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Benz F, Grolig L, Hannibal S, Buntrock C, Cuijpers P, Domschke K, Ebert DD, Ell J, Janneck M, Jenkner C, Johann AF, Josef A, Kaufmann M, Koß A, Mallwitz T, Mergan H, Morin CM, Riemann D, Riper H, Schmid SR, Smit F, Spille L, Steinmetz L, Van Someren EJW, Spiegelhalder K, Lehr D. Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well). Trials 2024; 25:371. [PMID: 38858707 PMCID: PMC11163861 DOI: 10.1186/s13063-024-08214-6] [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: 02/26/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined. METHODS This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment). DISCUSSION The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I. TRIAL REGISTRATION Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.
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Affiliation(s)
- F Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - L Grolig
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | - S Hannibal
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | - C Buntrock
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D D Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - J Ell
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Janneck
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - C Jenkner
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Josef
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kaufmann
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Koß
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Mallwitz
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - H Mergan
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - C M Morin
- École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, Canada
| | - D Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - S R Schmid
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
- Centre of Health-Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - L Spille
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Steinmetz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - K Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
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Solomon S, Elbedour L, Meiri G, Michaelovski A, Sadaka Y, Ilan M, Faroy M, Dinstein I, Menashe I. Sleep disturbances are associated with greater healthcare utilization in children with autism spectrum disorder. J Neurodev Disord 2024; 16:29. [PMID: 38849752 PMCID: PMC11157737 DOI: 10.1186/s11689-024-09550-z] [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: 01/24/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Sleep disturbances are frequently reported in children with autism spectrum disorder (ASD) and are associated with the severity of co-occurring symptoms. This study's aim was to examine the extent of healthcare utilization and clinical outcomes associated with sleep disturbances in children with ASD. STUDY DESIGN A retrospective, cross-sectional study of 541 children with ASD from the Azrieli National Center for Autism and Neurodevelopment Research (ANCAN) whose parents completed the Children's Sleep Habits Questionnaire (CSHQ). Children with a total CSHQ score ≥ 48 were defined as having sleep disturbances. Sociodemographic characteristics, ASD diagnostic measures, chronic co-occurring conditions, medication usage, hospitalizations, visits to the emergency room (ER), and visits to specialists were compared in ASD children with and without sleep disturbances. Multivariate logistic regression models were then used to assess the independent association of sleep disturbances with clinical characteristics and healthcare utilization. RESULTS Of the 541 children with ASD, 257 (47.5%) had sleep disturbances. Children with sleep disturbances exhibited higher rates of multiple (≥ 3) co-occurring conditions (19.1% vs. 12.7%; p = 0.0414) and prescribed medications (45.5% vs. 32.7%; p = 0.0031) than other children. Finally, ASD children with sleep disturbances were 1.72 and 2.71 times more likely to visit the ER and be hospitalized than their counterparts (aOR = 1.72; 99%CI = 1.01-2.95; and aOR = 2.71; 99%CI = 1.10-6.67, respectively). CONCLUSIONS Our findings suggest that sleep disturbances are associated with greater healthcare utilization among children with ASD. Further studies could examine whether treating sleep disturbances in children with ASD yields additional clinical benefits beyond improvements in sleep.
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Affiliation(s)
- Shirley Solomon
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leena Elbedour
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel
| | - Gal Meiri
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Child Development Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yair Sadaka
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Child Development Center, Ministry of Health, Beer-Sheva, Israel
| | - Michal Ilan
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Faroy
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Psychology Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Cognition and Brain Sciences Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center for Neurosciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Menashe
- Azrieli National Centre for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, 84105, Israel.
- Zlotowski Center for Neurosciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Ranteh O, Tedasen A, Rahman MA, Ibrahim MA, Sama-Ae I. Bioactive compounds from Ocimum tenuiflorum and Poria cocos: A novel natural Compound for insomnia treatment based on A computational approach. Comput Biol Med 2024; 175:108491. [PMID: 38657467 DOI: 10.1016/j.compbiomed.2024.108491] [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: 09/05/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Insomnia, a widespread public health issue, is associated with substantial distress and daytime functionality impairments and can predispose to depression and cardiovascular disease. Cognitive Behavioral Anti-insomnia therapies including benzodiazepines often face limitations due to patient adherence or potential adverse effects. This study focused on identifying novel bioactive compounds from medicinal plants, aiming to discover and develop new therapeutic agents with low risk-to-benefit ratios using computational drug discovery methods. Through a systematic framework involving compound library preparation, evaluation of drug-likeness and pharmacokinetics, toxicity prediction, molecular docking, and molecular dynamic simulations, two natural compounds such as 2-(4-hydroxy-3-methoxyphenyl)-8-methoxy-6-prop-2-enyl-3,4-dihydro-2H-chromen-3-ol from Ocimum tenuiflorum and 7-(2-hydroxypropan-2-yl)-1,4a-dimethyl-9-oxo-3,4,10,10a-tetrahydro-2H-phenanthrene-1-carboxylic acid from Poria cocos exhibited high binding affinity with orexin receptor type 1 (OX1R) and type 2 (OX2R), surpassing commercial drugs used in insomnia treatment. Additionally, they showed interactions with critical amino acid residues within the receptors that play crucial roles in competitive inhibitor activity, like commercial drugs such as Suvorexant, Lemborexant, and Daridorexant. Further, molecular dynamics simulations of the protein-ligand complexes under conditions that mimic the in vivo environment revealed both compounds' sustained and robust interactions with the OX1R and OX2R, reinforcing their potential as effective therapeutic candidates. Furthermore, upon evaluating both compounds' drug-likeness, pharmacokinetics, and toxicity profiles, it was discerned that they displayed considerable drug-like properties and favorable pharmacokinetics, along with diminished toxicity. The research provides a solid foundation for further exploring and validating these compounds as potential anti-insomnia therapeutics.
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Affiliation(s)
- Onggan Ranteh
- Department of Community Public Health, School of Public Health, Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand; Excellent Centre of Dengue and Community Public Health (EC for DACH), Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand.
| | - Aman Tedasen
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand; Research Excellence Center for Innovation and Health Products, Walailak University, Tha Sala, Nakhon Si Thammarat, 80161, Thailand.
| | - Md Atiar Rahman
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand; Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong-4331, Bangladesh.
| | | | - Imran Sama-Ae
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand; Center of Excellence Research for Melioidosis and Microorganisms (CERMM), Walailak University, Tha Sala District, Nakhon Si Thammarat, 80160, Thailand.
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Boyle JT, Nielson SA, Perlis ML, Dzierzewski JM. Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms. Sleep Health 2024; 10:321-326. [PMID: 38548566 PMCID: PMC11162937 DOI: 10.1016/j.sleh.2024.02.005] [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: 09/25/2023] [Revised: 02/13/2024] [Accepted: 02/24/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Insomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms. METHODS Seven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms. RESULTS Sedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = -0.002, t = -3.02, p = .003). CONCLUSIONS Sedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.
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Affiliation(s)
- Julia T Boyle
- Office of Research and Development, VA Boston Healthcare System, Massachusetts, USA; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Spencer A Nielson
- Department of Psychology, Virginia Commonwealth University, Virginia, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Chronobiology and Sleep Institute Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kemp E, Sutherland K, Bin YS, Chan ASL, Dissanayake H, Yee BJ, Kairaitis K, Wheatley JR, de Chazal P, Piper AJ, Cistulli PA. Characterisation of Symptom and Polysomnographic Profiles Associated with Cardiovascular Risk in a Sleep Clinic Population with Obstructive Sleep Apnoea. Nat Sci Sleep 2024; 16:461-471. [PMID: 38737461 PMCID: PMC11086425 DOI: 10.2147/nss.s453259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/27/2024] [Indexed: 05/14/2024] Open
Abstract
Aim Recent data have identified specific symptom and polysomnographic profiles associated with cardiovascular disease (CVD) in patients with obstructive sleep apnoea (OSA). Our aim was to determine whether these profiles were present at diagnosis of OSA in patients with established CVD and in those with high cardiovascular risk. Participants in the Sydney Sleep Biobank (SSB) database, aged 30-74 years, self-reported presence of CVD (coronary artery disease, cerebrovascular disease, or heart failure). In those without established CVD, the Framingham Risk Score (FRS) estimated 10-year absolute CVD risk, categorised as "low" (<6%), "intermediate" (6-20%), or "high" (>20%). Groups were compared on symptom and polysomnographic variables. Results 629 patients (68% male; mean age 54.3 years, SD 11.6; mean BMI 32.3 kg/m2, SD 8.2) were included. CVD was reported in 12.2%. A further 14.3% had a low risk FRS, 38.8% had an intermediate risk FRS, and 34.7% had a high risk FRS. Groups differed with respect to age, sex and BMI. OSA severity increased with established CVD and increasing FRS. The symptom of waking too early was more prevalent in the higher FRS groups (p=0.004). CVD and FRS groups differed on multiple polysomnographic variables; however, none of these differences remained significant after adjusting for age, sex, and BMI. Conclusion Higher CVD risk was associated with waking too early in patients with OSA. Polysomnographic variations between groups were explained by demographic differences. Further work is required to explore the influence of OSA phenotypic characteristics on susceptibility to CVD.
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Affiliation(s)
- Emily Kemp
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kate Sutherland
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Yu Sun Bin
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Andrew S L Chan
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Hasthi Dissanayake
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Brendon J Yee
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Kristina Kairaitis
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - John Robert Wheatley
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Philip de Chazal
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, Australia
| | - Amanda J Piper
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Peter A Cistulli
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - On behalf of the Sydney Sleep Biobank Investigators
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, Australia
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Eshera YM, Gavrilova L, Hughes JW. Sleep is Essential for Cardiovascular Health: An Analytic Review of the Relationship Between Sleep and Cardiovascular Mortality. Am J Lifestyle Med 2024; 18:340-350. [PMID: 38737888 PMCID: PMC11082862 DOI: 10.1177/15598276231211846] [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: 05/14/2024] Open
Abstract
The American Heart Association recently included sleep health as one of eight factors that define cardiovascular health. Restorative sleep is a pillar of lifestyle medicine influenced by sleep duration, quality, and disorders. Short and long sleep duration are associated with greater risk of cardiovascular disease. Short sleep appears causally related to cardiovascular risk. Long sleep is more strongly predictive of cardiovascular risk, which may be due to comorbidities and other risk factors. Good-quality sleep appears to protect against the increased risk and is independently associated with risk of cardiovascular disease (CVD). Insomnia, particularly difficulty falling asleep and non-restorative sleep, is associated with an increase in cardiac events. Obstructive sleep apnea (OSA) is associated with cardiac risk and outcomes, which is typically observed in the context of contributing comorbidities. However, treating OSA with continuous positive airway pressure (CPAP) may not improve prognosis. Further research is needed to understand the causal mechanisms connecting sleep health with CVD and whether modifying sleep can improve outcomes. Sleep health should be considered as part of a holistic approach to improving cardiovascular health, as reflected in the scoring of LE8 and as one of the interrelated components of lifestyle medicine.
