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Howell SN, Griesbach GS. Sex Differences in Sleep Architecture After Traumatic Brain Injury: Potential Implications on Short-Term Episodic Memory and Recovery. Neurotrauma Rep 2024; 5:3-12. [PMID: 38249321 PMCID: PMC10797171 DOI: 10.1089/neur.2023.0093] [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] [Indexed: 01/23/2024] Open
Abstract
Sleep-wake disturbances (SWDs) are common after TBI and often extend into the chronic phase of recovery. Such disturbances in sleep can lead to deficits in executive functioning, attention, and memory consolidation, which may ultimately impact the recovery process. We examined whether SWDs post-TBI were associated with morbidity during the post-acute period. Particular attention was placed on the impact of sleep architecture on learning and memory. Because women are more likely to report SWDs, we examined sex as a biological variable. We also examined subjective quality of life, depression, and disability levels. Data were retrospectively analyzed for 57 TBI patients who underwent an overnight polysomnography. Medical records were reviewed to determine cognitive and functional status during the period of the sleep evaluation. Consideration was given to medications, owing to the fact that a high number of these are likely to have secondary influences on sleep characteristics. Women showed higher levels of disability and reported more depression and lower quality of life. A sex-dependent disruption in sleep architecture was observed, with women having lower percent time in REM sleep. An association between percent time in REM and better episodic memory scores was found. Melatonin utilization had a positive impact on REM duration. Improvements in understanding the impact of sleep-wake disturbances on post-TBI outcome will aid in defining targeted interventions for this population. Findings from this study support the hypothesis that decreases in REM sleep may contribute to chronic disability and underlie the importance of considering sex differences when addressing sleep.
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Affiliation(s)
| | - Grace S. Griesbach
- Centre for Neuro Skills, Bakersfield, California, USA
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [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: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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Dorsey A, de Lecea L, Jennings KJ. Neurobiological and Hormonal Mechanisms Regulating Women's Sleep. Front Neurosci 2021; 14:625397. [PMID: 33519372 PMCID: PMC7840832 DOI: 10.3389/fnins.2020.625397] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023] Open
Abstract
Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.
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Affiliation(s)
| | | | - Kimberly J. Jennings
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Alterations of neural network organization during REM sleep in women: implication for sex differences in vulnerability to mood disorders. Biol Sex Differ 2020; 11:22. [PMID: 32334638 PMCID: PMC7183628 DOI: 10.1186/s13293-020-00297-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background Sleep plays an important role in vulnerability to mood disorders. However, despite the existence of sex differences in vulnerability to mood disorders, no study has yet investigated the sex effect on sleep network organization and its potential involvement in vulnerability to mood disorders. The aim of our study was to empirically investigate the sex effect on network organization during REM and slow-wave sleep using the effective connectivity measured by Granger causality. Methods Polysomnographic data from 44 healthy individuals (28 men and 16 women) recruited prospectively were analysed. To obtain the 19 × 19 connectivity matrix of all possible pairwise combinations of electrodes by Granger causality method from our EEG data, we used the Toolbox MVGC multivariate Granger causality. The computation of the network measures was realized by importing these connectivity matrices into EEGNET Toolbox. Results In men and women, all small-world coefficients obtained are compatible with a small-world network organization during REM and slow-wave sleep. However, compared to men, women present greater small-world coefficients during REM sleep as well as for all EEG bands during this sleep stage, which indicates the presence of a small-world network organization less marked during REM sleep as well as for all EEG bands during this sleep stage in women. In addition, in women, these small-world coefficients during REM sleep as well as for all EEG bands during this sleep stage are positively correlated with the presence of subclinical symptoms of depression. Conclusions Thus, the highlighting of these sex differences in network organization during REM sleep indicates the presence of differences in the global and local processing of information during sleep between women and men. In addition, this small-world network organization less marked during REM sleep appears to be a marker of vulnerability to mood disorders specific to women, which opens up new perspectives in understanding sex differences in the occurrence of mood disorders.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Gwénolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Route de Lennik, 808, 1070 Anderlecht, Brussels, Belgium
