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Zhong J, Tang R, Li L, Zheng W, Chen S, Feng J, Qu J, Wang X, Yin Y, Yuan Y, Wu S. Association Between Modifiable Lifestyle Factors and Incident Cardiac Conduction Disease. JACC. ASIA 2025:S2772-3747(25)00197-8. [PMID: 40396939 DOI: 10.1016/j.jacasi.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/04/2025] [Accepted: 03/10/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND The associations between modifiable lifestyles and cardiac conduction disease (CCD) are poorly studied. OBJECTIVES The study aimed to prospectively assess the association between modifiable lifestyle factors and incident CCD. METHODS A total of 89,377 participants (aged 18-90 years) free of CCD at baseline were enrolled in the Kailuan cohort. Lifestyle factors, including smoking, alcohol consumption, physical activity, sedentary behavior, and nighttime sleep duration, were collected to test the relations of both baseline and long-term lifestyle factors with incident CCD. RESULTS During 1,226,634.1 person-years of follow-up (median: 14.1 years; Q1-Q3: 13.8-14.2 years), 3,723 CCD cases (3.04 per 1,000 person-years; 95% CI: 2.94-3.13 person-years) were identified. Compared with the participants who had healthy lifestyles at baseline, the adjusted HRs for participants who consumed alcohol ≥5 drinks per day, had sedentary behavior ≥4 hours per day, and had night sleep ≥9 hours per day were 1.16 (95% CI: 1.04-1.32), 1.12 (95% CI: 1.03-1.22), and 1.32 (95% CI: 1.02-1.68), respectively. Furthermore, compared with the participants adhered to long-term healthy lifestyles, the adjusted HRs for participants who chronically consumed alcohol ≥5 drinks per day, had sedentary behavior ≥4 hours per day, and had night sleep ≥9 hours per day were 2.16 (95% CI: 1.68-2.79), 1.77 (95% CI: 1.50-2.09), and 1.67 (95% CI: 1.25-2.24), respectively. CONCLUSIONS The study revealed excessive alcohol consumption, high sedentary behavior, and longer sleep duration were associated with higher risks of CCD in adults. The findings supported the beneficial impact of a low-risk lifestyle on the primary prevention of CCD.
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Affiliation(s)
- Jiwen Zhong
- Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Rui Tang
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (lncubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liuxin Li
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Wei Zheng
- Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jun Feng
- Zuhua Minzu Hospital, Tangshan, China
| | - Jingli Qu
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (lncubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Wang
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (lncubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Yin
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (lncubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (lncubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China.
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Wu X, Tang Y, He Y, Tang Z, Zhao Y. Relationship between weekend catch-up sleep and the risk of diabetic kidney disease. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2025; 69:e240370. [PMID: 40323047 PMCID: PMC12051871 DOI: 10.20945/2359-4292-2024-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 01/21/2025] [Indexed: 05/08/2025]
Abstract
OBJECTIVE To investigate the association between weekend catch-up sleep (WCS) and the risk of diabetic kidney disease (DKD). Subjects and. METHODS Data from 1,621 adults aged 18 years or older from the National Health and Nutrition Examination Survey 2017-2020 were obtained for this cross-sectional study. WCS was calculated as the mean weekend sleep duration minus the mean weekday sleep duration. The outcomes were DKD, a reduced estimated glomerular filtration rate (eGFR), and proteinuria. The associations between WCS and DKD, the reduced eGFR or proteinuria were evaluated via a weighted multivariate logistic regression model. Subgroup analyses were performed for different sexes and participants with or without hypertension. RESULTS A total of 583 diabetic patients had DKD, of whom 198 patients displayed reduced eGFRs and 499 patients had proteinuria. After adjusting for all confounding factors, Group 4 (weekend CUS ≥ 2 and < 3 hours) still had lower odds of DKD [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.28-0.93] and proteinuria (OR = 0.51, 95% CI: 0.27-0.96). Additionally, subgroup analyses stratified by sex and hypertension consistently revealed connections in female diabetic patients (OR = 0.40, 95% CI: 0.20-0.78 for DKD; OR = 0.47, 95% CI: 0.22-0.97 for proteinuria) and in diabetic patients with hypertension (OR = 0.39, 95% CI: 0.18-0.81 for DKD; OR = 0.38, 95% CI: 0.19-0.77 for proteinuria). However, the fully adjusted model revealed no such association between WCS and a reduced eGFR. CONCLUSION WCS was found to decrease the likelihood of developing DKD and proteinuria among American adult patients diagnosed with diabetes, particularly among female patients or those with hypertension.
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Affiliation(s)
- Xia Wu
- Department of Nephrology, Jiading Branch of Shanghai General
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Yunhai Tang
- Department of Nephrology, Jiading Branch of Shanghai General
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Yayun He
- Department of Nephrology, Jiading Branch of Shanghai General
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Zhihuan Tang
- Department of Nephrology, Shanghai General Hospital, Shanghai, P.
R. China
| | - Yingdan Zhao
- Department of Nephrology, Jiading Branch of Shanghai General
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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Zhu Y, Chen B, Qin M, Yang J, Hu M, Zeng J, Fan M, Wang K, Chang L, Xu S. Joint effects of physical activity and sleep quality on all-cause and cardiovascular disease mortality in stroke survivors: a population-based cohort study from the UK-Biobank. BMC Public Health 2025; 25:1502. [PMID: 40269864 PMCID: PMC12016377 DOI: 10.1186/s12889-025-22588-5] [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: 09/04/2023] [Accepted: 04/02/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Stroke survivors exhibit a higher prevalence of sleep disturbances and physical activity (PA) deficiencies. The joint effects of the two behaviors on mortality risk among stroke survivors remains unclear. This study aimed to explore the joint association of PA and sleep quality with the all-cause and cardiovascular disease ( CVD ) mortality risk in stroke survivors. METHODS A total of 5,507 stroke survivors from the UK Biobank were included to assess the independent or joint associations of sleep score and PA with mortality. PA levels were categorized as meeting recommended moderate-to-vigorous physical activity (MVPA) and not meeting recommended MVPA. Sleep quality was classified as healthy, poor/intermediate based on a novel sleep score, leading to the identification of four distinct PA-sleep combinations. Cox proportional hazard models were employed to estimate hazard ratio (HR) for all-cause and cardiovascular disease (CVD) mortality, with data ascertained through October 2021. The dose-response relationship between PA or sleep duration and mortality risk were explored by plotting restricted cubic splines. Sensitivity analyses were conducted to examine the robustness of the results. RESULTS After an average follow-up of 12.55 years, healthy sleep score group were associated with an decreased all-cause mortality risk compared to poor/intermediate sleep score group (HR: 0.873; 95% CI: 0.767-0.995). Compared to individuals who did not meet the recommended MVPA levels, those who did achieve the recommended MVPA levels was exhibited a significantly lower risk of all-cause mortality (HR, 0.729; 95% CI, 0.640-0.831) and CVD mortality (HR, 0.786; 95% CI, 0.627-0.986). PA levels exhibit an L-shaped association with mortality(cut off value = 2,000 MET-minutes per week). Participants meeting MVPA recommendations and/or reporting healthy sleep scores reduced 28.5-35.9% risk of all-cause mortality. CONCLUSIONS Poor sleep quality is associated with a elevated risk of all-cause mortality. Stroke survivors meeting recommended MVPA levels exhibit lower mortality risk, even among those with poor sleep quality. Future intervention studies are needed to establish whether increasing PA to recommended levels among stroke survivors directly reduces mortality risk linked to poor sleep quality.
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Affiliation(s)
- Yanhan Zhu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Bo Chen
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Minghui Qin
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Department of Traditional Chinese Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Art and Science, Xiangyang, Hubei, China
| | - Jing Yang
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Mei Hu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Jingjing Zeng
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Menglin Fan
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ke Wang
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Department of Preventive Medicine, Medical College, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Liying Chang
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
| | - Shaoyong Xu
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
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Jonescu EE, Litton E, Farrell B. Investigating the Interplay of Thermal, Lighting, and Acoustics in Intensive Care for Enhanced Patient Well-being and Clinical Outcomes. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2025; 18:362-377. [PMID: 39957004 PMCID: PMC12050381 DOI: 10.1177/19375867251317235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
Abstract
This research explores the interplay among noise levels, thermal conditions, and lighting intensity in an intensive care unit (ICU), focusing on preserving circadian rhythm and promoting nighttime sleep to advance patient-centric care. This investigation assesses lighting levels (Lux), natural versus artificial light ratios, ICU room temperature, and correlations with acoustic data during a field research period and examines the collective impact of patient exposure to sleep linked to delirium and health outcomes, addressing critical gaps in understanding. Findings reveal that noise levels between 60 and 90 dB(A) during patient occupancy exceed sleep disruption thresholds, with daytime averages of 53.6 dB(A) and nighttime averages of 48.5 dB(A) surpassing recommended criteria. Temperature fluctuations, often outside the optimal sleep range, and suboptimal diurnal variations impact patient comfort and clinician challenges. Lux levels mostly fall short of the optimum range, affecting circadian rhythms. Temporal distinctions of these environmental factors directly impact clinicians and patients, with correlated spikes in noise, lighting, and temperature during admission periods requiring heightened attention for optimal care. These cumulative impacts necessitate clinicians to navigate challenges and ensure consistent and effective care. Patients experience sleep disruptions, highlighting the need for a holistic healthcare design addressing interconnected environmental dynamics. The findings underscore the importance of comprehensive approaches to healthcare design, optimizing the ICU environment for patient-centric care and supporting healthcare professionals' well-being. Recommendations include targeted interventions to improve sleep, reduce delirium incidence, and enhance recovery, advancing ICU design for better patient outcomes; and facilitating effective communication among healthcare practitioners.
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Affiliation(s)
- Emil E. Jonescu
- School of Arts and Humanities, Edith Cowan University, Perth, WA, Australia
- Research and Development, Hames Sharley, Perth, WA, Australia
| | - Edward Litton
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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Wang D, Zhang X, Cai Y, Dong H, Zhang Y. Multidimensional sleep impairment predicts steatotic liver disease spectrum risk. Sci Rep 2025; 15:10405. [PMID: 40140484 PMCID: PMC11947187 DOI: 10.1038/s41598-025-95336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 03/20/2025] [Indexed: 03/28/2025] Open
Abstract
To evaluate the correlation between various sleep and the risk of NAFLD\MAFLD\MASLD. This study included 4772 subjects from the National Health and Nutrition Examination Survey data from 2017 to 2020. Poor sleep factors were defined as: ①abnormal sleep duration (< 7 h or > 8 h); ②snoring; ③sleep apnea; ④self-reported sleep disorder; ⑤ daytime sleepiness. The frequency of each sleep factor was scored, and the scores of all components were summed to obtain a sleep score ranging from 0 to 12. The higher the score, the less healthy the sleep pattern. Then we divided the overall sleep pattern into mild (sleep score 0-3 points), moderate (sleep score 4-7 points) or severe (sleep score 8-12 points) sleep pattern according to the distribution of sleep scores. Multiple logistic regression and restricted cubic spline graph analysis were used to determine the association between sleep and NAFLD\MAFLD\MASLD. In Model 1 and Model 2, sleep score as a continuous or categorical variable had an effect on NAFLD\MAFLD\MASLD(p <0.05). The risk of NAFLD\MAFLD\MASLD was higher in subjects with severe sleep patterns (p < 0.05). Snoring and sleepy during day was associated with NAFLD\MAFLD\MASLD (p < 0.05). We then drew a restricted cubic spline plot and found that sleep duration was nonlinearly associated with MAFLD\MASLD (p < 0.01), and the risk of MAFLD\MASLD was lower when the sleep duration was 7.5 ~ 9.5 h/d. In this nationally representative survey, severe sleep patterns were associated with an increased risk of NAFLD/MAFLD/MASLD. It is worth noting that sleep duration was nonlinearly associated with MAFLD and MASLD.
