The Sleep/Wake Cycle is Directly Modulated by Changes in Energy Balance

Translational potential of mouse models of human metabolic disease

Obesity causes significant morbidity and mortality globally. Research in the last three decades has delivered a step-change in our understanding of the fundamental mechanisms that regulate energy homeostasis, building on foundational discoveries in mouse models of metabolic disease. However, not all findings made in rodents have translated to humans, hampering drug discovery in this field. Here, we review how studies in mice and humans have informed our current framework for understanding energy homeostasis, discuss their challenges and limitations, and offer a perspective on how human studies may play an increasingly important role in the discovery of disease mechanisms and identification of therapeutic targets in the future.

Chrononutrition in the context of Ramadan: Potential implications

Every year, healthy adult Muslims practice dawn to sunset fasting for a whole lunar month. No food or fluid is allowed for the fasting time window. After sunset, eating is allowed. The dramatic change in the timing of meals is accompanied by changes in sleeping hours and thus alterations in circadian rhythms. Hormonal mechanisms mainly determined by the latter also change. These include shifts in cortisol and melatonin. Food-dependent hormones such as Ghrelin and leptin also show changes. A well-established principle of chrononutrition is that the timing of eating may be as or more important than the content of food. Ramadan fasting (RF) is distinct from other forms of intermittent fasting, although there are also some similarities with time restricted eating (TRE). Both have been shown to have health benefits. Here, we examine existing literature to understand and learn from this very commonly practiced form of fasting and its relationships to circadian rhythms and homoeostatic mechanisms.

Sleep-wake patterns are altered with age, Prdm13 signaling in the DMH, and diet restriction in mice

Old animals display significant alterations in sleep-wake patterns such as increases in sleep fragmentation and sleep propensity. Here, we demonstrated that PR-domain containing protein 13 (Prdm13)+ neurons in the dorsomedial hypothalamus (DMH) are activated during sleep deprivation (SD) in young mice but not in old mice. Chemogenetic inhibition of Prdm13+ neurons in the DMH in young mice promotes increase in sleep attempts during SD, suggesting its involvement in sleep control. Furthermore, DMH-specific Prdm13-knockout (DMH-Prdm13-KO) mice recapitulated age-associated sleep alterations such as sleep fragmentation and increased sleep attempts during SD. These phenotypes were further exacerbated during aging, with increased adiposity and decreased physical activity, resulting in shortened lifespan. Dietary restriction (DR), a well-known anti-aging intervention in diverse organisms, ameliorated age-associated sleep fragmentation and increased sleep attempts during SD, whereas these effects of DR were abrogated in DMH-Prdm13-KO mice. Moreover, overexpression of Prdm13 in the DMH ameliorated increased sleep attempts during SD in old mice. Therefore, maintaining Prdm13 signaling in the DMH might play an important role to control sleep-wake patterns during aging.

Paying the brain's energy bill

How have animals managed to maintain metabolically expensive brains given the volatile and fleeting availability of calories in the natural world? Here we review studies in support of three strategies that involve: 1) a reallocation of energy from peripheral tissues and functions to cover the costs of the brain, 2) an implementation of energy-efficient neural coding, enabling the brain to operate at reduced energy costs, and 3) efficient use of costly neural resources during food scarcity. Collectively, these studies reveal a heterogeneous set of energy-saving mechanisms that make energy-costly brains fit for survival.

LKB1 Is Physiologically Required for Sleep from Drosophila melanogaster to the Mus musculus

Liver Kinase B1 (LKB1) is known as a master kinase for 14 kinases related to the adenosine monophosphate (AMP)-activated protein kinase (AMPK). Two of them salt inducible kinase 3 (SIK3) and AMPKα have previously been implicated in sleep regulation. We generated loss-of-function (LOF) mutants for Lkb1 in both Drosophila and mice. Sleep, but not circadian rhythms, was reduced in Lkb1-mutant flies and in flies with neuronal deletion of Lkb1. Genetic interactions between Lkb1 and Threonine to Alanine mutation at residue 184 of AMPK in Drosophila sleep or those between Lkb1 and Threonine to Glutamic Acid mutation at residue 196 of SIK3 in Drosophila viability have been observed. Sleep was reduced in mice after virally mediated reduction of Lkb1 in the brain. Electroencephalography (EEG) analysis showed that non-rapid eye movement (NREM) sleep and sleep need were both reduced in Lkb1-mutant mice. These results indicate that LKB1 plays a physiological role in sleep regulation conserved from flies to mice.

