Sleep duration, obesity and insulin resistance in a multi-ethnic UK population at high risk of diabetes

The role of circRNA in insulin resistance and its progression induced by adipose inflammation

CircRNAs refer to a type of closed circular non-coding RNA without a 5' cap or a 3' poly (A) structure. They are largely distributed in the cytoplasm or localized in exosomes and cannot be easily degraded by RNA exonuclease activity. Their stable expression is broadly observed across eukaryotic species. Insulin resistance (IR) refers to the inability of insulin to exert its normal biological function, as manifested by the impairment of glucose utilization in peripheral tissues (e.g., muscle and fat tissues). IR is a key factor in the pathogenesis of Type 2 diabetes (T2D) and is closely associated with obesity. Recent studies have shown that certain circRNAs play critical roles in obesity-induced diabetes by regulating IR and participating in inflammatory processes. CircRNAs, with their multiple microRNA (miRNA) binding sites, act as miRNA sponges to eliminate the inhibitory actions of miRNAs and up-regulate the expression of target genes. CircRNAs play a significant role in regulating obesity-induced diabetes through their interactions with disease-related miRNAs. In the present study, we explored the biological characteristics of circRNAs and extensively discussed the role of circRNAs in the development of inflammation and IR in adipocytes, highlighting their potential as therapeutic targets for obesity-induced diabetes. Specific circRNAs (e.g., circARF3 and circ-ZNF609) have been identified as key players in modulating IR and inflammatory responses in adipose tissue. CircRNAs are emerging as important regulators of IR and inflammation in adipocytes, with significant potential for therapeutic intervention in obesity-induced diabetes. Further research is needed to elucidate the mechanisms underlying their actions and to explore strategies for targeting circRNAs in clinical applications.

Transition of nighttime sleep duration and sleep quality with incident cardiovascular disease among middle-aged and older adults: results from a national cohort study

BACKGROUND

Sleep health has recently been incorporated into the Life's Essential 8 of the American Heart Association. Little is known about the associations between changes in nighttime sleep behavior and healthy outcomes, especially for the elderly. This study explores associations between transition of nighttime sleep duration and sleep quality and cardiovascular diseases (CVD) among middle-aged and older adults in China.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study from 2011 to 2018, and a total of 7,905 participants age ≥ 45 years were included. Participants were classified according to nighttime sleep duration (6-8, < 6 or > 8 h) and sleep quality assessed by the number of restless sleep days in the past week (< 3, 3-7 days). Four groups of the changing patterns in nighttime sleep duration and sleep quality between 2011 and 2015 were identified. CVD including heart disease and stroke was defined based on medical diagnosis. Robust Poisson regression and the restricted cubic spline were employed to evaluate the association between the transition of nighttime sleep behavior and the risk of CVD.

RESULTS

Compared to participants with consistently optimal nighttime sleep duration, those with consistently non-optimal (incidence rate ratio [IRR]: 1.36, 95% confidence interval [CI]: 1.15-1.61, P < 0.001), optimal to non-optimal (IRR: 1.20, 95% CI: 1.02-1.43, P = 0.032), or non-optimal to optimal (IRR: 1.23, 95% CI: 1.02-1.48, P = 0.026) transition in nighttime sleep duration had higher risks of CVD. Additionally, those with a good to poor (IRR: 1.42, 95% CI: 1.20-1.68, P < 0.001) or a consistently poor (IRR: 1.55, 95% CI: 1.32-1.83, P < 0.001) changing pattern in nighttime sleep quality were associated with an increased risk of CVD compared to those with a consistently good changing pattern. There was a U-shaped association between changes in nighttime sleep duration and the incidence of CVD in sleep-deprived people. Changes in sleep quality and the risk of CVD exhibited a linear association.

CONCLUSIONS

Persistent non-optimal nighttime sleep duration and poor sleep quality are associated with an increased risk of CVD in middle-aged and older adults. These findings highlight the importance of considering transitions in sleep behavior in CVD risk assessment for middle-aged and older adults, and emphasize the significance of long-term exposure to poor sleep behavior on their cardiovascular health.

Sleep duration and its associated factors in schizophrenia patients: a large-scale cross-sectional survey

BACKGROUND

Sleep disturbance is a common condition in patients with schizophrenia. Studies have shown that insufficient sleep and excessive sleep lead to adverse health outcomes. This study aimed to identify the factors associated with short and long sleep duration, as well as the prevalence of somatic comorbidities in schizophrenia patients.

METHODS

This study was conducted in 24 mental health institutes of Guangdong Province using a multistage-stratified and random sampling method. All information was collected by face-to-face interview with a structured questionnaire. The association of sleep duration with sociodemographic and clinical factors was determined using multinomial logistic regressions. Subgroup analysis was performed in the various source of patients.

RESULTS

A total of 6 024 schizophrenia patients were enrolled in this study, among whom 8.6% (n = 521) reported short sleep duration and 47.2% (n = 2 850) had long sleep duration. The most common comorbid chronic diseases in the entire cohort were hypertension (8.0%), diabetes (6.8%) and hyperlipidemia (3.2%). Factors such as, current smoker, outpatients, benzodiazepines (BZDs), side effects, comorbidities, age of onset, and illness duration were positively associated with short sleep duration. On the other hand, personal annul income < 10 000 yuan, personal annul income ≥ 40 000 yuan, chronic patients, first-generation antipsychotics (FGAs) and side effects were positively associated with long sleep duration. In outpatient settings, overweight was associated with long sleep duration, whereas in inpatient settings, being female positively correlated with long sleep duration.

CONCLUSION

Disruption of sleep duration and somatic comorbidities are highly prevalent in patients with schizophrenia. This study demonstrates the complex relationships among socioeconomic information, clinical factors and sleep duration in schizophrenia, highlighting the need for developing targeted interventions and management strategies for sleep duration.

CLINICAL TRIAL NUMBER

Not applicable.

Global and Regional Burden of Type 2 Diabetes Mellitus Attributable to Low Physical Activity From 1990 to 2021

AIM

Type 2 diabetes mellitus (T2DM) contributes to the heavy burden, but there lacks latest and comprehensive global research on the burden of T2DM attributable to low physical activity (LPA). This study aimed to quantify the global and regional burden of T2DM attributable to LPA from 1990 to 2021.

METHODS

We utilized data including disability-adjusted life years (DALYs), mortality, age-standardized disability-adjusted life years (ASDR), and age-standardized mortality rates (ASMR) from the Global Burden of Disease (GBD) 2021. We assessed the burden across different ages, genders, and sociodemographic index (SDI). Joinpoint regression analysis was applied to estimated average annual percent change (AAPC).

RESULTS

Between 1990 and 2021, DALYs and mortality of T2DM attributable to LPA increased rapidly. There was an increase in the ASDR and ASMR, with AAPC of 1.09 (95% CI: 1.03-1.16) and 0.32 (95% CI: 0.2-0.43), which was increased faster in males. Low-middle SDI countries have the highest ASDR and highest ASMR. The global PAF for ASDR and ASMR in 2021 is 7.38% and 9.45%. A U-shaped drift pattern was observed in most SDI quintiles in APC model. Population growth is a major contributor to the burden of T2DM, especially in countries with low SDI. Epidemiological changes also play an important role in DALYs and mortality. A negative correlation existed between SDI and both ASMR and ASDR.

CONCLUSION

Between 1990 and 2021, there was a marked rise in the global burden of T2DM associated with LPA. The findings lay the groundwork for informed decision-making a public health and healthcare delivery.

Associations between sleep parameters and falls among older adults with and without cardiovascular disease: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

AIM

Falls are a major global public health concern, requiring early screening and prevention. Cardiovascular disease (CVD) is associated with physical impairments and increased fall risk. Despite the link between CVD and sleep parameters, research on falls and sleep in CVD patients is limited. We aimed to compare the correlation between falls and sleep in populations with and without CVD to develop fall prevention strategies.

