Sleep is essential: a new strategic plan for the American Academy of Sleep Medicine

Sleep duration as a mediator in the association between dietary intake of live microbes and insulin resistance: a cross-sectional study

BACKGROUND

Insulin resistance and associated metabolic health symptoms remain a primary global health concern. In addition to healthy dietary and nutritional programs, sleep duration is closely related to and has been linked to healthy metabolism. This study aimed to determine the link between insulin resistance and sleep duration and the dietary intake of live microbes.

METHODS

Data were collected from 15,927 participants in the National Health and Nutrition Examination Survey database from 2005 to 2018; this sample is equivalent to 209,316,590 individuals in the United States. The participants were categorized according to their consumption of foods containing live microbes: low, medium, high, and medium-high. The relationship between diets containing live microbes and the triglyceride-glucose index was analysed using a weighted multivariate linear regression model with a multistage sampling approach. The individuals were deemed to have insulin resistance if their homeostatic model assessment score for insulin resistance was ≥ 2. The relationship between diets containing live microbes and insulin resistance status was assessed using weighted multivariate logistic regression analyses. The mediating role of sleep duration on the relationship between diets containing live microbes and the triglyceride-glucose index was also examined.

RESULTS

After accounting for potential confounders, diets containing live microbes at medium and medium-high levels were significantly associated with a reduced triglyceride-glucose index. The medium and medium-high levels of live microbial intake were also associated with a lower risk of insulin resistance. Within the 6-9 hours' sleep duration range, the indirect effect of medium and medium-high levels of live microbes on the triglyceride-glucose index was observed, accounting for 2.95% and 6.08% of the overall change, respectively.

CONCLUSIONS

This study suggests an association between a diet rich in medium and medium-high viable microbes, lower triglyceride-glucose index values, and a reduced risk of developing insulin resistance. Additionally, a sleep duration of 6-9 h may mediate this association.

Associations between dietary nutrient intake and sleep disorders in cancer survivors base on NHANES 2005 to 2018

Sleep disorders significantly impact the quality of life for many individuals, which remain largely unrecognized. It is widely believed that dietary nutrient intake plays a crucial role in promoting healthy sleep patterns. However, there is lack of research focusing on cancer survivors. This study utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate the correlation between dietary nutrient intake and sleep disorders in cancer survivors. Analyzing data from 2882 cancer survivors in NHANES spanning from 2005 to 2018. Dietary nutrient intake was evaluated through two 24-h dietary recalls. Weighted multivariable logistic regression model was employed to further applied to explore the association between dietary fiber intake and sleep disorders while controlling for relevant confounding factors. Additionally, the nonlinear and dose-response relationships were explored using restricted cubic spline (RCS) regression along with smooth curve fitting and threshold effect analysis. Stratified analysis and interaction analysis were conducted to assess the consistency of the results. Univariable and multivariable analysis demonstrated that dietary fiber intake showed negative correlation with sleep disorders (P < 0.05). Treating dietary fiber intake as continuous variable. After accounting for all covariates, the study reaffirmed the protective role of dietary fiber (odds ratio [OR]: 0.99, 95% confidence interval [CI]: 0.98-0.99, P = 0.044). Analysis of dietary fiber intake in quartiles further supported this trend (P < 0.001). Interestingly, further investigations indicated that dietary fiber intake was not associated with sleep apnea, insomnia, restless legs syndrome, or other types of sleep disorders (P > 0.05). Notably, no statistically significant interactions were observed in all subgroup analyses except poverty income ratio (PIR) (P for interaction < 0.05), indicating that the protective effect of dietary fiber on sleep disorders was more pronounced in individuals with PIR ≥ 2.5. Our results suggest that adequate dietary fiber intake may be beneficial dietary strategy to reduce sleep disorders in cancer survivors.

Higher ambient temperatures may worsen obstructive sleep apnea: A nationwide smartwatch-based analysis of 6.2 million person-days

Obstructive sleep apnea (OSA) is a serious type of sleep disorder that can lead to cardiometabolic and neurocognitive diseases. We utilized smart device-based photoplethysmography technology to collect sleep data from the Chinese population from 2019 to 2022. Distributed lag nonlinear models combined with a generalized nonlinear model or a linear mixed effects model were used to investigate the short-term associations between daily temperature and indicators of OSA severity. We included a total of 6,232,056 d of sleep monitoring data from 51,842 participants with moderate to severe risk of OSA from 313 Chinese cities. The relationships between ambient temperature and OSA exacerbation, apnea-hypopnea index (AHI), and minimum oxygen saturation (MinSpO2) were almost linear and present only on the same day. Higher temperatures were associated with a greater risk of OSA exacerbation, with an 8.4% (95% confidence interval (CI): 7.6%-9.3%) increase per 10 °C increase in temperature. A 10 °C increase in daily temperature corresponded to an AHI increase of 0.70 events/h (95% CI: 0.65-0.76) and a MinSpO2 decrease of 0.18% (95% CI: 0.16%-0.19%). Exposure to elevated temperatures during the night can also lead to adverse effects. The effects of higher temperatures on OSA severity were stronger among men, participants with a body mass index ≥ 24 kg/m2, those aged 45 years and older, individuals with a history of hypertension and diabetes, and during the cold season. This large-scale, nationwide, longitudinal study provides robust evidence suggesting that higher ambient temperatures may immediately worsen OSA.