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Affiliation(s)
- Dongling Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yujie Cai
- Shanxi University of Chinese Medicine, Taiyuan, China
| | - Haihang Dong
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yinqiang Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Shen L, Li BY, Gou W, Liang X, Zhong H, Xiao C, Shi R, Miao Z, Yan Y, Fu Y, Chen YM, Zheng JS. Trajectories of Sleep Duration, Sleep Onset Timing, and Continuous Glucose Monitoring in Adults. JAMA Netw Open 2025; 8:e250114. [PMID: 40042843 PMCID: PMC11883496 DOI: 10.1001/jamanetworkopen.2025.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 12/27/2024] [Indexed: 03/09/2025] Open
Abstract
Importance Understanding the interplay between trajectories of sleep duration, sleep onset timing, and glycemic dynamics is crucial for improving preventive strategies against diabetes and related metabolic diseases. Objective To examine the associations of sleep duration and onset timing trajectories with continuous glucose monitoring (CGM)-derived glycemic metrics in adults. Design, Setting, and Participants This cohort study analyzed data collected from January 2014 to December 2023 in the Guangzhou Nutrition and Health Study, a prospective cohort in Guangdong province, China, among participants aged 46 to 83. Participants who had repeated sleep assessments at several study visits and were equipped with CGM devices at the last visit were included. Data analyses were conducted between January and June 2024. Exposures The trajectories of sleep duration and onset timing were constructed using self-report sleep duration and sleep onset timing, recorded at multiple study visit points. Main Outcomes and Measures Measurements of glycemic variability and glycemic control were collected using a masked CGM device worn by patients for 14 consecutive days. Huber robust regression models were used to assess the associations between sleep trajectories and CGM-derived metrics. Results In this study of 1156 participants (mean [SD] age, 63.0 [5.1] years, 816 [70.6%] women), we identified 4 distinct sleep duration trajectory groups: severe inadequate, moderate inadequate, mild inadequate, and adequate. Severe sleep inadequacy was associated with an increment of glycemic variability indicators: 2.87% (95% CI, 1.23%-4.50%) for coefficient of variation and 0.06 (95% CI, 0.02-0.09) mmol/L for mean of daily differences. We found 2 trajectories of sleep onset timing: persistent early and persistent late groups. Late sleep onset was associated with larger coefficient of variation (β = 1.18%; 95% CI, 0.36%-2.01%) and mean of daily differences (β = 0.02 mmol/L; 95% CI, 0.01-0.04 mmol/L). Inappropriate sleep duration and timing trajectories in combination were associated with greater glycemic variability. Conclusions and Relevance In this cohort study of middle-aged and older participants, persistent inadequate sleep duration and late sleep onset, whether alone or in combination, were associated with greater glycemic variability. These findings emphasize the importance of considering both sleep duration and timing for optimizing glycemic control in the general population.
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Affiliation(s)
- Luqi Shen
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
| | - Bang-yan Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wanglong Gou
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Xinxiu Liang
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Haili Zhong
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Congmei Xiao
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Ruiqi Shi
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Zelei Miao
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Yan Yan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuanqing Fu
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Yu-ming Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ju-Sheng Zheng
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, School of Life Sciences, Westlake University, Hangzhou, China
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Jakubowski K, Riedmann CA, Chang Y, Koenen KC, Maki PM, Thurston RC. Trauma history and persistent poor objective and subjective sleep quality among midlife women. Menopause 2025; 32:207-216. [PMID: 39773930 DOI: 10.1097/gme.0000000000002480] [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: 01/11/2025]
Abstract
OBJECTIVES Whereas some work links trauma exposure to poor subjective sleep quality, studies largely rely upon limited trauma measures and self-reported sleep at one time point. It is unknown whether trauma is related to persistent poor sleep, whether associations differ based on childhood versus adulthood trauma, and whether trauma exposure is related to poorer objectively assessed sleep. We tested whether childhood or adult trauma associated with persistent poor objectively and subjectively measured sleep at two time points in midlife women. METHODS One hundred sixty-seven women aged 40-60 at baseline were assessed twice 5 years apart. At baseline, women reported childhood trauma (Child Trauma Questionnaire), adult trauma (Brief Trauma Questionnaire), demographics, depressive symptoms, apnea symptoms, and medical history, and provided physical measures. At both visits, women completed 3 days of actigraphy (total sleep time [TST], wake after sleep onset [WASO]) and reported sleep quality (Pittsburgh Sleep Quality Index). Relations of childhood and adult trauma exposure, respectively, with persistent poor sleep at both baseline and follow-up visits (TST [<6 hours], WASO [>30 minutes], Pittsburgh Sleep Quality Index [>5]) were assessed in logistic regression models, adjusted for age, race/ethnicity, education, body mass index, sleep medications, nightshift work, apnea, depressive symptoms, vasomotor symptoms, and alcohol use. RESULTS Childhood trauma was related to persistent high WASO (odds ratio [95% confidence interval] = 2.16 [1.04-4.50], P = 0.039, multivariable). Adult trauma was related to persistent poor sleep quality (odds ratio [95% confidence interval] = 2.29 [1.07-4.93], P = 0.034, multivariable). Trauma was unrelated to persistent short TST. CONCLUSIONS Childhood and adult trauma, respectively, were related to persistent poor objective sleep continuity and subjective sleep quality in midlife women, independent of risk factors.
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Affiliation(s)
- Karen Jakubowski
- From the Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Carly A Riedmann
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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Johnston MA, Brindle RC. Self-Reported Sleep Is Not Associated With Cardiovascular and Baroreflex Responses to Mental Stress. Psychophysiology 2025; 62:e70025. [PMID: 40013404 DOI: 10.1111/psyp.70025] [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: 10/07/2024] [Revised: 01/25/2025] [Accepted: 02/05/2025] [Indexed: 02/28/2025]
Abstract
Previous research has produced mixed results regarding the relationship between sleep and cardiovascular reactivity to acute mental stress. This study aimed to re-analyze this relationship as well as test the relationship between sleep and stress-related changes in baroreflex function in order to further clarify the relationship between sleep and stress reactivity. Participants (N = 127, 84 female, mean age = 20.64, 78 White) completed a mental arithmetic stress task, while measures of heart rate (HR), blood pressure (BP), and baroreflex function were undertaken. Participants self-reported sleep duration, timing, efficiency, quality, latency, and wake after sleep onset the night prior to testing. Mental stress caused significant increases in HR and BP and significant decreases in baroreflex sensitivity and effectiveness (all p < 0.001). However, no statistically significant relationships were found between any measures of sleep and HR or BP reactivity (all p ≥ 0.05). Similarly, stress-induced changes in baroreflex function were not associated with any measures of sleep (all p ≥ 0.05). Results suggest that self-reported sleep is not related to cardiovascular or baroreflex reactivity to acute mental stress.
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Affiliation(s)
- Margaret A Johnston
- Neuroscience Program, Washington and Lee University, Lexington, Virginia, USA
| | - Ryan C Brindle
- Neuroscience Program, Washington and Lee University, Lexington, Virginia, USA
- Department of Cognitive and Behavioral Science, Washington and Lee University, Lexington, Virginia, USA
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Sanchez Corredera C, Tadepalli PS, Scaccia J, Sibia AS, Mayrovitz HN. Implications of Long Sleep Duration on Cardiovascular Health: A Systematic Review. Cureus 2025; 17:e77738. [PMID: 39981486 PMCID: PMC11841827 DOI: 10.7759/cureus.77738] [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: 12/04/2024] [Accepted: 01/20/2025] [Indexed: 02/22/2025] Open
Abstract
Sleep duration is an important determinant of cardiovascular health, yet the adverse effects of long sleep duration remain underexplored. While short sleep has well-documented associations with increased cardiovascular risk, emerging evidence highlights a U-shaped relationship, with excessive sleep also linked to adverse outcomes. This systematic review evaluates the association between prolonged sleep duration and cardiovascular health outcomes, including coronary artery disease (CAD), stroke, myocardial infarction (MI), hypertension, heart failure (HF), and atherosclerosis. A systematic search of PubMed, Embase, and Web of Science identified 38 studies published between 2008 and 2024 that investigated the relationship between sleep duration and cardiovascular health. Prolonged sleep duration was consistently associated with increased risks of CAD, stroke (ischemic and hemorrhagic), hypertension, and MI. Elevated inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), emerged as potential mediators alongside demographic and lifestyle factors, including age, gender, and socioeconomic status. Long sleep duration may serve as a modifiable risk factor for cardiovascular diseases. Incorporating sleep assessments into cardiovascular risk evaluations could inform prevention strategies, and further research is needed to elucidate mechanisms and develop targeted interventions.
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Affiliation(s)
| | - Pranav S Tadepalli
- Cardiothoracic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Julian Scaccia
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Adiraj S Sibia
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education and Simulation, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Huang Q, An C, Tang S, Leng Y, Zhang Y, Wan B, Han Y, Luo Y, Xie C. Mendelian randomization analysis reveals causal factors behind diabetic nephropathy: evidence, opportunities, and challenges. Front Endocrinol (Lausanne) 2024; 15:1444808. [PMID: 39735650 PMCID: PMC11671268 DOI: 10.3389/fendo.2024.1444808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 11/25/2024] [Indexed: 12/31/2024] Open
Abstract
Diabetic nephropathy (DN), as the most serious minor vascular complication of diabetes, imposes a significant socioeconomic and medical cost around the world, and its prevention and treatment are a major challenge in the current medical community. Observational studies and randomized controlled trials have revealed protective and risk factors for some DN. However, the conclusions of these researches may be influenced by several types of confounding. Mendelian randomization is a new epidemiological method mainly used to infer the causal relationship between exposure and outcome. Many Mendelian randomization studies have found potential causal relationships between DN and some diseases and lifestyle habits, thus providing valuable data for future mechanistic studies as well as the development and implementation of clinical prevention strategies. As a result, the purpose of this review is to evaluate the published Mendelian randomization study of DN, using the bibliometric research method, analyze the current research status and hot spots, and further summarize the genetic evidence about the potential protection of DN and risk factors to provide new inspiration for the etiology of DN and as a reference for clinical intervention.
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Affiliation(s)
- Qinchuan Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen An
- Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyun Tang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yulin Leng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaowen Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Bin Wan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yutong Han
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yue Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chunguang Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Traditional Chinese Medicine (TCM) Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
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11
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Clark ELM, Gutierrez-Colina A, Ruzicka EB, Sanchez N, Bristol M, Gulley LD, Broussard JL, Kelsey MM, Simon SL, Shomaker LB. Racial and ethnic sleep health disparities in adolescents and risk for type 2 diabetes: a narrative review. Ann Med 2024; 56:2399756. [PMID: 39253865 PMCID: PMC11389628 DOI: 10.1080/07853890.2024.2399756] [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: 11/27/2023] [Revised: 05/21/2024] [Accepted: 07/09/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Sleep is an essential factor for health and wellbeing in people across the age spectrum; yet many adolescents do not meet the recommended 8-10 h of nightly sleep. Unfortunately, habitually insufficient sleep, along with the metabolic changes of puberty, puts adolescents at increased risk for a host of adverse health outcomes such as obesity and type 2 diabetes (T2D). Furthermore, individuals from historically minoritized racial and ethnic groups (e.g. Hispanic/Latinx, African American/Black) are more likely to experience shorter sleep duration compared to adolescents of White/European origin, placing them at even greater risk for disparities in T2D risk. METHODS We conducted a literature review on the role of race and ethnicity in adolescent sleep health and its relation to cardiometabolic outcomes, specifically T2D. We use the minority stress model and the stress and coping theory as guiding theoretical frameworks to examine individual and societal level factors that may contribute to sleep health disparities and their downstream effects on T2D risk. RESULTS This review highlights that the unique race-related stressors adolescents from minoritized groups face may play a role in the sleep and T2D connection on a biological, psychological, and social level. However, although there has been advancement in the current research on adolescent racial and ethnic sleep health disparities in relation to T2D, mechanisms underlying these disparities in sleep health need further investigation. Addressing these gaps is crucial for identifying and mitigating sleep health disparities and T2D among racial and ethnic minority youth. CONCLUSION We conclude with a discussion of the implications and future research directions of racial and ethnic disparities in sleep health and T2D prevention research. A comprehensive understanding of adolescent sleep health disparities has potential to better inform preventative and educational programs, interventions, and policies that promote sleep health equity and improve cardiometabolic outcomes like T2D.