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Affiliation(s)
- Yasmine M. Eshera
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Lyubov Gavrilova
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Joel W. Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Tian X, Zhang N, Tse G, Li G, Sun Y, Liu T. Association between lipoprotein(a) and premature atherosclerotic cardiovascular disease: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae031. [PMID: 38737415 PMCID: PMC11086656 DOI: 10.1093/ehjopen/oeae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
Aims High lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations, whereas its effects in the younger population remain unclear. This study evaluated the associations between Lp(a) and the risk of premature ASCVD. Method and results PubMed and Embase were searched for related studies until 12 November 2023. Fifty-one studies including 100 540 participants were included. Mean age of patients ranged from 35.3 to 62.3 years. The proportion of male participants ranged from 0% to 100%. The mean follow-up was provided in five studies ranging from 1 year to 40 years. The definition of elevated Lp(a) varied among studies, such as >30 mg/dL, >50 mg/dL, the top tertiles, the top quartiles, the top quintiles, and so on. Higher Lp(a) was significantly associated with the composite ASCVD [odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.53-3.02, P < 0.001], especially for coronary artery disease (OR: 2.44, 95% CI: 2.06-2.90, P < 0.001) and peripheral arterial disease (OR: 2.56, 95% CI: 1.56-4.21, P < 0.001). This association remained significant in familial hypercholesterolaemia (FH) (OR: 3.11, 95% CI: 1.63-5.96, P < 0.001) and type 2 diabetes mellitus (T2DM) patients (OR: 2.23; 95% CI: 1.54-3.23, P < 0.001).Significant results were observed in South Asians (OR: 3.71, 95% CI: 2.31-5.96, P < 0.001), Caucasians (OR: 3.17, 95% CI: 2.22-4.52, P < 0.001), and patients with baseline low-density lipoprotein cholesterol (LDL-c) level ≥ 2.6 mmol/L. Conclusion Elevated Lp(a) predicts the risk of the composite or individual ASCVD in young, regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. This association was important in South Asians, Caucasians, FH patients, T2DM patients, and patients with baseline LDL-c level ≥ 2.6 mmol/L.
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Affiliation(s)
- Xu Tian
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
- Epidemiology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yihong Sun
- Cardiology Department, China-Japan Friendship Hospital, Beijing, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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8
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Lawson Y, Wilding GE, El-Solh AA. Insomnia and risk of mortality in older adults. J Sleep Res 2024:e14229. [PMID: 38685752 DOI: 10.1111/jsr.14229] [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: 12/17/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
Existing evidence linking insomnia to all-cause mortality in older individuals remains inconclusive. We conducted a retrospective study of a large cohort of veterans aged 65-80 years old identified from the Corporate Data Warehouse, a large data repository derived from the Veterans Health Administration integrated medical records. Veterans' enrollees with and without International Classification of Diseases, Ninth and Tenth Revision, codes corresponding to insomnia diagnosis between 1 January 2010 and 30 March 2019 were assessed for eligibility. The primary outcome was all-cause mortality. A total of 36,269 veterans, 9584 with insomnia and 26,685 without insomnia, were included in the analysis. Baseline mean (SD) age was 72.6 (4.2) years. During a mean follow-up of 6.0 (2.9) years of the propensity score matched sample, the mortality rate was 34.8 [95% confidence interval: 33.2-36.6] deaths per 1000 person-years among patients with insomnia compared with 27.8 [95% confidence interval: 26.6-29.1] among patients without insomnia. In a Cox proportional hazards model, insomnia was significantly associated with higher mortality (hazard ratio: 1.39; [95% confidence interval: 1.27-1.52]). Patients with insomnia also had a higher risk of non-fatal cardiovascular events (hazard ratio: 1.21; [95% confidence interval: 1.06-1.37]). Secondary stratified analyses by sex, race, ethnicity and hypertension showed no evidence of effect modification. A higher risk of mortality (hazard ratio: 1.51; [95% confidence interval: 1.33-1.71]) was observed when depression was present compared with absent (hazard ratio: 1.26; [95% confidence interval: 1.12-1.44]; p = 0.02). In this cohort study, insomnia was associated with increased risk-adjusted mortality and non-fatal cardiovascular events in older individuals.
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Affiliation(s)
- Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Ali A El-Solh
- The Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine, Buffalo, New York, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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9
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Shi R, Meng W, Liu Z, Xue W, Chen X, Deng Y. Exploring acupuncture as a treatment for insomnia in perimenopausal women with stable angina pectoris: A protocol for a randomized, double-blind, placebo-controlled clinical trial. PLoS One 2024; 19:e0301827. [PMID: 38635812 PMCID: PMC11025937 DOI: 10.1371/journal.pone.0301827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Insomnia has emerged as a major public health issue jeopardizing human wellbeing. Furthermore, insomnia and angina arise concomitantly and exert reciprocal effects. Multiple studies suggest that perimenopausal females are more prone to experiencing both angina and insomnia, consequently substantially compromising their quality of life.Credible evidence suggests that acupuncture exerts a beneficial impact in alleviating insomnia. Nevertheless, the exhaustive investigation into the potential of acupuncture for mitigating insomnia co-occurring with stable angina in perimenopausal females remains a realm yet to be traversed in the realm of randomized controlled trials. Hence, the primary intent of this research protocol was to evaluate the effectiveness and safety profile of acupuncture when administered to perimenopausal subjects grappling with concomitant conditions of stable angina and insomnia. METHODS This study entails a single-center, randomized, double-blind, placebo-controlled clinical trial. A total of 110 patients exhibiting insomnia concomitant with stable angina in the perimenopausal period will be enlisted and randomized to either acupuncture or sham acupuncture. Participants in both arms will undergo 30-minute sessions thrice weekly over a 12-week intervention period, with a 12-week maximum follow-up. The primary outcome measure is the Pittsburgh Sleep Quality Index(PSQI). Secondary outcomes encompass the Health-Related Quality of Life Questionnaire (SF-36), Dosage of sleeping pills, SAP-associated evaluations, including C-reactive protein (CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2), cardiac fatty acid-binding protein levels (C-FABP), and the Seattle Angina Questionnaire (SAQ). Additionally, the study includes assessments using the Hamilton Depression Inventory (HAMD) and the Generalized Anxiety Disorder Scale (GAD-7). Primary and secondary outcomes will be evaluated at baseline, 4 weeks, 8 weeks, 12 weeks (upon completion of the intervention), and at an additional 12-week follow-up. Any adverse events will be rigorously classified and characterized with respect to time of onset and abatement, therapeutic interventions implemented, impact on the primary morbidity, and regression. DISCUSSION The current study is poised to furnish pivotal clinical data on the utility of acupuncture for stable angina with concomitant insomnia in perimenopausal women, with the findings to be propagated through academic conferences and peer-reviewed publications. CLINICAL TRIAL REGISTRATION Thai Clinical Trials Registry: TCTR20221121001. Registered 19 November 2022.
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Affiliation(s)
- Rui Shi
- Department of School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
- TCM Cardiovascular Clinical Medicine Research Center of Jilin Province, Changchun, China
| | - Wenyi Meng
- Department of Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, China
| | - Zhaozheng Liu
- Department of Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, China
| | - Wen Xue
- Department of School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xingyu Chen
- Department of School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Deng
- Department of School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
- TCM Cardiovascular Clinical Medicine Research Center of Jilin Province, Changchun, China
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10
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Sherwood A, Ulmer C, Wu JQ, Blumenthal JA, Herold E, Smith PJ, Koch GG, Johnson K, Viera A, Edinger J, Hinderliter A. Cognitive behavior therapy for insomnia for untreated hypertension with comorbid insomnia disorder: The SLEEPRIGHT clinical trial. J Clin Hypertens (Greenwich) 2024; 26:441-447. [PMID: 38468418 PMCID: PMC11007791 DOI: 10.1111/jch.14763] [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: 10/17/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 03/13/2024]
Abstract
Insomnia and poor sleep are associated with an increased risk of developing cardiovascular disease (CVD) and its precursors, including hypertension. In 2022, the American Heart Association (AHA) added inadequate sleep to its list of health behaviors that increase the risk for CVD. It remains unknown, however, whether the successful treatment of insomnia and inadequate sleep can reduce heightened CVD risk. SLEEPRIGHT is a single-site, prospective clinical trial designed to evaluate whether the successful treatment of insomnia results in improved markers of CVD risk in patients with untreated hypertension and comorbid insomnia disorder. Participants (N = 150) will undergo baseline assessments, followed by a 6-week run-in period after which they will receive cognitive behavior therapy for insomnia (CBT-I), comprised of 6 hourly sessions with an experienced CBT-I therapist over a 6-week period. In addition to measures of insomnia severity, as well as both subjective and objective measures of sleep, the primary outcome measures are nighttime blood pressure (BP) and BP dipping assessed by 24-h ambulatory BP monitoring (ABPM). Secondary outcomes include several CVD risk biomarkers, including clinic BP, lipid profile, vascular endothelial function, arterial stiffness, and sympathetic nervous system (SNS) activity. Data analysis will evaluate the association between improvements in insomnia and sleep with primary and secondary CVD risk biomarker outcomes. The SLEEPRIGHT trial (ClinicalTrials.Gov NCT04009447) will utilize CBT-I, the current gold standard treatment for insomnia disorder, to evaluate whether reducing insomnia severity and improving sleep are accompanied by improved biomarkers of CVD risk in patients with untreated hypertension.
