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Festus ID, Spilberg J, Young ME, Cain S, Khoshnevis S, Smolensky MH, Zaheer F, Descalzi G, Martino TA. Pioneering new frontiers in circadian medicine chronotherapies for cardiovascular health. Trends Endocrinol Metab 2024:S1043-2760(24)00040-7. [PMID: 38458859 DOI: 10.1016/j.tem.2024.02.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
Cardiovascular disease (CVD) is a global health concern. Circadian medicine improves cardiovascular care by aligning treatments with our body's daily rhythms and their underlying cellular circadian mechanisms. Time-based therapies, or chronotherapies, show special promise in clinical cardiology. They optimize treatment schedules for better outcomes with fewer side effects by recognizing the profound influence of rhythmic body cycles. In this review, we focus on three chronotherapy areas (medication, light, and meal timing) with potential to enhance cardiovascular care. We also highlight pioneering research in the new field of rest, the gut microbiome, novel chronotherapies for hypertension, pain management, and small molecules that targeting the circadian mechanism.
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Affiliation(s)
- Ifene David Festus
- Centre for Cardiovascular Investigations, University of Guelph; Guelph, Ontario, Canada; Department of Biomedical Sciences, University of Guelph; Guelph, Ontario, Canada
| | - Jeri Spilberg
- Centre for Cardiovascular Investigations, University of Guelph; Guelph, Ontario, Canada; Department of Biomedical Sciences, University of Guelph; Guelph, Ontario, Canada
| | - Martin E Young
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sean Cain
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, Division of Cardiology, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Fariya Zaheer
- Department of Biomedical Sciences, University of Guelph; Guelph, Ontario, Canada
| | - Giannina Descalzi
- Department of Biomedical Sciences, University of Guelph; Guelph, Ontario, Canada
| | - Tami A Martino
- Centre for Cardiovascular Investigations, University of Guelph; Guelph, Ontario, Canada; Department of Biomedical Sciences, University of Guelph; Guelph, Ontario, Canada.
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Fernández JR, Mojón A, Smolensky MH, Hermida RC. Impact of hypertension treatment-time on cardiovascular outcomes: erroneous trial selection leading to suspect findings. J Hypertens 2024; 42:190-191. [PMID: 38033259 DOI: 10.1097/hjh.0000000000003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin
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Hermida RC, Smolensky MH, Mojón A, Fernández JR. Clinical trial design for assessing hypertension medications: are critical circadian chronopharmacological principles being taking into account? Expert Rev Clin Pharmacol 2024; 17:119-130. [PMID: 38197151 DOI: 10.1080/17512433.2024.2304015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/08/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Clinical hypertension trials typically rely on homeostatic principles, including single time-of-day office blood pressure (BP) measurements (OBPM), rather than circadian chronopharmacological principles, including ambulatory monitoring (ABPM) done around-the-clock to derive the asleep systolic BP (SBP) mean and sleep-time relative SBP decline - jointly the strongest prognosticators of cardiovascular disease (CVD) risk and true definition of hypertension - to qualify participants and assess outcomes. AREAS COVERED Eight chronopharmacological elements are indispensable for design and conduct of hypertension medication trials, mainly those on ingestion-time differences in effects, and also a means of rating quality of investigations. Accordingly, we highlight the findings and shortcomings of: (i) 155 such ingestion-time trials, 83.9% finding at-bedtime/evening treatment more beneficial than conventional upon-awakening/morning treatment; (ii) HOPE and ONTARGET CVD outcomes investigations assessing in the former add-on ramipril at-bedtime and in the latter telmisartan, ramipril, or both in combination in the morning; and (iii) pragmatic TIME CVD outcomes trial. EXPERT OPINION Failure to incorporate chronopharmacological principals - including ABPM to derive asleep SBP and SBP dipping to qualify subjects as hypertensive and assess CVD risk - results in deficient study design, dubious findings, and unnecessary medical controversy at the expense of advances in patient care.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Hermida RC, Smolensky MH, Mojón A, Fernández JR. Critical appraisal of recent translational chronopharmacology and chronotherapeutic reviews, meta-analyses, and pragmatic patient trials discloses significant deficiencies of design and conduct and suspect findings. Chronobiol Int 2023; 40:1146-1167. [PMID: 37674275 DOI: 10.1080/07420528.2023.2253288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
The conduct of molecular and laboratory animal circadian rhythm research has increased exponentially in the past few decades, such that today investigations are being performed by scientists of many diverse disciplines. Knowledge gained from past works is now being explored for translational applications to clinical medicine, often termed "circadian medicine," through the implementation of patient trials. However, these trials are being led, more often than not, by investigators who have little or no formal training and in-depth expertise in the methods of human circadian rhythm research, causing them to be deficient in design and produce dubious findings that have already led to unnecessary medical controversy at the expense of advances in patient care. Evidence of the very significant shortcomings of today's translational circadian medicine research is exemplified in two recent publications in well-read reputable medical journals concerning the chronotherapy of blood pressure (BP) medications: one a review and meta-analysis by Maqsood et al. published in the journal Hypertension in 2023 that pertains to ingestion-time differences in the extent of BP reduction exerted by hypertensive medications and the other a report by Mackenzie et al. in the journal Lancet in 2022 that details the results of the pragmatic TIME study that assessed ingestion-time differences in cardiovascular disease outcomes. Herein, we appraise the inaccurate trial selection, lack of quality assessment, and the numerous other shortcomings that culminated in suspect findings and faulty conclusions of the former, as well as the deficiencies in design and conduct of the latter using as reference the eight items identified in 2021 by a working committee of the International Society for Chronobiology and American Association for Medical Chronobiology and Chronotherapeutics as being necessary for high-quality research of circadian rhythm-dependencies of the therapeutic effects of BP-lowering medications. The TIME study when rated for its quality according to the extent to which its investigational methods satisfy all of the eight recommended items attains a very low overall score of + 1 out of a possible range of -1 to + 7. Moreover, our review of the methods of the currently ongoing pragmatic BedMed trial discloses major deficiencies of the same sort rending a poor quality score of + 0.5. Although the focus of this article is the appraisal of the quality of contemporary circadian medicine hypertension chronotherapy research, it additionally exposes the inadequacies and dubious quality of the critique of such manuscripts submitted for publication to influential journals, in that some peer reviewers might also be deficient in the knowledge required to properly rate their merit.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Smolensky MH, Shah AP, Fernández JR, Sackett-Lundeen L, Hermida RC. 24-hour pattern of childhood febrile seizures substantiated by time series meta-analysis: circadian medicine perspectives. Epilepsia 2023. [PMID: 37133268 DOI: 10.1111/epi.17639] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Major objectives of this work were to: (i) substantiate the 24-hour pattern in the occurrence of childhood febrile seizures (CFSs) by a novel time series meta-analysis of past reported time-of-day data and (ii) discuss its potential circadian rhythm-dependencies. METHODS Comprehensive search of the published literature retrieved eight articles that met inclusion criteria. Three investigations were conducted in Iran, two in Japan, and one each in Finland, Italy, and South Korea, representing a total of 2461 mostly simple febrile seizures of children who on average were about two years of age. RESULTS Population Mean Cosinor Analysis validated (P<0.001) a 24-hour pattern in the onset of CFSs, with an approximate four-fold difference in the proportion of children expressing seizures at its peak, at 18:04 h (95% confidence limits: 16:40 to 19:07 h) vs. trough at 06:00 h. SIGNIFICANCE The CFS time-of-day pattern likely derives from the actions of multiple circadian rhythms, particularly the cytokines that comprise the pyrogenic inflammatory pathway and melatonin that influences the excitation level of central neurons and helps regulate body temperature. Past laboratory animal and patient investigations document the vulnerability to a seizure by a provoking trigger of the same intensity is not the same but different in a predictable-in-time manner during the 24 hours as a circadian susceptibility/resistance rhythm. Knowledge of the marked disparity in the time-of-day risk of CFSs can be translated into improved prevention, particularly during the late afternoon and early evening when highest, through proper timing of prophylactic interventions.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ami P Shah
- UMC Children's Hospital of Nevada, University of Nevada-Las Vegas Kirk Kerkorian School of Medicine, Las Vegas, Nevada, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies, Universidade de of Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service, Vigo, Spain
| | - Linda Sackett-Lundeen
- American Association for Medical Chronobiology & Chronotherapeutics, Roseville, Minnesota, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies, Universidade de of Vigo, Vigo, Spain
- Bioengineering & Chronobiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service, Vigo, Spain
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Khoshnevis S, Smolensky MH, Haghayegh S, Castriotta RJ, Hermida RC, Diller KR. Recommended timing of medications that impact sleep and wakefulness: A review of the American Prescribers' Digital Reference. Sleep Med Rev 2023; 67:101714. [PMID: 36509029 DOI: 10.1016/j.smrv.2022.101714] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
An appreciable number of medicines have a recommended unique single time-of-day or asymmetrical or unequal-interval multiple-daily administration schedule. Many prescription and over-the-counter (OTC) products, according to administration time, can exert positive or negative impact on nighttime sleep and daytime wakefulness. Intuitively, medicines used to manage nighttime sleep and daytime wake disorders should be taken, respectively, at night before bedtime and morning after arising. However, some utilized for other medical conditions, if improperly timed, may compromise nocturnal sleep and diurnal attentiveness. We conducted a comprehensive review of the American Prescribers' Digital Reference, internet version of the Physician's Desk Reference, for the recommended scheduling of medications and OTC remedies that can impact sleep and wakefulness. The search revealed several hundred therapies of various classes -- α2-receptor agonists, antidepressants, barbiturates, central nervous system stimulants, benzodiazepines, dopamine agonists, dopamine norepinephrine reuptake inhibitors, selective norepinephrine reuptake inhibitors, eugeroics, γ-aminobutyric acid modulators, H1 and H3-receptor antagonists, melatonin analogues, OTC melatonin-containing products, non-benzodiazepine benzodiazepine-receptor agonists, dual orexin-receptor antagonists, and serotonin modulators -- that have a recommended unique dosing schedule. The tables and text of this article are intended to guide the proper scheduling of these medicines to optimize desired and/or minimize undesired effects.
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Affiliation(s)
- Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA.
