Self-reported and actigraphic short sleep duration in older adults

Association between sleep duration and obesity in patients with type 2 diabetes: A longitudinal study

BACKGROUND

Obesity is prevalent in patients with type 2 diabetes (T2D) and negatively impacts diabetes outcomes. While studies in the general population have established a link between sleep duration and obesity, this relationship in T2D remains unclear.

OBJECTIVES

To assess the association between sleep duration and adiposity in patients with T2D.

METHODS

This prospective study of adults enrolled in the SLEEP T2D study from 13 UK NHS Trusts. Sleep duration was self-reported using the Pittsburgh Sleep Quality Index (PSQI) and categorized as short (≤ 6 h/ night), long (> 9 h/night) or (normal > 6-9 h/night). Adiposity was assessed using body mass index (BMI) and waist circumference.

RESULTS

Among 229 patients (61% male, mean age 61.2 (± 11.7) years, 63.7% with BMI ≥ 30 kg/m2). At baseline, sleep duration negatively correlated with BMI (r = -0.27, p < 0.001) and waist circumference (r = -0.25, p = 0.001). After adjusting for potential confounders in different models, short sleep duration was associated with higher BMI (β = -1.01; p = 0.006) and waist circumference (β = -1.91; p = 0.01). Following a median follow-up of 26.5 months, short sleep at baseline was associated with a 5% or more gain in BMI (adjusted OR 10.03; 95% CI 1.55-64.84; p = 0.01).

CONCLUSION

Short sleep duration is associated with higher adiposity measures (BMI and waist circumference) and weight gain in patients with T2D. Addressing sleep duration may reduce the burden of obesity in T2D, and future studies in this area are warranted.

Obesity and the accelerated decline in total sleep time increases the self-reported diagnoses of diabetes

Introduction

The aim of this study was to investigate the relationship between obesity and the accelerated decline in Total Sleep Time (TST) and its potential impact on the self-reported diagnoses of diabetes.

Methods

Our study addresses this gap by analyzing trends in a longitudinal cohort study conducted in China, using data from the China Health and Nutrition Survey (CHNS). Employing a joint model, inter-individual variability and intra-individual variability in TST, and its impact on self-reported diagnoses of diabetes were considered.

Results

Our findings reveal that self-reported diagnoses of diabetes prevalence in China rose from 1.10% in 2004 to 3.06% in 2015, accompanied by a decrease in average TST from 8.12 to 7.80. With age, TST decreased by 0.01 per year. Among coffee or tea consumers, it decreased by 0.03, while alcohol users saw a decrease of 0.07. The obese group experienced a decrease of 0.05, the overweight group 0.03, and the normal weight group 0.01. Each 1-hour decrease in TST was associated with a substantial 3.61-fold increase in self-reported diagnoses of diabetes risk (95% CI: 2.92-4.44). Specifically, individuals with a higher baseline TST tend to experience smaller changes over time, whereas those with a lower baseline TST tend to experience larger changes.

Discussion

For the obese, TST decreases at an accelerated rate which contributes to the risk of self-reported diagnoses of diabetes. The findings underscore the role of sleep loss in diabetes risk, with implications for public policy. Future research and interventions should emphasise the impact of sleep management, particularly on obesity and metabolic health, to develop more effective prevention and treatment strategies.

Sleep trajectories across three cognitive-aging pathways in community older adults

INTRODUCTION

Comparing sleep and rest-activity rhythms across different cognitive aging pathways can identify novel risk factors and potential mechanisms. However, our current understanding is restricted by differences in sleep measurement, limited longitudinal data, and heterogeneous cognitive aging processes.

METHODS

We applied cubic splines to longitudinal self-reported sleep and actigraphy data from 1449 participants in the Rush Memory and Aging Project and quantified differences in the levels and trajectories of sleep amount, regularity, and timing within and between three cognitive aging pathways: normal, stable mild cognitive impairment, dementia.

RESULTS

Sleep amount was lowest in the dementia pathway prior to cognitive impairment but increased with age, most rapidly after dementia. Regularity declined across all pathways, most rapidly after cognitive diagnoses. Timing advanced across all pathways.

DISCUSSION

Shorter sleep amount in cognitively healthy older adults may be a risk factor or prodromal indicator of dementia, while longer sleep amounts and decreasing regularity may reflect neurodegeneration.

HIGHLIGHTS

We quantified longitudinal changes in sleep across three cognitive-aging pathways. We incorporated both subjective and objective measures of sleep health. Self-report duration increased noticeably from before to after cognitive diagnosis. Sleep irregularity increased most prominently after cognitive diagnosis. Advances in sleep timing occurred in both normal and pathological aging.