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Affiliation(s)
| | - Christi Ulmer
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Jade Q. Wu
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Emma Herold
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Patrick J. Smith
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Gary G. Koch
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Anthony Viera
- Duke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Alan Hinderliter
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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11
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Mathew D, Rangasamy M. Effect of Yoga Therapy on Insomnia Severity and Systolic Blood Pressure in Aged Women: A 12-Week Intervention Study Conducted in Kerala. Cureus 2024; 16:e57169. [PMID: 38681468 PMCID: PMC11056023 DOI: 10.7759/cureus.57169] [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] [Received: 03/09/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
This study aimed to investigate the effects of a 12-week yoga therapy intervention on insomnia severity and systolic blood pressure in older women experiencing insomnia. A sample of 30 participants, aged between 60 and 70 years, underwent interventions, starting with an initial full-day workshop followed by 60-minute sessions held six days per week in the mornings. Women screening positive for insomnia using the Insomnia Severity Index Questionnaire were eligible for participation. The majority of participants were aged between 60 and 65 years, with a slight majority residing with a spouse. Economically, the group exhibited a diverse distribution, with a significant proportion classified as middle class. Educationally, the group also displayed a varied profile, with a range of educational qualifications. Pretests and post-tests were conducted to assess outcomes. The results revealed a significant reduction in Insomnia Severity Scores, with a mean decrease of 5.17 (±1.05), indicating a substantial effect size, from an initial average of 23.03 (±2.47) to 17.87 (±2.61) after the intervention. Similarly, there was a significant decrease in systolic blood pressure, with scores declining by a mean of 9.67 (±6.87), demonstrating a considerable effect size, from an average of 140.33 (±8.65) to 130.67 (±7.52). These findings suggest that yoga therapy holds promise as a non-pharmacological approach for alleviating insomnia symptoms and reducing systolic blood pressure in older women experiencing insomnia.
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Affiliation(s)
- Deepak Mathew
- Yoga Sciences and Therapy, Meenakshi Academy of Higher Education & Research (MAHER), Chennai, IND
| | - Muthulakshmi Rangasamy
- Physiology, Meenakshi Medical College Hospital & Research Institute (MMCHRI), Chennai, IND
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12
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Tse KYK, Maurer LF, Espie CA, Kyle SD. The effect of single-component sleep restriction therapy on depressive symptoms: A systematic review and meta-analysis. J Sleep Res 2024:e14180. [PMID: 38419123 DOI: 10.1111/jsr.14180] [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: 10/20/2023] [Revised: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Sleep restriction therapy is a behavioural component within cognitive behavioural therapy for insomnia and is an effective standalone treatment for insomnia, but its effect on depressive symptoms remains unclear. This review aimed to synthesise and evaluate the impact of single-component sleep restriction therapy on depressive symptoms relative to a control intervention. We searched electronic databases and sleep-related journals for randomised controlled trials and uncontrolled clinical trials, published from 1 January 1986 until 19 August 2023, that delivered sleep restriction therapy to adults with insomnia. Random-effects meta-analysis of standardised mean differences and Cochrane risk of bias assessment were performed on randomised controlled trials, while uncontrolled clinical trials were discussed narratively. The meta-analysis was pre-registered on PROSPERO (ID: CRD42020191803). We identified seven randomised controlled trials (N = 1102) and two uncontrolled clinical trials (N = 22). Findings suggest that sleep restriction therapy is associated with a medium effect for improvement in depressive symptoms at post-treatment (Nc = 6, g = -0.45 [95% confidence interval = -0.70 to -0.21], p < 0.001) and a small effect at follow-up (Nc = 4, g = -0.31 [95% confidence interval = -0.45 to -0.16], p < 0.001). Five of the seven included randomised controlled trials were judged to have a high risk of bias. Standalone sleep restriction therapy appears to be efficacious for improving depressive symptoms at post-treatment and follow-up. However, conclusions are tentative due to the small number of trials and because none of the trials was performed in a population with clinically defined depression. Large-scale trials are needed to test the effect of sleep restriction therapy in patients experiencing depression and insomnia. Findings also highlight the need to improve the standardisation and reporting of sleep restriction therapy procedures, and to design studies with more rigorous control arms to reduce potential bias.
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Affiliation(s)
- Katrina Yan Kei Tse
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Colin Alexander Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Big Health Inc., San Francisco, California, USA
- Big Health Inc., London, UK
| | - Simon David Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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13
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Yang J, Wang K, Wang W, Niu J, Liu X, Shen H, Sun Y, Ge H, Han H. The Effect of Sleep Quality on Coronary Lesion Severity and Prognosis in the Young Acute Coronary Syndrome Population. J Cardiovasc Dev Dis 2024; 11:68. [PMID: 38392281 PMCID: PMC10889764 DOI: 10.3390/jcdd11020068] [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: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166-1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313-6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274-8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.
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Affiliation(s)
- Jiaxin Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Kexin Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wenjie Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jialong Niu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hailong Ge
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Department of Cardiology, Beijing Geriatric Hospital, Beijing 100095, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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14
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Jansson-Fröjmark M, Nordenstam L, Alfonsson S, Bohman B, Rozental A, Norell-Clarke A. Stimulus control for insomnia: A systematic review and meta-analysis. J Sleep Res 2024; 33:e14002. [PMID: 37496454 DOI: 10.1111/jsr.14002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/28/2023]
Abstract
Stimulus control (SC) is commonly viewed as an evidence-based treatment for insomnia, but it has not been evaluated comprehensively with modern review and meta-analytic techniques. The aim of the current study was thus to perform a systematic review and meta-analysis of trials that examine the efficacy of stimulus control for insomnia. A systematic search for eligible articles and dissertations was conducted in six online bibliographic databases. The 11 included studies, with the majority published between 1978 and 1998, were randomised controlled and experimental studies in adults, comparing stimulus control for insomnia with passive and active comparators and assessing insomnia symptoms as outcomes. A random effects model was used to determine the standardised mean difference Hedge's g at post-treatment and follow-up for three sleep diary measures: the number of awakenings, sleep onset latency, and total sleep time. A test for heterogeneity was conducted, forest plots were produced, the risk of publication bias was estimated, and the study quality was assessed. In the trials identified, stimulus control resulted in small to large improvements on sleep onset latency and total sleep time, relative to passive comparators (g = 0.38-0.85). Compared with active comparators, the improvements following stimulus control were negligible (g = 0.06-0.30). Although methodological uncertainties were observed in the included trials, stimulus control appears to be an efficacious treatment for insomnia when compared with passive comparators and with similar effects to active comparators. More robust studies are, however, warranted before stronger conclusions are possible to infer.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Lisa Nordenstam
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Alfonsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Alexander Rozental
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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15
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Hu J, Wang X, Cheng L, Dang K, Ming Z, Tao X, Xu X, Sarker SK, Li Y. Sleep patterns and risks of incident cardiovascular disease and mortality among people with type 2 diabetes: a prospective study of the UK Biobank. Diabetol Metab Syndr 2024; 16:15. [PMID: 38212811 PMCID: PMC10782582 DOI: 10.1186/s13098-024-01261-8] [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: 09/22/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To explore the relationship between sleep patterns and cardiovascular disease (CVD) incidence and mortality risk in a population with type 2 diabetes through a UK Biobank sample. METHODS A total of 6860 patients with type 2 diabetes were included in this study. Five sleep factors (including Chronotype, sleep duration, insomnia, daytime sleepiness, and snoring) were collected as a questionnaire. The calculation generates a sleep score of 0-5, and then three sleep patterns were defined based on the sleep scores: poor sleep pattern (0-2), Intermediate sleep pattern (3-4), and healthy sleep pattern (5). HRs and 95% confidence intervals were calculated by multivariate COX proportional risk model adjustment. Restricted cubic splines were used to validate linear associations between sleep scores CVD events. RESULTS Our results found a reduced risk of CVD events in individuals with healthy sleep patterns compared to participants with poor sleep patterns. CVD Mortality (HR, 0.690; 95% CI 0.519-0.916), ASCVD (Atherosclerosis CVD) (HR, 0.784; 95% CI 0.671-0.915), CAD (Coronary Artery Disease) (HR, 0.737; 95% CI 0.618-0.879), PAD (Peripheral Arterial Disease) (HR, 0.612; 95% CI 0.418-0.896), Heart Failure (HR, 0.653; 95% CI 0.488-0.875). Restricted cubic spline responded to a negative linear correlation between sleep scores and CVD Mortality, ASCVD, CAD, PAD, and Heart Failure. CONCLUSIONS Healthy sleep patterns are significantly associated with a reduced risk of CVD Mortality, ASCVD, CAD, PAD, and Heart Failure in the diabetes population.
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Affiliation(s)
- Jinxia Hu
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Xuanyang Wang
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Licheng Cheng
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Keke Dang
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Zhu Ming
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Xinmiao Tao
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Xiaoqing Xu
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Shuvan Kumar Sarker
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China
| | - Ying Li
- Department of Nutrition and Food Hygiene, Key Laboratory of Precision Nutrition and Health, School of Public Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, People's Republic of China.
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16
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Cho SS, Jang TW, Kang MY. Association between ergonomic risk exposures and insomnia symptoms: a mediation analysis of the 5th Korean working conditions survey. BMC Public Health 2024; 24:149. [PMID: 38200530 PMCID: PMC10782752 DOI: 10.1186/s12889-024-17659-y] [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: 12/31/2022] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study investigates the relationship between ergonomic risk exposures and insomnia symptoms, using data representative of Korea's general working population. METHODS Data from the 5th Korean Working Conditions Survey were used for this study. The eligible population (employees) for the current study was 37,026. Insomnia symptoms were estimated using the minimal insomnia symptom scale (MISS) questionnaire. Logistic regression analysis was conducted to explore the association between ergonomic risks and insomnia symptoms. RESULTS All the investigated ergonomic risks increased odd ratios (ORs) for insomnia symptoms: Tiring or painful positions (OR, 1.64; 95% CI, 1.43-1.88); lifting or moving heavy loads (OR, 2.33; 95% CI, 1.99-2.71); long periods of standing (OR, 1.47; 95% CI, 1.29-1.69); and repetitive hand or arm movements (OR, 1.46; 95% CI, 1.29-1.67). The mediated proportion of musculoskeletal pain was 7.4% (95% CI, 5.81-10.13), and the mediated proportion of feeling of exhaustion was 17.5% (95% CI, 5.81-10.13). CONCLUSIONS This study provides evidence for the relationship between ergonomic risks and insomnia symptoms, for which musculoskeletal pains and the feeling of exhaustion may be potential mediators.