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, Division of Cardiology, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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Smolensky MH, Hermida RC, Sackett-Lundeen L, Hermida-Ayala RG, Geng YJ. Does Patient-Applied Testosterone Replacement Therapy Pose Risk for Blood Pressure Elevation? Circadian Medicine Perspectives. Compr Physiol 2022; 12:4165-4184. [PMID: 35950658 DOI: 10.1002/cphy.c220014] [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: 11/10/2022]
Abstract
We reviewed medication package inserts, US Food and Drug Administration (FDA) reports, and journal publications concerning the 10 nonbiosimilar patient-applied (PA) testosterone (T) replacement therapies (TRTs) for intraday serum T patterning and blood pressure (BP) effects. Blood T concentration is circadian rhythmic in young adult eugonadal males, being highest around awakening and lowest before bedtime. T level and 24 h variation are blunted in primary and secondary hypogonadism. Utilized as recommended, most PA-TRTs achieve nonphysiologic T 24 h patterning. Only Androderm® , an evening PA transdermal patch, closely replicates the normal T circadian rhythmicity. Accurate determination of risk for BP elevation and hypertension (HTN) by PA-TRTs is difficult due to limitations of office BP measurements (OBPM) and suboptimal methods and endpoints of ambulatory BP monitoring (ABPM). OBPM is subject to "White Coat" pressor effect resulting in unrepresentative BP values plus masked normotension and masked HTN, causing misclassification of approximately 45% of trial participants, both before and during treatment. Change in guideline-recommended diagnostic thresholds over time causes misclassification of an additional approximately 15% of participants. ABPM is improperly incorporated into TRT safety trials. It is done for 24 h rather than preferred 48 h; BP is oversampled during wakefulness, biasing derived 24 h mean values; 24 h mean systolic and diastolic BP (SBP, DBP) are inappropriate primary outcomes, because of not being best predictors of risk for major acute cardiovascular events (MACE); "daytime" and "nighttime" BP means referenced to clock time are reported rather than biologically relevant wake-time and sleep-time BP means; most importantly, asleep SBP mean and dipping, strongest predictors of MACE, are disregarded. © 2022 American Physiological Society. Compr Physiol 12: 1-20, 2022.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,The Center for Cardiovascular Biology and Atherosclerosis Research, Division of Cardiovascular Medicine, Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramon C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Linda Sackett-Lundeen
- American Association for Medical Chronobiology and Chronotherapeutics, Roseville, Minnesota, USA
| | - Ramon G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Yong-Jian Geng
- The Center for Cardiovascular Biology and Atherosclerosis Research, Division of Cardiovascular Medicine, Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Haghayegh S, Khoshnevis S, Smolensky MH, Hermida RC, Castriotta RJ, Schernhammer E, Diller KR. Novel
temperature‐controlled
sleep system to improve sleep: a p
roof‐of‐concept
study. J Sleep Res 2022; 31:e13662. [DOI: 10.1111/jsr.13662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Shahab Haghayegh
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
- Department of Biomedical Engineering Cockrell School of Engineering, The University of Texas at Austin Austin Texas USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering Cockrell School of Engineering, The University of Texas at Austin Austin Texas USA
| | - Michael H. Smolensky
- Department of Biomedical Engineering Cockrell School of Engineering, The University of Texas at Austin Austin Texas USA
- Department of Internal Medicine, Division of Cardiology McGovern School of Medicine, The University of Texas Health Science Center at Houston Houston Texas USA
| | - Ramon C. Hermida
- Department of Biomedical Engineering Cockrell School of Engineering, The University of Texas at Austin Austin Texas USA
- Bioengineering and Chronobiology Laboratories Atlantic Research Center for Telecommunication Technologies, University of Vigo Vigo Spain
| | - Richard J. Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Eva Schernhammer
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
- Department of Epidemiology Center for Public Health, Medical University of Vienna Vienna Austria
- Department of Epidemiology Harvard TH Chan School of Public Health Boston Massachusetts USA
| | - Kenneth R. Diller
- Department of Biomedical Engineering Cockrell School of Engineering, The University of Texas at Austin Austin Texas USA
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Hermida RC, Mojón A, Smolensky MH, Fernández JR. Consideration of nondipping heart rate during ambulatory blood pressure monitoring to improve cardiovascular risk assessment. Response. Rev Esp Cardiol (Engl Ed) 2022; 75:356. [PMID: 35058219 DOI: 10.1016/j.rec.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Ramón C Hermida
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Pontevedra, Spain.
| | - Artemio Mojón
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Pontevedra, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, United States; Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - José R Fernández
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Pontevedra, Spain
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10
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Geng YJ, Madonna R, Hermida RC, Smolensky MH. Pharmacogenomics and circadian rhythms as mediators of cardiovascular drug-drug interactions. Curr Res Pharmacol Drug Discov 2021; 2:100025. [PMID: 34909660 PMCID: PMC8663962 DOI: 10.1016/j.crphar.2021.100025] [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] [Received: 01/11/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/01/2022] Open
Abstract
This article summarizes the current literature and documents new evidence concerning drug-drug interactions (DDI) stemming from pharmacogenomic and circadian rhythm determinants of therapies used to treat common cardiovascular diseases (CVD), such as atherosclerosis and hypertension. Patients with CVD often have more than one pathophysiologic condition, namely metabolic syndromes, hypertension, hyperlipidemia, and hyperglycemia, among others, which necessitate polytherapeutic or polypharmaceutic management. Interactions between drugs, drugs and food/food supplements, or drugs and genetic/epigenetic factors may have adverse impacts on the cardiovascular and other systems of the body. The mechanisms underlying cardiovascular DDI may involve the formation of a complex pharmacointeractome, including the absorption, distribution, metabolism, and elimination of drugs, which affect their respective bioavailability, efficacy, and/or harmful metabolites. The pharmacointeractome of cardiovascular drugs is likely operated with endogenous rhythms controlled by circadian clock genes. Basic and clinical investigations have improved the knowledge and understanding of cardiovascular pharmacogenomics and pharmacointeractomes, and additionally they have presented new evidence that the staging of deterministic circadian rhythms, according to the dosing time of drugs, e.g., upon awakening vs. at bedtime, cannot only differentially impact their pharmacokinetics and pharmacodynamics but also mediate agonistic/synergetic or antagonistic DDI. To properly manage CVD patients and avoid DDI, it is important that clinicians have sufficient knowledge of their multiple risk factors, i.e., age, gender, and life style elements (like diet, smoking, psychological stress, and alcohol consumption), and comorbidities, such as diabetes, hypertension, dyslipidemia, and depression, and the potential interactions between genetic or epigenetic background of their prescribed therapeutics.
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Affiliation(s)
- Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rosalinda Madonna
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Chair of Cardiology, Department of Surgical, Medical and Molecular Pathology, University of Pisa, Pisa, Italy
| | - Ramon C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Michael H Smolensky
- Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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11
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Hermida-Ayala RG, Mojón A, Fernández JR, Smolensky MH, Hermida RC. Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials. Chronobiol Int 2021; 39:493-512. [PMID: 34906002 DOI: 10.1080/07420528.2021.2005084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pharmacodynamics of hypertension medications can be significantly affected by circadian rhythms in the biological mechanisms of the 24 h blood pressure (BP) pattern. Hypertension guidelines fail to recommend the time of day when patients, including those who require treatment with multiple medications, are to ingest BP-lowering therapy. We conducted a systematic review of published prospective trials that investigated hypertension medications for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of target organ pathology. Among the search-retried 155 trials, 17 published between 1991 and 2020 totaling 1,508 hypertensive participants concerned the differential ingestion-time dependent effects of 14 unique dual-combination therapies. All but one (94.1%) of the trials, involving 98.5% of the total number of investigated individuals, reported clinically and statistically significant benefits - including enhanced reduction of asleep BP without induction of sleep-time hypotension, reduced prevalence of BP non-dipping, decreased adverse effects, improved kidney function, and reduced cardiac pathology - when dual-combination hypertension medications were ingested at-bedtime/evening rather than upon-waking/morning. A systematic and comprehensive review of the literature published in the past three decades reveals no single dual-combination hypertension trial reported significantly better benefit of the still conventional, yet unjustified by medical evidence, upon-waking/morning hypertension treatment scheme.
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Affiliation(s)
- Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramón C Hermida
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
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12
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Delisle BP, George AL, Nerbonne JM, Bass JT, Ripplinger CM, Jain MK, Hermanstyne TO, Young ME, Kannankeril PJ, Duffy JF, Goldhaber JI, Hall MH, Somers VK, Smolensky MH, Garnett CE, Anafi RC, Scheer FAJL, Shivkumar K, Shea SA, Balijepalli RC. Understanding Circadian Mechanisms of Sudden Cardiac Death: A Report From the National Heart, Lung, and Blood Institute Workshop, Part 2: Population and Clinical Considerations. Circ Arrhythm Electrophysiol 2021; 14:e010190. [PMID: 34719257 DOI: 10.1161/circep.121.010190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sudden cardiac death (SCD) is the sudden, unexpected death due to abrupt loss of heart function secondary to cardiovascular disease. In certain populations living with cardiovascular disease, SCD follows a distinct 24-hour pattern in occurrence, suggesting day/night rhythms in behavior, the environment, and endogenous circadian rhythms result in daily spans of increased vulnerability. The National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death to identify fundamental questions regarding the role of the circadian rhythms in SCD. Part 2 summarizes research gaps and opportunities in the areas of population and clinical research identified in the workshop. Established research supports a complex interaction between circadian rhythms and physiological responses that increase the risk for SCD. Moreover, these physiological responses themselves are influenced by several biological variables, including the type of cardiovascular disease, sex, age, and genetics, as well as environmental factors. The emergence of new noninvasive biotechnological tools that continuously measure key cardiovascular variables, as well as the identification of biomarkers to assess circadian rhythms, hold promise for generating large-scale human data sets that will delineate which subsets of individuals are most vulnerable to SCD. Additionally, these data will improve our understanding of how people who suffer from circadian disruptions develop cardiovascular diseases that increase the risk for SCD. Emerging strategies to identify new biomarkers that can quantify circadian health (eg, environmental, behavioral, and internal misalignment) may lead to new interventions and therapeutic targets to prevent the progression of cardiovascular diseases that cause SCD.
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Affiliation(s)
- Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington (B.P.D.)
| | - Alfred L George
- Department of Pharmacology (A.L.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jeanne M Nerbonne
- Cardiovascular Division, and Developmental Biology, Departments of Medicine (J.M.N.), Washington University School of Medicine, St Louis, MO
| | - Joseph T Bass
- Department of Medicine (J.T.B.), Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Mukesh K Jain
- Department of Medicine, Case Western Reserve University, Cleveland, OH (M.K.J.)
| | - Tracey O Hermanstyne
- Department of Developmental Biology (T.O.H.), Washington University School of Medicine, St Louis, MO
| | - Martin E Young
- Department of Medicine, University of Alabama, Birmingham (M.E.Y.)
| | - Prince J Kannankeril
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN (P.J.K.)
| | - Jeanne F Duffy
- Department of Medicine (J.F.D.), Harvard Medical School, Boston, MA
| | - Joshua I Goldhaber
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (J.I.G.)
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, PA (M.H.H.)
| | | | | | | | - Ron C Anafi
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (R.C.A.)
| | - Frank A J L Scheer
- Division of Sleep Medicine (F.A.J.L.S.), Harvard Medical School, Boston, MA
| | - Kalyanam Shivkumar
- Departement of Medicine, David Greffen School of Medicine, University of California, Los Angeles (K.S.)
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (S.A.S.)
