The relationship between insomnia with short sleep duration is associated with hypercholesterolemia: a cross-sectional study

Associations Among Cardiometabolic Risk Factors, Sleep Duration, and Obstructive Sleep Apnea in a Southeastern US Rural Community: Cross-Sectional Analysis From the SLUMBRx-PONS Study

BACKGROUND

Short sleep and obstructive sleep apnea are underrecognized strains on the public health infrastructure. In the United States, over 35% of adults report short sleep and more than 80% of individuals with obstructive sleep apnea remain undiagnosed. The associations between inadequate sleep and cardiometabolic disease risk factors have garnered increased attention. However, challenges persist in modeling sleep-associated cardiometabolic disease risk factors.

OBJECTIVE

This study aimed to report early findings from the Short Sleep Undermines Cardiometabolic Health-Public Health Observational study (SLUMBRx-PONS).

METHODS

Data for the SLUMBRx-PONS study were collected cross-sectionally and longitudinally from a nonclinical, rural community sample (n=47) in the southeast United States. Measures included 7 consecutive nights of wrist-based actigraphy (eg, mean of 7 consecutive nights of total sleep time [TST7N]), 1 night of sleep apnea home testing (eg, apnea-hypopnea index [AHI]), and a cross-sectional clinical sample of anthropometric (eg, BMI), cardiovascular (eg, blood pressure), and blood-based biomarkers (eg, triglycerides and glucose). Correlational analyses and regression models assessed the relationships between the cardiometabolic disease risk factors and the sleep indices (eg, TST7N and AHI). Linear regression models were constructed to examine associations between significant cardiometabolic indices of TST7N (model 1) and AHI (model 2).

RESULTS

Correlational assessment in model 1 identified significant associations between TST7N and AHI (r=-0.45, P=.004), BMI (r=-0.38, P=.02), systolic blood pressure (r=0.40, P=.01), and diastolic blood pressure (r=0.32, P=.049). Pertaining to model 1, composite measures of AHI, BMI, systolic blood pressure, and diastolic blood pressure accounted for 25.1% of the variance in TST7N (R2adjusted=0.25; F2,38=7.37; P=.002). Correlational analyses in model 2 revealed significant relationships between AHI and TST7N (r=-0.45, P<.001), BMI (r=0.71, P<.001), triglycerides (r=0.36, P=.03), and glucose (r=0.34, P=.04). Results from model 2 found that TST7N, triglycerides, and glucose accounted for 37.6% of the variance in the composite measure of AHI and BMI (R2adjusted=0.38; F3,38=8.63; P<.001).

CONCLUSIONS

Results from the SLUMBRx-PONS study highlight the complex interplay between sleep-associated risk factors for cardiometabolic disease. Early findings underscore the need for further investigations incorporating the collection of clinical, epidemiological, and ambulatory measures to inform public health, health promotion, and health education interventions addressing the cardiometabolic consequences of inadequate sleep.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/27139.

Association Between Sleep Duration and Stroke in Different Status of Metabolic Syndrome: A Cross-Sectional Study in Shanghai Adult Residents

Purpose

This study aimed to investigate the relationship between sleep duration (SD) and stroke, and examine the effects of SD on stroke with or without metabolic syndrome (Mets) and its components among the adult residents in Shanghai, China.

Participants and Methods

A total of 20,245 participants (51.72% male, mean age 44.66 years) were included from Shanghai Chronic Disease and Risk Factors Surveillance (SCDRFS) in 2017. The weighted logistic regressions were performed to examine the associations between SD and stroke in different status of Mets and its components.

Results

The mean SD was 7.51±0.03 h/d. After adjusting for all the potential factors, SD<6 h/d (OR=1.73, 95% CI: 1.35-2.20) or ≥10 h/d (OR=1.66, 95% CI: 1.08-2.57) was significantly positively associated with stoke in the total participants; moreover, in the non-Mets group, only SD<6 h/d (OR=1.77, 95% CI: 1.19, 2.64) significantly increased the risk of stroke; while, in the Mets group, SD<6 h/d (OR=1.80, 95% CI:1.17-2.76) and ≥10 h/d (OR=1.97, 95% CI: 1.00-3.88) both had a positive significantly association with stoke. In addition, the effects of SD<6 h/d on stroke were more pronounced among those with high WC (OR=2.24, 95% CI: 1.40-3.58) and high TG (OR=2.60, 95% CI: 1.86-3.62), and the effects of SD≥10 h/d on stroke were more evident among those with high TG (OR=2.28, 95% CI: 1.02-5.08) and high FBG (OR=2.58, 95% CI: 1.30-5.10).

