[Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor]

Changed nocturnal levels of stress-related hormones couple with sleep-wake states in the patients with chronic insomnia disorder: A clinical pilot study

OBJECTIVES

To explore the relationship between nocturnal levels of stress-related hormones and different sleep-wake states in chronic insomnia disorder (CID) patients.

METHODS

Thirty-three CID patients and 34 good sleepers were enrolled and completed assessment of sleep log, Pittsburgh Sleep Quality Index and Insomnia Severity Index. During a-overnight polysomnography monitoring, the patients' vein bleeds were continually collected at different time points (pre-sleep, deep-sleep, 5-min or 30-min waking, and morning waking-up). The control subjects' bleeds were collected only at 22:00 and morning waking-up. The serum hormones were detected using enzyme-linked immunosorbent assay.

RESULTS

Compared with at pre-sleep, the level of cortisol was significantly higher at morning waking-up respectively in two-group subjects (Ps < 0.001), with insignificant inter-group differences in cortisol, corticotropin releasing hormone and copeptin at the two time-points. In the patients, the nocturnal secretion curves of three hormones were similar, with the highest concentration at morning waking-up, followed by 30-min waking, 5-min waking, pre-sleep, and deep-sleep. The patients' cortisol (Z = 79.192, P < 0.001) and copeptin (Z = 12.333, P = 0.015) levels were statistically different at different time-points, with higher cortisol at morning waking-up relative to deep-sleep, pre-sleep and 5-min waking (Ps < 0.05), and at 30-min waking relative to deep-sleep and pre-sleep (Ps < 0.05), and higher copeptin at morning waking-up relative to deep-sleep (P < 0.05).

CONCLUSIONS

In CID, the nocturnal wakes were instantaneously accompanied by high level, and deep sleep was accompanied by the lowest levels, of stress-related hormones, especially in cortisol, supporting the insomniac hypothesis of increased nocturnal pulse-release of cortisol.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil

Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

A nationwide study on pain manifestations and sleep problems in community-dwelling older adults: findings from ELSI-Brazil

PURPOSE

Sleep problems are common and affect approximately 36-70% of older adults worldwide and can be associated with negative outcomes such as pain. There is believed to be a bidirectional relationship between sleep problems and pain, modulated by inflammation and stress. The objective was to investigate the association between self-reported sleep problems and pain manifestations.

METHODS

A cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (2019-2021) was conducted. The exposure variables were self-reported sleep problems: poor sleep quality, insomnia (initial, intermediate, and final), and daytime sleepiness. The outcomes were self-reported pain manifestations: frequent pain, moderate/intense/strong pain, and pain-related disability. Logistic regressions were performed to verify the association between exposures and outcomes.

RESULTS

A total of 6875 community-dwelling older adults participated in this study (71.1 ± 8.3 years; 54.4% female). Older adults with self-reported poor sleep quality, initial, intermediate and final insomnia, and daytime sleepiness had, respectively, 1.99 (95% CI 1.57-2.53), 1.47 (95% CI 1.11-1.97), 1.65 (95% CI 1.27-2.14), 1.69 (95% CI 1.29-2.22), and 1.76 (95% CI 1.35-2.29) greater odds of reporting frequent pain. The odds of moderate/intense/strong pain were higher in older adults that reported poor sleep quality (OR: 2.21; 95% CI 1.08-4.51). Older adults with self-reported poor sleep quality, initial, intermediate and final insomnia, and daytime sleepiness had, respectively, 1.84 (95% CI 1.11-3.02), 1.73 (95% CI 1.14-2.62), 1.80 (95% CI 1.19-2.73), 1.58 (95% CI 1.07-2.34), and 1.63 (95% CI 1.11-2.39) greater odds of reporting pain-related disability.

CONCLUSION

Self-reported sleep problems are associated with pain manifestations in older adults. The results may help in the proposition of programs and public health policies.

Zizyphi Spinosae Semen: a natural herb resource for treating neurological disorders

Neurological disorders generally have the characteristics of occult onset and progressive development, which can do some serious damage to human body in the aging process. It is worth noting that traditional medicine can potentially prevent and treat such diseases. Zizyphi Spinosae Semen (ZSS), the seeds of Ziziphus jujuba var. spinosa it has a long clinical history for sleep regulation. In recent years, ZSS has been proved to exhibit various types of neuroprotective activity, such as sleep improvement, antidepressant, anti-anxiety, memory improvement and etc. It has become a popular natural product due to its many inherently available compounds that demonstrate medicinal and pharmacological importance. This paper reviews the main components and their metabolic transformation processes, highlights the various neurofunctional regulation activities and their mechanisms of ZSS, providing a theoretical basis for further research and clinical application of this natural medicine.