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13
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Delisle BP, George AL, Nerbonne JM, Bass JT, Ripplinger CM, Jain MK, Hermanstyne TO, Young ME, Kannankeril PJ, Duffy JF, Goldhaber JI, Hall MH, Somers VK, Smolensky MH, Garnett CE, Anafi RC, Scheer FA, Shivkumar K, Shea SA, Balijepalli RC. Understanding Circadian Mechanisms of Sudden Cardiac Death: A Report From the National Heart, Lung, and Blood Institute Workshop, Part 1: Basic and Translational Aspects. Circ Arrhythm Electrophysiol 2021; 14:e010181. [PMID: 34719240 PMCID: PMC8815462 DOI: 10.1161/circep.121.010181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sudden cardiac death (SCD), the unexpected death due to acquired or genetic cardiovascular disease, follows distinct 24-hour patterns in occurrence. These 24-hour patterns likely reflect daily changes in arrhythmogenic triggers and the myocardial substrate caused by day/night rhythms in behavior, the environment, and endogenous circadian mechanisms. To better address fundamental questions regarding the circadian mechanisms, the National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death. We present a 2-part report of findings from this workshop. Part 1 summarizes the workshop and serves to identify research gaps and opportunities in the areas of basic and translational research. Among the gaps was the lack of standardization in animal studies for reporting environmental conditions (eg, timing of experiments relative to the light dark cycle or animal housing temperatures) that can impair rigor and reproducibility. Workshop participants also pointed to uncertainty regarding the importance of maintaining normal circadian rhythmic synchrony and the potential pathological impact of desynchrony on SCD risk. One related question raised was whether circadian mechanisms can be targeted to reduce SCD risk. Finally, the experts underscored the need for studies aimed at determining the physiological importance of circadian clocks in the many different cell types important to normal heart function and SCD. Addressing these gaps could lead to new therapeutic approaches/molecular targets that can mitigate the risk of SCD not only at certain times but over the entire 24-hour period.
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Affiliation(s)
| | - Alfred L. George
- Department of Pharmacology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jeanne M. Nerbonne
- Departments of Medicine, Cardiovascular Division, and Developmental Biology, Washington University School of Medicine, St. Louis, MO
| | - Joseph T. Bass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Mukesh K. Jain
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Tracey O. Hermanstyne
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO
| | - Martin E. Young
- Department of Medicine, University of Alabama, Birmingham, AL
| | | | | | | | - Martica H. Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Ron C. Anafi
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Kalyanam Shivkumar
- Departement of Medicine, David Greffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven A. Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR
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14
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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15
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Smolensky MH, Hermida RC. Commentary on Bowles and Shea: Further perspectives and clinical implications of ingestion-time differences in the efficacy of blood pressure-lowering medications. Sleep Med Rev 2021; 59:101540. [PMID: 34425377 DOI: 10.1016/j.smrv.2021.101540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA
| | - Ramón C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain.
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16
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Hermida RC, Mojón A, Smolensky MH, Fernández JR. Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension-Pro Side of the Argument. Hypertension 2021; 78:879-893. [PMID: 34379438 DOI: 10.1161/hypertensionaha.120.16500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ramón C Hermida
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.).,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin (R.C.H., M.H.S.)
| | - Artemio Mojón
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.)
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin (R.C.H., M.H.S.).,Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston (M.H.S.)
| | - José R Fernández
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.)
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17
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Hermida RC, Mojón A, Fernández JR, Hermida-Ayala RG, Crespo JJ, Ríos MT, Domínguez-Sardiña M, Otero A, Smolensky MH. Elevated asleep blood pressure and non-dipper 24h patterning best predict risk for heart failure that can be averted by bedtime hypertension chronotherapy: A review of the published literature. Chronobiol Int 2021; 40:63-82. [PMID: 34190016 DOI: 10.1080/07420528.2021.1939367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Several prospective studies consistently report elevated asleep blood pressure (BP) and blunted sleep-time relative systolic BP (SBP) decline (non-dipping) are jointly the most significant prognostic markers of cardiovascular disease (CVD) risk, including heart failure (HF); therefore, they, rather than office BP measurements (OBPM) and ambulatory awake and 24 h BP means, seemingly are the most worthy therapeutic targets for prevention. Published studies of the 24 h BP pattern in HF are sparse in number and of limited sample size. They report high prevalence of the abnormal non-dipper/riser 24 h SBP patterning. Despite the established clinical relevance of the asleep BP, past as do present hypertension guidelines recommend the diagnosis of hypertension rely on OBPM and, when around-the-clock ambulatory BP monitoring (ABPM) is conducted to confirm the elevated OBPM, either on the derived 24 h or "daytime" BP means. Additionally, hypertension guidelines do not advise the time-of-day when BP-lowering medications should be ingested, in spite of known ingestion-time differences in their pharmacokinetics and pharmacodynamics. Between 1976 and 2020, 155 unique trials of ingestion-time differences in the effects of 37 different single and 14 dual-combination hypertension medications, collectively involving 23,972 patients, were published. The vast majority (83.9%) of them found the at-bedtime/evening in comparison to upon-waking/morning treatment schedule resulted in more greatly enhanced: (i) reduction of asleep BP mean without induced sleep-time hypotension; (ii) reduction of the prevalence of the higher CVD risk non-dipper/riser 24 h BP phenotypes; (iii) improvement of kidney function, reduction of cardiac pathology, and with lower incidence of adverse effects. Most notably, no single published randomized trial found significantly better BP-lowering, particularly during sleep, or medical benefits of the most popular upon-waking/morning hypertension treatment-time scheme. Additionally, prospective outcome trials have substantiated that the bedtime relative to the upon-waking, ingestion of BP-lowering medications not only significantly reduces risk of HF but also improves overall CVD event-free survival time.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, -USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - María T Ríos
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | | | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín E O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, -USA.,Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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18
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Hermida RC, Hermida-Ayala RG, Mojón A, Smolensky MH, Fernández JR. Systematic review and quality evaluation of published human ingestion-time trials of blood pressure-lowering medications and their combinations. Chronobiol Int 2021; 38:1460-1476. [PMID: 34107831 DOI: 10.1080/07420528.2021.1931280] [Citation(s) in RCA: 8] [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] [Indexed: 01/07/2023]
Abstract
The pharmacokinetics (PK) - absorption, distribution, metabolism, and elimination - and pharmacodynamics (PD) of hypertension medications can be significantly affected by circadian rhythms. As a consequence, the time when blood pressure (BP) lowering medications are ingested, with reference to the staging of all involved circadian rhythms modulating PK and PD, can affect their duration of action, magnitude of effect on features of the 24 h BP profile, and safety. We conducted a systematic and comprehensive review of published prospective human trials that investigated individual hypertension medications of all classes and their combinations for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of hypertension-associated target organ pathology of the kidney and heart. The systematic review yielded 155 trials published between 1976 and 2020 - totaling 23,972 hypertensive individuals - that evaluated 37 different single and 14 dual-combination therapies. The vast (83.9%) majority of them reported clinically and statistically significant benefits - including enhanced reduction of asleep BP mean without induced sleep-time hypotension, reduced prevalence of the higher cardiovascular risk non-dipper 24 h BP profile, decreased incidence of adverse effects, improved kidney function, and reduced cardiac pathology - when hypertension medications are ingested at-bedtime/evening rather than upon-waking/morning. Nonetheless, the findings and conclusions of some past conducted trials are inconsistent, often due to disparities and deficiencies of the investigative protocols. Accordingly, we developed a quality assessment method based upon the eight items identified as crucial according to the recently published guidelines of the International Society for Chronobiology and the American Association for Medical Chronobiology and Chronotherapeutics for the design and conduct of human clinical trials on ingestion-time differences of hypertension medications. Among the most frequent deficiencies are: absence or miscalculation of minimum required sample size (83.2%), incorrect choice of primary BP endpoint (53.6%), and inappropriate arbitrary and unrepresentative clock hours chosen for tested treatment times (53.6%). The inability of the very small proportion (16.1%) of trials to verify the advantages of the at-bedtime/evening treatment strategy is likely explained by deficiencies of their study design and conduct. Nonetheless, regardless of the quality score of the 155 trials retrieved by our systematic review, it is most noteworthy that no single published prospective randomized trial reported significantly enhanced BP-lowering, safety, compliance, or other benefits of the unjustified by medical evidence, yet still most recommended, upon-waking/morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
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19
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Fernández JR. Ingestion-time differences in the pharmacodynamics of hypertension medications: Systematic review of human chronopharmacology trials. Adv Drug Deliv Rev 2021; 170:200-213. [PMID: 33486007 DOI: 10.1016/j.addr.2021.01.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Pharmacokinetics of hypertension medications is significantly affected by circadian rhythms that influence absorption, distribution, metabolism and elimination. Furthermore, their pharmacodynamics is affected by ingestion-time differences in kinetics and circadian rhythms comprising the biological mechanism of the 24 h blood pressure (BP) pattern. However, hypertension guidelines do not recommend the time to treat patients with medications. We conducted a systematic review of published evidence regarding ingestion-time differences of hypertension medications and their combinations on ambulatory BP-lowering, safety, and markers of target organ pathology. Some 153 trials published between 1976 and 2020, totaling 23,869 hypertensive individuals, evaluated 37 different single and 14 dual-fixed combination therapies. The vast (83.7%) majority of the trials report clinically and statistically significant benefits - including enhanced reduction of asleep BP without inducing sleep-time hypotension, reduced prevalence of the higher cardiovascular disease risk BP non-dipping 24 h profile, decreased incidence of adverse effects, improved renal function, and reduced cardiac pathology - when hypertension medications are ingested at-bedtime/evening rather than upon-waking/morning. Non-substantiated treatment-time difference in effects by the small proportion (16.3%) of published trials is likely explained by deficiencies of study design and conduct. Systematic and comprehensive review of the literature published the past 45 years reveals no single study reported significantly better benefit of the still conventional, yet unjustified by medical evidence, upon-waking/morning hypertension treatment schedule.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712-0238, USA.
