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Solelhac G, Sánchez-de-la-Torre M, Blanchard M, Berger M, Hirotsu C, Imler T, Sánchez-de-la-Torre A, Haba-Rubio J, Marchi NA, Bayon V, Bailly S, Goupil F, Waeber A, Heiniger G, Pigeanne T, Gracia-Lavedan E, Zapater A, Abad J, Ordax E, Masdeu MJ, Cabriada-Nuño V, Egea C, Van Den Broecke S, Vollenweider P, Marques-Vidal P, Vaucher J, Bernardi G, Betta M, Siclari F, Barbé F, Gagnadoux F, Heinzer R. Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2023; 207:1620-1632. [PMID: 37017487 PMCID: PMC10273112 DOI: 10.1164/rccm.202206-1223oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/04/2023] [Indexed: 04/06/2023] Open
Abstract
Rationale: It is currently unclear which patients with obstructive sleep apnea (OSA) are at increased cardiovascular risk. Objective: To investigate the value of pulse wave amplitude drops (PWADs), reflecting sympathetic activations and vasoreactivity, as a biomarker of cardiovascular risk in OSA. Methods: PWADs were derived from pulse oximetry-based photoplethysmography signals in three prospective cohorts: HypnoLaus (N = 1,941), the Pays-de-la-Loire Sleep Cohort (PLSC; N = 6,367), and "Impact of Sleep Apnea syndrome in the evolution of Acute Coronary syndrome. Effect of intervention with CPAP" (ISAACC) (N = 692). The PWAD index was the number of PWADs (>30%) per hour during sleep. All participants were divided into subgroups according to the presence or absence of OSA (defined as ⩾15 or more events per hour or <15/h, respectively, on the apnea-hypopnea index) and the median PWAD index. Primary outcome was the incidence of composite cardiovascular events. Measurements and Main Results: Using Cox models adjusted for cardiovascular risk factors (hazard ratio; HR [95% confidence interval]), patients with a low PWAD index and OSA had a higher incidence of cardiovascular events compared with the high-PWAD and OSA group and those without OSA in the HypnoLaus cohort (HR, 2.16 [1.07-4.34], P = 0.031; and 2.35 [1.12-4.93], P = 0.024) and in the PLSC (1.36 [1.13-1.63], P = 0.001; and 1.44 [1.06-1.94], P = 0.019), respectively. In the ISAACC cohort, the low-PWAD and OSA untreated group had a higher cardiovascular event recurrence rate than that of the no-OSA group (2.03 [1.08-3.81], P = 0.028). In the PLSC and HypnoLaus cohorts, every increase of 10 events per hour in the continuous PWAD index was negatively associated with incident cardiovascular events exclusively in patients with OSA (HR, 0.85 [0.73-0.99], P = 0.031; and HR, 0.91 [0.86-0.96], P < 0.001, respectively). This association was not significant in the no-OSA group and the ISAACC cohort. Conclusions: In patients with OSA, a low PWAD index reflecting poor autonomic and vascular reactivity was independently associated with a higher cardiovascular risk.
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Affiliation(s)
| | - Manuel Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Margaux Blanchard
- Ecole Supérieur D’Electronique de l’Ouest, Angers, France
- Laboratoire d’Acoustique de l’Université du Mans, Le Mans, France
| | | | | | - Théo Imler
- Center for Investigation and Research in Sleep
| | - Alicia Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | - Sébastien Bailly
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | | | | | - Thierry Pigeanne
- Unité respiratoire, Pôle santé des Olonnes, Olonne sur Mer, France
| | - Esther Gracia-Lavedan
- Translation Research in Respiratory Medicine, University hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
| | - Andrea Zapater
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Jorge Abad
- Respiratory Department, University hospital Germans Trias I Pujol, Barcelona, Spain
| | - Estrella Ordax
- Respiratory Department, Burgos University hospital, Burgos, Spain
| | - María José Masdeu
- Respiratory Department, University hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Investigación OSI, Araba University hospital, IIS Bioaraba, Vitoria, Spain
| | - Sandra Van Den Broecke
- Center for Investigation and Research in Sleep
- Service de Pneumologie et Centre du Sommeil, Hôpital Neuchâtelois, site de Pourtalès, Neuchâtel, Switzerland
| | | | | | | | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Monica Betta
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Francesca Siclari
- Center for Investigation and Research in Sleep
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Ferran Barbé
- Translation Research in Respiratory Medicine, University hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; and
- INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep
- Pulmonary Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Berger M, Vakulin A, Hirotsu C, Marchi N, Solelhac G, Bayon V, Siclari F, Haba-Rubio J, Vaucher J, Waeber G, Vollenweider P, Marques-Vidal P, Appleton S, Heinzer R. Association of sleep microstructure with incident hypertension in a population-based sample: The HypnoLaus study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Solelhac G, Sánchez-de-la-Torre M, Berger M, Hirotsu C, Marchi N, Waeber A, Gracia-Lavedan E, Zapater A, Bernadi G, Betta M, Marques-Vidal P, Vollenweider P, Vaucher J, Siclari F, Barbé F, Heinzer R. Pulse wave amplitude drops (PWAD) : a new biomarker of cardiovascular risk in patients with obstructive sleep apnea in HypnoLaus and ISAACC cohorts. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Piovezan RD, Yu S, Hirotsu C, Marques-Vidal P, Haba-Rubio J, Tucker G, Adams R, Visvanathan R, Heinzer R. Associations of indicators of sleep impairment and disorders with low muscle strength in middle-aged and older adults: The HypnoLaus cohort study. Maturitas 2022; 164:52-59. [DOI: 10.1016/j.maturitas.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/07/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
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Berger M, Vakulin A, Hirotsu C, Marchi NA, Solelhac G, Bayon V, Siclari F, Haba‐Rubio J, Vaucher J, Vollenweider P, Marques‐Vidal P, Lechat B, Catcheside PG, Eckert DJ, Adams RJ, Appleton S, Heinzer R. Association Between Sleep Microstructure and Incident Hypertension in a Population‐Based Sample: The HypnoLaus Study. J Am Heart Assoc 2022; 11:e025828. [PMID: 35861817 PMCID: PMC9707830 DOI: 10.1161/jaha.121.025828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Poor sleep quality is associated with increased incident hypertension. However, few studies have investigated the impact of objective sleep structure parameters on hypertension. This study investigated the association between sleep macrostructural and microstructural parameters and incident hypertension in a middle‐ to older‐aged sample.
Methods and Results
Participants from the HypnoLaus population‐based cohort without hypertension at baseline were included. Participants had at‐home polysomnography at baseline, allowing assessment of sleep macrostructure (nonrapid eye movement sleep stages 1, 2, and 3; rapid eye movement sleep stages; and total sleep time) and microstructure including power spectral density of electroencephalogram in nonrapid eye movement sleep and spindles characteristics (density, duration, frequency, amplitude) in nonrapid eye movement sleep stage 2. Associations between sleep macrostructure and microstructure parameters at baseline and incident clinical hypertension over a mean follow‐up of 5.2 years were assessed with multiple‐adjusted logistic regression. A total of 1172 participants (42% men; age 55±10 years) were included. Of these, 198 (17%) developed hypertension. After adjustment for confounders, no sleep macrostructure features were associated with incident hypertension. However, low absolute delta and sigma power were significantly associated with incident hypertension where participants in the lowest quartile of delta and sigma had a 1.69‐fold (95% CI, 1.00–2.89) and 1.72‐fold (95% CI, 1.05–2.82) increased risk of incident hypertension, respectively, versus those in the highest quartile. Lower spindle density (odds ratio, 0.87; 95% CI, 0.76–0.99) and amplitude (odds ratio, 0.98; 95% CI, 0.95–1.00) were also associated with higher incident hypertension.
Conclusions
Sleep microstructure is associated with incident hypertension. Slow‐wave activity and sleep spindles, 2 hallmarks of objective sleep continuity and quality, were inversely and consistently associated with incident hypertension. This supports the protective role of sleep continuity in the development of hypertension.