Association between triglyceride glucose index and sleep disorders: results from the NHANES 2005-2008

BACKGROUND

To determine the association between sleep disorders and Triglyceride glucose index.

METHODS

A cross-sectional analysis of the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) was performed. The 2005 to 2008 NHANES national household survey for adults ≥ 20 years was examined for the sleep disorders.TyG index: ln [triglyceride (mg/ dL) × fasting blood glucose (mg/dL)/2].Multivariable logistic and linear regression models were used to explore the association between the TyG index and sleep disorders.

RESULTS

A total of 4,029 patients were included. Higher TyG index is significantly associated with elevated sleep disorders in U.S. adults. TyG was moderately correlated with HOMA-IR (Spearman r = 0.51). TyG was associated with higher odds of sleep disorders(adjusted OR [aOR],1.896; 95% CI, 1.260 2.854), Sleep apnea (aOR, 1.559; 95% CI, 0.660 3.683), Insomnia(aOR, 1.914;95% CI, 0.531 6.896), and Restless legs (aOR, 7.759; 95% CI,1.446 41.634).

CONCLUSIONS

In this study, our result shown that population with higher TyG index are significantly more likely to have sleep disorders in U.S. adults.

Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT

OBJECTIVE

The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health.

REVIEW METHODS

A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR.

SUMMARY

Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.

A Cross-Sectional Study on the Relationship Among Cytokines, 5-HT2A Receptor Polymorphisms, and Sleep Quality of Non-manual Workers in Xinjiang, China

BACKGROUND

Studies have shown that cytokine activity changes during the sleep-wake process, suggesting that inflammatory factors may be involved in a mechanism affecting sleep quality. Furthermore, the serotonergic system is also one of the essential components of airway relaxation during sleep, especially the serotonin 2A receptor (5-HTR2A) type that plays an important role in the sleep-wake process. Therefore, this research aimed to investigate the effects of cytokines and 5-HTR2A polymorphisms on sleep quality in non-manual workers in Urumqi, Xinjiang in order to explore the relationship between the three.

METHODS

This study used a cluster sampling method to randomly select non-manual workers who worked in Urumqi, Xinjiang for at least 1 year. From July 2016 and December 2017, this study recruited 1,500 non-manual workers for physical examination in the First Affiliated Hospital of Xinjiang Medical University. According to the inclusion and exclusion criteria, 1,329 non-manual workers were finally included in the questionnaire study. It used the Pittsburgh Sleep Quality Index questionnaire to assess sleep quality. Moreover, another 15% of respondents were randomly selected as the experimental study group. The polymerase chain reaction restriction fragment length polymorphism was used to detect 5-HTR2A gene genotypes. Simultaneously, the cytokine (IL-1β, IL-2, IL-6, and TNF-α) content was evaluated using an enzyme-linked immunoassay.

RESULTS

The results showed that among the 1,329 respondents, 870 had sleep quality problems, and the detection rate was 65.46%. The distribution of -1438G/A genotypes in the 5-HTR2A gene was significantly different among different sleep quality groups (p < 0.05), with no statistical significance present when comparing to T102C (p > 0.05). Logistic regression analysis showed that the AG [odds ratio (OR) = 2.771, 95% confidence interval (CI): 1.054-7.287] and GG (OR = 4.037, 95% CI: 1.244-13.105) genotypes at -1438G/A loci were both associated with poor sleep quality and were thus considered the susceptibility genotypes for sleep problems. Furthermore, IL-1β was shown to be a protective factor for sleep quality (OR = 0.949, 95% CI: 0.925-0.974). The interaction results showed that AG × IL-1β (OR = 0.952, 95% CI: 0.918-0.987) was associated with a lower risk of sleep problems than AA × IL-1β.

CONCLUSION

Cytokines and 5-HTR2A polymorphisms not only have independent effects on sleep but also may have cumulative effects. Therefore, it is necessary to further explore the related mechanisms affecting sleep quality to improve the sleep quality of non-manual workers.