METHODS

This longitudinal cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). Baseline data were collected in 2011, with follow-up in 2015. Falls and CVD were assessed based on self-reporting. Sleep parameters, including nighttime and total sleep duration, daytime napping, and sleep disturbance were collected via self-reported questionnaires. Data analysis was conducted using SPSS and R statistical.

RESULTS

A cohort of 4349 individuals with an average age of 68.00 ± 5.97 years was analyzed. From these individuals, 21.5% reported falls during follow-up. Baseline CVD was significantly associated with follow-up falls (P < 0.001). After adjusting for multiple factors, nighttime sleep durations of <6 h (P = 0.004), 8 to 9 h (P = 0.016) and >9 h (P = 0.031) were significantly associated with follow-up falls among the CVD group. Total sleep duration <7 h was significantly associated with follow-up falls in both the total and non-CVD groups (P < 0.05).

CONCLUSIONS

Maintaining a moderate sleep duration is crucial for preventing falls among older adults. Both excessively short and long sleep durations are associated with fall risks, particularly for individuals with CVD. Geriatr Gerontol Int 2025; 25: 38-47.

Non-linear association of sleep duration with osteoarthritis among U.S. middle-aged and older adults

BACKGROUND

The duration of sleep is linked to a range of disorders. Osteoarthritis (OA) stands as one of the most prevalent forms of arthritis and serves as a leading cause of disability. The correlation between the duration of sleep and OA remains ambiguous. Research indicates that waist circumference correlates with sleep duration and OA, respectively. This study aimed to investigate the association of sleep duration with OA and the mediated effect of waist circumference.

METHODS

The study sample comprised adults who were participants in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. Insufficient sleep is characterized by a duration of less than seven hours, whereas 7-8 h is considered appropriate, and 9 h or more is categorized as a long sleep duration. Three models were employed in this study. Model 1 was not adjusted for any covariates, while Model 2 was adjusted for sex, age, and race. Model 3 has been adjusted to account for all covariates. Utilizing multivariable logistic regression, subgroup analysis, interaction tests and smoothing curve fitting, the correlation between sleep duration and OA was explored. The mediating effect of waist circumference on the association between sleep duration and OA was investigated through mediation analysis.

RESULTS

In this study, 9380 did not have OA, while 2424 were diagnosed with the ailment. After multivariable adjustment, the odds ratios (OR) for OA were 1.19 (95% CI 1.06, 1.34; P = 0.0026) for people with insufficient sleep duration and 1.18 (95% CI 1.03, 1.35 P = 0.0142) for participants with long sleep duration. Sleep duration and the incidence of OA were found to be related in a U-shaped manner. Additionally, 12.1% of the correlation between sleep duration and OA appeared to be mediated by waist circumference.

CONCLUSIONS

Increased OA was found to be correlated in a U-shaped manner with sleep duration in the middle-aged and elderly cohorts. Both insufficient and long sleep duration contribute to an elevated risk of developing OA. A potential mediating factor in the association between OA and sleep duration is waist circumference. Focus on sleep health and visceral obesity in middle-aged and older adults is necessary.

Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women

BACKGROUND

Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.

METHODS

A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the "Life's Essential 8" (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including "low LE8" (0-49), indicating low CVH, "moderate LE8 (50-79)", indicating moderate CVH, and "high LE8 (80-100)", indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.

RESULTS

Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46-0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001).

CONCLUSION

While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.

Triglyceride-glucose index and combined indicators: effective indicators for screening NAFLD in snoring patients

AIMS

Nonalcoholic fatty liver disease (NAFLD) is a common complication in snoring patients, especially in patients with obstructive sleep apnea syndrome (OSA). Triglyceride-glucose (TyG) index was a simple indicator of metabolic status and a surrogate marker of insulin resistance. This study aimed to explore the relationship between NAFLD and TyG index in snoring patients.

METHODS

A retrospective study was conducted. The successive snoring patients enrolled in the Sleep Center of the First Affiliated Hospital of Fujian Medical University and had abdominal ultrasonography were included. The clinical characteristics of patients in different quartile TyG groups were compared. The relationship of the TyG index and NAFLD were valued via logistic regression models and restricted cubic spline analysis. The value of TyG index in predicting NAFLD was determined by receiver operating characteristic curve (ROC curve).

RESULTS

A total of 463 NAFLD cases were found among the 654 snoring patients. TyG index was a risk factor of NAFLD in snoring patients (OR = 2.38, 95% CI = 1.71-3.36). The risk of NAFLD was much higher in patients with the highest quartile of TyG index (OR = 5.12, 95% CI = 2.85-9.22), compared with the lowest quartile group. Restricted cubic spline (RCS) analysis showed a significant dose-response relationship between TyG index and risk of NAFLD (p for non-linearity < 0.001). A combination of TyG, neck circumference and ESS score presented the acceptable AUC for the detection of NAFLD in snoring patients (0.746, 95% CI 0.701-0.790, p < 0.001).

CONCLUSION

The TyG index was a risk factor of NAFLD in snoring patients. A combination of TyG, neck circumferences and ESS score could act as a convenient and effective indicator for screening NAFLD in snoring patients.

Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control: The Maastricht Study

AIMS/HYPOTHESIS

The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status.

METHODS

Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure.

RESULTS

Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping.

CONCLUSIONS/INTERPRETATION

Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and sleep disorders in US adults: NHANES 2005 to 2016

NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio) is a novel lipid parameter. However, the association between NHHR and sleep disorders remains unknown.; A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2016. The association between NHHR and sleep disorders was explored using weighted multivariate logistic regression and generalized summation models. Subgroup analyses were employed to verify the robustness of this association. The prevalence of sleep disorders was 25.83% in a total of 22,221 participants. Compared to the lowest quartile of NHHR, participants in the top quartile had a 14% higher odds of sleep disorders prevalence in fully adjusted model (OR: 1.14, 95% CI: 1.06-1.23). After subgroup analyses and interaction tests, sex, race, marital status, education level, body mass index (BMI), person income ratio (PIR), alcohol consumption, smoking status, hypertension, and diabetes mellitus were not significantly associated with this positive association (P for interaction > 0.05). The NHHR is positively associated with sleep disorders in US adults. The management and monitoring of NHHR may have a potential role in improving sleep disorders.

Sleep Disorders in Connective Tissue Diseases-Coexisting Diseases or Disease Components?

This comprehensive review examines the complex relationship between sleep disorders and rheumatic diseases, supported by findings from the latest research articles. It encompasses various rheumatic conditions, including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. The review reveals the bidirectional relationship between sleep disorders and these diseases, emphasizing their impact on disease progression and quality of life. Conventional and alternative therapeutic interventions for connective tissue diseases are presented, focusing on improving sleep quality and alleviating rheumatic symptoms. The role of pro-inflammatory cytokines and their potential modulation through pharmacological agents is also discussed. In the treatment of sleep disorders, various options are proposed, such as cognitive behavioral therapy for insomnia, physical activity, dietary modifications, and alternative approaches like reflexology and acupuncture. Thus, this review offers a nuanced understanding of the connection between sleep disorders and rheumatic diseases, supported by evidence from diverse studies. Such an approach is particularly important because it enhances sleep quality for overall patient well-being in the holistic management of rheumatic conditions.

Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study

Aim

Abnormalities in sleep patterns are a common health problem for the older adults. The relationship between sarcopenia and sleep duration in older people is controversial. This research is to examine the association between sleep duration and sarcopenia.

Methods

We drew 21,095 adults from the China Health and Retirement Longitudinal Survey (CHARLS). Not only we explore the relationship between sleep duration and sarcopenia, but also compare sleep duration to three sarcopenia subcomponents. Moreover, the sensitivity analysis was conducted by the gender and residence area to ascertain the discrepancy, separately. Finally, using restricted cubic spline to find the non-linear association between them.

Results

Among 7,342 community older adults engaged by CHARLS in 2015, the incidence of possible sarcopenia and sarcopenia was 23.14 and 11.30%, separately. Sleep duration (≤6 h) [OR(95%CI) = 1.30(1.03-1.65), p < 0.05] and (≥8 h) [OR(95%CI) = 1.33(1.05-1.69), p < 0.05] were significantly linked with possible sarcopenia, while long sleep duration (≥8 h) [OR(95%CI) = 1.41(1.01-2.02), p < 0.05] was correlated strongly with sarcopenia. A non-linear relationship (U-shaped) between sarcopenia risk and sleep duration was found (p for non-linear = 0.009).