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Affiliation(s)
- Mathieu Berger
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Nicola Andrea Marchi
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Virginie Bayon
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Francesca Siclari
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - José Haba‐Rubio
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Julien Vaucher
- Department of Medicine Internal Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Peter Vollenweider
- Department of Medicine Internal Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Pedro Marques‐Vidal
- Department of Medicine Internal Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Bastien Lechat
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Peter G. Catcheside
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Danny J. Eckert
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Robert J. Adams
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Sarah Appleton
- Flinders Health and Medical Research Institute: Sleep Health/Adelaide Institute for Sleep HealthFlinders UniversityCollege of Medicine and Public Health Adelaide Adelaide SA Australia
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland
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Lechat B, Hirotsu C, Appleton S, Younes M, Adams RJ, Vakulin A, Hansen K, Zajamsek B, Wittert G, Catcheside P, Heinzer R, Eckert DJ. A novel EEG marker predicts perceived sleepiness and poor sleep quality. Sleep 2022; 45:zsac051. [PMID: 35554584 DOI: 10.1093/sleep/zsac051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/16/2022] [Indexed: 09/21/2023] Open
Abstract
STUDY OBJECTIVES To determine if a novel EEG-derived continuous index of sleep depth/alertness, the odds ratio product (ORP), predicts self-reported daytime sleepiness and poor sleep quality in two large population-based cohorts. METHODS ORP values which range from 0 (deep sleep) to 2.5 (fully alert) were calculated in 3s intervals during awake periods (ORPwake) and NREM sleep (ORPNREM) determined from home sleep studies in the HypnoLaus (N = 2162: 1106 females, 1056 males) and men androgen inflammation lifestyle environment and stress (MAILES) cohorts (N = 754 males). Logistic regression was used to examine associations between ORPwake, ORPNREM, and traditional polysomnography measures (as comparators) with excessive sleepiness (Epworth sleepiness scale >10) and poor sleep quality (Pittsburgh sleep quality index >5) and insomnia symptoms. RESULTS High ORPwake was associated with a ~30% increase in poor sleep quality in both HypnoLaus (odds ratio, OR, and 95% CI) 1.28 (1.09, 1.51), and MAILES 1.36 (1.10, 1.68). High ORPwake was also associated with a ~28% decrease in excessive daytime sleepiness in the MAILES dataset. ORPNREM was associated with a ~30% increase in poor sleep quality in HypnoLaus but not in MAILES. No consistent associations across cohorts were detected using traditional polysomnography markers. CONCLUSIONS ORP, a novel EEG-derived metric, measured during wake periods predicts poor sleep quality in two independent cohorts. Consistent with insomnia symptomatology of poor perceived sleep in the absence of excessive daytime sleepiness, ORPwake may provide valuable objective mechanistic insight into physiological hyperarousal.
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Affiliation(s)
- Bastien Lechat
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Appleton
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Robert J Adams
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Kristy Hansen
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Branko Zajamsek
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellness, Adelaide University, Adelaide, SA, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Danny J Eckert
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
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Hirotsu C, Betta M, Bernardi G, Marques-Vidal P, Vollenweider P, Waeber G, Pichot V, Roche F, Siclari F, Haba-Rubio J, Heinzer R. Pulse wave amplitude drops during sleep: clinical significance and characteristics in a general population sample. Sleep 2021; 43:5715731. [PMID: 31978212 PMCID: PMC7355400 DOI: 10.1093/sleep/zsz322] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/06/2019] [Indexed: 11/13/2022] Open
Abstract
Study Objectives To explore the clinical significance of pulse wave amplitude (PWA)-drops during sleep as a biomarker for cardiometabolic disorders and describe their main characteristics in a general population sample. Methods Cross-sectional study of HypnoLaus cohort, in which 2162 individuals underwent clinical assessment and in-home full polysomnography. PWA-drops were derived from photoplethysmography and processed using a validated automated algorithm. Associations between PWA-drop features (index, mean duration, and mean area under the curve [AUC]) with hypertension, diabetes, and previous cardiovascular (CV) event were analyzed using multivariable-adjusted logistic regression. Results Two thousand one hundred forty-nine participants (59 ± 11 years, 51% women, 9.9% diabetes, 41.3% hypertension, 4.4% CV event) were included. Mean ± standard deviation (SD) of PWA-drop index, duration, and AUC during sleep were 51.0 ± 20.3 events/hour, 14.0 ± 2.7 seconds, and 527±115 %seconds, respectively. PWA-drop index was lower in women and decreased with age, while its mean duration and AUC increased in men and elderly. Overall, lower PWA-drop index, longer duration and greater AUC were associated with increased odds of hypertension, diabetes, or CV event after adjustment for confounders. Participants in the lowest quartile of mean duration-normalized PWA-drop index had a significantly higher odds ratio (OR) of hypertension (OR = 1.60 [1.19–2.16]), CV event (OR = 3.26 [1.33–8.03]), and diabetes (OR = 1.71 [1.06–2.76]) compared to those in the highest quartile. Similar results were observed for mean AUC-normalized PWA-drop index regarding hypertension (OR = 1.59 [1.19–2.13]), CV event (OR = 2.45 [1.14–5.26]) and diabetes (OR = 1.76 [1.10–2.83]). Conclusions PWA-drop features during sleep seem to be an interesting biomarker independently associated with cardiometabolic outcomes in the general population.
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Affiliation(s)
- Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vincent Pichot
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Frederic Roche
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed).,Pulmonary Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Albrecht E, Bayon V, Hirotsu C, Heinzer R. Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple-blind trial. Anaesthesia 2020; 76:45-53. [PMID: 33253427 PMCID: PMC7754482 DOI: 10.1111/anae.15236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/23/2022]
Abstract
Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short‐acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple‐blind trial tested the hypothesis that a combination of short‐acting agents (desflurane‐remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane‐fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desflurane‐remifentanil or sevoflurane‐fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea‐hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea‐hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre‐operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoea‐hypopnoea index on the first postoperative night were 18.9 (12.7–25.0) and 21.4 (14.2–28.7) events.h−1, respectively, in the short‐acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8–40.3) and 38.0 (18.3–57.6) events.h−1 (p = 0.34). Secondary sleep‐ and pain‐related outcomes were generally similar in the two groups. In conclusion, short‐acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations.
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Affiliation(s)
- E Albrecht
- Department of Anaesthesia, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - V Bayon
- Center for Investigation and Research in Sleep, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - C Hirotsu
- Center for Investigation and Research in Sleep, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - R Heinzer
- Center for Investigation and Research in Sleep, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. Health-related quality of life in patients with narcolepsy types 1 and 2 from a Sleep Center in Brazil. Arq Neuropsiquiatr 2020; 78:488-493. [PMID: 32627808 DOI: 10.1590/0004-282x20200032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Narcolepsy patients have higher prevalence of comorbidities, such as obesity, depression, and pain. Narcolepsy symptoms and concomitant medical conditions can impact the daily activities of patients. The objective of this study is to describe the quality of life in a sample of patients with narcolepsy, and the influence of the nutritional status in health domains. METHODS At Unifesp, two groups of 33 patients (narcolepsy types 1 and 2 meeting 2014 criteria, concerning hypocretin-1) and 33 controls without sleepiness, matched by age and sex, filled out the SF-36. RESULTS Narcolepsy groups, regardless of their nutritional status, had significantly lower scores in all domains, compared to controls, mainly in Role-physical, Role-emotional, and Energy/Fatigue. Role-physical score was lower in type 1 than in type 2 and controls (37.8±1.0 vs. 50.0±1.2 vs. 85.6±1.6; p<0.0001). Obese with type 2 narcolepsy scored lower than type 1 in physical scales. CONCLUSION In a Sleep Center in São Paulo, Brazil, physical and mental health were impaired in narcolepsy types 1 and 2. The first report of the poor health status in Brazilians with narcolepsy type 2 suggests that obesity negatively affects physical domains.
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Affiliation(s)
- Renata Carvalho Cremaschi
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Camila Hirotsu
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Lausanne University Hospital, Centre d'investigation et de recherche sur le sommeil, Lausanne, Switzerland
| | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
| | - Fernando Morgadinho Coelho
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
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Albrecht E, Hirotsu C, Bayon V, Heinzer R. 0726 Impact Of Anesthetic Agents On Sleep Apnea Severity. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep apnea is associated with negative outcomes after general anesthesia. Current recommendations suggest using short-acting over standard anesthetic agents to reduce this risk, but there is currently no evidence to support this. This randomized controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anesthesia on sleep apnea severity compared with standard agents (sevoflurane-fentanyl).
Methods
Sixty patients undergoing hip arthroplasty under general anesthesia were randomized to anesthesia with desflurane-remifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnea-hypopnea index on the first postoperative night. Secondary outcomes were the supine apnea-hypopnea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3.
Results
Preoperative sleep study data were similar between groups. Mean (95% confidence interval) values for the supine apnea-hypopnea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events/h, respectively, in the short-acting and standard anesthesia groups (p=0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events/h (p=0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups.
Conclusion
Short-acting anesthetic agents did not reduce the impact of general anesthesia on sleep apnea severity compared with standard agents. These data should prompt an update of current recommendations.
