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Li RB, Zhang JD, Cui XR, Cui W. Insomnia is related to long-term atrial fibrillation recurrence following radiofrequency ablation. Ann Med 2024; 56:2323089. [PMID: 38423515 PMCID: PMC10906119 DOI: 10.1080/07853890.2024.2323089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Atrial fibrillation (AF), the most common cardiac arrhythmia, presents significant health challenges, and the intricate connection between insomnia and AF has garnered substantial attention. This cohort study aims to investigate the relationship between insomnia and AF recurrences following radiofrequency ablation. MATERIALS AND METHODS Data were retrieved from an electronic database of patients who underwent radiofrequency ablation for AF. The primary endpoint was AF recurrence. We utilized a multivariable Cox model, coupled with three propensity score methods, for analysis. RESULTS Between January 1, 2017, and June 1, 2022, 541 patients who underwent radiofrequency ablation for AF were recorded in the database. After excluding 185 patients, the final cohort comprised 356 patients. Among them, 68 were afflicted by insomnia, while 288 were not. Over a median follow-up of 755 days, one patient died, and 130 (36.5%) experienced AF recurrence. Multivariate Cox regression analysis revealed that the insomnia group had a higher risk of AF recurrence compared to the non-insomnia group (HR: 1.83, 95% CI: 1.16-2.89). Further landmark analysis showed no significant difference in AF recurrence rates during the initial 1-year follow-up. However, beyond 1 year, the insomnia group demonstrated a significantly higher AF recurrence rate. As the number of insomnia symptoms increased, the risk of AF recurrence also rose significantly, indicating a dose-response relationship. CONCLUSION This study establishes a significant link between insomnia and long-term AF recurrence following radiofrequency ablation. It underscores the importance of identifying and addressing insomnia in patients with AF undergoing radiofrequency ablation.
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Affiliation(s)
- Rui-bin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ji-dong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-ran Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Lueth AJ, Allshouse AA, Silver RM, Hawkins MS, Grobman WA, Redline S, Zee P, Manchada S, Pien G. Allostatic load in early pregnancy and sleep-disordered breathing. J Matern Fetal Neonatal Med 2024; 37:2305680. [PMID: 38253519 DOI: 10.1080/14767058.2024.2305680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To assess the association between allostatic load in early pregnancy and sleep-disordered breathing (SDB) during pregnancy. METHODS High allostatic load in the first trimester was defined as ≥ 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine, and albumin) in the unfavorable quartile. SDB was objectively measured using the Embletta-Gold device and operationalized as "SDB ever" in early (6-15 weeks) or mid-pregnancy (22-31 weeks); SDB at each time point was analyzed as secondary outcomes. Multivariable logistic regression was used to test the association between high allostatic load and SDB, adjusted for confounders. Moderation and sensitivity analyses were conducted to assess the role of allostatic load in racial disparities of SDB and obesity affected the relationship between allostatic load and SDB. RESULTS High allostatic load was present in 35.0% of the nuMoM2b cohort. The prevalence of SDB ever occurred among 8.3% during pregnancy. After adjustment, allostatic load remained significantly associated with SDB ever (aOR= 5.3; 3.6-7.9), in early-pregnancy (aOR= 7.0; 3.8-12.8), and in mid-pregnancy (aOR= 5.8; 3.7-9.1). The association between allostatic load and SDB was not significantly different for people with and without obesity. After excluding BMI from the allostatic load score, the association decreased in magnitude (aOR= 2.6; 1.8-3.9). CONCLUSION The association between allostatic load and SDB was independent of confounders including BMI. The complex and likely bidirectional relationship between chronic stress and SDB deserves further study in reducing SDB.
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Affiliation(s)
- Amir J Lueth
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Amanda A Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Marquis S Hawkins
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA
| | - Susan Redline
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA
| | - Phyllis Zee
- Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL, USA
| | - Shalini Manchada
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University, Bloomington, IN, USA
| | - Grace Pien
- Department of Obstetrics and Gynecology, School of Medicine, John Hopkins University, Baltimore, MD, USA
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Hu P, Vinturache A, Chen Y, Ding G, Zhang Y. Joint Association of Sleep Onset Time and Sleep Duration With Cardiometabolic Health Outcome. J Am Heart Assoc 2024; 13:e034165. [PMID: 38874059 DOI: 10.1161/jaha.123.034165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The association of sleep onset time and duration with cardiometabolic health is not well characterized. METHODS AND RESULTS This study included 6696 adults aged 20 to 80 years from the NHANES (National Health and Nutrition Examination Study) 2015 to 2018. Participants were categorized into 9 groups according to the cross-tabulation of sleep onset time (<22:00 [early], 22:00-23:59 [optimal], and ≥24:00 [late]) and duration (<7 hours [insufficient], 7-8 hours [sufficient], and ≥9 hours [excessive]), with optimal sleep onset time and sufficient duration as the reference. The primary outcomes included hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, central obesity, and metabolic syndrome. Inappropriate sleep onset time and sleep duration were associated with increased odds of hypertension, hypertriglyceridemia, and metabolic syndrome, especially among participants aged 40 to 59 years. Compared with men reporting optimal onset and sufficient duration, men reporting optimal onset with excessive duration (odds ratio [OR]: 2.01 [95% CI, 1.12-3.58]) and late onset with insufficient duration (OR, 1.74 [95% CI, 1.13-2.68]) had higher odds of metabolic syndrome. Compared with women reporting optimal onset and sufficient duration, women reporting optimal onset and insufficient duration (OR, 1.61 [95% CI, 1.11-2.32]) and early onset and excessive duration (OR, 2.16 [95% CI, 1.30-3.57]) had higher odds of hypertension, and women reporting late onset and excessive duration (OR, 5.64 [95% CI, 1.28-6.77]) were at the highest odds of hypertriglyceridemia. CONCLUSIONS Late sleep onset as well as insufficient or excessive sleep duration are associated with adverse cardiometabolic outcomes, particularly in participants aged 40 to 59 years.
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Affiliation(s)
- Peipei Hu
- Department of Pediatrics, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Institute for Pediatric Research Shanghai China
| | - Angela Vinturache
- Department of Obstetrics and Gynecology University of Alberta Edmonton Alberta Canada
- Department of Neuroscience University of Lethbridge Lethbridge Alberta Canada
| | - Yan Chen
- Department of Pediatrics, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Institute for Pediatric Research Shanghai China
| | - Guodong Ding
- Department of Pediatrics, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Institute for Pediatric Research Shanghai China
| | - Yongjun Zhang
- Department of Pediatrics, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Institute for Pediatric Research Shanghai China
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Johnson KT, Zawadzki MJ, Kho C. Loneliness and sleep in everyday life: Using ecological momentary assessment to characterize the shape of daily loneliness experience. Sleep Health 2024:S2352-7218(24)00068-8. [PMID: 38839482 DOI: 10.1016/j.sleh.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Loneliness has been linked to an increased risk of sleep problems. Past research has largely relied on trait loneliness or daily recall loneliness when evaluating associations with sleep. OBJECTIVE The present study extended this work by evaluating the patterns of loneliness throughout the day, including a daily average of all reports, a maximum value, and daily variation. These loneliness patterns predicted daily subjective and objective sleep measures to evaluate whether they provide unique insight to this relationship. METHODS Undergraduate students (n = 71; 77% female; age 18-28) completed 2weeks of electronic surveys 4 times a day to assess loneliness. Each morning participants completed a diary of their prior night's sleep quality, as well as wore actigraphy devices to objectively assess sleep parameters. A total of 778 momentary surveys and 565days of actigraphy-assessed sleep data were collected. Multilevel models tested whether within-person daily aggregates of loneliness were associated with within-person daily sleep outcome variables. RESULTS Subjective sleep duration, quality, and fatigue were significantly predicted by daily average loneliness. Subjective sleep latency, quality, and fatigue were significantly predicted by daily max loneliness. Only fatigue was significantly predicted by daily loneliness variability. No objective sleep measures were significantly predicted by daily loneliness measures. CONCLUSIONS Patterns of daily loneliness focusing on central tendency (average) or intensity (max) were more consistently associated with subjective (but not objective) assessments of sleep than variability.
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Affiliation(s)
- Kayla T Johnson
- University of Wisconsin Milwaukee, Department of Psychology, Milwaukee, Wisconsin, USA; University of Minnesota, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA
| | - Matthew J Zawadzki
- University of California, Merced, Department of Psychological Sciences, Merced, California, USA.
| | - Carmen Kho
- North Dakota State University, Department of Human Development and Family Sciences, Fargo, North Dakota, USA
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Thomas CL, Carr K, Yang F, Fleisher S, Um P, Clemens B, McNutt R, Balkin T, Collen JF. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med 2024; 20:973-981. [PMID: 38420974 PMCID: PMC11145036 DOI: 10.5664/jcsm.11088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Diagnoses of military-relevant sleep disorders have increased substantially since the terrorist attacks of September 11, 2001. The cause of this increase appears to be complicated and multifactorial, with military and civilian populations clearly differing with respect to both the nature and distribution of sleep disorders diagnoses. In part, these differences may be attributable to the fact that a majority of service members are chronically sleep-restricted-an unavoidable consequence of continuous and sustained military operations that "set the stage" for development of specific sleep disorders. The purpose of this narrative review is to describe the military relevance of several common sleep disorders, assess the extent to which these disorders currently constitute a burden on the military health care system, and suggest strategies to alleviate that burden. The military health care system does not have enough sleep medicine providers to address the immediate and long-term consequences of sleep disorders in military personnel. Digital technologies and education packages can be leveraged to improve access to care. CITATION Thomas CL, Carr K, Yang F, et al. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med. 2024;20(6):973-981.
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Affiliation(s)
- Connie L. Thomas
- Walter Reed Army Institute of Research, Silver Spring, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
| | - Kyle Carr
- Uniformed Services University, Bethesda, Maryland
| | - Felix Yang
- Uniformed Services University, Bethesda, Maryland
| | | | - Paul Um
- Uniformed Services University, Bethesda, Maryland
| | | | - Ryan McNutt
- Womack Army Medical Center, Fort Liberty, North Carolina
| | - Thomas Balkin
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jacob F. Collen
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
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Alreshidi NF, Alenzi H, Alrashidi R, Aljaloud LZ, Alshammari AB. The Relationship Between Thyroid Dysfunction and Sleep Quality Among Population of Saudi Arabia. Int J Gen Med 2024; 17:2497-2505. [PMID: 38831928 PMCID: PMC11144793 DOI: 10.2147/ijgm.s462512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Thyroid problems and sleep disturbances are common health problems that impact people of all ages, income levels, and genders. The clinical relationship between these conditions is still not well understood, despite their widespread occurrence. The main objectives of the study were to determine the prevalence of thyroid disorders and evaluate the relationship between them and sleep quality in the Saudi Arabian population. Patients and Methods The study employed an observational cross-sectional design and included a representative Saudi Arabian cohort. The Pittsburgh Sleep Quality Index (PSQI) was included in a digital self-administered survey that participants were asked to complete. Results There were 1044 responders in the study, most of whom (54%) were between the ages of 21 and 30. Female respondents made up 62% of the sample. Thyroid disorders were diagnosed in 9.2% of cases. A significant correlation was found (p=0.001 and p<0.001, respectively) between thyroid disorders and sleep disturbances as well as the use of sleep medications. Conclusion The study revealed a significant prevalence of poor sleep quality in the Saudi population as a whole, with thyroid disorder diagnosis and female gender emerging as independent risk factors. More extensive longitudinal studies in the area are desperately needed.