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Affiliation(s)
- Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University of Korea, Busan, Republic of Korea
| | - Tae-Won Jang
- Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
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17
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Ikeda H, Kubo T. The association between work interval regularity and sleep regularity: a 2-week observational study in daytime employees. J Occup Health 2024; 66:uiae009. [PMID: 38365438 PMCID: PMC11019564 DOI: 10.1093/joccuh/uiae009] [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: 09/21/2023] [Revised: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Several health issues are associated with irregular sleep patterns. However, it is unclear what causes workers to sleep irregularly. The work interval (WI) between the end of one day's working hours and the start of the next day's working hours contains sleep opportunities, and an irregular WI may result in irregular sleep. This study investigated this association among Japanese daytime workers. METHODS This study recruited 141 daytime workers without shiftwork for a 14-day observational study. Participants reported the WI duration, WI timing, time in bed (TIB: difference between bedtime and wake-up time), and bedtime timing every day before bedtime. The SD over 14 days was used to calculate the regularity scores. Logistic regression analysis was performed. The dependent variables were ≥60 minutes of TIB SD and bedtime timing SD, whereas the independent variables were WI duration and timing SD. RESULTS The odds ratios (ORs) (95% CIs) for ≥60 minutes of TIB SD across categories of WI duration SD were 1.000 (reference) for <30 minutes, 1.344 (0.337-5.360) for 30-60 minutes, and 4.743 (1.441-15.607) for ≥60 minutes. The ORs (95% CIs) for ≥60 min of bedtime timing SD across categories of WI timing SD were 1.000 for <30 minutes, 4.154 (1.574-10.965) for 30-60 minutes, and 7.714 (2.124-28.015) for ≥60 minutes. CONCLUSIONS Regularity of WI was associated with regularity of sleep. To ensure worker health, workers should have regular WI, and if they are exposed to irregular WI, they should make every effort to maintain regular sleep.
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Affiliation(s)
- Hiroki Ikeda
- Japan Organization of Occupational Health and Safety, National Institute of Occupational Safety and Health, Nagao 6-21-1, Tama-Ku, 214-8585, Kawasaki, Japan
| | - Tomohide Kubo
- Japan Organization of Occupational Health and Safety, National Institute of Occupational Safety and Health, Nagao 6-21-1, Tama-Ku, 214-8585, Kawasaki, Japan
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Basheti MM, Bussing J, Grunstein R, Gordon C, Saini B. Developing, Implementing, and Evaluating the Effectiveness of a Sleep Health Educational Module for Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100632. [PMID: 38092088 DOI: 10.1016/j.ajpe.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/19/2023] [Accepted: 12/05/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Pharmacists need sleep health knowledge and management skills to deliver evidence-based treatments to patients with sleep disorders/disturbances. This study aimed to develop, implement, and evaluate a pedagogically informed, interactive sleep health educational module for pharmacy students. METHODS An educational module utilizing a flipped classroom approach, with an interactive lecture, student self-reflection of sleep patterns, case discussions, and pharmacist-patient role-play scenarios, was designed and implemented. A questionnaire assessing pre/post-module changes in knowledge about and attitudes toward sleep health as well as post-module learning satisfaction, was administered to all participating second-year pharmacy students at an Australian university. RESULTS Mean total knowledge scores for participating students (n = 125, 70.4% female) improved significantly, from a baseline of 11.1 ± 3.8 to 17.1 ± 3.5 post-module (range: 0-25). Attitudes toward sleep health were moderately high at baseline (28.8 ± 3.2) and improved marginally post-module (29.4 ± 3.8) (range: 10-50); however, this increase was insignificant. Participants expressed high satisfaction with the module through subjective feedback, and post-module reflective statements indicated plans for changing sleep behaviors. CONCLUSION The results of this study have shown that a targeted educational module for pharmacy students improved sleep health knowledge. It appeared that positive attitudes toward sleep health were not significantly increased which may reflect a ceiling effect. Future modules should focus on attitudinal aspects of positive sleep health to enhance pharmacists' skills in providing clinically related sleep health care to patients with sleep disturbance.
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Affiliation(s)
- Mariam M Basheti
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia.
| | - Jocelyn Bussing
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Ronald Grunstein
- Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia; University of Sydney, Faculty of Medicine and Health, School of Medicine, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Gordon
- Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Bandana Saini
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia
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Hinterberger A, Eigl ES, Schwemlein RN, Topalidis P, Schabus M. Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT-I)-based smartphone app on sleep: A randomised controlled trial. J Sleep Res 2023:e14136. [PMID: 38156655 DOI: 10.1111/jsr.14136] [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: 09/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2 part = 0.11) and PSQI (p = 0.050, ƞ2 part = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment.
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Affiliation(s)
- Alexandra Hinterberger
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Robyn Nina Schwemlein
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Pavlos Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
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20
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Mai Z, Wang S, Chen H, Zhang J, Liu H, Zhao L, Chen Y, Huang R, Zhou H, Chen X, Ding Y, Kong D. Genetically predicted lifestyle factors, socioeconomic status and risk of coronary artery disease in individuals with diabetes: a Mendelian randomization study. Front Public Health 2023; 11:1284958. [PMID: 38186695 PMCID: PMC10771329 DOI: 10.3389/fpubh.2023.1284958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background This study explores the causal links between genetically predicted lifestyle factors, socioeconomic status, and coronary artery disease (CAD) risk in individuals with diabetes using a bidirectional Mendelian-randomization approach. Methods This study explored the potential causal relationships of lifestyle factors and socioeconomic status with the risk of CAD in diabetes patients by a bidirectional, two-sample Mendelian-randomization (MR) analysis. Results Genetically predicted smoking initiation (p = 0.005, 95% CI: 1.08-1.55) and insomnia (p = 0.001, 95% CI: 1.06-1.29) were associated with a higher risk of CAD in individuals with diabetes, whereas educational attainment (p = 0.0001, 95% CI: 0.47-0.78) was associated with a lower risk of CAD. The lifetime smoking index (p = 0.016, 95% CI: 1.12-3.03) was suggestively associated with a higher risk of CAD, while household income before taxes (p = 0.048, 95% CI: 0.41-1.00) was suggestively associated with a lower risk of CAD. In addition, we observed a suggestive negative association between the genetically predicted risk of CAD and the lifetime smoking index (p = 0.016, 95% CI: 0.98-0.99) and a significant causal relationship between the risk of CAD and household income before taxes (p = 0.006, 95% CI: 0.97-0.99). Conclusion The results of this study provide evidence that smoking initiation, lifetime smoking index and insomnia are associated with an increased risk of CAD in individuals with diabetes, educational attainment and household income before taxes are associated with a reduced risk of CAD in individuals with diabetes, and the possible role of lifetime smoking index and household income before taxes on the risk of CAD in individuals with diabetes. It provides an opportunity for the prevention and management of CAD in individuals with diabetes.
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Affiliation(s)
- Zhenhua Mai
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Shuang Wang
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Hao Chen
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jingjing Zhang
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Hao Liu
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Le Zhao
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Yongze Chen
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
- Department of Gastroenterology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ruixian Huang
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Hao Zhou
- Department of Hospital Infection Management of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoming Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuanlin Ding
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
| | - Danli Kong
- Department of Epidemiology and Medical Statistics School of Public Health, Guangdong Medical University, Dongguan, China
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21
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Benz F, Meneo D, Baglioni C, Hertenstein E. Insomnia symptoms as risk factor for somatic disorders: An umbrella review of systematic reviews and meta-analyses. J Sleep Res 2023; 32:e13984. [PMID: 37434300 DOI: 10.1111/jsr.13984] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
The objective of this umbrella review is to present a comprehensive summary of systematic reviews and meta-analyses on the longitudinal association between insomnia and the risk of developing somatic disorders. Pubmed, Medline, CINAHL, PsycInfo and PsycArticles were searched until 16 December 2022. Fourteen systematic reviews and meta-analyses met the inclusion criteria. Results suggest that insomnia symptoms (i.e. aspects of disturbed sleep continuity as a single symptom) convey a risk factor for cardiovascular diseases, hypertension and thyroid cancer. The presence of insomnia symptoms may also enhance the risk for obesity, cognitive decline and dementia-however, results are contradictory and not conclusive here. Results do not suggest an association between insomnia symptoms and mortality. No conclusions can be drawn regarding insomnia disorder because the reviews did not ensure a valid diagnosis. It remains unclear what proportion of participants with insomnia symptoms fulfil diagnostic criteria for insomnia disorder and/or suffer from an organic sleep disorder such as sleep-related breathing disorder. Moreover, most of the included reviews were assessed to have critically low confidence according to the AMSTAR-2 tool. Inconsistent definitions of insomnia and methodological unclarities further underline that results should be interpreted with caution. There is a need for future longitudinal studies that focus on a careful definition and differential diagnosis of both insomnia and the outcome.
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Affiliation(s)
- Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Debora Meneo
- Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Elisabeth Hertenstein
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Universitäre Psychiatrische Dienste Bern (UPD), University of Bern, Bern, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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22
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Sandlund C, Westman J, Norell-Clarke A. Characteristics of Patients with Subjective Sleep Problems after Cognitive Behavioral Therapy for Insomnia: Secondary Analyses of a Randomized Controlled Trial. Sleep Sci 2023; 16:e417-e424. [PMID: 38197018 PMCID: PMC10773518 DOI: 10.1055/s-0043-1776881] [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: 04/03/2022] [Accepted: 01/31/2023] [Indexed: 01/11/2024] Open
Abstract
Objective Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but half of the patients do not reach remission. This study aimed to explore subjective remission by investigating the characteristics of patients who reported lingering sleep problems after CBT-I. Methods Secondary analyses of a randomized controlled trial of group CBT-I in 72 primary care patients with insomnia disorder. Sociodemographic characteristics and outcomes (insomnia severity, sleep variables, hypnotics use, fatigue, depressive symptoms, and dysfunctional beliefs/attitudes), including baseline data and symptom change, were investigated in relation to patients' posttreatment response to the yes-or-no question "Would you say that you have sleep problems?" Results A total of 56.9% of patients reported sleep problems after CBT-I. At baseline, they had worse depressive symptoms (14.9 (SD 7.5) vs. 10.2 (SD 5.9), p = 0.006) and more awakenings (2.6 (SD 1.5) vs. 1.8 (SD 1.3), p = 0.034) than those in subjective remission from sleep problems. Patients in the non-remission and remission groups showed similar improvements in sleep, fatigue, and depressive symptoms, but patients in the non-remission group had improved less in insomnia severity, dysfunctional beliefs/attitudes about sleep, and hypnotic use. In patients with more pronounced depressive symptoms before CBT-I, change in depressive symptoms during treatment partially explained subjective remission from sleep problems. Discussion More severe depressive symptoms prior to CBT-I and less improvements in depressive symptoms during treatment predicted remaining subjective sleep problems after treatment. These findings highlight the importance of assessing depressive symptoms in primary care patients with insomnia, as patients with pronounced depressive symptoms may need tailored treatment.