Conclusions

Our findings highlight the importance of sleep duration in the onset of sarcopenia and might assist older persons to maintain good sleeping habits.

Evidence-Based Eating Patterns and Behavior Changes to Limit Excessive Gestational Weight Gain: A Scoping Review

BACKGROUND

International prenatal care guidelines set a standard for clinicians to discuss gestational weight gain with their patients along with the complications associated with prepregnancy obesity and excessive gestational weight gain. Clinicians often lack evidence-based eating, nutrition, and activity strategies to share with patients.

METHODS

This systematic review aimed to find eating patterns and behaviors that could be used safely during pregnancy to limit excessive gestational weight gain. PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews performed in the United States or Canada and published in English from 2013 to 2023. Keyword search terms included weight, manage, behavior, strategy, strategies, gestational weight gain, and nutrition. Excluded research used pediatric or adolescent populations, restrictive diets, such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry or profit-earning programs using food brands, or specific diet programs.

RESULTS

A total of 844 abstracts were retrieved, with 103 full-text studies reviewed. Behaviors had to be useful for maintaining a healthy gestational weight gain and had to be safe for use during pregnancy. Behaviors useful during pregnancy included meal planning, home meal preparation, portion control, using diets such as the Mediterranean diet, the low-glycemic index diet, and the Dietary Approaches to Stop Hypertension diet (DASH), regular physical activity, sleeping 6-7 h a night, mindful eating, intuitive eating, and regular seif-weighing.

CONCLUSION

The evidence-based strategies outlined in this review are safe for use during pregnancy and can assist patients in avoiding excessive gestational weight gain while maintaining the nutrition needed for healthy fetal growth.

Effects of sleep duration and changes in body mass index on diabetic kidney disease: a prospective cohort study

Aims

To examine the associations of sleep duration and changes in BMI with the onset of diabetic kidney disease (DKD).

Materials and methods

2,959 participants with type 2 diabetes were divided into three groups based on sleep duration: short (<7 h/day), intermediate (7-9 h/day), or long (>9 h/day). Changes in BMI during follow-up were trisected into loss, stable, or gain groups. DKD was defined as either the urinary albumin/creatinine ratio (UACR) ≥ 3.39 mg/mmol or the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m², or both. Cox regression models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

During a mean follow-up of 2.3 years, DKD occurred in 613 participants (20.7%). A J-shaped curve was observed between sleep duration and DKD. Compared to intermediate sleep duration, long sleep duration was associated with higher risks of DKD (HR 1.47; 95% CI: 1.19-1.81). In the joint analyses, compared to participants with intermediate sleep duration and stable BMI, long sleep duration with BMI gain had the highest risks of DKD (HR 2.04; 95% CI: 1.48-2.83). In contrast, short or intermediate sleep duration accompanied by decrease in BMI was associated with a reduced risk of DKD, with HRs of 0.50 (95% CI: 0.31-0.82) and 0.61 (95% CI:0.47-0.80), respectively.

Conclusions

Long sleep duration is significantly associated with an increased risk of DKD, which is further amplified by obesity or BMI gain. These findings suggest that both proper sleep duration and weight control are essential to preventing DKD.

Sleep-associated insulin resistance promotes neurodegeneration

Lifestyle modification can lead to numerous health issues closely associated with sleep. Sleep deprivation and disturbances significantly affect inflammation, immunity, neurodegeneration, cognitive depletion, memory impairment, neuroplasticity, and insulin resistance. Sleep significantly impacts brain and memory formation, toxin excretion, hormonal function, metabolism, and motor and cognitive functions. Sleep restriction associated with insulin resistance affects these functions by interfering with the insulin signalling pathway, neurotransmission, inflammatory pathways, and plasticity of neurons. So, in this review, We discuss the evidence that suggests that neurodegeneration occurs via sleep and is associated with insulin resistance, along with the insulin signalling pathways involved in neurodegeneration and neuroplasticity, while exploring the role of hormones in these conditions.

Daytime napping, nighttime sleeping duration, and risk of hepatocellular carcinoma and liver disease-related mortality

Background & Aims

Sleep duration has been linked to metabolic dysfunction and chronic inflammation, which may contribute to the development of liver cancer and chronic liver disease (CLD). However, little is known about the relationship between sleep or napping duration and hepatocellular carcinoma (HCC) risk and CLD mortality.

Methods

We followed 295,837 individuals in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study. We examined the associations of nighttime sleep duration and daytime napping duration with risk of HCC incidence and CLD mortality. Cox proportional hazards regression was used to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results

A total of 357 incident HCC cases and 578 CLD deaths were identified after a median follow-up time of 15.5 years. After adjusting for confounder factors, we found U-shaped associations of nighttime sleep duration with the incidence of HCC (HR<5 vs. 7-8 h = 2.00, 95% CI: 1.22-3.26 and HR≥9 vs. 7-8 h = 1.63, 95% CI: 1.04-2.65) and CLD mortality (HR<5 vs. 7-8 h = 1.78, 95% CI: 1.18-2.69 and HR≥9 vs. 7-8 h = 1.91, 95% CI: 1.35-2.70). Daytime napping was associated with higher risk of HCC (HR≥1 vs. non-nappers = 1.46, 95% CI: 1.04-2.06) and higher CLD mortality (HR≥1 h vs. non-nappers = 1.54, 95% CI: 1.18-2.01) compared with no napping.

Conclusions

We observed U-shaped associations for nighttime sleeping and risk of HCC and CLD mortality. Additionally, longer daytime napping duration was associated with higher risk of HCC and CLD death. Our study suggests that clinical follow up of individuals at risk for liver cancer or living with a liver disease should include information on nighttime and daytime sleep.

Impact and implications

Sleep or napping duration may play a role in the development of liver cancer and chronic liver disease, but little is known about the relationship between them. In addition, abnormal sleep patterns in patients with chronic liver disease may further promote the development of liver disease, creating a vicious cycle. Our study suggests that clinical follow up of individuals at risk for liver cancer or living with a liver disease should include information on nighttime and daytime sleep, as they can be potentially important factors in the development and progression of liver disease.

Targeting microbiota to alleviate the harm caused by sleep deprivation

Sleep deprivation has become a common health hazard, affecting 37-58% of the population and promoting the occurrence and development of many diseases. To date, effective treatment strategies are still elusive. Accumulating evidence indicates that modulating the intestinal microbiota harbors significant potential for alleviating the deleterious impacts of sleep deprivation. This paper first reviews the effects of sleep deprivation on gastrointestinal diseases, metabolic diseases, and neuropsychiatric diseases, discussing its specific mechanisms of influence. We then focus on summarizing existing interventions, including probiotics, melatonin, prebiotics, diet, and fecal microbiota transplantation (FMT). Finally, we have discussed the advantages and limitations of each strategy. Compared with other strategies, probiotics showed a high potential in alleviating sleep deprivation-related hazards due to their reduced risk and high security. We suggest that future research should focus on the specific mechanisms by which probiotics mitigate the harms of sleep deprivation, such insights may unveil novel pathways for treating diseases exacerbated by insufficient sleep.

Sleep Duration Is Associated With Subclinical Carotid Plaque Burden

BACKGROUND

Sleep duration is associated with stroke risk and is 1 of 8 essential components of cardiovascular health according to the American Heart Association. As stroke disproportionately burdens Black and Hispanic populations in the United States, we hypothesized that long and short sleep duration would be associated with greater subclinical carotid atherosclerosis, a precursor of stroke, in the racially and ethnically diverse NOMAS (Northern Manhattan Study).