Satiety Associated with Calorie Restriction and Time-Restricted Feeding: Central Neuroendocrine Integration

This review focuses on summarizing current knowledge on how time-restricted feeding (TRF) and continuous caloric restriction (CR) affect central neuroendocrine systems involved in regulating satiety. Several interconnected regions of the hypothalamus, brainstem, and cortical areas of the brain are involved in the regulation of satiety. Following CR and TRF, the increase in hunger and reduction in satiety signals of the melanocortin system [neuropeptide Y (NPY), proopiomelanocortin (POMC), and agouti-related peptide (AgRP)] appear similar between CR and TRF protocols, as do the dopaminergic responses in the mesocorticolimbic circuit. However, ghrelin and leptin signaling via the melanocortin system appears to improve energy balance signals and reduce hyperphagia following TRF, which has not been reported in CR. In addition to satiety systems, CR and TRF also influence circadian rhythms. CR influences the suprachiasmatic nucleus (SCN) or the primary circadian clock as seen by increased clock gene expression. In contrast, TRF appears to affect both the SCN and the peripheral clocks, as seen by phasic changes in the non-SCN (potentially the elusive food entrainable oscillator) and metabolic clocks. The peripheral clocks are influenced by the primary circadian clock but are also entrained by food timing, sleep timing, and other lifestyle parameters, which can supersede the metabolic processes that are regulated by the primary circadian clock. Taken together, TRF influences hunger/satiety, energy balance systems, and circadian rhythms, suggesting a role for adherence to CR in the long run if implemented using the TRF approach. However, these suggestions are based on only a few studies, and future investigations that use standardized protocols for the evaluation of the effect of these diet patterns (time, duration, meal composition, sufficiently powered) are necessary to verify these preliminary observations.

The Effects of Shift Work on Cardio-Metabolic Diseases and Eating Patterns

Energy metabolism is tightly linked with circadian rhythms, exposure to ambient light, sleep/wake, fasting/eating, and rest/activity cycles. External factors, such as shift work, lead to a disruption of these rhythms, often called circadian misalignment. Circadian misalignment has an impact on some physiological markers. However, these proxy measurements do not immediately translate into major clinical health outcomes, as shown by later detrimental health effects of shift work and cardio-metabolic disorders. This review focuses on the effects of shift work on circadian rhythms and its implications in cardio-metabolic disorders and eating patterns. Shift work appears to be a risk factor of overweight, obesity, type 2 diabetes, elevated blood pressure, and the metabolic syndrome. However, past studies showed discordant findings regarding the changes of lipid profile and eating patterns. Most studies were either small and short lab studies, or bigger and longer cohort studies, which could not measure health outcomes in a detailed manner. These two designs explain the heterogeneity of shift schedules, occupations, sample size, and methods across studies. Given the burden of non-communicable diseases and the growing concerns about shift workers' health, novel approaches to study shift work in real contexts are needed and would allow a better understanding of the interlocked risk factors and potential mechanisms involved in the onset of metabolic disorders.

The therapeutic properties of ketogenic diets, slow-wave sleep, and circadian synchrony

PURPOSE OF REVIEW

To summarize emerging connections between sleep, ketogenic diets, and health.

RECENT FINDINGS

Mechanisms involved in the therapeutic benefits of ketogenic diets continue to be elucidated. Concurrently, the importance of sleep quality and circadian rhythms in their effects on metabolic and cognitive health is increasingly appreciated. Advances in the understanding of the actions of adenosine, nicotinamide adenine dinucleotide, and slow-wave sleep underscore connections between these areas of research.

SUMMARY

Many molecular pathways activated during ketogenic diets are known to modulate sleep-wake cycles, circadian rhythms, and sleep stages. Ketogenic diets often have beneficial effects on sleep at the same time as having beneficial effects on particular medical conditions. Enhancement of slow-wave sleep and rejuvenation of circadian programming may be synergistic with or causally involved in the benefits of ketogenic diets.

Time-Restricted Eating and Metabolic Syndrome: Current Status and Future Perspectives

Metabolic syndrome (MetS) occurs in ~30% of adults and is associated with increased risk of cardiovascular disease and diabetes mellitus. MetS reflects the clustering of individual cardiometabolic risk factors including central obesity, elevated fasting plasma glucose, dyslipidemia, and elevated blood pressure. Erratic eating patterns such as eating over a prolonged period per day and irregular meal timing are common in patients with MetS. Misalignment between daily rhythms of food intake and circadian timing system can contribute to circadian rhythm disruption which results in abnormal metabolic regulation and adversely impacts cardiometabolic health. Novel approaches which aim at restoring robust circadian rhythms through modification of timing and duration of daily eating represent a promising strategy for patients with MetS. Restricting eating period during a day (time-restricted eating, TRE) can aid in mitigating circadian disruption and improving cardiometabolic outcomes. Previous pilot TRE study of patients with MetS showed the feasibility of TRE and improvements in body weight and fat, abdominal obesity, atherogenic lipids, and blood pressure, which were observed despite no overt attempt to change diet quantity and quality or physical activity. The present article aims at giving an overview of TRE human studies of individuals with MetS or its components, summarizing current clinical evidence for improving cardiometabolic health through TRE intervention in these populations, and presenting future perspectives for an implementation of TRE to treat and prevent MetS. Previous TRE trials laid the groundwork and indicate a need for further clinical research including large-scale controlled trials to determine TRE efficacy for reducing long-term cardiometabolic risk, providing tools for sustained lifestyle changes and, ultimately, improving overall health in individuals with MetS.