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Affiliation(s)
- Christina Sandlund
- Karolinska Institutet, Neurobiology, Care Sciences and Society, Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Jeanette Westman
- Karolinska Institutet, Neurobiology, Care Sciences and Society, Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Marie Cederschiöld University, Health Sciences, Stockholm, Sweden
| | - Annika Norell-Clarke
- Örebro University, Law, Psychology and Social Work, Örebro, Sweden
- Kristianstad University, Health Sciences, Kristianstad, Sweden
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24
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Ell J, Schmid SR, Benz F, Spille L. Complementary and alternative treatments for insomnia disorder: a systematic umbrella review. J Sleep Res 2023; 32:e13979. [PMID: 37527850 DOI: 10.1111/jsr.13979] [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: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/03/2023]
Abstract
Insomnia is a common disorder and cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment. However, CBT-I is not widely distributed and infrequently available while medication is not indicated for long-term use. To close this evident gap in supply, alternative treatments could be utilised. High-quality research on this topic is scarce, and there is currently no comprehensive publication on the effectiveness of alternative treatments. To address this pressing question, we systematically summarised the existing research on alternative treatments for insomnia. A comprehensive search of systematic reviews and (network) meta-analyses of randomised controlled trials investigating the efficacy of alternative treatments compared to waiting-list control or placebo in adults with insomnia disorder with or without comorbidities was conducted in PubMed, MEDLINE, PsycInfo, and PsycArticles on December 6, 2022, yielding 391 records. Finally, 15 eligible studies were included. Evidence on acupuncture, exogenous melatonin, mind-body interventions and exercise, repetitive transcranial magnetic stimulation (rTMS), valerian, and light exposure was found. Acupuncture, rTMS and mind-body exercises significantly improved sleep quality and insomnia severity but effects on objectively assessed outcomes were inconclusive. Melatonin led to a reduction in both self-reported and objectively assessed sleep onset latency. Light exposure and valerian did not significantly improve sleep outcomes. Overall, the quality of studies was rated as low. Results indicate that alternative treatments are effective mostly on subjective outcomes. However, evidence on the efficacy of some intervention types is sparse and there is a need for high-quality original studies. Future research could investigate whether combining different alternative treatment aspects with CBT-I improves individual treatment.
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Affiliation(s)
- Johanna Ell
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Sarah R Schmid
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lukas Spille
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
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25
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Richmond RC, Howe LJ, Heilbron K, Jones S, Liu J, Wang X, Weedon MN, Rutter MK, Lawlor DA, Davey Smith G, Vetter C. Correlations in sleeping patterns and circadian preference between spouses. Commun Biol 2023; 6:1156. [PMID: 37957254 PMCID: PMC10643442 DOI: 10.1038/s42003-023-05521-7] [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: 02/14/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Spouses may affect each other's sleeping behaviour. In 47,420 spouse-pairs from the UK Biobank, we found a weak positive phenotypic correlation between spouses for self-reported sleep duration (r = 0.11; 95% CI = 0.10, 0.12) and a weak inverse correlation for chronotype (diurnal preference) (r = -0.11; -0.12, -0.10), which replicated in up to 127,035 23andMe spouse-pairs. Using accelerometer data on 3454 UK Biobank spouse-pairs, the correlation for derived sleep duration was similar to self-report (r = 0.12; 0.09, 0.15). Timing of diurnal activity was positively correlated (r = 0.24; 0.21, 0.27) in contrast to the inverse correlation for chronotype. In Mendelian randomization analysis, positive effects of sleep duration (mean difference=0.13; 0.04, 0.23 SD per SD) and diurnal activity (0.49; 0.03, 0.94) were observed, as were inverse effects of chronotype (-0.15; -0.26, -0.04) and snoring (-0.15; -0.27, -0.04). Findings support the notion that an individual's sleep may impact that of their partner, promoting opportunities for sleep interventions at the family-level.
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Affiliation(s)
- Rebecca C Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, UK.
| | - Laurence J Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, UK
| | - Karl Heilbron
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Samuel Jones
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Junxi Liu
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, UK
- Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xin Wang
- 23andMe, Inc., 223 N Mathilda Avenue, Sunnyvale, CA, USA
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Deborah A Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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Joung KI. Gender differences in spontaneous adverse event reports associated with zolpidem in South Korea, 2015-2019. Front Pharmacol 2023; 14:1256245. [PMID: 38026947 PMCID: PMC10665515 DOI: 10.3389/fphar.2023.1256245] [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: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Study objectives: While zolpidem is considered as an example of a gender effect on drug response, there is insufficient evidence to reach a consensus. This study aimed to investigate gender differences in adverse events (AEs) of zolpidem. Methods: We estimated the difference between the reporting odds ratios (RORs) calculated in gender subgroups for the AEs signals detected in data mining using 2015-2019 Korea voluntary adverse drug events reporting system (KAERS) data. Different reporting risk by gender was evaluated by using the log RORs being significantly different by gender at the 5% significance level and the 95% confidence intervals of the gender ROR. Results: A total of 94 AE signals were detected. Among these, 35 signals showed significant disparities by gender at the 5% level or were detected only in one gender. When categorized by similarity of AEs, parasomnia including somnambulism and paroniria, and cardiovascular disorders including coronary thrombosis had higher reporting risks in women. Men were more likely to report cognitive disorders such as delirium, insomnia related disorders, and movement disorders. Among all AEs with gender differences in reporting risk, the difference in somnambulism was the most consistent and substantial. Conclusion: For several AEs associated with zolpidem, gender-based reporting disparities were evident. Notably, women exhibited a higher susbeptibility to somnambulism, potentially serious adverse effects of zolpidem. This underscores the need for further investigation into the underlying factors influencing these gender-specific reporting patterns.
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Affiliation(s)
- Kyung-In Joung
- School of AI Healthcare, College of Integrated Health Science, CHA University, Pocheon, Republic of Korea
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Shi Y, Ren R, Zhang Y, Vitiello MV, Tang X. Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. J Sleep Res 2023:e14077. [PMID: 37897204 DOI: 10.1111/jsr.14077] [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: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.
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Affiliation(s)
- Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Hertenstein E, Schneider C, Nissen C. [Insomnia]. Dtsch Med Wochenschr 2023; 148:1384-1390. [PMID: 37820649 DOI: 10.1055/a-2182-0463] [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: 10/13/2023]
Abstract
Patients with insomnia suffer from problems falling asleep and/or maintaining sleep. This has a negative effect on their daytime wellbeing and performance. Insomnia is primarily diagnosed by a detailed clinical history, supplemented by questionnaires and sleep diaries. Polysomnography may be necessary for the differential diagnosis of organic sleep disorders. Insomnia is a frequent comorbidity of most mental disorders and many physical diseases. It is treated according to guidelines with cognitive behavioural therapy for insomnia (CBT-I). CBT-I is offered in individual or group format as well as online-supported treatment. If behavioural therapy is not effective or not available, pharmacotherapy can be discussed.
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Chiu YW, Su MH, Lin YF, Chen CY, Chen TT, Wang SH. Causal influence of sleeping phenotypes on the risk of coronary artery disease and sudden cardiac arrest: A Mendelian randomization analysis. Sleep Health 2023; 9:726-732. [PMID: 37429813 DOI: 10.1016/j.sleh.2023.05.009] [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: 05/14/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To assess the causal influence of sleep and circadian traits on coronary artery disease and sudden cardiac arrest with adjustment for obesity through a two-sample Mendelian randomization study. METHODS We used summary statistics of 5 sleep and circadian traits for genome-wide association studies, including chronotype, sleep duration, long sleep (≥9 h a day), short sleep (<7 h a day), and insomnia (sample size range: 237,622-651,295). Coronary artery disease genome-wide association studies with 60,801 cases and 123,504 controls, sudden cardiac arrest genome-wide association studies with 3939 cases and 25,989 controls, and obesity genome-wide association studies with 806,834 individuals were also used. Multivariable Mendelian randomization was performed to estimate the causality. RESULTS After adjusting for obesity, genetically predicted short sleep (odds ratio = 1.87 and p = .02), and genetically predicted insomnia (odds ratio = 1.17 and p = .001) were causally associated with increased odds of coronary artery disease. Genetically predicted long sleep (odds ratio = 0.06 and p = .02) and genetically predicted longer sleep duration (odds ratio = 0.36 for per-hour increase in sleep duration and p = .0006) were causally associated with decreased odds of sudden cardiac arrest. CONCLUSIONS The findings of this Mendelian randomization study indicate that insomnia and short sleep contribute to the development of coronary artery disease, whereas a longer sleep duration protects from sudden cardiac arrest, independent of the influence of obesity. The mechanisms underlying these associations warrant further investigation.
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Affiliation(s)
- Yen-Wei Chiu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Mei-Hsin Su
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Yen-Feng Lin
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Yen Chen
- Biogen, Cambridge, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tzu-Ting Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shi-Heng Wang
- College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan.
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Strumberger MA, Häberling I, Emery S, Albermann M, Baumgartner N, Bucher N, Erb S, Bachmann S, Wöckel L, Müller-Knapp U, Contin-Waldvogel B, Rhiner B, Walitza S, Berger G, Cajochen C, Schmeck K. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med 2023; 19:1775-1784. [PMID: 37323001 PMCID: PMC10545993 DOI: 10.5664/jcsm.10678] [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: 03/03/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
STUDY OBJECTIVES We aimed to examine the association between self-rated and clinician-rated sleep disturbances and C-reactive protein (CRP), an objective marker of inflammation, in pediatric depression. METHODS Two hundred fifty-six children and adolescents (15.2 ± 1.6 y, 72.3% female) with moderate to severe symptoms of depression participated in the study. Sleep disturbances were assessed by self-reports (Insomnia Severity Index) and clinician ratings (Kiddie-Schedule for Affective Disorder and Schizophrenia), inflammation by plasma CRP levels. RESULTS Higher levels of CRP correlated positively with clinician-rated middle insomnia and hypersomnia. After adjusting for control variables (body mass index, tobacco, alcohol, stress, age, sex, antidepressants, sleep medication, depression severity), regression models confirmed the significant association of clinician-rated hypersomnia and middle insomnia symptoms with elevated CRP levels. In the adjusted regression models, other clinician-rated manifestations of sleep disturbance (eg, initial insomnia) and insomnia self-ratings were not significantly associated with CRP. Body mass index correlated positively with CRP, but body mass index had no mediating effect on the associations between sleep disturbances and CRP. We did not find an association between depression severity, assessed by the Children's Depression Rating Scale-Revised, and CRP. CONCLUSIONS Results of the present study indicate a significant association of hypersomnia and middle insomnia symptoms with CRP in pediatric depression, not linked to alterations in the body mass index. CITATION Strumberger MA, Häberling I, Emery S, et al. Sleep disturbance, but not depression severity, is associated with inflammation in children and adolescents. J Clin Sleep Med. 2023;19(10):1775-1784.