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Affiliation(s)
- Emma L M Clark
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ana Gutierrez-Colina
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth B Ruzicka
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Natalia Sanchez
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Community & Behavioral Health, Epidemiology, and Global Health & Health Disparities, Colorado School of Public Health, Aurora, CO, USA
| | - Madison Bristol
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
- Community & Behavioral Health, Epidemiology, and Global Health & Health Disparities, Colorado School of Public Health, Aurora, CO, USA
| | - Lauren D Gulley
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Josiane L Broussard
- Health & Exercise Science, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan M Kelsey
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Stacey L Simon
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
- Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Lauren B Shomaker
- Human Development & Family Studies, College of Health & Human Sciences, Colorado State University, Fort Collins, CO, USA
- Pediatric Endocrinology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
- Community & Behavioral Health, Epidemiology, and Global Health & Health Disparities, Colorado School of Public Health, Aurora, CO, USA
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12
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Mansour W, Knauert MP. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Sleep Med Clin 2024; 19:607-623. [PMID: 39455181 DOI: 10.1016/j.jsmc.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa P Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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13
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Yang X, Zhuo S, Zhuang H, Fang T. Interaction between the systemic immune-inflammation index and trouble sleeping in nonalcoholic fatty liver disease: a cross-sectional study of the NHANES 2005-2018 data. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:175. [PMID: 39478637 PMCID: PMC11526651 DOI: 10.1186/s41043-024-00670-9] [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: 05/08/2024] [Accepted: 10/16/2024] [Indexed: 11/02/2024]
Abstract
BACKGROUND The systemic immune-inflammation index (SII) and trouble sleeping are independent risk factors for nonalcoholic fatty liver disease (NAFLD). Nevertheless, studies investigating the combined effects of the SII and troubled sleeping on NAFLD are lacking. In this study, we investigated the independent relationships and interactions between trouble sleeping and the SII among patients with NAFLD. METHODS Data from seven survey cycles of the National Health and Nutrition Examination Survey (NHANES) (2005-2018) were analyzed. The SII was obtained by counting platelets, neutrophils, and lymphocytes. NAFLD was diagnosed using the US fatty liver index. Trouble sleeping was diagnosed using a sleep disorder questionnaire. The correlation between trouble sleeping and the SII in NAFLD was investigated using multiple regression analysis, subgroup stratification, interaction tests, and restricted cubic spline, and the presence or absence of additive or multiplicative interactions was determined. Additionally, mediation analyses were performed to explore the role of the SII in mediating the effects of trouble sleeping on NAFLD. RESULTS The survey included 10 963 participants. Multivariate logistic regression revealed that SII (OR: 1.21, 95% CI 1.08-1.35) and trouble sleeping (OR: 1.24, 95% CI 1.05-1.47) were positively correlated with NAFLD. For NAFLD, an additive but not multiplicative interaction was noted between the SII and trouble sleeping. The SII partially mediated the association between trouble sleeping and NAFLD, accounting for approximately 3.11% of the total effect (95% CI 0.01-0.05). CONCLUSION The SII and trouble sleeping were independently correlated with NAFLD risk. Furthermore, a combined effect may exist between SII and trouble sleeping, which increases the risk of NAFLD.
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Affiliation(s)
- Xinxia Yang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Shitu Zhuo
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Huie Zhuang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Taiyong Fang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
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14
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Tokunaga A, Kimura N, Masuda T, Hanaoka T, Matsubara E. Objectively measured prolonged sleep is associated with plasma cytokines in older adults with mild cognitive impairment. J Sleep Res 2024; 33:e14135. [PMID: 38212137 DOI: 10.1111/jsr.14135] [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: 07/29/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
This study aimed to determine whether objective sleep time is associated with the concentrations of various plasma cytokines in older adults with mild cognitive impairment (MCI). In total, 118 adults with MCI (66 women; mean age: 75.7 years) participated in this prospective cohort study. All participants were required to wear a wristband sensor for 7.8 days, on average, every 3 months for 1 year and undergo measurement of 27 plasma cytokines using multiplex immunoassays. After adjusting for potential confounders, the associations of total sleep time with cytokine concentrations were assessed by multiple linear regression analysis. The total sleep time was significantly correlated with plasma interleukin (IL)-9 and macrophage inflammatory protein (MIP)-1β levels (r = 0.239, p = 0.009, and r = 0.242, p = 0.008, respectively). Moreover, these associations remained significant after adjusting for covariates, including demographic characteristics, lifestyle-related diseases, and apolipoprotein E status (β = 0.272, 95% confidence interval: 0.095-0.448, p = 0.003, and β = 0.27, 95% confidence interval: 0.092-0.449, p = 0.003, respectively). Thus, this study is the first to demonstrate the association between objective prolonged sleep and higher plasma IL-9 and MIP-1β levels in older adults with MCI.
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Affiliation(s)
- Akari Tokunaga
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Teruaki Masuda
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takuya Hanaoka
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Japan
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15
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Coronado RA, Pennings JS, Master H, Brintz CE, Cole KR, Helmy J, Oleisky ER, Davidson C, Abtahi AM, Stephens BF, Archer KR. The Combined Influence of Sleep Disturbance and Depression on 12-month Outcomes After Lumbar Spine Surgery. Spine (Phila Pa 1976) 2024; 49:1339-1347. [PMID: 38605675 PMCID: PMC11384552 DOI: 10.1097/brs.0000000000005000] [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: 01/19/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS). SUMMARY OF BACKGROUND DATA Psychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment. METHODS Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression. RESULTS Preoperative sleep disturbance and depression were associated with 12-month disability and pain ( P <0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes ( P <0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression. CONCLUSIONS The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Rogelio A. Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S. Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carrie E. Brintz
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith R. Cole
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph Helmy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily R. Oleisky
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M. Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F. Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R. Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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LI Q, WANG SS, LIU GD, WANG JH, ZHAO YL, LIU M, HE Y, YANG SS. Mediating role of inflammatory indicators in the association between sleep status and blood pressure in centenarians: evidence from China Hainan Centenarian Cohort Study. J Geriatr Cardiol 2024; 21:874-883. [PMID: 39483268 PMCID: PMC11522715 DOI: 10.26599/1671-5411.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024] Open
Abstract
Objectives To conduct a comprehensive analysis in Hainan centenarians on the link between sleep status and their blood pressure status. Furthermore, the study also aims to explore how inflammatory indicators may mediate the relationship. Methods The China Hainan Centenarians Cohort Study (CHCCS) collected baseline data on sleep status, inflammatory indicators, and blood pressure data. The study used a mediation model to investigate how inflammatory indicators mediate the relationship between sleep status and blood pressure status. Result In this study, a total of 967 centenarians were included. The prevalence of hypertension among the centenarians was 71.4%. The analysis showed that centenarians with poor sleep quality had a 43% higher risk of hypertension compared to those with normal sleep quality (OR = 1.43, 95% CI: 1.03-1.97). Additionally, centenarians with nighttime sleep durations of ≤ 6 h or > 9 h had higher proportions of high pulse pressure (PP), with OR values of 1.76 (95% CI: 1.18-2.63) and 2.07 (95% CI: 1.34-3.19), respectively. Mediation analysis illustrated that complement C3 played a mediating role in the relationship between sleep quality and hypertension, with an effect ratio of 2.4%. Similarly, lymphocyte count, the neutrophil-to-lymphocyte ratio (NLR), and the systemic immune-inflammation index (SII) were identified as mediating factors in the association between nighttime sleep duration and high PP, with effect ratios of 91.22%, 36.93%, and 0.20%, respectively. Conclusion In centenarians, poor sleep quality raises the risk of hypertension, with complement C3 as a mediator. Additionally, nighttime sleep durations of ≤ 6 h or > 9 h increases the risk of high PP, mediated by lymphocyte count, NLR, and SII.
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Affiliation(s)
- Qiao LI
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheng-Shu WANG
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guang-Dong LIU
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Jian-Hua WANG
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ya-Li ZHAO
- Central Laboratory of Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Miao LIU
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Yao HE
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shan-Shan YANG
- Department of Disease Prevention and Control, First Medical Center, Chinese PLA General Hospital, Beijing, China
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17
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Lin YY, Liao YH, Ting H, Masodsai K, Chen C. Effects of Somatosensory Games on Heart Rate Variability and Sleep-Related Biomarkers in Menopausal Women With Poor Sleep Quality. Innov Aging 2024; 8:igae072. [PMID: 39350942 PMCID: PMC11441328 DOI: 10.1093/geroni/igae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Indexed: 10/04/2024] Open
Abstract
Background and Objectives The aim of this study was to investigate the effects of 12-week somatosensory games on heart rate variability and sleep-related biomarkers in middle-aged women with poor sleep quality. Research Design and Methods Twenty-nine women with poor sleep quality were recruited as participants randomly assigned into ring fit adventure exergame group (RFA, n = 15) and control group (CON, n = 14). The RFA group received ring fit adventure exergame for 60 min each time, 2 times a week, for 12 weeks. The CON group was not allowed to participate in intervention activities during the study period. Heart rate variability, sleep quality, cortisol, serotonin, and high-sensitive C-reactive protein were measured before and after the 12-week intervention. Results The Pittsburgh Sleep Quality Index total score in the RFA group was significantly lower compared with the CON group. The value of the standard deviation of normal NN intervals and the root mean square of the successive RR Differences were significantly increased in the RFA group, when compared with the CON group. The change in the logarithm of high frequency (log HF) was significantly higher and change in the logarithm of low frequency to high frequency ratio (log LF/HF) was significantly lower in the RFA group, when compared to the CON group. The change level of serotonin in the RFA group was significantly higher compared with the CON group. Discussion and Implications The results suggest that somatosensory games might improve sleep quality, increase serotonin level, and decrease sympathetic nerve activities in middle-aged women with poor sleep quality.
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Affiliation(s)
- Yi-Yuan Lin
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Hung Liao
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hua Ting
- Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Kunanya Masodsai
- Area of Exercise Physiology, Faculty of Sports Science, Chulalongkorn University, Bangkok, Thailand
- Exercise Physiology in Special Population Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Chi Chen
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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18
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Zhao T, Liu R, Han Q, Han X, Ren J, Mao M, Lu J, Cong L, Wang Y, Tang S, Du Y, Qiu C. Associations of 24-hour movement behaviors with depressive symptoms in rural-dwelling older adults: a compositional data analysis. Aging Clin Exp Res 2024; 36:165. [PMID: 39120630 PMCID: PMC11315720 DOI: 10.1007/s40520-024-02827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND We aimed to explore the association of sleep duration with depressive symptoms among rural-dwelling older adults in China, and to estimate the impact of substituting sleep with sedentary behavior (SB) and physical activity (PA) on the association with depressive symptoms. METHODS This population-based cross-sectional study included 2001 rural-dwelling older adults (age ≥ 60 years, 59.2% female). Sleep duration was assessed using the Pittsburgh Sleep Quality Index. We used accelerometers to assess SB and PA, and the 15-item Geriatric Depression Scale to assess depressive symptoms. Data were analyzed using restricted cubic splines, compositional logistic regression, and isotemporal substitution models. RESULTS Restricted cubic spline curves showed a U-shaped association between daily sleep duration and the likelihood of depressive symptoms (P-nonlinear < 0.001). Among older adults with sleep duration < 7 h/day, reallocating 60 min/day spent on SB and PA to sleep were associated with multivariable-adjusted odds ratio (OR) of 0.81 (95% confidence interval [CI] = 0.78-0.84) and 0.79 (0.76-0.82), respectively, for depressive symptoms. Among older adults with sleep duration ≥ 7 h/day, reallocating 60 min/day spent in sleep to SB and PA, and reallocating 60 min/day spent on SB to PA were associated with multivariable-adjusted OR of 0.78 (0.74-0.84), 0.73 (0.69-0.78), and 0.94 (0.92-0.96), respectively, for depressive symptoms. CONCLUSIONS Our study reveals a U-shaped association of sleep duration with depressive symptoms in rural older adults and further shows that replacing SB and PA with sleep or vice versa is associated with reduced likelihoods of depressive symptoms depending on sleep duration.
