 95% CI = 55-192, p < 0.001). Difficulty initiating sleep was not associated with CSF Aβ42, nor were insomnia features associated with p-tau181, total-tau, or NfL levels. Insomnia symptoms were associated with higher CSF Aβ42 levels in this relatively young, cognitively unimpaired sample. These findings may reflect increased amyloid production due to acute sleep disruption.

Estimating sleep duration: performance of open-source processing of actigraphy compared to in-laboratory polysomnography in the community.

Comparisons of actigraphy findings between studies are challenging given differences between brand-specific algorithms. This issue may be minimized by using open-source algorithms. However, the accuracy of actigraphy-derived sleep parameters processed in open-source software needs to be assessed against polysomnography (PSG). Middle-aged adults from the Raine Study (n = 835; F 58%; Age 56.7 ± 5.6 years) completed one night of in-laboratory PSG and concurrent actigraphy (GT3X+ ActiGraph). Actigraphic measures of total sleep time (TST) were analyzed and processed using the open-source R-package GENEActiv and GENEA data in R (GGIR) with and without a sleep diary and additionally processed using proprietary software, ActiLife, for comparison. Bias and agreement (intraclass correlation coefficient) between actigraphy and PSG were examined. Common PSG and sleep health variables associated with the discrepancy between actigraphy, and PSG TST were examined using linear regression. Actigraphy, assessed in GGIR, with and without a sleep diary overestimated PSG TST by (mean ± SD) 31.0 ± 50.0 and 26.4 ± 69.0 minutes, respectively. This overestimation was greater (46.8 ± 50.4 minutes) when actigraphy was analyzed in ActiLife. Agreement between actigraphy and PSG TST was poor (ICC = 0.27-0.44) across all three methods of actigraphy analysis. Longer sleep onset latency and longer wakefulness after sleep onset were associated with overestimation of PSG TST. Open-source processing of actigraphy in a middle-aged community population, agreed poorly with PSG and, on average, overestimated TST. TST overestimation increased with increasing wakefulness overnight. Processing of actigraphy without a diary in GGIR was comparable to when a sleep diary was used and comparable to actigraphy processed with proprietary algorithms in ActiLife.

PS-P08-2: FACTORS RELATED TO PARTICIPATION IN HEALTH CHECKUPS AMONG MIDDLE-AGED JAPANESE COMMUNITY RESIDENTS IN THE PRECONTEMPLATION STAGE

Objective: In Japan, all medical insurers are obliged to conduct annual specific health checkups. These checkups are part of the National Health Service system and target all insured people aged 40–74 years and aim to facilitate prevention and early detection of atherosclerosis-related diseases such as hypertension, diabetes, and dyslipidemia. However, the participation rate in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). Additionally, previous studies suggested that those in the precontemplation stage were at higher risk for non-participation in health checkups. Therefore, this study explored the factors related to participation in specific health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage. Design and Method: This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal NHI aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After selecting those without missing data (n = 11,180) and those in the precontemplation stage, the analysis included 2,892 participants. Participants were classified into a participation group and a non-participation group. Those who selected “I underwent a specific health checkup in the past year” were classified as the participation group. The study protocol was approved by the Institutional Review Boards. Informed consent was obtained from all participants who were included in this study. Results: In this study, 994 (34.4%) participants were classified in the participation group, and 1,898 (65.6%) were classified in the non-participation group. Multivariable logistic regression analysis revealed factors related to participation in health checkups among those in the precontemplation stage. The factor with the highest odds ratio (OR) for participation in specific health checkups was recommendations from primary care physicians to participate in specific health checkups [multivariable-adjusted OR 3.19, 95% CI 2.45–4.15, presence of recommendations vs. absence of recommendations], followed by recommendations from public health nurses [multivariable-adjusted OR 2.07, 95% CI 1.26–3.41, presence of recommendations vs. absence of recommendations], and self-reported economic status [multivariable-adjusted OR 1.82, 95% CI 1.48–2.24, good vs. poor]. Conclusions: In particular, recommendations from primary care physicians and public health nurses might be important factors related to participation in health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage.

Individual-level social capital is associated with depressive symptoms among middle-aged community dwellers in rural Vietnam: a cross-sectional study

ObjectivesThere has been comparatively little research on the association between social capital and depressive symptoms in low- and middle-income countries. To address this deficit this study examined the association among...