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Affiliation(s)
- Nahlah Fahad Alreshidi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Hialah Alenzi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Rasha Alrashidi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Luluh Zamil Aljaloud
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
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Cavaillès C, Letellier N, Berr C, Samieri C, Empana JP, Tzourio C, Dartigues JF, Benmarhnia T, Dauvilliers Y, Jaussent I. The role of cardiovascular health and vascular events in the relationship between excessive daytime sleepiness and dementia risk. J Sleep Res 2024; 33:e14053. [PMID: 37822116 DOI: 10.1111/jsr.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
Many studies suggest a relationship between excessive daytime sleepiness (EDS) and dementia incidence, but the underlying mechanisms remain uncertain. The study aimed to investigate the role of cardiovascular burden in the relationship between EDS and dementia incidence over a 12-year follow-up in community-dwelling older adults. We performed analyses on 6171 subjects (aged ≥65 years) free of dementia and vascular disease at baseline. Participants self-reported EDS at baseline and an expert committee validated both prevalent and incident dementia. We defined cardiovascular burden by a low Cardiovascular Health score, constructed using the American Heart Association metrics, and incident vascular events. To explore the potential role of the cardiovascular burden in the relationship between EDS and dementia, we conducted mediation analyses with inverse odds ratio-weighted estimation, using multivariable-adjusted proportional hazard Cox and logistic regression models. Subjects with EDS had a higher risk of all-cause dementia (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.13-1.69) and dementia with vascular component (DVC) (HR 2.14, 95% CI 1.30-3.51), but not Alzheimer's disease (HR 1.18, 95% CI 0.93-1.51). Cardiovascular burden explained 5% (95% CI 4.1-5.2) and 11% (95% CI 9.7-11.3) of the relationship between EDS and all-cause dementia and DVC, respectively. These findings confirm that EDS may be implicated in the development of dementia and indicate a weaker than expected role of cardiovascular burden in the relationship between EDS and DVC.
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Affiliation(s)
- Clémence Cavaillès
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Noémie Letellier
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps Institution of Oceanography, UC San Diego, La Jolla, California, USA
| | - Claudine Berr
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Cecilia Samieri
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Jean-Philippe Empana
- Paris Descartes University, Faculty of Medicine, Paris, France; INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
| | - Christophe Tzourio
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps Institution of Oceanography, UC San Diego, La Jolla, California, USA
| | - Yves Dauvilliers
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
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Alger SE, Bennett C, Bennett N, Huebner MG, Lee JEC, Edge HJM, Simms A, Adler AB. Insufficient Sleep and Behavioral Health in the Military: A 5-Country Perspective. Curr Psychiatry Rep 2024; 26:229-239. [PMID: 38700836 PMCID: PMC11081997 DOI: 10.1007/s11920-024-01497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW The goal of this paper was to highlight the degree to which sleep, behavioral health, and leader involvement were interrelated using data from militaries in five English-speaking countries: Australia, Canada, New Zealand, the UK, and the United States. RECENT FINDINGS Many service members reported sleeping fewer than the recommended 7 h/night: 34.9%, 67.2%, and 77.2% of respondents from New Zealand, Canada, and the United States, respectively. Countries reporting shorter sleep duration also reported fewer insomnia-related difficulties, likely reflecting higher sleep pressure from chronic sleep loss. Across all countries, sleep problems were positively correlated with behavioral health symptoms. Importantly, leader promotion of healthy sleep was positively correlated with more sleep and negatively correlated with sleep problems and behavioral health symptoms. Insufficient sleep in the military is ubiquitous, with serious implications for the behavioral health and functioning of service members. Leaders should attend to these risks and examine ways to promote healthy sleep in service members.
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Affiliation(s)
- Sara E Alger
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 29010, US.
| | - Clare Bennett
- Defence Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - Neanne Bennett
- Australian Defence Force, Joint Health Command, Canberra, Australia
| | - Matthew G Huebner
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Jennifer E C Lee
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Heather J McCuaig Edge
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 29010, US
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Inkelis SM, Soja J, Mattson SN, Chambers CD, Bhattacharjee R, Thomas JD. Characteristics of sleep in children with heavy prenatal alcohol exposure. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:928-943. [PMID: 38523054 PMCID: PMC11073897 DOI: 10.1111/acer.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods. METHODS Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. RESULTS There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age. CONCLUSIONS Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.
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Affiliation(s)
- Sarah M Inkelis
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jacqueline Soja
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Rakesh Bhattacharjee
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Jennifer D Thomas
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, USA
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Javaloyes A, Mateo-March M, Peña-González I, Moya-Ramón M. Assessing sleep quality in elite and junior cyclists. Front Sports Act Living 2024; 6:1369435. [PMID: 38752212 PMCID: PMC11095108 DOI: 10.3389/fspor.2024.1369435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
In the pursuit of optimal recovery, the significance of sleep cannot be overstated for elite cyclists, including high-level cyclists within the junior category. This study aims to assess the sleep quality of elite athletes of different categories and disciplines, including junior. The sleep quality of 112 high-level cyclists (males n = 80; females n = 32) participating in endurance and sprint disciplines was evaluated using the Pittsburgh Sleep Quality Index (PSQI). A noteworthy 41% of both elite and junior cyclists displayed poor sleep quality. No significant differences were observed between elite and junior cyclists in terms of sleep quality, but there was a medium effect size, indicating greater sleep efficiency in junior cyclists [0.36 (0.16, 0.53)]. Gender differences were found, with females exhibiting worse PSQI scores (males = 4.00 [2.25]; females 5.00 [3.00]; p = 0.035). Endurance cyclists spent more time in bed compared to cyclists from sprinting disciplines (8:30 [1.00] and 8:00 [1:03], respectively; p = 0.019). These findings reveal poor sleep habits, even among individuals classified as good sleepers by the PSQI, emphasizing the importance of preventing sleep disorders in cyclists. This study provides valuable insights into athlete sleep quality, encompassing various categories, genders, and cycling disciplines. In conclusion, elite cyclists demonstrate suboptimal sleep quality, suggesting the potential for interventions utilizing the PSQI. These findings advocate for the incorporation of sleep quality assessments into routine evaluations for athletes.
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Affiliation(s)
- Alejandro Javaloyes
- Department of Sport Science, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
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Wang S, Rossheim ME, Nandy RR, Nguyen US. Interaction between sleep duration and trouble sleeping on depressive symptoms among U.S. adults, NHANES 2015-2018. J Affect Disord 2024; 351:285-292. [PMID: 38302062 DOI: 10.1016/j.jad.2024.01.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aims to examine the associations and interaction effects of sleep duration and trouble sleeping on depressive symptoms among U.S. adults. METHODS National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018 were analyzed (N = 10,044). Trouble sleeping and sleep duration were self-reported. Sleep duration was defined as short (≤6 h) or long (≥9 h), compared with normal (>6 and < 9 h). Depressive symptoms were determined by the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were reported. RESULTS There was a significant positive additive interaction between short sleep duration and trouble sleeping on depressive symptoms in the fully adjusted model (Relative excess risk due to interaction, RERIOR = 4.42, 95 % CI: 1.12, 7.73), with 43 % of the association with depressive symptoms attributed to the interaction (attributable proportion of interaction, AP = 0.43, 95 % CI: 0.22, 0.64). Similarly, a significant positive additive interaction between long sleep duration and trouble sleeping on depressive symptoms was found (RERIOR = 4.17, 95 % CI: 0.96, 7.38), with 41 % of the association with depressive symptoms attributed to the interaction (AP = 0.41, 95 % CI: 0.21, 0.60). No multiplicative interaction was detected between short or long sleep duration and trouble sleeping. LIMITATIONS The cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS Findings suggest that different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depressive symptoms. This underscores the importance of simultaneously considering multiple dimensions of sleep health in relation to depressive symptoms.
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Affiliation(s)
- Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Matthew E Rossheim
- Department of Health Administration & Health Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rajesh R Nandy
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Uyen-Sa Nguyen
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Carmon AS, Amato RJ, Patel SM, Finks SW. Effect of L-Methylfolate Supplementation on Sleep for Patients with Reduced Methylenetetrahydrofolate Reductase Activity. J Diet Suppl 2024:1-9. [PMID: 38528721 DOI: 10.1080/19390211.2024.2327541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Clinicians have limited options outside controlled substances to address sleep disturbance, which left untreated can negatively affect patient outcomes in cardiovascular health, mental health, immunologic function, and more. For some, genetic factors may influence sleep disturbances. L-methylfolate, the active form of folate, plays a critical role in regulation of monoamine neurotransmitters known to have significant impact on sleep regulation: dopamine, serotonin, norepinephrine. Single nucleotide polymorphisms of the enzyme methylene-tetrahydrofolate-reductase are common and can impact monoamine production. The goal of this study was to evaluate effects of L-methylfolate supplementation on sleep in a cohort with reduced methylene tetrahydrofolate reductase (MTHFR) activity. METHODS A retrospective cohort of patients being treated with L-methylfolate in a concierge medical clinic setting was studied. Patients presenting with sleep complaints were evaluated using the Patient-Reported Outcomes Measurement Information System at baseline. Patients with known MTHFR polymorphisms at either C667T and/or A1298C were recommended 5 mg of L-methylfolate daily and were reevaluated at 2 wks, at 4 wks, and at 8 wks of supplementation. Statistical comparisons were made utilizing ANOVA and T-test comparisons. RESULTS Ten were included in the final cohort: six male and four female, average age 43 ± 16 years. Beginning at wk 2, average sleep disturbance improved significantly by -6.94 points (p = 0.005) and by 8 wks, all patients had improvement with a -14.34 change in disturbance from baseline (p = 0.001). CONCLUSION Improvement in sleep disturbance was seen in both low and intermediate function phenotypes. L-methylfolate may be useful for improving sleep in patients with MTHFR polymorphism.