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Affiliation(s)
- Michael A. Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | - Naïma Bucher
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland
| | - Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, Thônex, Switzerland
- Department of Psychiatry Psychotherapy, Psychosomatic Medicine, Medical Faculty of Martin Luther University, Halle, Germany
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Clienia Littenheid AG, Littenheid, Switzerland
| | | | | | - Bruno Rhiner
- Child and Adolescent Psychiatric Services Thurgau, Münsterlingen, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Tolonen I, Saarinen A, Puttonen S, Kähönen M, Hintsanen M. High compassion predicts fewer sleep difficulties: A general population study with an 11-year follow-up. Brain Behav 2023; 13:e3165. [PMID: 37608595 PMCID: PMC10570475 DOI: 10.1002/brb3.3165] [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: 11/15/2022] [Revised: 03/17/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION This study investigated the cross-sectional and longitudinal associations between self-reported compassion and sleep quality. METHODS The data came from the population-based Young Finns Study with an 11-year follow-up on compassion and sleep (n = 1064). We used regression models, multilevel models, and cross-lagged panel models to analyze the data. RESULTS The results showed that high compassion was cross-sectionally associated with lesser sleep deficiency and fewer sleep difficulties. High compassion also predicted fewer sleep difficulties over an 11-year follow-up (adjusted for age, gender, socioeconomic position in childhood and adulthood, body mass index, health behaviors, and working conditions). This association disappeared when controlling for depressive symptoms. The predictive pathway seemed to proceed more likely from high compassion to fewer sleep difficulties than vice versa. DISCUSSION Compassion may buffer against sleep difficulties, possibly via reducing depressive symptoms.
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Affiliation(s)
- Iina Tolonen
- Division of Psychology, Faculty of Education and PsychologyUniversity of OuluOuluFinland
| | - Aino Saarinen
- Department of Psychology and Logopedics, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Sampsa Puttonen
- Faculty of Social SciencesTampere UniversityTampereFinland
- Finnish Institute of Occupational HealthHelsinkiFinland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Mirka Hintsanen
- Division of Psychology, Faculty of Education and PsychologyUniversity of OuluOuluFinland
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Yeung CHC, Bauer C, Xiao Q. Associations between actigraphy-derived rest-activity rhythm characteristics and hypertension in United States adults. J Sleep Res 2023; 32:e13854. [PMID: 36807441 DOI: 10.1111/jsr.13854] [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: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
People with disrupted circadian rhythms, such as shift workers, have shown a higher risk of hypertension. However, it is unclear whether more subtle differences in diurnal rest-activity rhythms in the population are associated with hypertension. Clarifying the association between the rest-activity rhythm, a modifiable behavioural factor, and hypertension could provide insight into preventing hypertension and possibly cardiovascular diseases. In this study, we investigated the association between rest-activity rhythm characteristics and hypertension in a large representative sample of United States adults. Cross-sectional data were obtained from the National Health and Nutrition Examination Survey 2011-2014 (N = 6726; mean [range] age 49 [20-79] years; 52% women). Five rest-activity rhythm parameters (i.e., pseudo F statistic, amplitude, mesor, amplitude:mesor ratio, and acrophase) were derived from 24-h actigraphy data using the extended cosine model. We performed multiple logistic regression to assess the associations between the rest-activity rhythm parameters and hypertension. Subgroup analysis stratified by age, gender, race/ethnicity, body mass index and diabetes status was also conducted. A weakened overall rest-activity rhythm, characterised by a lower F statistic, was associated with higher odds of hypertension (odds ratio quintile 1 versus quintile 5 [OR Q1vs.Q5 ] 1.61, 95% confidence interval [CI] 1.26-2.05; p trend < 0.001). Similar results were found for lower amplitude (OR Q1vs.Q5 1.51, 95% CI 1.13-2.03; p trend = 0.01) and amplitude:mesor ratio (OR Q1vs.Q5 1.34, 95% CI 1.01-1.78; p trend = 0.03). The results were robust to the adjustment of confounders, individual behaviours including physical activity levels and sleep duration and appeared consistent across subgroups. Possible interaction between the rest-activity rhythm and body mass index was found. Our results support an association between weakened rest-activity rhythms and higher odds of hypertension.
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Affiliation(s)
- Chris Ho Ching Yeung
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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Ali E, Shaikh A, Yasmin F, Sughra F, Sheikh A, Owais R, Raheel H, Virk HUH, Mustapha JA. Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data. PLoS One 2023; 18:e0291859. [PMID: 37733726 PMCID: PMC10513332 DOI: 10.1371/journal.pone.0291859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Insomnia is a prevalent sleeping disorder associated with increasing cardiovascular (CV) mortality and morbidity. However, data incorporating recent clinical studies evaluating these outcomes is scarce. Hence, we aimed to investigate the association of insomnia with CV mortality, myocardial infarction (MI), all-cause mortality, and incidence of CV disease by conducting the first-ever meta-analysis of real-world data evaluating these CV outcomes. MEDLINE and Scopus databases were queried till August 2022 to identify studies comparing prespecified outcomes in patients with and without insomnia. The primary outcomes were CV mortality and myocardial infarction, while secondary outcomes included all-cause mortality, and CV-disease incidence. All data were pooled using an inverse-variance weighted random-effects model, and results were reported as relative risks (RRs) and p-values. 21 studies were analyzed. Risks for CV mortality and MI were significantly higher in patients with insomnia (RR 1.53, p<0.01, and RR 1.48, p = 0.03, respectively). The risk for all-cause mortality and CV disease incidence was also significantly higher in insomnia patients (RR 1.14, p = 0.03, and RR 1.31, p<0.01, respectively). Individuals with insomnia experience a higher risk of long-term mortality, MI, and incidence of CV disease.
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Affiliation(s)
- Eman Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Yasmin
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Fatima Sughra
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Sheikh
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Owais
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hamna Raheel
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Jihad A. Mustapha
- Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
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Lundin S, Wahlgren CF, Johansson EK, Andersson N, Mogensen I, Ekstrom S, Jonsson M, Melen E, Ljungman PLS, Bergstrom A, Kull I. Childhood atopic dermatitis is associated with cardiovascular risk factors in young adulthood-A population-based cohort study. J Eur Acad Dermatol Venereol 2023; 37:1854-1862. [PMID: 37184288 DOI: 10.1111/jdv.19190] [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: 10/28/2022] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Studies have indicated that atopic dermatitis (AD) is associated with an increased risk of cardiovascular disease (CVD). However, data are conflicting. Furthermore, the longitudinal effect of childhood AD on cardiovascular risk factors in young adulthood is less investigated. OBJECTIVES To assess associations between AD in childhood and CVD risk factors in young adulthood. METHODS The study encompasses longitudinal data from a population-based birth cohort. Participants with data up to age 24 years were included (n = 2270). The primary outcomes were body mass index (BMI), waist circumference (WC), body fat per cent (BF%) and blood pressure (BP) at 24 years. The secondary outcome was blood lipids. Severe AD was defined as AD in combination with sleep disturbance due to itching. RESULTS In total, 18.6% (n = 420) had AD at 24 years. Males with AD had higher BMI (βAdj. 0.81, 95% CI 0.15-1.47), BF% (βAdj. 1.19, 95% CI 0.09-2.29), systolic BP (βAdj. 1.92, 95% CI 0.02-3.82), total cholesterol (βAdj. 0.14, 95% CI 0.00-0.28) and LDL cholesterol (βAdj. 0.15, 95% CI 0.02-0.27) compared with males without AD. No associations were seen in females. Current AD with prepubertal onset was associated with increased BMI in both males (βAdj. 0.89, 95% CI 0.11-1.67) and females (βAdj. 0.72, 95% CI 0.11-1.33). At 24 years, 23.1% (n = 97) of all with AD, had severe disease, which was significantly associated with overweight in both sexes, with BMI (βAdj. 1.83, 95% CI 0.72-2.94), WC (βAdj. 4.03, 95% CI 1.54-6.52) and BF% (βAdj. 2.49, 95% CI 0.60-4.39) in females and with BF% (βAdj. 2.96, 95% CI 0.23-5.69) in males, compared with peers with mild to moderate AD. CONCLUSION AD in males appears to be associated with CVD risk factors in young adulthood. The duration and severity of AD seem to be of importance in both sexes.