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Affiliation(s)
- Tong Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Rui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Qi Han
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, P.R. China
| | - Xiaolei Han
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
| | - Juan Ren
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Ming Mao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Jie Lu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China.
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China.
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China.
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China.
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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19
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Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, Lavie CJ, Virani SS, Slipczuk L. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:249-262. [PMID: 38795275 PMCID: PMC11192677 DOI: 10.1007/s11883-024-01207-5] [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] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE OF REVIEW Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.
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Affiliation(s)
- Vita N Jaspan
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siddhant Parihar
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Shapiro
- Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA.
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20
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Grech E, Cuschieri S. A Good Night's Sleep in Malta in 2023: A Cross-sectional Study Exploring Sleep Quality and its Determinants via Social Media. J Res Health Sci 2024; 24:e00602. [PMID: 39072538 PMCID: PMC10999107 DOI: 10.34172/jrhs.2024.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/10/2024] [Accepted: 03/07/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Sleep quality is affected by a plethora of different factors, although its relationship with chronic diseases is still unclear. This study explored perceived sleep quality and its associated determinants among the adult population of Malta. Study Design: A cross-sectional study. METHODS An anonymous online survey was distributed through social media targeting adults residing in Malta. Data pertaining to socio-demographic, medical history, lifestyle, well-being, sleep, and daytime sleepiness were gathered, and descriptive, univariant, and multiple binary logistic regression modelling analyses were performed. RESULTS A total of 855 adults responded, out of whom 35.09% (95% confidence interval [CI]: 31.90, 38.41) reported sleep difficulties, especially females (81.33%; 95% CI: 76.36, 85.49), while 65.33% (95% CI: 59.61, 70.65) reported suffering from chronic disease(s). Sleep problems were positively associated with multimorbidity (odds ratio [OR]: 2.17; 95% CI: 1.38, 3.40; P=0.001), sleeping<6 hours (OR: 3.79; 95% CI: 1.54, 9.30; P=0.040), and the presence of moderate anxiety symptoms (OR: 1.99; 95% CI: 1.10, 3.59; P=0.020). They were also related to the presence of mild (OR: 2.25; 95% CI: 1.46, 3.45; P=0.001), moderate (OR: 2.40; 95% CI: 1.24, 4.64; P=0.010), and moderately severe (OR: 15.35; 95% CI: 4.54, 31.86; P=0.001) depressive symptoms after adjusting for confounders. CONCLUSION Chronic conditions, including anxiety and depression, along with short sleep duration, appear to contribute to poor sleep quality in Malta. A multifaceted approach is required to deal with the issue holistically and safeguard the health of current and future generations.
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Affiliation(s)
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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21
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Yang S, Wang S, Liu G, Li R, Li X, Chen S, Wang J, Zhao Y, Liu M, He Y. Association of Sleep Status With Cognitive Functions in Centenarians: Evidence From Hainan Centenarian Cohort. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad185. [PMID: 38150001 PMCID: PMC10873833 DOI: 10.1093/geronb/gbad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES This study aimed to analyze the association between sleep quality, sleep duration, and cognitive functions among centenarians. METHODS The baseline data of the China Hainan Centenarians Cohort Study served as the foundation for this study. Logistic regression was utilized to demonstrate the relationship between sleep status and cognitive impairment. Moreover, a canonical correlation analysis was performed to analyze the correlation between these variables. RESULTS A total of 994 centenarians were included. After adjustment, poor sleep quality centenarians had an odds ratio of 1.77 (95% confidence interval [CI]: 1.00-3.09) for cognitive impairment when compared to centenarians with normal sleep quality. Centenarians who slept for more than 9 hr had a stronger association with severe cognitive impairment, indicated by an odds ratio of 1.41 (95% CI: 1.02-1.96), compared to those who slept for 7-9 hr. Additionally, the canonical correlation analysis results revealed that the linear combination of sleep quality V1, primarily determined by sleep latency, daytime dysfunction, and subjective sleep quality, was associated with cognitive function; the linear combination of cognitive function W1, mainly determined by orientation, attention and calculation, and memory. DISCUSSION There exists a correlation between poor sleep quality and cognitive impairment in centenarians, as well as a correlation between sleep duration >9 hr at night and severe cognitive impairment. The primary cognitive domains associated with sleep quality are orientation, calculation, and memory. It is imperative to monitor and safeguard the cognitive functions linked to poor sleep quality in the older individuals, with attention to orientation, calculation, and memory.
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Affiliation(s)
- Shanshan Yang
- Department of Disease Prevention and Control, First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Guangdong Liu
- Graduate School, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Rongrong Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jianhua Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yali Zhao
- Central Laboratory of Hainan Hospital, Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Miao Liu
- Department of Statistics and Epidemiology, Graduate School, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
- State Key Laboratory of Kidney Diseases, Beijing, China
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22
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Zhang Y, Yu B, Qi Q, Azarbarzin A, Chen H, Shah NA, Ramos AR, Zee PC, Cai J, Daviglus ML, Boerwinkle E, Kaplan R, Liu PY, Redline S, Sofer T. Metabolomic profiles of sleep-disordered breathing are associated with hypertension and diabetes mellitus development. Nat Commun 2024; 15:1845. [PMID: 38418471 PMCID: PMC10902315 DOI: 10.1038/s41467-024-46019-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: 07/14/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
Sleep-disordered breathing (SDB) is a prevalent disorder characterized by recurrent episodic upper airway obstruction. Using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we apply principal component analysis (PCA) to seven SDB-related measures. We estimate the associations of the top two SDB PCs with serum levels of 617 metabolites, in both single-metabolite analysis, and a joint penalized regression analysis. The discovery analysis includes 3299 individuals, with validation in a separate dataset of 1522 individuals. Five metabolite associations with SDB PCs are discovered and replicated. SDB PC1, characterized by frequent respiratory events common in older and male adults, is associated with pregnanolone and progesterone-related sulfated metabolites. SDB PC2, characterized by short respiratory event length and self-reported restless sleep, enriched in young adults, is associated with sphingomyelins. Metabolite risk scores (MRSs), representing metabolite signatures associated with the two SDB PCs, are associated with 6-year incident hypertension and diabetes. These MRSs have the potential to serve as biomarkers for SDB, guiding risk stratification and treatment decisions.
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Affiliation(s)
- Ying Zhang
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Bing Yu
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, 02115, USA
| | - Han Chen
- Human Genetics Center, Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Neomi A Shah
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Alberto R Ramos
- Sleep Medicine Program, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Phyllis C Zee
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL, 60611, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Martha L Daviglus
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60612, USA
| | - Eric Boerwinkle
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Peter Y Liu
- The Institute for Translational Genomics and Population Sciences, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, 02115, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, 02115, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA.
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23
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Longo-Silva G, Pedrosa AKP, de Oliveira PMB, da Silva JR, de Menezes RCE, Marinho PDM, Bernardes RS. Beyond sleep duration: Sleep timing is associated with BMI among Brazilian adults. Sleep Med X 2023; 6:100082. [PMID: 37554371 PMCID: PMC10404800 DOI: 10.1016/j.sleepx.2023.100082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/09/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES To examine the association of sleep duration and timing with BMI among adults. Also, to identify obesogenic and unhealthy behaviors (e.g.diet/sleep quality, physical activity, screen time, smoking) associated with short sleep duration and late bedtime. PARTICIPANTS Participants (n=755) were part of exploratory, population-based research, with data collection in a virtual environment. METHODS For purposes of characterizing the population we considered short sleepers<7h/night, and the population bedtime median was used to stratify participants into early and late sleepers (before and after 23:08). Student's t-test and chi-square test were performed to assess differences in characteristics between groups. Linear regression analyses were conducted to determine the association of sleep duration, bedtime, and wake-up time with BMI. Quantile regression was estimated for the 25th, 50th, and 75th quantiles to identify the distributional correlations between BMI and sleep variables. Restricted cubic splines were also used to study the shape of the association between sleep-BMI. Analyses were adjusted for potential confounding variables. RESULTS BMI decreased by 0.40Kg/m2 for each additional hour of sleep duration [95%CI=-0.68,-0.12,p=0.005] and increased by 0.37 kg/m2 for each additional hour of bedtime [95%CI=0.12,0.61,p=0.003]. The association between bedtime and BMI remained even after adjustment for sleep duration. These effects were higher and stronger with higher BMI values (p75th). Wake-up time did not show statistically significant associations. CONCLUSIONS Because we found that beyond sleep duration, bedtime was significantly associated with BMI, our data reflect the pertinence of assessing sleep timing patterns in disentangling sleep-obesity association. Insights into the characteristics, obesogenic and unhealthy behaviors related to short and late sleep may support specific strategies to prevent and treat excess body adiposity and other negative health outcomes.
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Affiliation(s)
- Giovana Longo-Silva
- Public Health Nutrition Laboratory, Faculty of Nutrition (FANUT), Federal University of Alagoas (UFAL), Avenida Lourival Melo Mota, S/N, Tabuleiro dos Martins, Maceió, AL, 57072-900, Brazil
| | - Anny Kariny Pereira Pedrosa
- Public Health Nutrition Laboratory, Faculty of Nutrition (FANUT), Federal University of Alagoas (UFAL), Avenida Lourival Melo Mota, S/N, Tabuleiro dos Martins, Maceió, AL, 57072-900, Brazil
| | - Priscilla Marcia Bezerra de Oliveira
- Public Health Nutrition Laboratory, Faculty of Nutrition (FANUT), Federal University of Alagoas (UFAL), Avenida Lourival Melo Mota, S/N, Tabuleiro dos Martins, Maceió, AL, 57072-900, Brazil
| | - Jéssica Ribeiro da Silva
- Public Health Nutrition Laboratory, Faculty of Nutrition (FANUT), Federal University of Alagoas (UFAL), Avenida Lourival Melo Mota, S/N, Tabuleiro dos Martins, Maceió, AL, 57072-900, Brazil
| | - Risia Cristina Egito de Menezes
- Public Health Nutrition Laboratory, Faculty of Nutrition (FANUT), Federal University of Alagoas (UFAL), Avenida Lourival Melo Mota, S/N, Tabuleiro dos Martins, Maceió, AL, 57072-900, Brazil
| | | | - Renan Serenini Bernardes
- European Ph.D. in Socio-Economic and Statistical Studies, Faculty of Economics, Sapienza University of Rome, Via del Castro Laurenziano, Rome, Italy
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24
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Kimura N, Sasaki Y, Masuda T, Ataka T, Eguchi A, Kakuma T, Matsubara E. Objective sleep was longitudinally associated with brain amyloid burden in mild cognitive impairment. Ann Clin Transl Neurol 2023; 10:2266-2275. [PMID: 37776077 PMCID: PMC10723246 DOI: 10.1002/acn3.51912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE Understanding the longitudinal association of objective sleep and physical activity with brain amyloid burden and cortical glucose metabolism has critical clinical and public health implications for dementia prevention in later life. METHODS We enrolled 118 individuals aged ≥65 years with mild cognitive impairment, who were followed up on from August 2015 to September 2019. All participants continuously wore an accelerometer sensor for 7 consecutive days every 3 months and received annual 11 C-Pittsburgh compound-B and 18 F-fluorodeoxyglucose positron emission tomography (PET). Sleep and physical activity parameters were assessed using accelerometer sensor data and PET imaging was quantified using a standardized uptake-value ratio. Fifty-seven participants (48.3%) completed a lifestyle factor assessment and PET imaging over the 3-year period. A linear mixed-effects model was applied to examine the longitudinal association of sleep and physical activity parameters with PET imaging over the 3-year period, controlling for potential confounders. RESULTS Sleep efficiency was inversely associated with amyloid uptake in the frontal lobe. Although sleep duration was positively associated with global amyloid uptake, particularly in the frontal lobe, their impact was extremely small. However, physical activity parameters were not significantly associated with the 11 C-Pittsburgh compound-B-uptake. Furthermore, sleep and physical activity parameters were not significantly associated with cortical glucose metabolism. INTERPRETATION Lower sleep efficiency could be an early symptom of greater brain amyloid burden at the mild cognitive impairment stage. Therefore, the assessment of sleep may be useful for identifying individuals at higher risk for brain amyloid burden. Future longer term observational studies are required to confirm these findings.