Support
SNSF
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Affiliation(s)
- E Albrecht
- Department of Anesthesia, Lausanne University Hospital, Lausanne, SWITZERLAND
| | - C Hirotsu
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, SWITZERLAND
| | - V Bayon
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, SWITZERLAND
| | - R Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, SWITZERLAND
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11
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Berger M, Hirotsu C, Haba-Rubio J, Betta M, Bernardi G, Siclari F, Waeber G, Vollenweider P, Marques-Vidal P, Heinzer R. Risk factors of excessive daytime sleepiness in a prospective population-based cohort. J Sleep Res 2020; 30:e13069. [PMID: 32412149 DOI: 10.1111/jsr.13069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023]
Abstract
Although excessive daytime sleepiness is commonly evaluated in clinical and research settings using the Epworth Sleepiness Scale, few studies have assessed the factors associated with its incidence in the general population. We prospectively investigated the predictors of incident and persistent excessive daytime sleepiness in 2,751 subjects (46.1% men, mean age 56.0 ± 9.8 years) from the CoLaus-PsyCoLaus population-based cohort (Lausanne, Switzerland) over 5 years. Participants completed the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, and underwent a full clinical evaluation at baseline and 5 years afterwards. Ambulatory polysomnography was performed at baseline in a sub-sample of 1,404 subjects. Among the 2,438 subjects without excessive daytime sleepiness (Epworth Sleepiness Scale ≤ 10) at baseline, the 5-year incidence of excessive daytime sleepiness was 5.1% (n = 124). Multivariate logistic regression revealed that male sex, depressive symptoms, reported poor sleep quality and moderate to severe obstructive sleep apnea were independent predictors of incident excessive daytime sleepiness, while older age, moderate coffee consumption, periodic leg movement during sleep and hypertension were independent protective factors. Stratified analysis according to sex and age showed some distinctive associations. Among the 313 patients with excessive daytime sleepiness at baseline, 137 (43.8%) had persistent excessive daytime sleepiness 5 years later. Our findings provide new insights into the predictors of incident excessive daytime sleepiness, but interventional studies are needed to understand the impact of treating these risk factors on the incidence of excessive daytime sleepiness.
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Affiliation(s)
- Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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12
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Marchi NA, Ramponi C, Hirotsu C, Haba-Rubio J, Lutti A, Preisig M, Marques-Vidal P, Vollenweider P, Kherif F, Heinzer R, Draganski B. Mean Oxygen Saturation during Sleep Is Related to Specific Brain Atrophy Pattern. Ann Neurol 2020; 87:921-930. [PMID: 32220084 DOI: 10.1002/ana.25728] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is much controversy about the neurobiological mechanisms underlying the effects of sleep-disordered breathing on the brain. The aim of this study was to investigate the association between markers of sleep-related hypoxemia and brain anatomy. METHODS We used data from a large-scale cohort from the general population (n = 775, 50.6% males, age range = 45-86 years, mean age = 60.3 ± 9.9) that underwent full polysomnography and brain magnetic resonance imaging to correlate respiratory variables with regional brain volume estimates. RESULTS After adjusting for age, gender, and cardiovascular risk factors, only mean oxygen saturation during sleep was associated with bilateral volume of hippocampus (right: p = 0.001; left: p < 0.001), thalamus (right: p < 0.001; left: p < 0.001), putamen (right: p = 0.001; left: p = 0.001), and angular gyrus (right: p = 0.011; left: p = 0.001). We observed the same relationship in left hemispheric amygdala (p = 0.010), caudate (p = 0.008), inferior frontal gyrus (p = 0.004), and supramarginal gyrus (p = 0.003). The other respiratory variables-lowest oxygen saturation, percentage of sleep time with oxygen saturation < 90%, apnea-hypopnea index, and oxygen desaturation index-did not show any significant association with brain volumes. INTERPRETATION Lower mean oxygen saturation during sleep was associated with atrophy of cortical and subcortical brain areas known for high sensitivity to oxygen supply. Their vulnerability to hypoxemia may contribute to behavioral phenotype and cognitive decline in patients with sleep-disordered breathing. ANN NEUROL 2020;87:921-930.
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Affiliation(s)
- Nicola Andrea Marchi
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cristina Ramponi
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antoine Lutti
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ferath Kherif
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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13
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Hirotsu C, Frange C, Hirata PH, Cremaschi RC, Coelho FM, Andersen ML, Tufik S. Sleepiness comorbid to musculoskeletal pain is associated with worse quality of life and mood symptoms in a general population sample. Sleep Sci 2019; 12:79-87. [PMID: 31879539 PMCID: PMC6922546 DOI: 10.5935/1984-0063.20190071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives Musculoskeletal (MSK) pain and hypersomnolence (HPS) are very disabling conditions that may share some pathophysiological factors. This study aimed to evaluate the interaction between MSK pain and HPS and its association with mood symptoms, fatigue, quality of life, and both objective and subjective sleep quality. Design Cross-sectional study. Setting General population based sample. Participants 510 individuals from EPISONO cohort, São Paulo (Brazil). Measurements All participants completed questionnaires, had clinical assessment and underwent a full-night polysomnography. HPS was defined according to Epworth Sleepiness Scale while the presence of MSK pain was defined by structured questionnaire. The sample was allocated into 4 groups: control (CTRL, n=281), HPS (n=141), MSK (n=50), and both conditions (HPS+MSK, n=38). Results MSK pain and HPS by themselves were associated with worse mood symptoms and quality of life. However, individuals with both associated conditions (HPS+MSK) presented higher frequencies of moderate to severe depression (44.1%) and anxiety symptoms (45.7%), as well as an additional decrease in quality of life compared to the other groups. There were no differences between HPS+MSK and MSK groups in objective sleep pattern. With regard to subjective sleep, HPS+MSK presented a higher prevalence of sleep attacks and cataplexy compared to all other groups. Conclusions The combination of MSK pain and HPS was associated with worse mood symptoms, quality of life and HPS-related features. This study suggests that sleepiness may be an important symptom to be investigated and treated in MSK pain-related conditions for a better quality of life.
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Affiliation(s)
- Camila Hirotsu
- Centre Hospitalier Universitaire Vaudois, Centre Hospitalier Universitaire Vaudois - Lausanne - Lausanne - Switzerland
| | - Cristina Frange
- Universidade Federal de São Paulo, Department of Neurology and Neurosurgery - São Paulo - São Paulo - Brazil
| | - Patricia H Hirata
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo - São Paulo - Brazil
| | - Renata C Cremaschi
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo - São Paulo - Brazil
| | - Fernando M Coelho
- Universidade Federal de São Paulo, Department of Neurology and Neurosurgery - São Paulo - São Paulo - Brazil.,Universidade Federal de São Paulo, Department of Psychobiology - São Paulo - São Paulo - Brazil
| | - Monica L Andersen
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo - São Paulo - Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo - São Paulo - Brazil
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14
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Rhyner P, Kirkham K, Hirotsu C, Farron A, Albrecht E. A randomised controlled trial of shoulder block vs. interscalene brachial plexus block for ventilatory function after shoulder arthroscopy. Anaesthesia 2019; 75:493-498. [PMID: 31854463 DOI: 10.1111/anae.14957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
The shoulder block may impair ventilatory function and diaphragmatic movement less than the interscalene brachial plexus block. We randomly allocated 30 adults who underwent shoulder arthroscopy under general anaesthesia to ultrasound-guided shoulder block or interscalene block with 20 ml bupivacaine 0.5%. The primary outcome, rate of ultrasound-measured hemidiaphragmatic excursion < 25% of baseline 30 min after blockade, was reduced from 12/15 with brachial plexus block to 2/15 with shoulder block, a difference (95%CI) of 67% (40-93%), p < 0.001. The mean (SD) numeric rating scale pain scores at rest after shoulder block were higher than after interscalene block at two postoperative hours, 1.4 (1.2) vs. 0.3 (0.7), p = 0.02, but lower at 24 postoperative hours, 1.3 (1.3) vs. 3.4 (2.3), p = 0.008. Mean (SD) pain scores on movement in the shoulder and interscalene blocks were similar, with respective values of 1.9 (1.9) vs. 0.7 (1.2), p = 0.13 at two postoperative hours and 3.7 (2.3) vs. 5.3 (2.5), p = 0.41, at 24 postoperative hours.