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The Measurement of Orthopaedic Surgeon Quality and Quantity of Sleep Using a Validated Wearable Device. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e065. [PMID: 30656253 PMCID: PMC6324888 DOI: 10.5435/jaaosglobal-d-18-00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Recurrent episodes of partial sleep deprivation resulting from shift work or call schedules are commonly seen in physicians. This study measures the quantity and quality of sleep in orthopaedic surgeons and determines the factors that are correlated with decreased quantity and quality of sleep. Methods: Orthopaedic surgery residents and attending surgeons at a single institution were prospectively enrolled and provided with a validated wearable device to objectively determine sleep quantity (total hours of sleep) and quality (sleep disturbances; sleep latency; sleep efficiency; and amount of rapid eye movement [REM] sleep, deep sleep, and light sleep). Sleep deprivation was defined as getting less than 7 hours of sleep per day. Bivariate correlations were determined using Spearman rank correlation. Multiple linear regression models were constructed to determine the effect of independent variables (age, attending physician, resident, postgraduate year [PGY] level, sex, number of calls, and total hours worked) and sleep quantity and quality. All P values were reported, and a significance level of α = 0.05 was used (ie, P < 0.05). Results: Of 26 enrolled subjects, 21 (80.8%; 12 residents and 9 attending surgeons, where 15 were men and 6 women, with mean age of 37.2 ± 10.9 years) completed the 4-week duration of the study. Orthopaedic surgeons obtained 6.5 ± 0.8 hours of sleep per night (17.7% REM, 19.4% deep sleep, and 62.6% light sleep; 4.5 ± 1.1 minutes of sleep latency; 4.9 ± 1.7 sleep disturbances; and 89.9% sleep efficiency). Fourteen orthopaedic surgeons (66.7%) of the 21 slept less than the recommended 7 hours of sleep per night. The total hours worked had a moderate negative correlation (r = −0.550; P = 0.010) with total sleep. PGY level had a moderate positive correlation with sleep latency (r = 0.546; P = 0.010). Discussion: Diminished sleep quantity is considered sleeping less than 7 hours per night, whereas decreased sleep quality is associated with decreased REM sleep, decreased deep sleep, increased light sleep, decreased sleep latency, decreased sleep efficiency, and increased sleep disturbances. Sleep deprivation in orthopaedic surgeons poses notable health and safety risks for both surgeons and patients. Conclusion: Orthopaedic surgeons demonstrate poor sleep quantity and quality which is markedly worse than the general population, with increased work hours markedly correlated with decreased hours of sleep.
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Morselli LL, Temple KA, Leproult R, Ehrmann DA, Van Cauter E, Mokhlesi B. Determinants of Slow-Wave Activity in Overweight and Obese Adults: Roles of Sex, Obstructive Sleep Apnea and Testosterone Levels. Front Endocrinol (Lausanne) 2018; 9:377. [PMID: 30050500 PMCID: PMC6052085 DOI: 10.3389/fendo.2018.00377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/22/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Slow-wave activity (SWA) in non-rapid eye movement (NREM) sleep, obtained by spectral analysis of the electroencephalogram, is a marker of the depth or intensity of NREM sleep. Higher levels of SWA are associated with lower arousability during NREM sleep and protect against sleep fragmentation. Multiple studies have documented that SWA levels are higher in lean women, compared to age-matched lean men, but whether these differences persist in obese subjects is unclear. Obstructive sleep apnea (OSA), a condition associated with obesity, is more prevalent in men than in women. Sex differences in SWA could therefore be one of the factors predisposing men to OSA. Furthermore, we hypothesized that higher levels of testosterone may be associated with lower levels of SWA. Objective: The aim of the current study was to identify sex differences in the determinants of SWA in young and middle-aged overweight and obese adults. Methods: We enrolled 101 overweight and obese but otherwise healthy participants from the community (44 men, 57 women) in this cross-sectional study. Participants underwent an overnight in-laboratory polysomnogram. The recordings were submitted to sleep staging and spectral analysis. Sex differences and the potential contribution of testosterone levels were evaluated after adjusting for age, body mass index and race/ethnicity. Results: OSA was present in 66% of men and in 44% of women. After adjustment for differences in age, race/ethnicity and BMI, the odds ratio for OSA in men vs. women was 3.17 (95% CI 1.14-9.43, p = 0.027). There was a graded inverse relationship between the apnea-hypopnea index (AHI) and SWA in men (β = -0.21, p = 0.018) but not in women (β = 0.10, p = 0.207). In a multivariate regression model, higher testosterone levels were independently associated with lower SWA in men after controlling for age, race/ethnicity and apnea-hypopnea index (β = -0.56, p = 0.025). Conclusion: Increasing severity of OSA was associated with significant decrease in sleep intensity in men but not in women. Higher testosterone levels were associated with lower sleep intensity in men. Men with higher testosterone levels may therefore have lower arousal thresholds and higher ventilatory instability in NREM sleep, and be at greater risk of OSA.
