Sleep Disturbances in Generalized Anxiety Disorder: The Role of Calcium Homeostasis Imbalance

Calcium channel blockers and mental health: a comprehensive meta-analysis of psychiatric adverse events in double-blind randomized controlled trials

OBJECTIVE

L-type calcium channel blockers (CCBs) are pivotal in managing cardiovascular disorders, such as hypertension and angina pectoris. Their action on L-type calcium channels, which are not only integral to cardiovascular function but also present in the brain, prompts questions about potential effects on mental health. While previous cohort studies explored this association with mixed results, our study aims to build upon these findings by systematically investigating psychiatric adverse events (PAEs) reported in double-blind randomized controlled trials (RCTs).

METHODS

A systematic search identified double-blind RCTs reporting frequencies of PAEs during CCB therapy across different indications. Separate meta-analyses were conducted for dihydropyridine (DHP) and nondihydropyridine (non-DHP) CCBs against placebo and active controls. This study was registered on INPLASY (INPLASY202480075).

RESULTS

In 187 studies, encompassing 28,201 patients exposed to CCBs, several PAEs were reported, with the most common being depression, insomnia, somnolence, and agitation. Meta-analyses revealed no significant difference in PAE occurrence for CCBs vs. placebo, β-blockers, renin-angiotensin system blockers, and thiazide/thiazide-like diuretics (all P  > 0.05). Restricting the analyses to cardiovascular studies, DHP CCBs were linked to lower risks of depression and insomnia compared to placebo [odds ratio (OR) 0.84, confidence interval (CI) 0.70-1.00 and OR 0.38, CI 0.15-0.99, both P  = 0.05); however, these results may be artifacts and should be interpreted with caution.

CONCLUSION

Concerns about negative mental health effects of CCBs appear to be unwarranted and should not deter clinicians from prescribing them when indicated. A detected signal towards positive mental health benefits in cardiovascular patients warrants further investigation.

Sleep disturbances in generalized anxiety Disorder: The central role of insomnia

Generalized anxiety disorder (GAD) is a chronic and disabling mental health condition characterized by excessive, uncontrollable worry and persistent psychological and somatic tension. Affecting approximately 3-6 % of the global population, GAD significantly impairs daily functioning and often coexists with other psychiatric conditions. Among its many symptoms, sleep disturbances-particularly insomnia-are among the most frequently reported and debilitating. Individuals with GAD commonly experience difficulties with sleep initiation, maintenance, and restorative rest, making insomnia one of the most pervasive features of the disorder. Emerging research highlights a bidirectional relationship between GAD and insomnia: while anxiety contributes to cognitive and physiological arousal that interferes with sleep, insomnia in turn exacerbates emotional dysregulation, amplifies worry, and may even precede the development of anxiety disorders. Neurobiological and neuroimaging studies support this reciprocal link, showing shared dysfunctions such as heightened hypothalamic-pituitary-adrenal (HPA) axis activity, increased amygdala reactivity, reduced prefrontal cortical control, and GABAergic deficits. These overlapping mechanisms underscore a common pathophysiological substrate that reinforces both conditions. Recognizing and addressing this interplay is critical, as untreated insomnia may perpetuate or intensify GAD symptoms. Notably, cognitive behavioral therapy for insomnia (CBT-I) has been effective in improving sleep and reducing anxiety severity-even without directly targeting anxiety-supporting a shift toward integrating sleep-focused interventions in the treatment of GAD. This review aimed to elucidate clinical and neurobiological evidence on the bidirectional link between insomnia and GAD, emphasizing shared mechanisms and treatment implications.

The characteristics of event-related potentials in generalized anxiety disorder: A systematic review and meta-analysis

OBJECTIVES

Previous studies have reported inconsistent findings regarding event-related potentials (ERPs) abnormalities in individuals with generalized anxiety disorder (GAD). This meta-analysis aimed to systematically review and synthesize the existing evidence on ERP alterations in individuals with GAD.