Five-Year Changes in 24-Hour Sleep-Wake Activity and Dementia Risk in Oldest Old Women

BACKGROUND AND OBJECTIVES

Sleep disruptions are associated with cognitive aging in older adults. However, little is known about longitudinal sleep changes in the oldest old and whether these changes are linked to cognitive impairment. We aimed to determine whether changes in 24-hour multidimensional sleep-wake activity are associated with mild cognitive impairment (MCI) and dementia in oldest old women.

METHODS

We studied cognitively unimpaired women enrolled in the Study of Osteoporotic Fractures who completed wrist actigraphy twice (baseline and follow-up) and had cognitive status evaluated at follow-up using a neuropsychological battery and adjudication. To identify multidimensional sleep-wake change profiles, we performed hierarchical clustering on principal components on the 5-year changes (median 5.0 [range 3.5-6.3] years) in nighttime sleep (sleep duration, sleep efficiency [SE], and wake after sleep onset [WASO]), napping (duration and frequency), and circadian rest-activity rhythms (RARs; acrophase, amplitude, mesor, and robustness). Using multinomial logistic regression, we evaluated the associations between these profiles-and individual parameter changes-and MCI and dementia risk at follow-up.

RESULTS

Of 733 participants (mean age 82.5 ± 2.9 years), 164 (22.4%) developed MCI and 93 (12.7%) developed dementia by the follow-up visit. We identified 3 sleep-wake change profiles: stable sleep (SS; n = 321 [43.8%]) was characterized by stability or small improvements; declining nighttime sleep (n = 256 [34.9%]) showed decreases in nighttime sleep quality and duration, moderate napping increases, and worsening circadian RARs; and increasing sleepiness (IS; n = 156 [21.3%]) exhibited large increases in daytime and nighttime sleep duration and quality, and worsening circadian RARs. After adjustment for age, education, race, body mass index, diabetes, hypertension, myocardial infarction, antidepressant use, and baseline cognition, women with IS had approximately double the risk of dementia (odds ratio 2.21, 95% CI 1.14-4.26) compared with those with SS. SE, WASO, nap duration, and nap frequency were individually associated with dementia. Neither sleep-wake change profiles nor individual parameters were associated with MCI.

DISCUSSION

Among community-dwelling women in their 80s, those with increasing 24-hour sleepiness over 5 years had doubled dementia risk during that time. Change in multidimensional 24-hour sleep-wake activity may serve as an early marker or risk factor for dementia in oldest old women.

A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean?

STUDY OBJECTIVES

To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis.

METHOD

We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses).

RESULTS

Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison.

CONCLUSIONS

Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed.

Performance of an Electroencephalography-Measuring Headband or Actigraphy Compared with Polysomnography in Older Adults with Sleep Disturbances

Study Objectives

In older adults, self-reported sleep measures may be inaccurate, but polysomnography (PSG) is burdensome. We assessed the performance of an electroencephalography-measuring headband (HB) or actigraphy (ACT) compared with PSG in older adults with sleep disturbances.

Methods

Sixty-three adults aged ≥60 years who reported symptoms of insomnia and/or daytime sleepiness ≥once/week completed a week-long, home-based protocol during which they wore the HB for seven nights, an actigraph for seven days and nights, and completed a one-night level II unattended PSG. For the current analysis, we compared total sleep time (TST) and wake after sleep onset (WASO) from all three devices on the PSG night. We calculated absolute differences and intraclass correlation coefficients (ICCs) for TST and WASO between HB and ACT, respectively, vs. PSG. We also evaluated the performance of the HB among subgroups of the poorest sleepers according to the presence of sleep apnea, insomnia, poor sleep quality, and periodic limb movements of sleep. Feasibility of the HB was assessed by measures of adherence (i.e., ability to use the HB over seven nights) and usability (i.e., ratings of items from the WEarable Acceptability Range [WEAR] scale).

Results

The average age was 72.8 [standard deviation 6.6] years, 63.5% were female, and 63.5% identified as non-Hispanic White. On PSG, averages for TST and WASO were 370.1 [93] and 88.9 [63] minutes, respectively. For the HB vs. PSG, mean differences and ICCs were -11.9 minutes and 0.83 [0.74, 0.89] for TST; and -15.5 minutes and 0.65 [0.48, 0.77] for WASO. For ACT vs. PSG, mean differences for TST and WASO were larger, and ICCs showed lower levels of agreement. The HB performed well among the poorest sleepers, with ICCs >0.65 for TST and WASO. On average, participants wore the HB for 6.5 [0.8] nights, and usability was rated highly.