Epigenetics: A missing link between early life stress and depression

Research has suggested a relationship between early life stress, and depression in particular longer episodes of depression with treatment resistant outcomes. However, the underlying mechanisms for this association remain poorly understood. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders are polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. In addition, the importance of the environment and its interaction with genes has pointed to a fundamental role of epigenetic mechanisms in psychiatric disorders, such as methylation of deoxyribonucleic acid (DNA), alterations, histone actions and regulation of gene expression by non-coding ribonucleic acids (RNAs). This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology and could lead to the identification of new targets for clinical intervention.

Qualidade do sono e fatores associados entre docentes de educação superior

Resumo Introdução: a baixa qualidade do sono pode comprometer tanto a saúde como a qualidade de vida. Objetivo: estimar a prevalência e os fatores associados à qualidade do sono ruim entre docentes de educação superior de uma universidade pública na Bahia. Métodos: estudo exploratório, transversal, realizado de novembro de 2015 a abril de 2016 com 423 docentes aleatoriamente selecionados. A qualidade do sono foi mensurada pela escala Mini-Sleep Questionnaire (MSQ). Resultados: a prevalência de qualidade do sono ruim foi de 61,3%. As queixas mais frequentes foram: dificuldade de adormecer, acordar cansado, acordar com dor de cabeça e não ter tempo para dormir durante o dia. Apresentaram-se estatisticamente associadas com a qualidade do sono ruim: manter mais de um vínculo empregatício, tempo irregular e/ou insuficiente para a prática de atividades de lazer, seis horas ou menos de sono, queixas de dor musculoesquelética e de cabeça, e alta exigência psicológica com baixo controle sobre o trabalho. Conclusão: condições de trabalho que propiciam os fatores associados à elevada prevalência de qualidade do sono ruim entre docentes devem ser repensadas em prol da saúde desses trabalhadores e da importância do seu trabalho para a sociedade.

Neuroendocrine Stress System in Bipolar Disorder

Hormones have a crucial part in the progress and manifestation of a wide variety of different behaviors. The main influence of the neuroendocrine system on behavior is its action on the neurobiology of neuropsychiatric disorders and its relationship with the pharmacodynamics of medicines. Of all the neuroendocrine axes, the hypothalamic-pituitary-adrenal (HPA) axis has been the most extensively studied. There is evidence that disturbance in the HPA axis, the primary stress hormone system, could increase treatment resistance and relapse, worsen illness outcome, and cause cognitive deficits. Glucocorticoids mediate their actions in negative feedback binding in two different cytoplasmatic receptors described as mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs). Different psychopathologies underlying bipolar disorders are supposed to involve persistent dysfunctions in the expression and role of both MR and GR in the hippocampus. We review and analyze the evidence related to the correlation between bipolar disorders and the consequences and impact of stressful life events on the HPA axis, exploring the importance of these findings in bipolar disorders and as potential new targets for treatment.

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.

Independent Association between Sleep Fragmentation and Dyslipidemia in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is independently associated with dyslipidemia. Previous studies have demonstrated that sleep fragmentation can impair lipid metabolism. The present study aimed to identify whether sleep fragmentation is independently associated with dyslipidemia, in a large-scale, clinic-based consecutive OSA sample. This cross-sectional study was conducted among 2,686 patients who underwent polysomnography (PSG) for suspicion of OSA from January 2008 to January 2013 at the sleep laboratory. Multivariate regression analyses were performed to evaluate the independent associations between the microarousal index (MAI) and lipid profiles adjusting for potential confounders, including metabolic syndrome components and nocturnal intermittent hypoxia. The adjusted odds ratios (ORs) for various types of dyslipidemia according to MAI quartiles, as determined by logistic regression were also evaluated. MAI was found positively associated with low-density lipoprotein cholesterol (LDL-c) but not with total cholesterol (TC), triglyceride (TG) or high-density lipoprotein cholesterol (HDL-c). Furthermore, the adjusted ORs (95% confidence interval) for hyper-LDL cholesterolemia increased across MAI quartiles, as follows: 1 (reference), 1.3 (1.1-1.7), 1.6 (1.2-2.0), and 1.6 (1.2-2.1) (p = 0.001, linear trend). Sleep fragmentation in OSA is independently associated with hyper-LDL cholesterolemia, which may predispose patients with OSA to a higher risk of cardiovascular disease.