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Affiliation(s)
- P Rhyner
- Department of Anaesthesia, Lausanne University Hospital, University of Lausanne, Switzerland
| | - K Kirkham
- Department of Anaesthesia, Toronto University Western Hospital, Toronto, ON, Canada
| | - C Hirotsu
- Center for Investigation and Research in Sleep, Lausanne University Hospital, University of Lausanne, Switzerland
| | - A Farron
- Department of Orthopaedic Surgery, Lausanne University Hospital, University of Lausanne, Switzerland
| | - E Albrecht
- Department of Anaesthesia, Lausanne University Hospital, University of Lausanne, Switzerland
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15
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Piovezan R, Hirotsu C, Moizinho R, de Sá Souza H, D'Almeida V, Tufik S, Poyares D. Sarcopenic obesity is associated with obstructive sleep apnea: a population-based study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Piovezan RD, Hirotsu C, Moizinho R, de Sá Souza H, D'Almeida V, Tufik S, Poyares D. Associations between sleep conditions and body composition states: results of the EPISONO study. J Cachexia Sarcopenia Muscle 2019; 10:962-973. [PMID: 31125517 PMCID: PMC6818458 DOI: 10.1002/jcsm.12445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/27/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence suggests anthropometric indicators of obesity are associated with changes in sleep quality and quantity, and the presence of obstructive sleep apnoea (OSA). Investigations including diverse and objective evaluations of sleep and body composition are scarce. We aimed to evaluate the associations between indicators of sleep impairment and body composition states in a sample from a population-based study. METHODS Participants of the first follow-up of the EPISONO (São Paulo, Brazil) >50 years were cross-sectionally evaluated. Sleep was assessed through questionnaires, actigraphy, and polysomnography. Body composition was evaluated by bioelectrical impedance analysis. Appendicular skeletal muscle mass adjusted for body mass index defined sarcopenia (men <0.789 and women <0.512). Total body fat defined obesity (men >30% and women >40%). The overlap between both conditions defined sarcopenic obesity (SO). Final results were obtained by multinomial logistic regression analysis. RESULTS Three hundred fifty-nine adults [mean (standard deviation) age, 61 (8.8) years; 212 (59.1%) female] were enrolled. Obesity was detected in 22.6% of the sample, sarcopenia in 5.6%, and SO in 16.2%. After controlling for covariates, OSA was associated with SO [odds ratio = 3.14, 95% confidence interval (CI) = 1.49-6.61]. Additionally, nocturnal hypoxaemia was associated with both obesity (adjusted odds ratio = 2.59, 95% CI = 1.49-4.49) and SO (odds ratio = 2.92, 95% CI = 1.39-6.13). Other indicators of poor sleep/sleep disorders were not associated with body composition states. CONCLUSIONS Sarcopenic obesity but not obesity alone was associated with OSA. Both obesity and SO but not sarcopenia were associated with nocturnal hypoxaemia. The findings suggest a complex pathophysiologic relationship between adverse body composition states and OSA. Upcoming research on risk factors and therapeutic interventions for OSA should target synchronically the lean and adipose body tissues.
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Affiliation(s)
- Ronaldo D Piovezan
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Renato Moizinho
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Helton de Sá Souza
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Vania D'Almeida
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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17
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Almendros I, Baillieul S, Caballero C, Degani-Costa LH, Furian M, Hirotsu C, Louvaris Z, Thiel S, Turnbull CD. Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology. ERJ Open Res 2019; 5:00201-2018. [PMID: 31304175 PMCID: PMC6612603 DOI: 10.1183/23120541.00201-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The 2018 European Respiratory Society (ERS) International Congress held in Paris, France, served as a platform to discover the latest research on respiratory diseases, the improvement in their treatments and patient care. Specifically, the scientific sessions organised by ERS Assembly 4 provided novel insights into sleep disordered breathing and fresh knowledge in respiratory physiology, stressing its importance to understanding and treating respiratory diseases. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each session has been written by early career members specialised in the different fields of this interdisciplinary assembly.
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Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- All authors contributed equally and are listed alphabetically
| | - Sébastien Baillieul
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
- All authors contributed equally and are listed alphabetically
| | - Candela Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- All authors contributed equally and are listed alphabetically
| | - Luiza Helena Degani-Costa
- Pulmonary Function and Clinical Exercise Physiology Unit, Pulmonary Division, Dept of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- All authors contributed equally and are listed alphabetically
| | - Michael Furian
- Dept of Pulmonology and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
- All authors contributed equally and are listed alphabetically
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep, University Hospital of Lausanne, Lausanne, Switzerland
- All authors contributed equally and are listed alphabetically
| | - Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Dept of Rehabilitation Sciences, KU Leuven, Research Group for Rehabilitation in Internal Disorders, University Hospitals Leuven, Leuven, Belgium
- All authors contributed equally and are listed alphabetically
| | - Sira Thiel
- Dept of Pulmonology and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
- All authors contributed equally and are listed alphabetically
| | - Christopher D. Turnbull
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- All authors contributed equally and are listed alphabetically
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18
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Guimenes Albuquerque R, Grüdtner Buratto G, Hirotsu C, Maeda SM, Floriano MC, Levy Andersen M, Tufik S, Tomimori J. Comparison of quality of life evaluated by SF-36 and DLQI in multibacillary and paucibacillary leprosy patients from Sao Paulo, Brazil. Int J Dermatol 2019; 58:1415-1422. [PMID: 31148144 DOI: 10.1111/ijd.14489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/07/2019] [Accepted: 04/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dermatological diseases have a negative impact on quality of life (QoL), affecting mental and physical health. Leprosy patients usually present with a worse QoL compared with those affected by other conditions. Reactions, neural damage, and pain are some of the consequences that contribute to the lower QoL. However, due to the wide spectrum of the disease, symptoms vary according to leprosy's subtype. This study aimed to compare the QoL between paucibacillary and multibacillary leprosy patients. Individuals were also compared considering the presence of reactions and a correlation between questionnaires was performed. METHODS A total of 104 patients with leprosy aged 18 years old and over were selected. QoL was assessed by the Brazilian-Portuguese validated versions of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the Dermatology Life Quality Life Index (DLQI). RESULTS Multibacillary patients showed a more impaired physical function, worse bodily pain, lower score of SF-36, and higher interference of skin on the performance of daily activities when compared to the paucibacillary group. Individuals without reactions presented lower bodily pain and less effect of the skin on clothing choices compared to those with reactions. The SF-36 domains exhibited weak correlations with most DLQI questions, and the linear regression model showed that 32% of changes in QoL were related to the skin aspect. CONCLUSIONS Multibacillary leprosy patients have a worse QoL when compared to paucibacillary patients. Reactions played a small role in the QoL of our cohort of patients.
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Affiliation(s)
| | | | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Solange M Maeda
- Department of Dermatology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Marcos C Floriano
- Department of Dermatology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Jane Tomimori
- Department of Dermatology, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
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19
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. The sensory pain of Dante's Inferno - Semantics of chronic pain in patients with narcolepsy. ACTA ACUST UNITED AC 2019; 12:49-52. [PMID: 31105895 PMCID: PMC6508941 DOI: 10.5935/1984-0063.20190055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To examine the semantics of chronic pain in narcolepsy and to compare with
the poem Inferno, from Dante Alighieri. Methods A cross-sectional study, in which type 1 (n=33) and type 2 (n=33) patients
(hypocretin-1 quantification in cerebrospinal fluid), were studied at
Departamento de Psicobiologia - Universidade Federal de São Paulo
(Brazil). We assessed pain descriptors in the Present Rating Index (PRI)
from McGill Pain Questionnaire. Results There was no significant difference in PRI between narcolepsy groups. In
both groups, the most frequent words had a sensory dimension: throbbing,
jumping, and tugging. Multiple correspondence analysis revealed the
predominance of sensory descriptors and the deficiency of affective
descriptors in these groups. Discussion A study that interpreted the poem Inferno, from Dante Alighieri, as McGill
Pain Questionnaires descriptors suggested a contribution of the sensory
dimension in pain of possibly narcolepsy patients, similar as in our
results.
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Affiliation(s)
- Renata Carvalho Cremaschi
- UNIFESP, Departamento de Psicobiologia - São Paulo - SP - Brazil.,UNIFESP, Departamento de Neurologia e Psicobiologia - São Paulo - SP - Brazil
| | - Camila Hirotsu
- UNIFESP, Departamento de Psicobiologia - São Paulo - SP - Brazil.,Lausanne University Hospital, Center for Investigation and Research in Sleep - Lausanne - Lausane - Switzerland
| | - Sergio Tufik
- UNIFESP, Departamento de Psicobiologia - São Paulo - SP - Brazil
| | - Fernando Morgadinho Coelho
- UNIFESP, Departamento de Psicobiologia - São Paulo - SP - Brazil.,UNIFESP, Departamento de Neurologia e Psicobiologia - São Paulo - SP - Brazil
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20
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Hirotsu C, Marques-Vidal P, Vollenweider P, Heinzer R, Haba-Rubio J. 0660 Periodic Limb Movement During Sleep And The Incidence Of Cardiometabolic Outcomes: The Hypnolaus Study. Sleep 2019. [DOI: 10.1093/sleep/zsz067.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camila Hirotsu
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raphael Heinzer
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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21
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Hirotsu C, Marques-Vidal P, Vollenweider P, Betta M, Bernardi G, Siclari F, Haba-Rubio J, Heinzer R. 0860 Pulse Wave Amplitude Drops During Sleep: Reference Values And Clinical Associations In A General Population. Sleep 2019. [DOI: 10.1093/sleep/zsz067.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camila Hirotsu
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Francesca Siclari
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jose Haba-Rubio
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Raphael Heinzer
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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22
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Heinzer R, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Betta M, Bernardi G, Lecci S, Siclari F, Haba-Rubio J. 0859 Sleep Determinants Of Incident Cardiovascular Events: A prospective Population-based Study. Sleep 2019. [DOI: 10.1093/sleep/zsz067.857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gerard Waeber
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Sandro Lecci
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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23
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Prata TA, Mancuzo E, Pereira CADC, Miranda SSD, Sadigursky LV, Hirotsu C, Tufik S. Spirometry reference values for Black adults in Brazil. ACTA ACUST UNITED AC 2019; 44:449-455. [PMID: 30726320 PMCID: PMC6459754 DOI: 10.1590/s1806-37562018000000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/08/2018] [Indexed: 11/21/2022]
Abstract
Objective: To derive reference equations for spirometry in healthy Black adult never smokers in Brazil, comparing them with those published in 2007 for White adults in the country. Methods: The examinations followed the standards recommended by the Brazilian Thoracic Association, and the spirometers employed met the technical requirements set forth in the guidelines of the American Thoracic Society/European Respiratory Society. The lower limits were defined as the 5th percentile of the residuals. Results: Reference equations and limits were derived from a sample of 120 men and 124 women, inhabitants of eight Brazilian cities, all of whom were evaluated with a flow spirometer. The predicted values for FVC, FEV1, FEV1/FVC ratio, and PEF were better described by linear equations, whereas the flows were better described by logarithmic equations. The FEV1 and FVC reference values derived for Black adults were significantly lower than were those previously derived for White adults, regardless of gender. Conclusions: The fact that the predicted spirometry values derived for the population of Black adults in Brazil were lower than those previously derived for White adults in the country justifies the use of an equation specific to the former population.