METHODS

NOMAS is a study of community-dwelling adults. Self-reported nightly sleep duration and daytime sleepiness were collected between 2006 and 2011. Carotid plaque presence, total plaque area, and intima-media thickness were measured by ultrasound between 1999 and 2008. Linear and logistic regression models examined the cross-sectional associations of sleep duration groups (primary exposure) or daytime sleepiness (secondary exposure) with measures of carotid atherosclerosis. Models adjusted for age, time between ultrasound and sleep data collection, sex, race and ethnicity, education, health insurance, smoking, alcohol use, physical activity, body mass index, hypertension, diabetes, hypercholesterolemia, and cardiac disease.

RESULTS

The sample (n=1553) had a mean age of 64.7±8.5 years and was 61.9% female, 64.8% Hispanic, and 18.2% non-Hispanic Black. Of the sample, 55.6% had carotid plaque, 22.3% reported nightly short sleep (<7 hours), 66.6% intermediate sleep (≥7 and <9 hours), and 11.1% had long sleep (≥9 hours). Compared with intermediate sleep, long sleep was associated with greater odds of carotid plaque presence relative to plaque absence (odds ratio, 1.6 [95% CI, 1.1-2.4]) and larger total plaque area (odds ratio, 1.4 [95% CI, 1.0-1.9]) after full covariate adjustment. Short sleep and daytime sleepiness were not significantly associated with any carotid measures.

CONCLUSIONS

The association between long sleep and subclinical carotid atherosclerosis may explain prior associations between long sleep and stroke.

Association of Self-Reported Nighttime Sleep Duration with Chronic Kidney Disease: China Health and Retirement Longitudinal Study

INTRODUCTION

The cohort study aimed to assess the association of nighttime sleep duration and the change in nighttime sleep duration with chronic kidney disease (CKD) and whether the association between nighttime sleep duration and CKD differed by daytime napping.

METHODS

This study included 11,677 individuals from the China Health and Retirement Longitudinal Study (CHARLS) and used data from the 2011 baseline survey and four follow-up waves. Nighttime sleep duration was divided into three groups: short (<7 h per night), optimal (7-9 h), and long nighttime sleep duration (>9 h). Daytime napping was divided into two groups: no nap and with a nap. We used Cox proportional hazards model to examine the effect of nighttime sleep duration at baseline and change in nighttime sleep duration on incident CKD and a joint effect of nighttime sleep duration and nap time on onset CKD.

RESULTS

With a follow-up of 7 years, the incidence of CKD among those with short, optimal, and long nighttime sleep duration was 9.89, 6.75, and 9.05 per 1,000 person-years, respectively. Compared to individuals with optimal nighttime sleep duration, short nighttime sleepers had a 44% higher risk of onset CKD (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.21-1.72). Compared to participants with persistent optimal nighttime sleep duration, those with persistent short or long nighttime sleep duration had an increased risk of incident CKD (HR: 1.44, 95% CI: 1.15-1.80). We found a lower incidence of CKD in participants with short nighttime sleep duration and a nap (HR: 0.74, 95% CI: 0.60-0.93), compared to those with short nighttime sleep duration and no nap.

CONCLUSION

Short nighttime sleep duration and persistent long or short nighttime sleep duration were associated with a higher risk of onset CKD. Keeping persistent optimal nighttime sleep duration may help reduce CKD risk later in life. Daytime napping may be protective against CKD incidence.

The relationship between sleep and salivary and serum inflammatory biomarkers in adolescents

Objectives

Poor sleep behavior can trigger an inflammatory response and contribute to the development of inflammatory diseases. Cytokines can act as indicators of inflammation and may precede the onset of inflammatory diseases. This study aimed to determine the association between sleep timing parameters (bedtime, sleep duration, sleep debt, and social jetlag) and the levels of nine serum and salivary inflammatory and metabolic biomarkers.

Methods

Data were collected from 352 adolescents aged 16-19 years enrolled in Kuwait's public high schools. The levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), adiponectin, leptin, and insulin were measured from saliva and serum samples. We conducted mixed-effect multiple linear regression modeling to account for the school variable as a random effect to assess the relationship between the sleep variables and salivary and serum biomarkers. Mediation analysis was conducted to check if BMI was a mediator between bedtime and the biomarkers.

Results

There was a statistically significant elevation in serum IL-6 level associated with later bedtime (0.05 pg./mL, p = 0.01). Adolescents with severe sleep debt of ≥2 h had an increase in salivary IL-6 biomarker levels (0.38 pg./mL, p = 0.01) compared to those who had sleep debt of <1 h. Adolescents with sleep debt of ≥2 h had significantly higher levels of serum CRP (0.61 μg/mL, p = 0.02) than those without sleep debt. Additionally, we found that the inflammatory biomarkers (CRP, IL-6, IL-8, IL-10, VEGF, and MCP-1) and metabolic biomarkers (adiponectin, leptin, and insulin) had more statistically significant associations with the bedtime variables than with sleep duration variables. CRP, IL-6, and IL-8 were associated with sleep debt, and IL-6, VEGF, adiponectin, and leptin levels were associated with social jetlag. BMIz was a full mediator in the relationship between late bedtime and increased serum levels of CRP, IL-6, and insulin.

Conclusion

Adolescents who go to bed at or later than midnight had dysregulated levels of salivary and serum inflammatory biomarkers, suggesting that disrupted circadian rhythm can trigger higher levels of systemic inflammation and potentially exacerbate chronic inflammation and the risk of metabolic diseases.

Sleep duration affects the sequential change of body mass index and muscle strength: a contribution to dynapenic obesity

BACKGROUND

With aging, body mass index (BMI) increases and muscle strength declines, resulting in dynapenic obesity. It remains unknown whether and how sleep duration contributes to the sequence of BMI and muscle strength change in the progression of dynapenic obesity.

METHODS

Data were derived from the first two waves of China Health and Retirement Longitudinal Study. Sleep duration was self-reported. BMI was calculated and grip strength (GS) was measured to reflect muscle strength. The effect of baseline sleep duration on the sequential change of BMI and GS was assessed using two mediation models considering the nonlinear associations between them. The moderating effect of metabolic disorder was also tested.

RESULTS

Totally 4986 participants aged ≥ 50 years (50.8% females) with complete information on variables were included. Baseline BMI fully mediated the nonlinear association between sleep duration and follow-up GS change, but baseline GS did not mediate between sleep duration and follow-up BMI change for older men and women. Short sleep duration positively affected BMI-induced GS change (β = 0.038; 95%CI, 0.015-0.074), while this favorable effect became nonsignificant for moderate sleep duration (β = 0.008; 95% CI, -0.003-0.024) and turned negative with prolonged sleep duration (β =  - 0.022; 95%CI, - 0.051 to - 0.003). This nonlinear mediation effect was more pronounced in older women who are relatively metabolically healthy at baseline.

CONCLUSION

For older adults in China, the influence of sleep duration on BMI-induced GS change but not the GS-induced BMI change suggested the contribution of sleep duration to the sequential course in the progression of dynapenic obesity. Sleep duration deviated either above or below normal range may confer adverse impact on GS through BMI. Strategies addressing sleep and obesity jointly to improve muscle function and delay the progression of dynapenic obesity are required.

Association between triglyceride glucose index and sleep disorders: results from the NHANES 2005-2008

BACKGROUND

To determine the association between sleep disorders and Triglyceride glucose index.

METHODS

A cross-sectional analysis of the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) was performed. The 2005 to 2008 NHANES national household survey for adults ≥ 20 years was examined for the sleep disorders.TyG index: ln [triglyceride (mg/ dL) × fasting blood glucose (mg/dL)/2].Multivariable logistic and linear regression models were used to explore the association between the TyG index and sleep disorders.

RESULTS

A total of 4,029 patients were included. Higher TyG index is significantly associated with elevated sleep disorders in U.S. adults. TyG was moderately correlated with HOMA-IR (Spearman r = 0.51). TyG was associated with higher odds of sleep disorders(adjusted OR [aOR],1.896; 95% CI, 1.260 2.854), Sleep apnea (aOR, 1.559; 95% CI, 0.660 3.683), Insomnia(aOR, 1.914;95% CI, 0.531 6.896), and Restless legs (aOR, 7.759; 95% CI,1.446 41.634).