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Affiliation(s)
| | | | | | - Shannon W Finks
- Züp Medical Services, Memphis, TN, USA
- Clinical Pharmacy and Translational Science, University of TN College of Pharmacy, Memphis, TN, USA
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13
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Garcia CC, Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Hoffman M, Anton RF, Witkiewitz K. Reductions in World Health Organization risk drinking level are associated with improvements in sleep problems among individuals with alcohol use disorder. Alcohol Alcohol 2024; 59:agae022. [PMID: 38606931 PMCID: PMC11010310 DOI: 10.1093/alcalc/agae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Among individuals with alcohol use disorder (AUD), sleep disturbances are pervasive and contribute to the etiology and maintenance of AUD. However, despite increased attention toward the relationship between alcohol use and sleep, limited empirical research has systematically examined whether reductions in drinking during treatment for AUD are associated with improvements in sleep problems. METHODS We used data from a multisite, randomized, controlled trial that compared 6 months of treatment with gabapentin enacarbil extended-release with placebo for adults with moderate-to-severe AUD (N = 346). The Timeline Follow-back was used to assess WHO risk drinking level reductions and the Pittsburgh Sleep Quality Index was used to assess sleep quality over the prior month at baseline and the end of treatment. RESULTS Sleep problem scores in the active medication and placebo groups improved equally. Fewer sleep problems were noted among individuals who achieved at least a 1-level reduction (B = -0.99, 95% confidence interval (CI) [-1.77, -0.20], P = .014) or at least a 2-level reduction (B = -0.80, 95% CI [-1.47, -0.14], P = .018) in WHO risk drinking levels at the end of treatment. Reductions in drinking, with abstainers excluded from the analysis, also predicted fewer sleep problems at the end of treatment (1-level: B = -1.01, 95% CI [-1.83, -0.20], P = .015; 2-level: B = -0.90, 95% CI [-1.59, -0.22], P = .010). CONCLUSIONS Drinking reductions, including those short of abstinence, are associated with improvements in sleep problems during treatment for AUD. Additional assessment of the causal relationships between harm-reduction approaches to AUD and improvements in sleep is warranted.
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Affiliation(s)
- Christian C Garcia
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, United States
| | - Henry R Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, 19104, United States
| | - Henri-Jean Aubin
- Université Paris-Saclay, Unive Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale, Villejuif, France
- APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, 94800, France
| | - Stephanie S O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, United States
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, 68159, Germany
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Research Triangle Park, NC, 27709, United States
| | - Michaela Hoffman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Raymond F Anton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
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14
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Haas A, Chung J, Kent C, Mills B, McCoy M. Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System. Cureus 2024; 16:e56223. [PMID: 38618450 PMCID: PMC11016242 DOI: 10.7759/cureus.56223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.
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Affiliation(s)
- Amy Haas
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Jonathan Chung
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Christopher Kent
- Research, Sherman College, Spartanburg, USA
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Brooke Mills
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Matthew McCoy
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
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15
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Chen S, Liu Z, Yan S, Du Z, Cheng W. Increased susceptibility to new-onset atrial fibrillation in diabetic women with poor sleep behaviour traits: findings from the prospective cohort study in the UK Biobank. Diabetol Metab Syndr 2024; 16:51. [PMID: 38414084 PMCID: PMC10898144 DOI: 10.1186/s13098-024-01292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Diabetic individuals often encounter various sleep-related challenges. Although the association between sleep duration and atrial fibrillation (AF) have been explored, the association of other sleep traits with the incidence of AF remains unclear. A comprehensive understanding of these traits is essential for a more accurate assessment of sleep conditions in patients with diabetes and the development of novel AF prevention strategies. METHODS This study involved 23,785 patients with diabetes without any pre-existing cardiovascular disease, drawn from the UK Biobank. Sleep behaviour traits examined encompassed sleep duration, chronotype, insomnia, snoring and daytime sleepiness. Sleep duration was categorised into three groups: low (≤ 5 h), proper (6-8 h) and long (≥ 9 h). We assessed associations using multivariate Cox proportional risk regression models. Furthermore, four poor sleep behaviours were constructed to evaluate their impact on the risk of new-onset AF. RESULTS Over a mean follow-up period of 166 months, 2221 (9.3%) new cases of AF were identified. Short (hazard ratio (HR), 1.28; 95% confidence interval (CI) 1.10-1.50) and long sleep durations (HR 1.16; 95% CI 1.03-1.32) consistently exhibited an elevated risk of AF compared to optimal sleep duration. Early chronotype, infrequent insomnia and daytime sleepiness were associated with 11% (HR 0.89; 95% CI 0.82-0.97), 15% (HR 0.85; 95% CI 0.77-0.95) and 12% (HR 0.88; 95% CI 0.81-0.96) reduced risk of new-onset AF, respectively. However, no significant association was found between snoring and the incidence of AF (HR 0.99; 95% CI 0.91-1.07). CONCLUSIONS In diabetic populations, sleep duration, chronotype, insomnia and daytime sleepiness are strongly associated with AF incidence. An optimal sleep duration of 6-8 h presents the lowest AF risk compared to short or long sleep duration. Additionally, poor sleep patterns present a greater risk of new-onset AF in women than in men.
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Affiliation(s)
- Siwei Chen
- Department of Cardiovascular Medicine, Nanchang People's Hospital (The Third Hospital of Nanchang), Jiangxi, China
| | - Zhou Liu
- Department of Geriatric Medicine, The Fifth People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Yangzhou University, Huai'an, China
- Department of Cardiology, The Fifth People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Yangzhou University, Huai'an, China
| | - Shaohua Yan
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhongyan Du
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.
- Key Laboratory of Blood-stasis-toxin Syndrome of Zhejiang Province, Zhejiang Engineering Research Center for "Preventive Treatment" Smart Health of Traditional Chinese Medicine, Hangzhou, 310053, China.
| | - Wenke Cheng
- Medical Faculty, University of Leipzig, Liebigstr 27, 04103, Leipzig, Germany.
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16
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Gao Z, Gao Z, Zheng C, Ma J, Zhao Y, Zhang L, Guo L. Reliability and validity of the cancer-related dysfunctional beliefs and attitudes about sleep scale in cancer patients. BMC Psychiatry 2024; 24:144. [PMID: 38378492 PMCID: PMC10880202 DOI: 10.1186/s12888-024-05580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/03/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Insomnia is a common health problem among cancer patients, which is not only a physical problem but also a psychological problem. Sleep plays an important role in the mental and somatic rehabilitation of cancer patients, and the sleep beliefs and attitudes of cancer patients are key factors in improving their sleep situation and quality of life. The aim of this study was to translate the Cancer-Related Dysfunctional Beliefs and Attitudes about Sleep (C-DBAS-14) scale into Chinese and to validate its reliability and validity in cancer patients. METHOD The C-DBAS-14 scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability and retest reliability. The validity of the scale was assessed through the content validity indicators, exploratory factor analysis and validation factor analysis. RESULT The Cronbach's ɑ coefficient of the Chinese version of the C-DBAS-14 was 0.932 while the McDonald's omega coefficient (ω t) was 0.934. The split-half reliability coefficient was 0.908, and the test-retest reliability was 0.857. The four-factor model was obtained using exploratory factor analysis, explaining 72.7% of the variance, with each item loading greater than 0.4 on the common factor. The results of the confirmatory factor analysis revealed that all indicators of model fit were within an acceptable range, indicating a well-fitting model. CONCLUSION The Chinese version of the C-DBAS-14 has good reliability and validity among cancer patients. It can be used to measure the sleep beliefs and attitudes of Chinese cancer patients.
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Affiliation(s)
- Ziyun Gao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Zihan Gao
- Shengjing Hospital affiliated to China Medical University, Shenyang City, Liaoning Province, P.R. China
| | - Chen Zheng
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Jianing Ma
- College of Health Management, Liaoyang Vocational and Technical College, Liaoyang City, Liaoning Province, P.R. China
| | - Ying Zhao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, P.R. China.
| | - Leilei Guo
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China.
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17
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Gonzalez DE, Lanham SN, Martin SE, Cleveland RE, Wilson TE, Langford EL, Abel MG. Firefighter Health: A Narrative Review of Occupational Threats and Countermeasures. Healthcare (Basel) 2024; 12:440. [PMID: 38391814 PMCID: PMC10888326 DOI: 10.3390/healthcare12040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Structural firefighters are responsible for protecting properties and saving lives during emergency operations. Despite efforts to prepare firefighters for these hazardous occupational demands, the unfortunate reality is that the incidence of health morbidities is increasing within the fire service. Specifically, cardiovascular disease, cancer, and mental health disorders are among the most documented morbidities in firefighters. Pubmed and Google Scholar search engines were used to identify peer-reviewed English language manuscripts that evaluated firefighters' occupational health threats, allostatic factors associated with their occurrence, and evidence-based strategies to mitigate their impact. This narrative review provides fire departments, practitioners, and researchers with evidence-based practices to enhance firefighters' health.
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Affiliation(s)
- Drew E Gonzalez
- Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX 77845, USA
| | - Sarah N Lanham
- First Responder Research Laboratory, Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY 40506, USA
| | - Steven E Martin
- Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX 77845, USA
| | - Richard E Cleveland
- Department of Leadership, Technology, and Human Development, Georgia Southern University, Statesboro, GA 30458, USA
| | - Thad E Wilson
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Emily L Langford
- First Responder Research Laboratory, Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY 40506, USA
- Department of Health and Human Sciences, University of Montevallo, Montevallo, AL 35115, USA
| | - Mark G Abel
- First Responder Research Laboratory, Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY 40506, USA
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18
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Sweeney MR, Nichols HB, Jones RR, Olshan AF, Keil AP, Engel LS, James P, Sandler DP, White AJ, Jackson CL. Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study. Sleep 2024; 47:zsad100. [PMID: 37018759 PMCID: PMC10851850 DOI: 10.1093/sleep/zsad100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/23/2023] [Indexed: 04/07/2023] Open
Abstract
STUDY OBJECTIVE To examine the association between light at night (LAN) and multiple sleep health dimensions. METHODS Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity. RESULTS Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women. CONCLUSIONS Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.
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Affiliation(s)
- Marina R Sweeney
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Zhu H, Qin S, Wu M. Association between weekend catch-up sleep and cardiovascular disease: Evidence from the National Health and Nutrition Examination Surveys 2017-2018. Sleep Health 2024; 10:98-103. [PMID: 38000943 DOI: 10.1016/j.sleh.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES This study aimed to investigate the relationship between the weekend catch-up sleep duration and cardiovascular disease prevalence among adults in the United States. DESIGN Cross-sectional study. SETTING The United States. PARTICIPANTS Participants from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) who were 20years old or older (n = 3400). MEASUREMENTS Sociodemographic characteristics, sleep duration (weekday and weekend), and the presence of cardiovascular disease, hypertension, and diabetes were recorded for all participants. Weekend catch-up sleep was defined as sleeping 1 hour longer on weekends than on weekdays. Adjusted multivariable logistic regression analysis was conducted to assess the relationship of weekend catch-up sleep with cardiovascular disease. RESULTS Participants with cardiovascular disease had shorter weekend catch-up sleep than those without cardiovascular disease (P < .01). Participants with weekend catch-up sleep had a lower prevalence of cardiovascular disease (P < .01) than those with no significant change in weekend sleep duration. An adjusted multivariate logistic regression analysis showed that weekend catch-up sleep duration was significantly associated with the prevalence of angina (P = .04), stroke (P < .01), and coronary heart disease (P = .01). Weekend catch-up sleep was associated with reduced cardiovascular disease prevalence when the weekday sleep duration was <6 hours (P < .01). A stratified analysis of participants with <6 hours of sleep on weekdays showed that weekend catch-up sleep duration (>2 hours) was associated with reduced prevalence of cardiovascular disease (P = .01). CONCLUSION Our findings indicate that weekend catch-up sleep duration of >2 hours is strongly associated with reduced cardiovascular disease prevalence when the sleep duration is <6 hours on weekdays.