METHODS

A comprehensive literature search was conducted in PubMed, the Cochrane Library, Excerpta Medica Database, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang database, and China Biology Medicine (CBM) databases from inception to November 11, 2024. Gray literature and reference lists were also manually searched. Studies investigating ERP component differences between individuals with GAD and healthy controls were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Influence and sensitivity analyses were performed to assess the robustness of the pooled results. Effect sizes (SMD, Hedge's g) were calculated for latency and amplitude differences. Heterogeneity was assessed using the I2 statistic. Meta-regression and subgroup analyses were conducted to explore the source of heterogeneity. Trim-and-fill analyses were applied to assess potential publication bias. Data synthesis was performed using R (version 4.2.3) software.

RESULTS

A total of 37 studies involving 1086 individuals with GAD and 1315 healthy controls were included. The overall risk of bias was rated as low for 25 studies and moderate for 12 studies. Ten ERP components were included in the quantitative meta-analysis: P3, N2, N1, P2, Error Related Negativity (ERN), Correction Related Negativity (CRN), Mismatch Negativity (MMN), P1 (amplitude), Pe, and LPP. Pooled results indicated that individuals with GAD exhibited decreased P3 amplitude (g = -0.54, 95% CI: -0.70 to -0.38, I2 = 20%, P = 0.22) and increased ERN amplitude (g = -0.42, 95% CI: -0.72 to -0.12, I2 = 40%, P = 0.11) compared to healthy controls. In addition, delayed latency of P3 (g = 0.43, 95% CI: 0.09 to 0.78, I2 = 75%, P < 0.01), N2 (g = 0.36, 95% CI: 0.11 to 0.62, I2 = 30%, P = 0.20), and MMN (g = 0.63, 95% CI: 0.52 to 0.75, I2 = 0%, P < 0.0001) was observed in individuals with GAD. Due to the limited number of included studies, the results of N170, N1/P2, N270, N400, VPP, BAEP, P1 (latency), P50, EPN and Nf were summarized narratively. Individuals with GAD were reported to have increased N170, N400, and VPP amplitude and delayed P1 latency compared to healthy controls. Age, sex ratio, sample size, diagnostic criteria, task-related modality, and paradigm were identified as potential influencing factors of ERP characteristics.

CONCLUSIONS

Individuals with GAD exhibit increased ERN amplitude and decreased P3 amplitude in contrast with healthy controls. In addition, delayed latency of P3, N2, and MMN is detected in individuals with GAD. The identified ERP components in individuals with GAD are associated with attention, cognition, visual perception, error or conflict monitoring, semantic information integration, and auditory sensory memory processes. Due to the limited number of included studies and high heterogeneity, further studies with high quality are needed to confirm these findings.

Per-and polyfluoroalkyl substances and disrupted sleep: mediating roles of proteins

Background

Per-and polyfluoroalkyl substances (PFAS) contamination may disrupt sleep through disrupted metabolic and immune functions. The study aims to investigate the association and potential mechanism between PFAS and sleep.

Methods

We included 136 young adults recruited between 2014-2018 and 76 were re-assessed between 2020-2022. Additional 8 participants only had complete data between 2020-2022. Plasma PFAS (PFOS, PFOA, PFHxS, PFHpS, PFPeS, PFNA, PFDA) were measured at both visits using liquid-chromatography high-resolution mass spectrometry. Plasma proteins were measured by Olink® Explore 384 Cardiometabolic and Inflammation Panel I. Sleep duration was self-reported at both visits along with follow-up sleep disturbance and sleep-related impairment using validated instruments. We utilized multiple linear regression to explore the association between individual PFAS (in tertile) and these sleep outcomes. PFAS associated with sleep outcomes were subjected to computational toxicology analysis using the Comparative Toxicogenomics Database and Toxicology in the 21st Century database to identify potential genetic links between them. Mediation analysis using proteomic data was then performed to confirm the findings from computational toxicology analysis.

Results

At baseline, one tertile increase in PFDA was associated with 0.39 (95 % CI: 0.05, 0.73) hours of shorter nightly sleep duration, and, at follow-up, PFHxS and PFOA were associated with 0.39 (95 % CI: 0.05, 0.72) and 0.32 (95 % CI: 0.01, 0.63) hours shorter sleep duration, respectively. One tertile increase in PFOS exposure was associated with a 2.99-point increase in sleep disturbance scores (95 % CI: 0.67, 5.31) and a 3.35-point increase in sleep-related impairment scores (95 % CI: 0.51, 6.20). Computational toxicology and mediation analyses identified potential mediating roles for several proteins in the PFAS-sleep associations, including 11-beta-dehydrogenase isozyme 1 (HSD11B1), cathepsin B (CTSB) and several immune system-related proteins.