Conclusion

Both short and long SD were significantly positively associated with stroke in the total participants, and the associations were stronger in the Mets group; conversely, in the non-Mets group, only short SD was significantly positively associated with stroke, and no significant association was observed between long SD and stroke. Therefore, more precise sleep measures may be needed to prevent stroke according to the different status of Mets.

The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey

Background

Hypercholesterolemia (HC) is an important precursor to many cardiovascular, cerebrovascular, and peripheral vascular diseases. A report conducted by the American Heart Association showed the prevalence of HC to be 11.9%, with around 28.5 million adults age ≥ 20 years having high cholesterol levels. This study aimed to evaluate the prevalence of HC and its associated risk factors among the general population of Al-Kharj, Saudi Arabia.

Method

A cross-sectional study was conducted on the general population of Al-Kharj, Saudi Arabia in 2016. The representative sample consisted of 1019 individuals, who all participated on a voluntary basis. The statistical analysis was performed using SPSS version 25.

Results

The results of this study showed the prevalence of HC in the sample to be 12.5%. There was a significant moderate positive association between increasing age and the prevalence of HC (r = 0.240, P < 0.0001). Males had a significantly higher prevalence of HC (56.7%) compared to their female counterparts (43.3%) (X² = 23.093, P ≤ 0.0001). BMI was positively and significantly associated with high cholesterol status. Participants in the overweight category had a significantly higher risk of HC (OR = 1.727; 95% CI = 1.58–1.914; P = 0.046). The non-obese (< 25 kg/m²) participants had an inverse significant association with the risk of hypercholesterolemia. (OR = 0.411; 95% CI = 0.216–0.783; P = 0.007).

Conclusion

In this population-based study, the predominant risk factors of HC in Al-Kharj region were being of a Saudi nationality, male, having obesity, being unemployed, and being a civilian worker. There is a clear need for future screening studies of HC, as most previous studies have reported contradictory prevalence data (because they were conducted in different regions of KSA). Furthermore, well-designed prospective cohort studies are needed in the future to assess how the association between lifestyle behavioural factors such as dietary intake patterns and levels of physical activity may affect the relative risk of HC status.

Risk of type 2 diabetes in patients with insomnia: A population-based historical cohort study

BACKGROUND

We investigated the risk of type 2 diabetes mellitus (T2DM) in patients with and without insomnia.

METHODS

In this historical cohort study, we performed a secondary analysis of data from 2001 to 2010, which was obtained from Taiwan's National Health Insurance Database. We developed a Cox proportional hazard regression model to estimate the effects of insomnia on T2DM risk. Kaplan-Meier survival analysis was applied to compare the differences in the cumulative incidence of T2DM between the groups with and without insomnia.

RESULTS

During the follow-up period, the T2DM incidence rate of patients with insomnia was significantly higher than that of patients without insomnia (34.7 vs 24.3 per 1000 person-years). Overall, patients with insomnia had a higher risk of T2DM than did patients without insomnia (adjusted hazard ratio, 1.16; 95% confidence interval [CI], 1.10-1.19). Among patients aged younger than 40 years, those with insomnia had a higher risk of T2DM than did the comparison cohort (adjusted hazard ratio, 1.31; 95% CI, 1.14-1.55). Compared with patients without insomnia, the risk tended to increase with the duration of follow-up in patients with insomnia; when the insomnia duration was <4 years, 4 to 8 years, and >8 years, the risk of T2DM increased by 1.14, 1.38, and 1.51 times (95% CI, 1.03-1.17, 1.15-1.49, and 1.20-1.86), respectively. Patients with insomnia had a higher risk of T2DM, and this risk was particularly pronounced among the younger (≤40 years) population.