Shorter Sleep Predicts Longer Subsequent Day Sedentary Duration in Healthy Midlife Adults, but Not in Those with Sleep Apnea

PURPOSE

Sedentary behavior and suboptimal sleep increase risks for chronic diseases. We hypothesized that sedentary behavior and sleep affect each other and that an underlying sleep disorder would alter these relationships. To test these hypotheses, we studied the bidirectional relationships between sedentary behavior and sleep (duration and efficiency) in healthy controls (HC) and people with untreated obstructive sleep apnea (OSA).

PATIENTS AND METHODS

Fifty-two volunteers (18 HC, 19 mild OSA [apnea/hypopnea index [AHI] range 5-14.9/hour], 15 moderate OSA [AHI range 15-29.9/hour]) were studied with actigraphy and sleep diaries across ~9 consecutive nights of self-selected consistent ~8-hour sleep episodes at home (range 4-21/nights per person). We analyzed whether total time asleep and sleep efficiency affected the subsequent daytime sedentary duration while controlling for body mass index and whether the severity of OSA altered this relationship. We also tested the reverse relationship, namely whether daytime sedentary duration affected the subsequent night's sleep and if any such relationship differed with OSA severity.

RESULTS

Overnight sleep duration and efficiency negatively predicted the subsequent day's sedentary duration in HC (p<0.02), but not in people with mild or moderate OSA (p>0.05). There was no significant reverse relationship between daytime sedentary duration and the subsequent night's sleep duration or efficiency (p≥0.2).

CONCLUSION

In healthy adults, short nighttime sleep predicts a longer duration of sedentary behavior on a subsequent day, but we did not observe this relationship in people with OSA. The mechanisms underlying this association in healthy individuals and its disruption in the presence of OSA need to be studied.

Diet and sleep health: a scoping review of intervention studies in adults

BACKGROUND

Recent research has demonstrated an association between dietary intake and sleep health that can influence chronic disease risk factors. A scoping review of research studies investigating dietary intake and sleep was undertaken to determine the extent and scope of research in laboratory-based, free-living and mixed settings. Additionally, this review determines how well subpopulations and geographical locations are represented and the methodologies used to assess outcome measures.

METHODS

Five online databases were used to identify papers published between 1970 and 2017. Included studies were those conducted in adults and reported both outcomes of interest: (i) sleep health, including sleep restriction and sleep hygiene and (ii) dietary outcomes, including altered nutrients, dietary patterns and supplements.

RESULTS

In total, 129 publications were included with the majority being dietary interventions investigating sleep outcomes (n = 109) with fewer being sleep interventions investigating and reporting dietary outcomes (n = 20). Dietary interventions were most often carried out in free-living environments, in contrast to sleep interventions that were most often carried out in laboratory-based environments. The majority of dietary interventions investigated use of a supplement (n = 66 studies), which was predominantly caffeine (n = 49). Sleep interventions investigated sleep duration only, with the majority (n = 17) investigating the effect of partial sleep restriction under 5.5 h per night on dietary intake, while three studies investigating total sleep deprivation.

CONCLUSIONS

Investigating broader aspects of dietary such as overall diet quality and dietary patterns and other components of sleep health such as quality,  timing and sleep hygiene are important aspects for future research.

Association between sleep-wake habits and use of health care services of middle-aged and elderly adults in China

OBJECTIVE

To examine the relationship between sleep-wake habits and the use of health care services.

RESULTS

The proportions of the participants who were "early to bed" and "late to bed" were 48.7% and 51.3%, respectively. In the full sample, compared with those who were early to bed and early to rise, participants who went to bed late were more likely to report physician visits (late to bed and early to rise: OR = 1.13, 95% CI: 1.08-1.19, late to bed and late to rise: OR = 1.27, 95% CI: 1.18-1.38, respectively). We found no significant association between sleep-wake habits and the number of hospitalization.

CONCLUSIONS

Those middle-aged and elderly people who stayed up late and got up late are more likely to visit the doctors than those who went to bed early and got up early.

METHODS

We obtained data from a cohort study of retired employees in China, and 36,601 (95.59%) involved in the present study. The participants were allocated into 4 sleep-wake habits groups: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Early-rise, and Late-bed/Late-rise. We explored the association between sleep-wake habits with the number of physician visits and hospitalizations.