P103 Associations between sleep regularity, OSA and hypertension in a middle-aged community population

Abstract Little is known about the association of irregular sleep patterns with obstructive sleep apnoea (OSA) and hypertension. This study examined whether irregular sleep patterns determined by the sleep regularity index (SRI) were associated with OSA and hypertension, and whether SRI modified the known association between OSA and hypertension. 635 adults (age mean[range]=57[42-77]years, female=58.6%) from the community-based Raine Study who were not current shift workers were assessed for OSA (in-laboratory polysomnography, AHI ≥5events/hour; time spent with oxygen saturation &amp;lt;90% (T90) ≥median), hypertension (doctor diagnosed or systolic BP ≥140mmHg and/or diastolic ≥90mmHg) and sleep (maximum 7 days of wrist actigraphy). The SRI was calculated from actigraphy (≥4 days) based on variation in usual sleep and wake times. Participants were categorised as regular sleepers (first tertile), average sleepers (second tertile), or irregular sleepers (third tertile). Logistical regression models examined the independent and combined associations between SRI, OSA and hypertension. Covariates included age, sex, body mass index, actigraphy sleep duration, insomnia, depression, activity, alcohol, smoking and anti-hypertensive medication. Compared to regular sleepers, irregular sleepers had increased odds of OSA defined by the AHI (OR 1.77 95% CI 1.10-2.83) and T90 (OR 1.69 95% CI 1.10-2.61) but not hypertension. There was no difference in hypertension odds for regular and irregular sleepers when the data were stratified by participants with and without OSA. Individuals with OSA are more likely to have irregular sleep patterns, which might exacerbate associated adverse health outcomes. However, irregular sleep patterns do not appear to modify the association between OSA and hypertension.

Cross-sectional interrelationships between chronotype, obstructive sleep apnea and blood pressure in a middle-aged community cohort.

Chronotype is linked to adverse health measures and may have important associations with obstructive sleep apnea and blood pressure, but data are limited. This study aimed to determine the separate and combined associations of chronotype with obstructive sleep apnea and blood pressure in a middle-aged community population. Adults (n= 811) from the Raine Study (female=59.2%; age mean [range]=56.6 [42.1-76.6] years) were assessed for chronotype (Morningness-Eveningness Questionnaire), blood pressure and hypertension (doctor diagnosed or systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg), and obstructive sleep apnea at different in-laboratory apnea-hypopnea index thresholds (5, 10, 15 events per hr). Linear and logistic regression models examined relationships between chronotype and the presence and severity of obstructive sleep apnea, blood pressure, hypertension, and blood pressure stratified by obstructive sleep apnea severity at above-mentioned apnea-hypopnea index thresholds. Covariates included age, sex, body mass index, alcohol consumption, smoking, physical activity, sleep duration, anti-hypertensive medication, insomnia, and depressive symptoms. Most participants were categorised as morning (40%) or intermediate (43%), with 17% meeting criteria for evening chronotypes. Participants with apnea-hypopnea index ≥ 15 events per hr and morning chronotype had higher systolic (9.9 mmHg, p< 0.001) and a trend for higher diastolic blood pressure (3.4 mmHg, p= 0.07) compared with those with an evening chronotype, and higher systolic blood pressure compared with those with an intermediate chronotype (4.8 mmHg, p= 0.03). Across chronotype categories, no differences in systolic or diastolic blood pressure or odds of hypertension were found at apnea-hypopnea index thresholds of ≥ 5 or ≥ 10 events per hr. Among participants with apnea-hypopnea index ≥ 15 events per hr, systolic blood pressure is higher in those with a morning chronotype than evening and intermediate chronotypes. Assessment for morning chronotype may improve risk stratification for hypertension in patients with obstructive sleep apnea.

Comparison of Five Expressions of Handgrip Strength for Predicting Cardiovascular Disease Risk Factors in Chinese Middle-Aged Community Residents.