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Affiliation(s)
- Noriyuki Kimura
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
| | - Yuuki Sasaki
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
| | - Teruaki Masuda
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
| | - Takuya Ataka
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
| | - Atsuko Eguchi
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
| | | | - Etsuro Matsubara
- Department of Neurology, Faculty of MedicineOita UniversityOitaJapan
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25
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Stoner L, Higgins S, Paterson C. The 24-h activity cycle and cardiovascular outcomes: establishing biological plausibility using arterial stiffness as an intermediate outcome. Am J Physiol Heart Circ Physiol 2023; 325:H1243-H1263. [PMID: 37737729 PMCID: PMC11932535 DOI: 10.1152/ajpheart.00258.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
This review proposes a biologically plausible working model for the relationship between the 24-h activity cycle (24-HAC) and cardiovascular disease. The 24-HAC encompasses moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior (SB), and sleep. MVPA confers the greatest relative cardioprotective effect, when considering MVPA represents just 2% of the day if physical activity guidelines (30 min/day) are met. While we have well-established guidelines for MVPA, those for the remaining activity behaviors are vague. The vague guidelines are attributable to our limited mechanistic understanding of the independent and additive effects of these behaviors on the cardiovascular system. Our proposed biological model places arterial stiffness, a measure of vascular aging, as the key intermediate outcome. Starting with prolonged exposure to SB or static standing, we propose that the reported transient increases in arterial stiffness are driven by a cascade of negative hemodynamic effects following venous pooling. The subsequent autonomic, metabolic, and hormonal changes further impair vascular function. Vascular dysfunction can be offset by using mechanistic-informed interruption strategies and by engaging in protective behaviors throughout the day. Physical activity, especially MVPA, can confer protection by chronically improving endothelial function and associated protective mechanisms. Conversely, poor sleep, especially in duration and quality, negatively affects hormonal, metabolic, autonomic, and hemodynamic variables that can confound the physiological responses to next-day activity behaviors. Our hope is that the proposed biologically plausible working model will assist in furthering our understanding of the effects of these complex, interrelated activity behaviors on the cardiovascular system.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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26
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Urushihata T, Goto M, Kabetani K, Kiyozuka M, Maruyama S, Tsuji S, Tada H, Satoh A. Evaluation of cellular activity in response to sleep deprivation by a comprehensive analysis of the whole mouse brain. Front Neurosci 2023; 17:1252689. [PMID: 37928729 PMCID: PMC10620513 DOI: 10.3389/fnins.2023.1252689] [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: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023] Open
Abstract
Sleep deprivation (SD) causes several adverse functional outcomes, and understanding the associated processes can improve quality of life. Although the effects of SD on neuronal activity in several brain regions have been identified, a comprehensive evaluation of the whole brain is still lacking. Hence, we performed SD using two different methods, gentle handling and a dedicated chamber, in targeted recombination in active populations 2 (TRAP2) mice crossed with Rosa-ZsGreen reporter mice and visualized cellular activity in the whole brain. Using the semi-automated post-imaging analysis tool Slice Histology Alignment, Registration, and Cell Quantification (SHARCQ), the number of activated cells was quantified. From the analysis of 14 brain regions, cellular activity was significantly increased in the olfactory areas and decreased in the medulla by the two SD methods. From the analysis of the further subdivided 348 regions, cellular activity was significantly increased in the vascular organ of the lamina terminalis, lateral hypothalamic area, parabigeminal nucleus, ventral tegmental area, and magnocellular reticular nucleus, and decreased in the anterior part of the basolateral amygdalar nucleus, nucleus accumbens, septohippocampal nucleus, reticular nucleus of the thalamus, preoptic part of the periventricular hypothalamic nucleus, ventromedial preoptic nucleus, rostral linear nucleus raphe, facial motor nucleus, vestibular nuclei, and some fiber tracts (oculomotor nerve, genu of corpus callosum, and rubrospinal tract) by the two SD methods. Two subdivided regions of the striatum (caudoputamen and other striatum), epithalamus, vascular organ of the lamina terminalis, anteroventral preoptic nucleus, superior colliculus optic layer, medial terminal nucleus of the accessory optic tract, pontine gray, and fiber tracts (medial lemniscus, columns of the fornix, brachium of the inferior colliculus, and mammillary peduncle) were differentially affected by the two SD methods. Most brain regions detected from these analyses have been reported to be involved in regulating sleep/wake regulatory circuits. Moreover, the results from the connectivity analysis indicated that the connectivity of cellular activity among brain regions was altered by SD. Together, such a comprehensive analysis of the whole brain is useful for understanding the mechanisms by which SD and/or sleep disruption affects brain function.
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Affiliation(s)
- Takuya Urushihata
- Department of Integrative Physiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Mio Goto
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keiko Kabetani
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Mai Kiyozuka
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Nutrition, Faculty of Wellness, Shigakkan University, Obu, Japan
| | - Shiho Maruyama
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Nutrition, Faculty of Wellness, Shigakkan University, Obu, Japan
| | - Shogo Tsuji
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hirobumi Tada
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Nutrition, Faculty of Wellness, Shigakkan University, Obu, Japan
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akiko Satoh
- Department of Integrative Physiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Department of Integrative Physiology, National Center for Geriatrics and Gerontology, Obu, Japan
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27
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Rainer MA, Palmer PH, Xie B. Sleep Duration and Chronic Disease Among Older Native Hawaiians or Other Pacific Islanders and Asians: Analysis of the Behavioral Risk Factor Surveillance System. J Racial Ethn Health Disparities 2023; 10:2302-2311. [PMID: 36109435 DOI: 10.1007/s40615-022-01409-0] [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: 06/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Older adults are particularly vulnerable to unhealthy sleep. This study examines the relationship between sleep duration and chronic diseases among older Native Hawaiians or Other Pacific Islanders (NHOPIs) and identifies variations with older Asians. METHODS In this cross-sectional study, data were analyzed using the 2016 Behavioral Risk Factor Surveillance System. The total sample of adults 50 years and older included 1277 NHOPIs and 4655 Asians. Weighted, survey logistic regressions were employed to analyze the relationship between sleep duration (i.e., short, healthy, and long) and seven chronic diseases: coronary heart disease, stroke, heart attack/myocardial infarction, pre-diabetes, diabetes, chronic obstructive pulmonary disease, and depressive disorder. Sleep duration was categorized into short sleep (SS; ≤ 6 h), healthy sleep (7-8 h), and long sleep (LS; ≥ 9 h), with healthy sleep as the reference group. RESULTS Among NHOPIs, SS and LS were significantly related to stroke (OR 3.19, 95% CI: 1.35-7.53 for SS and OR 9.52, 95% CI: 2.99-30.34 for LS) and SS was associated with pre-diabetes (OR 2.22 CI: 1.07-4.59), after adjusting for all covariates. In contrast, Asians with SS and LS reported higher odds of depression (OR 2.40, 95% CI: 1.20-4.79 and OR 5.03, 95% CI: 1.57-16.13, respectively). CONCLUSIONS Findings suggest older NHOPIs with SS or LS experience worse health. NHOPIs and Asians varied on the relationship between sleep and chronic disease, underscoring the need to disaggregate Asian/NHOPI data to understand health disparities.
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Affiliation(s)
- Michelle A Rainer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA.
| | - Paula Healani Palmer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
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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: 11] [Impact Index Per Article: 5.5] [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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Sofer T, Zhang Y, Yu B, Qi Q, Azarbarzin A, Chen H, Shah N, Ramos A, Zee P, Cai J, Daviglus M, Boerwinkle E, Kaplan R, Liu P, Redline S. Metabolomic Profiles of Sleep-Disordered Breathing are Associated with Hypertension and Diabetes Mellitus Development: the HCHS/SOL. RESEARCH SQUARE 2023:rs.3.rs-3171622. [PMID: 37503089 PMCID: PMC10371150 DOI: 10.21203/rs.3.rs-3171622/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Sleep-disordered breathing (SDB) is a prevalent disorder characterized by recurrent episodic upper airway obstruction. In a dataset from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we applied principal component analysis (PCA) on seven measures characterizing SDB-associated respiratory events. We estimated the association of the top two SDB PCs with serum levels of 617 metabolites, in both single-metabolite analysis, and a joint, penalized regression analysis using the least absolute shrinkage and selection operator (LASSO). Discovery analysis included n = 3,299 HCHS/SOL individuals; associations were validated in a separate dataset of n = 1,522 HCHS/SOL individuals. Seven metabolite associations with SDB PCs were discovered and replicated. Metabolite risk scores (MRSs) developed based on LASSO association results and representing metabolite signatures associated with the two SDB PCs were associated with 6-year incident hypertension and incident diabetes. MRSs have the potential to serve as biomarkers for SDB, guiding risk stratification and treatment decisions.
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Affiliation(s)
| | | | | | - Qibin Qi
- Albert Einstein College of Medicine
| | | | - Han Chen
- The University of Texas Health Science Center at Houston
| | | | | | - Phyllis Zee
- Northwestern University Feinberg School of Medicine
| | | | | | | | | | - Peter Liu
- Lundquist Institute at Harbor-UCLA Medical Center
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Alqaderi H, Abdullah A, Finkelman M, Abufarha M, Devarajan S, Abubaker J, Ramesh N, Tavares M, Al-Mulla F, Bin-Hasan S. The relationship between sleep and salivary and serum inflammatory biomarkers in adolescents. Front Med (Lausanne) 2023; 10:1175483. [PMID: 37305117 PMCID: PMC10250646 DOI: 10.3389/fmed.2023.1175483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Poor sleep behavior can trigger an inflammatory response and contribute to the development of inflammatory diseases. Cytokines can act as indicators of inflammation and may precede the onset of inflammatory diseases. This study aimed to determine the association between sleep timing parameters (bedtime, sleep duration, sleep debt, and social jetlag) and the levels of nine serum and salivary inflammatory and metabolic biomarkers. Methods Data were collected from 352 adolescents aged 16-19 years enrolled in Kuwait's public high schools. The levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), adiponectin, leptin, and insulin were measured from saliva and serum samples. We conducted mixed-effect multiple linear regression modeling to account for the school variable as a random effect to assess the relationship between the sleep variables and salivary and serum biomarkers. Mediation analysis was conducted to check if BMI was a mediator between bedtime and the biomarkers. Results There was a statistically significant elevation in serum IL-6 level associated with later bedtime (0.05 pg./mL, p = 0.01). Adolescents with severe sleep debt of ≥2 h had an increase in salivary IL-6 biomarker levels (0.38 pg./mL, p = 0.01) compared to those who had sleep debt of <1 h. Adolescents with sleep debt of ≥2 h had significantly higher levels of serum CRP (0.61 μg/mL, p = 0.02) than those without sleep debt. Additionally, we found that the inflammatory biomarkers (CRP, IL-6, IL-8, IL-10, VEGF, and MCP-1) and metabolic biomarkers (adiponectin, leptin, and insulin) had more statistically significant associations with the bedtime variables than with sleep duration variables. CRP, IL-6, and IL-8 were associated with sleep debt, and IL-6, VEGF, adiponectin, and leptin levels were associated with social jetlag. BMIz was a full mediator in the relationship between late bedtime and increased serum levels of CRP, IL-6, and insulin. Conclusion Adolescents who go to bed at or later than midnight had dysregulated levels of salivary and serum inflammatory biomarkers, suggesting that disrupted circadian rhythm can trigger higher levels of systemic inflammation and potentially exacerbate chronic inflammation and the risk of metabolic diseases.