Conclusion

Future large scale epidemiological and mechanistic studies should confirm our findings and test effect measure modification of the associations by age.

ITPR2 Mediated Calcium Homeostasis in Oligodendrocytes is Essential for Myelination and Involved in Depressive-Like Behavior in Adolescent Mice

Ca2+ signaling is essential for oligodendrocyte (OL) development and myelin formation. Inositol 1,4,5-trisphosphate receptor type 2 (ITPR2) is an endoplasmic reticulum calcium channel and shows stage-dependent high levels in postmitotic oligodendrocyte precursor cells (OPCs). The role and potential mechanism of ITPR2 in OLs remain unclear. In this study, it is revealed that loss of Itpr2 in OLs disturbs Ca2+ homeostasis and inhibits myelination in adolescent mice. Animals with OL-specific deletion of Itpr2 exhibit anxiety/depressive-like behaviors and manifest with interrupted OPC proliferation, leading to fewer mature OLs in the brain. Detailed transcriptome profiling and signal pathway analysis suggest that MAPK/ERK-CDK6/cyclin D1 axis underlies the interfered cell cycle progression in Itpr2 ablated OPCs. Besides, blocking MAPK/ERK pathway significantly improves the delayed OPC differentiation and myelination in Itpr2 mutant. Notably, the resting [Ca2+]i is increased in Itpr2 ablated OPCs, with the elevation of several plasma calcium channels. Antagonists against these plasma calcium channels can normalize the resting [Ca2+]i level and enhance lineage progression in Itpr2-ablated OPCs. Together, the findings reveal novel insights for calcium homeostasis in manipulating developmental transition from OPCs to pre-OLs; additionally, the involvement of OLs-originated ITPR2 in depressive behaviors provides new therapeutic strategies to alleviate myelin-associated psychiatric disorders.

Risk factors affecting the sleep quality of patients on dialysis: A single-center cross-sectional study

Sleep quality is among the common complication in patients on dialysis and serious affect their health and quality of life; however, other associated risk factors are unclear. This study aimed to investigate the risk factors affecting sleep quality in patients on dialysis. Data were collected from 260 patients who met the inclusion criteria at out hospital from May 2023 to October 2023. Questionnaires were completed by patients, and biochemical indicators were obtained from past medical records. Univariate and multifactor analyses were used to find factors influencing sleep quality in patients on dialysis. Simple linear regression results showed that female, type of kidney primary disease, high systolic blood pressure (SBP), pruritus, pruritus frequency, restless legs syndrome (RLS), anxiety, and depression were associated with poor sleep quality. Blood biochemical parameters showed that low sodium and calcium levels and high ferritin levels were associated with poor sleep quality. Multiple linear regression statistics showed that female, pruritus, RLS, high SBP, depression, and high ferritin levels were associated with poor sleep quality. This study showed that female, chronic nephritis syndrome, high SBP, pruritus, RLS, low mood. and high ferritin levels were associated with poor sleep quality. Future development of individual nursing and targeted therapies is key to improving sleep quality in patients on dialysis.

Severe Vitamin D Deficiency-A Possible Cause of Resistance to Treatment in Psychiatric Pathology

In the last few years, vitamin D functions have been studied progressively, and along with their main role in regulating calcium homeostasis, the potential function in the nervous system and the link between different psychiatric disorders and vitamin D deficiency have been revealed. The discovery of vitamin D receptors in multiple brain structures, like the hippocampus, led to the hypothesis that vitamin D deficiency could be responsible for treatment resistance in psychiatric diseases. The aim of this study was to analyze the current knowledge in the literature regarding vitamin D deficiency among individuals afflicted with psychiatric disorders and assess the potential therapeutic benefits of vitamin D supplementation. A systematic search was conducted on the PubMed database for articles published in the last five years (2016-2022) in English, focusing on human subjects. Results show that vitamin D deficiency has implications for numerous psychiatric disorders, affecting mood and behavior through its influence on neurotransmitter release, neurotrophic factors, and neuroprotection. It also plays a role in modulating inflammation, which is often elevated in psychiatric disorders. In conclusion, vitamin D deficiency is prevalent and has far-reaching implications for mental health. This review underscores the importance of exploring the therapeutic potential of vitamin D supplementation in individuals with psychiatric disorders and highlights the need for further research in this complex field.