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Affiliation(s)
- S Lundin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - C F Wahlgren
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - E K Johansson
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - N Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Mogensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - S Ekstrom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Occupational and Environmental Medicine, Region Stockholm, Sweden
| | - M Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - E Melen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - A Bergstrom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Occupational and Environmental Medicine, Region Stockholm, Sweden
| | - I Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Ha KH, Kim DJ, Han SJ. Associations of updated cardiovascular health metrics, including sleep health, with incident diabetes and cardiovascular events in older adults with prediabetes: A nationwide population-based cohort study. Diabetes Res Clin Pract 2023; 203:110820. [PMID: 37422164 DOI: 10.1016/j.diabres.2023.110820] [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: 04/25/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
AIMS To investigate the association of updated cardiovascular health (CVH) metrics, including sleep health, with the risk of diabetes and major adverse cardiovascular events (MACE) in older adults with prediabetes. METHODS A total of 7,948 older adults with prediabetes aged ≥ 65 years were included in this study. CVH was assessed using seven baseline metrics according to the modified American Heart Association recommendations. RESULTS During a median follow-up time of 11.9 years, 2,405 (30.3%) cases of diabetes and 2,039 (25.6%) MACE were recorded. Compared with the poor composite CVH metrics group, the multivariable-adjusted hazard ratios (HRs) in the intermediate and ideal composite CVH metrics groups were respectively 0.87 (95% confidence intervals [CI] = 0.78-0.96) and 0.72 (95% CI = 0.65-0.79) for diabetes events and 0.99 (95% CI = 0.88-1.11) and 0.88 (95% CI = 0.79-0.97) for MACE. The ideal composite CVH metrics group had a lower risk of diabetes and MACE in older adults aged 65-74 years, but not in those aged ≥ 75 years. CONCLUSIONS Ideal composite CVH metrics in older adults with prediabetes were associated with a lower risk of diabetes and MACE.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Ravichandran R, Gupta L, Singh M, Nag A, Thomas J, Panjiyar BK. The Interplay Between Sleep Disorders and Cardiovascular Diseases: A Systematic Review. Cureus 2023; 15:e45898. [PMID: 37885512 PMCID: PMC10598613 DOI: 10.7759/cureus.45898] [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: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Non-communicable diseases (NCDs) have emerged as the predominant cause of global mortality, resulting in a substantial annual loss of human lives. Among these conditions, cardiovascular diseases (CVD) stand out as the primary cause of death. The majority of CVD cases can be attributed to certain factors that, upon modification, have the potential to significantly decrease both the incidence and severity of the disease. For numerous years, the impact of sleep disorders on cardiovascular health has been a prominent subject of extensive discussion. Chronic sleep disturbances are known to have a range of negative health consequences, with the relationship between sleep apnea and hypertension being well-established through numerous studies. However, further exploration is needed to understand other disease associations with sleep apnea and to examine the impact of various sleep disorders, aside from sleep apnea, on cardiovascular health. This systematic review assesses the available evidence on the association between various sleep disorders and cardiovascular diseases by addressing the question: Do sleep disorders contribute to or exacerbate cardiovascular diseases? After a comprehensive review, we identified 122 articles. Following this initial review, seven papers directly aligned with our research topic. Subsequently, we meticulously assessed the remaining seven papers, all meeting our predetermined criteria. Our analysis showed a strong correlation between sleep disruptions and cardiovascular health. Numerous sleep disorders, such as narcolepsy, central sleep apnea, obstructive sleep apnea, and insomnia, have shown different effects on cardiovascular outcomes. Increased risks of illnesses such as acute coronary syndrome (ACS), hypertension, cardiovascular mortality, and coronary artery calcification were included in these consequences. This systematic review underscores the need for early identification and comprehensive management of sleep disturbances to mitigate their potential adverse effects on cardiovascular well-being. Integrating strategies that address sleep disorders and cardiovascular health is imperative in enhancing overall health outcomes. This study paves the way for more effective preventive and therapeutic approaches by focusing on the relationship between sleep disorders and cardiovascular diseases.
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Affiliation(s)
- Rakshana Ravichandran
- Department of Internal Medicine, Rajarajeswari Medical College and Hospital, Bangalore, IND
| | - Lovish Gupta
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Mansi Singh
- Department of Medicine, O. O. Bogomolets National Medical University, Kyiv, UKR
| | - Aiswarya Nag
- Department of Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Jingle Thomas
- Department of Internal Medicine, Al-Ameen Medical College, Vijayapura, IND
| | - Binay K Panjiyar
- Global Clinical Scholars Research Training (GCSRT) and Postgraduate Medical Education (PGME), Harvard Medical School, Boston, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Bakker MH, Oldejans NA, Hugtenburg JG, van der Horst HE, Slottje P. Insomnia management in Dutch general practice: a routine care database study. Scand J Prim Health Care 2023; 41:306-316. [PMID: 37470474 PMCID: PMC10478592 DOI: 10.1080/02813432.2023.2237073] [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: 03/15/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE To explore insomnia management in general practice, with a focus on sleep medication prescription. DESIGN Descriptive analysis of anonymized routine general practice care data extracted from electronic medical records (EMRs), including demographics, free text annotations from sleep consultations and sleep medication prescriptions covering one year before up to two years after the registration of the International Classification for Primary Care (ICPC) code P06 'Sleep disturbance'. SETTING Twenty-one general practices in an urban area of the Netherlands. PATIENTS Adults (18-85 year) with a first sleep consultation with their GP. OUTCOMES Documented non-pharmacological and sleep medication treatment. RESULTS Of the 1,089 patients who consulted their general practitioner (GP) for sleep disturbance for the first time, about 50% had one more sleep consultation during the two years follow-up. Over two years including the first consultation, GPs documented a non-pharmacological intervention for 48.4% of the patients and prescribed sleep medication to 77.0%. 64.6% of the patients received a sleep medication prescription in the first consultation. Among patients receiving medication (N = 838); 59.6% received more than one prescription; 76.8% received one or more short-acting benzodiazepine receptor agonist (BZRA), 39.5% one or more unrecommended drugs and 14.7% >180 pills of BZRAs in two years. CONCLUSION Although the guidelines advocate non-pharmacological treatment and warn against unwarranted sleep medication, it is still very common in Dutch general practice to prescribe medication, even at the first sleep consultation. Prescriptions frequently include unrecommended and off-label drugs or repeated BZRA prescriptions.
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Affiliation(s)
- Mette H. Bakker
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Nina A. Oldejans
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline G. Hugtenburg
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henriëtte E. van der Horst
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Wang B, Zhang H, Sun Y, Tan X, Zhang J, Wang N, Lu Y. Association of sleep patterns and cardiovascular disease risk is modified by glucose tolerance status. Diabetes Metab Res Rev 2023; 39:e3642. [PMID: 37009685 DOI: 10.1002/dmrr.3642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
AIMS To investigate whether the association between sleep patterns and cardiovascular disease (CVD) risk differs according to glucose tolerance status. MATERIALS AND METHODS This prospective study included 358,805 participants initially free of CVD from the UK Biobank. We created a sleep score based on five sleep factors (sleep duration, chronotype, insomnia, snoring, and daytime sleepiness) with one point for each unhealthy factor. Cox proportional hazards models were used to examine the association between sleep and incident CVD, including coronary heart disease (CHD) and stroke, according to normal glucose tolerance (NGT), prediabetes, and diabetes. RESULTS During a median follow-up of 12.4 years, 29,663 incident CVD events were documented. There was a significant interaction between sleep score and glucose tolerance status on CVD (P for interaction = 0.002). Each 1 point increment in sleep score was associated with a 7% (95% confidence interval 6%-9%), 11% (8%-14%), and 13% (9%-17%) higher risk of CVD among participants with NGT, prediabetes, and diabetes, respectively. Similar interaction patterns were observed for CHD and stroke. Among the individual sleep factors, sleep duration and insomnia significantly interacted with glucose tolerance status on CVD outcomes (all P for interaction <0.05). All five unhealthy sleep factors accounted for 14.2% (8.7%-19.8%), 19.5% (7.4%-31.0%), and 25.1% (9.7%-39.3%) of incident CVD cases among participants with NGT, prediabetes, and diabetes, respectively. CONCLUSIONS The CVD risk associated with a poor sleep pattern was exacerbated across glucose intolerance status. Our findings emphasise the importance of integrating sleep management into a lifestyle modification programme, particularly in people with prediabetes or diabetes.
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Affiliation(s)
- Bin Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haojie Zhang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Sun
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Tan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Jihui Zhang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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39
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Bock JM, Greenlund IM, Somers VK, Baker SE. Sex Differences in Neurovascular Control: Implications for Obstructive Sleep Apnea. Int J Mol Sci 2023; 24:13094. [PMID: 37685900 PMCID: PMC10487948 DOI: 10.3390/ijms241713094] [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: 07/11/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have a heightened risk of developing cardiovascular diseases, namely hypertension. While seminal evidence indicates a causal role for sympathetic nerve activity in the hypertensive phenotype commonly observed in patients with OSA, no studies have investigated potential sex differences in the sympathetic regulation of blood pressure in this population. Supporting this exploration are large-scale observational data, as well as controlled interventional studies in healthy adults, indicating that sleep disruption increases blood pressure to a greater extent in females relative to males. Furthermore, females with severe OSA demonstrate a more pronounced hypoxic burden (i.e., disease severity) during rapid eye movement sleep when sympathetic nerve activity is greatest. These findings would suggest that females are at greater risk for the hemodynamic consequences of OSA and related sleep disruption. Accordingly, the purpose of this review is three-fold: (1) to review the literature linking sympathetic nerve activity to hypertension in OSA, (2) to highlight recent experimental data supporting the hypothesis of sex differences in the regulation of sympathetic nerve activity in OSA, and (3) to discuss the potential sex differences in peripheral adrenergic signaling that may contribute to, or offset, cardiovascular risk in patients with OSA.
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Affiliation(s)
- Joshua M. Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Ian M. Greenlund
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55901, USA
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40
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Grandner M, Olivieri A, Ahuja A, Büsser A, Freidank M, McCall WV. The burden of untreated insomnia disorder in a sample of 1 million adults: a cohort study. BMC Public Health 2023; 23:1481. [PMID: 37537544 PMCID: PMC10399052 DOI: 10.1186/s12889-023-16329-9] [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: 02/15/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data assessing the burden of insomnia disorder on daytime functioning and its association with comorbidities. The objective of this study was to leverage large-scale, real-world data to assess the burden of untreated insomnia disorder in terms of daytime impairment and clinical outcomes. METHODS This United States medical claims database study compares patients diagnosed with insomnia disorder but not receiving treatment ('untreated insomnia' cohort) to patients without an insomnia disorder diagnosis and without treatment ('non-insomnia' cohort). International Classification of Disease, Tenth Revision codes were used as a proxy to represent the three symptom domains (Sleepiness, Alert/Cognition, Mood) of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), a newly developed and validated tool used in clinical studies to assess daytime functioning in insomnia disorder. Chronic Fatigue (R53.83) and Other Fatigue (R53.83), Somnolence (R40.0) and Disorientation (R41.0) were selected as categories representing one or more IDSIQ domains. Clinical outcomes included cardiovascular events, psychiatric disorders, cognitive impairment and metabolic disorders. RESULTS Approximately 1 million patients were included (untreated insomnia: n = 139,959; non-insomnia: n = 836,975). Compared with the 'non-insomnia' cohort, the 'untreated insomnia' cohort was more likely to experience daytime impairments, with mean differences in occurrences per 100 patient-years for: (a) fatigue, at 27.35 (95% confidence interval [CI] 26.81, 27.77, p < 0.01); (b) dizziness, at 4.66 (95% CI 4.40, 4.90, p < 0.01); (c) somnolence, at 4.18 (95% CI 3.94, 4.43, p < 0.01); and (d) disorientation, at 0.92 (95% CI 0.77, 1.06, p < 0.01). During the 1-year look-back period, patients in the 'untreated insomnia' cohort were also more likely to have been diagnosed with arterial hypertension (40.9% vs. 26.3%), psychiatric comorbidities (40.1% vs. 13.2%), anxiety (29.2% vs. 8.5%), depression (26.1% vs. 8.1%) or obesity (21.3% vs. 11.1%) compared with those in the 'non-insomnia' cohort. CONCLUSIONS This large-scale study confirms the substantial burden of insomnia disorder on patients in a real-world setting, with significant daytime impairment and numerous comorbidities. This reinforces the need for timely insomnia disorder diagnosis and treatments that improve both sleep, as well as daytime functioning.