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Affiliation(s)
- Lisa L. Morselli
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Karla A. Temple
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Rachel Leproult
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
| | - David A. Ehrmann
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Eve Van Cauter
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Babak Mokhlesi
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, United States
- *Correspondence: Babak Mokhlesi
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Steinach M, Kohlberg E, Maggioni MA, Mendt S, Opatz O, Stahn A, Gunga HC. Sleep Quality Changes during Overwintering at the German Antarctic Stations Neumayer II and III: The Gender Factor. PLoS One 2016; 11:e0150099. [PMID: 26918440 PMCID: PMC4769303 DOI: 10.1371/journal.pone.0150099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Antarctic residence holds many challenges to human physiology, like increased psycho-social tension and altered circadian rhythm, known to influence sleep. We assessed changes in sleep patterns during 13 months of overwintering at the German Stations Neumayer II and III from 2008 to 2014, with focus on gender, as many previous investigations were inconclusive regarding gender-based differences or had only included men. Materials & Methods Time in bed, sleep time, sleep efficiency, number of arousals, sleep latency, sleep onset, sleep offset, and physical activity level were determined twice per month during seven overwintering campaigns of n = 54 participants (37 male, 17 female) using actimetry. Data were analyzed using polynomial regression and analysis of covariance for change over time with the covariates gender, inhabited station, overwintering season and influence of physical activity and local sunshine radiation. Results We found overall longer times in bed (p = 0.004) and sleep time (p = 0.014) for women. The covariate gender had a significant influence on time in bed (p<0.001), sleep time (p<0.001), number of arousals (p = 0.04), sleep latency (p = 0.04), and sleep onset (p<0.001). Women separately (p = 0.02), but not men (p = 0.165), showed a linear increase in number of arousals. Physical activity decreased over overwintering time for men (p = 0.003), but not for women (p = 0.174). The decline in local sunshine radiation led to a 48 minutes longer time in bed (p<0.001), 3.8% lower sleep efficiency (p<0.001), a delay of 32 minutes in sleep onset (p<0.001), a delay of 54 minutes in sleep offset (p<0.001), and 11% less daily energy expenditure (p<0.001), for all participants in reaction to the Antarctic winter’s darkness-phase. Conclusions Overwinterings at the Stations Neumayer II and III are associated with significant changes in sleep patterns, with dependences from overwintering time and local sunshine radiation. Gender appears to be an influence, as women showed a declining sleep quality, despite that their physical activity remained unchanged, suggesting other causes such as a higher susceptibility to psycho-social stress and changes in environmental circadian rhythm during long-term isolation in Antarctica.
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Affiliation(s)
- Mathias Steinach
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Eberhard Kohlberg
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
| | - Martina Anna Maggioni
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Stefan Mendt
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Opatz
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Stahn
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Center for Space Medicine and Extreme Environments Berlin, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Butt M, Quan SF, Pentland AS, Khayal I. Gender Differences in Real-Home Sleep of Young and Older Couples. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2015; 10:289-299. [PMID: 26110099 DOI: 10.13175/swjpcc068-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY OBJECTIVES To understand gender differences in sleep quality, architecture and duration of young healthy couples in comparison to older couples in their natural sleep environment. DESIGN Sleep was monitored in a naturalistic setting using a headband sleep monitoring device over a period of two weeks for young couples and home polysomnography for the older couples. PARTICIPANTS Ten heterosexual young couples (male mean age: 28.2±1.0[SD] years/female mean age: 26.8±0.9 years) and 14 older couples (male mean age: 59.3±9.6 years/female mean age: 58.8±9.1 years). MEASUREMENTS AND RESULTS In the young couples, total sleep time (395±66 vs. 367±54 min., p<0.05), sleep efficiency (97.0±3.0 vs. 91.1±7.9, p<0.001), and % REM (31.1±4.8 vs. 23.6±5.5, p<0.001) in males was higher than in females. In contrast, % light sleep (51.7±7.1 vs. 59.7±6.7, p<0.001) and number of arousals (2.9±1.9 vs. 5.3±1.9, p<0.001) were lower. These differences persisted after controlling for evening mood and various evening pre-sleep activities. In the older couples, there were no differences between genders. In addition, children in the household adversely impacted sleep. CONCLUSIONS In couples recorded in the home, young males slept longer and had better sleep quality than young females. This difference appears to dissipate with age. In-home assessment of couples can aid in understanding of gender differences in sleep and how they are affected by age and social environment.