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Affiliation(s)
- Tarciane Aline Prata
- . Programa de Pós-Graduação das Ciências Aplicadas à Saúde do Adulto, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Eliane Mancuzo
- . Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil.,. Laboratório de Função Pulmonar, Hospital das Clínicas, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | | | - Silvana Spíndola de Miranda
- . Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | | | - Camila Hirotsu
- . Departamento de Psicobiologia, Universidade Federal de São Paulo -UNIFESP - São Paulo (SP) Brasil
| | - Sérgio Tufik
- . Departamento de Psicobiologia, Universidade Federal de São Paulo -UNIFESP - São Paulo (SP) Brasil
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24
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Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Temporal Analysis of Chronic Musculoskeletal Pain and Sleep in Postmenopausal Women. J Clin Sleep Med 2019; 15:223-234. [PMID: 30736875 DOI: 10.5664/jcsm.7622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/08/2018] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVES To investigate the temporal association between chronic musculoskeletal pain (CMP) and sleep in women who are postmenopausal in a 10-day actigraphic study. This is a microlongitudinal study in which 52 participants were allocated to 4 groups women who are postmenopausal: control (CTRL, n = 10), chronic musculoskeletal pain (CMP, n = 12), insomnia (INS, n = 15) and chronic musculoskeletal pain+insomnia (CMP+INS, n = 15). METHODS All volunteers underwent a clinical interview and completed questionnaires, used an actigraph, and kept sleep diaries for 10 consecutive days. RESULTS Women in the CMP+INS group presented more sleep episodes (mean of 1.02 episodes) and longer sleep latency (8.97 minutes), as well as higher pain intensity during the day compared to the other groups. Sleep duration recorded by actigraphy directly predicted pain intensity the following morning on waking, with a 1-unit increase in pain intensity, for every 6.9 minutes more of sleep. Higher pain intensity at bedtime was a significant predictor of both increased time in bed and sleep duration, meaning that for each 1-unit increase in pain intensity at bedtime, sleep duration increased by an average of 6.7 minutes. CONCLUSIONS Data showed that the coexistence of insomnia and CMP results in greater pain intensity and alterations in sleep homeostasis. Collectively, the data indicate that there is a bidirectional and directly proportional relationship between sleep duration and pain intensity in women who are postmenopausal with insomnia. This result strongly suggests that both sleep and pain conditions should be targeted in the treatment of women who are postmenopausal.
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Affiliation(s)
- Cristina Frange
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Lev Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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25
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Hirotsu C, Haba-Rubio J, Andries D, Tobback N, Marques-Vidal P, Vollenweider P, Waeber G, Heinzer R. Effect of Three Hypopnea Scoring Criteria on OSA Prevalence and Associated Comorbidities in the General Population. J Clin Sleep Med 2019; 15:183-194. [PMID: 30736872 DOI: 10.5664/jcsm.7612] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES Apnea-hypopnea index (AHI) is the main polysomnographic measure to diagnose obstructive sleep apnea (OSA). We aimed to evaluate the effect of three standard hypopnea definitions on the prevalence of OSA and its association with cardiometabolic outcomes in the general population. METHODS We analyzed data from the HypnoLaus study (Lausanne, Switzerland), in which 2,162 participants (51% women, 57 ± 19 years) underwent in-home full polysomnography. AHI was calculated using three hypopnea definitions: AASM1999 (≥ 50% decrease in airflow or lower airflow reduction associated with oxygen desaturation ≥ 3% or an arousal), AASM2007 (≥ 30% airflow reduction associated with ≥ 4% oxygen desaturation), and AASM2012 (≥ 30% airflow reduction associated with ≥ 3% oxygen desaturation or an arousal). Participants underwent clinical assessment for hypertension, diabetes, and metabolic syndrome. RESULTS Median AHI of AASM1999, AASM2007 and AASM2012 criteria were 10.9, 4.4, and 10.1 events/h, respectively. OSA prevalence defined as AHI ≥ 5, ≥ 15, and ≥ 30 events/h was 74.5%, 39.3%, and 16.3% using AASM1999; 46.9%, 18.8%, and 6.8% using AASM2007; and 72.2%, 36.6%, and 14.9% using AASM2012. Different AHI thresholds derived from AASM1999, AASM2007, and AASM2012 criteria, respectively, were associated with hypertension (11.5, 4.8, 10.7 events/h), diabetes (15.7, 7.1, 14.4 events/h), and metabolic syndrome (12.8, 5.5, 11.8 events/h). CONCLUSIONS Hypopnea definition has a major effect on AHI and on OSA prevalence in the general population and, hence, important implications for public health policies. There is a twofold difference in the threshold above which an association with diabetes, hypertension, and metabolic syndrome is observed using AASM2007 compared to AASM1999 or AASM2012 criteria.
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Affiliation(s)
- Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gérard Waeber
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Pulmonary Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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26
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Tempaku P, Hirotsu C, Mazzotti D, Xavier G, Maurya P, Brietzke E, Belangero S, Poyares D, Bittencourt L, Tufik S. Long Sleep Duration, Insomnia, and Insomnia With Short Objective Sleep Duration Are Independently Associated With Short Telomere Length. J Clin Sleep Med 2018; 14:2037-2045. [PMID: 30518442 DOI: 10.5664/jcsm.7532] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/31/2018] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVES We aimed to determine the association between short telomere length, sleep parameters, and sleep disorders in an adult general population sample. METHODS As part of the EPISONO cohort (São Paulo, Brazil), 925 individuals answered questionnaires, underwent a full-night polysomnography and clinical assessment, and had peripheral blood collected for DNA extraction. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition; and obstructive sleep apnea was defined according to apnea-hypopnea index. For the objective insomnia phenotype, we combined insomnia diagnosis with total sleep time from polysomnography with a cutoff of 360 minutes, allowing the classification of six groups. Self-reported sleep duration was used to classify the individuals as short (< 6 hours), average (6 to 8 hours) and long (> 8 hours) sleepers. The leukocyte telomere length was measured using quantitative real-time polymerase chain reaction. Based on its distribution, we considered leukocyte telomere length < 10th percentile as short telomere and leukocyte telomere length ≥ 10th percentile as non-short telomere. RESULTS After adjusting for sex, age, and body mass index, only insomnia disorder (odds ratio [OR] = 2.654, 95% confidence interval [CI] = 1.025-6.873, P = .044), insomnia disorder total sleep time < 360 minutes (OR = 4.205, 95% CI = 1.097-16.117, P = .036) and long sleepers (OR = 2.177, 95% CI = 1.189- 3.987, P = .012) were associated with short telomere. CONCLUSIONS Our findings support the existence of an association among insomnia, insomnia phenotype, and self-reported long sleep duration with the maintenance of telomere length. COMMENTARY A commentary on this article appears in this issue on page 1975.