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Affiliation(s)
- Hong Zhu
- Department of Pharmacy, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Shouquan Qin
- Department of Pharmacy, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Meng Wu
- Department of Oral and Maxillofacial Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
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20
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Tener SJ, Lin Z, Park SJ, Oraedu K, Ulgherait M, Van Beek E, Martínez-Muñiz A, Pantalia M, Gatto JA, Volpi J, Stavropoulos N, Ja WW, Canman JC, Shirasu-Hiza M. Neuronal knockdown of Cullin3 as a Drosophila model of autism spectrum disorder. Sci Rep 2024; 14:1541. [PMID: 38233464 PMCID: PMC10794434 DOI: 10.1038/s41598-024-51657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
Mutations in Cullin-3 (Cul3), a conserved gene encoding a ubiquitin ligase, are strongly associated with autism spectrum disorder (ASD). Here, we characterize ASD-related pathologies caused by neuron-specific Cul3 knockdown in Drosophila. We confirmed that neuronal Cul3 knockdown causes short sleep, paralleling sleep disturbances in ASD. Because sleep defects and ASD are linked to metabolic dysregulation, we tested the starvation response of neuronal Cul3 knockdown flies; they starved faster and had lower triacylglyceride levels than controls, suggesting defects in metabolic homeostasis. ASD is also characterized by increased biomarkers of oxidative stress; we found that neuronal Cul3 knockdown increased sensitivity to hyperoxia, an exogenous oxidative stress. Additional hallmarks of ASD are deficits in social interactions and learning. Using a courtship suppression assay that measures social interactions and memory of prior courtship, we found that neuronal Cul3 knockdown reduced courtship and learning compared to controls. Finally, we found that neuronal Cul3 depletion alters the anatomy of the mushroom body, a brain region required for memory and sleep. Taken together, the ASD-related phenotypes of neuronal Cul3 knockdown flies establish these flies as a genetic model to study molecular and cellular mechanisms underlying ASD pathology, including metabolic and oxidative stress dysregulation and neurodevelopment.
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Affiliation(s)
- Samantha J Tener
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Zhi Lin
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Scarlet J Park
- Department of Neuroscience, The Herbert Wertheim UF Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL, 33458, USA
| | - Kairaluchi Oraedu
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Matthew Ulgherait
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Emily Van Beek
- Waksman Institute, Rutgers University, Piscataway, NJ, 08854, USA
| | - Andrés Martínez-Muñiz
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Meghan Pantalia
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jared A Gatto
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Julia Volpi
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | | | - William W Ja
- Department of Neuroscience, The Herbert Wertheim UF Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL, 33458, USA
| | - Julie C Canman
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Mimi Shirasu-Hiza
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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21
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Nguyen VT, Fields CJ, Ashley NT. Temporal dynamics of pro-inflammatory cytokines and serum corticosterone following acute sleep fragmentation in male mice. PLoS One 2023; 18:e0288889. [PMID: 38096187 PMCID: PMC10721077 DOI: 10.1371/journal.pone.0288889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Obstructive sleep apnea is increasing worldwide, leading to disordered sleep patterns and inflammatory responses in brain and peripheral tissues that predispose individuals to chronic disease. Pro-inflammatory cytokines activate the inflammatory response and are normally regulated by glucocorticoids secreted from adrenal glands. However, the temporal dynamics of inflammatory responses and hypothalamic-pituitary-adrenal (HPA) axis activation in relation to acute sleep fragmentation (ASF) are undescribed. Male C57BL/6J mice were exposed to ASF or control conditions (no ASF) over specified intervals (1, 2, 6, or 24 h) and cytokine gene expression (IL-1β, TNF-α) in brain and peripheral tissues as well as serum glucocorticoid and interleukin-6 (IL-6) concentration were assessed. The HPA axis was rapidly activated, leading to elevated serum corticosterone from 1-24 h of ASF compared with controls. This activation was followed by elevated serum IL-6 concentration from 6-24 h of ASF. The tissue to first exhibit increased pro-inflammatory gene expression from ASF was heart (1 h of ASF). In contrast, pro-inflammatory gene expression was suppressed in hypothalamus from 1 h of ASF, but elevated at 6 h. Because the HPA axis was activated throughout ASF, this suggests that brain, but not peripheral, pro-inflammatory responses were rapidly inhibited by glucocorticoid immunosuppression.
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Affiliation(s)
- Van Thuan Nguyen
- Department of Biology, Western Kentucky University, Bowling Green, Kentucky, United States of America
| | - Cameron J. Fields
- Department of Biology, Western Kentucky University, Bowling Green, Kentucky, United States of America
| | - Noah T. Ashley
- Department of Biology, Western Kentucky University, Bowling Green, Kentucky, United States of America
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22
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Adejumo OA, Edeki IR, Mamven M, Oguntola OS, Okoye OC, Akinbodewa AA, Okaka EI, Ahmed SD, Egbi OG, Falade J, Dada SA, Ogiator MO, Okoh B. Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study. BMJ Open 2023; 13:e074025. [PMID: 38040427 PMCID: PMC10693864 DOI: 10.1136/bmjopen-2023-074025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD. DESIGN This was a cross-sectional study that involved patients with CKD . SETTINGS The study was carried out in the outpatient clinic of nine hospitals in Nigeria. METHODS Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant. RESULTS The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003). CONCLUSION Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.
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Affiliation(s)
| | | | - Manmak Mamven
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | | | - Ogochukwu Chinedum Okoye
- Department of Internal Medicine, Delta State University, Abraka, Nigeria
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | | | | | | | - Joshua Falade
- Department of Internal Medicine, University of Medical Sciences, Ondo City, Nigeria
| | | | | | - Barbara Okoh
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
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23
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Zhao Y, Cheng X, Song C. Joint associations of asthma and sleep duration with cardiovascular disease and all-cause mortality: a prospective cohort study. Ann Epidemiol 2023; 88:1-6. [PMID: 37865213 DOI: 10.1016/j.annepidem.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE This study aimed to investigate the joint association of asthma and sleep duration with cardiovascular disease (CVD) and mortality risk. METHODS This prospective cohort study included 366,387 participants from the UK Biobank. The participants were divided into three groups based on their sleep duration (short: <7 h/d; referent: 65+ years: 7-8 h/d; ages 39-64 years: 7-9 h/d; and long: 65+ years: >8 h/d; ages 39-64 years: >9 h/d). Cox proportional hazards models were used to examine the association between asthma and sleep duration on CVD and all-cause mortality. RESULTS Participants with asthma and short sleep duration showed increased risk of CVD (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.34-1.51) and all-cause mortality (HR, 1.26; 95% CI, 1.17-1.36), compared with participants with no asthma in the referent sleep duration group. We documented significant additive interactions between asthma and short sleep duration in relation to CVD (relative excess risk due to interaction [RERI], 0.13; 95% CI, 0.04-0.23) and all-cause mortality (RERI, 0.12; 95% CI, 0.01-0.23). CONCLUSIONS Asthma and short sleep duration may have additive interactions on CVD and all-cause mortality risk, highlighting the importance of controlling asthma in combination with improving sleep duration.
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Affiliation(s)
- Yuhao Zhao
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Song
- Nosocomial Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
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24
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Full KM, Johnson DA, Kaufmann CN, Malhotra A. An Update on Sleep Duration, Obesity, and Mortality Risk in Women. Sleep Med Clin 2023; 18:415-422. [PMID: 38501514 PMCID: PMC10969361 DOI: 10.1016/j.jsmc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Sleep health is an essential component to overall health. Because of numerous societal, economic, and biological factors, obtaining adequate sleep poses a unique challenge to aging women. Yet, women have been traditionally understudied in sleep research. An increasing body of research supports abnormal sleep duration as a risk factor for obesity, cardiovascular disease, and mortality. This review focuses specifically on 3 areas of the discussion of insufficient sleep in women: (1) the mysterious poor health of long sleepers, (2) the potential underlying mechanisms linking abnormal sleep duration and cardiometabolic health, and (3) the need to investigate multiple levels of social determinants driving sleep disparities.
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Affiliation(s)
- Kelsie M Full
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, 32603, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
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25
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Witte MA, Lloyd RM, McGree M, Kawai Y. Sleep quantity and quality of critically ill children perceived by caregivers and bedside nursing staff: a pilot study. J Clin Sleep Med 2023; 19:2027-2033. [PMID: 37539642 PMCID: PMC10692947 DOI: 10.5664/jcsm.10750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
STUDY OBJECTIVES Sleep is crucial for healing but often impaired in the pediatric intensive care unit due to environmental disruptions. Caregivers and bedside nursing staff are often most aware of these factors and the impact on patient sleep, but studies have not yet compared their perceptions. METHODS Caregivers and bedside nursing staff of pediatric patients staying a second night in the pediatric intensive care unit were asked to complete a survey regarding environmental factors (ie, temperature, light, sound, nursing staff room entries), sleep quality, and sleep quantity (ie, sleep duration, number of naps) of the pediatric patient. Caregivers were asked similar questions about their child's sleep at home. RESULTS The caregivers and nursing staff of 31 pediatric patients participated in this pilot study. There was no significant difference between caregiver and nursing staff ratings of sleep quality, sleep duration, number of naps, room temperature, sound, or light (P > .05 for all). Nursing staff did report significantly more room entries than caregivers (P = .01). Compared to sleep at home, caregivers reported sleep in the hospital to be of lower quality (P = .009) with more frequent room entries (P = .01). CONCLUSIONS Caregivers rate their child's sleep in the pediatric intensive care unit as lower quality than sleep at home. Caregivers and bedside nursing staff largely agree about pediatric patient sleep quality and quantity as well as environmental factors. This agreement may facilitate further research and interventions at improving sleep in the pediatric intensive care unit. CITATION Witte MA, Lloyd RM, McGree M, Kawai Y. Sleep quantity and quality of critically ill children perceived by caregivers and bedside nursing staff: a pilot study. J Clin Sleep Med. 2023;19(12):2027-2033.