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, 15703, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712-0238, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo 36310, Spain
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20
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Hermida RC, Mojón A, Hermida-Ayala RG, Smolensky MH, Fernández JR. Extent of asleep blood pressure reduction by hypertension medications is ingestion-time dependent: Systematic review and meta-analysis of published human trials. Sleep Med Rev 2021; 59:101454. [PMID: 33571840 DOI: 10.1016/j.smrv.2021.101454] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
Combined evidence of published prospective outcome trials and meta-analyses substantiate elevated asleep blood pressure (BP) and blunted sleep-time relative BP decline (non-dipping), regardless of wake-time office BP and awake or 24 h BP means, are jointly the most highly significant independent prognostic markers of cardiovascular disease (CVD) risk and worthy therapeutic targets for prevention. Nonetheless, current guidelines continue to recommend the diagnosis of hypertension, when based on ambulatory BP monitoring (ABPM), rely, solely, on either the 24 h or "daytime" BP means. They also fail to recommend the time to treat patients. We conducted a systematic review of published human trials regarding ingestion-time differences in the effects of hypertension medications on asleep BP and sleep-time relative BP decline. Some 62 such trials published between 1992 and 2020, totaling 6120 hypertensive persons, evaluated 21 different single and 8 dual-fixed combination therapies. The vast (82.3%) majority of the trials substantiate the bedtime/evening vs. upon-waking/morning treatment schedule produces statistically significant better clinical benefits, including enhanced reduction of asleep systolic BP by an average 5.17 mmHg (95%CI [4.04, 6.31], P < 0.001 between treatment-time groups) without inducing sleep-time hypotension, reduced prevalence of the high CVD risk non-dipper 24 h BP pattern, improved kidney function, and reduced cardiac pathology. Furthermore, systematic and comprehensive review of the ABPM-based literature published the past 29 years reveals no single study that reported significantly better benefits of the most recommended, yet unjustified by medical evidence, morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA.
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
| | - Ramón G Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, 15703, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
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21
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Hermida RC, Smolensky MH, Balan H, Castriotta RJ, Crespo JJ, Dagan Y, El-Toukhy S, Fernández JR, FitzGerald GA, Fujimura A, Geng YJ, Hermida-Ayala RG, Machado AP, Menna-Barreto L, Mojón A, Otero A, Rudic RD, Schernhammer E, Skarke C, Steen TY, Young ME, Zhao X. Guidelines for the design and conduct of human clinical trials on ingestion-time differences - chronopharmacology and chronotherapy - of hypertension medications. Chronobiol Int 2020; 38:1-26. [PMID: 33342316 DOI: 10.1080/07420528.2020.1850468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Current hypertension guidelines fail to provide a recommendation on when-to-treat, thus disregarding relevant circadian rhythms that regulate blood pressure (BP) level and 24 h patterning and medication pharmacokinetics and pharmacodynamics. The ideal purpose of ingestion-time (chronopharmacology, i.e. biological rhythm-dependent effects on the kinetics and dynamics of medications, and chronotherapy, i.e. the timing of pharmaceutical and other treatments to optimize efficacy and safety) trials should be to explore the potential impact of endogenous circadian rhythms on the effects of medications. Such investigations and outcome trials mandate adherence to the basic standards of human chronobiology research. In-depth review of the more than 150 human hypertension pharmacology and therapeutic trials published since 1974 that address the differential impact of upon-waking/morning versus at-bedtime/evening schedule of treatment reveals diverse protocols of sometimes suboptimal or defective design and conduct. Many have been "time-of-day," i.e. morning versus evening, rather than circadian-time-based, and some relied on wake-time office BP rather than around-the-clock ambulatory BP measurements (ABPM). Additionally, most past studies have been of too small sample size and thus statistically underpowered. As of yet, there has been no consensual agreement on the proper design, methods and conduct of such trials. This Position Statement recommends ingestion-time hypertension trials to follow minimum guidelines: (i) Recruitment of participants should be restricted to hypertensive individuals diagnosed according to ABPM diagnostic thresholds and of a comparable activity/sleep routine. (ii) Tested treatment-times should be selected according to internal biological time, expressed by the awakening and bed times of the sleep/wake cycle. (iii) ABPM should be the primary or sole method of BP assessment. (iv) The minimum-required features for analysis of the ABPM-determined 24 h BP pattern ought to be the asleep (not "nighttime") BP mean and sleep-time relative BP decline, calculated in reference to the activity/rest cycle per individual. (v) ABPM-obtained BP means should be derived by the so-called adjusted calculation procedure, not by inaccurate arithmetic averages. (vi) ABPM should be performed with validated and calibrated devices at least hourly throughout two or more consecutive 24 h periods (48 h in total) to achieve the highest reproducibility of mean wake-time, sleep-time and 48 h BP values plus the reliable classification of dipping status. (vii) Calculation of minimum required sample size in adherence with proper statistical methods must be provided. (viii) Hypertension chronopharmacology and chronotherapy trials should preferably be randomized double-blind, randomized open-label with blinded-endpoint, or crossover in design, the latter with sufficient washout period between tested treatment-time regimens.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, Texas, USA.,Division of Cardiology, McGovern School of Medicine, the University of Texas at Houston , Houston, Texas, USA
| | - Horia Balan
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania
| | - Richard J Castriotta
- Department of Medicine; Division of Pulmonary, Critical Care and Sleep Medicine; Keck School of Medicine, University of Southern California , Los Angeles, California, USA
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain.,Centro de Salud de Bembrive, Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | - Yaron Dagan
- Applied Chronobiology Research Center, Tel-Hai Academic College, Israel; Human Biology Department, Haifa University , Israel.,Sleep and Fatigue Institute, Assuta Medical Center , Israel
| | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, Maryland, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain
| | - Garret A FitzGerald
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | - Akio Fujimura
- Department of Clinical Pharmacology, Jichi Medical University , Tochigi, Japan.,Department of Internal Medicine, Shin-Kaminokawa Hospital , Tochigi, Japan
| | - Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston , Houston, Texas, USA
| | - Ramón G Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D) , Santiago de Compostela, Spain
| | | | - Luiz Menna-Barreto
- Escola de Artes, Ciências e Humanidades, Grupo Multidisciplinar de Desenvolvimento e Ritmos Biológicos (GMDRB), Universidade de São Paulo , São Paulo, Brazil
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain
| | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS) , Ourense, Spain
| | - R Daniel Rudic
- Department of Pharmacology & Toxicology, Augusta University , Augusta, Georgia, USA
| | - Eva Schernhammer
- Department of Epidemiology, Harvard T.H Chan School of Public Health , Boston, Massachusetts, USA.,Department of Epidemiology, Center for Public Health, Medical University of Vienna , Vienna, Austria.,Channing Division of Network Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | - Tomoko Y Steen
- Department of Microbiology and Immunology, School of Medicine, Georgetown University , Washington, DC, USA
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama, USA
| | - Xiaoyun Zhao
- Respiratory and Critical Care Medicine Department, Sleep Medicine Center, Tianjin Chest Hospital , Tianjin, China
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Smolensky MH, Hermida RC, Geng YJ. Chronotherapy of cardiac and vascular disease: timing medications to circadian rhythms to optimize treatment effects and outcomes. Curr Opin Pharmacol 2020; 57:41-48. [PMID: 33279870 DOI: 10.1016/j.coph.2020.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
Circadian rhythms impact cardiac and vascular pathophysiology, resulting in 24-hour patterning of symptoms and life-threatening/ending events (chronopathology), plus kinetics and dynamics of medications (chronopharmacology), resulting in administration-time differences in efficacy and safety. Scheduling medications according to circadian rhythm determinants (chronotherapy) can improve treatment effects, for example, before dinner/bedtime ingestion of cholesterol-lowering medications and acetylsalicylic acid, respectively, exerts enhanced control of hypercholesterolemia and after-awakening peak of platelet aggregation; bedtime ingestion of conventional hypertension medications optimizes normalization of sleep-time blood pressure (BP)-strongest independent BP marker of cardiovascular disease (CVD) risk-and most effectively prevents (chronoprevention) CVD morbidity and mortality. Exploration of chronotherapeutic strategies to improve management of cardiac arrhythmias and vascular pathophysiology is still awaited.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic) University of Vigo, Vigo, Spain
| | - Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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Hermida RC, Mojón A, Fernández JR, Otero A, Crespo JJ, Domínguez-Sardiña M, Ríos MT, Smolensky MH. Ambulatory blood pressure monitoring-based definition of true arterial hypertension. Minerva Med 2020; 111:573-588. [DOI: 10.23736/s0026-4806.20.06834-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Fernández JR. Ingestion-time – relative to circadian rhythms – differences in the pharmacokinetics and pharmacodynamics of hypertension medications. Expert Opin Drug Metab Toxicol 2020; 16:1159-1173. [DOI: 10.1080/17425255.2020.1825681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ramón C. Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, TX, USA
| | | | - Michael H. Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, TX, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
| | - José R. Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
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25
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Hermida RC, Ayala DE, Mojón A, Smolensky MH, Crespo JJ, Otero A, Domínguez-Sardiña M, Moyá A, Ríos MT, Castiñeira MC, Callejas PA, Pousa L, Sineiro E, Salgado JL, Durán C, Sánchez JJ, Fernández JR. Cardiovascular disease risk stratification by the Framigham score is markedly improved by ambulatory compared with office blood pressure. ACTA ACUST UNITED AC 2020; 74:953-961. [PMID: 32950423 DOI: 10.1016/j.rec.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/12/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ambulatory blood pressure (BP) better predicts cardiovascular disease (CVD) outcomes than office BP measurements (OBPM). Nonetheless, current CVD risk stratification models continue to rely on exclusively daytime OBPM along with traditional factors, eg, age, sex, smoking, dyslipidemia, and/or diabetes. METHODS Data from 19 949 participants of the primary care-based Hygia Project assessed by 48-hour ambulatory BP monitoring (ABPM) and without prior CVD events were used to compare the diagnostic accuracy, discrimination, and performance of the original Framingham risk score (RSOFG) and its adjusted version to the Hygia Project study population (RSAFG) with that of a novel CVD risk stratification model constructed by replacing OBPM with ABPM-derived prognostic parameters (RSABPM). RESULTS During the follow-up, lasting up to 12.7 years, 1854 participants experienced a primary CVD outcome of CVD death, myocardial infarction, coronary revascularization, heart failure, stroke, transient ischemic attack, angina pectoris, or peripheral artery disease. Asleep systolic BP (SBP) mean and sleep-time relative SBP decline were the only joint significant ABPM-derived predictive factors of CVD risk and were therefore used to substitute for in-clinic SBP in the RSABPM model. The RSABPM model, in comparison with the RSOFG and RSAFG models, showed significantly improved calibration, diagnostic accuracy, discrimination, and performance (always P<.001). The RSAFG-derived event-probabilities of 57.3% of the participants were outside the 95% confidence limits of the event probability determined by the RSABPM model. CONCLUSIONS These collective findings reveal important limitations of CVD risk stratification when based upon OBPM, as in the Framingham score, and corroborate the clinical value of around-the-clock ABPM to properly diagnose true hypertension and reliably stratify CVD vulnerability.
