Explore the vast range of titles available.

Reduced patient portal use has previously been reported among Black Americans when compared with that of the general population. This statistic is concerning because portals have been shown to improve the control of chronic conditions that are more prevalent and severe in Black Americans. At their very simplest, portals allow patients to access their electronic health records and often provide tools for patients to interact with their own health information, treatment team members, and insurance companies. However, research suggests that Black American patients have greater concerns over a lack of support, loss of privacy, and reduced personalization of care compared with other Americans, which results in a disparity of portal use. This qualitative investigation of primary care experiences of Black Americans from across the United States who participated in remote focus groups in April and May 2020 aims to explore the use and perceived value of patient portals to better understand any barriers to optimized treatment in the primary care setting. We performed an inductive thematic analysis of 8 remote focus group interviews with 29 Black American patients aged 30-60 years to qualitatively assess the experiences of Black American patients with regular access to portals. Thematic analysis uncovered the following interrelated themes regarding patient portals in primary care: the optimization of care, patient empowerment, patient-provider communication, and patient burden. In contrast to what has been described regarding the reluctance of Black Americans to engage with patient portals, our focus groups revealed the general acceptance of patient portals, which were described overwhelmingly as tools with the potential for providing exceptional, personalized care that may even work to mitigate the unfair burden of disease for Black Americans in primary care settings. Thus, opportunities for better health care will clearly arise with increased communication, experience, and adoption of remote health care practices among Black Americans.

Introduction The use of cannabis as a sleep aid has increased despite inadequate evidence of its efficacy or associated risks. Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive constituent of cannabis. Acute THC administration can induce CB1R mediated reductions in total peripheral resistance resulting in dose-dependent increases in heart rate and reductions in heart rate variability (HRV) in awake subjects. However, the influence of THC on vagal-cardiac modulation during sleep is unclear. Methods 7 individuals who use cannabis (>3x/week for 3 months; CUDIT-R = 8±1) and 8 cannabis-naïve participants (combined: age range 21-32 years; 9 female) were recruited to participate in this repeated measure, single blinded, placebo-controlled study. One hour before habitual sleep, participants received either a placebo pill or 10mg of THC. Polysomnography (PSG) and ECG were recorded over these 2 nights. HRV was assessed in both time and frequency domains in 2-min epochs of stable N2, N3 and REM sleep. Repeated measures ANOVA comparisons were made for PSG and HRV variables. [(*)=p< 0.05] Results There were no significant changes in total sleep duration or sleep architecture (N2%, N3%, & REM%) between the placebo and dosing night in either group. Compared to the placebo night, both individuals who use cannabis and cannabis naïve participants exhibited significant decreases in HRV variables throughout the night when dosed with THC. R-R interval decreased by 25±10* ms [mean±SE] (2%) in the naïve group and 62±11* ms (6%) in the cannabis group. RMSSD decreased by 15±3* ms (22%) in the naïve group and 11±3* ms (23%) in the cannabis group. PNN50 decreased by 9±3* % in the naïve group and 11±3* % in the cannabis group. In naïve participants high frequency spectral power decreased by 398±76* ms^2 (32%). Conclusion Our results suggest that THC ingestion before bedtime did not systematically affect sleep depth or duration, but did significantly reduce vagal-cardiac modulation in individuals who use cannabis as well as in cannabis naïve participants. Acute reductions in parasympathetic control of the heart may indicate increased cardiovascular stress during sleep when THC is ingested. Support (if any) AASM; K01HL151745; T32HL083808; OHSU OFDIR; R35 HL155681; Oregon Institute of Occupational Health Sciences