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Affiliation(s)
- Micaela A. Witte
- Department of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Robin M. Lloyd
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michaela McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Yu Kawai
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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26
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Ahn S, Chung ML, Logan JG. Sleep Deficiency by Caregiving Status: Findings From Nationally Representative Data. West J Nurs Res 2023; 45:1120-1129. [PMID: 37902143 DOI: 10.1177/01939459231208416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Caregiving demands may influence caregivers' sleep duration and quality, which are essential for optimal health. We aimed to examine the association between caregiving status and sleep deficiency (i.e., short sleep duration and/or poor quality) and identify factors associated with sleep deficiency among caregivers. METHODS This secondary analysis used data from 3870 adults living in the United States, obtained from the 2019 Health Information National Trends Survey. Multinomial logistic regressions were performed to examine the association between caregiving status (i.e., caregivers vs. non-caregivers) and sleep status (i.e., normal duration-good quality [optimal sleep, reference], short duration-good quality, normal duration-poor quality, and short duration-poor quality), and to identify caregiving-related factors associated with sleep deficiency in the caregiver group. RESULTS Compared to non-caregivers, caregivers were more likely to report short sleep duration (<7 hours) with good quality sleep (relative risk ratio [RRR] = 1.566, 95% CI [1.238, 1.980]) or poor quality sleep (RRR = 1.376, 95% CI [1.034, 1.832]) than the optimal sleep status. Caregivers providing care for ≥20 hours per week (vs. <20 hours) and providing care to individuals with dementia (vs. no dementia caregiving) were 2.8 times more likely to report normal sleep duration with poor sleep quality than optimal sleep (RRR = 2.796, 95% CI [1.125, 6.950]; RRR = 2.776, 95% CI [1.154, 6.675], respectively). CONCLUSION The findings of a higher risk of sleep deficiency among caregivers suggest that health care providers need to assess both caregivers' sleep duration and quality status. Interventions tailored to the caregiving context are also warranted.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
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27
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Lin J, Yao H, Li J, Tian S, Li X, Hou Q. Associations of sleep quality and exercise frequency and the risk of coronary heart disease in Chinese urban elderly: a secondary analysis of cross-sectional data. BMC Public Health 2023; 23:2199. [PMID: 37940903 PMCID: PMC10631020 DOI: 10.1186/s12889-023-17077-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Sleep quality and exercise frequency are closely associated with coronary heart disease (CHD). Few studies focused on the joint effect of initiating sleep, sleep disorders, and exercise frequency on the risk of CHD in the elderly. We used a secondary data analysis based on Boshan Elderly cross-sectional study. We explored the sleep quality, exercise frequency, and their joint effects on the risk of CHD. METHODS We collected 678 participants whose age ≥ 60 years old from Boshan District Hospital. We used the Pittsburgh Sleep Quality Index to evaluate the sleep quality and obtained physical examination information from the hospital. RESULTS Compared with the non-CHD group, patients with CHD spent more time in initiating sleep (time ≥ 60 min, 34.59% vs. 22.93%, P = 0.025) and less time exercising (exercise frequency < 1 times/week, 23.90% vs. 17.15%, P = 0.024). In multiple logistic regression analysis, sleep latency ≥ 60 min was associated with CHD risk (adjusted OR = 1.83; 95% CI: 1.11, 2.99; P-trend = 0.008). The adjusted OR (95% CI) of CHD was 2.24 (1.16, 4.34) for sleep duration < 5 h versus 5-9 h. Compared with exercise frequency < 1 times/week, the adjusted OR for exercise frequency ≥ 1 times/week was 0.46 (95% CI: 0.26, 0.83; P = 0.010). In addition, the joint effects of long sleep latency (≥ 60 min) and sleep disorders were associated with CHD (adjusted OR = 3.36; 95% CI: 1.41, 8.02). The joint effect of exercise frequency ≥ 1 times/week and sleep onset latency within normal limits (< 30 min) was also associated with CHD, and the adjusted OR (95% CI) was 0.42 (0.21, 0.87). CONCLUSIONS Long sleep latency, high frequency of initiating sleep difficulty, sleep disorders, and short sleep duration were positively associated with CHD. In addition, the joint effects of long sleep latency and sleep disorders were positively correlated with CHD incidence. However, the joint effects of exercise frequency ≥ 1 times/week and normal sleep onset latency were negatively associated CHD.
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Affiliation(s)
- Jiujing Lin
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Huichen Yao
- Cardiology Department, The Third Affiliated Hospital of Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jia Li
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shoufeng Tian
- Disease Control and Prevention Center of Jinan Shi Zhong District, Jinan, Shandong, China
| | - Xiaoliang Li
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
| | - Qingzhi Hou
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China.
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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29
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Zhang Y, Zhao W, Liu K, Chen Z, Fei Q, Ahmad N, Yi M. The causal associations of altered inflammatory proteins with sleep duration, insomnia and daytime sleepiness. Sleep 2023; 46:zsad207. [PMID: 37535878 DOI: 10.1093/sleep/zsad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/27/2023] [Indexed: 08/05/2023] Open
Abstract
STUDY OBJECTIVES Growing evidence linked inflammation with sleep. This study aimed to evaluate the associations and causal effects of sleep traits including insomnia, excessive daytime sleepiness (EDS), and sleep duration (short: <7 h; normal: 7-9 h; long: ≥9 h), with levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukins. METHODS Standard procedures of quantitative analysis were applied to estimate the expression differences for each protein in compared groups. Then, a two-sample Mendelian randomization (MR) analysis was performed to explore their causal relationships with published genome-wide association study summary statistics. The inverse-variance weighted was used as the primary method, followed by several complementary approaches as sensitivity analyses. RESULTS A total of 44 publications with 51 879 participants were included in the quantitative analysis. Our results showed that the levels of CRP, interleukin-1β (IL-1β), IL-6, and TNF-α were higher from 0.36 to 0.58 (after standardization) in insomnia compared with controls, while there was no significant difference between participants with EDS and controls. Besides, there was a U/J-shaped expression of CRP and IL-6 with sleep durations. In MR analysis, the primary results demonstrated the causal effects of CRP on sleep duration (estimate: 0.017; 95% confidence intervals [CI], [0.003, 0.031]) and short sleep duration (estimate: -0.006; 95% CI, [-0.011, -0.001]). Also, IL-6 was found to be associated with long sleep duration (estimate: 0.006; 95% CI, [0.000, 0.013]). These results were consistent in sensitivity analyses. CONCLUSIONS There are high inflammatory profiles in insomnia and extremes of sleep duration. Meanwhile, elevated CRP and IL-6 have causal effects on longer sleep duration. Further studies can focus on related upstream and downstream mechanisms.
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Affiliation(s)
- Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wangcheng Zhao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Kun Liu
- School of Life Sciences, Central South University, Changsha, China
| | - Ziliang Chen
- School of Life Sciences, Central South University, Changsha, China
| | - Quanming Fei
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Namra Ahmad
- School of Life Sciences, Central South University, Changsha, China
| | - Minhan Yi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
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30
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Hu J, Lu J, Lu Q, Weng W, Guan Z, Wang Z. Mendelian randomization and colocalization analyses reveal an association between short sleep duration or morning chronotype and altered leukocyte telomere length. Commun Biol 2023; 6:1014. [PMID: 37803147 PMCID: PMC10558505 DOI: 10.1038/s42003-023-05397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Observational studies suggest certain sleep traits are associated with telomere length, but the causal nature of these associations is unclear. The study aimed to determine the causal associations between 11 sleep-related traits and leukocyte telomere length (LTL) through two-sample Mendelian randomization and colocalization analyses using the summary statistics from large-scale genome-wide association studies. Univariable Mendelian randomization indicates that genetically determined short sleep is associated with decreased LTL, while morning chronotype is associated with increased LTL. Multivariable Mendelian randomization further supports the findings and colocalization analysis identifies shared common genetic variants for these two associations. No genetic evidence is observed for associations between other sleep-related traits and LTL. Sensitivity MR methods, reverse MR and re-running MR after removing potential pleiotropic genetic variants enhance the robustness of the results. These findings indicate that prioritizing morning chronotype and avoiding short sleep is beneficial for attenuating telomere attrition. Consequently, addressing sleep duration and chronotype could serve as practical intervention strategies.
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Affiliation(s)
- Jingyi Hu
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Jiawen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Qiuhan Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Weipin Weng
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, China
| | - Zixuan Guan
- Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, 226001, China
| | - Zhenqian Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, 518107, China.
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31
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Kim K, Kim H, Kong J, Kim JB. Enhanced functional connectivity in the reward circuitry in healthy adults with weekend catch-up sleep. Hum Brain Mapp 2023; 44:4927-4937. [PMID: 37466297 PMCID: PMC10472906 DOI: 10.1002/hbm.26429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/16/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
We aimed to identify structural and functional changes in healthy adults with catch-up sleep (CUS), we applied seed-based functional connectivity (FC) analysis using resting-state functional magnetic resonance imaging (MRI). We hypothesized that deficits in reward processing could be a fundamental mechanism underlying the motivation of taking CUS. Then, 55 healthy adults voluntarily (34 with CUS and 21 without CUS) participated in this study. Voxel-based morphometry was performed to explore region of gray matter volume (GMV) difference between CUS and non-CUS groups. Between-group comparison of FC was then carried out using resting-state functional MRI analysis seeding at the region of volume difference. Moreover, the region of volume difference and the strength of FC were correlated with scores of questionnaires for reward-seeking behavior and clinical variables. CUS group had a higher reward-seeking tendency, and increased GMV in the bilateral nucleus accumbens and right superior frontal gyrus relative to non-CUS group. FC analysis seeding at the bilateral accumbens revealed increases of FC in the bilateral medial prefrontal cortex in CUS group compared to non-CUS group. The questionnaire scores reflecting the reward-seeking tendency were correlated with the FC strength between bilateral accumbens and medial prefrontal cortex. Our results indicate that CUS is associated with reward-seeking tendency and increased GMV and FC in regions responsible for reward network. Our findings suggest that enhanced reward network could be the crucial mechanism underlying taking CUS and might be implicated in the detrimental effects of circadian misalignment.
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Affiliation(s)
- Keun‐Tae Kim
- Department of NeurologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
| | - Hayom Kim
- Department of NeurologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
| | - Jooheon Kong
- Department of NeurologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
| | - Jung Bin Kim
- Department of NeurologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
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Pasetes LN, Rosendahl‐Garcia KM, Goel N. Impact of bimonthly repeated total sleep deprivation and recovery sleep on cardiovascular indices. Physiol Rep 2023; 11:e15841. [PMID: 37849046 PMCID: PMC10582224 DOI: 10.14814/phy2.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
Since short sleep duration adversely affects cardiovascular (CV) health, we investigated the effects of exposures to total sleep deprivation (TSD), and baseline (BL) and recovery (REC) sleep on CV measures. We conducted a 5-day experiment at months 2 and 4 in two separate studies (N = 11 healthy adults; 5 females). During these repeated experiments, CV measures [stroke volume (SV), cardiac index (CI), systemic vascular resistance index (SVRI), left ventricular ejection time, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) and mean arterial pressure (MAP)] were collected at three assessment time points after: (1) two BL 8 h time-in-bed (TIB) sleep opportunity nights; (2) a TSD night; and (3) two REC 8-10 h TIB nights. CV measures were also collected pre-study. TSD significantly increased SV and CI, and decreased SVRI, with large effect sizes, which importantly were reversed with recovery, indicating these measures are possible novel biomarkers for assessing the adverse consequences of TSD. Pre-study SV, CI, SVRI, HR, SBP, and MAP measures also significantly associated with TSD CV responses at months 2 and 4 [Pearson's r: 0.615-0.862; r2 : 0.378-0.743], indicating they are robust correlates of future TSD CV responses. Our novel findings highlight the critical impact of sleep on CV health across time.