CONCLUSION

Chronic insomnia could be an important risk factor for T2DM.

Sleep Duration and Sleep Patterns in Chinese University Students: A Comprehensive Meta-Analysis

STUDY OBJECTIVES

This meta-analysis aimed to determine duration and patterns of sleep in Chinese university students.

METHODS

English (PubMed, PsycINFO, Embase) and Chinese (SinoMed, Wan Fang Database, and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from their inception until August 16, 2016. Data on sleep duration and sleep patterns of tertiary student population in eligible studies were extracted and pooled using random-effects models.

RESULTS

A total of 57 studies with 82,055 university students were included in the meta-analysis. Pooled mean sleep duration was 7.08 h/d (95% confidence interval [CI]: 6.84 to 7.32 h/d). The percentage of students with sleep duration shorter than 6 h/d and 7 h/d (short sleep) was 8.4% (95% CI: 5.7% to 12.3%) and 43.9% (95% CI: 36.9% to 51.1%), respectively. In contrast, the percentage of students with sleep duration longer than 8 hours and 9 hours (long sleep) was 18.3% and 5.7%, respectively. The pooled mean bedtime was at 12:51 am. The percentage of university students who fall asleep after midnight was 23.8%. The percentage of students with sleep latency more than 30 minutes was 25.5%. The pooled mean wake-up time was at 8:04 am on weekdays and on weekends.

CONCLUSIONS

Short sleep duration and unhealthy sleep patterns were found to be common among Chinese university students.

Insomnia and Multimorbidity in the Community Elderly in China

STUDY OBJECTIVES

To examine the comorbidity between insomnia and medical conditions.

METHODS

This cross-sectional study was conducted in community adults, aged ≥ 60 years, who resided in one of four major cities in northern China. Sociodemographic and clinical data were collected simultaneously. A total of 3,176 elderly adults (1,292 male, mean ± standard deviation age 70.2 ± 6.8 years; 1,884 female, 68.8 ± 6.7 years) were interviewed.

RESULTS

The prevalence of specific medical conditions in both people with insomnia and people without insomnia was detected. Significantly higher proportions of arrhythmia, hypertension, cerebral hemorrhage, migraine, and hyperlipidemia were observed in people with insomnia than in people without insomnia. Moreover, a significantly higher proportion of insomnia was seen in elderly people with arrhythmia and migraine. We also found that elderly people with insomnia who took sleep medications reported a higher prevalence of coexisting arrhythmia, hypertension, and migraine, even after adjusting for age, sex, and depression.

CONCLUSIONS

Our results indicate associations between insomnia and medical conditions in the community elderly in China. People who complained of insomnia had poorer physical health conditions. Sleep medication may not be a covariate that influences the comorbidity of some specific physical conditions.

CLINICAL TRIAL REGISTRATION

Trial name: The study of diagnosis and treatment of senile dementia in Hebei Province; URL: http://www.chictr.org.cn/showproj.aspx?proj=8194; Registration number: ChiCTR-RRC-11001345.

The insomnia with short sleep duration phenotype: an update on it's importance for health and prevention

PURPOSE OF REVIEW

It was first proposed in the late 1990s that objective markers of sleep disturbance could serve as an index of the biological severity of insomnia. In 2013, a heuristic model of two insomnia phenotypes based on objective sleep duration was proposed. Herein, we review the studies conducted in the past 3 years on the insomnia with short sleep duration phenotype and its implications for a clinical research agenda.

RECENT FINDINGS

Studies have shown that insomnia with objective short sleep duration is associated with physiologic hyperarousal and cardiometabolic and neurocognitive morbidity, whereas insomnia with normal sleep duration is not. Both insomnia phenotypes are associated with psychiatric morbidity albeit through different psychobiological mechanisms. Novel recent studies have included occupational outcomes, developmental approaches, at-home objective sleep testing, diagnostic accuracy measures, and response to cognitive-behavioral treatment.

SUMMARY

Accumulating evidence in the past years has continued to support that insomnia with short sleep duration is a more severe phenotype of the disorder associated with physiologic changes, significant morbidity and mortality and, potentially, a differential response to treatment.