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Affiliation(s)
- Ramón C Hermida
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, United States.
| | - Diana E Ayala
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain
| | - Artemio Mojón
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, United States
| | - Juan J Crespo
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), Orense, Spain
| | - Manuel Domínguez-Sardiña
- Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Ana Moyá
- Estructura de Xerencia Integrada Pontevedra e O Salnés, Servicio Galego de Saúde (SERGAS), Pontevedra, Spain
| | - María T Ríos
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - María C Castiñeira
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Lugo, Cervo e Monforte de Lemos, Servicio Galego de Saúde (SERGAS), Lugo, Spain
| | - Pedro A Callejas
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Lorenzo Pousa
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Elvira Sineiro
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xerencia Integrada Pontevedra e O Salnés, Servicio Galego de Saúde (SERGAS), Pontevedra, Spain
| | - José L Salgado
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Carmen Durán
- Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Juan J Sánchez
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Estructura de Xestión Integrada de Santiago de Compostela, Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - José R Fernández
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain
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Hermida RC, Hermida-Ayala RG, Smolensky MH, Mojón A, Crespo JJ, Otero A, Ríos MT, Domínguez-Sardiña M, Fernández JR. Does Timing of Antihypertensive Medication Dosing Matter? Curr Cardiol Rep 2020; 22:118. [DOI: 10.1007/s11886-020-01353-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hermida RC, Mojón A, Fernández JR, Otero A, Crespo JJ, Domínguez-Sardiña M, Ríos MT, Smolensky MH. Ambulatory blood pressure monitoring-based definition of true arterial hypertension. Minerva Med 2020. [PMID: 32700870 DOI: 10.23736/s0026‐4806.20.06834‐2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Daytime office blood pressure measurements (OBPM), still recommended and utilized today for diagnosis and management of hypertension and categorization of cardiovascular disease (CVD) risk, fail to reveal clinically important features of the mostly predictable BP 24 h pattern and leads to a large proportion of individuals being misclassified. Most clinical guidelines now recommend ambulatory BP monitoring (ABPM) be applied to adult patients to confirm the OBPM-based diagnosis of hypertension, based on the high prevalence of masked hypertension and masked normotension plus demonstrated significantly better CVD prognostic value of around-the-clock ABPM than daytime OBPM. Nonetheless, there is yet no consensus of which parameter(s) and ABPM thresholds to utilize to diagnose hypertension. Findings of large prospective ABPM-based CVD outcome trials permit prospective evaluation of treatment and other induced changes in OBPM and ABPM during follow-up on CVD risk by incorporating multiple periodic (at least annual) patient ABPM assessments. They indicate: 1) asleep systolic BP (SBP) mean and sleep-time relative SBP decline (dipping) together are the most significant and only BP-derived prognostic markers of CVD risk; accordingly, around-the-clock ABPM should be the recommended method to diagnose true arterial hypertension and accurately assess CVD risk; and (2) treatment-induced lowering of the asleep SBP mean and rise of the sleep-time relative SBP decline towards the normal dipper BP pattern are both significantly protective against CVD events, thus constituting novel therapeutic targets to substantially better reduce CVD risk compared to the traditional approach that targets control of daytime OBPM or awake BP mean.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain - .,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA -
| | - Artemio Mojón
- Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Alfonso Otero
- Service of Nephrology, Integrated Management Structure of Ourense, Servicio Galego de Saúde (SERGAS), University Hospital of Ourense, Verín e O Barco de Valdeorras, Spain
| | - Juan J Crespo
- Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain.,Integrated Management Structure of Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | | | - María T Ríos
- Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain.,Integrated Management Structure of Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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Hermida RC, Smolensky MH, Mojón A, Crespo JJ, Ríos MT, Domínguez-Sardiña M, Otero A, Fernández JR. New perspectives on the definition, diagnosis, and treatment of true arterial hypertension. Expert Opin Pharmacother 2020; 21:1167-1178. [PMID: 32543325 DOI: 10.1080/14656566.2020.1746274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Office blood pressure measurements (OBPM), still used today for diagnosis and management of hypertension, fail to reveal clinically important features of the mostly predictable blood pressure (BP) 24 h pattern, and lead to >45% of individuals being misclassified. Current hypertension guidelines do not provide recommendation on when-to-treat, despite multiple prospective clinical trials documenting improved normalization of 24 h BP pattern and significant reduction in cardiovascular disease (CVD) events when hypertension medications are ingested at bedtime rather than upon waking. AREAS COVERED In this review, the authors discuss current evidence on the: (i) most relevant attributes of the 24 h BP pattern deterministic of CVD risk; (ii) asleep systolic BP (SBP) mean as the most significant therapeutic target for CVD risk reduction; (iii) ingestion-time differences in pharmacodynamics of BP-lowering medications as reported with high consistency in multiple clinical trials; and (iv) enhanced prevention of CVD events achieved by bedtime hypertension chronotherapy. EXPERT OPINION Several prospective trials consistently document asleep SBP mean and sleep-time relative SBP decline (dipping) constitute highly significant CVD risk factors, independent of OBPM. Bedtime, compared to customary upon-waking, hypertension chronotherapy reduces risk of major CVD events. Collectively, these findings call for new definition of true hypertension and, accordingly, its proper diagnosis and management.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, TX, USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | - María T Ríos
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | | | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS) , Ourense, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, University of Vigo , Vigo, Spain.,Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo , Vigo, Spain
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Haghayegh S, Kang HA, Khoshnevis S, Smolensky MH, Diller KR. A comprehensive guideline for Bland-Altman and intra class correlation calculations to properly compare two methods of measurement and interpret findings. Physiol Meas 2020; 41:055012. [PMID: 32252039 DOI: 10.1088/1361-6579/ab86d6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The rapid emergence of new measurement instruments and methods requires personnel and researchers of different disciplines to know the correct statistical methods to utilize to compare their performance with reference ones and properly interpret findings. We discuss the often-made mistake of applying the inappropriate correlation and regression statistical approaches to compare methods and then explain the concepts of agreement and reliability. Then, we introduce the intraclass correlation as a measure of inter-rater reliability, and the Bland-Altman plot as a measure of agreement, and we provide formulae to calculate them along with illustrative examples for different types of study designs, specifically single measurement per subject, repeated measurement while the true value is constant, and repeated measurement when the true value is not constant. We emphasize the requirement to validate the assumptions of these statistical approaches, and also how to deal with violations and provide formulae on how to calculate the confidence interval for estimated values of agreement and intraclass correlation. Finally, we explain how to interpret and report the findings of these statistical analyses.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States of America
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30
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Affiliation(s)
- Akio Fujimura
- Department of Clinical Pharmacology, Jichi Medical University, Tochigi, Japan
- Department of Internal Medicine, Shin-Kaminokawa Hospital, Tochigi, Japan
| | - Kentaro Ushijima
- Division of Pharmaceutics, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan
| | - Michael H. Smolensky
- Department of Biomedical Engineering, The University of Texas, Austin, Texas, USA
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Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. 1196 Machine Learning Derived-Interpretative Algorithm Better Differentiates Sleep and Wake Epochs and Estimates Sleep Parameters from Wrist Actigraphy Data. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Several different interpretive algorithms (IAs) are available for scoring actigraphy-obtained body movement data for sleep and wake epochs. Although most have high sensitivity in detecting sleep epochs, they identify wake epochs poorly. We derived a machine learning (ML) based IA that improves differentiation of sleep and wake epoch to better estimate sleep parameters.
Methods
Forty-one adults (18 females) 26.6±12.0 years old underwent at-home single-night sleep assessment. Motionlogger® Micro Watch Actigraph recorded in zero crossing mode body movement per 30s epoch, with automated sleep scoring by single-channel electroencephalography (EEG) device (Zmachine® Insight+) as reference. The popular Cole-Kripke IA was applied to score body movement time series data of the following combination of current 1, preceding 4, and following 2 minute long epochs. Data of 21 subjects were utilized to train/derive the ML IA (logistic regression), and data of the other 20 subjects were used to test performance of it and the Cole-Kripke IA.
Results
In reference to the EEG, the Cole-Kripke actigraphy IA showed sensitivity of 0.98±0.02, specificity of 0.48±0.19, and kappa agreement of 0.53±0.16 in detecting sleep epochs, while the ML-derived IA showed corresponding values of 0.90±0.06, 0.71±0.14, and 0.57±0.11. The Cole-Kripke IA, relative to EEG, method significantly (P<0.05) underestimated sleep onset latency (SOL) by 18.0 min and wake after sleep onset (WASO) by 35.1 min, and overestimated total sleep time (TST) by 53.1 min and sleep efficiency (SE) by 9.6%. The ML-derived IA, relative to EEG significantly underestimated SOL by 15.1 min, but comparably (P>0.05) estimated WASO, TST, and SE.
Conclusion
The ML-derived IA, in comparison to Cole-Kripke IA, when applied to sleep-time wrist actigraphy data significantly better differentiates wake from sleep epochs and better estimates sleep parameters.
Support
This work was supported by the Robert and Prudie Leibrock Professorship in Engineering at the University of Texas at Austin.
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Affiliation(s)
- S Haghayegh
- The University of Texas at Austin, Austin, TX
| | | | | | - K R Diller
- The University of Texas at Austin, Austin, TX
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López-Soto PJ, Smolensky MH, Sackett-Lundeen L, Manfredini R, Fabbian F, Rodríguez-Borrego MA. Twenty-four-hour, weekly and annual patterns in serious falls of non-institutionalized independent Spanish seniors. Eur Rev Med Pharmacol Sci 2020; 24:1440-1453. [PMID: 32096194 DOI: 10.26355/eurrev_202002_20203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The study aimed to explore clock hour, day-of-week, and month-of-year patterns of serious falls experienced by non-institutionalized Spanish seniors (age ≥65 years) in relation to associated conventional intrinsic and extrinsic factors. PATIENTS AND METHODS Intake emergency department records from January 1 to December 31, 2013 of a tertiary hospital of southern Spain were abstracted for particulars of falls, including the time of occurrence, experienced specifically by non-institutionalized seniors. Chi-squares and Single and Multiple-Component Cosinor (time series) Analyses were applied to determine the statistical significance of observed 24-hour, 7-day, and annual variation. RESULTS Falls were ~2.5-fold more numerous in older women than older men and ~7-fold more frequent between 12:00 and 14:00 hours than ~02:00 hours, respectively, the time spans corresponding to the absolute peak and trough of the 24-hour pattern in falls. The midday/early afternoon peak primarily represented incidents of women ≥75 years of age that occurred inside the home while walking, standing, or moving on stairs. A late evening less prominent excess of mostly inside-the-home incidents of women ≥75 years of age, largely due to fragility, slipping, stumbling, or tripping, was additionally detected. Cosinor Analysis substantiates statistical significance of the 24-hour patterning of falls of men and women (both p<0.001). Day-of-week differences, with prominent Thursday peak and Sunday minimum, were additionally detected, but only for falls of women occurring outside the home (Cosinor Analysis: p=0.007). Day-of-week discrepancy in female/male sex ratio (SR) of fallers was demonstrated, arising from day-of-week disparity in the SR of inside-the-home incidents, with ~4.5-fold more elderly women than elderly men falling Thursday than any other day of the week (p=0.005). Non-statistically significant month-of-year difference in falls, lowest in autumn and highest (~60% more) in winter, was observed and explained by prominent seasonal difference in incidents by elderly women. CONCLUSIONS Serious falls of non-institutionalized independent seniors are characterized according to intrinsic and extrinsic factors by prominent 24-hour and 7-day patterning. These findings complement the understanding of the epidemiology of falls of the elderly and further inform fall prevention programs.