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Affiliation(s)
- Lauren N. Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | | | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
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Tahsin CT, Michopoulos V, Powers A, Park J, Ahmed Z, Cullen K, Jenkins NDM, Keller-Ross M, Fonkoue IT. Sleep efficiency and PTSD symptom severity predict microvascular endothelial function and arterial stiffness in young, trauma-exposed women. Am J Physiol Heart Circ Physiol 2023; 325:H739-H750. [PMID: 37505472 PMCID: PMC10642999 DOI: 10.1152/ajpheart.00169.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 07/29/2023]
Abstract
Posttraumatic stress disorder (PTSD) is linked to sleep disturbances and significantly higher risk of developing cardiovascular disease (CVD). Furthermore, vascular dysfunction and sleep are independently associated with CVD. Uncovering the link between PTSD symptom severity, sleep disturbances, and vascular function could shine a light on mechanisms of CVD risk in trauma-exposed young women. The purpose of the present study was to investigate the individual and combined effects of sleep efficiency and PTSD symptom severity on vascular function. We recruited 60 otherwise healthy women [age, 26 ± 7 yr and body mass index (BMI), 27.7 ± 6.5 kg/m2] who had been exposed to trauma. We objectively quantified sleep efficiency (SE) using actigraphy, microvascular endothelial function via Framingham reactive hyperemia index (fRHI), and arterial stiffness via pulse-wave velocity (PWV). PTSD symptom severity was assessed using the PTSD checklist for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL5). PWV was correlated with age (r = 0.490, P < 0.001) and BMI (r = 0.484, P < 0.001). In addition, fRHI was positively correlated with SE (r = 0.409, P = 0.001) and negatively correlated with PTSD symptoms (r = -0.382, P = 0.002). To explore the predictive value of SE and PTSD symptoms on PWV and fRHI, we conducted two multivariate linear regression models. The model predicting PWV was significant (R2 = 0.584, P < 0.001) with age, BMI, blood pressure, and SE emerging as predictors. Likewise, the model predicting fRHI was significant (R2 = 0.360, P < 0.001) with both PTSD symptoms and SE as significant predictors. Our results suggest that although PTSD symptoms mainly impact microvascular endothelial function, sleep efficiency is additionally associated with arterial stiffness in young trauma-exposed women, after controlling for age and BMI.NEW & NOTEWORTHY This is the first study to investigate the individual and combined impacts of objective sleep and PTSD symptoms severity on arterial stiffness and microvascular endothelial function in young premenopausal women. We report that in young trauma-exposed women, although low sleep efficiency is associated with overall vascular function (i.e., microvascular endothelial function and arterial stiffness), the severity of PTSD symptoms is specifically associated with microvascular endothelial function, after accounting for age and body mass index.
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Affiliation(s)
- Chowdhury Tasnova Tahsin
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs, Research Service Line, Atlanta Veterans Affairs Healthcare Systems, Decatur, Georgia, United States
| | - Zynab Ahmed
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Kathryn Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Nathaniel D M Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa, United States
| | - Manda Keller-Ross
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Ida T Fonkoue
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
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Chung J, Goodman M, Huang T, Wallace ML, Lutsey PL, Chen JT, Castro-Diehl C, Bertisch S, Redline S. Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis. Sleep 2023; 46:zsad048. [PMID: 37523657 PMCID: PMC10848217 DOI: 10.1093/sleep/zsad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/30/2023] [Indexed: 08/02/2023] Open
Abstract
STUDY OBJECTIVES Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010-2013). 1726 participants were followed for a median of 6.9 years (Q1-Q3, 6.4-7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori. RESULTS After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index. CONCLUSION More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.
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Affiliation(s)
- Joon Chung
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tianyi Huang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, the University of Minnesota, Minneapolis, MN, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Jung E, Ryu HH, Kim SW, Lee JH, Song KJ, Ro YS, Cha KC, Hwang SO. Interaction effects between insomnia and depression on risk of out-of-hospital cardiac arrest: Multi-center study. PLoS One 2023; 18:e0287915. [PMID: 37594944 PMCID: PMC10437782 DOI: 10.1371/journal.pone.0287915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/15/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Insomnia and depression have been known to be risk factors of several diseases, including coronary heart disease. We hypothesized that insomnia affects the out-of-hospital cardiac arrest (OHCA) incidence, and these effects may vary depending on whether it is accompanied by depression. This study aimed to determine the association between insomnia and OHCA incidence and whether the effect of insomnia is influenced by depression. METHODS This prospective multicenter case-control study was performed using Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiology Surveillance (CAPTURES-II) project database for OHCA cases and community-based controls in Korea. The main exposure was history of insomnia. We conducted conditional logistic regression analysis to estimate the effect of insomnia on the risk of OHCA incidence and performed interaction analysis between insomnia and depression. Finally, subgroup analysis was conducted in the patients with insomnia. RESULTS Insomnia was not associated with increased OHCA risk (0.95 [0.64-1.40]). In the interaction analysis, insomnia interacted with depression on OHCA incidence in the young population. Insomnia was associated with significantly higher odds of OHCA incidence (3.65 [1.29-10.33]) in patients with depression than in those without depression (0.84 [0.59-1.17]). In the subgroup analysis, depression increased OHCA incidence only in patients who were not taking insomnia medication (3.66 [1.15-11.66]). CONCLUSION Insomnia with depression is a risk factor for OHCA in the young population. This trend was maintained only in the population not consuming insomnia medication. Early and active medical intervention for patients with insomnia may contribute to lowering the risk of OHCA.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Medicine, Chonnam National University, Gwangju, Korea
| | - Sung Wan Kim
- Department of Psychiartry, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Ho Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Chernyshev OY. Sleep Deprivation and Its Consequences. Continuum (Minneap Minn) 2023; 29:1234-1252. [PMID: 37590831 DOI: 10.1212/con.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews the clinical, cognitive, behavioral, and physiologic consequences of sleep deprivation in relation to general neurology practice. LATEST DEVELOPMENTS Despite being one of the most common sleep problems in modern society, the role of sleep deprivation is underrecognized and underestimated in clinical medicine and general neurology practice. The recognition, diagnosis, and management of sleep deprivation in neurologic practice have only recently received close attention. The consequences of sleep deprivation involve all aspects of general neurology practice, including individuals with neurologic disease, neurologists, communities, and health care systems. The identification and timely management of sleep deprivation symptoms may help to improve symptoms of underlying primary neurologic disorders. ESSENTIAL POINTS This article emphasizes complexities related to the identification and evaluation of sleep deprivation in general neurology practice and describes the consequences of sleep deprivation. By recognizing sleep deprivation in patients with neurologic conditions, the neurologist can provide comprehensive care and contribute to improved clinical and neurologic outcomes.
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Sawadogo W, Adera T, Alattar M, Perera R, Burch JB. Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study. Neurology 2023; 101:e475-e488. [PMID: 37286360 PMCID: PMC10401688 DOI: 10.1212/wnl.0000000000207449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. METHODS The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. RESULTS A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. DISCUSSION Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.
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Affiliation(s)
- Wendemi Sawadogo
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond.
| | - Tilahun Adera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Maha Alattar
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - Robert Perera
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
| | - James B Burch
- From the Division of Epidemiology (W.S., T.A., J.B.B.), Department of Family Medicine and Population Health, and Division of Adult Neurology (M.A.), Sleep Medicine, Vascular Neurology, Department of Neurology; and Department of Biostatistics (R.P.), Virginia Commonwealth University, School of Medicine, Richmond
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Pasetes LN, Rosendahl-Garcia KM, Goel N. Cardiovascular measures display robust phenotypic stability across long-duration intervals involving repeated sleep deprivation and recovery. Front Neurosci 2023; 17:1201637. [PMID: 37547137 PMCID: PMC10397520 DOI: 10.3389/fnins.2023.1201637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction We determined whether cardiovascular (CV) measures show trait-like responses after repeated total sleep deprivation (TSD), baseline (BL) and recovery (REC) exposures in two long-duration studies (total N = 11 adults). Methods A 5-day experiment was conducted twice at months 2 and 4 in a 4-month study (N = 6 healthy adults; 3 females; mean age ± SD, 34.3 ± 5.7 years; mean BMI ± SD, 22.5 ± 3.2 kg/m2), and three times at months 2, 4, and 8 in an 8-month study (N = 5 healthy adults; 2 females; mean age ± SD, 33.6 ± 5.17 years; mean BMI ± SD, 27.1 ± 4.9 kg/m2). Participants were not shift workers or exposed to TSD in their professions. During each experiment, various seated and standing CV measures were collected via echocardiography [stroke volume (SV), heart rate (HR), cardiac index (CI), left ventricular ejection time (LVET), and systemic vascular resistance index (SVRI)] or blood pressure monitor [systolic blood pressure (SBP)] after (1) two BL 8h time in bed (TIB) nights; (2) an acute TSD night; and (3) two REC 8-10 h TIB nights. Intraclass correlation coefficients (ICCs) assessed CV measure stability during BL, TSD, and REC and for the BL and REC average (BL + REC) across months 2, 4, and 8; Spearman's rho assessed the relative rank of individuals' CV responses across measures. Results Seated BL (0.693-0.944), TSD (0.643-0.962) and REC (0.735-0.960) CV ICCs showed substantial to almost perfect stability and seated BL + REC CV ICCs (0.552-0.965) showed moderate to almost perfect stability across months 2, 4, and 8. Individuals also exhibited significant, consistent responses within seated CV measures during BL, TSD, and REC. Standing CV measures showed similar ICCs for BL, TSD, and REC and similar response consistency. Discussion This is the first demonstration of remarkably robust phenotypic stability of a number of CV measures in healthy adults during repeated TSD, BL and REC exposures across 2, 4, and 8 months, with significant consistency of responses within CV measures. The cardiovascular measures examined in our studies, including SV, HR, CI, LVET, SVRI, and SBP, are useful biomarkers that effectively track physiology consistently across long durations and repeated sleep deprivation and recovery.