Characteristics of the Dual Board-Certified Sleep Otolaryngology Workforce

OBJECTIVE

Sleep medicine is a multidisciplinary field that includes otolaryngology. After 2011, sleep medicine board eligibility required completion of a dedicated sleep medicine fellowship. The objective of our study is to describe the characteristics and geographic distribution of the dual board-certified sleep otolaryngology workforce and to assess the impact of the 2011 change.

METHODS

A cross-sectional analysis of sleep-certified otolaryngologists registered with the American Board of Otolaryngology-Head and Neck Surgery in 2019 was performed to characterize the sleep otolaryngology workforce. County and regional analysis of provider density was conducted by comparing provider characteristics with county-level data from the United States Census Bureau.

RESULTS

There were 275 active dual board-certified sleep otolaryngologists, or approximately 1 for every 1.12 million Americans. 77.8% were in private practice and 2.9% had American Society of Pediatric Otolaryngology membership. Eighty-eight percent were male, with females more likely than males to be in an academic setting (36.4% for females compared to 20.2% for males; P = .045). The South Atlantic and South Central regions had the highest number of sleep board-certified otolaryngologists per capita. Before 2011, an average of 75.7 otolaryngologists took the sleep board exam per 2-year cycle, compared to 14.3 otolaryngologists after 2011 (P = .029).

CONCLUSION

There are few dual board-certified sleep otolaryngologists across the country, which may affect care for patients with sleep-disordered breathing. Increased resident exposure and otolaryngology training in sleep medicine can strengthen the otolaryngology contribution to the multidisciplinary care of these patients.

LEVEL OF EVIDENCE

IV Laryngoscope, 2021.

Association of sleep disturbance and freezing of gait in Parkinson disease: prevention/delay implications

STUDY OBJECTIVES

Freezing of gait (FOG) severely impairs life quality of Parkinson disease (PD) patients. The relationship between sleep disturbance and FOG in PD remains unclear, so in this study, we aimed to investigate that relationship.

METHODS

First, we assessed clinical characteristics of freezers and nonfreezers among PD patients. Next, we assessed clinical characteristics of PD patients with different PDSS1 scores (score on first item of Parkinson's Disease Sleep Scale). Finally, we prospectively followed a cohort of nonfreezers from a baseline clinical visit and to a maximum of 18 months and performed a Cox regression analysis to further investigate the relationship between PDSS1 score and FOG in PD.

RESULTS

A total of 163 participants with PD were included in the baseline analysis. The freezers had significantly worse sleep compared with the nonfreezers. The proportion of freezers in the patients with low PDSS1 score (PDSS1 < 6) was significantly higher than that in the patients with high PDSS1 score (PDSS1 ≥ 6). A total of 52 nonfreezers were prospectively followed. During a maximum 18-month follow-up, FOG incidence (73%) in the PDSS1 < 6 group was significantly higher than that (24%) in the PDSS1 ≥ 6 group (P = .008). Low PDSS1 score (hazard ratio = 4.23, 95% CI 1.64-10.92, P = .003) and high levodopa equivalent daily dose (hazard ratio = 4.18, 95% CI 1.62-10.75, P = .003) were significantly associated with an increased hazard of FOG.

CONCLUSIONS

Our study indicated that low PDSS1 score may be a risk indicator for the development of FOG and provided important insights into potential targets for the prevention/delay of FOG in PD.

Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES 2009-2010

OBJECTIVES

To determine the prevalence of sleep disorders in the United States and the association between sleep disorders and all-cause mortality.

METHODS

A cross-sectional analysis of the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index (NDI) was performed. The 2009 to 2010 NHANES national household survey for adults ≥ 18 years was examined for the prevalence of sleep disorders as well as standard demographics and the presence of comorbidities (coronary artery disease [CAD], stroke, and emphysema). This dataset was linked to the 2015 NDI to associate the presence of sleep disorders with 5-year all-cause mortality.

RESULTS

The study sample had a mean age of 46.1 years old, was 48.3% male, and had an average body mass index (BMI) of 28.7 (28.4-28.9). 7.1% (6.5%-7.7%) of adults reported being diagnosed with a sleep disorder, which represents an estimated 15.9 million (13.2-18.6) patients. The estimated mortality rate for those having a sleep disorder was 9.3% (7.2%-11.9%) compared to 5.2% (4.5%-5.9%) without a sleep disorder (odds ratio 1.89, P = <.001). After adjusting for age, sex, BMI, CAD, stroke, and emphysema, having a sleep disorder remained a significant predictor of increased mortality (hazard ratio, 1.5 [1.02-2.18], P = .042).

CONCLUSION

This study reports a high prevalence of self-reported but physician-diagnosed sleep disorders; however, this likely represents an underestimate. Given the association with all-cause mortality, there is a need for increased recognition of undiagnosed sleep disorders within the United States.

LEVEL OF EVIDENCE

2b Laryngoscope, 131:686-689, 2021.