CONCLUSIONS

In this study, our result shown that population with higher TyG index are significantly more likely to have sleep disorders in U.S. adults.

Causal association between sleep traits and the risk of coronary artery disease in patients with diabetes

Background and aims

The association between sleep traits and coronary artery disease (CAD) in patients with diabetes has been reported in previous observational studies. However, whether these potential relationships are causal remains unclear. We aim to assess the causal relationship between sleep traits and CAD in diabetic.

Methods

Genetic instrumental variables associated with five sleep-related traits (insomnia, sleep duration, ease of getting up, morningness and snoring) were extracted from corresponding genome-wide association studies (GWAS). The associations of genetic variants with CAD were based on 15,666 individuals with diabetes (3,968 CAD cases and 11,696 controls). The primary analysis was derived using the inverse variance weighting method. Further sensitivity analysis was conducted to confirm the robustness and consistency of the main results.

Results

Genetic liability to insomnia was significantly related to the increased risk of CAD in individuals with diabetes [odds ratio (OR): 1.163; 95% CI: 1.072-1.254; p = 0.001]. Suggestive evidence was found for the borderline associations between both sleep duration (OR: 0.629; 95% CI: 0.380-1.042, p = 0.072) and snoring (OR: 1.010, 95% CI: 1.000-1.020, p = 0.050) with CAD risk. However, no consistent evidence was found for the association between ease of getting up and morningness with the risk of CAD in diabetic. Similar results can be verified in most sensitivity analyses.

Conclusions

We provide consistent evidence for the causal effect of insomnia on the increased risk of CAD in individuals with diabetes. The management of sleep health should be emphasized to prevent CAD in diabetic patients.

A J-shaped Relationship between Sleep Duration and the Risk of Insulin Resistance in a General Japanese Population

Objective Data on the role of sleep in the risk of insulin resistance (IR) are lacking. We therefore examined the association between sleep duration and IR in a general Japanese population. Methods Data of 1,344 individuals 34 to 89 years old from the Tanushimaru Study were analysed. IR was calculated using the fasting plasma glucose level×fasting insulin level/405, i.e. the homeostasis model assessment of IR (HOMA-IR). IR was defined as a HOMA-IR ≥1.73 based on the diagnostic criteria used in Japan. Information regarding sleep duration was collected via questionnaire. Results The frequencies of IR and metabolic syndrome (MetS) were 36.7% and 26.9%, respectively. A J-shaped relationship between sleep duration and IR was observed, and the same relationship was also shown between sleep duration and MetS; however, the relationship with MetS disappeared after adjusting for age, sex, and other confounding factors. Conclusion A J-shaped relationship was observed between sleep duration and the risks of IR in a general Japanese population.

Association of sleep duration with sarcopenic obesity in multi-ethnic older adults: findings from the WCHAT Study

OBJECTIVE

Sarcopenic obesity is a prevalent geriatric syndrome, characterized by concurrence of sarcopenia and obesity. Sleep duration is linked to both obesity and sarcopenia. However, little was known regarding the association of sleep duration with sarcopenic obesity. In this study, we aimed to examine the association of sleep duration with sarcopenic obesity in multi-ethnic community-dwelling older adults.

METHODS

Sarcopenia was defined according to the criteria established by Asian Working Group for Sarcopenia (AWGS) 2019. Obesity was defined as body fat percentage above the 60th percentile specified by sex. Sarcopenic obesity was defined as concurrence of obesity and sarcopenia. Sleep duration was collected by a self-reported questionnaire and was further divided into 5 groups: "<6 h", "6-7 h", "7-8 h", "8-9 h" (reference group) and "≥9 h" (long sleep). Logistic regressions were adopted to examine the association.

RESULTS

2256 multi-ethnic adults aged 60 and over from the West China Health and Aging Trend (WCHAT) study were involved for present study. Overall, 6.25% of the participants were classified as sarcopenic obesity. In the fully adjusted model, long sleep duration (≥ 9 h) was significantly associated with sarcopenic obesity compared with reference group (OR = 1.81, 95%CI = 1.10-2.98, P = 0.019). However, in subgroup analysis, this association can only be observed in male (OR 1.98, 95% CI = 1.02-3.87, P = 0.043) not in female (OR = 1.83, 95%CI = 0.85-3.94, P = 0.118). Regarding ethnic difference, Han older adults with long sleep duration (≥ 9 h) presented increased risk of sarcopenic obesity while ethnic minorities did not.

CONCLUSION

This study disclosed that long sleep duration significantly increased the risk of sarcopenic obesity among older adults. And our findings highlight the critical role of assessing sleep duration to identify individuals at risk of sarcopenic obesity.

Sleep quality, latency, and sleepiness are positively correlated with depression symptoms of Brazilians facing the pandemic-associated stressors of COVID-19

The severe acute respiratory syndrome coronavirus has implicated on mental health and psychopathological sequelae through viral infection. Suggestively, the pandemic-associated stressors (e.g., isolation, fear of illness, inadequate information and supply) may affect the sleep and feedback the depression symptoms, ultimately decreasing the immune system and offering further opportunities for severe acute respiratory syndrome coronavirus infection. Nevertheless, this association still requires investigation. Therefore, this study aimed to correlate the depression symptoms with sleep variables from subjects facing the restrictions of the ongoing pandemic in Brazil. One hundred sixty-two volunteers (age = 31 ± 13 years; body mass = 69.8 ± 14.9 kg; height = 168 ± 9 cm) answered the Beck Depression Inventory, Pittsburgh Sleep Quality Index/Epworth Sleepiness Scale for determination of depression symptoms and sleep variables, respectively. Significant and positive correlations were obtained between Beck score and sleep quality (r = 0.53; P = .000), sleep latency (r = 0.29; P = .000), and sleepiness (r = 0.22; P = .003), but not with sleep time (r = -0.10; P = .175). This report concluded that Brazilians struggling with pandemic-associated stressors with high depression symptoms may have negative impacts on sleep, mainly regarding its quality, latency, and sleepiness.

Association of Insulin Resistance With Cardiovascular Risk Factors and Sleep Complaints: A 10-Year Follow-Up

The aim of the study was to investigate the association of insulin resistance (IR) with cardiovascular risk factors and sleep complaints among citizens of Palanga over a 10-year follow-up period. This epidemiological longitudinal cohort study was performed with 835 subjects.

Methods

All participants were evaluated for sociodemographic, clinical and cardiovascular risk factors, behavioral factors, self-perceived health and biochemical analysis. IR was evaluated using the homeostasis model assessment of IR (HOMA-IR).

Results

All study participants were stratified into two groups, without IR (HOMA-IR ≤ 2.7) and with IR (HOMA-IR > 2.7). The analysis of parameters between the two study groups showed statistically significant relationships between IR, cardiovascular risk factors and sleep complaints within the 10-year period. After adjusting for a 10-year period, sex, age, body mass index, physical activity, education, systolic and diastolic blood pressures, presence of disease, total cholesterol, triglyceride levels, metabolic syndrome (MetS) and diabetes mellitus (DM), IR was statistically significantly more frequent in subjects with increased sleep latency [odds ratio (OR) 1.37, 95% CI 1.01-1.93; p = 0.043], snoring frequency (OR 1.37, 95% CI 1.05-1.79; p = 0.020) and very loud snoring (OR 1.34, 95% CI 1.04-1.74, p = 0.026).

Conclusions

The incidence of obesity, MetS, DM, elevated fasting glucose level, triglyceridemia and sleep complaints became more frequent after a 10-year period in subjects with IR. Over a 10-year period, IR was significantly associated with an increase in sleep complaints: sleep latency reflecting difficulty to fall asleep, snoring and very loud snoring.