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Affiliation(s)
- Maryam Butt
- Masdar Institute of Science and Technology, Abu Dhabi, UAE
| | - Stuart F Quan
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA ; Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ, USA ; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Inas Khayal
- Masdar Institute of Science and Technology, Abu Dhabi, UAE ; Massachusetts Institute of Technology, Cambridge, MA, USA
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Abstract
Over more than a century of research has established the fact that sleep benefits the retention of memory. In this review we aim to comprehensively cover the field of "sleep and memory" research by providing a historical perspective on concepts and a discussion of more recent key findings. Whereas initial theories posed a passive role for sleep enhancing memories by protecting them from interfering stimuli, current theories highlight an active role for sleep in which memories undergo a process of system consolidation during sleep. Whereas older research concentrated on the role of rapid-eye-movement (REM) sleep, recent work has revealed the importance of slow-wave sleep (SWS) for memory consolidation and also enlightened some of the underlying electrophysiological, neurochemical, and genetic mechanisms, as well as developmental aspects in these processes. Specifically, newer findings characterize sleep as a brain state optimizing memory consolidation, in opposition to the waking brain being optimized for encoding of memories. Consolidation originates from reactivation of recently encoded neuronal memory representations, which occur during SWS and transform respective representations for integration into long-term memory. Ensuing REM sleep may stabilize transformed memories. While elaborated with respect to hippocampus-dependent memories, the concept of an active redistribution of memory representations from networks serving as temporary store into long-term stores might hold also for non-hippocampus-dependent memory, and even for nonneuronal, i.e., immunological memories, giving rise to the idea that the offline consolidation of memory during sleep represents a principle of long-term memory formation established in quite different physiological systems.
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Affiliation(s)
- Björn Rasch
- Division of Biopsychology, Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
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Thase ME, Murck H, Post A. Clinical relevance of disturbances of sleep and vigilance in major depressive disorder: a review. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494354 DOI: 10.4088/pcc.08m00676gry] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/04/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of this article is to provide a concise review of the clinical relevance of sleep and vigilance in major depressive disorder. DATA SOURCES PubMed was reviewed (1990-2009) and English-language articles were identified using the key words sleep and depression and sleep and antidepressants. Secondary searches included articles cited in sources identified by the primary search. STUDY SELECTION The narrative review provides brief descriptions of the normal physiology of sleep and changes associated with depression, as well as the impact of various treatments on these processes. DATA SYNTHESIS Although it has long been known that sleep disturbances are an important characteristic of depression, relatively few studies have been conducted with the newer-generation antidepressants. Neither of the most widely used classes of antidepressants, the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors, have particularly beneficial effects on sleep and, among the medications that reliably improve sleep efficiency, including mirtazapine and the tricyclic antidepressants, problems with daytime sedation can offset therapeutic benefit. Despite relatively widespread use, trazodone has not been demonstrated to be an effective and safe hypnotic in patients taking other antidepressants. For many patients, ongoing concomitant treatment with benzodiazepines and related drugs is the preferred option, again without convincing empirical support of longer-term efficacy. Among newer and investigational antidepressants, agomelatine shows promise with respect to both overall safety and effects on insomnia, although possible negative effects on liver function warrant further study. CONCLUSIONS Sleep disturbances are a significant aspect of depressive syndromes, and relief of insomnia remains an important unmet need in antidepressant therapeutics. Development of a well-tolerated antidepressant medication that rapidly improves sleep maintenance without daytime sedation is a priority for drug development.