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Affiliation(s)
- Priscila Tempaku
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Center for Investigation and Research in Sleep, Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Diego Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia
| | - Gabriela Xavier
- LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pawan Maurya
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Biochemistry, Central University of Haryana, Mahendergarh, India
| | - Elisa Brietzke
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sintia Belangero
- LINC-Interdisciplinary Laboratory of Clinical Neurosciences, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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27
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Hirotsu C, Haba-Rubio J, Togeiro SM, Marques-Vidal P, Drager LF, Vollenweider P, Waeber G, Bittencourt L, Tufik S, Heinzer R. Obstructive sleep apnoea as a risk factor for incident metabolic syndrome: a joined Episono and HypnoLaus prospective cohorts study. Eur Respir J 2018; 52:13993003.01150-2018. [PMID: 30287472 DOI: 10.1183/13993003.01150-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/24/2018] [Indexed: 11/05/2022]
Abstract
Cross-sectional studies have demonstrated that obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) are often associated, but whether a temporal relationship exists is unknown. We aimed to investigate the effect of OSA on the risk of developing MetS in the general population.A prospective study was conducted combining two population-based samples: Episono (Brazil) and HypnoLaus (Switzerland). MetS was assessed according to unified criteria. Polysomnography (PSG) was performed at baseline and follow-up in Episono, and at baseline in HypnoLaus. OSA was defined according to the apnoea-hypopnoea index as mild (≥5- <15 events h-1) and moderate-to-severe (≥15 events·h-1). We included 1853 participants (mean±sd age 52±13 years, 56% female) without MetS at baseline.After mean±sd 6±1 years, 318 (17.2%) participants developed MetS. Moderate-to-severe OSA was independently associated with incident MetS (OR 2.58, 95% CI 1.61-4.11) and increased the number of MetS components from baseline to follow-up through mediation of the percentage of time with arterial oxygen saturation <90%. Subset analysis in Episono confirmed that the increase in this parameter between baseline and follow-up PSGs represented a risk factor for incident MetS (OR 1.42, 95% CI 1.04-1.95, for each 10% increase).OSA is independently associated with an increased risk of developing MetS through mediation of nocturnal hypoxaemia in the general population.
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Affiliation(s)
- Camila Hirotsu
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint first authors
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint first authors
| | - Sonia M Togeiro
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Pedro Marques-Vidal
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor) and Renal Division, University of São Paulo Medical School, São Paulo, Brazil
| | - Peter Vollenweider
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gérard Waeber
- Dept of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Lia Bittencourt
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Dept of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,These two authors are joint last authors
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland .,Pulmonary Dept, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,These two authors are joint last authors
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28
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Hirotsu C, Pedroni MN, Berro LF, Tufik S, Andersen ML. Nicotine and sleep deprivation: impact on pain sensitivity and immune modulation in rats. Sci Rep 2018; 8:13837. [PMID: 30218019 PMCID: PMC6138689 DOI: 10.1038/s41598-018-32276-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 06/01/2018] [Indexed: 11/09/2022] Open
Abstract
Repeated nicotine administration has been associated with increased paradoxical sleep in rats and antinociceptive properties, whereas paradoxical sleep deprivation (PSD) elicits pronociceptive and inflammatory responses. Thus, we aimed to evaluate the effect of repeated nicotine administration and its withdrawal combined with PSD on pain sensitivity and inflammatory markers. Sixty adult male Wistar rats were subjected to repeated injections of saline (SAL) or nicotine (NIC) for 12 days or 7 days of nicotine followed by acute mecamylamine administration on day 8 to precipitate nicotine abstinence (ABST). On day 9, the animals were submitted to PSD for 72 h or remained in control condition (CTRL); on day 12, thermal pain threshold was assessed by the hot plate test. PSD significantly decreased the latency to paw withdrawal in all groups compared to their respective controls. ABST-PSD animals presented higher levels of interleukin (IL)-6 compared to all groups, except ABST-CTRL. After adjustment for weight loss, IL-6, IL-4 and tumor necrosis factor alpha, ABST-PSD was associated with the lowest pain threshold. Nicotine and IL-4 levels were predictors of higher pain threshold. Hyperalgesia induced by PSD prevailed over the antinociceptive action of nicotine, while the association between PSD and ABST synergistically increased IL-6 concentrations and decreased pain threshold.
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Affiliation(s)
- Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Laís Fernanda Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, USA
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
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29
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. High fatigue frequency in narcolepsy type 1 and type 2 in a Brazilian Sleep Center. Sleep Med 2018; 52:234. [PMID: 30274905 DOI: 10.1016/j.sleep.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Renata Carvalho Cremaschi
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland.
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Fernando Morgadinho Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
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30
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Acosta-Castro P, Hirotsu C, Marti-Soler H, Marques-Vidal P, Tobback N, Andries D, Waeber G, Preisig M, Vollenweider P, Haba-Rubio J, Heinzer R. REM-associated sleep apnoea: prevalence and clinical significance in the HypnoLaus cohort. Eur Respir J 2018; 52:13993003.02484-2017. [PMID: 29976653 DOI: 10.1183/13993003.02484-2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/19/2018] [Indexed: 01/14/2023]
Abstract
This study determined the prevalence of rapid eye movement (REM) related sleep-disordered breathing (REM-SDB) in the general population and investigated the associations of REM-SDB with hypertension, metabolic syndrome, diabetes and depression.Home polysomnography (PSG) recordings (n=2074) from the population-based HypnoLaus Sleep Cohort (48.3% men, 57±11 years old) were analysed. The apnoea-hypopnoea index was measured during REM and non-REM sleep (as REM-AHI and NREM-AHI, respectively). Regression models were used to explore the associations between REM-SDB and hypertension, diabetes, metabolic syndrome and depression in the entire cohort and in subgroups with NREM-AHI <10 events·h-1 and total AHI <10 events·h-1The prevalence of REM-AHI ≥20 events·h-1 was 40.8% in the entire cohort. An association between increasing REM-AHI and metabolic syndrome was found in the entire cohort and in both the NREM-AHI and AHI subgroups (p-trend=0.014, <0.0001 and 0.015, respectively). An association was also found between REM-AHI ≥20 events·h-1 and diabetes in both the NREM-AHI <10 events·h-1 (odds ratio (OR) 3.12 (95% CI 1.35-7.20)) and AHI <10 events·h-1 (OR 2.92 (95% CI 1.12-7.63)) subgroups. Systolic and diastolic blood pressure were positively associated with REM-AHI ≥20 events·h-1REM-SDB is highly prevalent in our middle-to-older age sample and is independently associated with metabolic syndrome and diabetes. These findings suggest that an increase in REM-AHI could be clinically relevant.
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Affiliation(s)
- Patricia Acosta-Castro
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,Pulmonary Dept, University Hospital Ramon y Cajal, Madrid, Spain.,P. Acosta-Castro and C. Hirotsu contributed equally to this study as co-first authors
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,P. Acosta-Castro and C. Hirotsu contributed equally to this study as co-first authors
| | - Helena Marti-Soler
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Psychiatry Dept, University Hospital of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Dept of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,J. Haba-Rubio and R. Heinzer contributed equally to this study as co-last authors
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.,J. Haba-Rubio and R. Heinzer contributed equally to this study as co-last authors
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31
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Pak VM, Mazzotti DR, Keenan BT, Hirotsu C, Gehrman P, Bittencourt L, Pack AI, Tufik S. Candidate gene analysis in the São Paulo Epidemiologic Sleep Study (EPISONO) shows an association of variant in PDE4D and sleepiness. Sleep Med 2018; 47:106-112. [DOI: 10.1016/j.sleep.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/30/2017] [Indexed: 12/24/2022]
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32
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. Chronic pain in narcolepsy type 1 and type 2 – an underestimated reality. J Sleep Res 2018; 28:e12715. [DOI: 10.1111/jsr.12715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Renata C. Cremaschi
- Departamento de Psicobiologia Universidade Federal de São Paulo São Paulo Brazil
- Departamento de Neurologia e Neurocirurgia Universidade Federal de São Paulo São Paulo Brazil
| | - Camila Hirotsu
- Departamento de Psicobiologia Universidade Federal de São Paulo São Paulo Brazil
- Center for Investigation and Research in Sleep Lausanne University Hospital Lausanne Switzerland
| | - Sergio Tufik
- Departamento de Psicobiologia Universidade Federal de São Paulo São Paulo Brazil
| | - Fernando M. Coelho
- Departamento de Psicobiologia Universidade Federal de São Paulo São Paulo Brazil
- Departamento de Neurologia e Neurocirurgia Universidade Federal de São Paulo São Paulo Brazil
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Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Insomnia with Musculoskeletal Pain in Postmenopause: Associations with Symptoms, Mood, and Quality of Life. J Menopausal Med 2018; 24:17-28. [PMID: 29765923 PMCID: PMC5949304 DOI: 10.6118/jmm.2018.24.1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the relationship between insomnia (INS) combined with chronic musculoskeletal pain (MSP) in postmenopausal women and its characteristics regarding MSP, menopausal and mood symptoms, sleep and quality of life (QOL). Methods A cross-sectional control study in 4 groups of postmenopausal women: control (n = 15), MSP (n = 15), INS (n =15) and INS + MSP (n = 17). Sixty-two participants completed questionnaires and had blood collected, and 43 underwent polysomnography. Results INS was associated with increased anxiety (P = 0.04) and sleep fragmentation (P = 0.02); worse MSP severity (P = 0.00), MSP interference with daily function (P = 0.00), higher pain intensity at midday (P = 0.02) and menopausal symptoms (P = 0.00); and reduced QOL (P = 0.00). MSP was associated with increased anxiety (P = 0.02) and menopausal symptoms (P = 0.00), and reduced QOL (P = 0.05). In the whole sample, depression symptoms were higher but no statistical differences were found between groups (P = 0.47). Worse QOL was associated with both higher depressive symptoms (P = 0.01) and worse pain interference (P = 0.02) Conclusions INS + MSP was related to higher menopausal and anxiety symptoms, more sleep fragmentation and complaints of MSP severity and interference, more pain sites and worse QOL. The presence of INS was associated to more MSP. Sleep management is essential in women who have developed chronic MSP.