Conclusions

The HB demonstrated good agreement with PSG, outperforming ACT, including among the poorest sleepers. Devices like the HB might provide feasible measures of sleep that are more accurate than ACT and enhance the management of sleep health in older adults with sleep disturbances. Future research should focus on further validation of these devices in habitual sleep environments.

Eating frequency, timing of meals, and sleep duration before and after a randomized controlled weight loss trial for breast cancer survivors

PURPOSE

To examine eating frequency, timing of meals, and sleep duration before and after a weight loss intervention for breast cancer survivors.

METHODS

Female breast cancer survivors (n = 159; 55 ± 9 years; 31.4 ± 5.0 kg/m2; stage I-III, median [IQR] 9.5 [5.5] months post-diagnosis) participated in a randomized controlled trial of a 12-month weight loss intervention versus usual care. Eating frequency, proportion of daily calories consumed after 5 PM, eating after 8 PM, nightly fasting duration, and sleep duration were estimated and categorized based on existing associations with factors influencing breast cancer prognosis and breast cancer outcomes. These behaviors at baseline were compared to women from an Australian national survey with similar age and BMI range. Mixed-effects linear regression models were used to examine the changes in health behaviors from baseline to 18 months between intervention and usual care groups.

RESULTS

Before the trial, eating after 8 PM (67%) was higher, and short nightly fasting duration (< 13 h, 83%) and long sleep duration (> 9 h/day, 26%) were marginally higher, in breast cancer survivors than women in the national survey (52%, 75%, and 17%, respectively). "Less optimal" eating behaviors and sleep duration tended to co-occur. Behaviors remained unchanged over the 18-month follow-up, irrespective of the study group (p > 0.05; Cohen's effect sizes < 0.3).

CONCLUSIONS

Later timing of eating and long sleep duration were prevalent in breast cancer survivors and continued following a weight loss intervention.

IMPLICATIONS FOR CANCER SURVIVORS

Future multi-behavior interventions in breast cancer survivors should consider specific messages to target eating timing behaviors and sleep.

Sleeping <6.55 h per day was associated with a higher risk of low back pain in adults aged over 50 years: a Korean nationwide cross-sectional study

Background

Patients with low back pain (LBP) often suffer from sleep disorder, and insufficient sleep duration was recognized as a potential risk factor for LBP. Our aim was to explore the exact effect of sleep duration on LBP and the optimal sleep duration to reduce the risk of LBP.

Methods

Analyzing data from the Korean National Health and Nutrition Examination Survey (KNHANES), we investigated the association between sleep duration and LBP in individuals aged 50 years and older. We used logistic regression models, interaction stratification analysis, and threshold effect assessment to analyze the relationship between sleep duration and LBP.

Results

A total of 6,285 participants, comprising 3,056 males and 3,229 females with a median age of 63.1 years, were enrolled in the study. The association between sleep duration and LBP risk exhibited an L-shaped curve (p < 0.015) in RCS analysis. In the threshold analysis, the OR of developing risk of LBP was 0.864 (95% CI:0.78-0.957, p = 0.005) in participants with sleep duration <6.55 h. Each additional hour of sleep was associated with a 13.6% decrease in the risk of LBP. No significant association was observed between sleep duration ≥6.55 h and the risk of LBP. The risk of LBP did not decrease further with increasing sleep duration. Results remain robust across subgroups.

Conclusion

Our findings indicate that shorter sleep duration is a risk factor for LBP in adults aged over 50 years. We revealed an L-shaped association between sleep duration and LBP, with an inflection point at approximately 6.55 h per day. These results underscore the significance of sleep duration as a factor in the risk assessment for LBP.

Associations of actigraph sleep characteristics with blood pressure among older adults

OBJECTIVES

Many studies have examined links between sleep and blood pressure, with mixed findings, mostly using self-reported sleep data and cross-sectional designs. We examined whether actigraph-estimated sleep characteristics are associated with concurrent blood pressure or 5-year blood pressure change in a national cohort of older adults (National Social Life, Health and Aging Project), and whether these associations differ by hypertension medication use.

METHODS

Subjects were 669 older adults (62-90years), 471 with 5-year follow-up data. Sleep characteristics were duration (linear plus quadratic terms); sleep percentage; and categorical onset, midpoint, and waking times. Multivariable linear models adjusted for age, race, gender, obesity, smoking, daytime napping, and hypertension medication use. Interactions between sleep characteristics and hypertension medication were tested among the 401 subjects with consistent hypertension medication status over time.

RESULTS

We found U-shaped cross-sectional and longitudinal relationships between duration and blood pressure, with shorter and longer sleep times associated with higher blood pressure. Later onset times were cross-sectionally associated with higher systolic blood pressure, while earlier onset times were longitudinally associated with systolic blood pressure increase. Midpoint, wake time, and sleep percentage were not significantly associated with blood pressure. Significant interaction terms suggested hypertension medications attenuated associations of sleep onset and wake time with diastolic blood pressure.