Efficacy and safety of fecal microbiota transplantation for chronic insomnia in adults: a real world study

OBJECTIVE

To assess the efficacy and safety of fecal microbiota transplantation (FMT) for adult chronic insomnia.

METHODS

Patients treated with FMT for chronic diseases were divided into chronic insomnia and non-insomnia group. The primary endpoint was the efficacy of FMT for insomnia 4 weeks after treatment, the secondary endpoints included the impacts of FMT on anxiety, depression, health-related quality of life, gut microbiota, and adverse events associated with FMT. Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) were utilized to assess the efficacy of FMT on insomnia, self-rating anxiety/depression scale [Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS)] was employed to evaluate anxiety and depression. Quality of life was evaluated by SF-36. 16S rRNA sequencing was employed to analyze the gut microbiota and correlation analysis was performed.

RESULTS

Forty patients met the inclusion criteria and seven were excluded. 33 patients were enrolled and stratified into chronic insomnia group (N = 17) and non-insomnia group (N = 16). Compared to baseline, FMT significantly ameliorated the ISI (17.31 ± 5.12 vs. 5.38 ± 5.99), PSQI (14.56 ± 2.13 vs. 6.63 ± 4.67), SAS (54.25 ± 8.90 vs. 43.68 ± 10.64) and SDS (57.43 ± 10.96 vs. 50.68 ± 15.27) score and quality of life of chronic insomnia patients. 76.47% (13/17) of insomnia patients achieved the primary endpoints. In chronic insomnia patients, the relative abundance of Eggerthella marked enhanced at baseline, while the relative abundance of Lactobacillus, Bifidobacterium, Turicibacter, Anaerostipes, and Eisenbergiella significantly increased after FMT treatment, the latter positive correlated with the efficacy of FMT. Encouragingly, FMT also improved the sleep quality of non-insomnia patients.

CONCLUSION

Eggerthella may potentially serve as a distinctive genus associated with chronic insomnia. FMT maybe a novel treatment option for adults with chronic insomnia and provide an alternative to traditional treatments for insomnia. The effects were positive correlated with the augmentation of probiotics, such as Bifidobacterium, Lactobacillus, Turicibacter, and Fusobacterium.

Prenatal exposure to per- and polyfluoroalkyl substances and infant sleep disturbance: A prospective cohort study

BACKGROUND

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect fetal brain development, yet no study has investigated the potential association between prenatal PFAS exposure and infant sleep.

OBJECTIVES

To explore the associations of prenatal PFAS exposure with infant sleep disturbances during the first year of life in a prospective cohort study.

METHODS

We recruited 4127 pregnant women from the Shanghai Birth Cohort (SBC) and followed their children from birth to 12 months old. A total of 2366 infants were included in the 6-month analyses, and 2466 infants in the 12-month analyses. Ten PFAS were quantified in blood serum collected in the first trimester. Sleep quality was measured using the Brief Infant Sleep Questionnaire. We used multiple linear regression and multinomial logistic regression to estimate the individual effects of PFAS on sleep outcomes. We utilized a quantile-based g-computation model to determine the joint effects of the PFAS mixture on infant sleep outcomes. Additionally, generalized estimating equation (GEE) models were performed to examine the longitudinal effects of PFAS exposure during pregnancy.

RESULTS

In infants aged 6 months, perfluorooctane sulfonate and perfluoroheptanoic acid were associated with a more than 2-fold risk of parent-reported sleep problems as severe. Perfluorodecanoic acid was associated with an increased risk of often or almost always snoring in one-year-old infants (relative risk ratios, 1.79; 95% CI, 1.12-2.86). PFAS mixtures were positively associated with nighttime awakenings both among infants aged 6 months (β, 0.11; 95% CI, 0.04-0.19) and 12 months (β, 0.11; 95% CI, 0.05-0.18). Prenatal exposure to PFAS were associated with longer sleep latency, increased nighttime awakenings, longer nocturnal wakefulness hours, snoring, and earlier sleep-onset time in infants aged 6-12 months, according to GEE models.

CONCLUSIONS

Our study suggests that prenatal exposure to PFAS may increase the risk of sleep disturbance in infants.