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Affiliation(s)
- P J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.
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Smolensky MH, Haghayegh S, Khoshnevis S, Diller KR. Does before-bedtime body warming by bathing or other means attenuate sleep-time arterial blood pressure? Chronobiol Int 2019; 37:146-149. [PMID: 31809590 DOI: 10.1080/07420528.2019.1696812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Accuracy of Wristband Fitbit Models in Assessing Sleep: Systematic Review and Meta-Analysis. J Med Internet Res 2019; 21:e16273. [PMID: 31778122 PMCID: PMC6908975 DOI: 10.2196/16273] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a cost-efficient way. OBJECTIVE We conducted a systematic review of publications reporting on the performance of wristband Fitbit models in assessing sleep parameters and stages. METHODS In adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we comprehensively searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, MEDLINE, PubMed, PsycINFO, and Web of Science databases using the keyword Fitbit to identify relevant publications meeting predefined inclusion and exclusion criteria. RESULTS The search yielded 3085 candidate articles. After eliminating duplicates and in compliance with inclusion and exclusion criteria, 22 articles qualified for systematic review, with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), nonsleep-staging Fitbit models tended to overestimate total sleep time (TST; range from approximately 7 to 67 mins; effect size=-0.51, P<.001; heterogenicity: I2=8.8%, P=.36) and sleep efficiency (SE; range from approximately 2% to 15%; effect size=-0.74, P<.001; heterogenicity: I2=24.0%, P=.25), and underestimate wake after sleep onset (WASO; range from approximately 6 to 44 mins; effect size=0.60, P<.001; heterogenicity: I2=0%, P=.92) and there was no significant difference in sleep onset latency (SOL; P=.37; heterogenicity: I2=0%, P=.92). In reference to PSG, nonsleep-staging Fitbit models correctly identified sleep epochs with accuracy values between 0.81 and 0.91, sensitivity values between 0.87 and 0.99, and specificity values between 0.10 and 0.52. Recent-generation Fitbit models that collectively utilize heart rate variability and body movement to assess sleep stages performed better than early-generation nonsleep-staging ones that utilize only body movement. Sleep-staging Fitbit models, in comparison to PSG, showed no significant difference in measured values of WASO (P=.25; heterogenicity: I2=0%, P=.92), TST (P=.29; heterogenicity: I2=0%, P=.98), and SE (P=.19) but they underestimated SOL (P=.03; heterogenicity: I2=0%, P=.66). Sleep-staging Fitbit models showed higher sensitivity (0.95-0.96) and specificity (0.58-0.69) values in detecting sleep epochs than nonsleep-staging models and those reported in the literature for regular wrist actigraphy. CONCLUSIONS Sleep-staging Fitbit models showed promising performance, especially in differentiating wake from sleep. However, although these models are a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and are not a substitute for PSG.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
- Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Performance assessment of new-generation Fitbit technology in deriving sleep parameters and stages. Chronobiol Int 2019; 37:47-59. [PMID: 31718308 DOI: 10.1080/07420528.2019.1682006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We compared performance in deriving sleep variables by both Fitbit Charge 2™, which couples body movement (accelerometry) and heart rate variability (HRV) in combination with its proprietary interpretative algorithm (IA), and standard actigraphy (Motionlogger® Micro Watch Actigraph: MMWA), which relies solely on accelerometry in combination with its best performing 'Sadeh' IA, to electroencephalography (EEG: Zmachine® Insight+ and its proprietary IA) used as reference. We conducted home sleep studies on 35 healthy adults, 33 of whom provided complete datasets of the three simultaneously assessed technologies. Relative to the Zmachine EEG method, Fitbit showed an overall Kappa agreement of 54% in distinguishing wake/sleep epochs and sensitivity of 95% and specificity of 57% in detecting sleep epochs. Fitbit, relative to EEG, underestimated sleep onset latency (SOL) by ~11 min and overestimated sleep efficiency (SE) by ~4%. There was no statistically significant difference between Fitbit and EEG methods in measuring wake after sleep onset (WASO) and total sleep time (TST). Fitbit showed substantial agreement with EEG in detecting rapid eye movement and deep sleep, but only moderate agreement in detecting light sleep. The MMWA method showed 51% overall Kappa agreement with the EEG one in detecting wake/sleep epochs, with sensitivity of 94% and specificity of 53% in detecting sleep epochs. MMWA, relative to EEG, underestimated SOL by ~10 min. There was no significant difference between Fitbit and MMWA methods in amount of bias in estimating SOL, WASO, TST, and SE; however, the minimum detectable change (MDC) per sleep variable with Fitbit was better (smaller) than with MMWA, respectively, by ~10 min, ~16 min, ~22 min, and ~8%. Overall, performance of Fitbit accelerometry and HRV technology in conjunction with its proprietary IA to detect sleep vs. wake episodes is slightly better than wrist actigraphy that relies solely on accelerometry and best performing Sadeh IA. Moreover, the smaller MDC of Fitbit technology in deriving sleep parameters in comparison to wrist actigraphy makes it a suitable option for assessing changes in sleep quality over time, longitudinally, and/or in response to interventions.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard J Castriotta
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Performance comparison of different interpretative algorithms utilized to derive sleep parameters from wrist actigraphy data. Chronobiol Int 2019; 36:1752-1760. [PMID: 31658822 DOI: 10.1080/07420528.2019.1679826] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We compared performance of four popular interpretative algorithms (IAs), i.e., Cole-Kripke, Rescored Cole-Kripke, Sadeh, and UCSD, utilized to derive sleep parameters from wrist actigraphy data. We conducted in-home sleep study of 40 healthy adults (17 female/23 male; age 26.7 ± 12.1 years), assessing sleep variables both by Motionlogger® Micro Watch Actigraphy (MMWA) and Zmachine® Insight+ electroencephalography (EEG). Data of MMWA were separately scored per 30 sec epochs by each of the four popular IAs, and data of the Zmachine were also scored per 30 sec epochs by its proprietary IA. In reference to the EEG Zmachine method, all four of the MMWA algorithms showed high (~94 to 98%) sensitivity and moderate (~42 to 54%) specificity in detecting Sleep epochs. All of them significantly underestimated Sleep Onset Latency (SOL: ~9 to 20 min), and all of them, except the Sadeh IA, significantly underestimated Wake After Sleep Onset (WASO: ~22 to 25 min) and overestimated Total Sleep Time (TST: ~32 to 45 min) and Sleep Efficiency (SE: ~7 to 9%). The Sadeh IA showed significantly smaller bias than the other three IAs in deriving WASO, TST, and SE. Overall, application of 'Rescoring Rules' improved performance of the Cole-Kripke IA. The Sadeh and Rescored Cole-Kripke IAs exhibited highest agreement with the EEG Zmachine method (Cohen's Kappa: ~51%), while the UCSD IA exhibited lowest agreement (Cohen's kappa: ~47%). However, minimum detectable change across all sleep parameters was smallest with use of the UCSD IA and, except for SOL, largest with use of the Sadeh algorithm. Findings of this study indicate the Sadeh IA is most appropriate for deriving sleep parameters of healthy adults, while the UCSD IA is most appropriate for evaluating change in sleep parameters over time or in response to medical intervention.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Richard J Castriotta
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Hermida RC, Ayala DE, Mojón A, Smolensky MH, Fernández JR. Diagnosis and management of hypertension: around-the-clock ambulatory blood pressure monitoring is substantially more effective and less costly than daytime office blood pressure measurements. Chronobiol Int 2019; 36:1515-1527. [PMID: 31446805 DOI: 10.1080/07420528.2019.1658201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The cost-effectiveness of ambulatory blood pressure (BP) monitoring (ABPM) versus traditional office BP measurement (OBPM) for the diagnosis and management of hypertension has been evaluated only by few studies and based solely on the reduction of medical care expenses through avoiding treatment of isolated-office hypertension. Data from the 21963 participants in the Hygia Project, a multicenter outcomes study that incorporates into routine primary care periodic, at least yearly, 48 h ABPM evaluation, were utilized to assess the cost-effectiveness - relative to vascular pathology expenditures countrywide in Spain - of ABPM versus OBPM. The actual reported Spanish healthcare expenditure for vascular pathology in 2015 - aggregate costs of medical examinations, outpatient and inpatient care, therapeutic interventions, plus non-healthcare services (productivity losses due to morbidity/mortality and informal family/friends-provided care) - was used to compare yearly costs when diagnostic and treatment decisions for hypertension are based on the OBPM versus the ABPM-model. Our economic analysis is based on the more realistic and feasible approach of restricting ABPM solely to high-risk individuals of age ≥60 years and/or with diabetes, chronic kidney disease, and/or previous cardiovascular event, who in the Hygia Project accounted for >90% of all documented events. The projected net benefit countrywide in favor of the proposed ABPM-model is ~5294M€/year, i.e., 360.33€/year (95%CI [347.52-374.85]) per ABPM-evaluated person. This highly conservative economic analysis indicates ABPM is a much more cost-effective strategy than repeated OBPM not only for accurate diagnosis and management of true hypertension but marked reduction of expenditures on elevated BP-associated vascular pathology.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Diana E Ayala
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin , Austin , Texas , USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
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Abstract
Details of serious injuries to children ≤16 yrs. of age that necessitated urgent surgical intervention by the Department of Pediatric Surgery of the University Hospital of Lausanne, Switzerland were recorded into a database registry. Some 15 110 entries listed the precise time of injury, and 3114 (20.6%) of these resulted from participating in sport-associated activities. Time-of-day, day-of-week and month-of-year differences in the total number of children's accidental sport injuries (CASI) were validated. Time-of-day patterns were substantiated for "All Sports", for both boys and girls 5-16 yrs. of age, with more boys than girls experiencing incidents at almost every clock hour. Moreover, they were substantiated for this age group for each of the six different considered individual and team CASI categories - Physical Exercises at School; Bicycle Riding; Roller Skating and Skateboarding; Snow Skiing, Sledding, and Tobogganing; Soccer; and Basketball - for which sample sizes were sufficiently large (n > 230) to perform statistical assessment by ANOVA, t-test and/or cosinor analyses. CASI happened primarily between 06:00 and 17:00 h and rarely evening or overnight. Features - specific clock-time and number of peaks and troughs - of the CASI daily curve pattern of the individual six sport categories differed somewhat; nonetheless, excess or greatest number of CASI typically happened between 12:00 and 14:00 h, even when summertime and other scheduled school and family vacation periods were taken into account. Time-of-day and day-of-week patterns in the boy/girl sex ratio were also validated, with midday and Friday/Saturday peaks, respectively. We hypothesize the prominent 24 h patterns of CASI of 5-16 yr. olds, in particular, are representative of a combination of several determinants. These include exogenous periodic and cyclic environmental and sociocultural phenomena, genetic sex-related traits, plus endogenous circadian cognitive and physiologic rhythms, with the common midday injury excess of many sport categories, at least in part, the consequence of the well-documented midday dip in attention and vigilance of children.