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Affiliation(s)
- Michael E Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs, Medical Center, Philadelphia, Pennsylvania, USA.
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Colrain IM, Turlington S, Baker FC. Impact of alcoholism on sleep architecture and EEG power spectra in men and women. Sleep 2009; 32:1341-52. [PMID: 19848363 PMCID: PMC2753812 DOI: 10.1093/sleep/32.10.1341] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To determine the impact of alcoholism on sleep architecture and sleep EEG power spectra in men and women with uncomplicated alcoholism. DESIGN AND PARTICIPANTS 42 alcoholics (27 men) and 42 controls (19 men) screened for medical, psychiatric, and sleep problems participated in a full night of polysomnography following an adaptation night. Data were collected from multiple scalp sites and subjected to power spectral analysis. Sleep architecture and EEG spectral power measures were evaluated for the effects of diagnosis and sex using age as a covariate. RESULTS Compared with controls, alcoholics had less slow wave sleep and increased proportions of stage 1 and REM sleep. Spectral analysis of NREM sleep showed reduced levels of slow wave activity (SWA, 0.3-4 Hz) and slow theta (theta) power (4-6 Hz) in alcoholics. The differences in SWA extended across the slow band (0.3-1 Hz) and all delta (delta) frequencies and were most prominent over frontal scalp regions. No group differences were seen in the power spectra of REM sleep. Women had more SWA and theta power than men, but there were no sex by diagnosis interactions for any measures, suggesting that alcoholism does not differentially influence men and women. CONCLUSION Long-term alcoholism affects sleep even after long periods of abstinence in both men and women. Measures of frontal slow wave activity were particularly sensitive markers of this long-lasting effect. Sleep EEG measures would thus seem to provide a functional correlate of the changes in brain structure seen in frontal cortex of long-term alcoholics.
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Affiliation(s)
- Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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Abstract
Middle-aged and elderly populations exhibit gender differences in polysomnographic (PSG) sleep; however, whether young men and women also show such differences remains unclear. Thirty-one young healthy sleepers (16 men and 15 women, aged 18 to 30 yr, mean+/-SD, 20.5+/-2.4 yr) completed 3 consecutive overnight sessions in a sleep laboratory, after maintaining a stable sleep-wake cycle for 1 wk before study entry. Standard PSG sleep and self-rated sleepiness data were collected each night. Across nights, women showed better sleep quality than men: they fell asleep faster (shorter sleep onset latency) and had better sleep efficiency, with more time asleep and less time awake (all differences showed large effect sizes, d=0.98 to 1.12). By contrast, men were sleepier than women across nights. Both men and women demonstrated poorer overall sleep quality on the first night compared with the subsequent 2 nights of study. We conclude young adult healthy sleepers show robust gender differences in PSG sleep, like older populations, with better sleep quality in women than in men. These results highlight the importance of gender in sleep and circadian rhythm research studies employing young subjects and have broader implications for women's health issues relating to these topics.
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Affiliation(s)
- Namni Goel
- Department of Psychology, Wesleyan University, Middletown, Connecticut 06459, USA
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Unruh ML, Redline S, An MW, Buysse DJ, Nieto FJ, Yeh JL, Newman AB. Subjective and objective sleep quality and aging in the sleep heart health study. J Am Geriatr Soc 2008; 56:1218-27. [PMID: 18482295 DOI: 10.1111/j.1532-5415.2008.01755.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the extent to which subjective and objective sleep quality are related to age independent of chronic health conditions. DESIGN Cross-sectional study. SETTING The Sleep Heart Health Study (SHHS) is a multicenter study designed to determine the cardiovascular consequences and the natural history of sleep disordered breathing. PARTICIPANTS Five thousand four hundred seven community-dwelling adults who participated in the SHHS (mean age 63, range 45-99; 52% women). MEASUREMENTS Unattended home polysomnography (PSG) and sleep questionnaires. RESULTS Older age was associated with shorter sleep time, diminished sleep efficiency, and more arousals in men and women. In men, age was independently associated with more Stage 1 and Stage 2 sleep and less slow-wave (Stage 3 to 4) and rapid eye movement sleep. In women, older age was less strongly associated according to linear trend with sleep stage. Conversely, poor subjective sleep quality was not associated with older age in men, but older women had more trouble falling asleep, and there was a trend toward older women having more problems with waking up during the night and waking up too early. Associations between self-report and directly measured sleep time and sleep latency were low to moderate across age groups (correlation coefficient=0.06-0.32). CONCLUSION Older age was more strongly associated with poorer sleep according to PSG in men than women, yet the subjective report of poor sleep with older age was stronger in women. The higher prevalence of chronic health conditions, including sleep apnea, in older adults did not explain changes of sleep parameters with aging and age-sex differences in these relationships.