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Affiliation(s)
- Michael Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Antonio Olivieri
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil, 4123, Switzerland
| | - Ajay Ahuja
- Idorsia Pharmaceuticals US Inc, Radnor, PA, USA
| | - Alexander Büsser
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil, 4123, Switzerland.
| | | | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
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41
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Ballesio A. Inflammatory hypotheses of sleep disturbance - depression link: Update and research agenda. Brain Behav Immun Health 2023; 31:100647. [PMID: 37408788 PMCID: PMC10319168 DOI: 10.1016/j.bbih.2023.100647] [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: 03/08/2023] [Revised: 04/23/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
Studies in human and experimental animal models support a role of inflammation in the aetiology of depression, yet the precise role played by sleep disturbance (i.e., difficulties falling or maintaining sleep) is poorly understood. Consistent evidence from prospective epidemiological studies suggests sleep disturbance as a predictor of major depression episodes and depression recurrence. In parallel, up to 20% of individuals with sleep disturbance have low-grade peripheral inflammation (i.e., CRP>3 mg/l), and preliminary longitudinal evidence showed that sleep disturbance may even predict the levels of inflammation. Therefore, it is possible that sleep disturbance may increase inflammation, which in turn may contribute (i.e., mediate) to the onset - or worsening - of depression. Alternatively, sleep disturbance may serve as a vulnerability factor and increase the risk of developing depressive symptoms when facing an immune challenge. The aim of this review was to summarise the state of the science on the role of sleep disturbance in contributing to depression-related inflammation. A research agenda is also proposed to advance the study of sleep disturbance in the psychoneuroimmunology of depression.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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42
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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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43
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Stewart JC, Patel JS, Polanka BM, Gao S, Nurnberger JI, MacDonald KL, Gupta SK, Considine RV, Kovacs RJ, Vrany EA, Berntson J, Hsueh L, Shell AL, Rollman BL, Callahan CM. Effect of modernized collaborative care for depression on depressive symptoms and cardiovascular disease risk biomarkers: eIMPACT randomized controlled trial. Brain Behav Immun 2023; 112:18-28. [PMID: 37209779 PMCID: PMC10527905 DOI: 10.1016/j.bbi.2023.05.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023] Open
Abstract
Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results - 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI: 1.93-7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers - i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, ps ≥ 0.09). Our modernized collaborative care intervention - which harnessed technology to maximize access and minimize resources - produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches. Trial Registration:ClinicalTrials.gov Identifier: NCT02458690.
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Affiliation(s)
- Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.
| | - Jay S Patel
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Brittanny M Polanka
- Division Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John I Nurnberger
- Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Krysha L MacDonald
- Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Samir K Gupta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert V Considine
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J Kovacs
- Division of Cardiovascular Disease, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth A Vrany
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | | | - Loretta Hsueh
- Department of Psychology, University of Illinois Chicago, Chicago, IL, USA
| | - Aubrey L Shell
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Bruce L Rollman
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher M Callahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
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Dai Y, Chen B, Chen L, Vgontzas AN, Fernandez-Mendoza J, Karataraki M, Tang X, Li Y. Insomnia with objective, but not subjective, short sleep duration is associated with increased risk of incident hypertension: the Sleep Heart Health Study. J Clin Sleep Med 2023; 19:1421-1428. [PMID: 37078185 PMCID: PMC10394371 DOI: 10.5664/jcsm.10570] [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: 12/04/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
STUDY OBJECTIVES Insomnia with objective short sleep duration has been associated with higher risk of cardiometabolic morbidity. In this study, we examined the association between insomnia with objective short sleep duration, also based on subjective sleep duration, with incident hypertension in the Sleep Heart Health Study. METHODS We analyzed data from 1,413 participants free of hypertension or sleep apnea at baseline from the Sleep Heart Health Study, with a median follow-up duration of 5.1 years. Insomnia symptoms were defined based on difficulty falling asleep, difficulty returning to sleep, early morning awakening, or sleeping pill use more than half the days in a month. Objective short sleep duration was defined as polysomnography-measured total sleep time < 6 hours. Incident hypertension was defined based on blood pressure measures and/or use of antihypertensive medications at follow-up. RESULTS Individuals with insomnia who slept objectively < 6 hours had significantly higher odds of incident hypertension compared to normal sleepers who slept ≥ 6 hours (odds ratio = 2.00, 95% confidence interval = 1.09-3.65) or < 6 hours (odds ratio = 2.00, 95% confidence interval = 1.06-3.79) or individuals with insomnia who slept ≥ 6 hours (odds ratio = 2.79, 95% confidence interval = 1.24-6.30). Individuals with insomnia who slept ≥ 6 hours or normal sleepers who slept < 6 hours were not associated with increased risk of incident hypertension compared to normal sleepers who slept ≥ 6 hours. Finally, individuals with insomnia who self-reported sleeping < 6 hours were not associated with significantly increased odds of incident hypertension. CONCLUSIONS These data further support that the insomnia with objective short sleep duration phenotype based on objective, but not subjective measures, is associated with increased risk of developing hypertension in adults. CITATION Dai Y, Chen B, Chen L, et al. Insomnia with objective, but not subjective, short sleep duration is associated with increased risk of incident hypertension: the Sleep Heart Health Study. J Clin Sleep Med. 2023;19(8):1421-1428.
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Affiliation(s)
- Yanyuan Dai
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Le Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Alexandros N. Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Maria Karataraki
- Department of Psychiatry and Behavioral Sciences, University of Crete, Heraklion, Crete, Greece
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
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Muroi K, Ishitsuka M, Hori D, Doki S, Takahashi T, Ikeda T, Saito T, Shinichiro S, Matsuzaki I. Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan. F1000Res 2023; 12:103. [PMID: 37384304 PMCID: PMC10293797 DOI: 10.12688/f1000research.129340.1] [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] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood. METHODS We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable. RESULTS Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia. CONCLUSIONS It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.
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Affiliation(s)
- Kei Muroi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mami Ishitsuka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Daisuke Hori
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shotaro Doki
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsukasa Takahashi
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomohiko Ikeda
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tamaki Saito
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sasahara Shinichiro
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ichiyo Matsuzaki
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Muroi K, Ishitsuka M, Hori D, Doki S, Takahashi T, Ikeda T, Saito T, Shinichiro S, Matsuzaki I. Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan. F1000Res 2023; 12:103. [PMID: 37384304 PMCID: PMC10293797 DOI: 10.12688/f1000research.129340.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood. METHODS We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable. RESULTS Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia. CONCLUSIONS It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.
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Affiliation(s)
- Kei Muroi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mami Ishitsuka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Daisuke Hori
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shotaro Doki
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsukasa Takahashi
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomohiko Ikeda
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tamaki Saito
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sasahara Shinichiro
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ichiyo Matsuzaki
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Ha J, Mehta RS, Cao Y, Huang T, Staller K, Chan AT. Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses' Health Study II. JAMA Netw Open 2023; 6:e2324240. [PMID: 37466940 PMCID: PMC10357337 DOI: 10.1001/jamanetworkopen.2023.24240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Limited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality. Objective To prospectively investigate the association between GER symptoms and sleep quality. Design, Setting, and Participants This prospective cohort study included data from the Nurses' Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023. Exposures Frequency and duration of GER symptoms. Main Outcomes and Measures Poor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms. Results Among 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep. Conclusions and Relevance In this prospective cohort study of female nurses in the Nurses' Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.
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Affiliation(s)
- Jane Ha
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Raaj S. Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St Louis, Missouri
| | - Tianyi Huang
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kyle Staller
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Amiri S. Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis. SLEEP MEDICINE RESEARCH 2023; 14:66-79. [DOI: 10.17241/smr.2023.01732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 08/28/2023] Open
Abstract
Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.
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Harvey A, Scott H, Melaku YA, Lack L, Sweetman A, Micic G, Lovato N. The mortality risk of night-time and daytime insomnia symptoms in an older population. Sci Rep 2023; 13:9575. [PMID: 37311787 DOI: 10.1038/s41598-023-36016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023] Open
Abstract
The current study examined the association between insomnia symptoms and all-cause mortality in older adults (≥ 65 years). Data was used from 1969 older adults [M = 78 years, SD = 6.7 years] who participated in the Australian Longitudinal Study of Ageing. Insomnia symptoms were defined by nocturnal symptoms (difficulty falling asleep, difficulty maintaining sleep, early morning awakenings) and daytime symptoms (concentration difficulties, effort, inability to get going). Frequency of symptoms were combined to calculate an insomnia symptom score ranging from 0 (no symptoms) to 24 (sever symptoms) and quintiles of the score were constructed to provide a range of symptom severity. Multivariable Cox models were conducted to assess associations between insomnia symptom severity and mortality risk. In the median follow up of 9.2 years, there were 17,403 person-years at risk and the mortality rate was 8-per 100 person-years. Insomnia symptom severity was associated with increased mortality in the most severe quintile (adjusted HRQ1vsQ5 = 1.26, 95%CI [1.03-1.53], p = .02). Subsequent analyses showed this association was driven by daytime symptoms (adjusted HRQ1vsQ5 = 1.66, [1.39-2.00], p < .0001), since nocturnal symptoms alone were not associated with increased mortality (adjusted HR Q1vsQ5 = 0.89, [0.72-1.10], p = .28). Findings suggest daytime symptoms drive increased mortality risk associated with insomnia symptoms. Findings may be therapeutically helpful by reassuring individuals with nocturnal insomnia symptoms alone that their longevity is unlikely to be impacted.
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Affiliation(s)
- Amy Harvey
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, 5001, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, 5001, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, 5001, Australia
| | - Gorica Micic
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, 5001, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, 5001, Australia
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50
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Zhou W, Sun L, Zeng L, Wan L. Mediation of the association between sleep disorders and cardiovascular disease by depressive symptoms: An analysis of the National health and Nutrition Examination Survey (NHANES) 2017–2020. Prev Med Rep 2023; 33:102183. [DOI: 10.1016/j.pmedr.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
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