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Affiliation(s)
- Alain Reinberg
- a Chronobiology Unit , Fondation Adolphe de Rothschild , Paris , France
| | - Olivier Reinberg
- b Department of Pediatric Surgery , University Hospital of Lausanne (CHUV) , Lausanne , Switzerland
| | - Mohamed Mechkouri
- a Chronobiology Unit , Fondation Adolphe de Rothschild , Paris , France
| | - Yvan Touitou
- a Chronobiology Unit , Fondation Adolphe de Rothschild , Paris , France
| | - Michael H Smolensky
- c Department of Biomedical Engineering , The University of Texas at Austin, Cockrell College of Engineering , Austin , Texas , USA
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Riedel M, Smolensky MH, Reinberg A, Touitou Y, Riedel C, Le Floc'h N, Clarisse R. Twenty-four-hour pattern of operations-related injury occurrence and severity of off-site/on-call volunteer French firefighters. Chronobiol Int 2019; 36:979-992. [PMID: 31043081 DOI: 10.1080/07420528.2019.1604538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We assessed the 24-h pattern of operations-related injuries (ORI) experienced by scheduled off-site/on-call French volunteer firefighters (VFF) through analysis of an archival database. Occurrence and severity - evaluated by number of lost work days (LWD) and total medical costs (TMC) - of ORI were explored in terms of risk ratios, respectively, number of ORI/number of service operations (RRORI), number of LWD/number of ORI (RSLWD,) and TMC/number of ORI (RSTMC). Additionally, the collective work performance of all involved VFF was measured in terms of the lag time (LT) between emergency call-center firefighter-answered communication for service of observer-presumed out-of-hospital cardiac arrest (OHCA) and departure of vehicle from fire station to render aid, designated LTOHCA. Cosinor and cross-correlation statistical methods were applied. A total of 252 ORI occurred while performing 146,479 service operations. High-amplitude 24 h variation was detected in RRORI (p < .003), SRLWD (p < .001), SRTMC (p < .012), and LTOHCA (p < .001), all with nocturnal peak time. Coherence was found between the day/night variation of LTOHCA and RRORI (r = 0.7, p < .0002), SRLWD (r = 0.5, p < .02), and SRTMC (r = 0.4, p < .05). This investigation verifies the occurrence and severity of ORI of scheduled off-site/on-call VFF exhibit high-amplitude 24 h patterning with nocturnal excess that closely coincides with their day/night work performance measured by LTOHCA. These findings, which are essentially identical to ones of a previous study entailing on-site/on-call career firefighters, indicate the need for fatigue management and ORI prevention programs not yet available to VFF, who compose the majority of the field service workforce of French fire departments. Abbreviations:FF: firefighters; CFF: career firefighters; VFF: volunteer firefighters; FD: fire department; LTOHCA: lag time (LT) response in min:sec between fire department call-center-answered communication for service of presumed out-of-hospital cardiac arrest (OHCA) and departure from fire station of vehicle to render aid; LWD: lost work days; ORI: operations-related injuries; SRLWD: severity ratio of operations-related injuries in terms of number of lost work days, calculated as number of lost work days/number of operations-related injuries; RRORI: risk ratio of operations-related injuries calculated as number of operations-related injuries/number of operations; SRTMC: severity ratio of operations-related injuries in terms of total medical costs, calculated as total medical costs/number of operations-related injuries; TMC: total medical costs.
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Affiliation(s)
- Marc Riedel
- a Unité de chronobiologie, Fondation Adolphe de Rothschild , Paris , France.,b Université de Tours, Psychologie des Âges de la Vie et Adaptation , Tours , France.,c IFRASEC, Institut Français de Sécurité Civile , Paris , France
| | - Michael H Smolensky
- d Department of Biomedical Engineering , Cockrell College of Engineering, The University of Texas at Austin , Austin , USA
| | - Alain Reinberg
- a Unité de chronobiologie, Fondation Adolphe de Rothschild , Paris , France
| | - Yvan Touitou
- a Unité de chronobiologie, Fondation Adolphe de Rothschild , Paris , France
| | - Cedric Riedel
- e Université de Montpellier , Faculté de Médecine , Montpellier , France
| | - Nadine Le Floc'h
- b Université de Tours, Psychologie des Âges de la Vie et Adaptation , Tours , France
| | - René Clarisse
- b Université de Tours, Psychologie des Âges de la Vie et Adaptation , Tours , France
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Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR. Accuracy of PurePulse photoplethysmography technology of Fitbit Charge 2 for assessment of heart rate during sleep. Chronobiol Int 2019; 36:927-933. [PMID: 30990098 DOI: 10.1080/07420528.2019.1596947] [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] [Indexed: 10/27/2022]
Abstract
Elevated asleep heart rate (HR) is a risk factor for cardiovascular disease and other-cause morbidity and mortality. We assessed the accuracy of Fitbit Inc. PurePulse® photoplethysmography with reference to three-lead electrocardiography (ECG) in determining HR during sleep. HR of 35 (17 female) healthy adults 25.1 ± 10.6 years of age (mean ± SD) was continuously recorded throughout a single night of sleep. There was no significant difference in asleep HR mean (0.09 beats per minute [bpm], P = 0.426) between Fitbit photoplethysmography and ECG; plus, there was excellent intraclass correlation (0.998) and narrow Bland-Altman agreement range (2.67 bpm). The regression analysis of Bland-Altman plot of mean asleep HR indicates Fitbit tends to slightly overestimate reference values in the lower range of HR (HR < 50 bpm) by 0.51 bpm and slightly underestimate reference values in the higher range of HR (HR > 80 bpm) by 0.63 bpm. Mixed model analysis of epoch-by-epoch (5-min epochs) asleep HR showed significant "U" shape trend (P < 0.001) in amount of Fitbit error (absolute amount of difference between ECG and Fitbit values regardless of overestimation or underestimation) in regard to HR, i.e. smaller error in the medium range of HR (60-80 bpm) and slightly larger error for lower (<60 bpm) and higher (>80 bpm) ranges of HR. However, effect of age, body mass index, gender, and subjective sleep quality measured by Pittsburgh sleep quality index (good/poor sleepers) on error in estimating HR by the Fitbit method was not significant. It is concluded that Fitbit photoplethysmography suitably tracks HR during sleep in healthy young adults.
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Affiliation(s)
- Shahab Haghayegh
- a Department of Biomedical Engineering, Cockrell School of Engineering , The University of Texas at Austin , Austin , Texas , USA
| | - Sepideh Khoshnevis
- a Department of Biomedical Engineering, Cockrell School of Engineering , The University of Texas at Austin , Austin , Texas , USA
| | - Michael H Smolensky
- a Department of Biomedical Engineering, Cockrell School of Engineering , The University of Texas at Austin , Austin , Texas , USA.,b Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Kenneth R Diller
- a Department of Biomedical Engineering, Cockrell School of Engineering , The University of Texas at Austin , Austin , Texas , USA
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López-Soto PJ, Morales-Cané I, Smolensky MH, Manfredini R, Dios-Guerra C, Rodríguez-Borrego MA, Carmona-Torres JM. Gender, socioeconomic, medical, and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey. Women Health 2019; 59:985-996. [PMID: 30880631 DOI: 10.1080/03630242.2019.1587665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.
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Affiliation(s)
- Pablo J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - Ignacio Morales-Cané
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University of Ferrara , Ferrara , Italy
| | - Caridad Dios-Guerra
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - María Aurora Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain.,Department of Nursing, Reina Sofia University Hospital , Córdoba , Spain
| | - Juan Manuel Carmona-Torres
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,School of Nursing and Physiotherapy, University of Castilla-La Mancha (UCLM) , Ciudad Real , Spain
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43
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Smolensky MH, Touitou Y. Tribute to Alain Reinberg. Chronobiol Int 2018; 35:589-596. [PMID: 29851523 DOI: 10.1080/07420528.2018.1459663] [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: 10/14/2022]
Affiliation(s)
- Michael H. Smolensky
- Department of Biomedical Engineering, The University of Texas at Austin, College of Engineering, Texas, USA
| | - Yvan Touitou
- Chronobiology Unit, Fondation Adolphe de Rothschild, Paris, France
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44
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Hermida RC, Ayala DE, Fernández JR, Mojón A, Smolensky MH. Hypertension: New perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk. Eur J Clin Invest 2018; 48:e12909. [PMID: 29423914 DOI: 10.1111/eci.12909] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/04/2018] [Indexed: 12/14/2022]
Abstract
Diagnosis of hypertension-elevated blood pressure (BP) associated with increased cardiovascular disease (CVD) risk-and its management for decades have been based primarily on single time-of-day office BP measurements (OBPM) assumed representative of systolic (SBP) and diastolic BP (DBP) during the entire 24-hours span. Around-the-clock ambulatory blood pressure monitoring (ABPM), however, reveals BP undergoes 24-hours patterning characterized in normotensives and uncomplicated hypertensives by striking morning-time rise, 2 daytime peaks-one ~2-3 hours after awakening and the other early evening, small midafternoon nadir and 10-20% decline (BP dipping) in the asleep BP mean relative to the wake-time BP mean. A growing number of outcome trials substantiate correlation between BP and target organ damage, vascular and other risks is greater for the ABPM-derived asleep BP mean, independent and stronger predictor of CVD risk, than daytime OBPM or ABPM-derived awake BP. Additionally, bedtime hypertension chronotherapy, that is, ingestion of ≥1 conventional hypertension medications at bedtime to achieve efficient attenuation of asleep BP, better reduces total CVD events by 61% and major events (CVD death, myocardial infarction, ischaemic and haemorrhagic stroke) by 67%-even in more vulnerable chronic kidney disease, diabetes and resistant hypertension patients-than customary on-awaking therapy that targets wake-time BP. Such findings of around-the-clock ABPM and bedtime hypertension outcome trials, consistently indicating greater importance of asleep BP than daytime OBPM or ambulatory awake BP, call for a new definition of true arterial hypertension plus modern approaches for its diagnosis and management.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain
| | - Diana E Ayala
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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45
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Lunn RM, Blask DE, Coogan AN, Figueiro MG, Gorman MR, Hall JE, Hansen J, Nelson RJ, Panda S, Smolensky MH, Stevens RG, Turek FW, Vermeulen R, Carreón T, Caruso CC, Lawson CC, Thayer KA, Twery MJ, Ewens AD, Garner SC, Schwingl PJ, Boyd WA. Health consequences of electric lighting practices in the modern world: A report on the National Toxicology Program's workshop on shift work at night, artificial light at night, and circadian disruption. Sci Total Environ 2017; 607-608:1073-1084. [PMID: 28724246 PMCID: PMC5587396 DOI: 10.1016/j.scitotenv.2017.07.056] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 05/24/2023]
Abstract
The invention of electric light has facilitated a society in which people work, sleep, eat, and play at all hours of the 24-hour day. Although electric light clearly has benefited humankind, exposures to electric light, especially light at night (LAN), may disrupt sleep and biological processes controlled by endogenous circadian clocks, potentially resulting in adverse health outcomes. Many of the studies evaluating adverse health effects have been conducted among night- and rotating-shift workers, because this scenario gives rise to significant exposure to LAN. Because of the complexity of this topic, the National Toxicology Program convened an expert panel at a public workshop entitled "Shift Work at Night, Artificial Light at Night, and Circadian Disruption" to obtain input on conducting literature-based health hazard assessments and to identify data gaps and research needs. The Panel suggested describing light both as a direct effector of endogenous circadian clocks and rhythms and as an enabler of additional activities or behaviors that may lead to circadian disruption, such as night-shift work and atypical and inconsistent sleep-wake patterns that can lead to social jet lag. Future studies should more comprehensively characterize and measure the relevant light-related exposures and link these exposures to both time-independent biomarkers of circadian disruption and biomarkers of adverse health outcomes. This information should lead to improvements in human epidemiological and animal or in vitro models, more rigorous health hazard assessments, and intervention strategies to minimize the occurrence of adverse health outcomes due to these exposures.