Sleep deprivation induces changes in immunity in Trichinella spiralis-infected rats

Sleep is considered an important predictor of immunity. A lack of sleep may reduce immunity, which increases susceptibility to any type of infection. Moreover, sleep deprivation in humans produces changes in both, the percent of circulating immune cells (T cells and NK cells) and cytokine levels (IL-1, IFNγ, TNΦ-αα, IL-6 and IL-17). The aim of our study was to investigate whether sleep deprivation produces deregulation on immune variables during the immune response generated against the helminth parasite Trichinella spiralis. Because sleep deprivation is stressful per se, we designed another experiments to compared stress alone (consisting in movement restriction and single housing) with sleep deprivation, in both control (uninfected) and experimental (infected) rats. Our results demonstrate that the sleep deprivation and stress have a differential effect in mesenteric lymph nodes (MLN) and spleen. In uninfected rats sleep deprivation alone produces an increase in natural killer cells (NK+) and B cells (CD45+), accompanied by a decrease in cytotoxic T cells (CD3+CD8+) in spleen; while, in MLN, produces only an increase in natural killer cells (NK+). Both, SD and stress, produce an increased percentage of total T cells (CD3+) in spleen. In the MLN both are also associated to an increase in cytotoxic T cells (CD3+CD8+) and B cells (CD45+). In the spleens of parasitized rats, cell populations did not change. In spleens of both, sleep-deprived and stressed infected rats, we observed an increase in B cells (CD45+). In infected rats, sleep deprivation alone produced an increase in NK cells (NK+). In mesenteric node cell populations of parasitized rats, we observed a decrease in NK cells and an increase in T helper (CD4+) cells in both SD and stressed rats. Rats that were only subjected to stress showed a decrease in B cells (CD45+). These findings suggest that the immune response generated against infection caused by T. spiralis is affected when the sleep pattern is disrupted. These results support the notion that sleep is a fundamental process for an adequate and strong immune response generated against this parasite.

Avaliação da qualidade de vida de idosos em um município do Sul do Brasil

O objetivo do estudo foi avaliar a qualidade de vida de idosos residentes em um município do Sul do Brasil e verificar a correlação entre os domínios contemplados pelo instrumento de pesquisa e a faixa etária e o gênero. Para isso, foi conduzido um estudo observacional, transversal, com 376 idosos, utilizando um instrumento genérico de avaliação da qualidade de vida, desenvolvido na Inglaterra e adaptado para o Brasil: Perfil de Saúde de Nottingham. Os resultados apontaram uma pior qualidade de vida nos indivíduos do gênero feminino quando comparados com os indivíduos do gênero masculino, principalmente nos domínios "reações emocionais" (p=0,004), "interação social" (p=0,001) e "habilidades físicas" (p=0,009). Também em ambos os gêneros, e com exceção do domínio "interação social", constatou-se uma piora estatisticamente significativa (p<0,05) na qualidade de vida com o aumento da faixa etária. Os resultados permitem concluir que, ao longo do processo de envelhecimento, há piora na qualidade de vida.

Prolonged sleep fragmentation of mice exacerbates febrile responses to lipopolysaccharide

BACKGROUND

Sleep disruption is a frequent occurrence in modern society. Whereas many studies have focused on the consequences of total sleep deprivation, few have investigated the condition of sleep disruption.

NEW METHOD

We disrupted sleep of mice during the light period for 9 consecutive days using an intermittently rotating disc.

RESULTS

Electroencephalogram (EEG) data demonstrated that non-rapid eye movement (NREM) sleep was severely fragmented and REM sleep was essentially abolished during the 12h light period. During the dark period, when sleep was not disrupted, neither NREM sleep nor REM sleep times differed from control values. Analysis of the EEG revealed a trend for increased power in the peak frequency of the NREM EEG spectra during the dark period. The fragmentation protocol was not overly stressful as body weights and water consumption remained unchanged, and plasma corticosterone did not differ between mice subjected to 3 or 9 days of sleep disruption and home cage controls. However, mice subjected to 9 days of sleep disruption by this method responded to lipopolysaccharide with an exacerbated febrile response.