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Affiliation(s)
- Cristina Frange
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Casa de Saúde Santa Marcelina, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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Hirotsu C, Heinzer R, Poyares D, Haba-Rubio J, Coelho FM, Bittencourt L, Tufik S. 0951 Insomnia, Short-sleepers And Rem-related Sleep Disordered Breathing As Risk Factors For Incident Depression In The Episono Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Hirotsu
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - R Heinzer
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERL
| | - D Poyares
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - J Haba-Rubio
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SWITZERL
| | - F M Coelho
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, BRAZIL
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35
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Lucchesi LM, Hirotsu C, Smith A, Prado G, Pires GN, Tufik S, Togeiro S, Poyares D. 1039 Nocturnal Awakening With Headache In The Sao Paulo City, Brazil In The Follow-up Study (2015) And Relationship With Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L M Lucchesi
- Universidade Federal de São Paulo, Sao Paulo, BRAZIL
| | - C Hirotsu
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, BRAZIL
| | - A Smith
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, BRAZIL
| | - G Prado
- Universidade Federal de Sao Paulo, Universidade Federal de Sao Paulo, BRAZIL
| | - G N Pires
- Universidade Federa de São Paulo, Universidade Federal de São Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, BRAZIL
| | - S Togeiro
- Universidade Federal São Paulo, Universidade Federal de São Paulo, BRAZIL
| | - D Poyares
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, BRAZIL
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36
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Heinzer R, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Tafti M, Betta M, Bernardi G, Siclari F, Haba-Rubio J. 0889 Sleep Determinants of Incident Hypertension in a Population-Based Cohort: The CoLaus-HypnoLaus Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Heinzer
- Center for Investigation and Research in Sleep, Lausanne, SWITZERL
| | - C Hirotsu
- Center for Investigation and Research in Sleep, Lausanne, SWITZERL
| | | | | | - G Waeber
- University Hospital of Lausanne, Lausanne, SWITZERL
| | - M Tafti
- Lausanne University Physiology Department, Lausanne, SWITZERL
| | - M Betta
- MoMiLab Unit, IMT School for Advanced Studies, Lucca, ITALY
| | - G Bernardi
- MoMiLab Unit, IMT School for Advanced Studies, Lucca, ITALY
| | - F Siclari
- Center for Investigation and Research in Sleep, Lausanne, SWITZERL
| | - J Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne, SWITZERL
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37
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Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. 0711 Temporal Analysis of Chronic Musculoskeletal Pain and Sleep in Postmenopausal Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Frange
- Universidade Federal de São Paulo - Psychobiology Department, São Paulo - SP, BRAZIL
| | - H Hachul
- Universidade Federal de São Paulo - Psychobiology Department, Universidade Federal de São Paulo, BRAZIL
| | - C Hirotsu
- Universidade Federal de São Paulo - Psychobiology Department, Universidade Federal de São Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de São Paulo - Psychobiology Department, Universidade Federal de São Paulo, BRAZIL
| | - M L Andersen
- Universidade Federal de São Paulo - Psychobiology Department, Universidade Federal de São Paulo, BRAZIL
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38
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Tempaku PF, Hirotsu C, Mazzotti DR, Xavier G, Maurya PK, Rizzo LB, Brietzke E, Belangero SI, Poyares D, Bittencourt L, Tufik S. 0035 Long-sleepers and Insomnia with Short Objective Sleep Duration are Independently Associated with Short Telomere Length in the EPISONO Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P F Tempaku
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - C Hirotsu
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | | | - G Xavier
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - P K Maurya
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - L B Rizzo
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - E Brietzke
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - S I Belangero
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - D Poyares
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - L Bittencourt
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de São Paulo, São Paulo, BRAZIL
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39
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de Oliveira DL, Hirotsu C, Kim LJ, Tufik S, Andersen ML. 0875 Sleep Duration As An Independent Factor Associated With Vitamin D Levels In Episono Cohort. Sleep 2018. [DOI: 10.1093/sleep/zsy061.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Hirotsu
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - L J Kim
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - S Tufik
- Universidade Federal de São Paulo, São Paulo, BRAZIL
| | - M L Andersen
- Universidade Federal de São Paulo, São Paulo, BRAZIL
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40
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Tempaku PF, Mazzotti DR, Hirotsu C, Andersen ML, Xavier G, Maurya PK, Rizzo LB, Brietzke E, Belangero SI, Bittencourt L, Tufik S. The effect of the severity of obstructive sleep apnea syndrome on telomere length. Oncotarget 2018; 7:69216-69224. [PMID: 27690344 PMCID: PMC5342471 DOI: 10.18632/oncotarget.12293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/23/2016] [Indexed: 12/17/2022] Open
Abstract
Aging is associated with an increase in the prevalence of obstructive sleep apnea syndrome (OSAS) as well as the shortening of telomeres. It is known that OSAS-related factors are stimuli that can contribute to the acceleration of cellular senescence. Thus, the present study aimed to compare the leukocyte telomere length (LTL) between OSAS patients and controls, as well as to verify the correlation between LTL and sleep parameters. We used DNA extracted of 928 individuals from EPISONO to measure the LTL by the quantitative real-time polymerase chain reaction. All individuals were subjected to one full-night polysomnography. LTL was significantly shorter in OSAS patients compared to controls. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, respiratory disturbance index, desaturation index and wake after sleep onset. LTL was positively correlated with sleep efficiency, total sleep time, basal, minimum and maximum oxygen saturation. Lastly, it was observed that OSAS severity was associated with shorter LTL even after adjusting for sex, age, years of schooling, body mass index, diabetes, stroke and heart attack. In conclusion, our study indicates the presence of an association between LTL and OSAS and a significant impact of severity of OSAS in telomeres shortening.
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Affiliation(s)
- Priscila Farias Tempaku
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Diego Robles Mazzotti
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Gabriela Xavier
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Pawan Kumar Maurya
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Lucas Bortolotto Rizzo
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Department of Psychiatry, University of Tuebingen, Tuebingen, Germany.,Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Elisa Brietzke
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Sintia Iole Belangero
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
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41
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Palombini L, Godoy L, Hirotsu C, Bittencourt L, Poyares D, Guilleminault C, Tufik S. Upper airway resistance syndrome: validation of a definition based in long term outcomes. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Gimenes Albuquerque R, Hirotsu C, Farias Tempaku P, Tomimori J, Tufik S, Levy Andersen M. Sleep restriction increases telomere length in skin of rats. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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43
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Kim L, Hirotsu C, Esteves A, Bittencourt L, Andersen M, Tufik S. Prevalence and associated factors of restless legs syndrome and periodic limb movement in episono cohort. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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de Oliveira D, Hirotsu C, Kim L, Tufik S, Andersen M. Sleep duration as an independent factor associated with vitamin D levels. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Vidigal T, Oliveira L, Moura T, Haddad F, Sutherland K, Cistulli P, Schwab R, Pack A, Magalang U, Leinwand S, Keenan B, Chen NH, Maislin G, Mazzotti D, Hirotsu C, Tufik S, Bittencourt L. Can intra-oral and facial photos predict OSA in the general and clinical population? Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Pedroni MN, Hirotsu C, Porro AM, Tufik S, Andersen ML. The role of sleep in pemphigus: a review of mechanisms and perspectives. Arch Dermatol Res 2017; 309:659-664. [PMID: 28726005 DOI: 10.1007/s00403-017-1765-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Pemphigus is an autoimmune bullous disease that causes the development of blisters and erosions on the skin and/or mucosa. Its inflammatory process is mediated by cytokines, which interact with sleep in a bidirectional manner. Pain, a frequent symptom due to pemphigus lesions, is well known to impair sleep quality. Depression is also associated with pemphigus and pro-inflammatory cytokines and may impair sleep. Additionally, a common relationship among other dermatological diseases and sleep has increasingly been described. Poor sleep quality is associated with an increased risk for autoimmune diseases, and insomnia is a comorbidity that has recently been associated with pemphigus. Thus, this review will explore the evidence supporting the likely bidirectional relationship between pemphigus and sleep quality and its possible mechanisms involved. This approach covering both pemphigus and sleep will open a research avenue for future studies focusing on the efficacy of the sleep disorders treatment in patients with pemphigus. In the long term, this may provide relevant information to dermatologists regarding new strategies for the management of pemphigus clinical condition, allowing possibly a better quality of life for the patients.