CONCLUSIONS

These results with actigraph-estimated parameters confirm some, but not all, associations reported from research based on self-reported sleep data. Our findings are consistent with recommended intermediate sleep durations for cardiovascular health and suggest hypertension medication use may attenuate some associations between sleep timing and blood pressure.

Five-year changes in 24-hour sleep-wake activity and dementia risk in oldest old women

INTRODUCTION

Sleep disruptions are associated with cognitive aging in older adults. However, it is unclear whether longitudinal changes in 24-hour multidimensional sleep-wake activity are linked to cognitive impairment in the oldest old.

METHODS

We studied 733 cognitively unimpaired women (mean age=82.5±2.9 years) who completed two actigraphy assessments over five years. We performed hierarchical clustering on principal components in nine sleep, napping, and circadian rest-activity rhythm parameters to identify multidimensional sleep-wake change profiles and multinomial logistic regression to evaluate the associations between sleep-wake changes and risk of cognitive impairment at follow-up.

RESULTS

We identified three sleep-wake change profiles: Stable Sleep (43.8%), Declining Nighttime Sleep (34.9%), and Increasing Sleepiness (21.3%). After adjustment for demographics and comorbidities, women with Increasing Sleepiness had approximately doubled (odds ratio=2.21, p=0.018) risk of dementia compared to those with Stable Sleep.

DISCUSSION

Increasing sleepiness may be an independent marker or risk factor for dementia in oldest old women.

Association between sleep duration and possible sarcopenia in middle-aged and elderly Chinese individuals: evidence from the China health and retirement longitudinal study

BACKGROUND

Sarcopenia is a common cause of disability in the aging population, and managing sarcopenia is an important step in building intrinsic capacity and promoting healthy aging. A growing body of evidence suggests that sleep deprivation may be a mediator of the development of sarcopenia. The purpose of this study was to explore the longitudinal association between sleep duration and possible sarcopenia using data from a national sample.

METHODS

Two waves of data from the CHARLS database for 2011 and 2015 were used in this study. All possible sarcopenia participants met the Asia Working Group for Sarcopenia 2019 (AWGS 2019) diagnostic criteria. Sleep duration was assessed using a self-report questionnaire, and sleep duration was categorized as short (≤ 6 h), medium (6-8 h), or long (> 8 h) based on previous studies. Longitudinal associations between sleep duration and possible sarcopenia will be calculated by univariate and multifactorial logistic regression analyses and expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 5654 individuals participated in the follow-up study, with a prevalence of possible sarcopenia of 53.72% (578) in the short sleep duration group, 38.29% (412) in the medium sleep duration group, and 7.99% (86) in the long sleep duration group. According to the crude model of the second-wave follow-up study, short sleep durations were significantly more strongly associated with possible sarcopenia than were medium and long sleep durations (OR: 1.35, 95% CI: 1.17-1.55, P = 0.000). The association between short sleep duration and possible sarcopenia was maintained even after adjustment for covariates such as age, gender, residence, education level, BMI, smoking status, alcohol consumption and comorbidities (OR: 1.18, 95% CI: 1.02-1.36, P = 0.029). In the subgroup analysis, short sleep duration was associated with low grip strength (OR: 1.20, 95% CI: 1.02-1.41, P = 0.031).

CONCLUSIONS

Sleep deprivation may be closely associated with the development of possible sarcopenia in middle-aged and elderly people, which provides new insights and ideas for sarcopenia intervention, and further studies are needed to reveal the underlying mechanisms involved.

Predicting fragility fractures based on frailty and bone mineral density among rural community-dwelling older adults

OBJECTIVE

We aim to investigate the association between bone mineral density (BMD) measurement and fragility fractures and assess the predictive value of combining BMD measurement and frailty for fracture risk assessment.

METHODS

This retrospective cohort study analyzed data from 5126 rural Koreans in the Chungju Metabolic Disease Cohort study. Frailty was defined using Fried's frailty phenotype. Fractures were assessed via structured medical interviews. Adjusted odds ratios (ORs) were calculated considering age, sex, body mass index, behavior, BMD, handgrip strength, medications, and comorbidities.