COMPARISON WITH EXISTING METHODS

Existing methods to disrupt sleep of laboratory rodents often subject the animal to excessive locomotion, vibration, or sudden movements. This method does not suffer from any of these confounds.

CONCLUSIONS

This study demonstrates that prolonged sleep disruption of mice exacerbates febrile responses to lipopolysaccharide. This device provides a method to determine mechanisms by which chronic insufficient sleep contributes to the etiology of many pathologies, particularly those with an inflammatory component.

Sleep quality of hospitalized patients in surgical units

AIM

The aim of this study was to determine the sleep quality of the patients hospitalized in surgical units and the factors that influence it.

METHOD

The research was a randomized descriptive study. It was conducted in the surgical clinics of Sivas Cumhuriyet University Health Services Research Hospital. A total of 411 patients participated in the study. The research data were gathered by means of the Pittsburgh Sleep Quality Index (PSQI) and the Questionnaire aimed at capturing personal information about the participant patients and the factors influencing their sleep.

RESULTS

The sleep quality score of the patients "during the last week" (8.090 ± 3.504) was higher than their score in the "preadmission" period (4.229 ± 2.726) (p= .000). The sleep quality scores of "the patients with previous hospitalization and operation experience" (p= .000), "those who had undergone a major surgical procedure" (p= .000), "those who had been hospitalized for a week" (p= .022), and "those undergoing medical intervention during sleeping hours" (p= .000) "during the last week" were high. Patients who had a chronic illness history and whose operations were postponed had poor quality of sleep in both the hospitalization and preadmission period (p= .000).

CONCLUSIONS

It could be suggested that the patients in preoperative and postoperative periods cannot get adequate rest due to low sleep-quality levels.

IMPLICATIONS FOR PRACTICE

Nurses can prepare an environment aiding sleep as a way to increase surgical patients' sleep quality in hospital.

Parent and self-report of sleep-problems and daytime tiredness among adolescents with inflammatory bowel disease and their population-based controls

STUDY OBJECTIVES

to evaluate the frequency of sleep problems and daytime tiredness among adolescents with inflammatory bowel disease (IBD) in comparison with their healthy peers.

DESIGN

Parent and self-reports of sleep problems and daytime tiredness.

SETTING

questionnaire-based postal survey.

INTERVENTION

N/A.

PARTICIPANTS

one hundred sixty Finnish adolescents with IBD; 236 adolescents matched for age, sex, and place of residence; and the parents of both groups.

MEASUREMENTS AND RESULTS

Sleep Self-Report and sleep questions of the Child Behavior Check-List, and Youth Self-Report. The parents of adolescents with IBD reported in their index child more trouble sleeping (P < 0.01), more nightmares (P < 0.01), sleeping more than most children during the day/night (P < 0.001), and overtiredness (P < 0.001) than did the parents of control subjects. In contrast, adolescents with IBD themselves did not report more problems than their peers. However, in the group of patients with self-reported severe IBD symptoms, both the parents and the adolescents reported trouble sleeping and overtiredness more often (P values < 0.01) than in the group with mild symptoms or control subjects. Adolescents with severe IBD reported more often that their symptoms affected the quality of their sleep (P < 0.001) than did adolescents with mild disease.

CONCLUSIONS

adolescents with severe IBD symptoms have disturbed sleep and are overtired more often than are adolescents with mild IBD symptoms or control subjects. Thus, in adolescents with severe IBD symptoms, evaluating sleep is important in characterizing the disease burden. Both parent and adolescent reports are needed for comprehensive assessment of sleep in the young.

[Stress and sleep quality of nurses working different hospital shifts]

The purpose of this study was to analyze the relationship between stress and sleep quality among nurses who work on different hospital departments during morning, afternoon and night shifts. This study was performed in a hospital in Campinas, Sao Paulo. Data collection was performed using the Bianchi Stress Scale modified (BSSm) and Pittsburgh Sleep Quality Index (PSQI). Study participants were 203 registered nurses, mostly aged between 40 and 49 years. Results show there is a significant correlation between stress and sleep (Spearman Analysis; r = 0.21318; p = 0.0026). Nurses working morning shifts showed higher stress levels (p = 0.030; Chi-square Test,) and poor sleep quality. In conclusion, stress level was a factor directly correlated to sleep, showing that the higher the stress score, the worse the quality of sleep.