Daytime Sleepiness among Medical Colleges’ Students in Jordan: Impact on Academic Performance

Introduction

Sleep disorders are extremely prevalent in the general population. College students are more susceptible to sleep problems. This is due to the increased competition in getting a job position and the current alterations in the labor market. Poor sleep is prevalent and has deleterious effects on college students, but its frequency among college students has not been documented in Jordan. So, the aims of this study are to assess the prevalence of daytime sleepiness among medical college students in Jordan and to look for any links between daytime sleepiness and academic performance.

Methods

A cross-sectional study performed on medical and paramedical specialties students and Epworth sleepiness Sscale (ESS) was used. To assess the students' academic performance, the cumulative grade point average was utilized.

Results

977 students from five medical colleges participated in the study. ESS scores were abnormal in 34.4% of students and were considered to have daytime sleepiness. Significant lower ESS scores were associated with students who reported good sleep quality than students who reported poor sleep quality. Significant lower ESS scores were reported by students who slept more than 7 hours compared with students who slept less than 6 hours. The ESS scores were not significantly associated with students' CPGA.

Conclusion

Daytime sleepiness is highly prevalent among medical students in Jordan. The data of this study might be very helpful to assess the academic policy makers to develop intervention strategies that resolve the sleep disturbances in college students and reduce its impact on the academic achievements.

Impact of objectively-measured sleep duration on cardiometabolic health: A systematic review of recent evidence

Cardiometabolic disease is a spectrum of diseases including, cardiovascular diseases, and metabolic syndrome. It is the leading cause of morbidity and mortality worldwide, with premature deaths being preventable. Currently, sleep has emerged as a potential target for cardiometabolic disease prevention. Several epidemiological studies have provided ample evidence that objectively measured short sleep duration increases the risk of cardiometabolic disease. However, the findings are inconsistent, and few studies measure sleep duration on cardiometabolic profiles objectively. Therefore, in this review, we focused on the recently published literature that explored the association between objectively measured sleep duration and cardiometabolic profiles (cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome), seeking more insights regarding the applicability and, in turn, the impact of objectively measured sleep duration on cardiometabolic health, which is relatively understudied. We retrieved the information manually from PubMed, Google Scholar, HINARI, and the Cochrane Library from 2015 to 2022 using appropriate search terms, we included 49 articles. In this review, we found a strong relationship between objectively measured sleep duration and the risk of cardiometabolic disease, indicating that objectively measured short sleep durations increase cardiometabolic risks. In general, the association between objectively measured sleep duration and increased cardiometabolic risks (CMR) has been well-documented in higher-income countries. Several studies found that longer sleep duration was associated with a more favorable cardiometabolic profile in early adolescence, independent of other risk factors. On the other hand, objectively measured short sleep duration is associated with adverse cardiometabolic health outcomes such as coronary heart disease, hypertension, type 2 diabetes mellitus, and metabolic syndrome.

Effects of Exercise in Improving Cardiometabolic Risk Factors in Overweight Children: A Systematic Review and Meta-Analysis

This meta-analysis aims to evaluate the effects of exercise in improving cardiometabolic risk factors in overweight children and adolescents until the adolescent age, which is 18 years. A systemic search was conducted using the electronic databases PubMed/Medline, Cochrane Library, and Google Scholar, from inception to 29 June 2021. All statistical analyses were conducted in Review Manager 5.4.1. All studies meeting the inclusion criteria were selected. A random-effect model was used to pool the studies, and the results are reported in the odds ratio (OR) and corresponding 95% Confidence interval (CI). Twelve randomized control trials were selected for meta-analysis. Significant results were obtained for BMI in children after the interventions (0.38 95% CI 0.14, 0.62; p = 0.002; I2 = 65%). LDL level was also found significantly reduced (0.41 95% CI 0.01, 0.82; p = 0.05; I2 = 83%). Other factors such as HDL level, blood pressure, blood glucose level, body weight, and waist circumference were also analyzed. We found that exercise interventions significantly improved several cardiometabolic risk factors such as BMI, LDL level, BP, and blood glucose level. However, no significant effect on HDL concentration, waist circumference, and body weight were found. Long-term interventions are needed to attain improvement in all cardiometabolic risk factors.

Sleep duration and mortality in patients with diabetes: Results from the 2007-2015 Korea national health and nutrition examination survey

AIM

- To evaluate the association between sleep duration and mortality in adults with type 2 diabetes.

METHODS

- This study was a longitudinal analysis of all-cause mortality according to sleep duration based on the 2007-2015 Korea National Health and Nutrition Examination Survey (KNHANES) linked to the Cause of Death data (ver. 1.1). Adult participants with type 2 diabetes were included in the analysis. According to self-reported sleep duration, participants were divided into five groups (≤ 5 [short sleeper], 6, 7, 8, and ≥ 9 h/day [long sleeper]). All missing values were replaced using multiple imputation. We used Cox proportional hazards models to evaluate the relationship between sleep duration and mortality using age as the time scale.

RESULTS

- Among the final 51,603 participants who were linked to death certificate data, 5,930 (11.5%) had type 2 diabetes. During a median follow-up of 6.5 years, 735 (12.4%) deaths occurred. In multivariable analysis, a J-shaped association between sleep duration and all-cause mortality was observed (P for quadratic trend = 0.003). In particular, long sleep duration was significantly associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.65; 95% confidence interval, 1.29-2.11. In addition, modifying effects on the relationship between sleep duration and mortality were identified for chronic kidney disease and cancer (P for interaction = 0.003 and 0.002, respectively).

CONCLUSION

- A J-shaped relationship was identified between sleep duration and all-cause mortality in Korean adults with type 2 diabetes. In particular, a long sleep duration was significantly associated with an increased risk of all-cause mortality.

The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study

OBJECTIVE

This cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese.

METHODS

We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4-6], (6-8], (8-10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD.

RESULTS

A total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a "U-shaped" association between sleep duration and risk of CKD. Compared to 6-8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287-2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007-5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5-7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352-2.102), compared to those who rarely or never had a restless sleep.

CONCLUSIONS

Extreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD.

Insomnia symptoms are associated with metabolic syndrome in patients with severe psychiatric disorders

OBJECTIVE

To examine the relationship between insomnia symptoms and metabolic syndrome in patients with severe psychiatric disorders.

METHODS

We conducted a cross-sectional study including 272 inpatients (mean age: 34.06 ± 11.52 years, 67.3% males) with severe psychiatric disorders consecutively admitted in Shantou University Mental Health Center Inpatient Department. All patients underwent a psychiatric evaluation. Insomnia symptoms were assessed by the Pittsburgh Sleep Quality Index (PSQI) and defined present if PSQI>7. The diagnosis of metabolic syndrome was defined using the new International Diabetes Federation definition based on clinical and laboratory evaluation.

RESULTS

Among the 272 patients, 94 (34.6%) presented insomnia symptoms. Overall, patients with insomnia symptoms had significantly higher percentage of metabolic syndrome (23.4% vs. 12.4%, p = 0.019) and hypertriglyceridemia (30.9% vs. 19.1%, p = 0.029), and marginally significantly higher levels of fasting insulin (58.75 ± 37.22 pmol/L vs. 51.72 ± 34.09 pmol/L, p = 0.050), homeostasis model assessment of insulin resistance (1.83 ± 1.31 vs. 1.62 ± 1.25, p = 0.055) and percentage of insulin resistance (55.3% vs. 44.4%, p = 0.086) compared to those without insomnia symptoms. Multiple logistic regressions showed that patients with insomnia symptoms had significantly higher odds for metabolic syndrome [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.25-7.14], central obesity (OR = 3.02, 95% CI = 1.18-7.76), hypertriglyceridemia (OR = 2.46, 95% CI = 1.28-4.76) and marginally significantly higher odds for insulin resistance (OR = 1.68, 95% CI = 0.93-3.02) after controlling for potential confounders.

CONCLUSIONS

Within severely mentally ill patients, insomnia symptoms are associated with metabolic syndrome and insulin resistance. It appears that insomnia symptoms are independent clinical indicators of underlying metabolic syndrome in patients with severe psychiatric disorders.