RESULTS

The study cohort consisted of 5126 participants comprising 1955 (38.1%) males and 3171 (61.9%) females. Osteoporosis significantly increased the fracture risk across all types, except vertebral fracture, with adjusted OR (95% CI) of 1.89 (1.23-3.47) for any fracture, 2.05 (1.37-2.98) for hip fracture, 2.18 (1.06-4.50) for other fracture, and 1.71 (1.03-3.63) for major osteoporotic fracture (MOF). Frail individuals exhibited significantly increased risk for any fracture (OR 2.12; 95% CI, 1.21-3.71), vertebral fracture (2.48; 1.84-3.61), hip fracture (2.52; 1.09-3.21), other fracture (2.82; 1.19-8.53), and MOF (1.87; 1.01-3.47). The combination of frailty and BMD further increased the risks, with frail individuals demonstrating elevated ORs across BMD categories. In subgroup analyses, men showed a significant association between frailty with osteoporosis in hip fracture and MOF. Frail women with osteoporosis exhibited the highest risks for all fractures, particularly vertebral (OR 5.12; 95% CI, 2.07-9.68) and MOF (OR 5.19; 95% CI, 2.07-6.61). Age-specific analysis revealed that individuals aged 70 and older exhibited markedly higher fracture risks compared with those under 70. The combination of frailty and low BMD further elevated the fracture risk. Frailty was applied with BMD and demonstrated superior risk prediction for MOF compared with that with either score alone (area under the curve 0.825; P = .000).

CONCLUSIONS

Combining frailty with BMD provides a more accurate fracture risk assessment for individuals over 50 years.

Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study

Aim

Abnormalities in sleep patterns are a common health problem for the older adults. The relationship between sarcopenia and sleep duration in older people is controversial. This research is to examine the association between sleep duration and sarcopenia.

Methods

We drew 21,095 adults from the China Health and Retirement Longitudinal Survey (CHARLS). Not only we explore the relationship between sleep duration and sarcopenia, but also compare sleep duration to three sarcopenia subcomponents. Moreover, the sensitivity analysis was conducted by the gender and residence area to ascertain the discrepancy, separately. Finally, using restricted cubic spline to find the non-linear association between them.

Results

Among 7,342 community older adults engaged by CHARLS in 2015, the incidence of possible sarcopenia and sarcopenia was 23.14 and 11.30%, separately. Sleep duration (≤6 h) [OR(95%CI) = 1.30(1.03-1.65), p < 0.05] and (≥8 h) [OR(95%CI) = 1.33(1.05-1.69), p < 0.05] were significantly linked with possible sarcopenia, while long sleep duration (≥8 h) [OR(95%CI) = 1.41(1.01-2.02), p < 0.05] was correlated strongly with sarcopenia. A non-linear relationship (U-shaped) between sarcopenia risk and sleep duration was found (p for non-linear = 0.009).

Conclusions

Our findings highlight the importance of sleep duration in the onset of sarcopenia and might assist older persons to maintain good sleeping habits.

Sleep Health and Falls Risk for Older Adults Living in Residential Aged Care and in Community Dwelling Settings: A Longitudinal Observation Study

This study explored measures of subjective and objective sleep health and the association with fall occurrence and falls risk for older adults. A longitudinal observational study was conducted with participants in residential aged care (n = 36) and community dwelling (n = 35) settings. At baseline, objective sleep data involved wearing wrist worn accelerometers and measuring falls risk by walking using the Quantitative timed up and go (QTUG) of a simple, cognitive, and motor task. Subjective sleep data was collected by completing sleep diaries using the Karolinska Sleepiness Scale and sleep quality scale, respectively. Longitudinal falls data were collected at baseline, 3, 6, and 9 months. Falls risk was calculated via QTUG. Responses to a fall questionnaire were used to quantify fall occurrence. Independent samples t-test examined differences in objective and subjective sleep variables between settings. Logistic regression explored whether objective or subjective sleep variables could predict an overall fall occurrence. Linear regression determined if a particular sleep variable could predict an overall falls risk. Multiple regression determined if sleep variables could predict falls risk. No significant differences were found between residential and community-dwelling adults in subjective or objective sleep measures. Logistic regression showed no significant associations between most sleep variables and falls risk, except for average awakening length, where each additional minute was associated with a 1.8% increase in fall likelihood (OR = 1.02, 95% CI [1.00-1.03], P = .037). Conversely, higher awakening frequency was associated with reduced falls risk in the simple timed up-and-go task (R² = .21, β = -.69, P = .009, 95% CI [-1.20 to -0.18]). Findings suggest no significant differences in sleep health or falls risk between residential and community-dwelling older adults, though specific sleep disruptions showed minor associations with falls risk.

Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID

STUDY OBJECTIVES

Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration.

METHODS

Using data from 13,461 respondents from 16 countries who participated in the 2021 survey-based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID.

RESULTS

Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average-length sleepers without pre-existing conditions.

CONCLUSIONS

Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients.

CITATION

Berezin L, Waseem R, Merikanto I, et al. Habitual short sleepers with pre-existing medical conditions are at higher risk of long COVID. J Clin Sleep Med. 2024;20(1):111-119.