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Affiliation(s)
- Hend Alqaderi
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, United States
| | - Abeer Abdullah
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matthew Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, MA, United States
| | | | | | | | - Nikitha Ramesh
- Boston University School of Public Health, Boston, MA, United States
| | - Mary Tavares
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, United States
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Butris N, Tang E, Pivetta B, He D, Saripella A, Yan E, Englesakis M, Boulos MI, Nagappa M, Chung F. The prevalence and risk factors of sleep disturbances in surgical patients: A systematic review and meta-analysis. Sleep Med Rev 2023; 69:101786. [PMID: 37121133 DOI: 10.1016/j.smrv.2023.101786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
Determining the prevalence and risk factors related to sleep disturbance in surgical patients would be beneficial for risk stratification and perioperative care planning. The objectives of this systematic review and meta-analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. The inclusion criteria were: (1) patients ≥18 years old undergoing a surgical procedure, (2) in-patient population, and (3) report of sleep disturbances using a validated sleep assessment tool. The systematic search resulted in 21,951 articles. Twelve patient cohorts involving 1497 patients were included. The pooled prevalence of sleep disturbances at preoperative assessment was 60% (95% Confidence Interval (CI): 50%, 69%) and the risk factors for postoperative sleep disturbances were a high preoperative Pittsburgh sleep quality index (PSQI) score indicating preexisting disturbed sleep and anxiety. Notably, patients with postoperative delirium had a higher prevalence of pre- and postoperative sleep disturbances and high preoperative wake after sleep onset percentage (WASO%). The high prevalence of preoperative sleep disturbances in surgical patients has a negative impact on postoperative outcomes and well-being. Further work in this area is warranted.
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Affiliation(s)
- Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada
| | - Evan Tang
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada
| | | | - David He
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University Health Network, University of Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada
| | - Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, ON, Canada
| | - Mark I Boulos
- Division of Neurology, Department of Medicine, University of Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, ON, Canada
| | - Mahesh Nagappa
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Healthcare, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada; Institute of Medical Science, University of Toronto, ON, Canada.
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Knauert MP, Ayas NT, Bosma KJ, Drouot X, Heavner MS, Owens RL, Watson PL, Wilcox ME, Anderson BJ, Cordoza ML, Devlin JW, Elliott R, Gehlbach BK, Girard TD, Kamdar BB, Korwin AS, Lusczek ER, Parthasarathy S, Spies C, Sunderram J, Telias I, Weinhouse GL, Zee PC. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e49-e68. [PMID: 36999950 PMCID: PMC10111990 DOI: 10.1164/rccm.202301-0184st] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.
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Alternate-Day Fasting Combined with Exercise: Effect on Sleep in Adults with Obesity and NAFLD. Nutrients 2023; 15:nu15061398. [PMID: 36986128 PMCID: PMC10056902 DOI: 10.3390/nu15061398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Objective: This study investigated how alternate-day fasting (ADF) combined with aerobic exercise impacts body weight and sleep in adults with non-alcoholic fatty liver disease (NAFLD). Methods: Adults with obesity and NAFLD (n = 80) were randomized into one of four groups for 3 months: combination of ADF (600 kcal “fast day,” alternated with an ad libitum intake “feast day”) and moderate-intensity aerobic exercise (five sessions per week, 60 min/session); ADF alone; exercise alone; or a no-intervention control group. Results: By month 3, body weight and intrahepatic triglyceride content decreased (p < 0.001, group × time interaction) in the combination group versus the exercise group and control group, but not versus the ADF group. Sleep quality, measured by the Pittsburgh Sleep Quality Inventory (PSQI), did not change in the combination group (baseline: 6.0 ± 0.7; month 3: 5.6 ± 0.7), ADF group (baseline: 8.9 ± 1.0; month 3: 7.5 ± 0.8), or exercise group (baseline: 6.4 ± 0.6; month 3: 6.7 ± 0.6), versus controls (baseline: 5.5 ± 0.7; month 3: 4.6 ± 0.5). Wake time, bedtime, sleep duration, and insomnia severity did not change (no group x time interaction) over the course of the study in any group. Risk for obstructive sleep apnea was present in 30% of combination subjects, 75% of ADF subjects, 40% of exercise subjects, and 75% of controls, and did not change in the intervention groups, versus controls, by month 3. No associations were observed between changes in body weight, intrahepatic triglyceride content, and any sleep outcome. Conclusions: The weight loss induced by ADF combined with exercise does not improve sleep quality, duration, insomnia severity, or risk of obstructive sleep apnea in individuals with NAFLD.
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Zhu C, Lu Y, Cheng M, Zhou Z, Zhang Y, Lei X, Wang X, Hou Y, Lu M. Sleep profile and the risk of cardiovascular events in patients undergoing percutaneous coronary intervention. PSYCHOL HEALTH MED 2023; 28:799-811. [PMID: 34565236 DOI: 10.1080/13548506.2021.1985148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A significant proportion of patients with coronary artery disease (CAD) who undergo percutaneous coronary intervention (PCI) suffer from physical and mental disorders which lead to the decline of sleep profile. Sleep disorders are highly prevalent in these patients. But the effect of sleep on the outcomes of post-PCI patients remains unclear. We aim to examine the individual and joint effects of sleep quality and sleep duration on the risk of adverse cardiovascular events in post-PCI patients. We included 314 participants who were diagnosed with a first CAD and underwent PCI with drug-eluting stents and followed up for a mean duration of 341 days to assess major adverse cardiovascular events (MACEs). Sleep quality, based on the Pittsburgh Sleep Quality Index, was categorized as good (a score of ≤7) or poor (>7). Sleep duration was categorized into three classes: ≤ 5, 6-8 (reference group) and ≥ 9 hours per day. The log-rank test and the Cox regression model were used for data analysis. MACEs occurred in 26 (8.3%) patients. Subjects whose sleep duration was ≤ 5 hours per day had a shorter time to MACEs than those whose sleep duration was 6-8 hours (p = 0.036). A significantly increased risk for MACEs was observed for participants with a ≤ 5 hours sleep duration (HR = 2.18, 95% CI = 1.02-4.64) after adjustment for demographic and clinical confounders. Associations between long sleep duration (≥ 9 hours), sleep quality, or their joint effect and MACEs were not found. This suggests the importance of considering sleep loss when developing strategies to improve health outcomes of PCI patients. And further researches are needed to examine the effects of different aspects of sleep quality on the prognosis of PCI patients and explore the reasons that lead to the decline of sleep profile.
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Affiliation(s)
- Chenya Zhu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yang Lu
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Ming Cheng
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Zichun Zhou
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yuxian Zhang
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Xiaoqing Lei
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Xiaohua Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yunying Hou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Minxia Lu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Abstract
Despite sleep's fundamental role in maintaining and improving physical and mental health, many people get less than the recommended amount of sleep or suffer from sleeping disorders. This review highlights sleep's instrumental biological functions, various sleep problems, and sleep hygiene and lifestyle interventions that can help improve sleep quality. Quality sleep allows for improved cardiovascular health, mental health, cognition, memory consolidation, immunity, reproductive health, and hormone regulation. Sleep disorders, such as insomnia, sleep apnea, and circadian-rhythm-disorders, or disrupted sleep from lifestyle choices, environmental conditions, or other medical issues can lead to significant morbidity and can contribute to or exacerbate medical and psychiatric conditions. The best treatment for long-term sleep improvement is proper sleep hygiene through behavior and sleep habit modification. Recommendations to improve sleep include achieving 7 to 9 h of sleep, maintaining a consistent sleep/wake schedule, a regular bedtime routine, engaging in regular exercise, and adopting a contemplative practice. In addition, avoiding many substances late in the day can help improve sleep. Caffeine, alcohol, heavy meals, and light exposure later in the day are associated with fragmented poor-quality sleep. These sleep hygiene practices can promote better quality and duration of sleep, with corresponding health benefits.
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Hou X, Hu J, Wang E, Wang J, Song Z, Hu J, Shi J, Zhang C. Self-Reported Sleep Disturbance is an Independent Predictor of All-Cause Mortality and Respiratory Disease Mortality in US Adults: A Population-Based Prospective Cohort Study. Int J Public Health 2023; 68:1605538. [PMID: 36865999 PMCID: PMC9971003 DOI: 10.3389/ijph.2023.1605538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objective: Self-reported sleep disturbance is common but its association with mortality has rarely been investigated. Methods: This prospective cohort analysis included 41,257 participants enrolled in the National Health and Nutrition Examination Survey from 2005 to 2018. Self-reported sleep disturbance in the present study refers to the patients who have ever consulted doctors or other professionals for trouble sleeping. Univariate and multivariate survey-weighted Cox proportional hazards models were used to evaluate the association of self-reported sleep disturbance with all-cause and disease-specific mortality. Results: Approximately 27.0% of US adults were estimated to have self-reported sleep disturbance. After adjusting for all sociodemographic variables, health behavioral factors, and common comorbidities, participants with self-reported sleep disturbance tend to have higher all-cause mortality risk with a hazard ratio (HR) of 1.17 (95% CI, 1.04-1.32) and chronic lower respiratory disease mortality risk (HR, 1.88; 95% CI, 1.26-2.80), but not cardiovascular disease mortality risk (HR, 1.19; 95% CI, 0.96-1.46) and cancer mortality risk (HR, 1.10; 95% CI, 0.90-1.35). Conclusion: Self-reported sleep disturbance could be associated with higher mortality in adults, and may need to be paid more attention in public health management.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiajia Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Shi
- Department of Anesthesiology, Changsha Yamei Plastic Surgery Hospital, Changsha, China
| | - Chengliang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Chengliang Zhang,
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Guzeev MA, Kurmazov NS, Ekimova IV. [Chronic sleep restriction in rats leads to a weakening of compensatory reactions in response to acute sleep deprivation]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:35-42. [PMID: 37275996 DOI: 10.17116/jnevro202312305235] [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: 06/07/2023]
Abstract
OBJECTIVE To identify features in the compensatory mechanisms of sleep regulation in response to acute sleep deprivation after chronic sleep restriction in rats. MATERIAL AND METHODS Male Wistar rats 7-8 months old underwent 5-day sleep restriction: 3 h of sleep deprivation and 1 h of sleep opportunity repeating throughout each day. Six-hour acute total sleep deprivation was performed at the beginning of daylight hours on the 3rd day after sleep restriction. Polysomnogramms were recorded throughout the day before chronic sleep restriction, on the 2nd recovery day after chronic sleep restriction and after acute sleep deprivation. The control group was not subjected to chronic sleep restriction. RESULTS The animals after chronic sleep restriction had the compensatory increase in total sleep time in response to acute sleep deprivation weaker than in control animals. Animals after sleep restriction had the compensatory increase in the time of slow-wave sleep (SWS) only in the first 6 hours after acute sleep deprivation, whereas in control animals the period of compensation of SWS lasted 12 hours. A compensatory increase in slow-wave activity (SWA) was observed in both groups of animals, but in animals experiencing chronic sleep restriction the amplitude of SWA after acute sleep deprivation was less than in control animals. A compensatory increase in REM sleep in sleep restricted animals occurred immediately after acute sleep deprivation and coincides with a compensatory increase in SWS and SWA, whereas in control conditions these processes are spaced in time. CONCLUSION Compensatory reactions in response to acute sleep deprivation (sleep homeostasis) are weakened in animals subjected to chronic sleep restriction, as the reaction time and amplitude are reduced.