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Affiliation(s)
- Lauren N. Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | | | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Xu Y, Qu B, Liu F, Gong Z, Zhang Y, Xu D. Sleep Deprivation and Heart Rate Variability in Healthy Volunteers: Effects of REM and SWS Sleep Deprivation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:7121295. [PMID: 37469834 PMCID: PMC10353901 DOI: 10.1155/2023/7121295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 07/21/2023]
Abstract
Objective Using PSG-guided acute selective REM/SWS sleep deprivation in volunteers, this study examined the effects of sleep deprivation on the cardiovascular and autonomic nervous systems, as well as the relationship between cardiac neuromodulation homeostasis and cardiovascular disease. Methods An experiment was conducted using 30 healthy volunteers (male : female = 1 : 1, aged 26.33 ± 4.5 years) divided into groups for sleep deprivation of SWS and REM sleep, and then, each group was crossed over for normal sleep (2 days) and repeated sleep deprivation (1 day, 3 times). During the study period, PSG and ELECTRO ECG monitoring were conducted, and five-minute frequency domain parameters and blood pressure values were measured before and after sleep deprivation. Results Changes in VLF, LFnu, LF/HF, HF, and HFnu after SWS sleep deprivation were statistically significant (P < 0.05), but not LF (P = 0.063). Changes in VLF, LF, HF, LF/HF, LFnu, and HFnu after REM sleep deprivation were not statistically significant (P > 0.05). Conclusions An increase in sympathetic nerve activity results from sleep deprivation and sudden awakening from SWS sleep is associated with a greater risk of cardiovascular disease.
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Affiliation(s)
- YaHui Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - BinBin Qu
- Department of Respiratory and Critical Care Medicine, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - FengJuan Liu
- Clinical Trial Research Center, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - ZhiHua Gong
- Electrocardiogram Department, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yi Zhang
- Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, China
| | - DeXiang Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong, China
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Nakari I, Takadama K. Personalized Non-contact Sleep Stage Estimation with Weighted Probability Estimation by Ultradian Rhythm. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082968 DOI: 10.1109/embc40787.2023.10340252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This paper focused on ultradian rhythms (a sleep cycle of approximately 60 to 120 minute) for personalizing sleep stage estimation, and proposed a personalized sleep stage estimation method that weights the results estimated by machine learning with the predicted ultradian rhythms. The ultradian rhythms are predicted by the body movement density which is correlated with ultradian rhythm. To investigate the effectiveness of the proposed method, this paper conducts human subjects experiment for eight subjects.Clinical relevance- The proposed method is compared with the results estimated by conventional ML, and the result of the proposed method is competitive with their conventional counterparts. This indicates that the ultradian rhythm has the potential for developing personalized sleep stage estimation.
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Lyons LC, Vanrobaeys Y, Abel T. Sleep and memory: The impact of sleep deprivation on transcription, translational control, and protein synthesis in the brain. J Neurochem 2023; 166:24-46. [PMID: 36802068 PMCID: PMC10919414 DOI: 10.1111/jnc.15787] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
In countries around the world, sleep deprivation represents a widespread problem affecting school-age children, teenagers, and adults. Acute sleep deprivation and more chronic sleep restriction adversely affect individual health, impairing memory and cognitive performance as well as increasing the risk and progression of numerous diseases. In mammals, the hippocampus and hippocampus-dependent memory are vulnerable to the effects of acute sleep deprivation. Sleep deprivation induces changes in molecular signaling, gene expression and may cause changes in dendritic structure in neurons. Genome wide studies have shown that acute sleep deprivation alters gene transcription, although the pool of genes affected varies between brain regions. More recently, advances in research have drawn attention to differences in gene regulation between the level of the transcriptome compared with the pool of mRNA associated with ribosomes for protein translation following sleep deprivation. Thus, in addition to transcriptional changes, sleep deprivation also affects downstream processes to alter protein translation. In this review, we focus on the multiple levels through which acute sleep deprivation impacts gene regulation, highlighting potential post-transcriptional and translational processes that may be affected by sleep deprivation. Understanding the multiple levels of gene regulation impacted by sleep deprivation is essential for future development of therapeutics that may mitigate the effects of sleep loss.
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Affiliation(s)
- Lisa C Lyons
- Program in Neuroscience, Department of Biological Science, Florida State University, Tallahassee, Florida, USA
| | - Yann Vanrobaeys
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, Iowa City, Iowa, USA
- Interdisciplinary Graduate Program in Genetics, University of Iowa, Iowa City, Iowa, USA
| | - Ted Abel
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, Iowa City, Iowa, USA
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane R, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults. J Clin Sleep Med 2023; 19:1303-1311. [PMID: 37279079 PMCID: PMC10315594 DOI: 10.5664/jcsm.10588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? METHODS This was a cross-sectional survey of a diverse sample of 15,057 US adults. RESULTS COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. CONCLUSIONS In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization. CITATION Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Kyle Martin W, Schladweiler MC, Oshiro W, Smoot J, Fisher A, Williams W, Valdez M, Miller CN, Jackson TW, Freeborn D, Kim YH, Davies D, Ian Gilmour M, Kodavanti U, Kodavanti P, Hazari MS, Farraj AK. Wildfire-related smoke inhalation worsens cardiovascular risk in sleep disrupted rats. FRONTIERS IN ENVIRONMENTAL HEALTH 2023; 2:1166918. [PMID: 38116203 PMCID: PMC10726696 DOI: 10.3389/fenvh.2023.1166918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction As a lifestyle factor, poor sleep status is associated with increased cardiovascular morbidity and mortality and may be influenced by environmental stressors, including air pollution. Methods To determine whether exposure to air pollution modified cardiovascular effects of sleep disruption, we evaluated the effects of single or repeated (twice/wk for 4 wks) inhalation exposure to eucalyptus wood smoke (ES; 964 μg/m3 for 1 h), a key wildland fire air pollution source, on mild sleep loss in the form of gentle handling in rats. Blood pressure (BP) radiotelemetry and echocardiography were evaluated along with assessments of lung and systemic inflammation, cardiac and hypothalamic gene expression, and heart rate variability (HRV), a measure of cardiac autonomic tone. Results and Discussion GH alone disrupted sleep, as evidenced by active period-like locomotor activity, and increases in BP, heart rate (HR), and hypothalamic expression of the circadian gene Per2. A single bout of sleep disruption and ES, but neither alone, increased HR and BP as rats transitioned into their active period, a period aligned with a critical early morning window for stroke risk in humans. These responses were immediately preceded by reduced HRV, indicating increased cardiac sympathetic tone. In addition, only sleep disrupted rats exposed to ES had increased HR and BP during the final sleep disruption period. These rats also had increased cardiac output and cardiac expression of genes related to adrenergic function, and regulation of vasoconstriction and systemic blood pressure one day after final ES exposure. There was little evidence of lung or systemic inflammation, except for increases in serum LDL cholesterol and alanine aminotransferase. These results suggest that inhaled air pollution increases sleep perturbation-related cardiovascular risk, potentially in part by increased sympathetic activity.
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Affiliation(s)
- W. Kyle Martin
- Curriculum in Toxicology and Environmental Medicine, UNC, Chapel Hill, NC, United States
| | - M. C. Schladweiler
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Oshiro
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - J. Smoot
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - A. Fisher
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Williams
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Valdez
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - C. N. Miller
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - T. W. Jackson
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Freeborn
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - Y. H. Kim
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Davies
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Ian Gilmour
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - U. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - P. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. S. Hazari
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - A. K. Farraj
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
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Wright CJ, Milosavljevic S, Pocivavsek A. The stress of losing sleep: Sex-specific neurobiological outcomes. Neurobiol Stress 2023; 24:100543. [PMID: 37252645 PMCID: PMC10209346 DOI: 10.1016/j.ynstr.2023.100543] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Sleep is a vital and evolutionarily conserved process, critical to daily functioning and homeostatic balance. Losing sleep is inherently stressful and leads to numerous detrimental physiological outcomes. Despite sleep disturbances affecting everyone, women and female rodents are often excluded or underrepresented in clinical and pre-clinical studies. Advancing our understanding of the role of biological sex in the responses to sleep loss stands to greatly improve our ability to understand and treat health consequences of insufficient sleep. As such, this review discusses sex differences in response to sleep deprivation, with a focus on the sympathetic nervous system stress response and activation of the hypothalamic-pituitary-adrenal (HPA) axis. We review sex differences in several stress-related consequences of sleep loss, including inflammation, learning and memory deficits, and mood related changes. Focusing on women's health, we discuss the effects of sleep deprivation during the peripartum period. In closing, we present neurobiological mechanisms, including the contribution of sex hormones, orexins, circadian timing systems, and astrocytic neuromodulation, that may underlie potential sex differences in sleep deprivation responses.
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Affiliation(s)
| | | | - Ana Pocivavsek
- Corresponding author. Pharmacology, Physiology, and Neuroscience, USC School of Medicine, Columbia, SC, 29208, USA.
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45
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Khosroazad S, Abedi A, Hayes MJ. Sleep Signal Analysis for Early Detection of Alzheimer's Disease and Related Dementia (ADRD). IEEE J Biomed Health Inform 2023; 27:2264-2275. [PMID: 37018587 PMCID: PMC10243301 DOI: 10.1109/jbhi.2023.3235391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Alzheimer's Disease and Related Dementia (ADRD) is growing at alarming rates, putting research and development of diagnostic methods at the forefront of the biomedical research community. Sleep disorder has been proposed as an early sign of Mild Cognitive Impairment (MCI) in Alzheimer's disease. Although several clinical studies have been conducted to assess sleep and association with early MCI, reliable and efficient algorithms to detect MCI in home-based sleep studies are needed in order to address both healthcare costs and patient discomfort in hospital/lab-based sleep studies. METHODS In this paper, an innovative MCI detection method is proposed using an overnight recording of movements associated with sleep combined with advanced signal processing and artificial intelligence. A new diagnostic parameter is introduced which is extracted from the correlation between high frequency, sleep-related movements and respiratory changes during sleep. The newly defined parameter, Time-Lag (TL), is proposed as a distinguishing criterion that indicates movement stimulation of brainstem respiratory regulation that may modulate hypoxemia risk during sleep and serve as an effective parameter for early detection of MCI in ADRD. By implementing Neural Networks (NN) and Kernel algorithms with choosing TL as the principle component in MCI detection, high sensitivity (86.75% for NN and 65% for Kernel method), specificity (89.25% and 100%), and accuracy (88% and 82.5%) have been achieved.