ObjectiveTo compare the predictive performance of five handgrip strengths for cardiovascular disease (CVD) risk factors.MethodsA total of 804 Chinese middle-aged community residents' health medical examinations were collected. The absolute handgrip strength was denoted as HGS. HGS/body weight (HGS/BW), HGS/body mass index (HGS/BMI), HGS/lean body mass (HGS/LBM), and HGS/muscle mass (HGS/MM) represented relative handgrip strength (RHGS). To assess predictive performance, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were constructed.ResultsHGS was not associated with most CVD risk biomarkers; however, RHGS showed a negative correlation trend after controlling for covariates (sex, age, smoking, and exercise). HGS/BMI and HGS/BW had better AUCs for predicting CVD risk factors than HGS/LBM or HGS/MM. HGS/BMI and HGS/BW can successfully predict all CVD risk factors in men with AUCs 0.55–0.65; similarly, women may effectively predict arteriosclerosis, hyperglycemia, hyperuricemia, and metabolic syndrome with AUCs 0.59–0.64, all p < 0.05. The optimal HGS/BW cut-off points for identifying different CVD risk factors were 0.59–0.61 in men and 0.41–0.45 in women, while the HGS/BMI were 1.75–1.79 in men and 1.11–1.15 in women.ConclusionsAlmost all CVD risk biomarkers and CVD risk factors were unrelated to HGS. There is, however, a significant inverse relationship between RHGS and CVD risk factors. HGS/BMI or HGS/BW should be recommended to be the best choice for predicting the risk of CVD risk factors in five expressions of handgrip strength. We also acquired the recommended optimal cut-off points of HGS/BMI and HGS/BW for predicting CVD risk factors.

Prevalence of common sleep disorders in a middle-aged community sample.

There is a paucity of contemporary prevalence estimates for common sleep disorders of insomnia, obstructive sleep apnea (OSA), and restless legs syndrome. We aimed to assess the prevalence of clinically significant common sleep disorders in a middle-aged community sample. Parents of participants in the community-based Raine Study underwent assessments between 2015 and 2017, including comprehensive questionnaires, anthropometric measures, and in-laboratory polysomnography. Clinically significant sleep disorders were defined as chronic insomnia using the Pittsburgh Sleep Symptom Questionnaire-Insomnia with duration criterion ≥ 3 months; OSA as apnea-hypopnea index ≥ 5 events/h with excessive sleepiness (Epworth Sleepiness Scale ≥ 11) or apnea-hypopnea index ≥ 15 events/h (even in the absence of symptoms); restless legs syndrome when participants endorsed the International Restless Legs Syndrome Study Group diagnostic criteria (2003) with symptoms ≥ 5 times/month involving moderate-severe distress. At least 1 sleep-related assessment was completed by 1,005 (female = 586, 58.3%) middle-aged (45-65 years) participants, 72.5% of eligible Raine Study parents. The respective prevalences for clinically significant disease in females and males were as follows: OSA, 24.0% (95% confidence interval [CI]: 20.5-27.7) and 47.3% (95% CI: 42.2-53.4); insomnia, 15.8% (95% CI: 13.1-19.0) and 9.3% (95% CI: 6.8-12.4); restless legs syndrome, 3.7% (95% CI: 2.4-5.4) and 2.2% (95% CI: 1.1-3.9). At least 1 sleep disorder was present in 42.9% of those with complete data on all assessments (n = 895). Common sleep disorders are highly prevalent, to a clinically important extent, in an Australian community sample of middle-aged adults. Contemporary OSA prevalence is notably higher than previously reported and further work is needed to determine the communal impact of OSA. McArdle N, Reynolds AC, Hillman D, etal. Prevalence of common sleep disorders in a middle-aged community sample. J Clin Sleep Med. 2022;18(6):1503-1514.

Association between Recommendations from Public Health Nurses, Medical Professionals, and Family Members and Participation in Health Checkups among Middle-aged Community Residents with National Health Insurance.

Introduction: Participation in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). This study explored associations between recommendations from public health nurses, medical professionals, and family members and participation in specific health checkups among middle-aged Japanese community residents with NHI. Methods: This mail survey was conducted in 2020, and it included 33,902 community residents with NHI aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) community residents agreed to participate in the survey. After excluding those with missing data, 11,180 participants were included in the analyses. Participants were classified into a participation group and a nonparticipation group. Those who selected “I underwent a specific health checkup in the past year” were classified as the participation group. Results: Of the 11,180 community residents with NHI, 4,384 (39.2%) were classified in the participation group. After adjusting for confounding factors, the presence (vs. absence) of recommendations from public health nurses (multivariable-adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.47-2.24), primary care physicians (multivariable-adjusted OR, 2.79; 95% CI, 2.49-3.13), nurses (multivariable-adjusted OR, 2.06; 95% CI, 1.57-2.69), and family members (multivariable-adjusted OR, 1.22; 95% CI, 1.12-1.32) was positively associated with participation in specific health checkups. Conclusions: Our findings suggest that recommendations from public health nurses, medical professionals (primary care physicians and nurses), and family members may be important to promote participation in specific health checkups among middle-aged Japanese community residents with NHI.