Neuro-endocrine-immune network and inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal diseases of unknown etiology, including mainly ulcerative colitis (UC) and Crohn's disease (CD). Numerous studies have indicated that there is considerable relationship between the pathogenesis of IBD and the neuro-endocrine-immune network. This article will describe the essential role of the neuro-immune-endocrine network in the development of IBD in terms of the hypothalamus-autonomic nervous system (HANS) axis, hypothalamic-pituitary-adrenal (HPA) axis and immunity.

Some questions provoked by a chronic headache (with mixed migraine and cluster headache features) in a woman with a pineal cyst. Answers from a literature review

The main known function of the pineal gland in humans is the production of melatonin. Benign cysts of the gland have been related to headache, although the mechanism of production of this assumed clinical manifestation has not been clearly determined, due to the lack of large prospective studies. The question is complicated by the fact that pineal cysts are frequently found on brain magnetic resonance imaging. Much has been published about the possible role of benign pineal cysts in the pathophisiology of headaches and the potential of melatonin in headache therapy, as well as in other disorders. The aim of this article is to review the current state of the suject. We have tried to place accurately the relation between headache and pineal cysts based on the available evidence, as well as the actual role of melatonin in physiology and pharmacology, more specifically in headache therapy. We include a clinical case to illustrate the subject.

Estresse e qualidade do sono entre enfermeiros que utilizam medicamentos para dormir

OBJETIVOS: Identificar os níveis de estresse, analisar a utilização de medicamentos para dormir e correlacionar níveis de estresse, qualidade do sono e uso de medicamentos. MÉTODOS: Estudo quantitativo, transversal, descritivo e comparativo, realizado com 203 enfermeiros de uma instituição hospitalar da cidade de Campinas, São Paulo, Brasil. Foi utilizado um questionário de identificação, Escala Bianchi de Stress modificada (EBSm) e o Índice de Qualidade do Sono de Pittsburgh. RESULTADOS: Dentre 203 enfermeiros, 17,7% utilizavam medicamentos para dormir. Dos enfermeiros que utilizaram medicamentos para dormir 48,6% demonstraram estado de alerta e alto nível de estresse (p = 0, 016) e apresentaram na sua totalidade (n=36) uma qualidade de sono ruim. CONCLUSÃO: Os enfermeiros que utilizaram medicamentos para dormir apresentaram níveis de estresse mais elevados e prejuízos que comprometem a qualidade do sono.

Phagocyte migration and cellular stress induced in liver, lung, and intestine during sleep loss and sleep recovery

Sleep is understood to possess recuperative properties and, conversely, sleep loss is associated with disease and shortened life span. Despite these critical attributes, the mechanisms and functions by which sleep and sleep loss impact health still are speculative. One of the most consistent, if largely overlooked, signs of sleep loss in both humans and laboratory rats is a progressive increase in circulating phagocytic cells, mainly neutrophils. The destination, if any, of the increased circulating populations has been unknown and, therefore, its medical significance has been uncertain. The purpose of the present experiment was to determine the content and location of neutrophils in liver and lung tissue of sleep-deprived rats. These are two principal sites affected by neutrophil migration during systemic inflammatory illness. The content of neutrophils in the intestine also was determined. Sleep deprivation in rats was produced for 5 and 10 days by the Bergmann-Rechtschaffen disk method, which has been validated for its high selectivity under freely moving conditions and which was tolerated and accompanied by a deep negative energy balance. Comparison groups included basal conditions and 48 h of sleep recovery after 10 days of sleep loss. Myeloperoxidase (MPO), an enzyme constituent of neutrophils, was extracted from liver, lung, and intestinal tissues, and its activity was determined by spectrophotometry. Leukocytes were located in vasculature and interstitial spaces in the liver and the lung by immunohistochemistry. Heme oxygenase-1, also known as heat shock protein-32 and a marker of cellular stress, and corticosterone also were measured. The results indicate neutrophil migration into extravascular liver and lung tissue concurrent with cell stress and consistent with tissue injury or infection induced by sleep loss. Plasma corticosterone was unchanged. Recovery sleep was marked by increased lung heme oxygenase-1, increased intestinal MPO activity, and abnormally low corticosterone, suggesting ongoing reactive processes as a result of prior sleep deprivation.