Sleep-wake state discrepancy among cancer survivors with insomnia symptoms

PURPOSE

To evaluate the discrepancy and correlation between sleep-wake measures (i.e., time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%)) reported on sleep diary and measured by actigraphy among cancer survivors with insomnia symptoms; and examine the influences of sociodemographic and clinical variables on these measurement differences.

METHODS

A heterogenous sample of cancer survivors with insomnia symptoms (n = 120; M age = 63.7 ± 10.1; female = 58.3%) was included. Seven consecutive days of sleep diary and actigraphic data were obtained along with information on demographic, sleep, and mental health symptoms. Bland-Altman plot, Pearson correlation coefficient, concordance correlation coefficient, and mixed linear model approach were used to conduct the analysis.

RESULTS

Self-reported TIB, SOL, and WASO were longer than measured by actigraphy (TIB: 8.6 min. (95% CI, 3.7, 13.5; p < .001); SOL: 14.8 min. (95% CI, 9.4, 20.2; p < .0001); and WASO: 20.7 min. (95% CI, 9.4, 20.2; p < .0001), respectively); and self-reported TST and SE% were shorter than measured by actigraphy (TST: 6.8 min. (95% CI, -18.7, 5.13); and SE%: 0.7% (95%CI, -3.0, 2.0), respectively), but were not statistically significant. Sex, higher insomnia severity, and poor sleep quality were associated with discrepancy between several sleep-wake measures.

CONCLUSION

Subjective and objective sleep-wake measures may present discrepant finding among cancer survivors with symptoms of insomnia. Future research is needed to validate appropriate sleep-wake assessment, and better understand factors that influence the discrepancy that exists between measures among this population.

CLINICAL TRIAL REGISTRATION

Clinical trials identifier: NCT03810365. Date of registration: January 14, 2019.

Association between dietary pattern and insomnia symptoms among independent older adults: A cross-sectional study based on JAGES

BACKGROUND

Poor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults.

METHODS

This cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders.

RESULTS

Among 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05).

CONCLUSION

Our results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

US Veterans Show Improvements in Subjective but Not Objective Sleep following Treatment for Posttraumatic Stress Disorder: Secondary Analyses from a Randomised Controlled Trial

Background

Sleep disturbances are a prominent feature of posttraumatic stress disorder (PTSD), and poorer sleep quality is associated with higher PTSD severity. This highlights the importance of monitoring sleep outcomes alongside PTSD symptoms in treatments targeting PTSD. Yet few studies monitor both sleep and PTSD outcomes, unless sleep is the primary treatment target. Furthermore, inconsistencies remain about the effects of first-line, evidence-based PTSD treatments on sleep.

Methods

Here, we explored changes in sleep in secondary analyses from a randomised controlled trial that originally assessed the noninferiority of a breathing-based yoga practice (Sudarshan kriya yoga; SKY) to a first-line PTSD treatment (cognitive processing therapy (CPT)) for clinically significant PTSD symptoms among US veterans (intent-to-treat N = 85; per protocol N = 59). Sleep was assessed via subjective (self-reported sleep diary), PTSD symptom severity items (self-reported and clinician-administered insomnia/nightmare sleep items), and objective (wrist actigraphy) measures.

Results

Following treatment, subjective sleep diary measures of quality, latency, and wake duration showed small effect size (d = .24 - .39) improvements, with no significant differences between treatment groups. Significant improvements were also observed in PTSD sleep symptoms, though CPT (d = .34) more reliably reduced nightmares while SKY (d = .44-.45) more reliably reduced insomnia. In contrast, there were no significant treatment-related effects for any of the actigraphy-measured sleep indices.

Conclusions

To our knowledge, this is the first study to investigate sleep as an outcome of CPT or SKY for PTSD, across a combination of subjective diary, PTSD symptom severity, and objective actigraphic measures. Findings lend support to a growing body of evidence that trauma-focused psychotherapy for PTSD improves sleep and suggest that yoga-based interventions may also be beneficial for sleep among individuals with emotional or mental health disorders like PTSD. This trial is registered with NCT02366403.