Introduction Ambulatory blood pressure monitoring (ABPM) across 24 hours is recommended to confirm hypertension and, outside of a laboratory setting, is the only means to measure the extent of any nocturnal decrease in blood pressure (BP) i.e., nocturnal BP dipping. The ambulatory device is traditionally programmed to inflate every 20-30 minutes during awake and sleep. Despite diagnostic benefits, ABPM may disturb sleep and lead to reduced compliance in some individuals. Firefighters, an occupational group with a greater risk of developing cardiovascular disease, often note continued vigilance during sleep, possibly reflecting light sleep and/or frequent awakenings. This potential sleep disturbance may contribute to firefighters’ cardiovascular disease risk and may also impact ABPM data. Methods To assess the effect of ABPM on total sleep time (TST) and wake after sleep onset (WASO) in firefighters, we measured sleep using wrist actigraphy in 120 firefighters (91.3% male) from two different departments in Oregon. As part of a larger longitudinal study, participants’ sleep off-shift (as noted from daily survey) was recorded for up to 14 days at two different time points, two months apart. During two consecutive days off, participants completed 24-48 hours of ABPM with simultaneous actigraphy. Overall, there were 1273 measures of sleep, 206 with the cuff and 1067 without the cuff. Separate mixed models with cuff (on/off) as a fixed effect and participant as a random effect, were run for TST and WASO. Models were adjusted for total time in bed, department, and collection interval. Results Surprisingly, TST with the cuff on was significantly greater than nights without the cuff (marginal mean ± SE: 432.0±3.1 vs. 415.9±1.7 minutes respectively, p< 0.001). Increased TST was attributable to a lower WASO with the cuff than without the cuff (43.8±2.9 vs 59.8±1.7 minutes, respectively, p< 0.001). Conclusion Contrary to our expectations, ABPM was not associated with actigraphy measured disturbed sleep among firefighters. In fact, in these data, sleep appeared to be improved while wearing the cuff. Perhaps concerns around poor sleep when wearing the device may have led to improved sleep behaviors on those nights, but this hypothesis needs further investigation. Support (if any) U19OH010154, K01HL151745

Introduction In the US cannabis is recreationally legal in 15 states and medically legal in 34 states. Preclinical studies suggest beneficial effects of cannabis on the cardiovascular system (e.g., vasorelaxation). Yet, acute cases of hospitalization after cannabis consumption indicate potential adverse cardiac effects. Vascular endothelial function is a marker of cardiovascular disease and is measured as a change in resting brachial artery diameter (flow-mediated dilation, FMD) during reactive hyperemia. Both resting diameter (positively) and FMD response (negatively) are associated with cardiovascular risk. Resting diameter likely depends on long-term structural changes, and FMD response mostly depends on nitric oxide. Reactive hyperemia is more complex and depends on numerous variables, including adenosine and prostaglandins. FMD is attenuated in the morning when the frequency of adverse cardiovascular events peaks. To begin to understand the effects of chronic cannabis use on the cardiovascular system, in this pilot study, we compared morning measurements of vascular endothelial function, blood pressure, and heart rate between chronic cannabis users and controls while controlling for prior nighttime sleep opportunities. Methods Participants, cannabis non-users (n=5) and users (n=4), 44% female, age 25.4 ± 3.6 years - no demographic differences between groups, kept a consistent 2-week sleep schedule at home followed by an 8h sleep opportunity at their habitual time in the laboratory. Upon-wakening, we measured resting blood pressure, heart rate, baseline diameter, hyperemic response, and FMD. Statistical differences between groups were calculated using a two-tailed t-test. Results Systolic and diastolic blood pressures (p=0.13 and 0.26 respectively), heart rate (p=0.97), and FMD response (p=0.99) did not differ between groups. However, chronic cannabis users had a significantly higher baseline brachial artery diameter (mean difference: 1.04 mm ± 0.26, p=0.005), and lower hyperemic response (mean difference: -7944 iu/s ± 2538, p=0.02) compared to non-users. Conclusion These preliminary findings suggest that chronic cannabis consumption may be associated with adverse structural and functional changes in the vasculature of otherwise healthy young adults. Based on these initial observations, cannabis may act on the cardiovascular system via non-nitric oxide mechanisms. However, it is necessary to increase our sample size to test the robustness of these findings. Support (if any) KL2TR002370, AASM