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Affiliation(s)
- Mark L Unruh
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261, USA.
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15
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Vagiakis E, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, Roussos C, Kryger M. Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Med 2006; 7:424-30. [PMID: 16740405 DOI: 10.1016/j.sleep.2005.12.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 12/27/2005] [Accepted: 12/30/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Studies from North American clinics have reported that females with obstructive sleep apnea syndrome (OSAS) are about the same age as males but are heavier, have less severe apnea and make up a much smaller proportion of cases. We examined polysomnographic differences between Greek men and women with OSAS in order to study the influence of gender on clinical presentation and laboratory findings. PATIENTS AND METHODS This retrospective study included a cohort of 1,010 Greek patients (844 males, 166 females) diagnosed with OSAS by overnight polysomnography (PSG), who were referred to the Sleep Disorders Center of Evangelismos Hospital, Athens Medical School, University of Athens. All patients were studied over a period of three consecutive years, during which time clinical and polysomnography (PSG) findings were compared. RESULTS Body mass index (BMI) was similar in men and women with OSAS (BMI=31.6+/-5.5kg/m(2) in men versus BMI=32.5+/-8.1 (SD) kg/m(2) in women). Female patients were significantly older than male patients (56.9+/-10.6 versus 50.6+/-11.7 year, P=0.001). The mean apnea-hypopnea index (AHI) during total sleep time was higher in men than in women (42.4+/-28.2 versus 33.2+/-27.7 events/h, P<0.001). The AHI in non-rapid eye movement (NREM) sleep was higher in men than in women (42.9+/-28.9 versus 32.6+/-28.7 events/h, P<0.001), but in rapid eye movement (REM) sleep AHI was similar in men and women (36.0+/-23.3 versus 34.9+/-25.4 events/h). Forty percent of men had AHI-REM sleep >AHI-NREM compared to 62% of women, and the difference between REM and NREM-AHI was significantly less in men than in women (14.21+/-11.18 versus 19.76+/-13.43 events/h, P<0.001)). Several aspects of sleep were worse in women versus men: sleep efficiency index was lower (79.4+/-16.1% versus 85.1+/-12.5%, P<0.001); sleep onset latency (27.7+/-27.7 versus 17.9+/-18.1min, P<0.001), and REM onset latency (161.5+/-76.2 versus 145.7+/-71.4min, P<0.018) were longer; wake time after sleep onset (WASO) was also greater in women (42.6+/-46.5 versus 30.7+/-34.9min, P<0.003). CONCLUSIONS In Greek subjects with OSAS, there was no difference in BMI, and female patients were significantly older than male patients. OSAS was diagnosed in men five times more often than in women. AHI was greater in men than in women, but women are more likely than men to have a higher AHI in REM than NREM. Sleep quality is worse in female than in male patients.