Intensifying sleep slow oscillations does not improve metabolic control in healthy men

Impaired sleep quality and sleep loss compromise glucose homeostasis and metabolic function, but the mechanisms linking sleep and metabolic health are largely unclear. In order to gain insight into the relevance of specific electrophysiological sleep characteristics for metabolic control, we assessed the acute effect on glucose homeostasis as well as energy intake and expenditure of enhancing slow oscillatory activity, a hallmark of slow-wave sleep, by closed-loop auditory stimulation in healthy men. Twenty-two young, normal-weight men underwent an oral glucose tolerance test (oGTT), indirect calorimetry and the assessment of ad-libitum breakfast intake in the morning after nocturnal sleep with or without auditory stimulation in phase with the ongoing rhythmic occurrence of slow oscillation up-states during 210 min of slow-wave sleep in the first night-half. Stimulation vs. no stimulation strongly increased slow oscillatory activity without changing overall sleep structure, but did not alter fasting or oGTT-stimulated measures of glucose homeostasis. Food intake and energy expenditure were likewise comparable between conditions. Findings indicate that in healthy humans electrophysiological sleep quality is tuned to allow for optimal metabolic control. Future studies should investigate the potential of sleep stage-specific interventions to enhance metabolic control and well-being in patients with metabolic ailments.

Sleep and Metabolism: Eaat-ing Your Way to ZZZs

A new study in fruit flies identifies a molecule, Eaat2, that regulates both sleep and metabolic rate. Surprisingly, Eaat2 acts in a specific glial subtype to modulate both processes, suggesting a cellular link in the brain between sleep and metabolism.

A Metabolomic Signature of Acute Caloric Restriction

CONTEXT

The experimental paradigm of acute caloric restriction (CR) followed by refeeding (RF) can be used to study the homeostatic mechanisms that regulate energy homeostasis, which are relevant to understanding the adaptive response to weight loss.

OBJECTIVE

Metabolomics, the measurement of hundreds of small molecule metabolites, their precursors, derivatives, and degradation products, has emerged as a useful tool for the study of physiology and disease and was used here to study the metabolic response to acute CR.

PARTICIPANTS, DESIGN, AND SETTING

We used four ultra high-performance liquid chromatography-tandem mass spectrometry methods to characterize changes in carbohydrates, lipids, amino acids, and steroids in eight normal weight men at baseline, after 48 hours of CR (10% of energy requirements) and after 48 hours of ad libitum RF in a tightly controlled environment.

RESULTS

We identified a distinct metabolomic signature associated with acute CR characterized by the expected switch from carbohydrate to fat utilization with increased lipolysis and β-fatty acid oxidation. We found an increase in ω-fatty acid oxidation and levels of endocannabinoids, which are known to promote food intake. These changes were reversed with RF. Several plasmalogen phosphatidylethanolamines (endogenous antioxidants) significantly decreased with CR (all P ≤ 0.0007). Additionally, acute CR was associated with an increase in the branched chain amino acids (all P ≤ 1.4 × 10-7) and dehydroepiandrosterone sulfate (P = 0.0006).

CONCLUSIONS

We identified a distinct metabolomic signature associated with acute CR. Further studies are needed to characterize the mechanisms that mediate these changes and their potential contribution to the adaptive response to dietary restriction.

Molecular Mechanisms of Sleep Homeostasis in Flies and Mammals

Sleep is homeostatically regulated with sleep pressure accumulating with the increasing duration of prior wakefulness. Yet, a clear understanding of the molecular components of the homeostat, as well as the molecular and cellular processes they sense and control to regulate sleep intensity and duration, remain a mystery. Here, we will discuss the cellular and molecular basis of sleep homeostasis, first focusing on the best homeostatic sleep marker in vertebrates, slow wave activity; second, moving to the molecular genetic analysis of sleep homeostasis in the fruit fly Drosophila; and, finally, discussing more systemic aspects of sleep homeostasis.

Role of the Orexin System on the Hypothalamus-Pituitary-Thyroid Axis

Hypocretin/orexin (ORX) are two hypothalamic neuropeptides discovered in 1998. Since their discovery, they have been one of the most studied neuropeptide systems because of their projecting fields innervating various brain areas. The orexinergic system is tied to sleep-wakefulness cycle, and narcolepsy is a consequence of their system hypofunction. Orexinergic system is also involved in many other autonomic functions such as feeding, thermoregulation, cardiovascular and neuroendocrine regulation. The main aim of this mini review article is to investigate the relationship between ORX and thyroid system regulation. Although knowledge about the ORX system is evolving, its putative effects on hypothalamic-pituitary-thyroid (HPT) axis still appear unclear. We analyzed some studies about ORX control of HPT axis to know better the relationship between them. The studies that were analyzed suggest Hypocretin/ORX to modulate the thyroid regulation, but the nature (excitatory or inhibitory) of this possible interaction remains actually unclear and needs to be confirmed.