PERCEPTION ON PENAN'S OROO’ LANGUAGE AMONG LOCAL COMMUNITY AT BATU BUNGAN, MULU, SARAWAK, MALAYSIA

Oroo’ secret sign language is a medium that has been used to communicate in the forest among Penan community. It is threatened language and identified as living cultural heritage that has high potential to be promoted as a major tourism product in the World Heritage Site, Mulu. However, the local level appreciation on their cultural elements is a question that would have implications for this language to become extinct imminently. Thus, this study aims to examine perception on the importance of Oroo’ language among Penan community at Batu Bungan. This exploration was conducted through a qualitative approach with personal interview with two Penans who are tribal chief and boatman who lived at the settlement. They were identified as key informants due to their active involvement and grown in the community. The narrative was analysed by thematic analysis deductively to elucidate their views on importance of Oroo’ secret sign language in the community today. It was found that most young generation did not understand the language due to some factors. They perceived that Oroo’ has no significant to their life because words are main medium of communication nowadays. While middle-aged community has at least basic knowledge of Oroo’ from their self-experience with old-aged generation in the forest. The language is threatened with extinction due to its significant declining users. There is a need for relevant stakeholders to take actions towards preserving this intangible and unique cultural heritage.

Abstract 11604: The Cincinnati Atrial Fibrillation Score (CAFS): Multi-Center Derivation of the First Polysomnography-Based Risk Scoring System for Predicting Incident Atrial Fibrillation in Asymptomatic Community Adults

Introduction: Early diagnosis of atrial fibrillation (AF) leading to early therapy can improve clinical outcomes (e.g., stroke). Current approaches for AF risk stratification are limited. Dynamic ECG analysis during sleep is an alternate, underexplored approach for AF risk stratification. Hypothesis: Dynamic ECG analysis during sleep predicts AF incidence in community adults, and adds major independent prognostic value to conventional AF risk factors and scores. Methods: In the multi-center prospective Sleep Heart Health Study, we studied consecutive, asymptomatic, ostensibly healthy, middle-aged and older community adults without a history of AF who were in sinus rhythm during home polysomnography. We performed comprehensive and systematic univariate and multivariate analyses of all available clinical, ECG and polysomnography parameters for association with AF incidence over follow-up. Results: Over 5.3±0.29 years, 315 (11.2%) of 2,807 people had new onset AF. We identified the major independent significant AF predictors, including established risk factors and ECG dynamics, and derived a multivariate prediction model entitled, the Cincinnati AF score (CAFS) ( FIGURE 1 ). Addition of CAFS to a multivariate model with (1) CHA 2 DS 2 -VASc score increased ROC curve area by 9% and yielded net reclassification improvement (NRI) of 90% [43+47% for cases and non-cases, respectively]; or with (2) CHARGE-AF score increased ROC curve area by 3.5% and yielded NRI of 54% [23+31%]. These improvements were driven primarily by the ECG dynamics, independent of sleep apnea and other risk factors. Conclusion: Dynamic ECG analysis during sleep adds major independent prognostic value to established AF risk factors and scores. The ability to better identify individuals who will and will not develop AF has potential for broad clinical impact. We are currently validating CAFS in another multi-center cohort of asymptomatic ambulatory adults with a diverse demographic profile.

Association between Cognitive Function and Depression with Human T-Cell Lymphotropic Virus 1 Seropositivity and Serointensity in UK Adults.

Several viral, bacterial, and parasitic diseases have been associated with cognitive function and neuropsychiatric outcomes in humans, including human T-cell lymphotropic virus 1 (HTLV-1). In this study, we sought to further generalize previously reported associations of cognitive function and depression with HTLV-1 seropositivity and serointensity using a community-based sample of adults aged approximately 40 to 70 years (mean = 55.3 years) from the United Kingdom. In this sample, the results of adjusted linear regression models showed no associations of HTLV-1 seropositivity or serointensity with reasoning, pairs-matching, or reaction-time cognitive tasks or with depression. In addition, neither age, sex, educational attainment, nor income moderated associations of HTLV-1 seropositivity or serointensity with cognitive function or depression. In this middle-aged to older middle-aged adult community sample, HTLV-1 seropositivity and serointensity do not appear to be associated with reasoning, pairs-matching, and reaction-time tasks or with depression.

P124 Chronotype and OSA combine to modify risk of hypertension

Abstract Introduction There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population. Methods Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension. Results After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004). Discussion Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.