Self-Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation

Sleep disturbances are common and may impact fracture risk directly by influencing bone turnover or indirectly through shared risk factors or mediators. To investigate the association between self-reported sleep disturbances across the menopausal transition (MT) and fractures, we prospectively studied 3101 women enrolled in the Study of Women's Health Across the Nation (SWAN). At each of 14 study visits spaced approximately 18 months apart, a standardized validated scale ascertained trouble falling asleep, waking up several times during the night, and waking up earlier than planned. Two time-varying exposures were modeled: presence of any of the three disturbances at least three times per week and waking up several times during the night at least three times per week. Base models adjusted for fixed (race/ethnicity, study site) and time-varying characteristics (age, body mass index, and MT stage). Fully adjusted models also included time-varying bone beneficial and detrimental medications, smoking, alcohol, physical activity, diabetes, depression and sleep medications, and depressive symptoms. Women who experienced a fracture were more likely to report a greater frequency of having trouble falling asleep, waking up several times, and/or waking up earlier: 35% versus 30% at baseline, p = 0.02. In the base models, women who had any of the three sleep disturbances at least three times per week had a higher risk of any fracture, odds ratio (OR) = 1.23 (95% confidence intervals, 1.02, 1.48) and nontraumatic fracture, OR = 1.36 (1.03, 1.80). These associations were largely attenuated to nonsignificance in the fully adjusted model. Sensitivity analyses limiting our sample to 2315 SWAN women enrolled in the bone mineral density (BMD) centers yielded similar results. Additional adjustment for femoral neck BMD had no effect on our results. In conclusion, self-reported sleep disturbances were associated with an increased risk of fractures, but these associations likely reflect shared risk factors or factors in the causal pathway. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Lifestyle-related risk factors and their cumulative associations with hippocampal and total grey matter volume across the adult lifespan: A pooled analysis in the European Lifebrain consortium

BACKGROUND

Lifestyle-related risk factors, such as obesity, physical inactivity, short sleep, smoking and alcohol use, have been associated with low hippocampal and total grey matter volumes (GMV). However, these risk factors have mostly been assessed as separate factors, leaving it unknown if variance explained by these factors is overlapping or additive. We investigated associations of five lifestyle-related factors separately and cumulatively with hippocampal and total GMV, pooled across eight European cohorts.

METHODS

We included 3838 participants aged 18-90 years from eight cohorts of the European Lifebrain consortium. Using individual person data, we performed cross-sectional meta-analyses on associations of presence of lifestyle-related risk factors separately (overweight/obesity, physical inactivity, short sleep, smoking, high alcohol use) as well as a cumulative unhealthy lifestyle score (counting the number of present lifestyle-related risk factors) with FreeSurfer-derived hippocampal volume and total GMV. Lifestyle-related risk factors were defined according to public health guidelines.

RESULTS

High alcohol use was associated with lower hippocampal volume (r = -0.10, p = 0.021), and overweight/obesity with lower total GMV (r = -0.09, p = 0.001). Other lifestyle-related risk factors were not significantly associated with hippocampal volume or GMV. The cumulative unhealthy lifestyle score was negatively associated with total GMV (r = -0.08, p = 0.001), but not hippocampal volume (r = -0.01, p = 0.625).

CONCLUSIONS

This large pooled study confirmed the negative association of some lifestyle-related risk factors with hippocampal volume and GMV, although with small effect sizes. Lifestyle factors should not be seen in isolation as there is evidence that having multiple unhealthy lifestyle factors is associated with a linear reduction in overall brain volume.

Lifestyle factors that affect cognitive function-a longitudinal objective analysis

Background

Identifying lifestyle factors associated with cognitive decline has critical clinical and public health implications for dementia prevention in later life. The longitudinal associations of sleep and physical activity with cognitive function remain unclear. This study examined whether objectively measured sleep and physical activity were longitudinally associated with cognitive function in older adults over a three-year period.

Methods

This prospective cohort study enrolled 855 community-dwelling adults aged 65 and older, who were followed from 2015 to 2019. All participants were required to wear a wearable sensor for 7 consecutive days every 3 months and had annual cognitive assessments. Wearable sensor data (August 2015-September 2019) and Mini-Mental State Examination (MMSE) scores (August 2015-April 2019) were collected over 3 years of follow-up. First, principal component analysis was conducted to reduce the dimensions of the sleep and physical activity variables to two principal components for inclusion in a mixed-effects model. The sleep index consisted of sleep efficiency, time awake after sleep onset, and waking frequency. The physical activity index was composed of walking comprised steps per day and time devoted to light or moderate-to-vigorous physical activity. A higher sleep index indicated poor sleep quality, whereas a lower physical activity index indicated less physical activity. Second, a linear mixed effect model was used to examine the longitudinal association of sleep and physical activity indices with cognitive decline over time.

Results

In total, 855 adults were recruited for this study at baseline. Of these, 729 adults (85.3%) completed a measurement of lifestyle factors and an annual cognitive testing, whereas 126 were excluded because of death or loss during follow-up. After adjusting for age, sex, education level, and time, the sleep index was inversely associated with MMSE scores (estimate, -0.06229; standard error, 0.02202; p = 0.0047) and the physical activity index was positively associated with MMSE scores (estimate, 0.06699; standard error, 0.03343; p = 0.0453).