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Affiliation(s)
- Matheus Negrao Pedroni
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Adriana Maria Porro
- Departamento de Dermatologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
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47
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Albuquerque RG, Hirotsu C, Tufik S, Andersen ML. Why Should We Care About Selenium in Obstructive Sleep Apnea? J Clin Sleep Med 2017; 13:931-932. [PMID: 28502283 DOI: 10.5664/jcsm.6674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | - Camila Hirotsu
- Department of Psychobiology - Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology - Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology - Universidade Federal de São Paulo, São Paulo, Brazil
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48
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Piovezan RD, Hirotsu C, Feres MC, Cintra FD, Andersen ML, Tufik S, Poyares D. Obstructive sleep apnea and objective short sleep duration are independently associated with the risk of serum vitamin D deficiency. PLoS One 2017; 12:e0180901. [PMID: 28686746 PMCID: PMC5501615 DOI: 10.1371/journal.pone.0180901] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/22/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies demonstrate an association between vitamin D (25(OH)D) deficiency and sleep disturbances, such as obstructive sleep apnea (OSA) and short sleep duration. However, to date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D. OBJECTIVES To evaluate whether OSA and objective short sleep duration are independently associated with reduced 25(OH)D in an adult population sample. METHODS A cross-sectional study included 657 individuals from the city of Sao Paulo, Brazil, as part of the ERA project. Participants fulfilled questionnaires and underwent clinical evaluation, polysomnography and blood sample collection for 25(OH)D quantification. OSA was classified into three categories (mild, moderate and severe). The risk of 25(OH)D deficiency was considered as levels<30 ng/mL. Short sleep duration was defined as total sleep time<6 hours. RESULTS The risk of 25(OH)D deficiency was observed in 59.5% of the sample, affecting more individuals of the female gender, obese, with African American ethnicity, and those that were smokers, sedentary and presented hypertension and diabetes. In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both OSA and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D<30 = 2.21, 95% CI: 1.35-3.64, p<0.01; severe OSA: OR for 25(OH)D<30 = 1.78, 95% CI: 1.06-3.00, p = 0.03; short sleep duration: OR for 25(OH)D<30 = 1.61, 95% CI: 1.15-2.26, p = 0.01). After a subgroup analysis, similar results were observed only in participants ≥50 years. CONCLUSION OSA and short sleep duration are independently associated with the risk of 25(OH)D deficiency in an adult population. Age-related changes in vitamin D metabolism and the frequency of sleep disorders may be involved in these associations. Future studies exploring whether 25(OH)D levels may modulate OSA and sleep curtailment-related outcomes are needed.
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Affiliation(s)
- Ronaldo D. Piovezan
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Marcia C. Feres
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Fatima D. Cintra
- Department of Medicine, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Monica L. Andersen
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
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49
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Abstract
The role of vitamin D in osteomineral metabolism is well known. Several studies have suggested its action on different biological mechanisms, such as nociceptive sensitivity and sleep-wake cycle modulation. Sleep is an important biological process regulated by different regions of the central nervous system, mainly the hypothalamus, in combination with several neurotransmitters. Pain, which can be classified as nociceptive, neuropathic and psychological, is regulated by both the central and peripheral nervous systems. In the peripheral nervous system, the immune system participates in the inflammatory process that contributes to hyperalgesia. Sleep deprivation is an important condition related to hyperalgesia, and recently it has also been associated with vitamin D. Poor sleep efficiency and sleep disorders have been shown to have an important role in hyperalgesia, and be associated with different vitamin D values. Vitamin D has been inversely correlated with painful manifestations, such as fibromyalgia and rheumatic diseases. Studies have demonstrated a possible action of vitamin D in the regulatory mechanisms of both sleep and pain. The supplementation of vitamin D associated with good sleep hygiene may have a therapeutic role, not only in sleep disorders but also in the prevention and treatment of chronic pain conditions.
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Affiliation(s)
| | - Camila Hirotsu
- Department of PsychobiologyUniversidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of PsychobiologyUniversidade Federal de São Paulo, São Paulo, Brazil
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50
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Lomakina O, Alekseeva E, Valieva S, Bzarova T, Nikishina I, Zholobova E, Rodionovskaya S, Kaleda M, Nakagishi Y, Shimizu M, Mizuta M, Yachie A, Sugita Y, Okamoto N, Shabana K, Murata T, Tamai H, Smith EM, Yin P, Jorgensen AL, Beresford MW, Smith EM, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Wahezi D, Rubinstein T, Jones C, Newland P, Marks S, Corkhill R, Ekdawy D, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW, Smith EM, Lewandowski L, Phuti A, Jorgensen A, Scott C, Beresford MW, Batu ED, Kosukcu C, Taskiran E, Akman S, Ozturk K, Sozeri B, Unsal E, Ekinci Z, Bilginer Y, Alikasifoglu M, Ozen S, Lythgoe H, Beresford MW, Brunner HI, Gulati G, Jones JT, Altaye M, Eaton J, Difrancesco M, Yeo JG, Leong J, Bathi LDT, Arkachaisri T, Albani S, Abdelrahman N, Beresford MW, Leone V, Groot N, Shaikhani D, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Wright RD, Smith EM, Beresford MW, Abdawani R, Al Shaqshi L, Al 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Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Suárez RG, Nordal EB, Rypdal VG, Berntson L, Ekelund M, Aalto K, Peltoniemi S, Zak M, Nielsen S, Glerup M, Herlin T, Arnstad ED, Fasth A, Rygg M, Duarte AC, Sousa S, Teixeira L, Cordeiro A, Santos MJ, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Coda A, Cassidy S, West K, Hendry G, Grech D, Jones J, Hawke F, Grewal DS, Coda A, Jones J, Grech D, Grewal DS, Foley C, Killeen O, MacDermott E, Veale D, Fearon U, Konukbay D, Demirkaya E, Tarakci E, Arman N, Barut K, Şahin S, Adrovic A, Kasapcopur O, Munro J, Consolaro A, Morgan E, Riebschleger M, Horonjeff J, Strand V, Bingham C, Collante MTM, 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Sundberg E, Horne A, Ehl S, Ammann S, Lehmberg K, De Benedetti F, Beutel K, Foell D, Minoia F, Horne A, Bovis F, Davì S, Pagani L, Espada G, Gao YJ, Insalaco A, Lehmberg K, Sanner H, Shenoi S, Weitzman S, Ruperto N, Martini A, Cron RQ, Ravelli A, Prencipe G, Caiello I, Pascarella A, Bracaglia C, Ferlin WG, Chatel L, Strippoli R, de Min C, De Benedetti F, Jacqmin P, De Graaf K, Ballabio M, Nelson R, Johnson Z, Ferlin W, Lapeyre G, de Benedetti F, Cristina DM, Wakiguchi H, Hasegawa S, Hirano R, Okazaki F, Nakamura T, Kaneyasu H, Ohga S, Yamazaki K, Nozawa T, Kanetaka T, Ito S, Yokota S, McLellan K, MacGregor I, Martin N, Davidson J, Kuemmerle-Deschner J, Hansmann S, Wulffraat N, Eikelberg A, Haug I, Schuller S, Benseler SM, Nazarova LS, Danilko KV, Malievsky VA, Viktorova TV, Mauro A, Omoyinmi E, Barnicoat A, Brogan P, Foley C, Killeen O, MacDermott E, Veale D, Foley C, Killeen O, MacDermott E, Veale D, Gomes SM, Omoyinmi E, Hurst J, Canham N, Eleftheriou D, Klein N, Lacassagne S, Brogan P, Wiener A, Hügle B, Denecke B, Costa-Filho I, Haas JP, Tenbrock K, Popp D, Boltjes A, Rühle F, Herresthal S, de Jager W, van Wijk F, Schultze J, Stoll M, Klotz L, Vogl T, Roth J, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Sánchez AMM, Borrell RP, Barril SM, Gallo MM, Caballero CM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Giner T, Hackl L, Albrecht J, Würzner R, Brunner J, Pastore S, Minute M, Parentin F, Tesser A, Nocerino A, Taddio A, Tommasini A, Nørgaard M, Herlin T, Alberdi-Saugstrup M, Zak MS, Nielsen SM, Herlin T, Nordal E, Berntson L, Fasth A, Rygg M, Müller KG, Avramovič MZ, Dolžan V, Toplak N, Avčin T, Ruperto N, Lovell DJ, Wallace C, Toth M. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part two. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461533 DOI: 10.1186/s12969-017-0142-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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