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Affiliation(s)
- M A Guzeev
- Sechenov Institute of Evolutionary Physiology and Biochemistry, St Petersburg, Russia
| | - N S Kurmazov
- Sechenov Institute of Evolutionary Physiology and Biochemistry, St Petersburg, Russia
| | - I V Ekimova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, St Petersburg, Russia
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Qin F, Luo M, Xiong Y, Zhang N, Dai Y, Kuang W, Cen X. Prevalence and associated factors of cognitive impairment among the elderly population: A nationwide cross-sectional study in China. Front Public Health 2022; 10:1032666. [PMID: 36466480 PMCID: PMC9713248 DOI: 10.3389/fpubh.2022.1032666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cognitive impairments are associated with increased risk for progression to dementia. In China, limited surveys have been conducted to estimate the national prevalence and risk factors associated with cognitive impairment in China. This study aims to assess the national prevalence and modifiable risk factors for cognitive impairments in the Chinese elderly population. Methods This cross-sectional study was based on the 2018 China Health and Retirement Longitudinal Study. The Mini Mental State Examination (MMSE) is recommended to test for cognitive impairment. Univariate and multivariate logistic regression models were used in assessing risk factors for cognitive impairments in the Chinese elderly population. Results A total of 3768 participants aged 60 years or older were enrolled in this study. The national prevalence of cognitive impairments was 22.24% in China, and the prevalence of cognitive impairment was higher in the south-west region than in the north region (29.94 vs. 16.53%, p < 0.05). The risk for cognitive impairments was higher in the following participants: not married or not living with spouse relative to married with spouse present (OR = 1.39, 95% CI, 1.15-1.70; p = 0.001), nap duration of ≥ 90 min relative to 30-60 min (OR = 1.54, 95% CI, 1.20-1.98; p = 0.001), sleep duration of ≥ 8 h relative to 6-8 h (OR = 1.73, 95% CI, 1.29-2.31; p < 0.001), and depression relative to no depression (OR = 1.67, 95% CI, 1.41-1.97; p < 0.001). The risk of cognitive impairment was lower in participants living in the urban areas relative to the rural areas (OR = 0.57, 95% CI, 0.47-0.69; p < 0.001) and consuming alcohol once a month relative to never consuming alcohol (OR = 0.69, 95% CI, 0.51-0.94; p = 0.02). Conclusion Cognitive impairment prevalence was high in the Chinese elderly population. The potentially modifiable risk factors for cognitive impairment should be further assessed in the development of interventions for the elderly Chinese population.
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Affiliation(s)
- Feng Qin
- National Chengdu Center for Safety Evaluation of Drugs, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Zhang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China,Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yanping Dai
- National Chengdu Center for Safety Evaluation of Drugs, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Weihong Kuang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China,Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobo Cen
- National Chengdu Center for Safety Evaluation of Drugs, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Xiaobo Cen
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Huang YM, Xia W, Ge YJ, Hou JH, Tan L, Xu W, Tan CC. Sleep duration and risk of cardio-cerebrovascular disease: A dose-response meta-analysis of cohort studies comprising 3.8 million participants. Front Cardiovasc Med 2022; 9:907990. [PMID: 36237900 PMCID: PMC9551171 DOI: 10.3389/fcvm.2022.907990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The effect of extreme sleep duration on the risk of cardiovascular and cerebrovascular diseases (CCDs) remains debatable. The pathology of CCDs is consistent in some respects (e.g., vascular factors), suggesting that there may be an overlapping range of sleep duration associated with a low risk of both diseases We aimed to quantify the dose-response relationship between sleep duration and CCDs. Study objective To explore whether there is an optimal sleep duration (SD) in reducing the risk of CCDs. Methods PubMed and EMBASE were searched until June 24, 2022 to include cohort studies that investigated the longitudinal relationships of SD with incident CCDs, including stroke and coronary heart disease (CHD). The robusterror meta-regression model (REMR model) was conducted to depict the dose-response relationships based on multivariate-adjusted risk estimates. Results A total of 71 cohorts with 3.8 million participants were included for meta-analysis, including 57 for cardiovascular diseases (CVD) and 29 for cerebrovascular disease. A significant U-shaped relationship was revealed of nighttime sleep duration with either cardiovascular or cerebrovascular disease. The nighttime sleep duration associated with a lower risk of CVD was situated within 4.3-10.3 h, with the risk hitting bottom at roughly 7.5 h per night (p non-linearity < 0.0001). Sleep duration associated with a lower risk of cerebrovascular diseases ranges from 5 to 9.7 h per night, with the inflection at 7.5 h per night (p non-linearity = 0.05). Similar non-linear relationship exited in daily sleep duration and CCDs. Other subgroup analyses showed non-linear relationships close to the above results. Conclusion Rational sleep duration (7.5 h/night) is associated with a reduced risk of cardio-cerebrovascular disease for adults.
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Affiliation(s)
- Yi-Ming Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xia
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yi-Jun Ge
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jia-Hui Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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Liu R, Ren Y, Hou T, Liang X, Dong Y, Wang Y, Cong L, Wang X, Qin Y, Ren J, Sindi S, Tang S, Du Y, Qiu C. Associations of sleep timing and time in bed with dementia and cognitive decline among Chinese older adults: A cohort study. J Am Geriatr Soc 2022; 70:3138-3151. [PMID: 36128778 DOI: 10.1111/jgs.18042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The longitudinal associations of sleep timing and time in bed (TIB) with dementia and cognitive decline in older adults are unclear. METHODS This population-based cohort study used data from 1982 participants who were aged ≥60 years, free of dementia, and living in rural communities in western Shandong, China. At the baseline (2014) and follow-up (2018) examinations, sleep parameters were assessed using standard questionnaires. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Dementia was diagnosed following the DSM-IV criteria, and the NIA-AA criteria for Alzheimer disease (AD). Data were analyzed using restricted cubic splines, Cox proportional-hazards models, and general linear models. RESULTS During the mean follow-up of 3.7 years, dementia was diagnosed in 97 participants (68 with AD). Restricted cubic spline curves showed J-shaped associations of sleep duration, TIB, and rise time with dementia risk, and a reverse J-shaped association with mid-sleep time. When sleep parameters were categorized into tertiles, the multivariable-adjusted hazard ratio (HR) of incident dementia was 1.69 (95%CI 1.01-2.83) for baseline sleep duration >8 hours (vs. 7-8 h), 2.17 (1.22-3.87) for bedtime before 9 p.m. (vs. 10 p.m. or later), and 2.00 (1.23-3.24) for mid-sleep time before 1 a.m. (vs. 1-1.5 a.m.). Early bedtime and mid-sleep time were significantly associated with incident AD (HR range: 2.25-2.51; p < 0.05). Among individuals who were free of dementia at follow-up, baseline long TIB, early bedtime and mid-sleep time, early and late rise time, and prolonged TIB and advanced bedtime and mid-sleep time from baseline to follow-up were associated with a greater decline in MMSE score (p < 0.05). These associations with cognitive decline were statistically evident mainly among men or participants who were aged 60-74 years. CONCLUSIONS Long TIB and early sleep timing are associated with an increased risk of dementia, and the associations with greater cognitive decline are evident only among older people aged 60-74 years and men.
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Affiliation(s)
- Rui Liu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Xiaoyan Liang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yi Dong
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Yu Qin
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Juan Ren
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Shireen Sindi
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, People's Republic of China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.,Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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Chen LJ, Hamer M, Lai YJ, Huang BH, Ku PW, Stamatakis E. Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:596-604. [PMID: 33713846 PMCID: PMC9532590 DOI: 10.1016/j.jshs.2021.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study examined the joint associations of sleep patterns and physical activity (PA) with all-cause, cardiovascular disease (CVD), and cancer mortality. METHODS A total of 341,248 adults (mean age = 39.7 years; men: 48.3%) were included in the study, with a 15-year follow-up. Participants reported sleep duration and disturbances (difficulty falling asleep, easily awakened, or use of sleeping medication). PA was classified into 4 levels: <7.5, 7.5-14.9, 15.0-29.9, and ≥30.0 metabolic equivalent hours per week (MET-h/week). To understand the joint associations of sleep patterns and PA with mortality, Cox proportional hazard models were conducted, with exposure variables combining sleep duration/disturbances and PA. RESULTS Compared with the reference group (sleeping 6-8 h/day), individuals who slept >8 h/day had higher risk for all-cause mortality (hazard ratio (HR) = 1.307, 95% confidence interval (95%CI): 1.248-1.369), CVD mortality (HR = 1.298, 95%CI: 1.165-1.445), and cancer mortality (HR = 1.128, 95%CI: 1.042-1.220). Short sleep duration was not associated with mortality risk. Increased risk of all-cause and CVD mortality was found in participants who had difficulty falling asleep (HR = 1.120, 95%CI: 1.068-1.175; HR = 1.163, 95%CI: 1.038-1.304, respectively), and used sleeping medication (HR = 1.261, 95%CI: 1.159-1.372; HR = 1.335, 95%CI: 1.102-1.618, respectively) compared with those who slept well. Long sleep duration and sleep disturbances were not associated with risk of all-cause and CVD mortality among individuals achieving a PA level of ≥15 MET-h/week, and in particular among those achieving ≥30 MET-h/week. CONCLUSION Long sleep duration, difficulty falling asleep, and use of sleeping medication were related to a higher risk of death. Being physically active at a moderate intensity for 25-65 min/day eliminated these detrimental associations.
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Affiliation(s)
- Li-Jung Chen
- Department of Exercise Health Science, (National) Taiwan University of Sport, Taichung 40404, China
| | - Mark Hamer
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, WC1E 6BT, UK
| | - Yun-Ju Lai
- Department of Exercise Health Science, (National) Taiwan University of Sport, Taichung 40404, China; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou 54552, China; School of Medicine, (National) Yang-Ming University, Taipei 11221, China
| | - Bo-Huei Huang
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, (National) Changhua University of Education, Changhua 50007, China; Department of Kinesiology, (National) Tsing Hua University, Hsinchu 30013, China.
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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Grandner MA. Sleep, Health, and Society. Sleep Med Clin 2022; 17:117-139. [DOI: 10.1016/j.jsmc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Knechel NA, Chang PS. The relationships between sleep disturbance and falls: A systematic review. J Sleep Res 2022; 31:e13580. [PMID: 35288982 DOI: 10.1111/jsr.13580] [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: 10/28/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this systematic review was to examine critically the literature that addresses the association between sleep disturbance and falls. Electronic databases OVID MEDLINE, PubMed, and CINAHL were searched using MeSH terms "sleep" and "accidental falls." Search limits included adults, humans, and English. The articles selected for the final sample were assessed for methodological quality. Eleven key attributes of sleep disturbance were extracted. The search yielded 177 articles from OVID MEDLINE, 124 from PubMed, and 46 from CINAHL. The final sample included 42 papers. The mean methodological quality score was 7.5 (range 2-10). Those who self-report >11 h or ≤5 h of nocturnal sleep duration may have a greater fall risk, but variations in cutoff points, study designs, and data collection methods contribute to difficulty in comparing study results. Subjective sleep fragmentation is associated with falls. The few studies on obstructive sleep apnea and insomnia demonstrate evidence of an increased risk for falls. It remains unclear whether daytime sleepiness, self-reported sleep quality, snoring, or napping are associated with falls, since some but not all studies demonstrate an association and the study quality did not differ.