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Affiliation(s)
- Ruth M Lunn
- Office of the Report on Carcinogens, Division of the National Toxicology Program, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, United States
| | - David E Blask
- Department of Structural and Cellular Biology, Laboratory of Chrono-Neuroendocrine Oncology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Andrew N Coogan
- Maynooth University Department of Psychology, National University of Ireland, Maynooth, County Kildare, Ireland
| | - Mariana G Figueiro
- Light and Health Program, Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Michael R Gorman
- Department of Psychology and Center for Circadian Biology, University of California, San Diego, CA, United States
| | - Janet E Hall
- Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Johnni Hansen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Randy J Nelson
- Department of Neuroscience, Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Michael H Smolensky
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States; Sleep Medicine, The University of Texas-Houston McGovern School of Medicine, Houston, TX, United States
| | - Richard G Stevens
- School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Fred W Turek
- Center for Sleep & Circadian Biology, Northwestern University, Evanston, IL, United States
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Tania Carreón
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Claire C Caruso
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Christina C Lawson
- National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, OH, United States
| | - Kristina A Thayer
- Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, United States
| | - Michael J Twery
- National Center on Sleep Disorders Research, Division of Lung Diseases, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD, United States
| | - Andrew D Ewens
- Contractor in support of the NIEHS Report on Carcinogens, Integrated Laboratory Systems (ILS), Durham, NC, United States
| | - Sanford C Garner
- Contractor in support of the NIEHS Report on Carcinogens, Integrated Laboratory Systems (ILS), Durham, NC, United States
| | - Pamela J Schwingl
- Contractor in support of the NIEHS Report on Carcinogens, Integrated Laboratory Systems (ILS), Durham, NC, United States
| | - Windy A Boyd
- Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, United States.
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Smolensky MH, Reinberg AE, Sackett-Lundeen L. Perspectives on the relevance of the circadian time structure to workplace threshold limit values and employee biological monitoring. Chronobiol Int 2017; 34:1439-1464. [PMID: 29215915 DOI: 10.1080/07420528.2017.1384740] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The circadian time structure (CTS) and its disruption by rotating and nightshift schedules relative to work performance, accident risk, and health/wellbeing have long been areas of occupational medicine research. Yet, there has been little exploration of the relevance of the CTS to setting short-term, time-weighted, and ceiling threshold limit values (TLVs); conducting employee biological monitoring (BM); and establishing normative reference biological exposure indices (BEIs). Numerous publications during the past six decades document the CTS substantially affects the disposition - absorption, distribution, metabolism, and elimination - and effects of medications. Additionally, laboratory animal and human studies verify the tolerance to chemical, biological (contagious), and physical agents can differ extensively according to the circadian time of exposure. Because of slow and usually incomplete CTS adjustment by rotating and permanent nightshift workers, occupational chemical and other contaminant encounters occur during a different circadian stage than for dayshift workers. Thus, the intended protection of some TLVs when working the nightshift compared to dayshift might be insufficient, especially in high-risk settings. The CTS is germane to employee BM in that large-amplitude predictable-in-time 24h variation can occur in the concentration of urine, blood, and saliva of monitored chemical contaminants and their metabolites plus biomarkers indicative of adverse xenobiotic exposure. The concept of biological time-qualified (for rhythms) reference values, currently of interest to clinical laboratory pathology practice, is seemingly applicable to industrial medicine as circadian time and workshift-specific BEIs to improve surveillance of night workers, in particular. Furthermore, BM as serial assessments performed frequently both during and off work, exemplified by employee self-measurement of lung function using a small portable peak expiratory flow meter, can easily identify intolerance before induction of pathology.
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Affiliation(s)
- Michael H Smolensky
- a Department of Biomedical Engineering , Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Alain E Reinberg
- b Unité de Chronobiologie , Fondation A. de Rothschild , Paris , France
| | - Linda Sackett-Lundeen
- c American Association for Medical Chronobiology and Chronotherapeutics , Roseville , MN , USA
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47
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López-Soto PJ, Smolensky MH, Sackett-Lundeen LL, Rodríguez-Borrego MA. Reply to 'Seasonal ambient changes influence inpatient falls' Magota et al. Age Ageing 2017; 46:1016-1017. [PMID: 28985253 DOI: 10.1093/ageing/afx130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- P J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - M H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, TX, USA
| | - L L Sackett-Lundeen
- American Association for Medical Chronobiology and Chronotherapeutics, Roseville, MN, USA
| | - M A Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
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48
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Reinberg AE, Smolensky MH, Riedel M, Riedel C, Brousse E, Touitou Y. Do night and around-the-clock firefighters' shift schedules induce deviation in tau from 24 hours of systolic and diastolic blood pressure circadian rhythms? Chronobiol Int 2017; 34:1158-1174. [PMID: 28920706 DOI: 10.1080/07420528.2017.1343833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Systolic (S) and diastolic (D) blood pressures (BP) [SBP and DBP] are circadian rhythmic with period (τ) in healthy persons assumed to be maintained at 24.0h. We tested this assumption in a sample of 30 healthy career (mean >12 yrs) 30-to-46 yr-old male Caucasian French firefighters (FFs) categorized into three groups according to work schedule and duties: Group A - 12 FFs working 12h day, 12h night, and occasionally 24h shifts and whose primary duties are firefighting plus paramedical and road rescue services; Group B - 9 FFs working mostly 12h day and 12h night shifts and whose duties are answering incoming emergency calls and coordinating service vehicle dispatch from fire stations with Group A personnel; Group C - 9 day shift (09:00-17:00h) FFs charged with administrative tasks. SBP and DBP, both in winter and in summer studies of the same FFs, were sampled by ambulatory BP monitoring every 1h between 06:00-23:00h and every 2h between 23:01-05:59h, respectively, their approximate off-duty wake and sleep spans, for 7 consecutive days. Activity (wrist actigraphy) was also sampled at 1-min intervals. Prominent τ of each variable was derived by a power spectrum program written for unequal-interval time series data, and between-group differences in incidence of τ≠24h of FFs were assessed by chi square test. Circadian rhythm disruption (τ≠24h) of either the SBP or DBP rhythm occurred almost exclusively in night and 24h shift FFs of Group A and B, but almost never in day shift FFs of Group C, and it was not associated with altered τ from 24.0h of the circadian activity rhythm. In summer, occurrence of τ≠24 for FFs of Group A and B differed from that for FFs of Group C in SBP (p=0.042) and DBP (p=0.015); no such differences were found in winter (p>0.10). Overall, manifestation of prominent τ≠24h of SBP or DBP time series was greater in summer than winter, 27.6% versus 16.7%, when workload of Group B FFs, i.e. number of incoming emergency telephone calls, and of Group A FFs, i.e. number of dispatches for provision of emergency services, was, respectively, two and fourfold greater and number of 12h night shifts worked by Group B FFs and number of 24h shifts worked by Group A FFs was, respectively, 92% and 25% greater. FFs of the three groups exhibited no winter-summer difference in τ≠24h of SBP or SDP; however, τ≠24h of DBP in Group B FFs was more frequent in summer than winter (p=0.046). Sleep/wake cycle disruption, sleep deprivation, emotional and physical stress, artificial light-at-night, and altered nutrient timings are hypothesized causes of τ≠24h for BP rhythms of affected Groups A and B FFs, but with unknown future health effects.
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Affiliation(s)
- Alain E Reinberg
- a Unité de Chronobiologie , Fondation A. de Rothschild , Paris cedex , France
| | - Michael H Smolensky
- b Department of Biomedical Engineering, Cockrell School of Engineering , The University of Texas at Austin , Austin , TX , USA
| | - Marc Riedel
- c EA 2114, psychologie des âges de la vie , Université François Rabelais de Tours , France.,d Service Départemental d' Incendie et de Secours des Bouches du Rhône (SDIS 13) , France.,e Psychologie des âges de la vie , Université François Rabelais de Tours , EA , France
| | - Cedric Riedel
- f Faculté de Médecine , Université de Montpellier , France
| | - Eric Brousse
- c EA 2114, psychologie des âges de la vie , Université François Rabelais de Tours , France
| | - Yvan Touitou
- a Unité de Chronobiologie , Fondation A. de Rothschild , Paris cedex , France
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49
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López-Soto PJ, Smolensky MH, Sackett-Lundeen LL, Rodríguez-Borrego LMA. Reply to ‘Seasonal ambient changes influence inpatient falls’ Magota et al. Age Ageing 2017. [DOI: 10.1093/ageing/afx156] [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: 11/13/2022] Open
Affiliation(s)
- P J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Spain
| | - M H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, USA
| | - L L Sackett-Lundeen
- American Association for Medical Chronobiology and Chronotherapeutics, Roseville, Minnesota, USA
| | - L M A Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Spain
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50
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Hermida RC, Ayala DE, Fernández JR, Mojón A, Crespo JJ, Ríos MT, Smolensky MH. Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management. Heart Fail Clin 2017; 13:759-773. [PMID: 28865783 DOI: 10.1016/j.hfc.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Consistent evidence of numerous studies substantiates the asleep blood pressure (BP) mean derived from ambulatory BP monitoring (ABPM) is both an independent and a stronger predictor of cardiovascular disease (CVD) risk than are daytime clinic BP measurements or the ABPM-determined awake or 24-hour BP means. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of 6 different classes and their combinations significantly improves BP control, particularly sleep-time BP, and reduces adverse effects.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain.
| | - Diana E Ayala
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain; Centro de Salud de Bembrive, Estructura de Gestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - María T Ríos
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), E.I. Telecomunicación, University of Vigo, Campus Universitario, Pontevedra, Vigo 36310, Spain; Centro de Salud de A Doblada, Estructura de Gestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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