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Affiliation(s)
- E Vagiakis
- Critical Care and Pulmonary Services, Medical School, Sleep Disorders Center, Evangelismos Hospital, University of Athens, Athens, Greece
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16
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Voderholzer U, Al-Shajlawi A, Weske G, Feige B, Riemann D. Are there gender differences in objective and subjective sleep measures? A study of insomniacs and healthy controls. Depress Anxiety 2003; 17:162-72. [PMID: 12768650 DOI: 10.1002/da.10101] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It is well known that insomnia is more frequent in women than in men throughout all age groups. In this respect insomnia resembles other psychiatric disorders that occur more frequently in women such as anxiety and depressive disorders. Since insomnia is frequently a symptom of anxiety and depression, it remains an open question whether the comorbidity with psychiatric disorders fully explains the gender differences in the prevalence of insomnia or whether gender influences sleep independently from psychiatric conditions. We analyzed sleep measures of patients diagnosed with a primary insomnia (n=86) and of an age- and sex-matched healthy control group (n=86) by polysomnography; additionally, subjective rating scales were available for 70 patients and 54 controls matched for mean age and sex ratio. Surprisingly, none of the sleep continuity measures (sleep duration, sleep efficiency, arousal index, and wake%), nor slow wave or REM sleep % showed significant gender differences in both insomniacs and healthy controls. Also, subjective estimates of sleep quality were comparable in both sexes. As expected, insomniacs strongly differed from the control group in all subjective measures of sleep. Polysomnography showed significantly reduced sleep duration and efficiency, increased arousal index, and slightly, but significantly, less REM sleep in the insomniacs as compared to the healthy controls. These studies indicate that gender seems to have, if any, relatively little influence on sleep per se. We hypothesize that the clear gender differences in the prevalence of insomnia are caused predominantly by gender differences in the prevalence of anxiety and depression. Primary insomnia may be, at least in a part of the cases, a subclinical or subthreshold form of anxiety or depression.
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Affiliation(s)
- Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany.
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17
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Nissen C, Feige B, Voderholzer U, Berger M, Riemann D. Gender-Dependent Age Effects on Sleep EEG Power Density in Major Depression. Einfluss von Alter und Geschlecht auf die spektrale EEG-Leistung bei Patienten mit Major Depression. SOMNOLOGIE 2002. [DOI: 10.1046/j.1439-054x.2002.02006.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Reimão R, Souza JC, Gaudioso CE, Guerra HD, Alves AD, Oliveira JC, Gnobie NC, Silvério DC. Nocturnal sleep pattern in Native Brazilian Terena adults. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:233-8. [PMID: 10849620 DOI: 10.1590/s0004-282x2000000200005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Social-economic factors influence sleep habits. This research analyzes characteristics of nocturnal sleep in Brazilian Native Terena adults. Sixty-four adults (31 M; 33 F) from 18 to 75 years, with a mean age of 37.0, from the Indian Reservation village of Córrego do Meio, in the central region of Mato Grosso do Sul, an agriculturally oriented group were evaluated. Nocturnal sleep characteristics were evaluated by means of a standard questionnaire applied to each individual. It was observed that reported nocturnal sleep was longer, sleep onset was earlier and wake up time was also earlier than usually described in urban populations. The mean total time in bed was 8.5 h or more, in every age bracket. The seven-day prevalence rate of insomnia was 4.6%, while the seven-day prevalence rate of hypnotic use was 1.5%, both remarkably less than described in urban populations. These findings stress the need to consider ethnic influences on sleep patterns and disorders.
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Affiliation(s)
- R Reimão
- CDS-Centro de Distúrbios do Sono(R), São Paulo
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Reimão R, Souza JC, Gaudioso CE, Guerra HD, Alves AD, Oliveira JC, Gnobie NC, Silvério DC. Siestas among Brazilian Native Terena adults : a study of daytime napping. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:39-44. [PMID: 10770864 DOI: 10.1590/s0004-282x2000000100006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Regular daytime napping behavior, also known as siesta culture, is influenced by circadian, cultural and environmental factors. This research analyzes characteristics of regular daytime napping in Brazilian Native Terenas. We evaluated 65 adults ( 32 M; 33 F ) from 18 to 75 years, with a mean age of 37.2, from the Indian Reservation village Córrego do Meio, in the central region of Mato Grosso do Sul. Daytime napping characteristics were evaluated by means of a standard questionnaire applied to each individual. It was observed that weekly daytime napping (at least once a week) was present in 72. 3% of the population. There was a tendency to occur in males. The effects of weekends was mild. Mean onset time of daytime sleep was 12.2 h, remarkably earlier than usually described in urban populations. This data stresses the need to consider ethnic influences in order to understand sleep habits.
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Affiliation(s)
- R Reimão
- CDS-Centro de Distúrbios do Sono, São Paulo. SP
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