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Fu L, Wang B, Chan PSF, Luo D, Zheng W, Ju N, Hu Y, Xiao X, Xu H, Yang X, Fang Y, Xu Z, Chen P, He J, Zhu H, Tang H, Huang D, Hong Z, Ma X, Hao Y, Cai L, Yang J, Yuan J, Chen YQ, Xiao F, Wang Z, Ye S, Zou H. Associations between COVID-19 related stigma and sleep quality among COVID-19 survivors six months after hospital discharge. Sleep Med 2022; 91:273-281. [PMID: 34802891 PMCID: PMC8529895 DOI: 10.1016/j.sleep.2021.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/11/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many COVID-19 survivors reported stigmatization after recovery. This study investigated the association between stigma (discrimination experiences, self-stigma and perceived affiliate stigma) and sleep quality among COVID-19 survivors six months after hospital discharge. METHODS Participants were recovered adult COVID-19 survivors discharged between February 1 and April 30, 2020. Medical staff of five participating hospitals approached all discharged COVID-19 period during this period. A total of 199 participants completed the telephone interview during July to September, 2020. Structural equation modeling was performed to test the hypothesize that resilience and social support would mediate the associations between stigma and sleep quality. RESULTS The results showed that 10.1% of the participants reported terrible/poor sleep quality, 26.1% reported worse sleep quality in the past week when comparing their current status versus the time before COVID-19. After adjusting for significant background characteristics, participants who had higher number of discrimination experience, perceived stronger self-stigma and stronger perceived affiliate stigma reported poorer sleep quality. Resilience and social support were positively and significantly associated with sleep quality. The indirect effect of self-stigma on sleep quality through social support and resilience was significant and negative. Perceived affiliate stigma also had a significant and negative indirect effect on sleep quality through social support and resilience. CONCLUSIONS Various types of stigma after recovery were associated with poor sleep quality among COVID-19 survivors, while social support and resilience were protective factors. Resilience and social support mediated the associations between self-stigma/perceived affiliate stigma and sleep quality.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Paul Shing Fong Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dan Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Niu Ju
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xin Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hui Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xue Yang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Zhijie Xu
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ping Chen
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jiaoling He
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hongqiong Zhu
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Huiwen Tang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Dixi Huang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhongsi Hong
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaojun Ma
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yanrong Hao
- Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lianying Cai
- Department of Education, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jianrong Yang
- Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jianhui Yuan
- Shenzhen Nanshan District Center for Disease Control and Prevention, Shenzhen, China
| | - Yao-Qing Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Fei Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shupei Ye
- Department of Emergency, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia; Shenzhen Center for Disease Control and Prevention, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
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Lin LH, Xu WQ, Wang SB, Hu Q, Zhang P, Huang JH, Ke YF, Ding KR, Hou CL, Jia FJ. U-shaped association between sleep duration and subjective cognitive complaints in Chinese elderly: a cross-sectional study. BMC Psychiatry 2022; 22:147. [PMID: 35209875 PMCID: PMC8867774 DOI: 10.1186/s12888-022-03738-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Subjective cognitive decline (SCD) may be the early screening signal to distinguish susceptible population with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Subjective cognitive complaints (SCCs) have been proved strongly associated with SCD. This study aimed to explore the association between sleep duration and SCCs in the Chinese elderly. METHODS We conducted a cross-sectional study involving 688 participants aged 60 years and older in Guangdong Province, China. SCCs were assessed by the Subjective Cognitive Decline questionnaire 9 (SCD-Q9), which contained 9 items with two dimensions, including the overall memory function and time comparison (OMTC) and daily activity ability (DAA). Restricted cubic splines and generalized additive model (GAM) were used to fit the association between sleep duration and SCD-Q9 score. RESULTS There were significant U-shaped associations between sleep duration and overall score of SCD-Q9 (EDF = 3.842, P < 0.001), as well as the OMTC dimension (EDF = 4.471, P < 0.001) in the age- and gender-adjusted GAM. The lowest points on the overall score of SCD-Q9 and OMTC score were observed in those sleeping 8 h per night. After further adjusting for other demographic characteristics, lifestyle behaviors, hypertension and diabetes, the U-shaped associations between sleep duration and the overall score of SCD-Q9 (EDF = 3.575, P = 0.004), sleep duration and the OMTC score (EDF = 4.478, P = 0.010) were still found. The daily activity ability (DAA) score was also non-linear associated with sleep duration both in the age- and gender-adjusted GAM (EDF = 2.314, P < 0.001) and further adjusted GAM (EDF = 2.080, P = 0.010). CONCLUSIONS Both longer sleep duration (> 8 h) and shorter duration (< 8 h) were linked to worse SCCs. Future studies should explore the protective effect of managing sleep duration on SCD and its progression to dementia.
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Affiliation(s)
- Li-Hua Lin
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong Province, China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Wen-Qi Xu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China.
| | - Qing Hu
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Ping Zhang
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Jia-Hao Huang
- Yuexiu District Center for Disease Control, Guangzhou, 510080, Guangdong Province, China
| | - Yun-Fei Ke
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Kai-Rong Ding
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
| | - Cai-Lan Hou
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong Province, China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Fu-Jun Jia
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong Province, China.
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
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Wang H, Sun J, Sun M, Liu N, Wang M. Relationship of sleep duration with the risk of stroke incidence and stroke mortality: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Sleep Med 2022; 90:267-278. [PMID: 35245890 DOI: 10.1016/j.sleep.2021.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The relationship between inappropriate sleep duration with stroke incidence and mortality remains controversial. We carried out dose-response meta-analysis to quantify their dose-response relationships. METHODS We systematically searched and extracted data from prospective cohort studies regarding sleep duration and stroke published on PubMed, EMBASE, Cochrane Library, CNKI, and Wangfang Data until October 20, 2020. We used Stata version 15.0 for meta-analysis and dose-response meta-analysis. RESULTS A total of 20 articles including 27 reports were included. There had fifteen and 12 reports concerning sleep duration and stroke incidence and stroke mortality respectively. Meta-analysis showed that short sleep was linked to an increased risk of stroke incidence and stroke mortality (RR: 1.33, 95% CI: 1.19-1.49 and RR: 1.37, 95% CI: 1.16-1.62 respectively). Long sleep was also associated with an increased risk of stroke incidence and stroke-related death (RR: 1.71, 95% CI: 1.50-1.95 and RR: 2.41, 95% CI: 1.87-3.09, respectively). Dose-response meta-analysis demonstrated that U-shaped relationship was observed between sleep duration and risk of all outcomes. Sleep duration presented a nonlinear relationship with stroke incidence, stroke mortality, ischemic stroke, female stroke and male stroke. Prolonged sleep was associated with an increased risk of hemorrhagic stroke and male stroke. CONCLUSIONS Our findings indicate that both short and long sleep duration was linked to a higher risk of stroke incidence and stroke mortality. Extended sleep duration was more associated with adverse outcomes compared with short sleep duration. Inappropriate sleep duration correlated more with ischemic stroke and an increased risk of stroke in females.
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Affiliation(s)
- Hongxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou, Gansu 730030, China.
| | - Jing Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou, Gansu 730030, China
| | - Mengjiao Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou, Gansu 730030, China
| | - Ning Liu
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou, Gansu 730030, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou, Gansu 730030, China.
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Gao C, Guo J, Gong TT, Lv JL, Li XY, Liu FH, Zhang M, Shan YT, Zhao YH, Wu QJ. Sleep Duration/Quality With Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies. Front Med (Lausanne) 2022; 8:813943. [PMID: 35127769 PMCID: PMC8811149 DOI: 10.3389/fmed.2021.813943] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background To quantitatively evaluate the evidence of duration and quality of sleep as measured by multiple health outcomes. Methods This review is registered with PROSPERO, number CRD42021235587. We systematically searched three databases from inception until November 15, 2020. For each meta-analysis, the summary effect size using fixed and random effects models, the 95% confidence interval, and the 95% prediction interval were assessed; heterogeneity, evidence of small-study effects, and excess significance bias were also estimated. According to the above metrics, we evaluated the credibility of each association. Results A total of 85 meta-analyses with 36 health outcomes were included in the study. We observed highly suggestive evidence for an association between long sleep and an increased risk of all-cause mortality. Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep and increased risk of overweight and/or obesity; poor sleep quality and increased risk of diabetes mellitus and gestational diabetes mellitus. Conclusions Only the evidence of the association of long sleep with an increased risk of all-cause mortality was graded as highly suggestive. Additional studies are needed to be conducted. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021235587
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Affiliation(s)
- Chang Gao
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiao Guo
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Ting-Ting Gong
| | - Jia-Le Lv
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin-Yu Li
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang-Hua Liu
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meng Zhang
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi-Tong Shan
- Department of Statistics, University of Washington, Seattle, WA, United States
| | - Yu-Hong Zhao
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Qi-Jun Wu
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Um YJ, Chang Y, Jung HS, Cho IY, Shin JH, Shin H, Wild SH, Byrne CD, Ryu S. Decrease in Sleep Duration and Poor Sleep Quality over Time Is Associated with an Increased Risk of Incident Non-Alcoholic Fatty Liver Disease. J Pers Med 2022; 12:jpm12010092. [PMID: 35055407 PMCID: PMC8777783 DOI: 10.3390/jpm12010092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
The impact of changes in sleep duration and sleep quality over time on the risk of non-alcoholic fatty liver disease (NAFLD) is not known. We investigated whether changes in sleep duration and in sleep quality between baseline and follow-up are associated with the risk of developing incident NAFLD. The cohort study included 86,530 Korean adults without NAFLD and with a low fibrosis score at baseline. The median follow-up was 3.6 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. Hepatic steatosis (HS) and liver fibrosis were assessed using ultrasonography and the fibrosis-4 index (FIB-4). Cox proportional hazard models were used to determine hazard ratios (HRs) and 95% confidence intervals (Cis). A total of 12,127 subjects with incident HS and 559 with incident HS plus intermediate/high FIB-4 was identified. Comparing the decrease in sleep duration of >1 h, with stable sleep duration, the multivariate-adjusted HR (95% CIs) for incident HS was 1.24 (1.15–1.35). The corresponding HRs for incident HS plus intermediate/high FIB-4 was 1.58 (1.10–2.29). Comparing persistently poor sleep quality with persistently good sleep quality, the multivariate-adjusted HR for incident HS was 1.13 (95% CI, 1.05–1.20). A decrease in sleep duration or poor sleep quality over time was associated with an increased risk of incident NAFLD, underscoring an important potential role for good sleep in preventing NAFLD risk.
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Affiliation(s)
- Yoo Jin Um
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea; (Y.J.U.); (H.-S.J.); (I.Y.C.); (J.H.S.); (H.S.)
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, Korea
- Correspondence: (Y.C.); (S.R.)
| | - Hyun-Suk Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea; (Y.J.U.); (H.-S.J.); (I.Y.C.); (J.H.S.); (H.S.)
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea
| | - In Young Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea; (Y.J.U.); (H.-S.J.); (I.Y.C.); (J.H.S.); (H.S.)
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jun Ho Shin
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea; (Y.J.U.); (H.-S.J.); (I.Y.C.); (J.H.S.); (H.S.)
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Hocheol Shin
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea; (Y.J.U.); (H.-S.J.); (I.Y.C.); (J.H.S.); (H.S.)
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Sarah H. Wild
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, Korea
- Correspondence: (Y.C.); (S.R.)
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50
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Liu R, Tang S, Wang Y, Dong Y, Hou T, Ren Y, Cong L, Liu K, Qin Y, Sindi S, Du Y, Qiu C. Self-reported sleep characteristics associated with dementia among rural-dwelling Chinese older adults: a population-based study. BMC Neurol 2022; 22:5. [PMID: 34979998 PMCID: PMC8722012 DOI: 10.1186/s12883-021-02521-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep characteristics associated with dementia are poorly defined and whether their associations vary by demographics and APOE genotype among older adults are unclear. METHODS This population-based cross-sectional study included 4742 participants (age ≥ 65 years, 57.1% women) living in rural China. Sleep parameters were measured using the self-rated questionnaires of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Global cognitive function was assessed with the Mini-Mental State Examination (MMSE). Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and the National Institute on Aging-Alzheimer's Association criteria for Alzheimer's disease (AD). Data were analysed using multiple logistic and general linear regression models. RESULTS Dementia was diagnosed in 173 participants (115 with AD). Multivariable-adjusted odds ratio (OR) of dementia was 1.71 (95%CI, 1.07-2.72) for sleep duration ≤4 h/night (vs. > 6-8 h/night), 0.76 (0.49-1.18) for > 4-6 h/night, 1.63 (1.05-2.55) for > 8 h/night, 1.11 (1.03-1.20) for lower sleep efficiency (per 10% decrease), and 1.85 (1.19-2.89) for excessive daytime sleepiness. Very short sleep duration (≤4 h/night), lower sleep efficiency, and excessive daytime sleepiness were significantly associated with being diagnosed with AD (multivariable-adjusted OR range = 1.12-2.07; p < 0.05). The associations of sleep problems with dementia and AD were evident mainly among young-old adults (65-74 years) or APOE ε4 carriers. Among dementia-free participants, these sleep characteristics were significantly associated with a lower MMSE score. CONCLUSIONS Self-reported sleep problems in dementia are characterized by very short or long sleep duration, low sleep efficiency, and excessive daytime sleepiness, especially among young-old people and APOE ε4 carriers. TRIAL REGISTRATION ChiCTR1800017758 (Aug 13, 2018).
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Affiliation(s)
- Rui Liu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Yi Dong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Keke Liu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Yu Qin
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Shireen Sindi
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China. .,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China. .,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China.
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi Road, 250021, Jinan, Shandong, People's Republic of China. .,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China. .,Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.
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