The Role of Sleep Curtailment on Leptin Levels in Obesity and Diabetes Mellitus

Emerging evidence has identified sleep as a significant, but modifiable, risk factor for metabolic syndrome, diabetes, and obesity. Leptin, an adipocyte-derived peptide and a regulator of food intake and energy expenditure, has been shown to be associated with a short sleep duration in the pathophysiology of obesity and consequently type 2 diabetes. This review focuses on the current evidence indicating the effects of a short sleep duration on the regulation of leptin concentration in association with obesity and diabetes mellitus. In summary, the evidence suggests that sleep deprivation, by affecting leptin regulation, may lead to obesity and consequently development of type 2 diabetes through increased appetite and food intake. However, findings on the role of leptin in diabetes due to sleep deprivation are contradictory, and further studies with larger sample sizes are needed to confirm previous findings.

Sleep Disturbances and Cognitive Impairment in the Course of Type 2 Diabetes-A Possible Link

There is an increasing number of patients worldwide with sleep disturbances and diabetes. Various sleep disorders, including long or short sleep duration and poor sleep quality of numerous causes, may increase the risk of diabetes. Some symptoms of diabetes, such as painful peripheral neuropathy and nocturia, or associated other sleep disorders, such as sleep breathing disorders or sleep movement disorders, may influence sleep quality and quantity. Both sleep disorders and diabetes may lead to cognitive impairment. The risk of development of cognitive impairment in diabetic patients may be related to vascular and non-vascular and other factors, such as hypoglycemia, hyperglycemia, central insulin resistance, amyloid and tau deposits and other causes. Numerous sleep disorders, e.g., sleep apnea, restless legs syndrome, insomnia, and poor sleep quality are most likely are also associated with cognitive impairment. Adequate functioning of the system of clearance of the brain from toxic substances, such as amyloid β, i.e. glymphatic system, is related to undisturbed sleep and prevents cognitive impairment. In the case of coexistence, sleep disturbances and diabetes either independently lead to and/or mutually aggravate cognitive impairment.

Investigating Causal Relations Between Sleep-Related Traits and Risk of Type 2 Diabetes Mellitus: A Mendelian Randomization Study

Objective

Extensive literature put forward the link between sleep and type 2 diabetes mellitus (T2DM), however, little is known about the underlying causality of the associations. Here we aim to assess the causal relationships between five major sleep-related traits and T2DM.

Design, Setting, and Participants

Two-sample Mendelian randomization (MR) was utilized to investigate the potential causal relations. Independent genetic variants associated with five sleep-related phenotypes—insomnia, sleep duration, short sleep duration, long sleep duration, and morningness—were chosen as instrumental variables to estimate the causal associations with T2DM. Summary statistics were acquired from the genome-wide association studies of UK Biobank and 23andMe (for sleep-related measures), the DIAbetes Genetics Replication And Meta-analysis and the FinnGen (for T2DM).

Main Methods

Individual Cochran’s Q statistic was applied to remove the pleiotropic instruments, global Q statistics and MR-Egger regression were adopted to test for the global heterogeneity and horizontal pleiotropy of the screened instruments, respectively. Two T2DM cohorts were selected to analyze their associations with sleep traits. A modified inverse variance weighted (IVW) estimate was performed to combine the ratio estimators from each instrument and acquire the causal estimate, alternative methods including IVW with first-order weights, simple and weighted median estimations, and MR-Egger regression were conducted as sensitivity analyses, to ensure the robustness and solidity of the findings.

Results

Two-sample MR supported findings for an adverse effect of genetically predicted insomnia on T2DM risk (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.09–1.19, p = 1.29E–08) at the Bonferroni-adjusted level of significance (p < 0.005). We further investigated the causal role of T2DM on insomnia but obtained a non-significant estimation. There was also little evidence for the causal effect of other sleep-related measures on T2DM. Results were largely consistent when leveraging two different T2DM cohorts, and were robust among various sensitivity analyses.

Conclusion

Findings provide significant evidence for an adverse effect of insomnia on T2DM risk. The study extends fundamental knowledge to further understanding of the pathophysiological mechanisms of T2DM, and points out the non-negligible role of insomnia on epidemiologic intervention and clinical therapeutics of T2DM.

Prospectively Reallocating Sedentary Time: Associations with Cardiometabolic Health

PURPOSE

This study aimed to investigate whether prospectively reallocating time away from sedentary behavior (SB) into different physical activity intensities is associated with 12-month change to cardiometabolic health in a cohort at high risk of type 2 diabetes (T2DM).

METHODS

Participants with known risk factors for T2DM were recruited from primary care (Leicestershire, United Kingdom) as part of the Walking Away from Type 2 Diabetes trial (n = 808). Participants were followed up at 12, 24, and 36 months. SB, light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) were measured objectively by accelerometer. Postchallenge glucose, triglycerides, HDL cholesterol, systolic blood pressure, and waist circumference were analyzed individually and combined into a clustered cardiometabolic risk score (CMRS). Associations of changing SB over each consecutive 12-month period were analyzed taking account of repeated measures.

RESULTS

Reallocating 30 min from SB to LPA was associated with 0.21-cm (95% confidence interval, 0.03-0.38 cm) reduction in waist circumference, 0.09-mmol·L (0.04-0.13 mmol·L) reduction in 2-h glucose, 0.02-mmol·L (0.00-0.04 mmol·L) reduction in triglycerides, and 0.02 (0.01-0.03) reduction in CMRS. Every 30-min reallocation from SB to MVPA was associated with 1.23-cm (0.68-1.79 cm) reduction in waist circumference, 0.23-mmol·L (0.10-0.36 mmol·L) reduction in 2-h glucose, 0.04-mmol·L (0.00-0.09 mmol·L) reduction in triglycerides, and 0.07 (0.04-0.11) reduction in CMRS. Reallocating 30 min from LPA into MVPA was also associated with 1.02-cm (0.43-1.60 cm) reduction in waist circumference, 0.16-mmol·L (0.02-0.30 mmol·L) reduction in 2-h glucose, and 0.05 (0.01-0.09) reduction in CMRS.

CONCLUSION

Over 12 months, reallocating time away from SB into LPA or MVPA was associated with improved cardiometabolic health in a population at risk of T2DM, with the greatest benefits observed for MVPA.

Effect of exercise on sleep and bi-directional associations with accelerometer-assessed physical activity in men with obesity

This study examined the effect of exercise training on sleep duration and quality and bidirectional day-to-day relationships between physical activity (PA) and sleep. Fourteen inactive men with obesity (age: 49.2 ± 7.9 years, body mass index: 34.9 ± 2.8 kg/m²) completed a baseline visit, 8-week aerobic exercise intervention, and 1-month post-intervention follow-up. PA and sleep were assessed continuously throughout the study duration using wrist-worn accelerometry. Generalised estimating equations were used to examine associations between PA and sleep. Sleep duration increased from 5.2 h at baseline to 6.6 h during the intervention period and 6.5 h at 1-month post-intervention follow-up (p < 0.001). Bi-directional associations showed that higher overall activity volume and moderate-to-vigorous physical activity (MVPA) were associated with earlier sleep onset time (p < 0.05). Later timing of sleep onset was associated with lower overall volume of activity, most active continuous 30 min (M30_CONT), and MVPA (p < 0.05). Higher overall activity volume, M30_CONT, and MVPA predicted more wake after sleep onset (WASO) (p < 0.001), whereas greater WASO was associated with higher overall volume of activity, M30_CONT, and MVPA (p < 0.001). An aerobic exercise intervention increased usual sleep duration. Day-to-day, more PA predicted earlier sleep onset, but worse sleep quality and vice versa. Novelty: Greater levels of physical activity in the day were associated with an earlier sleep onset time that night, whereas a later timing of sleep onset was associated with lower physical activity the next day in men with obesity. Higher physical activity levels were associated with worse sleep quality, and vice versa.

Physical behaviors and chronotype in people with type 2 diabetes

INTRODUCTION

Previous investigations have suggested that evening chronotypes may be more susceptible to obesity-related metabolic alterations. However, whether device-measured physical behaviors differ by chronotype in those with type 2 diabetes (T2DM) remains unknown.