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46
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Khosroazad S, Gilbert CF, Aronis JB, Daigle KM, Esfahani M, Almaghasilah A, Ahmed FS, Elias MF, Meuser TM, Kaye LW, Singer CM, Abedi A, Hayes MJ. Sleep movements and respiratory coupling as a biobehavioral metric for early Alzheimer's disease in independently dwelling adults. BMC Geriatr 2023; 23:252. [PMID: 37106470 PMCID: PMC10141904 DOI: 10.1186/s12877-023-03983-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Sleep disorder is often the first symptom of age-related cognitive decline associated with Alzheimer's disease (AD) observed in primary care. The relationship between sleep and early AD was examined using a patented sleep mattress designed to record respiration and high frequency movement arousals. A machine learning algorithm was developed to classify sleep features associated with early AD. METHOD Community-dwelling older adults (N = 95; 62-90 years) were recruited in a 3-h catchment area. Study participants were tested on the mattress device in the home bed for 2 days, wore a wrist actigraph for 7 days, and provided sleep diary and sleep disorder self-reports during the 1-week study period. Neurocognitive testing was completed in the home within 30-days of the sleep study. Participant performance on executive and memory tasks, health history and demographics were reviewed by a geriatric clinical team yielding Normal Cognition (n = 45) and amnestic MCI-Consensus (n = 33) groups. A diagnosed MCI group (n = 17) was recruited from a hospital memory clinic following diagnostic series of neuroimaging biomarker assessment and cognitive criteria for AD. RESULTS In cohort analyses, sleep fragmentation and wake after sleep onset duration predicted poorer executive function, particularly memory performance. Group analyses showed increased sleep fragmentation and total sleep time in the diagnosed MCI group compared to the Normal Cognition group. Machine learning algorithm showed that the time latency between movement arousals and coupled respiratory upregulation could be used as a classifier of diagnosed MCI vs. Normal Cognition cases. ROC diagnostics identified MCI with 87% sensitivity; 89% specificity; and 88% positive predictive value. DISCUSSION AD sleep phenotype was detected with a novel sleep biometric, time latency, associated with the tight gap between sleep movements and respiratory coupling, which is proposed as a corollary of sleep quality/loss that affects the autonomic regulation of respiration during sleep. Diagnosed MCI was associated with sleep fragmentation and arousal intrusion.
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Affiliation(s)
- Somayeh Khosroazad
- Electrical and Computer Engineering, University of Maine, 5708 Barrows Hall, Orono, ME, 04469, USA
- Activas Diagnostics, LLC, 20 Godfrey Dr., Orono, ME, 04473, USA
| | - Christopher F Gilbert
- Activas Diagnostics, LLC, 20 Godfrey Dr., Orono, ME, 04473, USA
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA
| | - Jessica B Aronis
- Activas Diagnostics, LLC, 20 Godfrey Dr., Orono, ME, 04473, USA
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA
| | - Katrina M Daigle
- Psychology Department, Suffolk University, 73 Tremont St., Boston, MA, 02108, USA
| | | | - Ahmed Almaghasilah
- Electrical and Computer Engineering, University of Maine, 5708 Barrows Hall, Orono, ME, 04469, USA
- Graduate School of Biomedical Science & Engineering, University of Maine, 5775 Stodder Hall, Orono, ME, 04469, USA
| | - Fayeza S Ahmed
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA
| | - Merrill F Elias
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA
| | - Thomas M Meuser
- Center for Excellence On Aging, University of New England, 11 Hills Beach Rd., Biddeford, ME, 04005, USA
| | - Leonard W Kaye
- Center On Aging, University of Maine, 327 Camden Hall, Orono, ME, 04469, USA
| | - Clifford M Singer
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA
- Mood and Memory Clinic, Northern Light Health, 269 Stillwater Ave., Bangor, ME, 04402, USA
| | - Ali Abedi
- Electrical and Computer Engineering, University of Maine, 5708 Barrows Hall, Orono, ME, 04469, USA
- Activas Diagnostics, LLC, 20 Godfrey Dr., Orono, ME, 04473, USA
| | - Marie J Hayes
- Activas Diagnostics, LLC, 20 Godfrey Dr., Orono, ME, 04473, USA.
- Psychology Department, University of Maine, 5740 Beryl Warner Williams Hall, Orono, ME, 5740-04469, USA.
- Graduate School of Biomedical Science & Engineering, University of Maine, 5775 Stodder Hall, Orono, ME, 04469, USA.
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Benjamin DG, Gummanur P. Loneliness - Cancer of the Mind. Indian J Palliat Care 2023; 29:212-216. [PMID: 37325265 PMCID: PMC10261937 DOI: 10.25259/ijpc_200_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
World is greying as the proportion of the ageing population increases and the demography is changing both in the developing and developed world. Contact between people is the central part of everyone's life and the glue that holds communities and society together. Lack of social relations is considered to cause loneliness and isolation for the individual and, simultaneously, on a societal level, leads to marginalisation, social disintegration and diminishing trust between people. This has come to sharp focus during the corona pandemic. Meaningful social connections are central to the physical and mental health of human beings. Off late, the deleterious health implication of social isolation and loneliness has increasingly been noticed, with a higher risk of premature death and accelerated risks of coronary heart disease, stroke, depression, and dementia. Worldwide, there is an increasing awareness regarding the alarming consequences of loneliness, especially among older adults. In response, 2018 saw the launch of a UK loneliness strategy and the first minister for loneliness in the world appointed.
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Affiliation(s)
| | - Priyasha Gummanur
- Department of Geriatrics, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
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Liu D, Niu Y, Duan Y, Wang J, Yan G. Association of 3-year change in sleep duration with risk of all-cause mortality in Chinese older population: A national cohort study. Sleep Med 2023; 105:25-31. [PMID: 36940517 DOI: 10.1016/j.sleep.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Existing evidence on the association of dynamic change in sleep duration with risk of all-cause mortality in Chinese older population is limited. We aimed to explore the association of 3-year change in sleep duration with risk of all-cause mortality in a Chinese older population. MATERIALS AND METHODS A total of 5772 Chinese older participants (median age 82 years) were enrolled in the current study. Cox proportional-hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of 3-year change in sleep duration with risk of all-cause mortality. Subgroup analyses of the association between 3-year change in sleep duration and risk of all-cause mortality were conducted by age, sex and residence. RESULTS During a median of 4.08 years of follow-up, death developed in 1762 participants. Compared with -1 to <1 h/day change in sleep duration, the adjusted risk of all-cause mortality with < -3 h/day change in sleep duration may increase 26% (HR = 1.26, 95% CI: 1.05-1.52); the risk of all-cause mortality with 3-year change from short to long sleep duration, or long to short sleep duration versus stable normal sleep duration status was increased about 28% and 52%, respectively (HR = 1.28, 95% CI: 1.00-1.64 and HR = 1.52, 95% CI: 1.21-1.92). Subgroup analyses demonstrated that similar significant associations were observed among participants with 65 to <85 years, men and living in city and town. CONCLUSIONS Dynamic sleep duration change was significantly associated with risk of all-cause mortality. The current study suggests that sleep duration may be a non-invasive indicator for interventions aiming to reduction risk of all-cause mortality in Chinese older population.
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Affiliation(s)
- Dechen Liu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yuqi Niu
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yingqi Duan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Jinjin Wang
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Guoli Yan
- School of Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China.
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Guo X, Qin Z, Meng C, Lv J, Hu Y, Fei J, Liang L, Li J, Yuan T, Mei S, Tong Q. Investigation of the Sleep Quality Among Hospitalized Cardiovascular Patients Using Regression Models and Qualitative Comparative Analysis. Clin Nurs Res 2023; 32:580-588. [PMID: 36633212 DOI: 10.1177/10547738221148150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aimed to explore the relationships between modifiable and non-modifiable factors that influence sleep quality in hospitalized patients with cardiovascular disease in China. This study design was cross-sectional and descriptive. This study involved a convenience sample of 242 patients hospitalized for cardiovascular issues. Hierarchical regression model and qualitative comparative analysis model were performed. Regression revealed that age and depression both had statistically significant effects on sleep quality. The combination of conditions with strongest predictive effect on sleep quality was male of younger age, high level of depression, high level of anxiety, and low level of social support. Other combinations with predictive power on sleep quality are as follows: (1) younger male patients (aged 47-63 years) with high level of anxiety, high level of social support, and low level of depression; (2) older male patients (aged 63-79 years) with high level of depression, high level of social support, and low levels of anxiety; and (3) older male patients with high level of anxiety and low level of social support. Nurses may promote primary and secondary prevention of cardiovascular health prior to hospitalization, through routine screening for depressive and anxious symptoms and assessment of the patient's social support network. It is unknown whether these findings are unique to hospitalized patients. Therefore, future work should assess the fit of the model to other more diverse groups of hospitalized patients.
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Affiliation(s)
- Xinmeng Guo
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Zeying Qin
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Cuicui Meng
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jianping Lv
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yueyang Hu
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Junsong Fei
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Leilei Liang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jingyang Li
- First Hospital, Jilin University, Changchun, Jilin Province, China
| | - Tongshuang Yuan
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Songli Mei
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Tong
- First Hospital, Jilin University, Changchun, Jilin Province, China
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50
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Yuan S, Levin MG, Titova OE, Chen J, Sun Y, Million Veteran Program VA, Åkesson A, Li X, Damrauer SM, Larsson SC. Sleep duration, daytime napping, and risk of peripheral artery disease: multinational cohort and Mendelian randomization studies. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead008. [PMID: 36936389 PMCID: PMC10017627 DOI: 10.1093/ehjopen/oead008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/02/2023] [Indexed: 03/18/2023]
Abstract
Aims Sleep duration has been associated with cardiovascular disease, however the effect of sleep on peripheral artery disease (PAD) specifically remains unestablished. We conducted observational and Mendelian randomization (MR) analyses to assess the associations of sleep duration and daytime napping with PAD risk. Methods and results Sleep traits were assessed for associations with incident PAD using cohort analysis among 53 416 Swedish adults. Replicated was sought in a case-control study of 28 123 PAD cases and 128 459 controls from the veterans affairs Million Veteran Program (MVP) and a cohort study of 452 028 individuals from the UK Biobank study (UKB). Two-sample Mendelian randomization (MR) was used for casual inference-based analyses of sleep-related traits and PAD (31 307 PAD cases 211 753 controls). Observational analyses demonstrated a U-shaped association between sleep duration and PAD risk. In Swedish adults, incident PAD risk was higher in those with short sleep [<5 h; hazard ratio (HR) 1.74; 95% confidence interval (CI) 1.31-2.31] or long sleep (≥8 h; HR 1.24; 95% CI 1.08-1.43), compared to individuals with a sleep duration of 7 to <8 h/night. This finding was supported by the analyses in MVP and UKB. Observational analysis also revealed positive associations between daytime napping (HR 1.32, 95% CI 1.18-1.49) with PAD. MR analysis supported an inverse association between sleep duration [odds ratio (OR) per hour increase: 0.79, 95% CI, 0.55, 0.89] and PAD and an association between short sleep and increased PAD (OR 1.20, 95% CI, 1.04-1.38). Conclusion Short sleep duration was associated with an increased risk of PAD.
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Affiliation(s)
| | | | - Olga E Titova
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Dag Hammarskjölds Väg 36, 752 37 Uppsala, Sweden
| | - Jie Chen
- Centre for Global Health, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, P.R. China
| | - Yuhao Sun
- Centre for Global Health, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, P.R. China
| | | | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, Stockholm, 17177, Stockholm, Sweden
| | - Xue Li
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, P.R. China
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