Conclusion

Poor sleep quality and lower physical activity were significant risk factors for subsequent cognitive decline in older adults. The present study facilitates the development of novel evidence-based interventions for physical activity and sleep quality to delay cognitive decline.

Insomnia with objective short sleep duration in community-living older persons: A multifactorial geriatric health condition

BACKGROUND

Insomnia or poor sleep quality with objective short sleep duration (hereafter referred to as ISSD) has been identified as a high-risk phenotype among middle-aged persons. We evaluated the prevalence and clinical correlates of ISSD among community-living older persons.

METHODS

In 3053 men from the Osteoporotic Fractures in Men Sleep Study (MrOS; average age 76.4 ± 5.5 years) and 3044 women from the Study of Osteoporotic Fractures (SOF; average age 83.6 ± 3.8 years), we evaluated the prevalence of ISSD (trouble getting to sleep within 30 minutes, waking up in the middle of the night or early morning, and/or taking a medication to help with sleep ≥3 times per week and actigraphy-estimated sleep duration <6 h). Using separate logistic regression models in men and women, we evaluated the cross-sectional associations between predisposing, precipitating, and perpetuating factors for ISSD, as compared with normal sleep (no insomnia and actigraphy-estimated sleep duration of 6-9 h).

RESULTS

Overall, 20.6% of older men and 12.8% of older women had insomnia with short sleep duration. Multiple predisposing, precipitating, and perpetuating factors were cross-sectionally associated with ISSD in both men and women. In multivariable models that adjusted for predisposing factors (demographics, multimorbidity, obesity), precipitating (depression, anxiety, central nervous system-active medication use, restless legs syndrome) and perpetuating (napping, falls) factors were significantly associated with ISSD in men and women (adjusted odds ratios ranging 1.63-4.57).

CONCLUSIONS

In this cross-sectional study of community-living older men and women, ISSD was common and associated with multiple predisposing, precipitating, and perpetuating factors, akin to a multifactorial geriatric health condition. Future work should examine causal pathways and determine whether the identified correlates represent modifiable risk factors.

The links between sleep duration, obesity and type 2 diabetes mellitus

Global rates of obesity and type 2 diabetes mellitus (T2DM) are increasing globally concomitant with a rising prevalence of sleep deprivation and sleep disorders. Understanding the links between sleep, obesity and T2DM might offer an opportunity to develop better prevention and treatment strategies for these epidemics. Experimental studies have shown that sleep restriction is associated with changes in energy homeostasis, insulin resistance and β-cell function. Epidemiological cohort studies established short sleep duration as a risk factor for developing obesity and T2DM. In addition, small studies suggested that short sleep duration was associated with less weight loss following lifestyle interventions or bariatric surgery. In this article, we review the epidemiological evidence linking sleep duration to obesity and T2DM and plausible mechanisms. In addition, we review the impact of changes in sleep duration on obesity and T2DM.

Objectively Measured Sleep Characteristics and Incidence of Ischemic Stroke: The Sleep Heart Health Study

OBJECTIVE

Sleep disorders are associated with the prevalence of stroke. However, there is limited evidence regarding the association between objectively measured sleep characteristics and ischemic stroke.

METHODS

Ischemic stroke was assessed during the mean follow-up period of 11 years in the Sleep Heart Health Study. Sleep parameters such as wake after sleep onset (WASO) and sleep efficiency (SE) were objectively measured based on in-home polysomnography records. Multivariable Cox regression analysis was utilized to examine the relationship between objective sleep characteristics and ischemic stroke incidence.

RESULTS

This study involved 4204 participants (1978 males and 2226 females, 63.8±11.1 years). The incidence of ischemic stroke increased in individuals with long WASO, poor SE, and short sleep duration. Multivariable Cox regression analysis showed that WASO within the fourth quartile (hazard ratio [HR] 3.771, 95% confidence interval [CI] 1.805-7.877, P<0.001), third quartile (HR 3.009, 95% CI 1.433-6.317, P=0.004), and second quartile (HR 3.108, 95% CI 1.470-6.568, P=0.003) had a higher incidence of ischemic stroke than WASO within the first quartile. Poor SE (<80.0%) was also found to be a predictor for ischemic stroke (HR 2.220, 95% CI 1.244-3.960, P=0.007). Additionally, a short sleep duration (<6 h) was associated with an increased risk of ischemic stroke (HR 1.725, 95% CI 1.026-2.899, P=0.040).

CONCLUSION

Our results revealed a relationship between WASO, SE, and sleep duration and ischemic stroke. Therefore, these sleep characteristics may be adequate predictors for the incidence of ischemic stroke.