RESEARCH DESIGN AND METHODS

This analysis reports data from the ongoing Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) observational study. Eligible participants were recruited from both primary and secondary care settings in the Midlands area, UK. Participants were asked to wear an accelerometer (GENEActiv, ActivInsights, Kimbolton, UK) on their non-dominant wrist for 7 days to quantify different physical behaviors (sleep, sedentary, light, moderate-to-vigorous physical activity (MVPA), intensity gradient, average acceleration and the acceleration above which the most active continuous 2, 10, 30 and 60 min are accumulated). Chronotype preference (morning, intermediate or evening) was assessed using the Morningness-Eveningness Questionnaire. Multiple linear regression analyses assessed whether chronotype preference was associated with physical behaviors and their timing. Evening chronotypes were considered as the reference group.

RESULTS

635 participants were included (age=63.8±8.4 years, 34.6% female, body mass index=30.9±5.1 kg/m²). 25% (n=159) of the cohort were morning chronotypes, 52% (n=330) intermediate and 23% (n=146) evening chronotypes. Evening chronotypes had higher sedentary time (28.7 min/day, 95% CI 8.6 to 48.3) and lower MVPA levels (-9.7 min/day, -14.9 to -4.6) compared to morning chronotypes. The intensity of the most active continuous 2-60 min of the day, average acceleration and intensity gradient were lower in evening chronotypes. The timing of physical behaviors also differed across chronotypes, with evening chronotypes displaying a later sleep onset and consistently later physical activity time.

CONCLUSIONS

People with T2DM lead a lifestyle characterized by sedentary behaviors and insufficient MVPA. This may be exacerbated in those with a preference for 'eveningness' (ie, go to bed late and get up late).

Periodontal disease, sleep duration, and white blood cell markers in the 2009 to 2014 National Health and Nutrition Examination Surveys

BACKGROUND

Elevated levels of inflammatory biomarkers are consistently associated with chronic conditions, for which periodontitis and sleep are established risk factors. We examined the relationships between periodontitis, hours of sleep and white blood cell (WBC) markers among a nationally representative sample of US adults.

METHODS

Cross-sectional study using existing demographic, examination, laboratory and questionnaire data on 11,813 participants (5,814 men and 5,999 women, mean age ± SE; range: 52.74 ± 0.24; 30 to 80 years) from the 2009 to 2014 National Health and Nutrition Examination Surveys. Unadjusted, sex- and age-adjusted, as well as fully adjusted linear and logistic regression models were conducted in addition to generalized structural equations models, while considering sampling design complexity. β, odds ratios with their 95% confidence intervals, indirect effects and mediation proportions were estimated.

RESULTS

The weighted mean WBC count was 7,130 cells/µL, with the WBC 5-part differential estimated in terms of percentages of lymphocytes (29.50%), monocytes (7.99%), neutrophils (59.03%), eosinophils (2.84%), and basophils (71.88%). Furthermore, 36.2% of participants reported <7 hours of sleep and 49.8% had periodontitis. In fully adjusted models controlling for sociodemographic, lifestyle, and health characteristics, neither WBC markers nor periodontitis were related to hours of sleep. By contrast, periodontitis was directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men. However, the relationship of periodontitis with %neutrophils and %lymphocytes may be modified by hours of sleep, as it was specific to individuals reporting ≥7 hours of sleep.

CONCLUSION

Periodontitis may be directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men and individuals reporting ≥7 hours of sleep, with implications for primary and secondary prevention.

Self-Reported Sleep Duration and Pattern in Old Order Amish and Non-Amish Adults

STUDY OBJECTIVES

We hypothesized that sleep duration in the Amish would be longer than in non-Amish.

METHODS

Sleep duration was obtained by questionnaire administered to Amish individuals (n = 3,418) and from the 2015-2016 National Health and Nutrition Examination Survey (NHANES; n = 1,912). Self-reported sleep duration was calculated as the difference in usual times that the participants went to bed at night and woke up in the morning.

RESULTS

In Amish (43.7 ± 16.7 years) and NHANES (50.0 ± 20.6 years), women had a longer sleep duration than men (P < .0001 in both groups) and sleep was significantly longer in those aged 18-29 years and ≥ 70 years, compared to those aged 30-69 years. Seasonal-adjusted sleep duration was shorter in Amish than that in NHANES (7.8 minutes shorter, age- and sex-adjusted P < .0001). However, Amish were less likely to report sleeping fewer than 7 hours per night (15.4% in Amish versus 20.5% in NHANES, P < .0001). Amish went to bed 80.4 minutes earlier than NHANES and arose 87.6 minutes earlier (age-, sex-, and season-adjusted P < .0001 for both). In the Amish, sleep duration was longer in clerks than in farmers (P < .0001) and was significantly correlated among household members (.15 < r < .62, P < .001), although there was no evidence that this trait was heritable (h² approximately 0) after adjustment for household.

CONCLUSIONS

The lower frequency of short sleepers in the Amish may contribute to the relatively lower risks of cardiometabolic diseases observed in this population.

CITATION

Zhang M, Ryan KA, Wickwire E, Postolache TT, Xu H, Daue M, Snitker S, Pollin TI, Shuldiner AR, Mitchell BD. Self-reported sleep duration and pattern in old order amish and non-amish adults. J Clin Sleep Med. 2019;15(9):1321-1328.

The Association between Habitual Sleep Duration and Sleep Quality with Glycemic Traits: Assessment by Cross-Sectional and Mendelian Randomization Analyses

Evidence on whether habitual sleep duration and sleep quality are associated with increased insulin resistance is inconsistent. Here, we investigated the associations between different measures of habitual sleep with glycemic traits through cross-sectional and Mendelian randomization (MR) analyses. We assessed the associations of sleep duration and sleep quality with glycemic traits using multivariable linear regression models adjusted for potential confounders in 4672 middle-aged (45–65 years; 48% men) nondiabetic participants of the Netherlands Epidemiology of Obesity (NEO) study. Genetic variants for total, short, and long sleep duration were used as instrumental variables in MR analyses using summary-level data of glycemic traits in nondiabetic individuals (MAGIC; n = 58,074). In cross-sectional analyses, shortest sleepers (median 5.0 h of sleep per night) had 14.5% (95% confidence interval (CI): 2.0; 28.6%) higher fasting insulin level and 16.3% (95% CI: 2.7; 31.7%) higher HOMA-β. Bad sleep quality was associated with higher insulin resistance (e.g., 14.3% (95% CI: 4.7; 24.9%) higher HOMA-IR). All these associations disappeared after adjustment for BMI and the risk of sleep apnea. MR analyses did not indicate a causal association between total, short or long sleep duration and glycemic traits. Therefore, our used measures of habitual sleep duration and sleep quality are unlikely to directly associate with insulin resistance.

Association between insulin resistance and objective measurement of physical activity in community-dwelling older adults without diabetes mellitus

AIMS

The main objective of this study was to determine the association between objectively measured physical activity (PA) and cardiometabolic risk factors, particularly insulin resistance (IR), in Japanese community-dwelling older adults without diabetes mellitus.

METHODS

Daily PA was measured by accelerometers in 388 community-dwelling older adults. IR was determined using homeostasis model assessment of insulin resistance (HOMA-IR). Regression analyses adjusted by age and sex were performed to determine the association of light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), or total steps per day with cardiometabolic risk factors. Then, multiple regression analysis was performed with HOMA-IR as an independent variable and those factors with p < 10% in the regression analysis as explanatory variables.

RESULTS

Objectively measured LPA was negatively associated with systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, and triglyceride (TG) and positively associated with high-density lipoprotein cholesterol (HDL-C). LPA was also negatively associated with IR. Total steps per day also had significant association with IR. MVPA was associated with TG, HDL-C, and IR. Multiple regression analysis showed that the association between LPA and IR was independent of other covariates, whereas that between MVPA and IR was lost after adjustment for other covariates.

CONCLUSION

IR was associated with LPA or total steps, but not with MVPA, in community-dwelling older adults without diabetes mellitus.